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

[Outdoornut]

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/wild...903/index.html

[mycrofft]

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

[AVPU]

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]

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.

[Outdoornut]

Originally Posted by AVPU

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]

Originally Posted by Outdoornut

(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- (starts humming the twilight zone theme)

[Outdoornut]

Originally Posted by Trayos

And just last week I took the bandages off- (starts humming the twilight zone theme)

creepy...car door??

[Trayos]

No, stuck by a piece of metal though

[EMSLaw]

Originally Posted by Outdoornut

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]

Originally Posted by EMSLaw

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?