I’ve seen a lot of questions in the last couple of weeks about basic medical training. Folks want to be able to help out if a friend or ally gets hurt at a protest, or if they see someone attacked because of their ethnicity, gender, sexuality, or so on.
The aim of this post is to lay out a roadmap for getting the best training for your situation. It’s a chose-your-own-adventure go-at-your-own-pace guide to learning how to take care of the people around you before an ambulance arrives. I’m going to lay out the options I think are most compelling and why. Your job is to put these suggestions together into a plan that works for you.
Why should you listen to me?
I worked as a volunteer EMT for an EMS and technical rescue organization in New Jersey for several years. I spent thousands of hours on call, and hundreds of hours treating and transporting hundreds of patients. I have hundreds of hours of classroom and scenario-based training in all aspects of BLS patient care and more than half a dozen different technical rescue disciplines. I’ve led numerous camping, backpacking, and rock-climing trips into the back country, serving as the primary medical provider for groups of 10–20 people. I taught CPR, wilderness first aid, and wilderness first responder classes for years to hundreds of students.
Core medical skills
The gold standard in medical training for someone who doesn’t work as a medical professional is the first responder certification. This training focuses on a process for evaluating patients and on critical life-saving care skills which are easy to use even if you haven’t practiced them for a year. If someone is seriously injured near you, first responder training will enable you to provide them with the best possible care with the resources at hand, whether that’s literally nothing, a pocket first aid kit you carry with you, or a larger kit available nearby.
If you’re thinking about providing care during a protest, in a situation of civil unrest, or when it might otherwise be difficult for professional EMS to reach you because they’re overwhelmed or access is limited, you want a wilderness class. The word “wilderness” is a little confusing — it doesn’t necessarily mean that you’re up a mountain, deep in the woods, or stranded in the desert. It refers to providing medical care in any austere environment: one in which your resources may be limited, and professional EMS isn’t immediately available to transport a patient to a well-equipped hospital. From a medical perspective, the middle of a city can become the wilderness during a protest or natural disaster. It’s not about how much nature there is around, but your access to ambulances and hospitals.
Wilderness first responder (WFR) is an 80-hour class typically taught over nine full days of mixed classroom and scenario-based instruction. Depending on the provider and location, it generally costs $500–$1200, with a typical cost of $750.
If a WFR represents more time or money than you can afford, consider a first aid (WFA) or advanced first aid (WAFA) class instead. WFA is much shorter: 16 hours over two days, and it only costs $200–$300. WAFA sits between the two at 40 hours over four or five days and a typical cost of $400-$600. Neither first aid nor advanced first aid provides the same breadth or depth of skills as WFR, but either is a huge leap from having no training whatsoever, and you can always take a more advanced class later.
Instructors in a WFR, WAFA, or WFA class generally assume that participants want to stay safe while working or recreating outdoors. Since that may not be the situation you’re most concerned about, make sure to let your instructors know so that they can tailor the material to your needs. This could be as easy as sending them a short email right after you sign up. Most instructors will begin class by letting everyone introduce themselves so that they can make the material relevant to everyone in the room. That’s also a great chance to speak up about what you’re looking to get out of the class. Don’t be shy! Instructors want to give you the best and most relevant training possible; they really appreciate it when you explain your situation so that they can use examples relevant to you.
Lots of providers offer medical training. Sadly, the quality of the curriculum and instruction varies wildly. Content varies from carefully evidence-based to compendia of mythological treatments which have no basis in fact. Instruction is similarly varied: some instructors only know the topic, while others have a extensive background in how to be effective teachers.
If I’m injured and need urgent medical care when EMS isn’t available, I sincerely hope that the person available to treat me was trained by the Wilderness Medicine Institute of the National Outdoor Leadership School (WMI of NOLS). I’ve received medical training from a number of providers, but for the last ten years, I’ve taken every class I can through WMI.
WMI’s recommendations and curriculum are constantly updated based on published and original research by their curriculum director Tod Schimelpfenig. What you’re taught in a WMI class is always based on the latest and most comprehensive research as well as NOLS’s extensive database of wilderness risk-management and emergency events. In my experience, WMI’s curriculum substantially precedes the adoption of the same practices into other contexts — like the EMT textbook or the protocols of EMS services.
Perhaps even more important than a well-maintained curriculum, WMI pays close attention to making sure that classes have good learning outcomes. Instructors are given training and feedback on how to be good teachers and classes are structured to combine classroom and practical learning to maximize the odds that you’ll remember what’s important when your adrenaline is pumping because something terrifying just happened.
In the San Francisco Bay Area, the best way to find WMI classes is through ReadySF who host classes and do all the logistics to make them happen. In the south-east of the USA, Landmark Learning works with WMI and provides a similar function as well as offering a selection of other relevant training. Elsewhere in or outside the USA, it’s easiest to go to WMI’s course listings directly.
