New 68W Training

[Doczilla]

In the infantry 20 minutes flew by...as a medic with multiple cat a it's an eternity

Results vary. I see no delineation between infantry and medics "down there", because you're too busy putting rounds downrange. When you finally do get to put more hands on them, you have so much to do, that time flies by. You would be suprised how many people will address "ABC" then stare at them for the next 17 mins.

There is always something to do.

 

[RocketMedic]

But most of them are neither trained nor knowledgeable enough to even recognize that, Doczilla. That's what I'm trying to change in my unit.

 

[RocketMedic]

Pistol Training Day = Lolz.

Seriously, how do you not grasp the concept of a secondary weapon?

 

[EMT11KDL]

Ok. I have to pop in and say something. As a current whiskey and one that understands the changes to the 68w program. the whole 20 min thing has 2full assessments plus a rapid trauma assessment. The 20 min starts as soon as u reach ur and pull him to cover. Also they should be being taught that any critical medical care is addressed immediently ie airway breathing circulation. They should also know triage and have an understanding of it. Also first 5 mins once u get ur pt to safety is doing any life threatening conditions. After that if u can keep providing medical care u do. If u can't u pick up ur rifle and return fire or move patient to a safer location than continue your assessment. Now if the medics are coming out of training not knowing this that is either bad on them for not staying awake in class or the instructors

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[EMT11KDL]

The 20 also includes packaging the patient for transport.

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[RocketMedic]

EMT, most of these soldiers are good at cookie-cutter scenarios. What they seriously lack (as do most W's) is critical thinking skills and an understanding of medicine beyond "tourniquet, IV, go!".

Let me ask you something- do you think you are prepared for a real MCI from something like an active shooter?

 

[EMT11KDL]

EMT, most of these soldiers are good at cookie-cutter scenarios. What they seriously lack (as do most W's) is critical thinking skills and an understanding of medicine beyond "tourniquet, IV, go!".

Let me ask you something- do you think you are prepared for a real MCI from something like an active shooter?

Me personally or new emt or whiskeys?

for me. Yes i do believe i can handle one. Actually i know i can because i have been the incident commander on multiple mci and also been the only medical personal on a mci of 9 pt for 25 mins before i had one more emt and it was 55 mins before first pt was able to be transported.

Now i also have 5 years of combined 911 and whiskey work experience with working in a level 1 trauma center as a lead trauma tech.

Now for new emt or whiskey no i do not believe they could, but neither could you or anyone that is fresh out of school. There is no school in the world that can teach someone everything you learn on the job. This is why the civilian side has this amazing thing called FTO and why new emt and paramedics have to have an fto when they first start. So they can learn how things are done on the streets aNd i also believe that the military should adapt the same standard.

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[RocketMedic]

So what can we do here to bring 68Ws up to standard?

 

[EMT11KDL]

Honestly let them work. Let them touch patients and work in a er and on ambulance. They need experience.

 

[RocketMedic]

True- are you (or your agency) in a position to do that? We have a partnership between 1/1AD and El Paso Fire Department that we're trying to restart, and I can probably take a medic out with me to my part-time job, but what can we start across the nation?

 

[EMT11KDL]

I have taken some medics on ride alongs but there is nothing set for that. And i don't see that happening until they start training whiskey at the advanced level. That way they can use there skills im lucky enough to work in a trauma center with my military pa being a pa in the trauma center also. So i can do alot and keep my whiskey skills up.

 

[airborne2chairborne]

In airborne units at least medics have a good oppertunity for stateside trauma experience thanks to jump injuries as well as barracks medicine (cmon, what medic hasn't gotten that 3 AM knock on the door with "dooooc! We accidently shot the newbie in the eye with an airsoft gun!"?). Maybe other units just need to find a way to injure their infantrymen stateside more? I'm totally kidding about that last part, but I don't necessarily agree that civilian EMT work would be all that beneficial due to a completely seperate set of protocols as well as a much lowered scope of practice that civilian EMT-Bs have opposed to 68Ws. No IVs, no crics, no needle decompressions, etc etc etc... I think more available goat labs would be good though, those were fun

 

[RocketMedic]

I think that the vast majority of our 68Ws would greatly benefit from patient assessment skills and a wider clinical knowledge base. Hearing your medics (new and veteran alike) tell you that "I'm not going to carry a stethoscope or check lung sounds because this is gonna be combat and I won't be able to hear over the gunfire" and similar drivel is sickening, especially when their answer is "I'll dart the side that doesn't move".

Whiskey Phase is essentially a four-week CLS course.

Back to the topic, interventions are important, but they're far less important than assessment and problem recognition.

