What have you seen Combat Medics do down range that was out of the scope of practice?

SFC Private RallyPoint Member — Wed, 12 Mar 2014 13:18:51 -0400

Just looking for some vignettes (stories) about what you have seen Combat Medics do down range that was out of the scope of practice.  PAs and DOCs I need you to chime in with events you know your medics have done down either at home station or down range.  Also for the providers; what do you train your combat medics on besides what is listed in the STP.  Within the 10 medical areas where should AMEDD put additional thoughts and resources to improve the training of Combat Medics moving forward into the wars of 2020 and beyond?

Response by SSgt Private RallyPoint Member made Mar 12 at 2014 1:31 PM

SSgt Private RallyPoint Member — Wed, 12 Mar 2014 13:31:35 -0400

My brother was a medic during the Cold War and he said if you worked hard enough and were reliable that doctors would let you do more.

Response by SFC(P) Private RallyPoint Member made Mar 13 at 2014 2:46 AM

SFC(P) Private RallyPoint Member — Thu, 13 Mar 2014 02:46:56 -0400

A medic's scope of practice is often expanded or contracted based off their relationship with the PA or the BN Surgeon if deployed. In my experience for a "good" medic their scope can be a lot more beyond the STP critical task list. I have personally performed many minor procedures in a field MTF environment as PFC while deployed. This was always proceeded by vetting through the BN Surgeon on every aspect of the of the procedure such as identification/conservative treatments/procedure risks/procedure steps/supervised executions.

From what I've seen, of medics that are coming out of the school house, they are still getting the full run through of combat oriented treatments, but are severely lacking on the general sick call identification, treatment, and documentation (Medical treatment ,organic and area support). I also had some basic field sanitation knowledge coming out of training, but now they seem to have none (Preventive medicine services). Which is a very large issue as the line medic can often serve in the place of the unit field sanitation team. For both of these shortfalls in training, I have not seen new medics come out with any additional training so I have no idea what may have taken its place.

Response by SGT Private RallyPoint Member made Mar 13 at 2014 3:10 AM

SGT Private RallyPoint Member — Thu, 13 Mar 2014 03:10:31 -0400

A medics scope of practice is a relative concept down range. Practically, medics don't have a scope of practice so long as they have proven they know what they are doing, and this also varies medic by medic, unit by unit. I'm well aware that this is legally not condoned, but as I said this is in practice how it works. Short of a medic performing open heart surgery in the field, so long as a medic can justify what they've done and are not incompetent then most PAs by my experience will back them up.

Response by SFC Private RallyPoint Member made Mar 13 at 2014 11:41 AM

SFC Private RallyPoint Member — Thu, 13 Mar 2014 11:41:17 -0400

Okay, to me this is a broad subject. A medic will excell has they see fit. During OIF 6 I had 4 NCOs that had no hands on medical trauma prior to deployment. It was up to me the FAS NCOIC to get them up to par. You always start with the basics ie bleeding airway.. Blah blah. But being that we were in a secluded place we had to go further. They learned the dynamics of what was in the MES sets and what every medication and very single piece of class viii was used for. Between the PA and I they were taught the basics along with the advanced. What I'm saying by advanced is RSI , intubation , chest tubes knowing the basics of ACLS amongst others. It was a daily learning experience. By the end of our deployment my Soldiers were treating children with the Broslow bag, intubating on their own. Was the PA there, yes, but not over there shoulders.  As a add on... I believe addition training should focus on medication medication medication. Especially now since the Army is going back to the ADTMC system. Since the war is coming to the end, more focus needs to be on sick call procedures. You would be surprised how many medics can't do a basic HEENT exam... And I'm tired of hearing this Motorpool medic also... just my two cents

Response by TSgt Brian Kidwell made Mar 13 at 2014 5:34 PM

TSgt Brian Kidwell — Thu, 13 Mar 2014 17:34:42 -0400

Well I was not a medic but I am proud to say my son is a combat medic station at Ft Lewis

Response by CSM Michael J. Uhlig made Mar 20 at 2014 9:59 PM

CSM Michael J. Uhlig — Thu, 20 Mar 2014 21:59:06 -0400

Medics, we had the full spectrum of medics with us in Task Force Spartan (1-36 Indantry) during OIF 05-07 (surge), our medics demonstrated some amazing feats of courage. Our first Silver Star was awarded to a medic (a Specialist) attached with our A co, 1-36 Infantry, his courage under fire was amazing, his action was something you'd expect to see a movie made about.

