# New 68W Training



## RocketMedic

Perhaps I'm behind the times, but my new guys were trained to start performing interventions like saline locks before even a rapid trauma assessment, instead performing only an extremity and torso blood sweep, and well before any patient packaging, evacuation concerns, or further evaluation. Not only that, but they've apparently only learned '500mL of Hextend if there's no radial pulse!' and no other fluids, meds, proper assessment techniques...it's scary. 

These kids are going to be at war in 12 months and they can't even _start_ IVs in classroom conditions, much less perform proper trauma assessments, and the less said about medical problems, the better.


----------



## seanm028

When I graduated in April '10 that's not how it was.  Granted there wasn't quite as much pharmacology as I would have liked, but I guess that is more of a unit-specific skill.


----------



## RocketMedic

I'm really, really disappointed in Fort Sam's education. Even new civilian EMTs are better at their jobs than these new medics, even confronted with similar problems.


----------



## Handsome Robb

I'm pretty sure the new TCCC guidelines say 500 of Hextend then 500 more if no effect and that's the max, but don't quote me on it. 

That's still no excuse for what they are teaching though.


----------



## RocketMedic

TCCC guidelines say that, yes, but these medics don't even know what Hextend is, much less how to use it appropriately.


----------



## Handsome Robb

Rocketmedic40 said:


> TCCC guidelines say that, yes, but these medics don't even know what Hextend is, much less how to use it appropriately.



Fail. Not on your part, just to be clear.


----------



## DocCheddar

Rocketmedic, I'm not sure what they are teaching the 68W, but I have been a Navy Corpsman for 7 plus years. Im a certified TCCC instructor, and the guidelines for hextand not to exceed 1000ml is correct. In fact we are not pushing fluids like we use to 5 years ago, and in most cases its not necessary.  TCCC focuses more on care under fire, and evacuating pts.  They should still be taught a trauma assessment but not like civilian emts.  We have no need for primary, and secondary assessments while under fire.


----------



## RocketMedic

Its not improper tc3, its the total lack of any other knowledge.


----------



## Doczilla

The bottom line is, they Army only cares about putting warm bodies where the need is great. Even the instructors that give a crap are chastised for giving people a "no-go", because statistically it will reflect negatively on the organization. 

They used to have one shot to  pass the NREMT, then they would get recycled, or worse. Then it moved up to three, then six. 

Six shots?! For NREMT-B? 

So, the primary concern is just getting people through the program in the hopes that someone at their receiving unit will "fix" them. But this dosen't happen either. The end result? I see a 68W trying to *suture bullet holes up*, or surgically cric a 3-year-old, or giving out claritin for anaphylaxis.

Makes me sick.


----------



## WhiskeySix5

Doczilla said:


> The bottom line is, they Army only cares about putting warm bodies where the need is great. Even the instructors that give a crap are chastised for giving people a "no-go", because statistically it will reflect negatively on the organization.
> 
> They used to have one shot to  pass the NREMT, then they would get recycled, or worse. Then it moved up to three, then six.
> 
> Six shots?! For NREMT-B?
> 
> So, the primary concern is just getting people through the program in the hopes that someone at their receiving unit will "fix" them. But this dosen't happen either. The end result? I see a 68W trying to *suture bullet holes up*, or surgically cric a 3-year-old, or giving out claritin for anaphylaxis.
> 
> Makes me sick.



Sad to hear. The old program used to be pretty good back in the day, but now it seems that the education they are putting out down there is pretty lack luster. I read a report that stated much of the training was being done by civilians, who did not have the appropriate qualifications in the opinion of the DOA. My first time at Ft Sam was in 1986... then again in 1989. It was much different back then.


----------



## RocketMedic

Rumors from our new guys are that they are cutting NR out of it- EMT, optional test, whiskey phase and go.

Our newbies are sickeningly bad at anything not penetrating-trauma.

What do y'all think will come of the push to paramedic-patch the flight medics?


----------



## EMS123

Is there any truth to EMT certification being removed from Medic Training?


----------



## RocketMedic

Not sure, Ill tell you in March when new guys show up.


----------



## Forrest

I'll share their dirty secrets when I'm done and thru. Four more months and Ill be there jumping in halfway thru as an E4.

