What Does Better Wildland Medical Care Cost And Who Decides It

John of Backcountry Medics gets specific about capability, not just labels. What’s the real operational difference between Type 1 ALS and Type 2 ALS? Why does vehicle extrication keep coming up when we talk about firefighter fatality risk from auto accidents and cardiac events? We also dig into why assumptions like “the local structure department can handle it” can fall apart in remote wildland settings where time, tools, and staffing are never guaranteed.

From there, we zoom out to what actually raises the bar: better MedL education, more transparency and accountability across contractors, and smarter planning between REMS teams so complementary gear and staffing show up when a single patient turns into three. We swap hard earned lessons from long field care and backcountry rope rescue, where lightweight systems and real experience beat overloaded packs and textbook answers.

If you care about REMS, wildland fire medical care, UTV based response, rope rescue, or incident medical planning, this one is for you. Subscribe, share this with a teammate, and leave a review so more people ordering and delivering care can find it.

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[00:00:00] The Viper Transition Problem
[00:07:59] Why NWSA Conference Matters
[00:15:07] Real Rescues And Rope Systems
[00:18:03] Staffing Standards And Team Coordination
[00:19:59] Hiring Bar And Where To Apply

Transcript

SPEAKER_00 0:00

That's the big challenge facing all of us coming into the Viper transition. Let's say I'm a company with one UTV, one REMS team. I've historically been able to say, hey, I've got a type one team and I can downgrade them as necessary. And that's allowed us to be able to answer more solicitations. Now with this transition, right, I've got to earmark that team. So I've got my one UTV and I have to decide in May or April, and it's just going to be a type two VLS or is this going to be a type three or a type 2. And what region, you know, what region's going to be busy this year. Exactly. And that that's going to be that's going to be a challenge for a lot of us.

SPEAKER_01 0:35

And for the teams ordering because they're just not going to get the resources that they need. We don't know.

SPEAKER_02 0:39

Yeah, they're going to have way less to pick from. Feels like you're playing roulette right now since we're at the casino, but you have to like you have one chip and you have to put it by a type in a specific place.

SPEAKER_01 0:50

That may mean you don't get called till August or September, you know?

SPEAKER_00 0:54

Exactly. And one of the things, you know, one of the answers to this is how do we educate our Med-Elves? The more Med-Elves can understand what's available and the true differences between the teams, the better it is, but it's a lot of fun.

SPEAKER_01 1:51

Think so. At least. Holds a special place in our heart as technically the first customer for the Journeyman. Like proud first customer. Very proud first. And so we appreciate you, your business, um, and your people being on the platform. Tell us about you, your people, and your business.

SPEAKER_00 2:11

Well, my people are astronomically better than me, and that's the best thing about my company. That's the secret. Isn't it? So yeah, so I run a company called Backcountry Medics. Uh, we've been around for I think five years now or so. We specialize in REMs, uh, always kind of have been. That's my background as a, you know, as you guys know, a technical rope rescue instructor. I teach with Rescue 3 at the independent level, and that's given me the opportunity to teach maybe half a dozen to a dozen other REMs companies. And uh it's just yeah, a great opportunity to get in front of different teams. I learned some things from them, they learned some things from me. Uh, and that's that kind of comes back to our specialty. That's my background as Tech Rescue. So REMs is it's where we live, where we plant our flag, and I've been able to bring on a lot of really good people that's helped our company get to the point where we're at. And so just like just like you guys know, and why you guys are are one of the best, it's it's uh hiring really good people, equipping them and listening to them, and that's why I've loved to follow your journey and that's you know, bring us back to the journeyman app. We were uh we were struggling with running a a larger company with so many different people, so many different schedules, trying to track down different payments. It was a challenge. And so when you guys first talked about it what four or five years ago on the Fireline with us, we were on we were all on a roll together. I was like, God, I hope this thing works, man. I really hope it works. And I um I'm so happy that it's the two of you that have made that work. Um, I uh I couldn't think of a better group of people behind a business, and it just it makes me excited to support people that I know and people that I genuinely love. So thanks for thanks for killing it. Uh and I would I would happily pay double um if you want to edit that out, but I would happily pay I'd happily pay double. Uh it's just a great resource, and we're excited to partner with you guys.

SPEAKER_02 4:06

I forgot you we were all together when this idea kind of came out on a napkin, essentially, you know. We were kicking it around and then asking people on the fire line, writing it down. Uh customer discovery on the fire line.

SPEAKER_00 4:20

Early beta tests were were good. It was really dirty and muddy, but now uh just to to watch from the background and kind of where it started on that back of a napkin to to where it's at now has been uh uh really fun process for us. So thank you.

SPEAKER_02 4:34

Well, it's gonna be fun for us to watch you use it because like we truly love it. I you've said it many times last summer, like dude, what how were we running this last year? You know?

