WFR vs WEMT (Wilderness First Responder vs Wilderness EMT) for search and rescue

note: There’s a follow up post to this, as well. 

As I study my WEMT material, I’m pondering the differences between the two courses thus far. Currently a WFR, I’m headed up to Alaska in the fall for a multi-week WEMT course. Sleeping in a bunkhouse with my other classmates, on a somewhat remote Alaskan island (population 741), I’ll have 8am-8pm class 6 days a week, in addition to the months of material I’ve had to go over in advance (doing it now) and the WFR I needed just to register.

I started writing a whole primer on the various levels of wilderness medicine but I deleted it all as the topic is huge. Instead, I’ll try something new and focus on the title: WFR vs WEMT, specifically for search and rescue folks.

Coming in with roughly ~100 hours of training is the Wilderness First Responder, or WFR, pronounced “woof-er”. This swiss army knife of wilderness medical response is the expected level of quality sar team members and outdoor guides need.

• Laser beam focused on the task and environment. You’ll learn nothing about ambulance gear because hey: there’s no ambulances in the wilderness.
• While still a multi-week time commitment it’s possible for most normal people to figure out a way to pay for it and take the time off.
• Available in a lot of parts of the world.
• Fairly uncomplicated focus on critical system stability. Identify and treat the things that are field manageable, identify and prioritize transport for the things that need higher levels of care.
• By being able to dismiss the urban setting and ambulance (or better) equipment, things get simple pretty fast.
• You are not operating under an agency’s medical direction so your protocols (reducing dislocations, clearing spines, administering epinephrine, stopping CPR, and declaring dead people dead) is actually much more than an EMT would be able to do provided you’re in a wilderness context (typically defined as two or more hours from definitive care).

Coming in with roughly ~200 hours of training (tack on another 100 for the WFR you generally need to take the course) is the funky WEMT or EMT+W. It’s basically an EMT+B with special focus given to non-ambulance gear and prolonged care and life support in an austere environment.

• You can have way more patient exposure if you want it. As an EMT-B you can be treated like shit and underpaid riding around in ambulances with horrible working hours. But hey, it’s work and more importantly it’s experience.
• On a SAR team you’ll probably be the, or at least one of, the primary medical providers as WEMT is a rare designator that few people trot around with. Again, experience.
• You can expand your reach by riding ambulances, joining (typically smaller) fire agencies, and even working in hospitals or at a local physician’s office.
• With all that experience, you can move towards being a paramedic (EMT-P) if that suits you and you have the time/money.
• You’ll understand more of what’s going on with your patients at a physiological level and have a broader understanding of chronic and acute disease.

The real benefits for WEMT comes down to experience and advancement. Working as an EMT-B sucks for most people. You’ll make roughly $12/hour, which is what I currently pay my babysitter and she sits around watching Netflix not dealing with death around the clock. Even paramedics make roughly $17/hour, and that’s after spending $10,000 – $20,000 to go to paramedic school and after having worked as an EMT making peanuts long enough to get the experience to even apply to paramedic school.

All that being said, your ability to gain experience and advancement as a WFR is basically zero, strictly from a medical perspective. You’ll be limited to the patient contact you have in SAR which can be pretty thin. Also, you’re hogging it and not letting others on your team drink from the firehose that is the primary medical provider role.

It was explained to me when I got my USCG Captain’s License: this means you can do the job, you don’t get good at it until you’ve done it a lot. When you first get your driver’s license you’re a terrible driver. It’s the years of driving experience on top of the license that make you decent. The same goes with all skills including medicine.

Captains with a license but not a lot of time running commercial ships are referred to as “paper captains” on the waterfront: it’s not a term of endearment. Whether it’s driving a car, flying a kite, or diagnosing hypovolemia you are better at it the more you do it.

Search and rescue is basically an all volunteer system, as it always has been. Going back to 1000AD, search and rescue is a side gig. And in a big way, that’s what makes it so great. Everyone is taking time away from their families, taking time off work, and prioritizing helping others. I heard a joke the other day that to get into sar you need to take the psychological test, and fail it. Getting a chance to work with these outstanding people is a privilege. And of course it is a privilege and not a right to treat a patient when they are in one of the scariest moments of their life.

Everyone in sar needs to make the decisions for themselves as to how far “good enough” is. Perhaps because I’m a bad climber, middle of the road tracker, and crummy mountaineer I think my medical skills are where I can do the most good. It’s not lost on me that my own daughter’s life was saved by a sar team’s medical chops.

If you’re a WFR and keep your skills sharp, I’ll work with you anytime. I’ve seen firsthand a WFR keep someone alive for hours in a jacked up situation before evacuation could occur. If you’re a WFR and want to get more time with patients and perhaps go onto other aspects of medicine short of nursing or doctoring, consider the WEMT route.