EMT? WEMT? WFR? Just my insight on it all (and hi by the way ;)

Outdoornut

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So I’m new but since this is one of the topics I actually know about I thought I would contribute to the conversation!
First I saw a lot of people asking whether WEMT would be useful to them within their urban EMT career. While some may differ in opinion I would say no…not unless you will be working also within a wilderness context….here’s why:
WEMT was ‘created’ for wilderness medicine but is not highly sought.
In the outdoor industry Wilderness First Responder is actually the standard they expect you to be trained in if you even think about applying to be a guide/instructor anywhere. Many of the places that provide this training (including Wilderness Medicine Institute of NOLS) will tell you that WEMT (even within the outdoor industry mind you) is overkill and unnecessary unless you plan on doing one of two things which I will mention below.
Frankly, if you have a WFR and a WEMT with a group and a situation occurs, the protocol each will follow will be the same...really, what good is knowing how to start an IV when you’re 12 hours from the nearest one? If you take a look at WFR courses (the standard now is 80 hours of training) a lot of them overlap a lot with the EMT-B curriculum minus the things they won’t have in the woods (such as an ambulance ;) There is a reason why in wilderness medicine there is simply WEMT (as opposed to WEMT-B, WEMT-I, and WEMT-P) the higher you go in urban certification the less your training is going to be helpful in the wilderness context because it relies heavily on having an ambulance full of toys to use. I’ve known quite few instructors (Paramedics themselves) who have admitted that if they found themselves in the woods with a broken leg they would rather have a well-trained WFR stumble upon them then a WEMT simply because a WFR isn’t thinking about what they don’t have and can’t do (this is where the wilderness medicine classes for medical professionals comes in…you already have the medical knowledge as an EMT they just help you adapt it for the very different environment you will be in).
So….why are there WEMTs? Good question! For one main reason: experience.
Even if you become a wilderness guide for 30 day expedition trips the chances of running into a situation that resembles one of your ‘midnight scenarios’ from your WFR course (such as a bear attack with multiple victims, as well as some unlucky soul who got attacked by the bear and then struck by lightning before falling off a cliff) is very rare. Mostly you deal with athletic injuries but the majority of WFR is preventative medicine: making sure things don’t happen and making sure small things don’t turn into bigger things.
Typical WFR stuff:
You’re leading a trip and are on your 10th day out on a 12 day trip with say a group of 10 teens. Everyone is tired, no one has been sleeping well, the trail is difficult and people are starting to slow down and complain for various reasons (apparently it is ‘bogus’ that you took their phones, sleeping on the ground is ‘lame’ and they were under the impression that Dominos would deliver to their campsite) one of the teens was goofing off a day before and got poison ivy on his hand and keeps freaking out and showing you every 10 minutes (“are you sure it’s ok?!”), one of the teen girls constantly “doesn’t feel good” but miraculously feels better when you suggest stopping, one of the other guys has a cold so you’ve been harping on him to USE the hand sanitizer and not to share his Nalgene with anyone, and your co-leader has a headache and is nauseous…you suspect (from their full water bottles) that they are dehydrated but they keep insisting they have drank lots of water. As you reach the top of the next ridge you decide to take a water break for a ‘hot spot check’, blisters would not make this trip any easier!

Since WFR’s only have to recertify every three years (which in my opinion is waaay to long especially since they don’t usually have a lot of ‘practice’ during the year) and don’t get much ‘action time’ WEMT’s can bring a whole bag of experience to the table. As a WFR you can take an instructor course and teach a WFA class but who teaches WFRs? WEMT’s of course!!
Within the wilderness medical industry there are two jobs (off the top of my head) that you can do solely as a WEMT. Most of the jobs out there will be instructors for organizations like SOLO, WMA, and WMI. If teaching is your thing you should check out WMI’s requirements to be an instructor they require ‘previous medical experience’ and they are not talking about bandaging blisters on weekend hikes. It makes since…though WEMT’s experience will be (for the most part) urban…experience is experience. Most people who end up WEMT’s are people (guides/instructors mostly since leading trips is also a prerequisite to be a WMI instructor) who were WFRs that hung out with unlucky groups and got a lot of ‘experience’ themselves and decided to ‘upgrade’ and go into teaching. I know that WMI doesn’t recommend instructors/guides who are already WFR certified to take the course unless they are thinking about teaching or are absolutely set on it. Unless you want to be an instructor for WMI (or other wilderness medicine organization), or want to work in both wilderness and urban medicine at the same time it is not practical…it is too expensive, too long, and too ‘overkill’ to require ALL guides have it.
Of course if you already happen to be an EMT and have taken some recreational hiking/backpacking trips (maybe helped lead your sons Boy Scout trip), and the thought of teaching sounds appealing their website:

