Posted on Jul 13, 2021
Do we adequately train medics to treat the most common injuries seen in the military? Where is the gap?
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According to the articles below, The primary cause of death in the military is not from combat but lies in the realm of DNBI. There are significant efforts aimed at training medics to be proficient in trauma medicine while observing tactical awareness using the phases of care under TCCC. What happens when the ASM, CLS, or medic come across a scenario like a heart attack during PT, vehicle vs. pedestrian, or a rollover in the training area when they don't expect it and may not have their aid bag handy? Working at the JBLM MSTC and in cooperation with the Madigan Emergency Department, we found that in a training environment standards went out the window and commonly there was no medic at POI or handoff to the ambulance, and no casualty documentation created or passed to the receiving MEDEVAC crew or MTF.
Where is the breakdown? Are medics not being trained as medics and lacking the knowledge of trauma skills usage in a training area and that DD 1380s are still fully applicable in a training environment? Is there a training gap that exists from the institutional standpoint that fails to cover how to react to a medical scenario or trauma scenario in a tactically safe environment? Respond with your thought and how we can make this better. Follow and comment on the thread here as well https://www.milsuite.mil/book/message/948063.
Trends in Active-Duty Military Deaths Since 2006
https://fas.org/sgp/crs/natsec/IF10899.pdf
"Summary of Deaths. Between 2006 and 2021, a total of 18,571 active-duty personnel have died while serving in the U.S. Armed Forces. (Throughout this In Focus, the designation “active duty” refers to all active duty troops, including mobilized Reserve and Guard components.) Of those that died, 25% were killed while serving in OCO operations—primarily within the territory of Iraq and Afghanistan. The remaining 75% died during operations classified in this In Focus as Non-Overseas Contingency Operations, or Non-OCO".
Since 9/11, military suicides dwarf the number of soldiers killed in combat
https://www.nbcnews.com/news/military/9-11-military-suicides-dwarf-number-soldiers-killed-combat-n1271346
"Since 9/11, four times as many U.S. service members and veterans have died by suicide than have been killed in combat, according to a new report".
A year without combat deaths: This Memorial Day, military fatalities overseas were the fewest since 9/11
https://www.militarytimes.com/news/your-military/2021/05/31/a-year-without-combat-deaths-this-memorial-day-military-fatalities-overseas-were-the-fewest-since-911/
"In the year since Memorial Day, 2020, 18 U.S. service members have died while supporting overseas operations, including Operation Enduring Freedom, Operation Freedom’s Sentinel, Operation Inherent Resolve, and NATO’s Kosovo Force. In 2001, 11 servicemembers died, but by 2003, numbers had soared to more than 500 deaths. The death toll peaked in 2007 at 1,020. And, as of May 27, there have been three deaths in 2021.None of the deaths were caused by hostile forces, and most were attributable to vehicle accidents. A U.S. servicemember has not been killed in action since March 11, 2020, when a rocket attack on Camp Taji in Iraq killed Army Spc. Juan Covarrubias and Air Force Staff Sgt. Marshal Roberts".
A 12-Year Analysis of Nonbattle Injury Among US Service Members Deployed to Iraq and Afghanistan
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6583884/?report=printable
"In this study, approximately one-third of injuries during the Iraq and Afghanistan wars resulted from NBI, and the proportion of NBIs was steady for 12 years. Understanding the possible causes of NBI during military operations may be useful to target protective measures and safety interventions, thereby conserving fighting strength on the battlefield".
Deaths due to injury in the military
https://pubmed.ncbi.nlm.nih.gov/10736538/
"Results: From 1980 to 1992, injuries (unintentional injuries, suicides, and homicides combined) accounted for 81% of all non-hostile deaths among active duty personnel in the Armed Services. The overall death rate due to unintentional injuries was 62.3 per 100,000 person-years. The suicide rate was 12.5, the homicide rate 5.0, and the death rate due to illness 18.4. From 1980 to 1992 mortality from unintentional injuries declined about 4% per year. The rates for suicide and homicide were stable. Men in the services die from unintentional injuries at about 2.5 times the rate of women and from suicides at about twice the rate of women. Women in the military, however, have a slightly higher homicide rate than men".
