# Wilderness Advanced Life Support



## NPO (Dec 5, 2017)

Has anyone ever taken one of the Wilderness Advanced Life Support classes, or a similar class?

It's always been something I've wanted to take, not for any particular career goal or advancement but just for the fun and learning experience of it. There's a chance I could get my employer to pay for it through Professional Development.

If anyone has any thoughts or recommendations on courses I'd love to hear them.


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## Summit (Dec 5, 2017)

I haven't taken one, but some things to look at:
1. Which organization is teaching it, or more specifically who is the instructor?
2. Is the there more focus on organized rescue medicine or improvised/austere/expedition medicine?
3. Who is the course aimed at and and what is the minimum provider level to get in the course?

There are couple curriculum and alphabet soups:

WALS - Wilderness Advanced Life Support by WMA (Wilderness Medical Associates Intl.) - I am very impressed by Dr. Johnson (and my wife took her first WFR from one of their instructors and she was impressed) sometimes he teaches it (I think he is retiring soon) also has a PA and a Medic that handle some classes. WMS FAWM credit.

AWLS - Advanced Wilderness Life Support by AdventureMed - Very impressive physician faculty, mostly FAWM. Associated with some medical school. Lots of international offerings. WMS FAWM credit.

RMAP - Remote Medicine for the Advanced Provider by RMI (Remote Medical International) - They offer courses around the world... other than that I know little. I don't know who the instructors are.

These courses seemed aimed at everyone from experienced wilderness providers looking to up their game to hospital emergency practitioners seeking an introduction to wilderness care to non-emergency physicians. A lot of these look like WEMT Upgrade courses except they throw in some suturing, medications, and ALS stuff not found in WEMT. I've had two friends who took WALS (experienced SAR medics) who were favorably impressed.


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## NPO (Dec 5, 2017)

The WALS course you mentioned is the one I was mostly looking at, as it seemed the most reputable. 

I'm not looking so much for rescue type education, but more of the improvised and expanded thought process type medicine often used in wilderness areas.


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## Summit (Dec 5, 2017)

Sounds like it is what you are looking for


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## NPO (Dec 5, 2017)

Summit said:


> Sounds like it is what you are looking for


Thanks for the insight!


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## EpiEMS (Dec 5, 2017)

SOLO offers a course called "GeoMedic" - might be of interest, as well.


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## NPO (Dec 5, 2017)

My employer has agreed to pay for the class for me. I'll be attending the WALS class from AdventureMed due to availability. 

I'll be sure to follow up after I take the course in April.


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## CALEMT (Dec 5, 2017)

NPO said:


> My employer has agreed to pay for the class for me.



That must be nice...


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## NomadicMedic (Dec 5, 2017)

I had a friend who took the RMAP course, found it to be disappointing.


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## Summit (Dec 5, 2017)

Summit said:


> I've had two friends who took WALS (experienced SAR medics) who were favorably impressed.


So I may not have remembered so well... I asked one just now: 
"Years ago... don't remember who taught it or if it was WALS or AWLS. Death by power point, wasn't very informative - good for docs who had never a SAM splint or stokes litter. Mine had almost no ALS.... BLS except for antibiotics." 

That's from a SAR Medic who teaches WEMT course (he taught mine) and his statement makes sound like...



> A lot of these look like WEMT Upgrade courses except they may throw in a little suturing, medications, and ALS stuff not found in WEMT.



I will point out that the AWLS doesn't even require you to have ALS, just EMT, and does point out the course is appropriate for non-emergency physicians.

I'd assume WALS would be more field based, knowing how WMA runs.

I'd push hard to talk to the instructor for the exact course you are looking at and get a good feel. If nothing feels right, go take a WEMT Upgrade. It will deliver the improvised care and wilderness care philosophy as well as offering the environmental emergencies content. I recommend Colorado Mountain College (I know they teach one out in Moab and you'll have an experienced medic instructor) or Desert Mountain Medicine or WMA. WMI (NOLS) and SOLO also have good reputations.


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## NPO (Dec 5, 2017)

Summit said:


> So I may not have remembered so well... I asked one just now:
> "Years ago... don't remember who taught it or if it was WALS or AWLS. Death by power point, wasn't very informative - good for docs who had never a SAM splint or stokes litter. Mine had almost no ALS.... BLS except for antibiotics."
> 
> That's from a SAR Medic who teaches WEMT course (he taught mine) and his statement makes sound like...
> ...


I do think I'd prefer the WALS course more... Just based off what I see online. However there are no upcoming courses near me.

The AWLS course is a less than a days drive. I looked at the curriculum for AWLS and it may be the death by PowerPoint one... But oh well.