Sent from my HTC using Tapatalk


----------



## Luno

Can't comment about the future of NREMT and the US Army, but as the training NCO for a medical Company in a BSB, we still maintain NREMT, and per AR will for the foreseeable future...

BTW, was not impressed with some of the soldiers coming out of 68w training recently...


----------



## EMT11KDL

First off, i have not heard that we are removing the nremt from trying and i do not believe we will due to it is required for out mosq . Still currently as i just received two medics three weeks ago. they are getting multiple  iv sticks at bullis.  now on the rx side of the house , no they are not training very much on that side of the house. they are leaving that for your unit pa or doc to determine what medications they are allowed to push so that all medics with in that unit are trained the same. we all must remember fort Sam is just the first stop in our medical training. we are always learning and training everyday


----------



## RocketMedic

It's worse than that- these medics haven't even been taught assessments of non-acute trauma or medical patients.


----------



## EMT11KDL

The two i just received did during their emt training... But not during whiskey phase


----------



## RocketMedic

Hmmm...maybe we just keep getting the ones who rocked the Hacienda.


----------



## 325Medic

Rocketmedic40 said:


> Hmmm...maybe we just keep getting the ones who rocked the Hacienda.



So, the Hacienda is still there huh? I rocked it in 94. LOL.

F.M.


----------



## EMT11KDL

That place is never going to leave


----------



## RocketMedic

Sweet god, these people @ my unit do not understand that I am NOT the NREMT! It's not MODS or MEDPROS, I can't write to it! 

Why they can't document their training I don't know, but it's annoying.


----------



## Luno

Jeez, I hope you're not their training NCO...   Between Table VIII validation, and all the MEDIC tables we have to do every year, they should be gtg.   Yeah, the hacienda... that was a good time...   Well, that and the burger place right off base...  The marriott at the riverwalk wasn't bad either.


----------



## alabamatriathlete

I'll put my 2 cents in since I graduated from "Factory Sam" this past week. 

First off, I was a prior EMS coming into the military and have had experience on both the civilian and tactical side of the spectrum as well. Before I went to the company I graduated with, I had to sit things out, with a few other EMTs and Paramedics who were fasting-tracking also, with another company. So we sat in on the EMT side of the course (Yes - NREMT is required. 3 shots or you're reclassed nowadays). Personally, I thought the 6-7 weeks EMT course they were teaching was BS, from the two weeks myself and the other prior EMS had to sit around and watch. The instructors, so-called Paramedics, were alright, but we were questioning alot of what they were teaching. Not to mention, we were correcting them many times, and they would come up to us at the end of class and ask us "Hey did we teach this right?" Also, once I got to our new company when we finally did fast-tracked, I was amazed at how little the other students retained. Needless to say, all of us prior EMS stuck together as most of these kids didn't know what they were doing. Not going to say it's entirely their fault - it's just how the Army does things, not to mention with the budget cuts nowadays. 

Now to the Whiskey side - some of it was fun, but it was boring at the same time. All we were really taught was Cric's, IVs (saline and direct line), NCD, a brief overview of intubations (but we never practiced them...), and a few other skills. Our rapid trauma's were heavily focused on HABC guideline and so forth. I think we did close to 40-50 sticks on each other and then 4-5 on final FTX. Yet even with that amount, there were alot of those were still very incompetent at even the EMT side of the game. 

Overall - good course, but I barely learned anything. Looking forward to getting to my unit and actually learning alot more. Sad thing is how many folks were actually pushed through and passed - they tried to scare us all the time by saying that "such and such" would fail you out of the course, yet I was amazed at how many people were couldn't even tell you when you should vent a patient made it through... 

Trauma, mainly on our side of the business, is sexy, but it gets old. Stop bleeding, secure an airway, shock, fluids - give or take. I, personally, like the medical aspect of EMS. Why I will be getting my civi Medic and then RN.

As far as the "new" flight medic program. It's interesting - it's the big push they're doing now for Whiskeys. I think out of my class, they had 20 or so going into the new course that starts in April or March. Not entirely sure. Hell, even some of our Whiskey instructors are enrolled in the same class as these new Medics are. And some of the instructors have been flight medics for past few years, yet without the EMT-P cert. I was offered a slot, but I decided to turn it down at this time. I wasn't too keen seeing how the military was going to do with getting a typical 1-2 yr course down these guy's throats in 7-8 months. Not saying it will be unsuccessful, but if it is anything like how they teach the EMT-B course for NREMT, I would rather take a civi-course elsewhere. Granted, it is taught at UT-San Antonio, but still. 

