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Remote Medical International uses Remote Site Paramedics for offshore and remote site operations. In our experience, the street sense for rescue, independence, and hands-on skills provide a solid foundation, we also require extended expedition experience and an ability to get along with all types of people under conditions of isolation and intense stress. My point though is to develop the discussion of Advanced Practice Paramedics. Our medics suture, administer antibiotics, conduct in depth primary-care type examinations and perform other advanced skills. They are certified as extended providers in Advanced Trauma Life Support, Critical Care Paramedic, and a variety of other courses and certifications, including our own Remote Medicine for the Advanced Provider (RMAP™) and internal physician-taught courses.

Our experience has been great so far, supported by an Anesthesiologist, Emergency Physician, and a Dentist, the teams seem to work very well. We work hard to make sure that open communication exists between all parties, and in a remote setting, often as a single care provider, patient outcomes are very easy to document, so we have an environment and outcomes that prove our model works. The military uses a similar model with 18D Medics, and in England, the HSE has the Offshore Medic program which certifies paramedics and nurses to work in the Oil & Gas Industry.

It is apparent that in the wilderness setting, there is a need for individuals to have advanced training in certain practices and procedures, and this should be evidence-based, but normalized for the wilderness or disaster setting. The applications for disaster scenes, wild-land fire, rural areas, homeless clinics and remote site operations I think are well warranted as well as tactical medics working for the government and SWAT teams as the job is categorically different than the in-hospital equivalents.