Emergency medical services (EMS), also known as ambulance services or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to definitive care. They may also be known as a first aid squad, FAST squad, emergency squad, ambulance squad, ambulance corps, life squad or by other initialisms such as EMAS or EMARS.
An emergency medical technician (EMT), also known as an ambulance technician, is a health professional that provides emergency medical services. EMTs are most commonly found working in ambulances. In English-speaking countries, paramedics are a separate profession that has additional educational requirements, qualifications, and scope of practice.
NOLS is a non-profit outdoor education school based in the United States dedicated to teaching environmental ethics, technical outdoor skills, wilderness medicine, risk management and judgment, and leadership on extended wilderness expeditions and in traditional classrooms. It was previously known as the National Outdoor Leadership School, but in 2015, this label was retired in favor of the independonym "NOLS". The "NOLS" mission is to be the leading source and teacher of wilderness skills and leadership that serve people and the environment. NOLS runs courses on six continents, with courses in a variety of wilderness environments and for almost any age group.
A certified first responder is a person who has completed a course and received certification in providing pre-hospital care for medical emergencies. Certified individuals should have received much more instruction than someone who is trained in basic first aid and cardiopulmonary resuscitation (CPR) but they are not necessarily a substitute for more advanced emergency medical care rendered by emergency medical technicians (EMTs) and paramedics. First responders typically provide advanced first aid level care, CPR, and automated external defibrillator (AED) usage. The term "certified first responder" is not to be confused with "first responder", which is a generic term referring to the first medically trained responder to arrive on scene and medically trained telecommunication operators who provide pre-arrival medical instructions as trained Emergency Medical Dispatchers (EMD). Many police officers and firefighters are required to receive training as certified first responders. Advanced medical care is typically provided by EMS, although some police officers and firefighters also train to become emergency medical technicians or paramedics.
Wilderness medicine is defined by difficult patient access, limited equipment, and environmental extremes. Today, wilderness or expedition medicine is practiced by Wilderness First Responders, Wilderness EMTs, Remote/Offshore/Wilderness Paramedics and Physicians on expeditions, in outdoor education, search and rescue, mountain rescue, remote area operations including research, exploration, and offshore oil platforms, as well as tactical environments. In mainland Europe, where mountain rescue is done by paid professionals, there are courses for physicians that help qualify them to be mountain rescue or expedition doctors. Many of these courses lead to an International Diploma in Mountain Medicine, which is recognized by the Union Internationale des Associations Alpinistes.
Wilderness Emergency Medical Technician (WEMT) is an emergency medical technician that is better equipped than other licensed healthcare providers, who typically function almost exclusively in urban environments, to better stabilize, assess, treat, and protect patients in remote and austere environments until definitive medical care is reached. Despite the term, WEMT training is available and geared not just to the EMT, but also the paramedic, prehospital registered nurse, registered nurse, physician assistant, and medical doctor. After all, without an understanding of the applicable gear, skills, and knowledge needed to best function in wilderness environments, including a fundamental understanding of the related medical issues more commonly faced, even an advanced provider may often become little more than a first responder when called upon in such an emergency. WEMT training and certification is similar in scope to wilderness advanced life support (WALS) or other courses for advanced providers such as AWLS, WUMP, WMPP, and RMAP. Unlike more conventional emergency medicine training, wilderness emergency medicine places a greater emphasis on long-term patient care in the backcountry where conventional hospital care can be many hours, even days, away to reach.
In the United States, emergency medical services (EMS) provide out-of-hospital acute medical care and/or transport to definitive care for those in need. They are regulated at the most basic level by the National Highway Traffic Safety Administration, which sets the minimum standards that all states' EMS providers must meet, and regulated more strictly by individual state governments, which often require higher standards from the services they oversee.
Stonehearth Open Learning Opportunities (SOLO) is the oldest continuously operating school of wilderness medicine in the world. SOLO is one of the originators of today's Wilderness First Responder (WFR) and Wilderness Emergency Medical Technician (WEMT) programs. SOLO is accredited by the University of New Hampshire's Lifelong Learning program. In 2004 it provided first aid training to the cast and crew of PBS' Colonial House program, and a number of colleges and universities across the United States recognize its courses for credit. SOLO also trains advanced providers in disaster recovery medicine and extended remote care through its GEOMEDIC course.
The National Registry of Emergency Medical Technicians is a US certification agency covering prehospital medical providers.