http://www.nols.edu/wmi/pdf/WFRITC.pdf

The second job I know that is available to WEMTs is accompanying trips as the medical personal. Now these trips are not week or even two weeks trips these would be the 3-6 month backpacking expeditions where help is at minimum 24 hours away (and that’s pushing it…probably more like 48) sounds fun right? I once got the opportunity to talk with a WEMT who had done this on a couple trips. He was not a guide on the trip but he ‘accompanied’ them, he knew everyone’s medical history, had an evacuation plan for everything, and was carrying a butt load of medical equipment. While the other guides could handle the blisters, dehydration etc... His job was to be prepared for when (not if but when) that massive emergency took place (broken leg, severe fall, cardiac arrest, etc). Now, I suppose it would depend on the company if you could be hired solely in this position. He had been a guide for several years, upgraded to WEMT and they occasionally had him take part on trips because of that certification. Most guiding companies though will be happy with WFR and if you happen to be an EMT that has loads of hiking/backpacking and guiding experience it may or not be a plus to them…it just depends.

So, urban EMT is useful in the wilderness context simply because those who have WEMT have a lot of previous medical experience that most WFRs won’t get.

How does WEMT help you if you are working as an EMT….not much in my opinion. Frankly, I don’t see how they can call it an ‘upgrade’ I feel like it is more moving from one column over to the next rather than moving upwards in training. Really, though it depends on where you live and what you will be doing. If you live in the middle of Chicago and work as an EMT there WEMT is not going to help you much. On the other hand if you live in the backwoods of AL you never know!
I have a good friend who is an EMT who works with SAR. Because is an EMT he is held to their standards even when he is with a patient that they may have to carry an hour back to the ambulance, he has to follow what EMTs can and can’t do. However, he is also certified in WFA (wilderness first aid) and can actually do MORE with this certification than with his EMT when he is in this situation! I suppose it’s one of those you can have the cake and eat it too things.

I would say that if you are already an EMT and think you may be interested in teaching some day or love backpacking and would love the idea of possibly being ‘medical person’ on a trip take the WFR course offered by WMI. It’s an EXCELLETNT course, a lot cheaper than the WEMT course, and frankly, will be more useful to you since you already have the urban training.

Other than that if you spend a lot of time within the wilderness (with accident prone people ;) you could take a WFR course for legal issues. If you take a WFR course you will find that a WFR has more jurisdiction to do things (Within that wilderness context that is) than a WEMT can when he is in the urban setting. This is simply because WFRs do not operate under the same ‘rules’ urban medical professionals are trained in (the urban rule book is tossed out the window when you are 6-24 hours from help). On the other hand, because WFRs are ‘outside’ of urban protocol once they are in an urban context they are rarely recognized, and for the most part can only differ to helping like any other average Joe in event of an emergency (CPR, choking, etc.) which makes since…their training isn’t relevant to the urban setting. If someone breaks their femur I am not going to set up a traction splint…I’m going to call 911 and thank God it’s not me! So if you are an WEMT you have the best of both worlds…..I believe that is a song somewhere…

There are a ton of awesome resources out there for anyone looking for more info. Here’s one
http://wildfiremag.com/forestry/wilderness-first-responder-emergency-emt-200903/index.html
 

mycrofft

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Then some states only sort of recognize the "W"'s.

Your spot was interesting, practical and a good read.
A+.
B)
 

AVPU

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Interesting. Thanks for sharing, some valid points. What, may I ask, is your background? WEMT? WFR? And a wilderness guide? Medican support? Just want a better picture of where you're coming from
 

WildSally

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I agree, A+. I'm about to get my WEMT (I'm already WFA), and I'd love to do something like SAR or expedition medic. That was very helpful, especially the part about the legal issues- how if you've got both WFR and EMT you have more freedom in both wilderness and urban settings.
 