WMI emphasizes CPR in a wilderness context — somewhere you’re exceedingly unlikely to have access to an AED and even less likely to be able to get someone into the back of an ambulance within a few minutes. Fortunately, you spend most of the time under circumstances where an ambulance will be at your door within a few minutes if you call 911. A heart attack or choking is the life-threatening event you’re most likely to witness if you live in North America. A CPR class based on the assumption that you can call 911 gives you the best ability to save a life if this happens.
Take the Heartsaver AED class offered by the American Heart Association. There’s very little theoretical knowledge that goes into CPR, and this class consists mostly of practicing the steps to take if you witness a sudden cardiac arrest, and on good CPR technique. The class takes about four hours and prices vary. The best way to find a class is to look for them on the AHA website. Don’t bother with the half-online class: the in-person instructor training is the most important part.
Sudden allergic reactions can be life-threatening. There’s an easy treatment which is almost-always life-saving in these cases: use of an epinephrine (epi) auto-injector like an EpiPen. There’s only one catch, you need to have the epi in order to use it to save a life, and it’s a prescription medication.
In California if you take a class like WFR which teaches you how to use epi and you have a current CPR certification, you can ask the the state Emergency Medical Services Authority to certify your proficiency with epi. This requires mailing them a copy of your class paperwork and a $15 application fee. Once they send you a certification card, you can ask your doctor to prescribe you epi so that you can use it to provide urgent medical treatment for someone else. There are similar programs in some other states, but I’m not familiar with the processes elsewhere.
Whatever the process in your state, getting certified to carry epi gives you the means to reliably save a life if the occasion arises. Epi is even more reliable for sudden allergic reactions than CPR is for heart attacks, and severe allergies are increasingly common. In a protest or civil unrest context, someone experiencing a severe allergic reaction for the first time might not have any other access to epi, and even a mild or moderate reaction might be compounded by the use of chemical weapons which impede normal breathing.
Disaster Medicine & Triage (CERT)
One useful skill that’s generally not covered in much depth in a WFR class is triage: the process of deciding who needs treatment most urgently in order to do the most good for the greatest number when there are more injured people than people available to assist.
Although the principle of triage is one that’s well-established in medicine, no particular triage system has been shown to demonstrably improve patient outcomes. In fact, even well-trained rescuers triage the same groups of people differently when they’re using the same triage system (typically START in the USA). Practicing triage is important for a very different reason. Hands-on triage training help you develop a good rescuer mindset for incidents in which the scene may not be completely safe and there are many more patients than you can treat at once. That is to say: practicing triage helps you get in the right headspace to help treat people at a protest.
When things go wrong at protests, they are liable to go seriously wrong. When the cops attack a protest group, many people can be injured quickly. If something dangerous or alarming occurs at one end of a protest, people can be trampled. If chemical weapons are used on a crowd, lots of people may be affected, but it’s probably only immediately life-threatening to a few.
The easiest way to get disaster medicine training and triage practice is to join your local Community Emergency Response Team or CERT (in San Francisco, this program is called Neighborhood Emergency Response Team or NERT). Programs typically start with about 24h of training broken up over a few days or several shorter evening classes, and have regular drills or exercises where you can practice your disaster medicine and triage skills. These programs are free. And they also teach you to respond to likely natural disasters in your area when regular resources are overwhelmed.
The medical incident to expect at a protest but not elsewhere is the use of “less lethal” chemical weapons against crowds. The phrase “less lethal” is in scare-quotes because although tear gas and pepper spray/balls aren’t designed to kill, they can be life-threatening to people with existing challenges breathing — like asthma — or those who have particularly severe reactions.
Elle Armageddon has a great primer on treating tear gas.
If you’ve been working your way steadily though this guide, you should have a basic grounding in appropriate medical care or a plan to obtain it. This doesn’t mean that you’ll be ready to step up and perform the role of medic on the street. Protests are unique environments and the role of medic generally demands more than just medical proficiency.
If you are interested in performing this role, find a street medic group near you (if you’re looking in San Francisco, feel free to get in touch). Get to know how they work and see if they’re running any workshops to train new medics. Medic workshops can vary widely in the quality of the medical instruction. That’s okay because you already have a good grounding in basic medical skills. But they’re incredibly important for understanding the culture and tactics of the groups you’ll be working with, and for understanding the landscape of a protest.
Street medic groups vary widely in their philosophies, tactics, and organization. If you live in a major urban area, there may be several street medic groups with very different approaches. There’s a lot that you can learn from experienced medics, even if the group and it’s processes are peculiar for you. You may have to look into multiple groups before you find one where you feel comfortable.
The physical risks at a protest are very different from other scenarios. Learning to be aware of these risks and to work well with a team can help you even if you never need to provide medical care. Unless you take a workshop and learn from the established medics in your area, it can be hazardous to identify yourself as a medic during a protest. When they’re planning to attack a crowd, police forces often target medics first to demoralize and limit the ability of protesters to recover from violence. If you’re not working with the established medic groups at a protest, your presence and identification as a medic might seem suspicious and make others less likely to trust you.
