# Has anyone taken an wilderness advanced life support class?



## KELRAG (Jun 11, 2008)

There are several options for wilderness ALS and Im trying to figure out which one is the best.  the prices range from $500 to around $1500.  If im gonna pay any of those amounts I want to get alot out of it.  Ive seen some from WMI and WMS.  Has anyone taken any of these or heard anything about a course good or bad?  The price isnt as important as the content.  Thanks!


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## BossyCow (Jun 12, 2008)

There are a lot of options and some of them are indeed pretty pricey. I would take into account what you are going to be doing with the information. Are you going to be working as a paid EMS provider in a wilderness setting? Otherwise, the layout for wilderness ALS is pretty pointless. You have to consider the return on your investment.

One of the big differences between wilderness and urban med is the isolation, higher risk of infection and the ever crucial, "do I even start care" question. So, you need to look at the area where you will be practicing to determine if you really need the Wilderness ALS component. Otherwise a regular Wilderness BLS or First Aid might be enough. 

If your wilderness is highly accessible and a short distance from a hospital or trauma center, there's less differences in your care of a pt than there is with a two to three day pack out with a critical pt.


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## yowzer (Jun 12, 2008)

I think the biggest bonus to having a wilderness ALS capability is in the ability to give pain killers.

Had a hours-long steep angle evac a few weeks ago of a guy with a nasty leg fracture. He was in agony, screaming at every bump... It would have been wonderful to have had someone there able to give him morphine or the like to make it easier for him.


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## BossyCow (Jun 13, 2008)

yowzer said:


> I think the biggest bonus to having a wilderness ALS capability is in the ability to give pain killers.
> 
> Had a hours-long steep angle evac a few weeks ago of a guy with a nasty leg fracture. He was in agony, screaming at every bump... It would have been wonderful to have had someone there able to give him morphine or the like to make it easier for him.



We have had to deal with that issue  in our SAR group. We have two paramedic volunteers. Our group is only BLS and not allowed to carry narcotics. One of the medics was able to get a vial of morphine for a particular rescue. He had to sign it out with the permission of the MPD and it was in his possession for the entire time. 

Narcotics are so highly regulated that the logistics of carrying them in a wilderness pack is difficult. Where is the pack stored? Who's responsible for outdates? How do you make sure that the meds are tampered with?


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## KELRAG (Jun 13, 2008)

Im trying to get a job as a medic for a dive/ sailing camp.  I am not sure how remote it actually is but I know that there is only one level three trauma center anywhere near.  there also might be a jungle component to it. I realize I prob wont be doing any ALS there anyway but id like to have the additional knowledge for the future and to say look what I can do.  I have a hard time seeing chest tubes in the protocal. The WEMT prob would work.  but i think the WALS would make me more attractive to hire.

Is his forum mainly people from WA?  

Thanks for all ya'lls posts


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## yowzer (Jun 14, 2008)

BossyCow said:


> Narcotics are so highly regulated that the logistics of carrying them in a wilderness pack is difficult. Where is the pack stored? Who's responsible for outdates? How do you make sure that the meds are tampered with?



Oh, it's not really feasible. It would still be nice, though.


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## yowzer (Jun 14, 2008)

KELRAG said:


> Is his forum mainly people from WA?



No. I think there's only 3 or 4 of us who admit to it; it's just that 2 of us are involved in SAR and thus wilderness medicine.


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## jbiedebach (Aug 4, 2017)

I took the NOLS Wilderness first aid class and I now teach a class for a Wilderness group here in TX.  My class focuses on decision-making more than hands-on skills.  I have seen a lot of Boy Scout classes like "put an onion on a burn" or "make a litter out of tree branches and duct tape".  That stuff is all well and good but most of the stuff my folks do is not true back country.  I saw a definition somewhere that "wilderness" is defined as a 30 min or more delay from EMS resources, and we run several trips a year that meet that criteria (backpacks, canoe trips, etc).

I teach some hands on skills, but more of what I teach is recognizing the things you need help with early and how to stabilize your patient until help arrives.  Example: You are likely not going to be able to hike a 250lb man with a broken ankle, 2 miles back to the trail head.  You are going to be much better off, sending help and stabilizing the patient until you can get an ATV or helicopter in to rescue your patient. 

Every situation is different.  I think the biggest decision for true back country is how much are you going to pack in?  Every liter bag weighs 2lbs, a lot of drugs break down in extreme heat.  I think most of wilderness EMS comes down to pre-planning and good decision making.

TLDR: Take your city skills and marry them with some sound decision making and that is most of Wilderness medicine (not talking about technical rescue at all, that is a whole nother beast)


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## luke_31 (Aug 4, 2017)

jbiedebach said:


> I took the NOLS Wilderness first aid class and I now teach a class for a Wilderness group here in TX.  My class focuses on decision-making more than hands-on skills.  I have seen a lot of Boy Scout classes like "put an onion on a burn" or "make a litter out of tree branches and duct tape".  That stuff is all well and good but most of the stuff my folks do is not true back country.  I saw a definition somewhere that "wilderness" is defined as a 30 min or more delay from EMS resources, and we run several trips a year that meet that criteria (backpacks, canoe trips, etc).
> 
> I teach some hands on skills, but more of what I teach is recognizing the things you need help with early and how to stabilize your patient until help arrives.  Example: You are likely not going to be able to hike a 250lb man with a broken ankle, 2 miles back to the trail head.  You are going to be much better off, sending help and stabilizing the patient until you can get an ATV or helicopter in to rescue your patient.
> 
> ...


From all my experience the most you are going to need when that far out is pain meds and stuff to splint with for injuries, and maybe some nausea and allergy meds. There isn't much you can do for a true life threatening emergency in the backcountry. In the context of once you gave medications you still need to be at the hospital it a short period of time. I've been places before cell phones were really popular where the nearest road was a day hike away barring any further complications. Some of those places I think only a satellite phone still is your only communication method.


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## JW5974 (Aug 4, 2017)

yowzer said:


> I think the biggest bonus to having a wilderness ALS capability is in the ability to give pain killers.
> 
> Had a hours-long steep angle evac a few weeks ago of a guy with a nasty leg fracture. He was in agony, screaming at every bump... It would have been wonderful to have had someone there able to give him morphine or the like to make it easier for him.


Never taken a wilderness class, but wouldn't it be nice if antibiotics were included in it. Yes painkillers should be a must but if you can't get the patient to the hospital in a timely manner infection can set in... if that happens we're just hospice.


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## luke_31 (Aug 4, 2017)

JW5974 said:


> Never taken a wilderness class, but wouldn't it be nice if antibiotics were included in it. Yes painkillers should be a must but if you can't get the patient to the hospital in a timely manner infection can set in... if that happens we're just hospice.


If it's more then a few hours to get out antibiotics are a good thing to have, it will help lessen the hospital stay if they did have an infection.


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