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Outdoornut

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Interesting. Thanks for sharing, some valid points. What, may I ask, is your background? WEMT? WFR? And a wilderness guide? Medican support? Just want a better picture of where you're coming from

Hey,

Sorry it took me so long to reply back (have two fingers splinted together so haven't been doing much typing lately!)

Thanks for the question though! I an a WFR and my entire life is outdoor recreation!! I love backpacking, rock climbing, hiking etc.. and am just 'getting started' in that field as a profession (long road...mostly depends on who you know really...) Just about to start an internship (as some sort of outdoor instructor or rafting guide) and then will do another internship in January (hopefully a 3 month one with NOLS) I can actually get a job with Outward Bound as an assistant instructor BUT I would like to have some more experience first...sides I am young i have plenty of time to work up to something like that. ;)

As for medical...yeah WFR is it. I was going to upgrade to WEMT at WMI but have been advised against it unless interested in actually working urban EMS which, I DO find fascinating but don't really see myself doing everyday as a job (kinda makes me shudder thinking about it...there is a lot more tha can happen to people in an urban setting than in the wilderness...but then again I have been trained fro wilderness emergencies). WFR is something you learn to help keep tabs on the physical state of the group you are leading (are they limping do they have blisters, is that suburn? is he drinking enough water? Is she dehydrated...so and so looks cold etc..) and treat emergencies when needed BUT urban EMS is very different you are doing it all the time and it looks very fast pased (rather than stablize a patient, protect from environmental threats, physical/emotional needs and waiting for help to come to you.... you are going to them and loading and going). I would like to get into SAR at some point and I love the crisis/risk management aspect (I am a nerd what can I say). Most of the people I know at this point are SAR, wilderness medicine instructors or wilderness medicine instructors in training (now THAT is a long road) so it's cool to see the different aspects.

I would love to chat with any of the SAR folks on here btw! I was reading through some of the forums and noted some WEMTs too, would love to hear from you guys as well. How you got into it? why you got into it etc...

In any case lol I think I more than adeuatley answered your question lol sorry for the rant. Oh lol and I challenge anyone to tape the two middle fingers of their left hand together and attempt to type....shakes head (it's beyond me how I can make it through a week long backpacking expedition unscaved and can't shut a car door without incident...darn urban threats!) ;)
 

Trayos

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(it's beyond me how I can make it through a week long backpacking expedition unscaved and can't shut a car door without incident...darn urban threats!) ;)
And just last week I took the bandages off-:ph34r: (starts humming the twilight zone theme)
 

EMSLaw

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As for medical...yeah WFR is it. I was going to upgrade to WEMT at WMI but have been advised against it unless interested in actually working urban EMS which, I DO find fascinating but don't really see myself doing everyday as a job (kinda makes me shudder thinking about it...there is a lot more tha can happen to people in an urban setting than in the wilderness...but then again I have been trained fro wilderness emergencies).

YMMV on this, but you don't have to go through the whole WMI class to get your WEMT. Many places you can send your EMT card and WFR card and get a shiny WEMT card in place of your WFR (since the wilderness part is basically the same).

But, as I said, I'm not an expert, and you'd have to want to take, and actually take, a street EMT course. Just might be easier and cheaper to do it part time near home.
 

mct601

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YMMV on this, but you don't have to go through the whole WMI class to get your WEMT. Many places you can send your EMT card and WFR card and get a shiny WEMT card in place of your WFR (since the wilderness part is basically the same).

But, as I said, I'm not an expert, and you'd have to want to take, and actually take, a street EMT course. Just might be easier and cheaper to do it part time near home.

I might do this. In TN, they offer WFR but no WEMT. I'd like WEMT because I'd like to take part in disaster response at some point (I'm stacking up all the credentials and education I can to assist me in pursuing this).

Do you think I'll miss out on any curriculum by doing this?
 
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Outdoornut

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I might do this. In TN, they offer WFR but no WEMT. I'd like WEMT because I'd like to take part in disaster response at some point (I'm stacking up all the credentials and education I can to assist me in pursuing this).

