Posted on Mar 12, 2014
What have you seen Combat Medics do down range that was out of the scope of practice?
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<p>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. </p><p>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?</p>
Medical
Training
Combat
Combat Service Support
Deployment
Posted 12 y ago
Responses: 35
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I stiched a guys dick back together. FYI that falls into plastic surgery SOP. He lived and his dick still works.
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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.
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.
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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.
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SFC (Join to see)
NO there should be no concerns of that in this type of environment. If you ask people to define the scope of a medic... you would hear a lot of different levels of responsibility. This is one issue with the field craft, as a SGT I was allowed to give blood at point of injury if I had it available. This practice is vastly looked down upon from many others but the practice is supposed to be with the scope of the SSG, just look at our STP.
Just need the stories
Just need the stories
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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. <br><br>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. <br>
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SFC (Join to see)
Okay, we know open heart surgery will not be performed by anyone in a dirty environment, but do you think medics need or require training on post damage control resuscitation (DCR)?
DCR is defined as a systemic approach to major trauma
combining the <C>ABC (catastrophic bleeding, airway,
breathing, circulation) paradigm [1] with a series of clinical
techniques from point of wounding to definitive treatment in
order to minimise blood loss, maximise tissue oxygenation and
optimise outcome.
This isn't simply doing the TC3 steps and evac. This would be TC3 and then sitting on a PATIENT waiting on evac for 6-12 hours short term and possibly, depending on evac cat, longer.
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SGT (Join to see)
Absolutely sergeant. More training is always great, and what to do while sitting on a patient isn't always something focused on during training, so that especially would be beneficial. Lord knows evac times in Afghanistan are notoriously horrendous.
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MAJ (Join to see)
SFC Jolly....we already teach them damage control resuscitation right here at Fort Sam. It's called Brigade Combat Team Trauma Training (BCT3) . The instructors are by far the best I've ever seen, not constrained by the METC or DC MT curriculum.....and I am it's OIC
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Work demeaning civilians jobs because skills are not a respected transfer. Many more qualified than Doctor. God bless EMTs.
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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.
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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.
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CSM Richard Welsch
Any medic 68 W an 18D would know this but all medics should know their A B C
Evaluation of the unconscious Patient
Overdose, And Poisoning.
A. Initial evaluation
B. Differential diagnosis
C. Metabolic disturbances
This is very easy to overlook among much other things.But I will say this.What I learned in medical school Up State Sunny
NY is nothing like the battle field or Red Zone
Evaluation of the unconscious Patient
Overdose, And Poisoning.
A. Initial evaluation
B. Differential diagnosis
C. Metabolic disturbances
This is very easy to overlook among much other things.But I will say this.What I learned in medical school Up State Sunny
NY is nothing like the battle field or Red Zone
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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
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