WEMT through NOLS or NOLS WFR + EMT through local CO programgs

[wildmed]

Hey!
I am a current CU boulder pre health student, my final goal one day would be to be a PA or DO. However I am way ahead in school and am yearning to start helping people. I also recently started training to be apart of a SAR team and I am really excited about learning to help people in a wilderness setting. I am planning to take a semester break from regular university classes in the spring semester and am planning to complete an EMT course during that time. I have several questions for you all. First off what do people think about WEMT program at NOLS WMI? It seems like a great program and the idea of a full emersion into EMT life for a month seems like it would be a great way for me to learn. I know that there is a strong opposition to "shake and bake" courses but I this program seems to stand out way above the rest. I have also looked into the Health one /RRCC partnership program at north suburban, and the program at Front range CC in boulder county. However there seems to be a lack of review from both of these programs. Which of these programs is better? I would really like to have the wilderness cert for SAR applications so if i would do the latter i would take a WFR class before my EMT course and then submit the certs to NOLS to get a W-EMT card. Are all of these programs going to adequately prepare me to work for EMS or as an ED tech?? I would also like to Get my IV cert. Can i do this while i was taking a EMT-B course at a local program? I know that this is alot of questions, I would really appreciate any help i can get!

 

[Level1pedstech]

Welcome to the board. If you search my past posts you will see I have given some good advice about working as an ER tech. This should get you started until you get some more replies. Remember the search button is your best friend on this board. There are plenty of great people who are more than willing to help you with any questions you may have.

 

[Summit]

Hey!
I also recently started training to be apart of a SAR team and I am really excited about learning to help people in a wilderness setting.

RMRG is a long road.

First off what do people think about WEMT program at NOLS WMI? It seems like a great program and the idea of a full emersion into EMT life for a month seems like it would be a great way for me to learn. I know that there is a strong opposition to "shake and bake" courses but I this program seems to stand out way above the rest.

Overpriced, but good. If you are taking a semester off, I'd go to Colorado Mountain College in Breckenridge which has an excellent program and take an EMT course there for a semester, then get the WEMT upgrade class from them. Total cost will be $540 if you are in district, $750 if only in state.

I would really like to have the wilderness cert for SAR applications so if i would do the latter i would take a WFR class before my EMT course and then submit the certs to NOLS to get a W-EMT card.

I hope you do realize that while wilderness training stresses longer term care techniques and improvised care, having an actual WEMT card doesn't give you any expanded scope of practice.

I would also like to Get my IV cert. Can i do this while i was taking a EMT-B course at a local program?

IV must be taken after you are a fully certed EMT.

PS That's your screen name? Seriously? Seriously? Jeeeeez.... :wacko:

 

[WarDance]

I think NOLS is over priced and not worth it. I am also on a SAR team in CO and you will be fine without the WEMT because much of the time you will be running with EMS or they will be on their way. Most situations are treated the same regardless of injury or CC because of the backcountry limitations. When it comes down to it your job is to stop the bleeding, gove them O2, keep them warm and get them to an ambulance. Instead of sinking a ton of money into the NOLS course get your EMT-B through a local ambulance service and then spend the leftover money to take a class on rope rescue or something similar. Knowledge in that aspect will be far more valuable in SAR in this part of the country.

The IV cert here is not part of an EMT-B class. It is a seperate entity that you take after you pass your EMT class.

 

[WarDance]

Well looks like my friend from summit is on a similar wavelength!

Oh and another thing. I like the traditional EMT class better because it is a longer amount of time. That means more time to get yourself into the mindset and to learn it better. I think those skills will stick with you longer if you learn them and practice them over the couple of months an EMT class lasts.

 

[wildmed]

Thanks guys, thats what you have said is pretty much what I have been reading. I would like to do the class at cmc but i cant afford to live in summit county for a semester, too bad because that would be awesome. Does anyone know about the two programs I asked about specifically? Also if you get your EMT-B class done in colorado, are you automatically certified as an CO EMT? or is it the same process as when you have a NREMT where you have to submit a bunch of paperwork and wait 6 weeks? Summit... about the name, I happen work as an outdoor skills specialist for a summer camp for special needs children that was superhero themed for the 09 summer. I miss camp quite badly, which is the reason why I am looking to get emt certified, so I can do something worthwhile, helping other people, when I am not teaching at camp. Thus the name, sorry if it comes off the wrong way, just the first thing that came to mind.