SPEAKER_00 4:47

Yeah, it's yeah, like thinking back to the way we were running things and what the potential your app provides us. I mean, it makes my job easier. And the nice thing about that is the easier my job is, the more time I get to dedicate to better patient care and being better at our job. And our job is not to go out on the line and make money, our job is patient care to the best of our ability to what our firefighters deserve. You can speak to that. Oddly, uh, one of my medics was the guy who uh who responded to you. So that was yeah, so that was really interesting to have one of my guys that I trained. Fine that out of my first time respond, yeah, respond to you. Like one of my closest friends who've been like, I'm really happy that we're able to provide a resource of that caliber for someone that I genuinely love. So that that was special for me and like a good proof of concept. So thank you.

SPEAKER_02 5:39

Yeah, you got to see me piss myself. So twice. I don't want to I don't want to make sure it booze twice. I got the full download, but we have a new level. He's seen parts of me that I haven't seen of him.

SPEAKER_00 5:52

No, yeah, it's it's not fair. We can arrange for that. We do it.

SPEAKER_02 5:56

Yeah.

SPEAKER_01 5:57

But yeah, no, we definitely wanted it to free up your time because, like you said, you're a great instructor. You teach really quality courses, and people people need that and want that. And so if we can help free up some of the administrative and logistic things, uh, not only for you and your other um like managers, but um for your guys on the line too, when they're you know doing their shift tickets or uploading stuff for their resource, knowing what they have assigned to them and and what they're supposed to take care of.

SPEAKER_00 6:22

Yeah, and that's uh that's a big thing too, because we always talk about what it's like from the owner's perspective or the manager's perspective. But I think one of the biggest benefits that you guys offer is a better employee interaction as well. Some of the challenges are like we've all seen the companies that maybe struggle a bit more in this industry, they don't provide their employees with the right things, the right training, and the right background. And that's uh that opportunity that you guys provide is I mean, it's phenomenal. It's like, you know, the old adage, man, anybody can have kids, but a lot of people shouldn't. Anybody can create a company, but a lot of people probably shouldn't. And that's uh so you guys are making that challenge easier. So I do really appreciate it.

SPEAKER_01 7:06

Yeah, and providing a little more transparency. I think everyone always wants transparency and accountability for what we're doing out there because it is not to say one team would fight, but you know, we're out there doing the same job.

SPEAKER_00 7:17

So yeah, the the the benefit there is it holds companies to a higher standard. And by doing that, we're enabling them to provide better patient care. And that's really what everything comes back to is how do we do a better job at saving firefighters and at enabling them to have a better outcome? And that's you know, that the recipe for that is is pretty simple. Spend a lot of money on gear, spend a lot of money on training, hire really good people, and then support them. So of those four pillars, you guys are that fourth pillar, and that's why like I'm really excited for you guys to be a critical part of our success and and ultimately serving firefighters moving forward.

SPEAKER_02 7:58

Yeah. Uh we are here in Reno at the NWSA conference. Uh, why do you come to this conference? Why are we here? What happens at these types of events?

SPEAKER_00 8:10

Yeah, that's a that's a good question. You know, I I come here to learn from others, right? Um, I am in no way the best boss or the best rope rescue instructor or put on the best show. And so coming here allows me to rub shoulders with some people that have great ideas that I've never thought of, but also allows us to establish this collective voice to advocate for ourselves, which is ultimately advocating for firefighter treatment, what's best for them. And so being able to be in the same room as some of those decision makers and some of the federal people higher ups with the Forest Service, and yeah. Exactly. That's that's the real win. And man, every year it gets better and better. And I think this industry historically has been hyper competitive. We always kind of looked at each other as like this this pie is is not gonna get any bigger, and I'm gonna hide all my secrets because I don't want you to know how we're doing it, and that's not to the benefit of everybody else. And so that's also why we like to come here and and say, this is what we found to work, this is what we haven't found to work, and uh I get yeah, I get the opportunity to learn from you guys, and every now and then maybe you pick something up from me, and it's a it's a it's a it's a good deal.

SPEAKER_02 9:22

And then you learn about what's going on in the government, and like we're frustrated about some things, but then you get the opportunity to see it from their side, and then it softens the blow a little bit on some of the things, but then the others are just like why can't that still just be changed? But uh should we hit the waves top wave tops of some of the REMs typing things? And the reason I say that is just because it'll give us the opportunity to maybe tell our REMs guys about why we may or may not get as many orders this year.