Do you think I'll miss out on any curriculum by doing this?



Check out NOLS chart http://www.nols.edu/wmi/courses/course_matrix.shtml if you take the WFR course (being already an EMT) it will make you a WEMT. If you're not already an EMT (and WEMT isn't availible) it might be better to go ahead and take an EMT course and then do WFR...or you could take NOLS 1 month WEMT program but it is $$.

Not sure about the curriculum. I do know that since WEMTs are EMT-B they have to meet the national registry requirements for that...they just have more of a wilderness focus. Most WEMT classes are also a lot shorter than taking a typical EMT class (believe me I checked a lot out!). They are several hours a day with full time instructors and they are intensive! NOLS's WEMT couse is a month long, Landmark Learning has a three week WEMT program http://www.landmarklearning.org/courses-emergency-services.php. I actually was going to go ahead and do the three week program simply because I love learning like that (you live it 24/7 and get really into it lol...I did my WFR course that way and I found it highly effective...there was no time to think about anything other than what you were learning). But to each his own. =) Hope that helped. ^_^
 

mct601

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It did. I am already an EMT. I appreciate your thread, you enlightened me on the world of wilderness FR/EMT.
 
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Outdoornut

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No, stuck by a piece of metal though :wacko:

Fun! I bet that felt good! Hehe yeah, pretty sure I fractured my finger (and maybe even the metacarpal too yay)... but I refuse to get x-rays...I am not a big fan of hospitals in general...last time I went they told me what I already knew and then charged me $1,000 for it...not that I am bitter. <_<
 

LucidResq

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Hey there!

I've been messing around lately looking at work for various camps and programs that send kids on expeditions. Most of them require WFR... which I don't have.... but I'm an EMT with 3 years of SAR experience with plenty of training as to how to manage stuff in BFE with some duct tape and branches (har har). Or hmmm... maybe I shouldn't put this patient on 15 LPM via NRB when all I have is one D tank and we're going to be carrying them out for 6 hours.

You might automatically think, well, that's taking care of a single patient that you stumble upon in the woods, not a group of people over days-weeks-months. However, as I'm often one of the highest medically trained people on the team (scary huh?), I've ended up watching out and taking care of many more of my colleagues than I have taken care of the people we've looked for... especially when I was a Lt. and I was helping put on our weekend-long trainings. I am a highly trained hydration/sunscreen nazi, RICEd countless ankles and knees, checked in on my asthmatic/diabetic/etc ducklings, and learned that you can't assume "trained" people will bring gloves to a call in a blizzard...

As our EMS officer, I also did inventory of all of our medical stuff and kept our packs up in working condition. Creating our first pack specifically for pediatrics was my baby (no pun intended).

Anyways, what I'm getting at is (believe it or not there is a point), although I don't have the certification in hand, it seems like my EMT + experience would substitute. Any thoughts?
 

LucidResq

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Oh yes and I'm looking at WUMP right now, but not only are there no upcoming courses near me, I'm also broke.
 
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Outdoornut

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Hey there!

I've been messing around lately looking at work for various camps and programs that send kids on expeditions. Most of them require WFR... which I don't have.... but I'm an EMT with 3 years of SAR experience with plenty of training as to how to manage stuff in BFE with some duct tape and branches (har har). Or hmmm... maybe I shouldn't put this patient on 15 LPM via NRB when all I have is one D tank and we're going to be carrying them out for 6 hours.

You might automatically think, well, that's taking care of a single patient that you stumble upon in the woods, not a group of people over days-weeks-months. However, as I'm often one of the highest medically trained people on the team (scary huh?), I've ended up watching out and taking care of many more of my colleagues than I have taken care of the people we've looked for... especially when I was a Lt. and I was helping put on our weekend-long trainings. I am a highly trained hydration/sunscreen nazi, RICEd countless ankles and knees, checked in on my asthmatic/diabetic/etc ducklings, and learned that you can't assume "trained" people will bring gloves to a call in a blizzard...

As our EMS officer, I also did inventory of all of our medical stuff and kept our packs up in working condition. Creating our first pack specifically for pediatrics was my baby (no pun intended).

