From the Department of Emergency Medicine (Change LP, Wang TL), Shin-Kong Wu Ho-Su Memorial Hospital

Correspondence to Dr. Tzogn-Luen Wang, Department of Emergency Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, 95 Wen Chang Road, Taipei, Taiwan. E-mail M002183@ms.skh.org.tw

Wilderness medicine is the term commonly used in extending the topics commonly taught in first aid, first responder, and emergency medical technician programs.^1-18 Wilderness medicine usually presumes that the ambulance or air ambulance is hours to days from arriving in the context of emergencies. The usual scenarios may be that the injury occurs on a backcountry trail, someone may well have to walk out to summon help, or the patient may have to be laboriously carried out.
Wilderness medicine also includes injury from extreme environment such as cold, heat,^3,4 or high altitude;^5-18 the effects of toxic plants and animals, and the types of injuries that may be experienced from the stresses of outdoor living.
The so-called “Wilderness Emergency Medical Technician (WEMT)” training should include the standard EMT material plus wilderness search and rescue in the environment.¹⁹ There are currently no standard training program for WEMT as yet, except a few sporadic courses developed by some organizations in Taiwan. Although there are sine common lessons, the section of “wilderness medicine” are still developed solely by the individual organizations and country. So it is urgent for us to design the protocol of wilderness medicine including the basics of rescue, long-term care techniques and transport in backcountry settings.

The WEMT's roles include educating other search and rescue team members in wilderness prehospital care, providing medical support during a search, serving in the medical position on a search team to care for wilderness patient during a rescue.
The WEMTs provide care for the patient carrying only simple medical kit initially, and always need additional materials if continued medical care to victim during the evacuation is indicated. During the evacuation, the WEMT acts as both a nurse and a physician's assistant and do best as they can. The WEMTs usually accompany the patient to the hospital, along with the local prehospital personnel if needed or may simply transfer care to transporting personnel.

Wilderness EMTs need special training for the wilderness environment and for search and rescue, as described above. The EMT safety depends on his or her ability to coexist safely with wilderness in a search and rescue situation. The WEMT must carry out emergency medical tasks despite severe environmental stress (for example, freezing rain, blizzards, 41c heat). Wilderness emergency medical equipment is limited by what the team members can carry on their back or improvise. When a search and rescue team is out for one day or more and when the team is out of contact with a command physician, the WEMT is the sole rescue team's medical expert.

In U.S., the EMT or paramedics (or equivalent certification) is a prerequisite for WEMT. In U.S , the WEMT members has search and rescue experience prior to a student enrolling in a Wilderness Emergency Service Institute WEMT course .
Wilderness EMT is toughly a team effort that compare to street EMT. The wilderness basic EMT will often to assist their WEMT-Paramedics team members with advanced skill (e.g. helping prepare IV bags and lines under the WEMT-P's supervision). In U.S Wilderness EMS Institute, a common course curriculum would be used for the EMT and paramedic, although there is additional training in wilderness for WEMT.

The WEMTs have the training in scene management do much better on both indoor and field exercises because of the management of scene for the purpose of insuring safety of the rescuers and patient must be stressed.
Communication, reporting, and documentation are even more important to a WEMT than to a ‘street' EMT. When medical command and search and rescue team communications are spread out over many hours, small mistakes can mean big problems. The picture the WEMT paints to the Wilderness Command Physician must be accurate if the WEMT expects good command and good medical advice.