Advanced emergency medical technicians (AEMT) are providers of prehospital emergency medical services in the United States. A transition to this level of training from the emergency medical technician-intermediate (EMT-I), which have somewhat less training, began in 2013 and has been implemented by most states at this point. The AEMT is not intended to deliver definitive medical care in most cases, but rather to augment prehospital critical care and provide rapid on-scene treatment. AEMTs are most usually employed in ambulance services, working in conjunction with EMTs and paramedics, however are also commonly found in fire departments and law enforcement agencies as non-transporting first responders. Ambulances operating at the AEMT level of care are commonplace in rural areas, and occasionally found in larger cities as part of a tiered-response system, but are overall much less common than EMT- and paramedic-level ambulances. The AEMT provides a low-cost, high-benefit option to provide advanced-level care when the paramedic level of care is not feasible. The AEMT is authorized to provide limited advanced life support, which is beyond the scope of an EMT.
In the United States, the licensing of prehospital emergency medical providers (EMTs) and oversight of emergency medical services are governed at the state level. Each state is free to add or subtract levels as each state sees fit. Therefore, due to differing needs and system development paths, the levels, education requirements, and scope of practice of prehospital providers varies from state to state. Even though primary management and regulation of prehospital providers is at the state level, the federal government does have a model scope of practice including minimum skills for EMRs, EMTs, Advanced EMTs and Paramedics set through the National Highway Traffic Safety Administration (NHTSA).
Emergency medical responders are people who are specially trained to provide out-of-hospital care in medical emergencies. There are many different types of emergency medical responders, each with different levels of training, ranging from first aid and basic life support. Emergency medical responders have a very limited scope of practice and have the least amount of comprehensive education, clinical experience or clinical skills of emergency medical services (EMS) personnel. The EMR program is not intended to replace the roles of emergency medical technicians or paramedics and their wide range of specialties. Emergency medical responders typically assist in rural regions providing basic life support where pre-hospital health professionals are not available due to limited resources or infrastructure.
The Wilderness Medical Society was created on 15 February 1983 by three physicians from California, United States — Dr. Paul Auerbach, Dr. Ed Geehr, and Dr. Ken Kizer. It is the largest international non-profit membership organization devoted to addressing wilderness medicine challenges, more specifically defined as "medical care delivered in those areas where fixed or transient geographic challenges reduce availability of, or alter requirements for, medical or patient movement resources". It also publishes Wilderness & Environmental Medicine Journal, Wilderness Medicine Magazine, and Wilderness Medicine Clinical Practice Guidelines.
A wilderness medical emergency is a medical emergency that takes place in a wilderness or remote setting affinitive care. Such an emergency can require specialized skills, treatment techniques, and knowledge in order to manage the patient for an extended period of time before and during evacuation.
Wilderness medicine is a rapidly evolving field and is of increasing importance as more people engage in hiking, climbing, kayaking, and other potentially hazardous activities in the backcountry. The modern definition of wilderness medicine is "medical care delivered in those areas where fixed or transient geographic challenges reduce availability of, or alter requirements for, medical or patient movement resources". A primary focus of the field is the evaluation, prioritization (triage), preliminary treatment of acute injuries or illnesses which occur in those environments and the emergency evacuation of victims. However, back country rescue and wilderness first aid is not the sole activity of wilderness medical professionals, who are also concerned with many additional topics. These include but are not limited to:
Wilderness first aid as an established medical discipline is a relatively new phenomenon compared to the more established field of prehospital emergency medicine. While instructional guidelines for curriculum for prehospital emergency medical care have been standardized by the U.S. federal government, there are no current federal regulations defining scopes of practice for varying levels of wilderness medicine.
Seth Christopher Collings Hawkins is an American emergency physician, writer, anthropologist, and organizational innovator. He has made notable contributions to the fields of wilderness medicine, Emergency Medical Services (EMS), and medical humanities. His work has particularly specialized in EMS and wilderness medicine in the southeastern United States, where he is the founder of the Appalachian Center for Wilderness Medicine, the Appalachian Mountain Rescue Team, and the Carolina Wilderness EMS Externship.
William 'Will' R. Smith, is an emergency physician and wilderness medicine consultant who lectures about integrating combat medicine into wilderness rescues around the world. He started Wilderness & Emergency Medicine Consulting, a company that helps people with pre-trip planning, online medical support, travel medicine in remote areas and provides expert witness testimony in court cases related to wilderness medicine. As medical director for the National Park Service, he oversaw the largest rescue event ever to occur in Grand Teton National Park. He lives in Jackson, Wyoming where he is an emergency medicine physician at St. John’s Medical Center.
The Carolina Wilderness EMS Externship (CWEMSE) is an out-of-hospital medical training for 4th year medical students and resident physicians interested in furthering their educational interests in wilderness EMS.