 

[wildmed]

By the way, I am mostly interested in the W-EMT cert because I often go on extended backpacking and climbing trips with lots of people and it would be nice to be confident in my skills managing an emergency situation a few miles in. I also am possibly interested in maybe doing ski patrol next year in eldora or loveland which requires W-EMT right? PS I also know SAR is an extremely long road. I am just excited about the prospect of helping people in the element I love. Its a pretty awesome goal if you ask me.

 

[Summit]

Wardance: great mind think alike... or something...

I would like to do the class at cmc but i cant afford to live in summit county for a semester, too bad because that would be awesome.

It's not as bad as you think. EMT taken over a semester shouldn't be such a burden that you cannot have a job, especially someone who is looking at PA/DO career paths. The material is not difficult. The classes are always at night two days a week and on some weekends.

Work for Breck or Keystone, and employee housing can be had. Otherwise, housing is not really that expensive. You can get a 1BR for $800-1000 or go in on a place and pay $300-$600 as your share. Additional options are attending the Leadville, Steamboat, or Glenwood CMC campuses which have student housing.

The W upgrade wouldn't require living up in Summit County.

Also if you get your EMT-B class done in colorado, are you automatically certified as an CO EMT? or is it the same process as when you have a NREMT where you have to submit a bunch of paperwork and wait 6 weeks?

The latter, but you make it sound a lot worse than it is. The state EMS office is easy to deal with and not much of a headache if you have your NREMT. The only headache is getting a FBI background check if you don't qualify for a CBI only check.

Summit... about the name, I happen work as an outdoor skills specialist for a summer camp for special needs children that was superhero themed for the 09 summer.

Ah, makes sense now. That camp wouldn't happen to be in RMNP, would it?

By the way, I am mostly interested in the W-EMT cert because I often go on extended backpacking and climbing trips with lots of people and it would be nice to be confident in my skills managing an emergency situation a few miles in.

For most people who solely want to do that, I say that a WFR is the best choice for this application. Since you want to do SAR, a W upgrade to an EMT will be great.

I also am possibly interested in maybe doing ski patrol next year in eldora or loveland which requires W-EMT right?

No ski area requires WEMT. Most require EMT and/or OEC. Loveland requires OEC even if you an EMT. You'll want to speak to a patrol director about becoming a National (volunteer) ASAP in order to have a chance of getting into a class this year. Additionally, most patrols require a ski test and this is usually done in the spring.

I also know SAR is an extremely long road. I am just excited about the prospect of helping people in the element I love. Its a pretty awesome goal if you ask me.

I say good for you and good luck to you!
That's an admirable mindset and as long as reality fulfills your expectations, you'll love it and go far.

 

[Summit]

Here is a good thread:
http://www.tetongravity.com/forums/showthread.php?t=133626

 

[LucidResq]

I think NOLS is over priced and not worth it. I am also on a SAR team in CO and you will be fine without the WEMT because much of the time you will be running with EMS or they will be on their way.

Concurred. Your SAR team (RMRG?) should offer training that will cover much of the same stuff. You will not be any more hire-able as a WEMT as opposed to an EMT, unless maybe if you are looking at Ski Patrol or actually working for NOLS.


And by the way, HealthONE is awesome. I went through their program at the main campus, but I'm sure the one at North Sub. is just as good. I had a few friends go through at Front Range too, and work with a few of their instructors. They're pretty darn good.

PS:

Boulder Emergency Squad

CU Student Emergency Medical Services

You should PM me. I have a friend who has been doing SAR for like 5-7 years, will be graduating from CU 2010 (pre-med and I'd bet $100 that he'll get in somewhere), works in the ED at BCH, and volunteers at a camp for kids with cancer every year. Pretty freaky, actually!

 

[wyoskibum]

By the way, I am mostly interested in the W-EMT cert because I often go on extended backpacking and climbing trips with lots of people and it would be nice to be confident in my skills managing an emergency situation a few miles in.

I don't think which route you go will matter that much. EMT-B + WFR vs WEMT. The only thing that will give you confidence is getting some actual experience. Trial by fire so to speak. On your SAR team, you will be working with experienced wilderness providers. You will learn more from them than anyone.

I also am possibly interested in maybe doing ski patrol next year in eldora or loveland which requires W-EMT right? PS I also know SAR is an extremely long road. I am just excited about the prospect of helping people in the element I love. Its a pretty awesome goal if you ask me.

