15 min read

Course Review: NOLS WEMT, Part 3 - Advice

Study strategies, course critiques, and resources
A view of a conference room with an open window looking out onto a snowy landscape.

This blog post is part of a series. See also:

Summary

  • You must do the required pre-work and more to succeed in this course. Apply active learning strategies (especially self-testing and spaced repetition) to ensure knowledge retention.
  • For pre-work, favor breadth over depth once you’ve covered the foundations of anatomy, physiology, pathophysiology, patient assessment, and handling threats to the critical body systems (cardiac, respiratory, neurological).
  • Make the most of the practice tests and mock scenarios available to you. The most useful resources are highlighted below.
  • NOLS could improve this course by adding more time, better preventing environmental injuries, revamping their outdated COVID policies, and elevating simplifications left over from their WFR curriculum.
  • My NOLS WEMT course was and is a peak life experience for me, with life and leadership lessons that transcend the medicine. Helping others is incredibly fulfilling; find your way to serve.

Before the Course

To succeed in this course, you must put in the (pre-)work.

Some general principles:

  • Study like a medical student with active learning strategies: self-testing, spaced repetition, elaborative interrogation, etc. If you do nothing else, learn how to apply these strategies to everything you learn.
  • Anatomy, physiology, and pathophysiology are foundational: when you can predict a patient's clinical presentation from their pathophysiology, identify where in the Patient Assessment System you would gather this information, list the most common emergency issues that could be afflicting the patient, and explain treatment options, you'll know you're in a great spot.
  • After you have the foundations down, favor breadth over depth: new knowledge will be much easier to encode if you're not learning seeing all the vocabulary and ideas for the first time
  • Skim-read before you focus-read: do a "picture walk" to see the photos, diagrams, tables, etc. of a chapter. Then look at its end-of-chapter vocabulary list. Then jump back and look at headings and the first couple lines of each section. You should now have a good idea of what the chapter covers and how it fits into your pre-existing knowledge.
  • Seek out alternative explanations from high-quality sources. Osmosis and StatPearls were some of my favorites when I wanted deep-dives. Finding the right metaphor or starting-point intuition can really make the difference for anchoring new knowledge.

Here’s the pre-course study plan I wish I’d had:

  • Get the textbook + workbook + EMT Crash Course right after registering for the course (like literally the next set of tabs you open)
  • Download the course outline/schedule, which is your day-by-day guide
  • Preview the NOLS PAS (examples 1, 2, 3) if you don’t already know it. Don't worry about memorizing the exact steps at this point, as those get tweaked periodically and the class will standardize on an exact sequence. This is purely to have something to visualize every time you're reading about assessing a patient
  • Download Anki onto all of your devices. This is an intelligent flashcard system that shows flashcards to you just as you're likely about to forget that chunk of knowledge.
  • Install the Image Occlusion Enhanced plugin for Anki and learn how to use it to make flashcards for labeling diagrams; this is incredibly useful for anatomy
  • Use this recursive reading algorithm to get ahead on the course's content
    • Skim-read in the order of the course outline
    • Focus-read the chapters that cover key topics (ones you saw come up repeatedly in skimming) and where you have the least prior knowledge
    • Do the end-of-chapter quiz questions
    • Revisit topics you didn’t understand until you can confidently explain the end-of-chapter questions.
    • Make Anki flashcards for any knowledge chunk that needs to recallable on-demand
    • Go back to focus-reading until all chapters are covered
  • Once you’ve completed reading Section 1, begin taking 10-quiz questions every day with Pocket Prep for EMS. It’s the public resource that closest in style to NREMT exam questions and has fantastic built-in explanations. It’s a great bite-size study tool
  • Once the Canvas page for the course opens 3 weeks before Day 1, go through all of that content in advance. I would prioritize this over any remaining textbook reading.
  • The week before the course begins, complete the workbook quiz questions for the pre-reading chapters. This will refresh that foundational knowledge.