Our Surgeon saved countless lives throughout the deployment to Hit (between Aramark & Al Asad). Medics were essential to saving the life of one of our company commanders, we broke 5 tourniquets on him while exfilling him to the evac site.

One of our medics was a cutter, he would take a razor blade and cut his upper arm/shoulders....he said it was therapeutic to him. And our PA (at FB5 - across the Euphrates River) started losing it, he would shoot stray dogs and then try to save their lives. Our medics were all over our battle space, multiple Valorous awards were awarded to our medics, they were a huge combat multiplier for us!

Response by SGT Alexis Hernandez made Apr 2 at 2014 11:36 AM

SGT Alexis Hernandez — Wed, 02 Apr 2014 11:36:01 -0400

I deployed right out of AIT. My PA at the time was awesome, he taught us emergency chest tubes, suturing, nerve blocks, medication and various other skills. We actually bought a local goat to practice. (no the goat was not alive) but it did make for a great BBQ afterwards. Seeing as I ultimately spent most of my time as a medic in a combat situation, or taking care of the aftermath, the additional skills came in handy. Having training on what to do when "sitting" on a patient would be handy, outside of the basics. I never really had one for long before they were passed on to the next echelon or transported. I spent one week in a sick call after hurting my back, and I found it to be a challenge. Again, my PA was awesome, if I couldn't figure it out on my own, he didn't give me the answer, he gave me his medical books. He would then double check my findings. I have found trauma is easier to deal with, it is in your face and you see what you are dealing with, illness can be a very sneaky un-obvious thing. Just my input.

Response by SGT Shon D. Hill made May 13 at 2014 5:02 AM

SGT Shon D. Hill — Tue, 13 May 2014 05:02:58 -0400

Great question/discussion right here! I served 14 1/2 years as a combat medic, so I believe I have some nuggets to share on this. When I deployed to Baghdad, Iraq in 2004, I had 12 years and E5 rank on my "belt", but volunteered to be a platoon line medic with my Infantry unit, since there were too many NCO's on FOB for sick call anyway, lol! My company and platoon often ran missions far from base, so I was expected to not only handle any "trauma" medicine we are trained for, but also do my level best to diagnose/assess routine or intermediate illnesses or treatments that many junior medics probably not have ability or experience on. As a young medic, my NCO's drilled into me to take personal responsibility to never stop training or learning, even if above scope! Never stop reading, learning, seeking, pestering PA's/Dr/RN, etc to get more experience and chance to be the best medic you can be. I often treated IRAQI FN's wounds, sutures, even dx and tx illnesses often. I was mostly complete with RN Education at that time, so DR/PA's trusted my judgement. AMEDD dept needs to push directive that those medics who strive for more than just meet standard, have more opportunities to climb medical ladder! I had to pursue RN on my own, no real help from ARMY on that, my only real "gripe".

Response by MAJ Private RallyPoint Member made May 18 at 2014 4:23 PM

MAJ Private RallyPoint Member — Sun, 18 May 2014 16:23:34 -0400

As a Physician Assistant in the United States Army, a former combat medic, and a front line provider, I train my medics in everything I possibly can. The idea is to push as much knowledge forward as possible since I certainly cannot be everywhere. I train my medics to do everything as it relates to trauma (tourniquets, airways, crics, NCDs, chest tubes, digita intubation, morphine and ketamine usage, Narcan, and when it comes to noncombat (DNBI), i teach constantly to increase their awareness and ability to treat. Any provider who doesnt is failing his medics, in my opinion, and therefore failing the warfighter. AMEDD has done a poor job adapting its combat medic program with the reality of combat medicine. And as we leave the known combat theater, it will need to get its head wrapped around the idea of sustainment training for all medics, because table 8 BS is worthless and MSTC sites are hit and miss. If we dont support a solid program moving forward we will lose a massive amount of institutional knowledge and return to the medic we went to war with, not the Combat medic we brought home.

Response by MAJ Private RallyPoint Member made May 18 at 2014 4:34 PM

MAJ Private RallyPoint Member — Sun, 18 May 2014 16:34:42 -0400

The hardest thing is getting tech to the boots on ground. Took us years to get tourniquets mandatory. On the upside, dustoff is getting so quick these days that we can have most casualties at a role 2/3 within a few hours. It was common for us to get casualties below an hour from incident. The survival rate was nearing 100% if we could get them into surgery within the golden hour. But we need to keep pushing things like quick clot and smart tourniquets to the combat medics to maintain until they hit the role 3.