It is a long road but worth it! Good luck!

 

[Mountain Res-Q]

Must have missed this thread last week with all my running around... Obviously we have several Colorado based SAR folks that will know better than me how it works in that area...

But, from my perspective... WEMT is useless unless it gives you an expanded scope that you must have for SAR. I am sure that the information is great and I would never advocate against any class that expands your mind by even an ounce. But, IMHO, the cost is not justified when you look at the reality of what we do 99% of the time in SAR. Medically speaking, by the time we in SAR get to a patient, they are already dead as a result of their injuries or alive despite their injuries. At that point we either bag them or we support what was survivable until we evacuate them. In reality, I can think of only a handfull of pure medical SAR calls I have been on. Sure, all calls (except the recoveries) will include an aspect of the S in LAST (locate, access, stabilize, and transport) but what we do medically in SAR is often not rocket science.

The biggest concern in wilderness medicine is thermoregulation. Keep them warm, dry, hydrated, fed, and as comfortable as possible... and get then the heck out of there... It is about taking what you know as a MFR or EMT and thinking more primitive. Reality is that in a wilderness setting we can not carry an ambulance with us in the woods... so you do what you can with what you have. If ALS is truely needed in the wilderness setting then the focus needs to be evacuation and not treatment, because even a medic can't do anything meaningful... get them out.

That is why I can see only a few things in the WEMT or even OEC scope/training that trumps what you can meaningfully do in the wilderness as a street level BLS-provider... it is more about stopping the street-medicine thought process and thinging "redneck". Even as a EMT, I have been told by a FACEP with a background in SAR that in the end (and I will never advocate this although I may agree) that once I am in a wilderness setting, it is "screw street protocol... if I know how to do it and it is in the best interest of the pt.... DO IT." I have been taught by that FACEP to reduce dislocations... and according to him, it is medically accepted by ortho guys that a rapid reduction is preferable to ANYTHING else... so do it if possible, regardless of certification, because it is the prudent thing to do medically. Legally... well that is another story. Do I honestly see a time when I will need to do so? Probably not... in all honesty, medical issues are far more likely to be encountered in fellow team members...

In my area the EMSA has no standing protocols for wilderness medicine, so we have been told that WEMT is useless and not approved. DON'T CARE. So I do not get any official wilderness cert... it ain't worth it because the official protocols will not change and my level of knowledge and abilty will not really increase... so when put in a situation where I have to use my brain to determine what is in the best interest of my patient, I will do what is neccessary as long as I have the knowledge and training to do it... (WEMT or not)

On the other hand... I highly value my OEC guys over my Medics on the team.... they just have a better grasp on how medicine is really applied in the wilderness setting... You really can;t translate street EMS to the woods... it is a different beast...

Just my thoughts... but if someone paid for me to go get my WEMT... sure I'd do it... but the reality for me doesn't justify the cost... OEC, however, on top of street EMT would be a good combo, IMHO

 

[Summit]

That is why I can see only a few things in the WEMT or even OEC scope/training that trumps what you can meaningfully do in the wilderness as a street level BLS-provider... it is more about stopping the street-medicine thought process and thinging "redneck". Even as a EMT, I have been told by a FACEP with a background in SAR that in the end (and I will never advocate this although I may agree) that once I am in a wilderness setting, it is "screw street protocol... if I know how to do it and it is in the best interest of the pt.... DO IT." I have been taught by that FACEP to reduce dislocations... and according to him, it is medically accepted by ortho guys that a rapid reduction is preferable to ANYTHING else... so do it if possible, regardless of certification, because it is the prudent thing to do medically.

OK my friend, don't take this the wrong way, but I'm not sure you really understand what WEMT involves. Either that or things are TAUGHT VERY different in CA.

The whole point of WEMT (and WFR) is to focus on improvised care ("redneck medicine" as you put it), considerations for extended extrication, and generally how you do things when the ER isn't 5 minutes away with a doc on the cellphone. Additionally, expedition care and management is often taught.

Reducing indirect locations, as you mentioned learning from that MD, of the shoulder, patella, and finger are all part of the WEMT/WFR curriculum.

Yes, the W card itself grants no legal superpowers in most areas, but a Wilderness Upgrade (or WFR) gives GREAT background to SAR providers. Yes you can learn it all through experience and mentoring as well.

OEC, however, on top of street EMT would be a good combo, IMHO

Why on earth would you recommend OEC on top of EMT versus a WEMT upgrade class???