Know this: the chapters listed for each day are what you are expected to come in at 0800 having already read. Your goal is get as far ahead on the reading as you can, covering at least the first week, so that you have that first weekend to catch up. Realistically, you will probably be behind on many other things at that point, so I recommend covering the first 10 days and ideally the whole course.

In addition, Sections 1-3 of the textbook are foundational and are a knowledge-base you'll need for the whole course. Sections 4 and onwards are mostly standalone with respect to each other. The first few chapters of each section provide the knowledge needed for the remainder of the section, so prioritize skimming them if you're triaging reading.

I've omitted the orange NOLS Wilderness Medicine book in the plan above. If you have time, you can apply the same reading algorithm to it, but its content will be well-covered in class. I strongly recommend prioritizing the textbook reading instead, especially if you've taken a WFR course before.

Your goal is to come in with a solid foundation of knowledge, one that is organized and structured, making it easy to cross-link in new knowledge. Here are concrete outcomes you can target for course success:

  • Able to explain the vocabulary and key concepts (e.g., blood flow through the heart's chambers, shock pathophysiology, etc) from the Section 1 (Foundations) chapters
  • Able to recite normal vital sign ranges for all ages
  • Read the chapters assigned for the first 10 days of the course and passed their corresponding quizzes from the textbook and workbook
  • A score of >= 80% on Pocket Prep (I was at 65% from what I retained from WFR, and at 87% before the start of the course)

During the Course

During the course itself, you’ll want to: Preview, Review, Encode.

  • Preview: Read Crash Course to cover upcoming lectures. Stay a few days ahead if you can, but at least preload for the next day.
  • Review: Run Pocket Prep + Anki at breakfast and after dinner (before studying new topics) to keep knowledge fresh. At the end of the day, answer any lingering questions from that day’s lectures/demonstrations. Your goal is to ensure a working understanding of new material. Don’t let unknowns pile up.
  • Encode: use the workbook quizzes to test your understanding of the day’s/week’s covered chapters. Dig in deeper as needed for understanding. Only make flashcards after you've absorbed a topic and have identified what actually needs fast-recall, like vital sign ranges, signs/symptoms, and more advanced vocabulary.

Remember to distinguish urban vs. wilderness protocols as you encode knowledge into memory. Some interventions (like the Focused Spine Assessment) are only applied in a wilderness setting. Urban scope of practice is generally more restrictive and conservative, and your organization’s protocols will always take precedence.

In general, practice quizzes and exams are your friend. The biggest set of them is on Canvas. These draw from the class textbook and two other ones. Don’t be freaked out by content differences from other textbooks. MAST is no longer used as a shock treatment for example. If you don’t recognize a term, Google it, check that it’s not in the class textbook, and move on.

The highest-quality practice quizzes and exams are found in the official workbook companion to the class textbook. It is well worth the cost. In addition, both the overall class final exam and the wilderness exam have practice finals you can use as readiness benchmarks.

For practical scenarios, see the list under “Resources” near the bottom of this post.

Don’t forget to make friends, stay active, sleep well, accomplish all of your New Year’s resolutions, and reach Enlightenment. I’m joking. You won’t have time for everything. I recommend prioritizing your physical and mental health above all else.

Lastly, particularly key topics are noted in this Limmer cram sheet. If you can whiteboard-explain all of these topics to a classmate by the final week of the course, you're in a good spot.

Psychomotor Training

To pass these final psychomotor exams, you must master the covered skills in isolation, then practice composing them, and then finally practice them while handling curveballs under time pressure. I call it the "Crawl, Walk, Run, Run Under Fire" model of learning. Add "Return Fire" if you're able to impress the evaluators with exceptional skill and style.

Here are the highest ROI (return on investment) resources for this course:

  • Skill demonstration videos on Canvas. They cover most of the practical skills.
  • NREMT psychomotor testing demonstration videos on YouTube. These cover the remainder.
  • The NREMT skill testing sheets, which list the critical-fail criteria and point-scoring opportunities. You can fail a psychomotor exam for e.g., skipping ahead to asking the patient about their medications before you've cleared life threats. You can also fail by not making the most of point-gathering opportunities like voicing that you've decided ALS is (not) necessary.

