# WEMT v. WALS



## redcrossemt (Nov 3, 2008)

I am an EMT-I and on a ground SAR team. I would like to take a wilderness medicine class. Are there major differences between the WEMT and WALS classes, other than fluid administration? Are there a lot of differences in ALS care between wilderness and urban situations? Is WALS worth taking?


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## Brooks416 (Dec 7, 2008)

Depends on the states protocols. In Maine WEMT has benefits, such as reducing dislocations of shoulders,knees(patellas) and ankles. WALS has a great deal of more drugs available. We are lucky in my rural area that our medical director believes in and helped set up the WEMT class I took. Most if the other wemt training is more trending and severely aggressive wound cleaning.


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## redcrossemt (Dec 8, 2008)

Is this just the difference between EMT and Medic, or does Maine actually license Wilderness levels?

I'm just wondering if WALS covers drugs/uses that are not covered in an "urban" medic class? (I'm in medic class now.)


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## Brooks416 (Dec 8, 2008)

WEMT is a license upgrade and has a different set of protocols. WALS has use of drugs that a medic can't carry.


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## redcrossemt (Dec 8, 2008)

Can you point me to a copy of those separate protocols? From what I can find on the Maine EMS website, it says that WEMT is not a licensure level, just a certification like in other states. The 2008 protocols say that WEMTs can do reductions and apply other skills as long as they are within the standard protocols. I can't find another set of protocols or a list of additional meds for WALS providers.


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## Brooks416 (Dec 8, 2008)

I may stand corrected that it is a certification. but we have a wilderness protocol book that kicks in when a hospital is more or less than a 2 hr transport or extrication ie wilderness or complicated extrication from a vehicle. If I can figure out the way for private msg here I will scan it and send it to you. Don't know if it is too long for posting here.


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## BossyCow (Dec 8, 2008)

Or you could post a link to it.


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## medicdan (Dec 8, 2008)

I had a long conversation with my WEMT instructor about the role of AWEMT or WALS. For the wildernes there are generally no protocols, just guidelines. There is not much use for a monitor/12-lead, in most cases, you cant hang a bag. The real uses for Wilderness ALS are Pain control, but with extreme care and fluid bolus for extreme dehydration (although starting lines and hanging bags is problematic in the field). 
Codes-- dont happen and dont end well in the wilderness. Are you expecting to bag a patient while carrying them out in a litter? 
With all of that said, I know SOLO and I think WMI teaches AWEMT or WALS courses-- check with them for details.


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## medicdan (Dec 8, 2008)

Sorry, my above post was quite convoluted. Sleep is a necessary element to life. Essentially I was trying to say that there is not much ALS can do in the deep field.


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## daedalus (Dec 8, 2008)

> WEMT is a license upgrade and has a different set of protocols. WALS has use of drugs that a medic can't carry.


This is not correct. 'WEMT" is rarely recognized anywhere, and even where it is, it is taken as an equivalent of the normal EMT. If I went into work saying I was a WEMT and that I had different protocols than everyone else, I would be laughed at. WEMT does not give you ANY special abilities, and you still must practice under the normal state/county EMT protocols. Its a essentially useless class, and I must stress that you have no additional rights over another EMT because you took the class. I could offer a class called EMT-Narcotic, and certify my graduates with a "certificate issued by Daedalus". Do you think the state is going to let them administer narcs? Anyone can offer any sort of class they want to, but it means nothing without the blessings of the state and has real accreditation as an education provider. 

Likewise, NO ONE having taken a "WALS class" can carry ANY drugs. If you are a real paramedic that finished an authorized and accredited paramedic program, and find employment with an agency under a medical director, you can use the medications allowed by your local scope of practice WHILE AT WORK and under your medical director. Anything to the contrary is practicing medicine without a license. No hospital or EMS agency worth its weight in salt will even recognize WALS as a real certification, and even if they did, it will still not allow employment because you still need a real state paramedic card and AHA ACLS.


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## medicdan (Dec 8, 2008)

WEMT/WALS are additional courses for the EMT-B/P meant to introduce them to different treatment modalities when out in the wilderness, often with little or no medical supplies or equipment and long transport times. There is no medical direction or protocols in the wilderness-- the assumption is that every situation is different, no "cookbook medicine" as some here like to call the state of urban EMS. 
WEMT/WALS is NOT a certification, its a training course. To ensure this, in order to enroll into these classes you need to show proof of certification/license in your home state (NREMT-B + State car+ CPR) and for WALS, EMT-P +ACLS, and the guidelines are limited to street drugs and procedures, but adapted to the wilderness setting. 