Response by SSG Roger Ayscue made May 19 at 2015 11:51 PM

SSG Roger Ayscue — Tue, 19 May 2015 23:51:03 -0400

TO ALL THE FNG's and Young Troopers still fighting the fight today reading this...Just ONE real-world, mission essential piece of advice...TAKE CARE OF YOUR MEDIC!, because Doc is Damn Sure gonna take care of you.
Doc don't pull guard, because when you are copping zulus Doc is checking feet and fevers...
Doc dont dig his own hole, he don't need blisters on the hands that will start your IV.
Doc eats FIRST, because he will spend 90% of that chow break making sure your NUGS and Privates are drinking water and eating something besides candy bars (I know this is YOUR JOB there Squad Leader, but Doc does it too, because he fracking cares).
Take care of Doc, Help him carry his load, cause most of his load, is for you and the platoon. One last thing, if your are still reading...Check Doc's feet once in a while, offer him a cookie from home in that box from your little sister, let Doc know he is part of the platoon, and is misassigned to HHC. Invite Doc to your platoon cookouts, and even to Christmas dinner if he is single.
In the fight or in Garrison, Doc is a Grunt's best friend.

Response by SGT Rick Ash made Sep 14 at 2015 6:13 PM

SGT Rick Ash — Mon, 14 Sep 2015 18:13:56 -0400

There was a medic forward with us, PFC Ryan and I remember for a fact he was from Presque Isle, Maine. I know he gave me HIS clean pair of socks for which I was so grateful. He denied it but I KNOW. It wasn't just me, all of our boots were always wet as we all remember well.

Response by MAJ Private RallyPoint Member made May 2 at 2016 11:13 PM

MAJ Private RallyPoint Member — Mon, 02 May 2016 23:13:59 -0400

For some time the 68W school had very low admission requiremts while at the same time graduation requirements were as high as ever. This meant high attrition for folks who should never have even been let into that MOS. I know the navy corpsmen are a smaller cohort with higher standards expected. Just about every line medic who is sent as borrowed medical manpower to the local TMC has to be extensively trained to standards. It is important to realize too that many medics have some advanced college credit or else they worked civilian EMS. Invariably the really bright ones are not fully utilized while the underperforms --who should be doing motor stables work-- are sent to the TMC to triage troops who are suddenly ill on the morning of Brigade fun runs

Response by SGT Private RallyPoint Member made May 2 at 2016 11:49 PM

SGT Private RallyPoint Member — Mon, 02 May 2016 23:49:05 -0400

I stiched a guys dick back together. FYI that falls into plastic surgery SOP. He lived and his dick still works.

Response by SGT Jerrold Pesz made May 3 at 2016 1:41 AM

SGT Jerrold Pesz — Tue, 03 May 2016 01:41:21 -0400

This was not a combat situation and was long ago but I never miss a chance to give our medics a pat on the back. The only surgery that I have ever had in my life was done by an SFC medic at Ft. Jackson who removed a tumor from my neck. From beginning to end this medic handled all of my treatment and I was extremely impressed by his knowledge and professionalism.

Response by SSG Leroy Farmer made Aug 23 at 2016 9:29 AM

SSG Leroy Farmer — Tue, 23 Aug 2016 09:29:40 -0400

I was a grunt for 13 years and have nothing but respect and admiration for all DOC's. Feel free to disagree, but if one provides first hand stories of medic performing procedures beyond their allowed skills, then do they not open themselves up to liability/military discipline? I'm just looking out for the medics who have done what needed to be done to save life or mitigate serious injury.

Response by Sgt Frank Rinchich made Aug 23 at 2016 10:34 AM

Sgt Frank Rinchich — Tue, 23 Aug 2016 10:34:52 -0400

To save a life or limb, in combat there are no rules. you mentioned in your topic intubating, I was a Paramedic 30 years ago and we were intubating on the street back then, or would you rather see a fighting man die because he can't breath. thumbs up to the medics that try any knowledge they have to save a life in combat. and to intubate you need an laryngoscope, you sure you know what intubation is ? and a PA or Dr don't have to be looking over your shoulder when you are trying a procedure , if you been trained to do something , you do it.