After the Course

Congratulations! At this point, I would:

  • Pick a date (I recommend 2-3 weeks after the course) and place (I recommend at-home) for the NREMT exam
  • Read any remainders from Crash Course.
  • Do practice exams from the workbook, Pocket Prep, and EMTReview. (Note: EMTprep is inferior in the quality of its questions and I do not recommend it)
  • Begin working on any other pre-requisites required by your prospective employers, like additional vaccinations, hazmat certifications, etc.

Critiques of the Course

I'll list in ~descending order of importance.

(1) I wish this course were twice as long or at least had another 2 weeks, with more depth in pathophysiology and breadth in special populations and circumstances. Folks who are interested primarily in urban medicine, who have the time available, or who would not do well with an accelerated schedule should instead go for a high-quality urban EMT course and then do WUMP. Having more time to study pathophysiology, have spaced repetition of psychomotor skills, etc. absolutely makes a difference. This will also let you learn from the approaches taken by two different instructor teams. In a world where I had unlimited resources, I would do a great urban EMT course and then do NOLS WEMT.

Alternatively, if your local urban EMT course isn't great or your primary employment will be outdoors, prefer NOLS, as it's 3x the outdoor scenario time of a WFR or WUMP and double the night scenarios. Similarly so for folks who have an urgent need for EMT (e.g., for employment for an upcoming fire season). They can still feel good about this course, but should expect to need more review for medical and EMS operations topics. Of course, this all assumes proper active studying techniques.

(2) Preventable frostbite injuries. We had a few folks suffer mild frostbite to their fingers and toes. Their digits all rewarmed without permanent effect, but I still think this is preventable. I would recommend having layers available to rent, as well as instructor checks of clothing. The example to follow here is the gear management of the Expeditions branch of NOLS. Even with such outdoorsy students, those from warmer climes will be less likely to have battle-tested layers. It can be hard to know in advance if a particular combination will be warm enough until you’ve actually tried it, especially with boots and gloves.

(3) NOLS’ COVID policies are grossly outdated. We had 1 person sent home due to COVID and this triggered protocols that were a straight throwback from 2020. For example, distancing outdoors is a pointless relic from before SARS-CoV-2 was recognized as airborne. Masking indoors but without ventilation or filtration is ineffective, especially when combined with eating together as one big group every day in the same dining area with 60+ people. Table separation is pointless: again, aerosols, not droplets! Given all this, I don’t recommend attendance for the immunocompromised; I don’t see a way to safely accommodate them in such a close-quarters setting. And while I spent much of the pandemic deeply engrossed in its minutia, I have to admit that society had moved on. We would all be much better served by working to prevent the next pandemic, rather than going through cycles of neglect, panic, and incompetent responses. That is a long rant for another time.

(4) Too many oversimplifications are held over from the WFR curriculum. This seems to be a consequence of the time constraints + NOLS' curriculum being WFR-centered. For example, NOLS gives a simplified model of shock as cardiogenic, vasogenic, or hypovolemic. But obstructive shock is taxonomically distinct from vasogenic shock, which itself is better encapsulated by distributive shock. Give the full shock taxonomy instead (cardiogenic, obstructive, distributive, hypovolemic) and link the pathophysiology to the signs and symptoms, along with their progression as a patient worsens towards death. Don't dumb things down, help students understand the full version instead.

(5) Oversimplifications in the NREMT curriculum itself. For example, the definitions of “stoma” and “fistula” in the textbook and Crash Course are for specific scenarios rather than the general definition. This seeds unnecessary confusion and made me distrust the glossary. Again, don’t dumb things down!

(6) The NREMT-mandated curriculum is slow to evolve. Supplemental oxygen is no longer recommended for suspected stroke or acute myocardial infarction. Backboarding has fallen out of favor based on studies showing more harm than benefit. Our instructors are aware of and mentioned all this but still had to teach to the current (hah) NREMT standards. Our classmates with real world experience chimed in with wisdom on contemporaneous prehospital practice.