That just doesn't make any sense unless someone wants to do ski patrol at a resort that requires OEC.

OEC is behind the times and basically an EMT-light class with a outdoor (usually skiing) focus and no urban focus. OEC's CE is sad too. Our team treats it the same as First Responder. OEC in most places is extremely Ski Patrol oriented because the whole thing was invented and is maintained by... the NATIONAL SKI PATROL. It only exists instead of EMT because volunteer patrols use it because of the low CE burden and because NSP wants money. That is why they'll let any EMT-B challenge the OEC... as long as they pay NSP. OEC is less in depth than WEMT.

The ski patrols around here dropped OEC as a requirement and expect any OEC patroller to become an EMT after the first year. Some won't accept OEC and only take EMTs. As a result, the local community college stopped even offering OEC instead offering WFR and W-Upgrade along with their EMT-B classes. Only one resort of the 7 near me requires OEC (they use a lot of NSP volly patrollers).

Ski patrol may be closer to SAR than urban EMS, but WEMT is a better match for SAR than OEC.

-----

I took an intensive EMT/WEMT class (went on about 220+ hours) to get certed. I've since taken two W upgrade classes to refresh my WEMT. I get no expanded scope, but I get great practice and knowledge and 32 hours of quality CEs.

 

[Mountain Res-Q]

OK my friend, don't take this the wrong way, but I'm not sure you really understand what WEMT involves. Either that or things are TAUGHT VERY different in CA.

The whole point of WEMT (and WFR) is to focus on improvised care, redneck medicine, considerations for extended extrication, and generally how you do things when the ER isn't 5 minutes away with a doc on the cellphone. Additionally, expedition care and management is often taught.

Reducing indirect locations, as you mentioned learning from that MD, of the shoulder, patella, and finger are all part of the WEMT/WFR curriculum.

Yes, the W card itself grants no legal superpowers in most areas, but a Wilderness Upgrade (or WFR) gives GREAT background to SAR providers.

Why on earth would you recommend OEC on top of EMT versus a WEMT upgrade class???

That just doesn't make any sense unless someone wants to do ski patrol at a resort that requires OEC.

OEC is behind the times and basically an EMT-light class with a outdoor (usually skiing) focus and no urban focus. OEC's CE is sad too. Our team treats it the same as First Responder. OEC in most places is extremely Ski Patrol oriented because the whole thing was invented and is maintained by... the NATIONAL SKI PATROL. It only exists instead of EMT because volunteer patrols use it because of the low CE burden and because NSP wants money. That is why they'll let any EMT-B challenge the OEC... as long as they pay NSP. OEC is less in depth than WEMT.

Ski patrol may be closer to SAR than urban EMS, but WEMT is a better match for SAR than OEC.

Summit, I think you misunderstood what I meant.

Sure, any EMS program that is focused on wilderness medicine will provide you with the ability to take the street EMS that can not just be translated over the wilderness setting and modify it so that you understand "improvised care, redneck medicine, considerations for extended extrication, and generally how you do things when the ER isn't 5 minutes away with a doc on the cellphone".

My point is that the cost of taking a class that teaches this isn't IMHO worth it in the long run. I have known many folks to get their WEMT, and they have no more ability than a street EMT, but they do know how to work in a setting that is, in my experience, more challenging, since you are on your own (without the ALS ambo, the helo, the trauma center, etc. within arms reach) and are forced to think outside the box. Thinking outside the box, or even learning those little extra things (like reductions) does not require spending all that money just to put a W before the EMT; especially since the W does not provide you with any real "power" beyond what the EMT does. Your "power" is found in the knowledge that can be gained elsewhere and the confidence to operate in that setting; a confidence that is not garunteed by spending $XXX on a wilderness cert that in no way is benificial outside the SAR setting (if it is really benificial in the SAR setting) and since the OP's question originally including ER Tech questions, it should be made clear that WEMT does NOTHING for you other than to be 4 extra letters on a resume; letters that mean nothing in urbania...

What I am advocating is the ability to modify what you know as a street EMT to operating in the wilderness setting; which is why I would say that OEC is worth it. OEC is not EMT or WEMT (although thoughts on this differ), but if you already have your EMT, OEC can offer something that is far more important than three new letters to add to your eyechart of certifications: knowledge about the realities of wilderness medicine. I am not interested in the certification or the extra letters, I am interested in the practicality of what I do and how I can do that best... and that W is just another letter that (in an imperfect system) does nothing to make me a better medical provider.

