Wilderness Emergency Medical Technician

Wilderness Emergency Medical Technician, or WEMT, is the second highest level of wilderness emergency medical training available in the USA (second to Wilderness Advanced Life Support (WALS)), or other courses for advanced providers such as AWLS, and RMAP (Remote Medicine for Advanced Providers). In addition to an urban EMT-Basic course, WEMT places a greater emphasis on long term patient care in the backcountry where conventional hospital care can take days to reach. Some of the main providers of Wilderness EMT training in the United States include Wilderness Medical Associates (WMA), NOLS' Wilderness Medicine Institute, SOLO, and Remote Medical International.

History
Near the end of the 19th century, volunteer organizations such as St. John Ambulance began teaching the principles of first aid at mining sites and near large railway centers. By the dawn of the 20th century, additional organizations such as the Boy Scouts and the American Red Cross began teaching first aid to lay people. Over the years, these organizations trained hundreds of thousands of people in the elements of providing assistance until definitive care could be arranged. The training in these courses assumed that definitive care was nearby and could be delivered quickly. Eventually there was a realization that this training, while valuable, needed to be supplemented and/or revised to deal with the extended time and limited resources inherent when a medical crisis occurs in a wilderness setting. In the 1950's organizations such as The Mountaineers began developing training programs that addressed these special needs. In 1966, the US Government, through the National Traffic and Motor Vehicle Safety Act, gave the Department of Transportation (DOT) reponsibility for creating a national Emergency management System (EMS). From this program came the standarized curriculum for the position of Emergency Medical Technician (EMT). The first Wilderness EMT course was taught in 1976 to help EMTs in Colorado adapt their skills and knowledge when working with Search and Rescue teams. By 1977 organizations such as Stonehearth Open Learning Opportunities (SOLO) and Wilderness Medical Associates were offering specialized Wilderness First Aid training to their instructors. Meanwhile the DOT EMS program recognized a need to develop standardized training for "first responders" such as truck drivers, policemen and fireman who could lend assistance during the initial part of "golden hour" until an ambulance with an EMT arrived. In 1984 SOLO developed and taught the first Wilderness First Responder course. The purpose of creating the course was to provide Rangers, outdoor leaders, and guides the necessary knowledge to provide care in crisis situations in the wilderness. In 1985, SOLO began providing WFR training to Outward Bound instructors in Florida. Today WFR certification is frequently a pre-requisite for professional positions that involve work in the outdoors. The largest providers of this training today are SOLO, Wilderness Medicine Institute (WMI) - affliated with NOLS, Wilderness Medical Associates (WMA) - frequently associated with Outward Bound, and Remote Medical International.

Training
WEMT training is not standardized and varies by state and school but typically involves around 50 hours of wilderness medicine training in addition to traditional EMT-B certification. All WEMTs have valid National Registry EMT or state certified EMTs before joining a course, unless the course also incorporates the urban Emergency Medical Technician curriculum. Most schools also allow for other health care professionals, such as RNs, MDs, or Paramedics, to become wilderness certified, but the curriculum is the same. Often a student will have to travel a long distance to attend a WEMT class, and as a result, most WEMT classes involve taking classes 8-10 hours per day for one or more weeks (depending on whether the student is already an EMT).

There is a strong focus on rendering aid with improvised means (for instance, using a branch and some rope to splint an injured extremity rather than using commercially available splinting devices). In wilderness settings it is unlikely that the specialized equipment found in an ambulance will be available, so the focus is on using only what is at hand in your assessment and care for a patient. There is also a greater focus on long-term care, since a WEMT may have to be with a patient for many hours, while most urban EMTs are with each patient for no more than an hour (at the most).

Providing care in the wild can be a daunting task, since the golden hour is usually out of the question, and one may have to treat or stabilize a critical patient for hours until help arrives or you can get them the care they need. Backcountry medicine often speaks of the golden day -- a patient's survival chances for critical injuries drastically drop off around 24 hours without hospital care.

WEMT's can perform all of the Wilderness First Responder Skills in addition to more advanced interventions, such as traction on a fractured femur, or assisting patients with their prescribed medications.

WEMTs also are allowed some acts outside the scope of practice of conventional EMTs, such as stopping CPR after all efforts have been exhausted.