Some states acknowledge WEMT (ME and NH are the only two that come to mind), and acknowledge the cert and different guidelines-- and may incorporate different procedures away from urban medicine (C-spine clearance). 

There have been discussions of this before, possibly on this sub-forum, but possibly elsewhere.

Good Luck!


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## BossyCow (Dec 8, 2008)

Anyone who tells students that there are not protocols governing Wilderness Med immediately loses credibility in my eyes. While there will be exceptions made to the regional protocols because of the added complications of being futher away and spending more time with a patient, there will certainly be, in any reputable agency a set of protocols governing your scope of practice. These will be signed off by the Medical Program Director who has the license under which you practice. 

Our area operates under different protocols depending on whether we are on State lands or in the National Park. Only because the park has their own MPD. 

Yes there are differences, this does not mean you practice a sort of cowboy medicine without rules or protocols. I would highly recommend sitting down with your instructor and getting some further clarification on this topic. I think you must have misunderstood.


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## mikie (Dec 8, 2008)

I understand how WEMT differs than urban, but how does ALS differ?


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## daedalus (Dec 8, 2008)

emt-student, you are still mistaken. WEMT does not allow you to use a different set of protocols at work than your "urban" EMT counterparts. If field c-spine clearance is part of the protocols in your region, than any EMT can preform it, not just EMTs that have taken a WEMT class.


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## Hal9000 (Dec 9, 2008)

I recently talked to a person who writes protocols for my state.  The subject of WEMS was brought up, including field C-Spine clearance.  State protocols do not endorse field C-Spine clearance.  The W-EMT course is not able to replace state protocols.  The W-EMT course is also not able to be used as an official endorsement along the lines of "Monitoring-Basic, Airway-Basic, etc."  Some EMTs who had taken a W-EMT course were under the impression that they could use W-EMT protocols on SAR calls, as their medical director "took responsibility and cleared the endorsement."  This was also not correct.  

While the medical director could send an official request for exemption or implementation to have the W-EMTs protocols put in place, it would understandably have to have valid, quantifiable evidence to prove its worth and soundness of practice.  This has not happened.  

It was therefore concluded that using these "protocols" was not within the scope of practice, and therefore not good medicine.  

Giving that it came from the man who creates the protocols for the BOME, I'm willing to say that it is accurate for my state.

Now, with that said, is the W-EMT useless?  No, certainly not.  It stresses ingenuity and self-reliance.  If I was with my family and we got hurt way out in a wilderness area, without roads nearby, without cell or radio service, and without contact, do you think that I'd use what I'd learned?  Of course I would.  I just wouldn't use it when I'm on a job or when there are better, more proven methods.  

Good subject anyhow.  Hope I made a helpful contribution!

Take care.


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## Brooks416 (Dec 9, 2008)

Maine protocols give basic emt's the ability to do spinal rule out. Wilderness emt protocols in Maine are specific and they automatically can be used if time to get the patient to the hospital is more or less 2 hours.


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## Hal9000 (Dec 9, 2008)

*So you're saying...*



Brooks416 said:


> Maine protocols give basic emt's the ability to do spinal rule out. Wilderness emt protocols in Maine are specific and they automatically can be used if time to get the patient to the hospital is more or less 2 hours.



That Maine's state protocols specifically allow for W-EMT protocols to take effect under certain conditions?  That would make more sense, protocol wise, although I'd be interested to see how accurate field C-spine clearance is.  I've heard from my BOME that the error rate is generally around 12%, although this is hearsay and not fact.   I'd love to see the actual studies.  

Thanks for the info, in any case!


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## daedalus (Dec 9, 2008)

Brooks416 said:


> Maine protocols give basic emt's the ability to do spinal rule out. Wilderness emt protocols in Maine are specific and they automatically can be used if time to get the patient to the hospital is more or less 2 hours.


Really? 
http://www.state.me.us/dps/ems/legal.html

I took a look at the state protocols and could not find mention of this.


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