Response by SFC Bill Snyder made Aug 23 at 2016 10:52 AM

SFC Bill Snyder — Tue, 23 Aug 2016 10:52:45 -0400

i've been out longer then most of you have been in, but in Vietnam, most Medics, Army and Navy, participated in medical missions in the villages when not on operations. I did some Swift Boat stuff while assigned to a PsyWar type of unit, and we always had a Navy Medic (not a Marine) administering to the villages on remote Islands north of Nha Trang. It was amazing what a little bit of kindness did (at least for me). These villages were in insecure areas and never was there a problem. Great experience.

Response by Bruce Binder made Aug 23 at 2016 11:36 AM

Bruce Binder — Tue, 23 Aug 2016 11:36:15 -0400

Combat medics should be granted national civilian paramedic certification. These highly skilled clinicians should be able to transfer their skill and experience into the civilian world without the current hassle. Loosing just one would be a tragedy.

Response by SFC Everett Lunday made Aug 24 at 2016 10:34 AM

SFC Everett Lunday — Wed, 24 Aug 2016 10:34:38 -0400

When I taught at the Medical NCO school we conducted and certified passers with the ACLS card, even giving Instructor Potential. Also, at the end of training we would have a hands on exercise known as the Goat Lab where an anesthetize goat would be provided for advances procedures such as cut downs, cricothyroidotomies, and chest tube insets ions. The soldiers working under the PA who are trained by him/her are actually working under his license/certification and they are responsible for medical actions the soldier takes. The soldiers are there to assist the PA and Docs and if the PA it's kind of the person on the grounds responsibility to utilize their personnel as the tactical situation requires. IMO of course.

Response by SGT Rodney Wynn made Aug 24 at 2016 11:29 AM

SGT Rodney Wynn — Wed, 24 Aug 2016 11:29:31 -0400

In a perfect world once a medic hits E-5 they should be sent to the W1 course at Bragg. When I was tasked as a Medical OC/T with 1st Training Brigade USACAPOC I ran into a few senior NCOs that had not had the pleasure of having thoughtful PAs & Doctors that I had who went out of their way to train any medic that wanted to learn. These were medics that worked in hospital units or with a FST before getting transferred to a CA unit. They had no idea what it is like to not have surgeons with an OR right there. They would try to sharp shoot me about scope of practice or the proper way to package a patient. The NCOs that did this had no idea what is to have to wait hours for evac to arrive while trying keep someone alive all by your lonesome. If you are going by the official scope of practice people wll die. I am pretty confident in stating that there are quite few service members alive today because a medic did what they had to so someone could live. I have tried to train medics that believe because they outrank you they know better and they are usually the ones to tell you are going beyond the official scope of practice as laid out by AMEDD. This is why I think W1 should be required when a medic becomes an NCO, so the NCOs who lead are trained up as much as possible. We DO set the example. Well I did at one time before getting the blue ID card.

Response by MAJ Private RallyPoint Member made Aug 24 at 2016 1:48 PM

MAJ Private RallyPoint Member — Wed, 24 Aug 2016 13:48:37 -0400

A combat medic in my unit had way too much to drink at a unit function, so some other combat medics took IV solution from our classroom supplies (we were a training unit) and flushed her out in the barracks.

Response by Capt Seavy Barefoot made Aug 24 at 2016 3:48 PM

Capt Seavy Barefoot — Wed, 24 Aug 2016 15:48:40 -0400

Started my career as a Medic. Scrubbed surgery from 17 to 21 years old. Absorbed knowledge at a
very fast rate. The two Surgeons I scrubbed with taught me to perform minor surgeries on my own. My eyes and hands , knowledge of anatomy became very good. I went on to study after my tour, earned a couple of college degrees, went back in the service to fly airplanes. Guess you could say I went from defense to offense. No one ever complained or questioned my ability. I found my fellow airmen appreciated anything I could do for them. Treat your medics well, they do work hard to earn your respect. Compassion is a strength not a weakness.

Response by SPC Private RallyPoint Member made Aug 24 at 2016 3:59 PM

SPC Private RallyPoint Member — Wed, 24 Aug 2016 15:59:50 -0400

Not really downrange, but when I was at Carson, my Senior Medic used to drop his Med gear (hiding from the 1SG) and walk the line with us. He ran patrols with us, he pulled fireguard, etc. He basically turned himself into our Medical Grunt!

Response by 1SG Patrick Sims made Aug 24 at 2016 5:41 PM

1SG Patrick Sims — Wed, 24 Aug 2016 17:41:20 -0400

On the subject of Combat Medics, this fall is a motion picture called (Hacksaw Ridge) will come out. It's about the life of one of the greatest Combat Medics in history, Desmond Daus. I would recommend everyone on Rally Point watch it. A trailer is now available if you wish to watch it.