 

[TheMidnightPhilosopher]

My Thoughts

I believe all Navy 8404's and Army 68W would benefit from spending some time working in a clinical setting after their initial Field Medical Training. The clinic was the place that made me a better Corpsman, Trauma is important however diseases and various types of non-traumatic illnesses can sideline your boys as quick as a bullet can. However with the various conflicts military medicine is supporting, the powers that be are trying to crank out as many medics as they can.

 

[airborne2chairborne]

when i went through medic phase was about 10 weeks, I think it's down to like 8 now. I wouldn't say calling it a several week CLS class is accurate (unless they took out a lot of stuff?), but it was pretty much all field medicine aside for a week or 2 of clinical medicine. Honestly I dont see anything wrong with that. A medic going to a line unit is going to need those trauma skills more than sick call ones since there's plenty of people (senior medics, PAs, etc) to look over his shoulder in the clinic and teach him. In the field on the other hand there wont be. I'd rather a new medic know his way around TCCC and the skills for that and be an idiot with assessing clinical stuff than the other way around. If a new medic goes to a hospital then he'll get that clinical time anyway, and the point of AIT is to get you to the point of being able to learn from your unit, not to be supermedic right out of graduation. Does clinical time make you better at your medical skills? Absolutely, there's no arguing that. But with the limited time for AIT and the possibility of going straight to a deployed unit, field trauma training is more important during that.


As for stethoscopes and needle decompressions there's 2 sides to that. The argument "I wont hear it under fire" is true but stupid: unless it's a prolonged firefight you shouldn't waste your time on that anyway. get a tourniquet on and go back to shooting, a patient isn't going to develop severe pneumothorax and die within a minute or 2. On the other hand it doesn't take a genius to figure out which side to stick for open pneumothorax. See what side the hole is on, cover the hole(s), and drop the needle in. 2 holes on your right side isn't going to fill the left side up with air. Even if it's not needed right then it allows you to move on to other casualties with having 1 less thing to worry about, so in that sense a stethoscope is a bit useless. Keep in mind this is combat medicine not civie medicine, civilian medics don't have to worry about going from a secure place to having to shoot back at a moments notice and military medics dont have a rig full of supplies. So yes in 99% of situations I'd agree that assessment is more important than interventions, however combat is a bit of an exception. Assessment is needed (obviously, how do you know what to do if you don't know what the problem is) but it doesn't have to be detailed and most of the time what you can physically see is a good indicator. See a lot of blood coming from a limb, tourniquet it. See an open wound to the chest and back, seal it and drop in a needle on that side. I'd rather have enough tools to treat what I can see (remember: limited space) than have extra tools to diagnose what I can't see and not have the equipment to do jack about it. Situation dictates though.

 

[RocketMedic]

You've never done this for real, have you?

EDIT: If the medic is shooting, things are going off-plan rather quickly. BTDT.
EDIT2: Penetrating chest trauma does not work that way.
EDIT3: See top of post.

Fort Sam's 68W program could be much, much better.

 

[airborne2chairborne]

actually I have, I spent my time as a line medic and have more than my share of experience with casualties both on deployment and on drop zones. have you?

if a medic is shooting it doesnt mean things are going off plan. different units do things differently. In mine you were an infantryman first and a medic second, since fire superiority will prevent more injuries than you'd be able to treat in that same period of time. I've come across units that don't like their medic to get involved unless its treating a casualty. just because your unit did it that way doesn't mean all units do. I don't know when you got out, but read TCCC, it encourages medics to shoot back.

in a nut shell it does. air is going to get sucked in through the openings and will therefore cause pneumothorax in the injured side. closed pneumothorax is a different matter. Of course not all chest injuries are like that (especially in the case of shrapnel or blast injuries) but I gave a text book example and it was more about how trauma is something you can easily assess with just your eyes.

training could ALWAYS be much much better, and that doesn't just count for military thats civie side as well. The problem though is finding what needs to be changed and implementing changes, and by the time that's done it's already out dated or will be at the end of AIT.

 

[airborne2chairborne]

just in case you haven't read it, and don't know the current protocols for combat medicine, here you go:

http://www.naemt.org/Libraries/PHTLS TCCC/TCCC Guidelines 110808.sflb

What's the very first thing it says to do again? And whats the first step for breathing? Are you sure you've done this for real?

 

[Doczilla]

The whole "medic stays with the PSG" idea is not compatible with small unit movements, or even kinetic operations as a whole.

You better be ready to lay down some scunion when needed. Good line medics are qualified on crew-served weapons, and game- changers like mortars, Carl-G, and 40mm systems (203, 320, MK19,and M47).

If you're planning on being useful, you have to be a lethal weapon first--- yet still be a master of the basics up through PHTLS and some ATLS skills.

Being a well rounded medic is not easy.

 

[airborne2chairborne]

Well put doczilla