A Unique Program for Exceptional Medics
As there is no universally accepted certification process that authorizes the procedures, skills, and degree of autonomy required by medics who provide treatment in remote and austere conditions matching our mission and operational remit, Boots on the Ground (BOTG) began developing a Competence and Curriculum framework in 2010 suitable for real-world needs called the Remote and Austere Medical Practitioner (RAMP).
RAMPs are what we consider to be a new and exciting breed of medical professional who, while not doctors, work to the medical model. The RAMP pipeline combines elements of the United States Special Operations Command’s (USSOCOM) Advanced Tactical Practitioner (ATP) program with that of other allopathic medical models (such as the Physician Associate, Surgical Care Practitioner, and Surgical First Assistant) to produce medics that have the knowledge, skills, and experience needed to provide the highest level of emergency, extended, and primary medical care required after natural or man-made disasters, in developing nations, and in regions torn by conflict.
Because RAMPs can be needed virtually any place on the planet, regardless of the season, time of year, or given weather conditions, they must be multifaceted. We know that the survival rate of trauma victims, for example, depends largely on the close proximity and timing of a patient receiving definitive care. Moving a critically injured patient to a hospital, particularly in high-risk or remote areas, is often impractical or impossible. Accordingly, RAMPs are well trained and equipped to treat a variety of medical emergencies to include those commonly found in combat zones, harsh desert and wilderness, and other settings where communities and tribes generally have no heath care providers to assist when people become sick and injured.
Combined with very limited resources, RAMPs must be able to think both inside and outside of the typical medical box, and work to solve complex medical problems while taking into consideration the unique operational environment they may be in. RAMPs maintain significant certifications such as prehospital trauma life support (PHTLS), advanced cardiac life support (ACLS), and pediatric education for prehospital professionals (PEPP), all of which are provided in the pipeline either as initial certifications or re-certifications for candidates.
The training pathways that RAMPs engage in are broad, deep, and very controlled. Once certified, RAMPs are capable of treating patients in all environmental extremes, and have the ability and knowledge to practice preventive medicine, dispense and administer medications, perform multiple complex procedures, and provide lifesaving care to those in need where doctors or other senior medical professionals are otherwise unavailable.
Training & Certifications Provided
RAMP candidates run through an intensive training pipeline designed to bring individuals from different backgrounds and at varying levels of expertise to a single point of base competency expected of any certified RAMP by our organization. Training is incredibly intense, demanding, and highly academic in nature.
Candidates study a variety of foundational and advanced courses including, but not limited to, organic and inorganic chemistry, anatomy and physiology, pathophysiology, microbiology, pharmacology and pharmacotherapeutics, parasitology, and virology, clinical problem solving, differential diagnosis, advance clinical care, pre-hospital trauma emergencies, advanced trauma skills, surgical procedures, obstetrics and pediatric emergencies, cardiac pharmacology, training in combat trauma management, PEPP, and many others. Cultural training, sociology, and elementary French and Spanish are also required.
Professional certification include, but are not limited to, Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), Pediatric Life Support (PALS), International Trauma Life Support (ITLS) - Prehospital Trauma Life Support (PHTLS) bridge at the basic, intermediate, and advanced levels, basic Search and Rescue Technician (SARTECH), Wilderness Emergency Medical Technician (EMT-W) add on, Tactical Combat Casualty Care (TCCC), Geriatric Education for Emergency Responders (GEMS), and others.
Once RAMP academic components are completed, candidates move on to complete a clinical rotation and field internship abroad in South America, Haiti, or Africa. In some instances, candidates are provided opportunities to gain further certifications and training in areas well beyond the core RAMP curriculum, which are already significant, such as intermediate and advanced search and rescue techniques, close-protection, tactical driving, rescue and recovery diver (scuba), alternative deployment operations, team protection, protective intelligence, conflict resolution and peace operations, and others.