Anyways, what I'm getting at is (believe it or not there is a point), although I don't have the certification in hand, it seems like my EMT + experience would substitute. Any thoughts?


Hey there!

First, I think it would depend on who you are looking to be hired by. It's true that most companies that do any sort of long expedition type trips (especially with kids) require WFR certification but if you contact them and ask them about it they might surprise you.

I believe that one of the reasons WFR is the standard is because it shows one has been trained for medical emergencies and prevention in the backcountry. The concern with any urban training would be that you wouldn't have the 'mindset' of being in the backcountry or really thinking about small things (such as small cuts) that given the dirt, sweat etc.. might turn into festering wounds only a couple days later. Not to say that wilderness medical training is surgery...it's just a different way of looking at things and they know if you have that 'W' that you have been trained to think that way.

However, since you are in SAR and have spent time in the backcountry, dealing with that environment I would say you would be fine...but again, it depends on who you want to work for and what their policies are. I do know that some protocals are different within the wilderness than they are within the urban context and so "how" one is to handle a situation may differ and some companies (in order to keep all guides on the same page in the event that there is a big emergency) may wish you to have that "W".

There may be some legal issues too...but in no way to I even come close to being an expert on that! I do know that there is some interesting 'dancing' around what is legal and what happens within wilderness medicine. I know that in my WFR training we were told a couple times "legally you can't do this...BUT you will and here is HOW you do it...." I know there are things that I can do in the wilderness context that there is NO way I could do in the urban. For instance...reducing dislocations if I am in the urban context and someone dislocates something I drive them to the ER, if I attempted to relocate something I could be sued. If, however, we were say two days in the woods and my friend dislocated something...I would relocate it and head on out to the hospital and even if they decided to sue me it wouldn't really matter because I would have acted under my WFR certification with something I was trained to do.

As I said, I in no way, am an expert in legal issues but there may be some things that even though you KNOW how to do in the wilderness context you legally can't do with your EMT certification because of state laws or national standards or something crazy like that. In order to keep you and their company/organization from being sued the expedition companies may want to make sure all of their people are legally able to preform things they may have to do in the wilderness/backcountry and this might reuire them to have at least the WFR requirement. But as I said...it depends on who you want to work for. It is also likely that if they know you have spent a fair amount of time in the backcountry (along with you sunscreen naziness, hydration, and minor athletic injuries) they will hire you as well because you have personal backcountry experience. All the medical training in the world is not going to be very useful if you've never been in the backcountry one day in your life (always said that on ABC's tv show Lost things would have gone so much better if instead of a doctor they had had a WEMT or WFR ;) but it could be that I am slightly biased....

But as I said, depends on who and where you want to work. Give them a call, see what they say. It may be just as simple as you sitting down with them to go over their policies. Most likely they just want to make sure you are familiar with how outdoor environments effect the body, and how you know how to prevent them, and take care of those you are in charge of. It's like one of those "flashbackwards" shows...instead of ariving at an emergency scene you are before any potential emergency and have the oppertunity to make sure some things don't happen... (wouldn't you love to be able to flashback to before the skateboarder jumped off the roof and broke his leg at which point his friends called 911 and you had to come pick up the pieces lol <_< when I am with a group I am constantly thinking backwards as in this is our biggest threat to prevent it I must do A, B and C etc.. prevention is probably the number one thing stressed in any wilderness medicine course...it's the small things that can sometimes make the biggest emergencies!

Regaurdless, I hope that you do find a job working for one if that's what you're interested in doing. It's tons of fun working with kids/teens in the backcountry (plus you get cool points for doing it!!) B)

Hope that was helpful. If anyone knows anymore about the legal stuff feel free to elaborate...it's been a while since I went through it...actually due for a recertification coming up here soon.... :D can't wait!!
 
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Outdoornut

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and to tack on

P.S.

If you have any other questions I would highly and I mean highly suggest going to NOLS website http://www.nols.edu/ and doing the live chat with a WMI representative. THey are extremely helpful (plus can explain a lot more than I can) most of those you will talk to will be instructors (which are WEMT's who have worked many years in both the urban and wilderness environments). They can explain to you what that "W" entails and such plus have a lot of other advice as well (especially if you're wanting to work within the outdoor industry!).