Anyways - just my thoughts.

Oh and P.S. - hacienda was torn down lol a new "Student Activity Center" is now being built.


----------



## RocketMedic

Good to hear your perspective- what's your duty station? I'm 3-41 IN 1st AD at Bliss.

I'm the SPCIC of training- can't write to MODS because I'm an E4, can't get time to train a lot of our new guys because I'm one of the few licensed on the Stryker MEV, can't teach anything beyond TC3 without getting reamed. Had to teach EFMB textbook crap for two months straight because the platoon leadership got retarded. I have E5s trying to teach ETTs by virtue of a day in BNCOC or ALC, then a PA who doesn't think a line medic should be allowed morphine...

I've got a lot of work to do to get them ready. A few have learned well though.


----------



## alabamatriathlete

Shipping out to CP Casey, Korea (fml...) with 2nd ID in a month for a year tour. Should be interesting, to say the least. Good time to explore and see another culture, though I suppose.

Yea I agree - even in TRADOC spectrum, each E5 and above had a different standard on how they teach and expect things done, which I understand to an extent; but that's the military for you...

I dunno - to be honest, I would've graduated about 25 folks out of the company (about 220 folks). Half of them don't even want to be Medics, and another quarter have a permanent alerted mental status. Only a few I see worthy of actually going hands-on a real patient. Maybe it's my background in civi-EMS, but so far, not entirely too impressed with military medicine. Hopefully it gets better, but so far, I need to see a chiropractor for how much I just shake at my head at the system and many of the folks involved.


----------



## Doczilla

alabamatriathlete said:


> Shipping out to CP Casey, Korea (fml...) with 2nd ID in a month for a year tour. Should be interesting, to say the least. Good time to explore and see another culture, though I suppose.
> 
> Yea I agree - even in TRADOC spectrum, each E5 and above had a different standard on how they teach and expect things done, which I understand to an extent; but that's the military for you...
> 
> I dunno - to be honest, I would've graduated about 25 folks out of the company (about 220 folks). Half of them don't even want to be Medics, and another quarter have a permanent alerted mental status. Only a few I see worthy of actually going hands-on a real patient. Maybe it's my background in civi-EMS, but so far, not entirely too impressed with military medicine. Hopefully it gets better, but so far, I need to see a chiropractor for how much I just shake at my head at the system and many of the folks involved.



The best I can tell you is that the Army will give you a combination of the best and worst training you have ever had--- learn how to filter out the :censored::censored::censored::censored:ty advice you'll get from burnt-out medics. 

Also, don't expect to be trained adequately by your unit. Latch on to your PA and do nothing but ask questions. Don't get upset if you get sniped on something medical, just go home, study, and come back ready for more. Before long, you'll find that your effort pays off.


----------



## RocketMedic

I nearly snapped today- I have to teach "all of your paramedic airway stuff, but only how you do it, and you're also going to have to do it in two hours".

That was today. Last week was a brand new SPC trying to pull his rank on a PV2 doing the right thing when he messed up, then complaining I was unfair to expect homework and intelligence from him.

Five more months. .


----------



## Phen0m

I ran into this post looking for information on how whiskey school used to be because of how stupid easy basic was I thought maybe ait had gotten easier as well. It seems this is the case.
I began ait here at ft Sam a few weeks ago we are just moving into pharmacology and just finished the primary assessment module. Our instructors seem to do a decent job but I have no basis for comparison. There are many incompetent soldiers who don't seem to put forth effort. I hope none of us get cut any slack. I feel our mos requires a full commitment and should never be subject to being filled with warm bodies. I realize I don't know :censored::censored::censored::censored: about what's going on yet but well see how ait pans out


----------



## RocketMedic

Phen0m said:


> I ran into this post looking for information on how whiskey school used to be because of how stupid easy basic was I thought maybe ait had gotten easier as well. It seems this is the case.
> I began ait here at ft Sam a few weeks ago we are just moving into pharmacology and just finished the primary assessment module. Our instructors seem to do a decent job but I have no basis for comparison. There are many incompetent soldiers who don't seem to put forth effort. I hope none of us get cut any slack. I feel our mos requires a full commitment and should never be subject to being filled with warm bodies. I realize I don't know :censored::censored::censored::censored: about what's going on yet but well see how ait pans out



Welcome to the herd.