(7) Urban EMS operations had poor coverage throughout, with only a few specific topics like hazmat and vehicle extrications. Learning more ambulance equipment (power stretchers, stair chairs, etc) and operations (where/how to park) in more depth, would have been particularly valuable.

(8) The publisher-written quizzes are crap and should be replaced by NOLS-written ones instead. If we use NREMT questions as the bar for 100% quality, then the publisher-written quizzes had 60-70% quality. Some questions were poorly worded and generated justifiable confusion. Others were just too easy. The final was better, at about 85% quality and significantly more difficult. EMTprep is 80% quality in comparison, and Pocket Prep is 95% quality.

(9) NOLS’ curriculum for cold water immersion follows Gordon Giesbrecht, which doesn’t hold up against the literature: 1-10-1 Rule myth. Giesbrecht agrees that a person’s cold shock response will kill far faster than hypothermia in the result of sudden immersion in cold water, but understates how immediately debilitating that response will be without prior acclimation. I recommend curriculum updates here based on guidelines from the National Center for Cold Water Safety.

(10) It’s an expensive course, especially relative to the incomes of most prospective students. Without access to NOLS’ internal costs, it’s hard for me to assess whether the tuition could/should be lower. NOLS does offer scholarships that are worth an application. 529 funds, AmeriCorps awards, and veterans benefits are also all usable for this course. Lastly, see if your employer would be willing to help with the costs.

(11) I have mixed feelings on kitchen duty. I overall think it should be eliminated as not beneficial enough for the group overall. Kitchen crew leads have the most to gain via leadership experience. Everyone else will appreciate back-of-house staff at restaurants even more if they haven't worked that kind of job before. But I’m not convinced we became demonstrably better WEMTs from our kitchen crew time.

(12) It drives me nuts that the EMT textbook does not give original sources. All textbooks should be fully citation-backed. We need to prevent errors like the 100-micron dogma that held back recognition of COVID-19 as an airborne disease (the rationalist community calls this type of problem an “information cascade”). Continuing-education texts are better, e.g., the Prehospital Trauma Life Support (PHTLS) text is full of glorious citations. And to my relief, the 4th edition textbook for Advanced Medical Life Support (AMLS) does give the latest guidance on supplemental oxygen (pages 136 + 288).

Lessons in Leadership

Even given all of the previous critiques, the NOLS WEMT course remains of the most rewarding (and intense) challenges I have ever taken on. It is an experience I will remember and treasure for the rest of my life. I feel far more confident in my ability to not just respond but lead in a stressful situation. It is called the National Outdoor Leadership School for a reason.

I learned life lessons as well:

  • It is incredibly fulfilling to help people in a hands-on way. I’ll never forget one patient in particular from one of my emergency department rotations. He came in with all of the signs and symptoms that make up acute coronary syndrome. In other words, it looked like he was suffering a massive heart attack. I got to practice taking a history and vitals while we waited for the troponin lab result to confirm what the EKG and chest x-ray had found. The work-up ultimately showed unstable angina, and he walked out upon discharge with such gratitude and happiness, shaking all of our hands. I know there’s more primary/preventive healthcare needed for the underlying coronary artery disease, but it felt so good to be part of the solution for the immediate life threat.
  • Do not brag. The classmates whom I admired most for their competence and character were also among the least braggy in the course. The inverse was also true. Confidently outline your qualifications during introductions and then get back to work. Show that you know your stuff; don't brag about it all day then fail to live up to it. The world has too many incompetent blowhards.
  • Don’t be afraid to step up and lead. Every time I was quiet and shy despite knowing what to do, I regretted it. But when I took the lead, I learned so much and felt the joy of making an impact directly.
  • You can find common ground with almost anyone. I loved learning more about my classmates and their wildly varying backgrounds.
  • There’s always more to learn. This course unlocks taking the test and getting on-the-job training. Agencies and companies have their own rookie academies, protocols and procedures.
  • Consider the weekly life and long-term optionality of different life/career pathways. I appreciate the pay, temporal and spatial flexibility, and career mobility of tech work so much more now. I am currently pursuing a bivocational approach with my career as a result.
  • Figure out what makes you feel most unique and fulfilled and then pursue it. I have never felt so alive as I did during this course. My WEMT stickers proudly ride on my laptop and water bottle every day.