SPEAKER_00 9:55

100%, and that's the big that's the big challenge facing all of us from the employee to the owner side coming into the Viper transition. So historically there have been three types, right? Our type one team, always ALS, type two, and type three. Well, we just learned, right? Type two can now be ordered as an ALS or BLS, and then type three may or may not also involve a Menmod or an MSU or whatever, whatever that name looks like. And so now I've got four to five different types of teams that I am going to have to put into Viper. And if I only own one UTV, let's say I'm a company with one UTV, one REMS team, I've historically been able to say, hey, I've got a type one team and I can downgrade them as necessary, right? Thinking about as a type two BLS or a type three, we're just gonna remove the number of people and we're gonna arrive with more than what's asked for. And that's allowed us to be able to answer more solicitations. Now with this transition, right, I've got to earmark that team. So I've got my one UTV and I have to decide in May or April. I mean, is this gonna be a type two BLS or is this gonna be a type three or a type two? And what region, you know, what region's gonna be busy this year. Exactly. And that that's gonna be that's gonna be a challenge for a lot of us.

SPEAKER_01 11:16

And for the teams ordering because they're just not gonna get the resources that they need. We don't know.

SPEAKER_02 11:20

Yeah, they're gonna have way less to pick from. Feels like you're playing roulette right now since we're at the casino, but you have to like you have one chip and you have to put it by a type in a specific place.

SPEAKER_01 11:33

And that may mean you don't get called till August or September, you know.

SPEAKER_00 11:38

Exactly. And one of the things, you know, one of the answers to this is how do we educate our Med-Els to understand what are the what's the true difference between a type 2 ALS and a type 1 ALS? Well, the answer is vehicle extrication, more and better training. But a lot of times in my experience, teams will just order a type 2 because they say, oh, well, a type 1 I can never get her, type 1's too expensive. They're they're historically largely the same place, uh the same same price, and they're usually available as well. And so the more Med-Els can understand what's available and the true differences between the teams, the better it is.

SPEAKER_02 12:17

Well, and the doctor pointed out rightly that you know, cardiac's number one killer firefighters, but auto accidents is like other number one. Like goes back and forth. Uh it's auto accidents or uh cardiac, but like so. That's only a type one team. So I think they should spend a couple extra hundred bucks a day. It's not that big of a deal to get a type one. Or in some cases the same price, yeah.

SPEAKER_00 12:47

It's the same price. And I I hear a lot, oh well, we don't need vehicle electrication because there's a structured apartment that's nearby that will provide that. Well, that's I used to be a volunteer structure firefighter, so I I guess I can say this. Usually not staffed by the uh the best of the best sometimes. And even if they are staffed by really qualified people, it takes them too long to get there. And usually their tools are older. Like we run new hall matro vehicle extrication tools. Battery operated battery operated, they're like$15,000,$20,000 a pop. Our guys go through a multi-day vehicle extrication process in addition to whatever they've got before they arrive. And so that value that that type one team provides of they answer that number one life threat, cardiac, and number two historically, vehicle accidents. Man, that that paints a pretty good picture for an ALS like unit type one. Right. And that's and that's the big goal. And you know, we're we're a bit interested to see with the type three. Hopefully, they add patient packaging. I know most teams already arrive with patient packaging in their UTVs for type three, and I think that's how it should be ordered. And I'd be surprised if it doesn't change to that.

SPEAKER_02 13:53

It's just wild to me that some people think that it would be appropriate to go to a fire with the UTV as a medical staff, but not have the means to move the patient with the fucking UTV that you've got. Yeah, it's like fobbling on a one-yard line.

SPEAKER_00 14:12

You just do the right thing and try to be the best they can, and so that's but that that's also that's a product of why like you guys have been so successful, not just in Journeyman, but for your own company as well. Like you all have been doing that since day one. You guys spend more money on UTV, spend more money on training, spend more money on equipping your people, and that's been noticed. And you can see there's the medals they know when you show up to a fire, right? And you can see when you're in that room and a new team checks in and they look like a bag of shit. And that medals, they just they they roll their eyes and go, not these guys, right? But it also means you guys get to go on cooler to cooler assignments. Guess who's hiking it with a shock crew or guess who's getting flown in and getting the spike out? It's the teams that do a better job historically, and they stay on fire longer. That competitive advantage is only achieved by being better than your peers, and you guys have done a wonderful job with that. Likewise, do you guys as well?

SPEAKER_01 15:08

You guys had a really good rescue just last year, right? Super long or long field care.