American War and Military Operations Casualties: Lists and Statistics
https://fas.org/sgp/crs/natsec/RL32492.pdf
"This report provides U.S. war casualty statistics. It includes data tables containing the number of casualties among American military personnel who served in principal wars and combat operations from 1775 to the present. It also includes data on those wounded in action and information such as race and ethnicity, gender, branch of service, and cause of death. The tables are compiled from various Department of Defense (DOD) sources".
Where is the breakdown? Are medics not being trained as medics and lacking the knowledge of trauma skills usage in a training area and that DD 1380s are still fully applicable in a training environment? Is there a training gap that exists from the institutional standpoint that fails to cover how to react to a medical scenario or trauma scenario in a tactically safe environment? Respond with your thought and how we can make this better. Follow and comment on the thread here as well https://www.milsuite.mil/book/message/948063.
Trends in Active-Duty Military Deaths Since 2006
https://fas.org/sgp/crs/natsec/IF10899.pdf
"Summary of Deaths. Between 2006 and 2021, a total of 18,571 active-duty personnel have died while serving in the U.S. Armed Forces. (Throughout this In Focus, the designation “active duty” refers to all active duty troops, including mobilized Reserve and Guard components.) Of those that died, 25% were killed while serving in OCO operations—primarily within the territory of Iraq and Afghanistan. The remaining 75% died during operations classified in this In Focus as Non-Overseas Contingency Operations, or Non-OCO".
Since 9/11, military suicides dwarf the number of soldiers killed in combat
https://www.nbcnews.com/news/military/9-11-military-suicides-dwarf-number-soldiers-killed-combat-n1271346
"Since 9/11, four times as many U.S. service members and veterans have died by suicide than have been killed in combat, according to a new report".
A year without combat deaths: This Memorial Day, military fatalities overseas were the fewest since 9/11
https://www.militarytimes.com/news/your-military/2021/05/31/a-year-without-combat-deaths-this-memorial-day-military-fatalities-overseas-were-the-fewest-since-911/
"In the year since Memorial Day, 2020, 18 U.S. service members have died while supporting overseas operations, including Operation Enduring Freedom, Operation Freedom’s Sentinel, Operation Inherent Resolve, and NATO’s Kosovo Force. In 2001, 11 servicemembers died, but by 2003, numbers had soared to more than 500 deaths. The death toll peaked in 2007 at 1,020. And, as of May 27, there have been three deaths in 2021.None of the deaths were caused by hostile forces, and most were attributable to vehicle accidents. A U.S. servicemember has not been killed in action since March 11, 2020, when a rocket attack on Camp Taji in Iraq killed Army Spc. Juan Covarrubias and Air Force Staff Sgt. Marshal Roberts".
A 12-Year Analysis of Nonbattle Injury Among US Service Members Deployed to Iraq and Afghanistan
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6583884/?report=printable
"In this study, approximately one-third of injuries during the Iraq and Afghanistan wars resulted from NBI, and the proportion of NBIs was steady for 12 years. Understanding the possible causes of NBI during military operations may be useful to target protective measures and safety interventions, thereby conserving fighting strength on the battlefield".
Deaths due to injury in the military
https://pubmed.ncbi.nlm.nih.gov/10736538/
"Results: From 1980 to 1992, injuries (unintentional injuries, suicides, and homicides combined) accounted for 81% of all non-hostile deaths among active duty personnel in the Armed Services. The overall death rate due to unintentional injuries was 62.3 per 100,000 person-years. The suicide rate was 12.5, the homicide rate 5.0, and the death rate due to illness 18.4. From 1980 to 1992 mortality from unintentional injuries declined about 4% per year. The rates for suicide and homicide were stable. Men in the services die from unintentional injuries at about 2.5 times the rate of women and from suicides at about twice the rate of women. Women in the military, however, have a slightly higher homicide rate than men".