Lastly, you never know when the world will need your skills. Less than 1 week after receiving my NREMT certification, I came across an unresponsive woman under a bus stop. I paused and took a deep breath. Then I sized up the scene, put on my gloves, and approached a bystander who had witnessed the collapse.

"Hi, I'm Ky-Cuong and I'm a Wilderness EMT. How can I help?"

Appendix

Ways to Serve

As a career:

  • Urban emergency medical services (EMS)
  • Ski patrol
  • Urban fire
  • Wildland fire
  • Emergency room technician
  • Military (talk to specific service branches’ recruiters before enrolling with NOLS, as many have their own EMT or paramedic training programs; get all promises in your contract; etc.)

As a volunteer:

  • Rural fire departments (often mostly or all volunteer)
  • Search and rescue teams
  • Fire reserves in urban fire departments
  • Athletic event medical staff

In all cases, learn the most common languages that your patient population speaks. Knowing Spanish, Vietnamese, Tagalog, Chinese, etc. can make the difference for learning life-saving information while getting a patient history.

Resources

Tooling:

Practice scenarios:

Books for during the course (get them in print to avoid digital distractions and bugs, and yes the workbook is well worth it for all of its practice quizzes):

Books for after the course:

Other reviews of the NOLS WEMT course:

Recertification

To recertify as an EMT, you’ll need to satisfy requirements from the NREMT and your state/county. As of 2025, the NREMT requires 40 hours of continuing education every 2 years, with a certain breakdown. Your state/county may require upkeep of additional skills as well, like starting IVs (a scope-of-practice extension option in Colorado), supraglottic airways, epinephrine auto-injectors, glucometer usage. The latter two should honestly just be part of the baseline curriculum and standards for EMTs.

To recertify the Wilderness component of your WEMT, take one of these every 2 years:

  • Wilderness Upgrade for Medical Professionals (WUMP): 5 days
  • Wilderness First Responder Recertification (WFR-R): 3 days
  • Hybrid Wilderness First Responder Recertification (HWFR-R): 2 days + online pre-work

I recommend WUMP if you can spare the time and money; your classmates will be seasoned healthcare providers with their own wisdom to contribute. This is also a good way to preview other healthcare paths if you are pursuing EMT as a stepping stone.

Pathways to WEMT

The W in WEMT is a NOLS-issued add-on, and not a national standard the way Wilderness Paramedic (WP-C) is. There are three ways to get to WEMT:

  1. Urban EMT course followed by WFR or WUMP
  2. WFR then urban EMT course
  3. Integrated WEMT course through NOLS

This post series was dedicated to describing Option (3), which is currently offered in Lander, Wyoming only. Note that you can also do (3) as the first step of the Wilderness Medicine and Rescue (WMR) semester, which I think is the cream-of-the-crop offering from NOLS. That semester seems targeted toward gap-year students. It opens with WEMT, followed by multiple field courses. It is the only NOLS offering that covers SAR-level rock rescue skills and not just improvised personal rock rescue. However, it is pricey at $25k and out of reach for folks who don't e.g., already have their college education paid for by their family.

Somewhat confusingly, NOLS also used to offer an accelerated urban EMT course followed by WUMP as an WEMT pathway, i.e., an example of Option (1). And they also marketed this under "Wilderness EMT". I do not recommend this option if it ever reappears. It was taught by a community college in North Carolina (who were albeit fantastic based on reviews), which means there is no advantage to this course over any other accelerated urban EMT course. As of January 2024, NOLS seems to no longer offer this.

Ultimately, the trade-off space involves time, money, and quality. NOLS is incredibly high-quality, but does it in 4 weeks (which could be a net positive or negative, depending on your circumstances) and is very expensive. An urban EMT course could be anywhere from 5-16 weeks, followed by the 5-day WUMP. Doing an urban course followed by WUMP will give more time to absorb material and is much cheaper, but the quality of instructors and classmates will vary widely.