SPEAKER_00 15:12

Like we we had a couple, unfortunately. We had that one in California with that tree strike that took out uh three guys. We actually got an award from the Forest Service for that one, uh, which was really special as a as a contractor to be uh to be recognized for our work. And we had a fantastic medic, and and that was wild too, because we had two EMTs, you know, four-person team, one medic, we run all three EMTs. I mean, each of those EMTs were with their own critical patient. And that paramedic was running his patient and the scene as well for a duration. And so that was a challenge. A month and a half later, we had another um long duration extrication with medical considerations where we did four to five maybe uh rope pitches, all with our hiking cash, all things that we are already hiked in on, so we wouldn't in inclement weather, too. In inclement weather, which has been a which it seems like those happens every year, is like you know, it's at least once a year we get a multi-pitch rescue hike in, starts in the day, goes to night, and it's obviously raining. Um and but that's that's that's why we build rope rescue systems, and that's why I teach small lightweight systems, because it has what what what I learned as a structured firefighter uh has has little to nothing to do with what we do in the backcountry. And that's and that's what separates I think some of the really good teams and some of the teams that don't appreciate the nuance of you know mountain rescue versus uh running two half-inch ropes and clutches on everything to hike it in. So that would have not been acceptable for all of our rescues historically. We still have it if we ever need to do a road-based you know, extrication. We're we're praying because they're so much easier.

SPEAKER_02 16:58

Yeah, I spent all this money on the shit. I want to use the clutch on the camera.

SPEAKER_00 17:02

Yeah. We've we've had one, uh, we've had one uh we actually had a motorcycle go off the road adjacent to camp at night, and a shock crew, this is a great, like, great reason for REMs, a shock crew um ended up responding to it, and this is like 10 or 11 o'clock at night. They go down to try to get that patient, check on them, and two or three of them fall while doing that. Then they call us and we're able to come there, set up some lines, and enable easier and safer access to and from and ultimately pull that guy up and out.

SPEAKER_01 17:32

Yeah, even if it's just a guideline that they go hand over hand on the way up is yeah, big.

SPEAKER_00 17:37

Just a little bit goes a long way. And it that takes that in particular takes a really experienced operator to know that, I mean, I've got all these bags of tricks, but the best guy at rope rescue in a mountain rescue environment like this, I mean, he's using as little gear as possible so he can move light and fast. But you can't make that decision off of a three-day rope rescue course or even six-day. Um, it takes years of experience, and that's where hiring good people. Yeah, yeah. Right tool for the right job, man.

SPEAKER_01 18:05

And you mentioned having you have one medic and three EMTs. We have a team that has a medic EMT, or sometimes we'll get lucky and have two. I think one of the changes, or at least, and maybe not a change, is they're not requiring all four members to be EMS qualified. And that can, you know, that I think kind of makes us all uncomfortable. A little bit. And and the point of this is like if you're a resource or another REMs teams, you should be talking to those REMs teams to figure out what their capabilities are. Not only it to work with them, but if if that's your REMS team on your division responding, and you only have they only have one medic, but you have two or three critical patients, you may need to get another resource in there. Yeah. I'm like, don't assume they're all medics or all EMS qualified in general.

SPEAKER_00 18:51

We had a we had a rescue on the Anvil or the Dutch, or not the Anvil, I forget what the the actual call was. We referred to as the Anvil because that was the fire it was on, where we deployed and we ultimately had two additional REMS teams deployed to the single patient. We did all of that work ahead of time saying, okay, if my patient goes down here, we're gonna hike in with this equipment. We want team B from a different company to bring additional gear that complements what we have. And we created that plan ahead of time. And you know, lo and behold, three days later, we have that exact patient in that exact spot, and they knew what to bring in. But that was only possible because we got together and said, hey, what am I really good at? What do I have? What are you really good at? What do you have? Let's we don't need three cardiac monitors to get hyped in two miles, you know. I just need what I need. And so uh that's been really good for us. But the whole, yeah, one medic, one EMT is a challenge based off the example I just gave this year. We had a call for three critical patients. Um, and so I I'm always a fan of more standards at a and and higher standards because that's what benefits our uh that's what benefits our our patients. That's what benefits our firefighters.

SPEAKER_02 19:59

Well, John, we love you, brother. Uh are you are you hiring or bringing people on? And if you are, like tell the audience about how they can work for one of the premier guys in the game.

SPEAKER_00 20:12

Uh yeah, so we're we are hiring. We're actually probably just about full on paramedics at this point. We didn't have any turnover in the last year, but we're gonna add a couple. Uh we're obviously hiring on the Journeyman app. That's where most of our good candidates come from, which I love. Uh we do take a lot of pride in in hiring veterans. I think 60 to 70 percent of us, depending on the year, are veterans like you guys and myself as well. And that that goes a long way. One of the things that we really and particularly want in our candidates is man, it's physical fitness and be professional, right? You can't you can't move weight on your body in the mountains if you're not running like a sub-10, 30 mile and a half, man. So that's our standard. We we like to move. Uh, and so yeah, we're we're iron, especially looking for EMTs, but ultimately, I think like yourselves, we're looking for good people.

SPEAKER_01 20:59

Yeah, good people. We'll make sure we get your Instagram and your website posted up on it too, so people know where to find you and reach out. Thank you. No, thank you, brother.

SPEAKER_02 21:07

Thank you for doing this, man.

SPEAKER_01 21:10

Thank you.