Yes, WEMT provides some new protocols and concepts as far as providing care that street EMSers are not forced to confront, but the real benifit of a wilderness cert is the ability to think outside the box. In this regard, OEC does offer a less expensive and a "as valuable" alternative to what can be a very expensive cert when you get your WEMT with some school. Like I said, I know plenty of WEMTs and OEC guys. (Meaningless) Protocols aside, I actually have more faith in the OEC (which is, I agree, basiclly WFR, at best) guys I know than the WEMTs, simply because OEC is normally attatched to ski patrol, a job that offers more chances for routine wilderness patient care than SAR does.

Either way you cut it, it is all still BLS... and in SAR I would rather have an OEC that has been doing Ski Patrol for 1 year and knows the reality of wilderness EMS than a Medic that has been doing street EMS for 30 years... It is a mentality that can be learned through a official pricey WEMT class or can be learned cheaper and more practicaly with the same end result. Sure the protocols and book learnig differ greatly between OEC and Medic... but ALS has little practicle place in the wilderness (in my experience) since wilderness medicine is largely BLS and if ALS is needed: EVAC ASAP! Although, there are times I could see the use for having EMT-IV or just Intermediate certification for those extra ALS capabilities, something that does not exist in my area (sadly).

Of course this is all my opinion based on my area and my experience...

 

[Summit]

Ah, your argument seems to be a lot about price and job experience, not course content.

If you are taking experience into hand, the cert has less to do with it than the job does. You prefer ski patrollers, not OECs specifically.

As far as price, here, you can get your WEMT upgrade course for about $100 from the community college. WFR is about $200. OEC is hard to find around me... I just checked 6 community college campuses in the CO mountains and for the last two semesters I found the following classes available:
1 OEC
5 WFR
2 WEMT upgrade
10 EMT

Keep in mind these are the schools that feed the ski resorts and SAR teams as well as having Outdoor Leadership programs to feed the various guiding services and camps. Only the volly patrols are specifically OEC. I think those professional patrols want the (slightly) deeper background and (slightly) higher standards of EMT-B and they'll teach the other skills in on-the-job-training.

 

[Mountain Res-Q]

Ah, your argument seems to be a lot about price and job experience, not course content.

If you are taking experience into hand, the cert has less to do with it than the job does. You prefer ski patrollers, not OECs specifically.

As far as price, here, you can get your WEMT upgrade course for about $100 from the community college. WFR is about $200. OEC is hard to find around me... I just checked 6 community college campuses in the CO mountains and for the last two semesters I found:
1 OEC
5 WFR
2 WEMT upgrade
10 EMT

Keep in mind these are the schools that feed the ski resorts and SAR teams as well as having Outdoor Leadership programs to feed the various guiding services and camps.

Like I said in that first post, you folks in CO would have a better regional idea than, I was just giving my thoughts based on my SAR experience, which is, without doubt, gonna be different from everyone elses, even within my state.

However, yes, cost does play a factor, but is not the motivation for my comments in of itself. Cost is only a factor for me when you combine it with the fact that, IMHO, the content of a WEMT course is not benifical enough to justify the cost. Obviously the content of the class is important information and ability to have (especially when it comes to dealing with the reality of wilderness medicine versus street). But, as I said before, that information is not the sole domain of a offical institution like NOLS, and can be learned elsewhere; for instance, in-house for SAR teams. On my team we have XX number of WEMTs, OEC, and others that have spent "too" much time as EMTs or Medics on SAR (not to mention that old time SAR Medic/FACEP) that are all capable of spending a SR Campout weekend orienting newbies to the realities of wilderness EMS... and we come free... LOL

As far as considering job and experience versus the cert: What jobs are out there for WEMTs and OEC outside ski patrol? Last time I check (and I am speaking locally of course) all the ski patrol groups require either OEC or EMT (occasionally I have seen WEMTs). So, the majority of Ski Patrollers are OEC. I know very few WEMTs that have experience outside SAR other than to say, "If my friend gets hurt when we are fishing or hunting, I know what to do." Hells Bells... so do I... without the W.