American War and Military Operations Casualties: Lists and Statistics
https://fas.org/sgp/crs/natsec/RL32492.pdf
"This report provides U.S. war casualty statistics. It includes data tables containing the number of casualties among American military personnel who served in principal wars and combat operations from 1775 to the present. It also includes data on those wounded in action and information such as race and ethnicity, gender, branch of service, and cause of death. The tables are compiled from various Department of Defense (DOD) sources".
Posted in these groups: 
Tactical Combat Casualty Care (TCCC)
Medic
Combat Medic
Platoon Medic
68W: Healthcare Specialist (Combat Medic)
Tactical Combat Casualty Care (TCCC) Medic Combat Medic Platoon Medic 68W: Healthcare Specialist (Combat Medic)
Posted >1 y ago
Responses: 4
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Whether or not they have morphine out in the field, during training excersizes. This was an issue that goes way back. I saw/heard in happening , going back to the late 1980's- early 1990's. Higher-up obstruction create such a PITA or didn't allow it , becuase of the schedule nature of the drug.
But it dam would have been needed in cases of traumatic injuries. Burned my ass ,everytime I heard our Medics in the field didn't have morphine because of the BS zero tolerance and top-down control measures crap that infested the Mil leadership about it.
But it dam would have been needed in cases of traumatic injuries. Burned my ass ,everytime I heard our Medics in the field didn't have morphine because of the BS zero tolerance and top-down control measures crap that infested the Mil leadership about it.
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It is not a training problem, it is a utilization problem. Active duty units need to stop seeing their medics as motor pool jockeys, parade formations, CQ, and all of the other non-medical tasks they do during peacetime. Once that stops, get them out in the field and in peacetime, that is not the Army. Here in El Paso we have Life Ambulance running 911 calls in the country, at least three volunteer fire departments, and AMR an hour away with the city and county 911 contract. I am dual licensed and for the past six years doing both RN for the Army and paramedic to keep my skills and was a 91B in 1993. It is a win win situation for any Army community, your medics get out in the community helping the community (great PR) and the medics see real live shit. You can find a 911 service close to every military post and 75% of the fire service is volunteer. I just retired and my last unit just filled FB with picts of putting the hospital up and doing fake patients. A culture change needs to come from big Army and until that happens in my opinion, our peacetime medics will not get better. Even with active duty medics, unless you were at something like Mogadishu or Fallujah One or Two or the Mosul mess hall bombing, or Keating, etc you really have not seen much. As things stand now, a seasoned medic has seen a lot of buddies get hurt and that experience is not worth the cost in PTSD. We have the civilians around our posts that get hurt, get sick, and taking care of them does not mess with your head as much as the infantry guy you used to go on long walks with...
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SGT Erica Smith
I could not agree more. Medics are not utilized appropriately in their units. And instead of getting training in their downtime, they are used to pull nonsense details that anyone could do. I’ve also been in units where the senior medics have less knowledge and understanding of army medicine due to the types of units I was in previously. While they were doing paperwork and various other tasking, I actually did training. But when I tried to assist them with training I was met with resistance because “we don’t do that here”. It’s a whole culture of the Army not caring to utilize their medical personnel appropriately.
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I agree with your statement and the answer I keep getting from the schoolhouses is that its TRADOC and they can't make the AIT longer due to $$
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SPC Christopher Perrien
MAJ Byron Oyler - I understand they cycle some Army doctors though ER's in big cities like Chicago, because there are so many gun-shot wounds. Far more than they would see "over-there", (good training) sadly
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SGM Erik Marquez
MAJ Byron Oyler - I admit, Im a product of my past, so maybe limited in "experience"
But over a career of 28 years E-1 to Sergeant Major E9 as an Infrantraymen in Infrtary units other than one speciality assignment as a Drill Sergeant, I did not see our assigned medics used "as motor pool jockeys, parade formations, CQ, and all of the other non-medical tasks"
Did they go to the MP on command maintenance days and maintain their assigned vehicle? YES
Did they get listed on the DA Form 6 and pull duty like the rest of the company? YES, unless exempted for a needed training event..which was common.
