Depending upon the Wilderness 1st aid/EMT/EMT-ALS program you take, there may be a different emphasis on both the improvising of equipment/supplies as well as performing various skills that would not normally be practiced in an urban setting. Some examples of equipment improvisation might include using a SAM splint for a C-collar, not only the idea of using it for that purpose, but also learning how to bend and configure it to provide the correct support and fit. For ALS the use of a self-contained finger pulse ox, which might not be FDA approved. The use of a digital outdoor thermometer (the kind with a metal probe on a wire, where the meter portion is normally kept indoors), which can be used for taking continuous rectal temperatures for hypothermic patients. The probe is pre-coated and cured with silicone sealer to prevent soft-tissue injury. In-the-field reductions of dislocations. Splinting/taping methods that will allow the patient to continue to use the affected limb, so they can continue to travel. The use of I.V. antibiotics and other medications for long term management of trauma patients in areas such as caves, where removal of the patient can take days/weeks. Many states have Wilderness protocols in place, which the individual jurisdictions can implement at the discretion of the Medical Director. Generally, individuals who have only Wilderness EMT/EMT-ALS training without state level EMT/EMT-P certification/licensing cannot implement those skills and still be protected by law. Exceptions to this may occur on federal lands, such as National Parks, where the rangers may have WEMT and can implement those skills to which they have been instructed. Pete
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