Other Support Skills
Medical care isn’t the only support that you can provide folks trying to be the change they want to see in the world. Consider other ways that you can help people protesting
- bystander intervention training
- psychological first aid training
- legal observer roles and jail & courtroom support
- bringing supplies for others: phone chargers, snacks, bottled water, suncreen, ibuprophen or naproxen, tampons/pads…
The more you practice, the better your skills get. Reviewing your textbook or reference guide every few months helps you keep on top of things. When your skills seem shaky, that’s the time to set up some hands-on practice. Even just running through the whole of the patient assessment system with an imaginary patient can be useful.
If you’re working through this guide with some friends, consider setting up a quarterly or semi-annual training day (or training evening) where you can go over the your skills together and get hands on practice with straightforward scenarios of each other’s devising.
WMI offers a regular-but-infrequent email newsletter called The Scenario where they pose a situation you might encounter in the wilderness and it’s up to you to think it through and plan how you’d deal with the patient. Subscribe to those emails for a monthly cue to bust out your rusty skills.
Recertification & Refreshers
Most courses will certify that your skills will stay with you for two years. This isn’t a money-making scheme. You really do need to take a refresher class every other year. If you don’t refresh regularly, your skills will stop working. If you take a refresher every year instead, your skills will be stronger and you’ll be able to use them more effectively. Re-taking a class more frequently than once a year isn’t likely to help much more. Failing to take a refresher within two years will definitely hurt your skills. Skills also change: over two years, there can be plenty of new research which leads to change in recommended treatment. Getting up-to-date information let’s you provide the best possible care.
If you decided to take a WFA or WAFA class instead of WFR, your one or two year deadline is a good time to think about whether it makes sense to step up to the next level.
For EMTs & beyond
If you already have EMS or advanced medical training, some of the instructions are different for you. Instead of a WFR class, take a Wilderness Upgrade for Medical Professionals ($625-$850, 48h) or if that’s too much, Wilderness Medicine for the Professional Practicioner ($650, 18h). If you enjoy camping, a Wilderness Medicine Expedition ($2325, 8 days) is a fantastic way to get extensive hands-on patient care in a wilderness context.
Make sure that your BLS/ACLS, ITLS/ATLS/PHTLS, PEPP, GEMS, &c. are all current. Focus your self-directed CE classes towards relevant topics: protest medic, tactical medic, treatment of less-lethal chemical weapons, wilderness medicine, MCIs, and disaster medicine. Take classes in bystander intervention and psychological first-aid.
Take a workshop from a street medic and don’t be too loud about the fact that you have advanced training — you’re not there to learn basic medical skills, you’re there to learn protest-specific situational-awareness, teamwork, and tactics. If the workshop facilitator gives slightly-incorrect medical advice let it pass unless they’ve suggested something life-threatening; consider talking with them about the issue during a break, but only if it’s important.
Work on your situational awareness, scene-control, and command voice. Make sure that your boots are appropriate for a protest. Can you comfortably hike five or ten miles in them with a jump bag on your back? Can you run a few hundred meters or jog half a mile in them?
Prepare a protest medical kit. This should probably be smaller than your standard jump bag, dispensing with bulky-but-improbable items like the OB/GYN kit, and potentially even with particularly-heavy items like O2. Remove anything in your kit which could be construed as a weapon or which requires a prescription or standing orders unless you are absolutely certain about your documentation. Remember that you might be arrested, and have a hostile and grumpy police officer going through your kit.
You probably need more PPE than usual. Do you know how to use chemical-weapons PPE in the field? Do you want leather gloves to be able to move a hot tear-gas canister? Add chemical-weapons decontamination supplies: LAW and sprayable water/saline. Plan for your hydration and food needs. Consider knee-pads to help you spend more time helping patients without injury. Consider how you look in your gear: do you seem threatening to patients or police; could you look like a cop to protesters?
Hike in your boots, with your kit as you’d bring it to a protest. Consider how heavy it is and adjust until you can comfortably carry it all day without tiring yourself out. Hike some more with your kit. Practice decontaminating yourself and deploying your chemical-weapons PPE. Practice using your kit for airway/breathing and trauma issues. Practice in the dark, with loud noise, on uneven ground, and in confined spaces.
- Pocket First Aid Kits by Tom Lowenthal
- “What’s in the Bag?” — A Guide to Packing a Protest First Aid Kit by Elle Armageddon
- NOLS Wilderness Medicine by Tod Schimelpfenig
- Medicine for Mountaineering by James A. Wilkerson, Ken Zafren, Ernest E. Moore
- Tactical Emergency Casualty Care Guidelines and TECC for First Responders by the Committee for Tactical Emergency Casualty Care
- The Quick and Dirty Tear Gas Primer by Elle Armageddon
- OPSEC For Activists, Part 1: The Basics by Elle Armageddon
- OPSEC for Activists, Part 2: Packing for a Protest by Elle Armageddon
- Digital Security Tips for Protesters by Bill Budington
- Cybersecurity for the People: How to Protect Your Privacy at a Protest by Micah Lee, Lauren Feeney
- Secure Journalism at Protests by Martin Shelton, Geoffrey W. King