Woofing in the Woods
Training as a rescue medical professional
In my outdoor adventures, I have seen the need for lifesaving intervention more than a few times, having someone available with medical training is indeed essential.
I recently wrote about volunteering at my local sheriff’s Search and Rescue team. My specialties include “rescue medical professional”, which requires me to obtain certain credentials. Specifically, Oregon regulations defining scope of practice mandate that all medical emergency providers (EMS) be licensed.
I let my certifications expire, and the last time I was in a first responder class was some 25 years ago. So it was time to seek formal training again. But where should I start, EMT school?
Looking at how an Emergency Medical Responder (EMS) is defined by DOT/NHSTA we can see that its primary focus is urban environments. Auto accidents, heart attacks, and respiratory distress top the list of incidents.
The mission parameters of a Search and Rescue medical provider, on the other hand, aren’t quite the same as what an EMT might experience in an ambulance or fire department. Fractures, sprains, and hypothermia are much more commonplace, and the SAR patient is typically found in a remote or challenging location. The provider must first reach them before any lifesaving treatment, and then figure out a way to package and evacuate the patient to better care.
So the medical training I am seeking needs to be appropriate for Search and Rescue and hopefully, it won’t require me to go back to academia. Fortunately, there are a few excellent options available.
Wilderness First Responder
Wilderness First Responder (WFR) is the preferred certification for rangers, climbing instructors, guides, and other outdoor professionals. While similar to what an Emergency Medical Responder (EMR) would study, the training is more focused on the wilderness context. The WFR patient is usually found more than 3 hours away from a hospital or doctor’s office, and the rescuer doesn’t have the luxury of an ambulance to carry equipment around.
There are a number of organizations offering accredited WFR courses. The average course involves around 80 hours of training. But Since this wasn’t my first rodeo, ( I have done this a few times before), I opted to take the Hybrid WFR course from the National Outdoor Leadership School (NOLS).
The hybrid course included three online modules and five days of in-person training.
According to the NOLS website, the online module should require 10-15 hours each. I found though, that because of my past experience and SAR training, I was able to complete the online portion in a day and pass all the assessments with flying colors.
The in-person class took place a couple of weeks later and consisted of four intense 10 to 12-hour days of training followed by a half-day of testing. The classwork was no joke. There was an abundance of material to review in which we were required to demonstrate competence. As an added benefit, since my class occurred during the winter months, we enjoyed working on rescue scenarios and mass-casualty simulations in the brisk Oregon evening air.
We were drilled in how to properly assess a situation, and improvise a treatment for the patient given whatever limited resources we had. Further, we had to document and communicate each event in a SOAP note format.
All in all, I thought the instructors from NOLS were outstanding and did an excellent job teaching the class. There was a lot to cover, and while I would have personally liked to have seen more time on traumatic wound management and hypothermia, NOLS was prioritizing the material based on the incidents its students see.
The only downside, and it’s my personal (OK boomer) opinion, so ignore me if you wish, is that NOLS, like so much of the outdoor industry, has been infected with the ideological tenants of wokeism. I would have preferred they stick to the topic and avoid injecting “men can get pregnant” politics in the text.
Bridging to EMR
While the WFR course has enough material to cover a lot of what a SAR rescuer is likely to experience, the WFR credential is not recognized by the Oregon Health Authority, (and as it turns out several Federal agencies) as an emergency medical provider. There are a number of hoops you will have to jump through before obtaining the proper licenses and credentials.
You will still need to complete an EMR bridge course, and fortunately, NOLS provides one as an add-on to WFR. The big caveat here is after receiving or recertifying your WFR credential you have only 12 months to complete the entire bridge process. This process consists of not only taking the bridge course but also passing the EMR test with the National Registry of Emergency Medical Technicians (NREMT).
The NOLS bridge course is composed of an online series of videos and quizzes. The topics covered include:
Extrication, Special Rescue, Hazmat
You must also obtain a Professional level CPR card on your own. The NOLS CPR Certification does not fulfill this requirement. But the American Heart Association Basic Life Support (BLS) or American Red Cross CPR for Healthcare Providers are both acceptable.
Keep a copy of the AHA Guidelines for CPR around, you will need to know this material.
After you have completed the bridge course with NOLS, you need to also create an account with NREMT and apply for EMR certification. NOLS will give you the details of how to fill out that form and convey to NREMT that you have completed the bridge class.
A few days later, NREMT will present you with an Authorization To Test (ATT) letter. The ATT allows you to schedule a cognitive examination with the folks at Pearson VUE. The process is detailed in the candidate workbook.
The National Registry Test
While there is a lot of buzz about the NREMT cognitive examination what it really boils down to is that you schedule an exam at a Pearson VUE location, where you sign in, demonstrate that you have no hidden cheat materials, and you answer a bunch of multiple-choice questions on their computer.
Note that the NREMT Cognitive test is no cakewalk. There is a lot of material that you are responsible to know, much of which was not really covered in WFR or the bridge course. A list of skills you are expected to know can be found in NCCP EMR Guide.
Airway, Respiration & Ventilation
Cardiology & Resuscitation
But a lot of the questions are very specific to urban EMS. For example, here are a couple of questions about EMS operations from a popular test training site:
So how do I study for this?
In the past, I was able to take the 56-hour Red Cross EMR class, based on the Red Cross EMR Textbook (which is available online and in print). I couldn’t find any, and suspect COVID killed that business, although Oregon Health Authority has a pointer to a few training agencies.
The good news is that there are a number of online resources available.
There are a few sample quiz sites, like EMT national training and Pocket Prep. I think they are useful to get you an idea of what a test looks like, but I would emphasize understanding the technical material and not just memorizing quiz answers.
The other Youtube resource I found useful was the Institute of Human Anatomy. I found it very indispensable when it came to undertanding the details of how all the parts work. And yeah, they are using real cadavers.
There are a few other documents you should review before the exam, at a minimum, you should download the DOT Emergency Response Guidebook and make note of the placard numbers and colors.
Your first test try cost is covered by the NREMT application. If you don’t pass you have three tries before having to start the bridge process again. This is all detailed in the candidate workbook.
OK, I passed, now what?
Congratulation. If you live in Oregon you have the privilege of coughing up an additional $45.00 to the Oregon Health Authority for your license and an additional $58.75 to be fingerprinted by FieldPrint.
The Oregon EMR license and National Registry certification can be refreshed by obtaining “Continuing Education” (CE) credits spread out over time. These CE credits can often be obtained locally for no or very low cost, possibly even some SAR Medical Team training. There are also a bunch of great resources at the Wilderness Medical Society
Here is a list of costs I incurred on my WFR/EMR journey, excluding travel and lodging for the WFR course. Your mileage may vary.