General info about certifications and meds.

[wanderlust39]

I'm a wilderness guide that bounces back and forth between the mountain west and Alaska and I'm considering getting my AEMT or paramedic status to enhance my own capabilities if something should go wrong in the backcountry and I'm curious about medications. I want to build a decent, advanced med kit with some meds like antibiotics, normal saline products, epi-pens, morphine, dextrose and some other things to handle cardio and respiratory issues as well as some trauma and diabetic meds. I guess my question is, in order to get some of these things, will an AEMT be enough to get the credentials to get any of that or even a paramedic for that matter, or do I need to be a part of an EMS crew? Thanks.

 

[DesertMedic66]

No you will not be able to get any of those. All of the medications require a prescription from a doctor.

 

[LACoGurneyjockey]

You cannot practice ALS without a medical director. Bleeding control and some basic splints is about as far as you can go.

 

[wanderlust39]

Damn, I get a lot well-to-do 50 somethings that are really outside of their own experiences and it's terrifying. Is IV training part of AEMD? If nothing else, I can bags of saline for blood loss or extreme dehydration.

 

[LACoGurneyjockey]

You cannot practice ALS without a medical director. Bleeding control and some basic splints is about as far as you can go.

Is IV training part of AEMD? If nothing else, I can bags of saline for blood loss or extreme dehydration.

No, you can't bring saline and you can't start IV's, not legally. I wasn't over simplifying when I said bleeding control and splinting is as far as you can go. No oxygen, no meds, no invasive procedures. Your AEMT or Paramedic cert does not allow you to practice without a medical director. You can be an over qualified first-aid provider and that's about it.

 

[wanderlust39]

Yikes. Well thanks for the info.

 

[281mustang]

You can purchase IV supplies and saline online without a medical director, but legally speaking you open yourself up to a lot of liability issues in the event someone wanted to press the issue and take you to court.

If you choose to go that route I'd limit the practice to family and close friends in the event the need ever arose. That is of course is after you've been formally educated on the technique and contraindications associated with fluid therapy. Blindly giving a trauma patient large volumes of fluids can be detrimental...

 

[wanderlust39]

Right, I mean when you're hiking out ten miles over rock and the client sits at desk for 30 years and treats himself to a moderately difficult trip, the whole time I've got my fingers crossed that he doesn't keel over and die or that he's doing an aspirin regiment. That, on top of the insistence of moderately heavy drinking between hikes and way less water intake than is necessary. Guys like that have problems and it's the domino effect, particularly at altitude.

 

[LACoGurneyjockey]

This isn't really my specialty, but don't take out of shape people on trips well above their ability level? And make sure they are taking in sufficient water? As a wilderness guide, you're much better off preventing injury/illness preemptively than trying to treat someone in the middle of nowhere with a severe lack of resources, equipment, and experience.

 

[281mustang]

Right, I mean when you're hiking out ten miles over rock and the client sits at desk for 30 years and treats himself to a moderately difficult trip, the whole time I've got my fingers crossed that he doesn't keel over and die or that he's doing an aspirin regiment. That, on top of the insistence of moderately heavy drinking between hikes and way less water intake than is necessary. Guys like that have problems and it's the domino effect, particularly at altitude.

Be proactive, encourage people to take water breaks when necessary.

Starting IV's on clients is playing with fire.

 

[wanderlust39]

I work for a service but I'd also starve if I refused everyone that wasn't an Olympian. The best we can do is waivers and rather intensive explanations of conditions and health warnings.

 

[TimRaven]

I would recommend you look into a Wilderness First Responder(WFR)/Wilderness EMT program which might be better fit than AEMT/Paramedic for your occupation.
But again, check with local laws and scope of practice.

 

[Gurby]

So the problem here is that you need a physician's medical license to work under. The way EMS works is that doctors come up with protocols, and then technicians (EMT's) carry them out. By laying out protocols, the doctor is basically saying, "in this situation, I want you to do xyz". You don't have a physician doing this for you, currently.

This is probably over your head, but maybe your service could look into collaborating with a physician on this? I'm sure you could at the very least get the go-ahead to carry some epipens.

 

[EMTinCT]

As I understand it (gramma told me this once) there are two ways that you're allowed to start advanced interventions on a patient: if you're an AEMT or paramedic and part of a legally operating EMS service with a medical director and protocols -or- you're a doctor with a valid medical license. Other than that you'd be making a big old no-no and gramma definitely wouldn't be happy with you.

 

[Carlos Danger]

I'm a wilderness guide that bounces back and forth between the mountain west and Alaska and I'm considering getting my AEMT or paramedic status to enhance my own capabilities if something should go wrong in the backcountry and I'm curious about medications. I want to build a decent, advanced med kit with some meds like antibiotics, normal saline products, epi-pens, morphine, dextrose and some other things to handle cardio and respiratory issues as well as some trauma and diabetic meds. I guess my question is, in order to get some of these things, will an AEMT be enough to get the credentials to get any of that or even a paramedic for that matter, or do I need to be a part of an EMS crew? Thanks.

Does your employer have a medical officer? They would probably be the first person to talk to. They can prescribe an epi-pen, a broad spectrum antibiotic, zofran ODT, loperamide, acetaminophen, and written instructions on how and when to offer them to the patient for self-administration. Off the top of my head that's about all the meds I would recommend, owing both to economy and lack of training in ALS. Those meds + bandaging supplies and a couple SAM splints (you don't need much of that either, because those things are easily improvised) and you've got all you need to handle 95% of what you can realistically expect to encounter. Anything really serious like a head injury or other major trauma, seizures, chest pain or signs of stroke, etc need a medevac ASAP, no matter what training you have or how large your med kit is.

You don't need dextrose or glucagon because you won't find many brittle diabetics at risk for hypoglycemia on physically taxing outings in remote areas. On the outside chance that does occur, make them show you their glucagon kit and dextrose gel and make sure you know where it is. IV fluid is heavy and bulky and takes a lot of understanding to use safely in the settings you are describing. Oral rehydration works better than IV, anyway.

A WEMT course is really the way to go; they'll go over all this stuff and you'll get to network and learn from others who do this work. Lots of good books out there on this stuff, too.

I'd focus on learning the risks of going into a remote area to do physically taxing stuff when you are out of shape, and also how to to do a good risk assessment on an individual and how to tactfully explain risks to those who need to hear it in a way that doesn't sound like you are trying to talk them out of it, but just make sure they are well informed. A well-written medical questionnaire / release of liability for complications relating to medical condition would be a good place to start, if your employer doesn't already have one. I would imagine tools are available out there for this stuff, but if not, a physician or PA or NP who has experience in this area should be able to help you out.

 

[wanderlust39]

Sweet can you recommend any schools or instructors for a WEMT? I didn't even know that was a thing. My kit is limited to a pelican 1600 EMS case which I use now with blood stoppers, isopropyl alcohol, betadine, burn cream, Neosporin, a ton of band aids etc. Essentially, a scaled up and slightly enhanced backpacking set up. We don't have a doctor on staff but we send people to local clinics when we return to town if there are injuries, because they're, well, local. An epipen may be a good addition too.

 

[TimRaven]

Here are some best known WEMS course providers:

National Outdoor Leadership School (NOLS)
http://www.nols.edu/wmi/

Wilderness Medical Associates
http://www.wildmed.com/

SOLO Wilderness Medical School
http://soloschools.com/

Remote Medical International
http://www.remotemedical.com/

All of the above are governed by Wilderness Medical Society of University of Utah.

 

[wanderlust39]

That's convenient. I live in salt lake when I'm actually home.