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>
Posted >1 y ago
Responses: 35
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.
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.
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SGT Eric Knutson
Well said bud, I keep think of MSG Pils, the stud sure took care of us, didn't he? I had another, Sgt Dietrich, I forget where, but those 2 really stood out in my mind.
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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.
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MAJ (Join to see)
In my perfect army the Charlie Med company medics would have had extensive working experience with the PA or PROFIS Dr. Perhaps the afternoon one day a week the TMC could shut down and the medics could huddle around the PA to learn as much as he or she could teach them about all the stuff you cited above. You have no doubt accumulated a vast narrative about the medics you took to war compared to the combat medic you brought home. What we most need is men like you and other P.A. from the BAS who could go to AMEDD C&S and do a thorough review of the curricula and if need be add stuff or toss out/decrease other stuff based on what you saw and where you identified gaps or flaws in their training.
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CSM Charles Hayden
MAJ (Join to see) When I visited a former BN, the medics were so pleased to introduce me to 'their' PA!!! Thank you for your service and your 'care'!
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MSG Christopher Keller
when I first became a medic and was assigned to 2/10 (Air) Cavalry at FT Ord in 1980 our Bn PA had me follow him everywhere, he gave me a book to read a fat green book on differential diagnosis (i still have it) when he wasn't grilling me I was reading, when he was suturing I was holding the light while he explained why he did everything. In the aid station or in the feild I was with him until he felt I was ready to be on my own, Did we do things outside our scope, hell yes, we did what we needed to do to take care of our soldiers. The more your learn in garrison or training the more ready you are if/when the sh** hits the fan.
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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.
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.
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SFC (Join to see)
So what I need from you is a story, yours or someone else's that you witnessed. I've been a combat medic for 15 years now and need to expand upon stories from the field with AMEDD Lessons Learned and social media. So what do you have for me?
If you want to tell me why preventive med is needed from the combat medic in a manuever company/platoon/squad formation from your story(s) experience, please do.
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SGT Suraj Dave
Surgical Cric under fire and Chest tubes aren't really out of scope... it is taught to most medics in forsecom during BCT3...
Going to my first unit, I had no clue how to do sick call or write SOAP notes. Learned all that at my first unit. In juries I treated under fire were normally just extremity GSW's but I did deal with a GSW to the neck and inguinal region also.
Going to my first unit, I had no clue how to do sick call or write SOAP notes. Learned all that at my first unit. In juries I treated under fire were normally just extremity GSW's but I did deal with a GSW to the neck and inguinal region also.
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SSG Genaro Negrete
I agree with the field san portion. It took me weeks to get the BSMC's Prev Med soldier out to my COB for an inspection of the facilites. By then, it was more of a formality. But that bad case of the shits can leave a soldier susceptible to more debilitating ailments or simply puts them out of the fight for something easily preventable.
It seems that the school house has had a lot of pressure to crank out deploy-able medics. All the clinical and preventative medicine seems to have taken a back seat.
It seems that the school house has had a lot of pressure to crank out deploy-able medics. All the clinical and preventative medicine seems to have taken a back seat.
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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.
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MAJ (Join to see)
That was a damn good P.A you had. I think most of the medics in my Charlie Med Company didn't really meet or know the P.A prior to our deployment. In the actual run-up to deploying to our fixed Aid Station we should have had far more training lined up for the medics. Since they are generally "owned" by the company commander and 1SG it requires a strong prior enlisted PA to demand time to train the medics to his or her standards.
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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!
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!
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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
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MAJ (Join to see)
Medics should be held up to higher standards. Get them a few ER rotations. Pair them up with a Bn PA. If you have someone you can trust to do ET tube insertion, chest tubes etc then let them do it with good supervisory oversight. Good review of meds and regularly scheduled Rx familiarization during Sergeants Time would be helpful.
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Cpl George Crab
During WW2, on a submarine (in?), a corpsman (Pharmacists Mate?) had to do an appendectomy. He wasn't trained on doing that. But he had to do it, or the patient would have died. The patient lived!
