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
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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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 .
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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".
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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.
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MSG Christopher Keller
I had the pleasure of meeting several MOH awardees in the late 80's at Ft Leavenworth, I don't recall the event but several surviving MOH awardees were present Desmond Doss, Chuck Hagemeister and Roger Donlon were present. The first medal of the Vietnam war was presented to Roger Donlon for rescuing and administering first aid to several wounded soldiers and leading a group against an enemy force. Chuck Hagemeister was also a medic who risked his life to render medical aid to several injured soldiers and protected them until they could be evacuated. I have the pleasure of seeing those 2 gentlemen periodically as they live in the same town I live in. I will look for the movie I would love to see it.
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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!
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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.
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.
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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.
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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.
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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.
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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.
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