Medical Training - A Course Review by J.N.

Wednesday, Apr 5, 2006

This past month, I attended a Wilderness Emergency Medical Technician W-EMT class put on by Wilderness Medical Associates at a local university. I can say that this is by far the best survival-oriented medical training I have received to date. This particular class was geared towards those who are already certified at the EMT level. The class was intense, and I learned a lot of things that were never brought up in my regular EMT classes.
To start, here is a bit of background on what levels of medical training are out there. Most of these are accessible to the average person willing to put in the time and money.
Basic First Aid - This is what you are typically taught in school, Boy Scouts, or a one-day class offered by the Red Cross. The most basic life-saving skills are taught, such as how to manage bleeding, how to recognize when someone should not be moved due to a possible spinal injury, etc. Everyone should at least get themselves to one of these classes. Many times, they are offered for free or at low cost at a community center, college, etc.

Wilderness First Aid - This is another class that goes over the basics, but in more depth. The Wilderness First Aid (WFA) courses will cover topics like altitude sickness, heat/cold emergencies, and wound care in more depth than a regular (urban) first aid class. These classes are typically two days or so.

Wilderness Advanced First Aid (WAFA) - Similar topics to a WFA class, but goes into much more depth. Typical class is 4 days.\

Wilderness First Responder (WFR) - This is standard training for professional outdoor guides and group leaders. A lot of emphasis is placed on patient assessment, evacuation, etc. These classes are around 8 days, and will be intense. I would recommend a class like this to anyone who is serious about survival and/or outdoor travel.

Emergency Medical Technician - EMT is the certification level that is recognized at the county and state level, and is the entry-level certification for working on an ambulance crew, as a tech in an ER or other basic EMS work. It typically involves 150+ hours of training, plus hands-on contact with patients at an ER or on ambulance ride-alongs. You will learn basic anatomy, the critical body systems, how to identify common medical emergencies, extrication, patient packaging, trauma, delivery of some medications such as Oxygen, and get a basic grounding in emergency medicine.

Wilderness EMT - This class is EMT plus another 40-50 hours of training. The additional training covers topics that are specific to the back country (hypo/hypertherima, altitude, etc) in more detail than regular EMT or WFR training does and also introduces six new protocols. These include administering epinephrine injections for allergic reactions (anaphylaxis), managing sever asthma, reducing simple dislocations, advanced wound care, cessation of CPR, and clearing patients for spine injury. This would be about the best level of training most of us not working full-time in a medical field would be able to get to.
Note that EMT training is typically offered in evening or weekend format in most areas. I think a good bang-for-bucks training strategy would be to go for a first aid or better yet WFR class to get the basics plus wilderness training, then think about enrolling in an EMT program at your local community college. Mine took a semester of night classes to complete, and cost about $300, including enrollment, rooks and uniform.

The upgrade from EMT to W-EMT is a voluntary class that is not recognized by the state or county agencies in many cases. However, many employers recognize it and allow WIlderness-trained EMTs to use that extra training when they are away from a hospital/standard EMS.
The class that I took was five full days, and very hands on and intensive. It was taught at a level of training that assumed students knew basic medical terminology and standard EMT skills. We started with classroom review of the important body systems needed for survival, went over differences in assessing patients in the back country, then went right into the wilderness protocols. Each day was 9-10 hours long, and the class included three full-scale disaster simulations, with made-up patients needing assessment and treatment. The simulations were videotaped and critiqued in class. There was definitely no room for big egos here, as everyone made lots of mistakes, and improved their skills from one simulation to the next. They worked us pretty hard, and expected 100% from everyone.
The instructors were both outdoors people, one a working flight paramedic and the other a mountain-school instructor. Their insights and stories helped flesh out a lot of detail as to how and why a lot of this stuff is done. Additionally, a lot of discussion was had about medical topics not in the EMT protocols, such as applications for OTC and prescription medications for personal use, and what to expect from ALS (paramedic/advanced life support) crews, aircraft and search and rescue. Unlike the urban EMT class, they placed a lot of emphasis on making do with what's on hand, and using hands-on skills in place of equipment you may not have.
I think an important thing I learned is that just about anyone can be taught how to do even advanced medical procedures. The hard part, is knowing when to do them (and when not to).
I would encourage anyone concerned about being prepared to look into one of these classes. I went to the WMA school but we also heard good things about the other two schools included in the following links:

Wilderness Medical Associates
http://www.wildmed.com

SOLO Schools
http://www.soloschools.com

Wilderness Medical Society
http://www.wms.org

Regards, - JN


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