RAMP Program

The Remote and Austere Medical Practitioner (RAMP) is a unique hybrid medic, whose baseline knowledge and skill sets begin with meeting the cognitive and psychomotor requirements for certification as an entry-level medic, and then progressively expands to focus on a myriad of both medical and trauma management problems that are typically well above the scope of practice of many other prehospital care providers.

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) developed a Competence and Curriculum framework suitable for real-world needs called the Remote and Austere Medical Practitioner (RAMP).

RAMPs are a new breed of medical professionals 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.

Different RAMP Levels

Fully certified and registered RAMPs have progressed through a strict regimen of academic and hands-on training, and hold multiple component and ancillary certifications. We currently have five main RAMP levels, and each level identifies the abilities and limitations of the holder with the context of our Competence and Curriculum framework and standard operating procedures.

RAMP-Recruit is a non-certified entry-level position for individuals accepted into our RAMP training program. All candidates are 18 years or older and most have already completed an EMT course, or are currently enrolled. This is the beginning phase of training that leads to Step 1 certification.

RAMP Step 1 is the basic certification level required by BOTG to provide support to DMATs on deployments. RAMP 1s are generally EMT-B certified and have at least three years of pre-hospital care training and experience, in addition to having successfully passed RAMP Phase 1 training.

RAMP Step 2 is the intermediate certification level required by BOTG to act as assistant team leaders while on deployments. Generally, Step 2 holders have three to five years of experience and are EMT-I or P certified or equivalent, in addition to having successfully passed RAMP Phase 2 training

RAMP Step 3 is the advanced certification level required for autonomous deployments and to act as a team leader. Most RAMP 3s have five to ten years of experience and hold an EMT-P certification or higher (such as PAs or NPs), in addition to having successfully passed RAMP Phase 3 training.

RAMP Step 4 is our highest designated certification level. RAMP 4s are generally EMT-Ps who have passed SOF ATP certification, our RAMP Phase 4 training, or both. In addition, they have had significant deployments under their belt to multiple countries in a variety of environments, and have demonstrated leadership ability.

There are also RAMP ranks that are positional in nature, and are based on leadership ability, experience, and functionality within the organization.

How can I become a RAMP?

There are several different paths new recruits that can be taken to become a BOTG certified RAMP eligible for deployments under our organization’s umbrella. All candidates must pass a background investigation, oral board and/or interviews, physical and written examination regardless of service, previous education, current medical certification level, deployment experience, or background. Please read the following explanations to identify which best describes your current circumstance. If you require further information, feel free to get in touch with a recruiter by completing our volunteer application.

Recent and Current SOF Medics:

Those individuals who have graduated from the Joint Special Operations Medical Training Center’s (JSOMTC) Special Operations Combat Medic Course (SOCM) at Fort Bragg, N.C. or the Air Force Pararescue (PJ) School at Kirtland AFB, N.M. within the last twenty years, and have prior or current certification as an ATP through USSOCOM Command Medic Certification Program (CMCP) within the last four years, may submit their record for review.

Though not universally so, candidates with these credentials are generally grandfathered in as RAMP 4s, assuming they also have the requisite BLS, ACLS, PHTLS, PEPP, and other ancillary certifications that RAMPs must possess to be registered. Candidates from other countries who have trained in similar schools with allied countries may also be considered.

Prior SOF Medics (more than four years and/or no ATP certification):

Candidates who served as PJs, 18Ds, or in similar capacities within the SOF community, but do not fall within parameters listed above, or have never held ATP certification, are encouraged to apply and will be evaluated on a case-by-case basis. In all instances, candidates in this category will be required to establish their service record and competency levels prior to acceptance at any RAMP level.

Recent and Current Combat/Service Medics:

Those individuals who have graduated from military service schools in any branch of the armed forces and have also held EMT certification at any level within the last two years, may directly transfer into our RAMP certification program. As with the above example, candidates must pass a background investigation and a comprehensive written medical skills examination to establish their current medical knowledge level. Once the exam is graded, the candidate will be placed in the appropriate RAMP training phase.

Prior Combat/Service Medics:

Candidates who served as combat or service medics in any branch of the military within the last ten years may apply for direct appointment into our RAMP training program, but must undergo comprehensive testing to establish their current medical knowledge.

Non-Military EMTs & Paramedics:

Those candidates who are currently certified as EMTs (B, I or P) at the state or national level, and who successfully pass our recruitment process, may directly enter our RAMP recruit program to be evaluated for advanced placement to one of the RAMP training phases or steps. This process is challenging and is designed to establish the candidates physical and mental capacities, as well as their clinical knowledge. Once a recruit is accepted into the training program, they are assigned an FTO (Field Training Officer), tested, and placed in the appropriate phase or at a given step.

Associate RAMPs:

BOTG offers training programs designed to allow non-organizational medics the opportunity to become RAMP certified. EMTs (or equivalently trained medical personnel) from around the globe are allowed to enter our Associate RAMP training program, which mirrors the requirements of our RAMP Recruit Program, but does not have the same residency requirements. Successful candidates who matriculate into the A-RAMP program spend six to twelve months completing distance learning assignments, each of which concludes with a proctored exam. In addition, they must fulfill a significant internship at an approved clinic, hospital, or other similar organization.

Background Checks:

Because of the sensitive nature of our deployments and those we interact with internationally, ALL candidates will undergo an extensive background investigation inline with that required to hold a Secret clearance with the US government or its allies. Those individuals who can provide a copy of an active Secret (or higher) clearance issued by the DOD, DOS, or similar agency are exempt. Anyone with a felony conviction, of any kind, or a conviction at any level involving moral turpitude should not apply for our RAMP program (with the exception of anyone who’s had a pardon, been given clemency, or has had their rights fully restored AND more than a decade has passed since the conviction).

Further, anyone with a dishonorable discharge from the armed services should not apply for our RAMP program. Please note that our goal is not to exclude capable and skilled candidates who have a heart for service, but rather, to reduce risk and ensure mission safety and the safety and security of those we serve. In some cases a moral waiver may be obtained (in rare instances), but you should not count on it. We are very strict about the people we work with, and we tend to only seek candidates who have a verifiable history of service, the highest levels of integrity, a life of honesty, and trustworthiness. If you have ANYTHING in your background you are concerned about, we’d encourage you to be upfront about it very early in the process.

Successful applicants are provided with a full grant to cover all tuition and books worth $25,000 USD.

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