Response by MAJ Matthew Arnold made Aug 24 at 2016 5:57 PM

MAJ Matthew Arnold — Wed, 24 Aug 2016 17:57:48 -0400

After the Army, "downrange", I whitnessed a former army medic and a former navy corpsman work together to save the life of a man on our team. To be brief, the local doctors, by their ignorance, were trying to kill our team mate. Our medical pros had to argue with the local doctors and guard their patient. They guarded and treated him 24/7, for a week until he was evacuated to home country care. He survived only because of those 2 pros. God bless the "Docs".

Response by Sgt Frank Rinchich made Aug 24 at 2016 9:54 PM

Sgt Frank Rinchich — Wed, 24 Aug 2016 21:54:41 -0400

I made a response , question was do you know what intubation is, I think I could have worded it better, I meant no disrespect , if you can spell it I am sure you know what it is, again my apology and no disrespect .

Response by Sgt Frank Rinchich made Aug 24 at 2016 9:56 PM

Sgt Frank Rinchich — Wed, 24 Aug 2016 21:56:31 -0400

Response by Susan Weekley made Aug 25 at 2016 1:33 AM

Susan Weekley — Thu, 25 Aug 2016 01:33:29 -0400

Told and occasional video. Respect.

Response by Susan Weekley made Aug 25 at 2016 1:48 AM

Susan Weekley — Thu, 25 Aug 2016 01:48:26 -0400

Work demeaning civilians jobs because skills are not a respected transfer. Many more qualified than Doctor. God bless EMTs.

Response by SPC Brian Mason made Aug 25 at 2016 2:40 AM

SPC Brian Mason — Thu, 25 Aug 2016 02:40:43 -0400

As a a Combat Medic myself with two deployments, I'll tell you that almost all the other ones I worked with did things outside of our SoP. We are trained as an EMT-B (Civilian) and Combat Medic (Army). I won't run down everything we do just from that.
I've given tons of IV's, shots, dressed bandages, bagged patients with breathing difficulty, treated wounded under fire, stabilized I don't know how many people, etc. Here's the 'fun' part. I've held a man's brains in his head, while intubating him with help from another medic. I've had to assist packing a gunshot would on an Iraqi prison who shot himself: fit 2 unrolled Kerlix rolls into him to help stop the bleeding. I've ventilated 3 children all under 7; 2 of whom we lost. Cut dead skin off a woman's foot with diabetes so I could bleed and she would hopefully keep her foot.
Gave an IV inside a moving military ambulance; which is NOT easy. This guy along with 3 other patients at the same time. Applied tourniquets to those that needed and bagged the worst one while trying to close a severe head wound. I learned Advanced Airway and Advanced Trauma procedures roughly a month after I got to my first duty station.
Our PL (who is also a PA) decided who got the additional training. I got to carry Morphine and Narcan which we usually aren't allowed to carry unless the PA feels we are efficient in it's use. EMT's and Medics aren't about treatment so much as "Pack and Go" or stabilize and transport. With Medic training being 4 1/2 weeks there is no way be can become efficient in our knowledge and skills above basic level.

Response by SSG David Bennett made Aug 25 at 2016 9:25 PM

SSG David Bennett — Thu, 25 Aug 2016 21:25:11 -0400

I honestly don't care to talk about it but I saw a lot. We had a combat medic on our truck and he did awesome and amazing things. That's really all I want to say. No offense

Response by CSM Charles Hayden made Aug 26 at 2016 3:08 AM

CSM Charles Hayden — Fri, 26 Aug 2016 03:08:04 -0400

Response by CSM Richard Welsch made Sep 2 at 2016 11:26 AM

CSM Richard Welsch — Fri, 02 Sep 2016 11:26:04 -0400

confused because of the pressure and was about to start an IV with a 14 ga.And the worst part was his BS was very low including his respiration.I only wish we could have Administrated morphine at that time but he would never made it.

Response by SGT Private RallyPoint Member made Jan 23 at 2019 7:20 PM

SGT Private RallyPoint Member — Wed, 23 Jan 2019 19:20:48 -0500

My providers gave us a pretty broad blanket. We ran the role 2, triaged, highlighted the things we felt needed their attention, got a lot of things started before they even got there. They gave us a pretty wide scope to use a lot of meds we don’t necessarily have access to back home, so they definitely upped my pharmacology game and primary care skills.