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LTC Thomas Cahill
The story of the Pharmacists Mate who did the appendectomy is true. What is also true is that even though it saved the man's life - remember this was before we had antibiotics that could treat the peritonitis that results from a ruptured appendix, even if they would have been available on a submarine - the Nave wanted to try the Pharmacists Mate for acting outside his Scope of Practice.
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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.
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MSG (Join to see)
I fully agree, in theater they see more in a deployment than many Paramedics do in a year. Their experience is invaluable especially if they go home to a small town or a volunteer fire department.
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MAJ (Join to see)
From what I have heard, this is by-design because the military does not want to lose trained medics. Apparently the curriculum that produces a combat medic exceeds the EMT-B but falls just short of the EMT-I for this very reason. I have been out of the military medical scene for several years now, so maybe this has changed.
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Well I was not a medic but I am proud to say my son is a combat medic station at Ft Lewis
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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.
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Cpl George Crab
Bill, the USMC doesn't have people that are trained to do Medics work. The USN always provides the Corpsmen to do that job, even though Marines are trained in first aid.
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SFC Bill Snyder
Cpl George Crab - I realize that. II Corps was not the AO for Marines (they were in I Corps). That's why I made a point in saying they were Navy Medics not Marines.
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SGT Rodney Wynn
Unfortunately the NREMT says we don't get enough didactic time, they don't care about OJT.
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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.
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Sgt Frank Rinchich
1st Lt Rev David Poedel - you are telling me I lied about intubating 30 years ago? and you are saying I didn't have the brains to master a vital skill , not only were we intubating, we were giving streptokinase a clot buster as protocol you disagree that a medic should use all his skills to save a combat injury's life. if that is correct I disagree with you, if I was on the battle field and a man could not breath and there was a piece of bamboo close by I would use it and do a tracheostomy. and I was not skilled in that but knew how it was done. you a Rev. and you would put your job or career and ahead of a life and allow a solider to die.
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Sgt Frank Rinchich
Sir I do not question your skills or medical knowledge, and the do you know what intubation is was directed at the original poster not at you. my question to you is would you allow a solider to die if you thought with what medical skills you had you would not try a tracheostomy, you would not go beyond your skills and try to save a life on the battle field?
And no I have never done a Digital intubation. but I have done many many intubations in my 20 years as a Paramedic from children to the late elderly I have done a femoral artery clamp on the street by flashlight and was not trained in it, but I was book smart so I did it, other wise the patient would have died in a short time. and with Gods help the young man lived. it was not my skills it was luck but I didn't worry about my job I only seen a young man bleeding to death. And you know the ER doc. didn't chew me out , patted me on the back and said good job Frank.
And no I have never done a Digital intubation. but I have done many many intubations in my 20 years as a Paramedic from children to the late elderly I have done a femoral artery clamp on the street by flashlight and was not trained in it, but I was book smart so I did it, other wise the patient would have died in a short time. and with Gods help the young man lived. it was not my skills it was luck but I didn't worry about my job I only seen a young man bleeding to death. And you know the ER doc. didn't chew me out , patted me on the back and said good job Frank.
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Sgt Frank Rinchich
Yes things have changed a bit in the last 30 years, IVs I don't think they even use D5W tko any more, unless its a trauma with loss of blood probably they don't even attempt an IV. notice they only carry saline or ringers, I have at times used a butterfly but mostly on young or elderly only to give meds.
in reference to tapping the pericardium we were taught a brief procedure but never trained doing it. to me that would be easier then intubation. do it slow watch for fluid in the syringe and I can't see doing any harm. may be all wet on that but only my opinion.
anyway thanks for your service and your education , I did learn something, I never knew anything about a digital intubation so never to old to learn.
Semper fi
in reference to tapping the pericardium we were taught a brief procedure but never trained doing it. to me that would be easier then intubation. do it slow watch for fluid in the syringe and I can't see doing any harm. may be all wet on that but only my opinion.
anyway thanks for your service and your education , I did learn something, I never knew anything about a digital intubation so never to old to learn.
Semper fi
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