One thing to also keep in mind that is if you are working as a guide/leader of a trip you are not working in the context of being an EMT or a WFR...you are the guide and therefore the medical certification comes secondly to your other duties. Being a guide means having the necessary training in case something were to happen and also being able to prevent things from happening but it also requires decission making, group management, and crisis management skills as well (which I am sure you are not a stranger too being in SAR). In my training we have had to learn how to handle scenerios many of which have nothing to do with medical emergencies (i.e. you're on the 3rd day of 6 day backpacking trip, your group has only managed to travel 4 miles-do to extreme elevation gain- and it's now midnight. you set up camp and go to find water sources...when you get back you discover that a bear has ravaged your campsite...destroyed two packs compleltey and eaten at least two days worth of food. What do you do? Should you find another campsite-remember it is now dark and late and everyone is tired- What should you consider with the bear? what do you do the next morning?? You stil have 3 days left and roughly 28 miles to go...do you stretch out the food? turn back? and so on and so fourth)... hehe I actually enjoyed this scenerio...maybe I will put one in the scenerio thread.... ;)
 

wildmed

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Oh yes and I'm looking at WUMP right now, but not only are there no upcoming courses near me, I'm also broke.

They did have one that was supposed to be happening right now in boulder but they canceled it a few weeks ago... I think I am just going to bite the bullet and take a WFR course to upgrade to WEMT in august. I think that is probably the best option anyways, EMT+ WFR, the more education the better right? I don't know how Remote medical fits WEMT+MPIC into a month long class and expects people to be completely proficient. How ever... if someone was set on going the WEMT route, that is probably the program I would recommend.
 

paradoqs

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So I got my WFR in 2007 and just got my EMT-B Dec. of 2009. Recertified my WFR (which was expiring May 2009) and since I now have a EMT-B, NOLS recerted me as a WEMT. WEMT is nothing other than EMT-B plus a WFR. I would advise against taking the 3 week WEMT class because I think it is similar to other EMT-B mill programs in its brevity. Although it would probably be very good if one was ONLY doing wilderness medicine. One note though is the WMA (Wilderness Medical Associates) does a WEMT that certifies to the level of EMT-I85 in one month. If I were going to get my EMT from a wilderness medicine school i would choose that one just to be a EMT-I. Personally, I got my EMT-B at a very intense urban program which lasted five months and it was very challenging (I also have a BA and all the credits for an MA minus a thesis). I dont think a month long program could ever match one like mine in the quality of EMT instruction it gives, but wilderness is a different story.
 
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redcrossemt

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really, what good is knowing how to start an IV when you’re 12 hours from the nearest one? There is a reason why in wilderness medicine there is simply WEMT (as opposed to WEMT-B, WEMT-I, and WEMT-P) the higher you go in urban certification the less your training is going to be helpful in the wilderness context because it relies heavily on having an ambulance full of toys to use.

How does WEMT help you if you are working as an EMT….not much in my opinion. Frankly, I don’t see how they can call it an ‘upgrade’ I feel like it is more moving from one column over to the next rather than moving upwards in training. Really, though it depends on where you live and what you will be doing. If you live in the middle of Chicago and work as an EMT there WEMT is not going to help you much. On the other hand if you live in the backwoods of AL you never know!

Hey, thanks for your post! Very interesting read as to your views and some of the information that's out there.

I will say that being a medic in the woods has it's advantages. I would first argue that most EMT-Bs, WFAs, WFRs, and WEMTs don't have a good grasp on anatomy, physiology, nor pathophyisiology of disease. The extended education of the advanced provider will help in diagnosing conditions in the wilderness and making good decisions, even if we don't have all of the fancy tools from the ambulance.

In addition to a better assessment, I would also argue that advanced level practitioners could provide IM/IN analgesia and medications that are often needed for other wilderness emergencies -- such as anaphylaxis, asthma, HAPE/HACE, etc.

I understand that walking out into the woods today with no equipment on me, I couldn't provide more treatment than a WFR. However, I believe that my experience and education would help with decision making and overall patient management. Also, if you have a duty to act in a rural or wilderness medical capacity, you should be prepared with the necessary tools to do your job effectively - including medications necessary for common wilderness emergencies.
 

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