Did they stand in formation for a Parade? If so it happened so rarely I have no memory of it..they were always AT the parade, but with ATLS bag and staged to render aid as needed.
I also saw more than a few 68W attend advanced training (live tissue training AKA Goat lab), get advanced certs (EMT-P and EMT-I ) all under the direction and support of the command.
Perhaps my experience is limited and the rest of the Army units I was not part of used their assigned 68W in a completely different manner. If so, I don't understand why....No more than I can understand why a unit might put a Turret mechanic on a 180 tasker as a lifeguard and assign a 88M to work on turrets or a 88M tasked out as wash rack attendant and leaving driving duties to an out of MOS 11B.
The only time I have seen such is when the SM in question was significantly incompetent in MOS duties, to a critical point and not using them as assigned was safer than keeping them in place.
But over a career of 28 years E-1 to Sergeant Major E9 as an Infrantraymen in Infrtary units other than one speciality assignment as a Drill Sergeant, I did not see our assigned medics used "as motor pool jockeys, parade formations, CQ, and all of the other non-medical tasks"
Did they go to the MP on command maintenance days and maintain their assigned vehicle? YES
Did they get listed on the DA Form 6 and pull duty like the rest of the company? YES, unless exempted for a needed training event..which was common.
Did they stand in formation for a Parade? If so it happened so rarely I have no memory of it..they were always AT the parade, but with ATLS bag and staged to render aid as needed.
I also saw more than a few 68W attend advanced training (live tissue training AKA Goat lab), get advanced certs (EMT-P and EMT-I ) all under the direction and support of the command.
Perhaps my experience is limited and the rest of the Army units I was not part of used their assigned 68W in a completely different manner. If so, I don't understand why....No more than I can understand why a unit might put a Turret mechanic on a 180 tasker as a lifeguard and assign a 88M to work on turrets or a 88M tasked out as wash rack attendant and leaving driving duties to an out of MOS 11B.
The only time I have seen such is when the SM in question was significantly incompetent in MOS duties, to a critical point and not using them as assigned was safer than keeping them in place.
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MAJ Byron Oyler
SGM Erik Marquez - I have been assigned to both TDA ands TO&E over the last 18years and getting enlisted medical personnel doing their job can be extremely difficult. Ten years ago I sat down with my SR Rater and CSH CO asking for more leadership opportunities and his response was, " I need you training my medics." I spent 75% of my time in the ED as a staff nurse and the other 25% as the CSH doing inventory and setting up tents. The medics were almost never available. I had an LPN in Afghanistan that had not touched a patient since AIT and he was an E5. Having done 91B and been an EMT since 1993, both the medic side and EMT is entry level. Training on a goat is cool (did it 2007) but until you have a sick or injured human, it is all training. We spend lots of money on paramedic training but unless you are working a truck in a busy 911 system, you are a paper paramedic. We have a bad habit in the Army of getting all these certifications and calling it good; the real training and experience is when someone is crashing on you and you are the top dog. Three years ago on short notice (two days) we sent the entire 31st CSH to do a Emergency Deployment Readiness Exercise. We put the tents up, had fake patients, and my favorite, I pulled guard duty as a major and critical care nurse. I volunteered for that to get away from the fake patients. The reality of what our medics train for and get experience in is night and day difference than what most people believe it is. If either of my children decide to enlist, I will do everything I can to keep them from a medical MOS unless IDMP or 18D. They can do something cool and I can give them all the training they need to be a good medic.
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