I download their text book, which I was sent a link for after I paid, and I'll look it over tonight.

Even if it's heavy on the PowerPoint stuff, I'll be happy to take it. Hopefully they at least have some good lecturers.


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## DrParasite (Dec 6, 2017)

Out of curiosity, I did look at into the websites for both courses, and didn't find much.  the AWLS didn't tell me anything about the course, other than where it was located; the WALS was a lot better, but I am still missing where the ALS comes from; it looks like much of it would be simply called Wilderness Life Support.  and while the WALS does include some cool stuff (dislocations and reductions, spinal assessment and treatments, etc), will you actually find an MD who will sign off on letting you do it?  Other than that, it looked like SAR awareness, mostly BLS stuff, with a little bit of cool ALS (if approved) stuff thrown in.


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## Summit (Dec 6, 2017)

@DrParasite I believe you have assessed it correctly. And most of those "cool skills" will be found in a WEMT and WFR as well (specifically the field dislocation reductions, spine clearance assessment, etc.)

A course like that should provide a mindset of thinking hours and days ahead instead of seconds and minutes. (There is a good reason why Dr. Wilkerson describes Wilderness Medicine as akin to nursing in his opening to Medicine for Mountaineers... which is a very good book btw).

A course like that should provide improvised care techniques, because in a most wilderness situations as you well know, you won't be carrying two jump bags 100ft on the cot from the ambu... you are loaded for an 8 day backpacking trip and you need to figure out a good way to use a water bladder as an air splint or turn some backpacking gear into a litter.

A course like that should provide a thought process what injuries in the wilderness need extrication vs treat and continue (this is a huge deal and not always obvious).

A course like that should provide a didactic basis on special environmental injuries with a wilderness treatment context: dive, avalanche, altitude, exercise induced, and tropical illnesses for example...

Almost everything in wilderness care is BLS unless you are an ALS backcountry response agency...  or you happen to be at Everest Base Camp. The simple reason is nobody wants to carry around ALS toys for a regular trip. Medical kits see very targeted selections of medications, maybe a needle decomp kit, maybe a suture kit, and that is about as "advanced" as most people get unless they are a large expedition or an organized backcountry ALS response team. Hopefully what the "advanced" courses include is including some of those medication considerations as well as the course being taught at a slightly higher level (assuming everyone is a least a Paramedic or RN) vs simplifying things for the FR/EMT level. I'll be interested to hear @NPO 's take.

For point of comparison, the AWLS/WALS courses seem to be in the 36-48 hour range. A Wilderness Upgrade course (requires medical professional cert of at least EMT, RN, PA, MD etc) is 48-54 hours, and a WFR is about 80 hours (no prereqs).


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## Summit (Apr 23, 2018)

@NPO how was the course?


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## NPO (Apr 23, 2018)

Summit said:


> @NPO how was the course?


Dates were moved to May. I'll update.


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## NPO (May 21, 2018)

Yesterday was my third day of my three day course. It wasn't bad, but it wasn't what I hoped it would be. 

Most topics were survival and recognition of things that you might encounter in the wilderness. 

We covered things like bits/stings, HACE/HAPE, dive injuries, GI infections, external infections, water filtration, burns, cold injuries, drowning, etc. 

My main disappointment is that no topic was covered in depth. There was a little patho involved with the altitude and dive injuries. Beyond that it was mostly explanations of what types of insults can occur and what commercial devices can help. Much of the class seemed like a wilderness safety prep class, and I don't think a layperson would struggle with it. There was some talk about antibiotics for GI which was beyond my scope of training and experience but none of it was in the test.

I was the only Paramedic in the class. And in fact I was the only prehospital provider. The other 11 were MDs or PAs. The bulk of the MDs were EM, we had one pull/critical care and one OBGYN.

I feel like this class is more suited for in-hospital providers who expect to be practicing medicine in the wilderness on a trip or mission.

It was not death by PowerPoint though. There was that component but they made an obvious effort to get outside after about 2-4 hours of lecture. I would say it was a 50/50 split between PowerPoint and outside discussion and scenerios.

Overall, it was a review of material I learned in paramedic school. This is a fine review course of environmental emergencies but for the season provider I would not expect to learn any groundbreakingly new material. Also, I cannot yet confirm that any CEs will be applicable for EMTs or paramedics.

The class was hosted by the University of Utah School of Medicine.
It was presented by

Richard Ingebretsen MD, PHD
https://faculty.utah.edu/u0034209-RICHARD_J_INGEBRETSEN,_MD,_PhD/teaching/index.hml


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