Words and photos by Meghann Gunther, MTI Contributor
I graduated from a Wilderness Emergency Medical Technician class through Aerie Backcountry Medicine in Montana. This intensive, 3-month course was challenging and rewarding.
Instructors Matter
Our class had two incredible instructors who invested in us. The lead instructor spent a significant amount of time in the military and as a Paramedic and instructor. As a brand new student in EMS, his experience and knowledge were invaluable to me. Additionally, his assistant instructor brought in a solid foundation as an EMS provider, Ski Patrol, overseas student, and instructor. While the basics of EMT school are almost the same wherever you go, in my experience it’s the instructors who have the power to influence what kind of provider you can be when you graduate.
At first I struggled with the teaching style that our lead instructor brought into class. It seemed overly stern and it was intimidating! It felt like I got barked at when I made mistakes. During hands on skills, I was put on the spot to explain why I was doing something. It was a rough start for me. A week or so into school, I realized it was me who had the wrong attitude about it. As I got to know the instructors a little better, I saw how much they cared about us and our training.
It turned out that the teaching style was exactly what I needed. I was being challenged to be the very best student and EMT in training possible. Our instructors cared about keeping the high standard of training held by Aerie Backcountry Medicine and for that, I am very grateful. Our whole class graduated and passed our National Registry test on the first go around. A lot of that is owed to the dedication and teaching of our incredible instructors.
Most important, the instructors ensured we got our BLS (Basic Life Support) skills dialed in. We trained and studied to become very proficient in those skills. We built a solid foundation. This was very important to them because basics save lives, and it became very important to me as well. There are many incredible tools in the EMS world to help support providers’ care for people, but in rural settings, like the wilderness, I learned that those basic life saving skills may be the only thing you can do and to do them well is my duty as a provider.
Training Environments Matter
Although we had a lot of classroom time, we also ran through hands-on training scenarios around the college building we were in and outside on the surrounding grounds. Our scenarios were urban-based and sometimes outside “actors”, (usually former students) would come in and be our patients. It was helpful to me to have patients who were complete strangers, as it was realistic to what I would face in the real world. I had started to have a sense of comfort when I was doing my hands-on skills on a fellow student and that was a detriment to me in training.
On the weekends, we trained in wilderness areas in the Bitterroot corridor of Montana. Sun, rain or snow we trained. Our instructors set up a variety of scenarios from animal attack victims to lost and wounded hikers to group casualties and long term patient care. We dealt with bear and moose and hunter scenarios gone wrong. Warming fires were built and we macgyvered things we needed, learning how much the environment can mess up your plans. I “ordered” resources for patients and they got “canceled” due to weather. The training was dynamic and challenging and forced our class to work as a team and think for ourselves. I found great value in training outside the classroom because it forced me to take into account the environment for myself, our team and our patients, which cannot be underestimated in Montana during the winter. When all I had was my medical bag, my partner, and a patient in the woods who was more than an hour from advanced life support, it challenged me to put skills and knowledge together more efficiently.
At the end of our schooling, our class was handed our biggest training challenge. We had just spent all day Saturday training and we were told to expect to stay out all night. No other information was provided. Our scenario unfolded a couple hours later. Here I learned how little information you may have when responding to an incident, but I also learned how to take action with what I had and to continue to seek out information moving forward.
As a team, our class was tasked to respond to a mass casualty incident, a plane crash in the woods. Our instructors gave very little information and almost zero feedback and for the most part didn’t answer our questions. They observed. Before our class got a structure established, it was chaotic. Not knowing how many patients we had, we first submitted a request for a flight roster. Then we started gridding the woods in pairs looking for patients. Soon, teams were finding walking wounded. We set up an IC post and figured out a command structure. Our instructors had prepared us well; we just had to put it all together without their guidance. All night we found patients, provided care, and brought them to IC.
We made mistakes, like talking about missing patients in front of our other patients who promptly went into hysterics about their missing friends. We didn’t communicate over the radios clearly. I let a TBI patient start to wander away down the road in the dark. After that, I had another EMT babysit the patient at the IC because they showed a pattern of wanting to wander off on their own.
One team had to perform CPR on an infant patient with the “mother” present. The infant wasn’t revived. Even though it was a fake baby in a training scenario, it was very sobering to be a part of. I learned how long mass casualty events can take. Finding patients, providing care, and then moving them takes a lot of manpower and a lot of time.
Several hours in, I realized I hadn’t eaten or had any water. After hiking several miles in the dark with a pack, it was a lesson to make sure that I was fueled to perform my duty instead of becoming a liability for my team. A frustrating lesson for me that night was situational awareness. I walked right by a “patient” several times in the dark – a training dummy who had been carried off the plane wreck by a bear and was under some brush. This patient had injuries not compatible with life due to the animal attack. It taught me that sometimes what you’re searching so hard for might be right under your nose.
I was so focused on all the other things going on that I didn’t look at my feet, literally just yards away from IC post, to finally find and account for my last patient.
On the other hand, there were things we did well, including setting up our own Incident Command Post. Our two person teams worked well with each other and we also assisted each other as teams as needed for patients. Everyone stayed strong through a long night and kept tabs on how the others were doing mentally and physically. Gridding was communicated to make sure we were covering all the ground we could looking for patients during the night. We finished our mission at 4am the next day and debriefed. I walked away with many other lessons learned from that night.
Continuing Education Matters
Our instructors gave us many great resources to continue our education in EMS and encouraged us to continue to be students of our trade. These included podcasts, medical societies, conferences, books and online training. They both have made themselves available for my questions even after finishing class and relocating to another state. It is clear to me that they both valued staying current with the ever-changing world of emergency medicine.
Learning from other providers has been a big lesson for me. Asking questions, listening, and working with other EMT’s has grown my knowledge and experience. Ride-alongs with fire departments, law enforcement, and ambulances is another way I have learned to stay engaged as I continue to learn. I prioritize being a part of as many hands-on training scenarios as possible every year in both urban and wilderness settings.
Recently, one such training opportunity took place for me in Idaho at the Ski and Mountain Trauma conference, where I participated with a group in a mass shooting simulation with the Idaho National Guard. First, we went over Tactical Combat Casualty Care in a classroom. Then they blindfolded us, and we were led outside and forced to listen to an audio recording of shooting and screaming. After they cleared the “threat,” we went in. There was no predetermined structure. Each provider went in independently to simulate a real-world response of off-duty individuals responding in an urban setting. Bleeding, screaming patients were scattered among vehicles and bystanders were yelling at us to do something. We had to find medical supplies. My adrenaline skyrocketed.
After we finished the mission, we did an AAR on what we could have done better, which was the most valuable part for me. One lesson was not to wear white shoes around simulated blood anymore. My mistake. Another issue was the lack of communication and uniformity among providers. We all ran around doing our own thing, trying to take care of our own patients. Several of us, myself included, went running in search of medical supplies, and it was not clear to all providers when medical supplies were available on the scene.
We should have created an IC post, identified an IC, brought our patients to one central location, and worked together to be efficient. The training showed me that my trauma skills were good but that I need to work on my leadership, command, and communication skills.
My journey in EMS has just begun and I look forward to building knowledge and experience. W-EMT school with Aerie Backcountry Medicine gave me a solid foundation, a good provider mindset, and a clear path, and I can’t wait to continue moving forward.
Meghann is a full time Wildland Firefighter in California.