As far as cost goes, those numbers do not jive with what I have out here. The last person I knew to upgrade their EMT, spent $500 for the upgrade to W (not counting travel expenses since no one locally offers this). OEC, on the other hand, runs much cheaper and can be free if you are associated with a ski patrol group that organizes this. On top of that, remember that SAR is largely VOLUNTEER... which means NO MONEY... LOL... Now, I have no objection to spending money of my own if need be to support my obsession, but that much money is not justified in my "SAR reality" especially when it has no practical application outside SAR (and very little in SAR when you consider alternatives). However, OEC (on top of EMT) could/would be, especially if you spent winter working Ski Patrol part time and getting some money back, getting free ski time, and get some experience with wilderness medicine.

Dunno... maybe my reality differs from Colorado's (probably)... but if the OP is serious with medicine, why waste time/money with WEMT, instead of Medic, RN, PA, MD, or whatever. Especially, when i can not see any really HUGE benifit in WEMT over a street EMT with a apptitude for modifying his abilities for the wilderness, something that anyone interesting in SAR should already be inclined to do...

Like I said, I would take WEMT if it was local and cheeper, but just because I love class, especially Medical and or SAR related... but I do not feel as though anything of substance would be presented to me that would make me significatly better at what I do...

again.... IMHO... LOL

 

[rforsythe]

The latter, but you make it sound a lot worse than it is. The state EMS office is easy to deal with and not much of a headache if you have your NREMT. The only headache is getting a FBI background check if you don't qualify for a CBI only check.

Yep. Submit your CBI fingerprint card a month before your class finishes so they have time to get through it. Note that if you're not a state resident by their definition it will take longer and I think cost more, but those details are on their site. As long as you do this it's a quick process. I took my NR exam a few days out of class, got my NR # 2 days after that, and was at CDPHE handing in the app the next day (you only need the NR # for it, not the actual card). I was completely credentialed as a Colorado EMT in less than two weeks after completing my class, including the time to take the National. If you're on it you can do it quickly.

And by the way, HealthONE is awesome. I went through their program at the main campus, but I'm sure the one at North Sub. is just as good. I had a few friends go through at Front Range too, and work with a few of their instructors. They're pretty darn good.

Same here, at the main campus. Great program! I've heard good things about the North one too.

 

[BossyCow]

One of the biggest areas where wilderness EMS differs from street EMS, besides the thermoregulation mentioned in a previous posts is recognition of signs of infection. In urban EMS settings, our bandages need to stay in place while the pt is lying on a cot for the time it takes to transport to the local ED. In a wilderness setting, with a two day or more pack out, other factors are working fer ya and agin ya.

We have a totally different baseline for what constitutes 'ambulatory', the pt will walk as much as possible. Triage is very different when it includes looking at maps for the closest LZ and factoring in who's going to carry the pt that far up that hillside.

Wilderness injuries are dirty! Urban EMS doesn't generally have to worry about a small injury developing into a raging infection during transport.

But, I believe that a good solid EMT class followed by the WFR upgrade is going to suit pretty much everybody dealing with backcountry injuries. And I agree about the pricyness of some of the programs being more about how important they feel they are than in the integrity of the program.

 

[Mountain Res-Q]

Wilderness injuries are dirty! Urban EMS doesn't generally have to worry about a small injury developing into a raging infection during transport.

On the other hand... even in a wilderness setting, if a wound is washed simply with water, your chances of developing an infection is far less than your chances of developing an infection in the "controlled" setting of a hospital. IMHO, dirt from my woods is cleaner than a counter at a hospital... Think about it... when in the woods how often do you wash your hands before reaching for the trail mix? "Woods" dirty don't bother me... Touch a patient (or a nurse, lol) in a hospital and I want AJAX before i touch food... But, yes... IMHO, wilderness medicine comes down to these things:

Learning to improvise

Become very fluent in regards to thermogregulation

Know how to deal with wounds and fractures without having an ambulance strapped to your back... ^_^

 

[Seaglass]

On the other hand... even in a wilderness setting, if a wound is washed simply with water, your chances of developing an infection is far less than your chances of developing an infection in the "controlled" setting of a hospital. IMHO, dirt from my woods is cleaner than a counter at a hospital... Think about it... when in the woods how often do you wash your hands before reaching for the trail mix? "Woods" dirty don't bother me... Touch a patient (or a nurse, lol) in a hospital and I want AJAX before i touch food...

I'm not a wilderness provider, but doesn't infection risk really vary by local environment? I'd be less inclined to worry about some of that sandy Sierra dirt getting in a cut than I would about swamp gunk...