Thoughts on Medical Training For TEOTWAWKI, by Lumberjack

Sunday, Feb 20, 2011

Many people both on this blog and elsewhere in the prepping community have advocated some form of professional medical training prior to encountering a disaster situation.  While I agree with this sentiment, this article is meant to discuss the limits of some medical training for lay persons in a post-TEOTWAWKI scenario, as well as review the options and advantages of the various training programs available for lay people.  That my qualifications may be known, I am an emergency room RN, an EMT, and an instructor of the Wilderness First Responder and Advanced Wilderness Life Support curriculum, with experience in wildland fire and search and rescue.   

The biggest fallacy on this topic that I see routinely propagated is the notion of cardio-pulmonary resuscitation (CPR) training for use in a post-TEOTWAWKI situation.  While I agree that more people should have this training, it is really useful only so long as the larger medical infrastructure is intact.  Let me explain: CPR stands for cardio-pulmonary resuscitation.  Think chest compressions and rescue breathing.  As things stand now, in a grid up world, CPR at best only buys time keeping the brain and vital organs alive until definitive care, in the form of defibrillation and advanced airway control and medications can be given and surgical stenting in some cases.  CPR is commonly used in cases of sudden cardiac arrest, with some effectiveness if definitive care is reached in a timely (less than 10 minutes) manner.  It is also used, with greater effectiveness in cases of drowning/near drowning and lightning strike.  These are the only instances when CPR can be expected to have any positive impact in a grid down situation, as cardiac arrest requires extensive medical infrastructure to complete the chain of survival.  CPR in cases of traumatic injury (gunshot, car crash, falls, etc) is virtually never successful.   

Not to take any thing away from CPR; if more people were trained and willing to step in and perform CPR when it is needed (patient is not breathing and has no pulse) today, when the grid is up, more people would survive sudden arrest and near drowning.  In a grid down situation, where there is no definitive care available, CPR has a virtually negligible effect on survival.  In cases where there are multiple casualties or hostile opponents attempting CPR only takes resources away from those who need them, either other patients or repulsing a hostile enemy.   

So if CPR is not the end all-be all of medical training for lay persons, what are our options?  I will review the most commonly available levels of training and their strengths, in a more or less ascending order.   First, basic first aid.  Commonly taught by the Red Cross in concert with a basic CPR course, these classes deal with stopping bleeding, dressing wounds, immediate treatment for choking patients, and recognizing more severe injury or illness that needs an ambulance.  This level should be considered the most basic level acceptable, in that it at least covers topics in addition to CPR such as bleeding control.  The class may be from 4-8 hours long, and is usually offered by the Red Cross several times per year for less than $100.  

Wilderness First Aid (WFA)

Next up the ladder would be a Wilderness First Aid (WFA) class.  In addition to the topics covered in a basic first aid course, WFA introduces topics such as immobilization and treatment of bone and joint injury, penetrating trauma, basic wound care, and environmental emergencies and prevention such as heat stroke, hypothermia, dehydration, and others.  This class is usually 18-24 hours long (a long weekend) and is taught well by schools such as the Wilderness Medicine Institute (WMI), SOLO, WMA, Northern Arizona University, and others.  With great respect to the Red Cross for the things they do well, I do not recommend their WFA course, as I feel it is too short and does not adequately cover the topics.  Cost may be from $120-$300.  

Next up the ladder would be something along the line of the Outdoor Emergency Course (OEC), commonly taught to and required of ski patrol.  Covering the same information as WFA but in greater depth and detail and with greater emphasis on cold injury, OEC approaches the level of Wilderness First Responder, covered next.  

Wilderness First Responder (WFR) 

My recommendation for all serious preppers, the Wilderness First Responder (WFR) class is commonly taught over 7-to-10 days (80 hours) and emphasizes hands on practice and improvisation and medical care in difficult and remote circumstances.  It covers immediate life saving treatment for all types of traumatic injury, medical emergencies and first aid for cardiac, stroke, diabetes, neurological problems, and more, as well as a great deal of time on preventing and treating environmental emergencies like dehydration, heat and cold injury, burns, lightning, altitude, animal bites, and more.  Emphasis is on judgment, application of skills to difficult and remote areas, and improvisation, as well as extended patient contact time.  This last is in contrast to many other training programs for lay people, which assume a short length of time in contact with the patient before handing off to EMS.  Some programs also teach scene management, helicopter interface, and mass casualty scenes and triage.  The same schools which teach WFA also teach WFR, and cost ranges from $400-700, and is worth every penny.  

EMT-Basic 

EMT-Basic (EMT-B). Usually 120 hours in most states, teaches the immediate treatment, stabilization, and transport of patients as part of a larger, intact functional medical system.  While this class places less emphasis on judgment and long term patient contact, it does go into greater depth of anatomy and physiology and pharmacology that does WFR, as well as covering obstetrical emergencies.  In rural areas you may have the cost of this class covered if you join your volunteer fire department.  Other wise local community colleges are the best place to find this training.    Wilderness EMT-B (WEMT) This class merely combines the curriculum of WFR and EMT, leading to state certification as an EMT-B and the knowledge and judgment of WFR.  Arguably the best of both worlds, this course is often taught over a one month period on location out in the woods or in a base camp somewhere.  Reputable schools include the WMI, Aerie, and Desert

Mountain Medicine 

Levels of medical training beyond this require more than 1 month or 1 semester of education, and commonly require field experience as well.  You can’t be a paramedic without first being an EMT.    For those with a background in medicine, but whose skills might not be useful in a wilderness or grid down situation, there are several “bridge” type classes available.  For people like dentists, nurses, paramedics, doctors, and others, classes like Advanced Wilderness Life Support take their current scope of practice and incorporate elements of improvisation and environmental emergencies.  Other similar courses include Wilderness Advanced Life Support and dedicated wilderness medicine expeditions taught by the WMI.   

Hopefully this information will help others decide what type of medical training is most appropriate for them.  Obviously my recommendation is WFA as a minimum for all preppers, WFR as the best most practical option, and WEMT for those who can afford the time and money or have a particular interest in the topic.  Perhaps in your retreat group of friends/family you have everyone as WFAs, several WFRs, and your medical team leader as a WEMT.  This has the added advantage of everyone speaking the same language of medicine and injury/illness prevention, which as we all know is better than any cure.  Lastly, the experience and knowledge of patient assessment and recognizing which patients have manageable problems at home with minimal resources and which problems represent true emergencies requiring specialized help will go a long way in any scenario, even with the grid up, preventing unnecessary trips to the ER and better informed, more productive (and perhaps fewer) trips to the doctor's office.


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