----------



## airborne2chairborne

Saw this and figured I'd chime in. Anyone who's been to 68W school (or any of its predecessors) knows you spend more time in class trying to stay awake and waiting for the next gut truck break for more coffee than you spend actually learning. That being said how "good" new students come out of it depends on your viewpoint. If you think that school exists JUST to teach new medics enough so they can go to their unit and learn then it does its job. If you're expecting competent medics straight out of it, then it fails pretty badly. Just to put my own 2 cents into it, I think they need to cut out a lot from the 68W program and leave it to units to train their new medics. A program that spends 8-10 weeks drilling JUST TC3 will get a lot better results than one that tries to cram pharmacology, sick call medicine, clinical medicine, etc etc etc into that time frame. The medical skills used in TC3 are the only ones a brand new medic would need to have down to a T, anything else there will be plenty of other medics/providers around to teach him and push him out of the way if needed.


----------



## RocketMedic

Dear God, the new ones are even worse!

How do you graduate four people who don't even understand how _*tourniquets*_ work?


----------



## airbornemedic11

*New generation of medics*

I feel AIT focuses more on TC3 than NREMT, as it should. Most of these new medics will go off to a battle field where they will need more of the trauma skills than anything else. Combitubes, King LTs, Cric's, IV's, splinting, tourniquets, etc. . . Most of these soldiers will first be line medics. They'll be with a casualty no more than 20 minutes. By that time they should be MEDEVAC'd to a CSH where they'll receive higher level of care from a PA, M6's and RN's. In that first 20 minutes there's hardly any time for medical assesments and there aren't too many drugs they'll be pushing, except maybe morphine. Stop the bleeding, secure that airway, move out.
That's also why they're emphasising Hextend. They're probably going to be dealing with some major blood loss considering the injury is probably from trauma. 1 or 2 bags of Hextend is my first choice as opposed to 4 L of NS, absent radial pulses. 
I wish we could abolish the NREMT requirements, but that's a political/fiscal decision.


----------



## RocketMedic

The views and attitude expressed above are why we have horrible medics and extremely poor knowledge bases.


----------



## Doczilla

20 mins, eh? If you're lucky. Air assets are finicky. Had to sit on someone for 14 hours who got stitched up by an AK, and while we were doing transfusions, RSI, F.A.S.T exams, treating arrythmias, placing two chest tubes,the " whiseys" were standing around bull:censored::censored::censored::censored:ting. 

Thats what continuing education if for, because if youre only good for 20 mins, your spot is better filled by a SAW gunner. 


I





airbornemedic11 said:


> I feel AIT focuses more on TC3 than NREMT, as it should. Most of these new medics will go off to a battle field where they will need more of the trauma skills than anything else. Combitubes, King LTs, Cric's, IV's, splinting, tourniquets, etc. . . Most of these soldiers will first be line medics. They'll be with a casualty no more than 20 minutes. By that time they should be MEDEVAC'd to a CSH where they'll receive higher level of care from a PA, M6's and RN's. In that first 20 minutes there's hardly any time for medical assesments and there aren't too many drugs they'll be pushing, except maybe morphine. Stop the bleeding, secure that airway, move out.
> That's also why they're emphasising Hextend. They're probably going to be dealing with some major blood loss considering the injury is probably from trauma. 1 or 2 bags of Hextend is my first choice as opposed to 4 L of NS, absent radial pulses.
> I wish we could abolish the NREMT requirements, but that's a political/fiscal decision.


----------



## Akulahawk

airbornemedic11 said:


> I feel AIT focuses more on TC3 than NREMT, as it should. Most of these new medics will go off to a battle field where they will need more of the trauma skills than anything else. Combitubes, King LTs, Cric's, IV's, splinting, tourniquets, etc. . . Most of these soldiers will first be line medics. They'll be with a casualty no more than 20 minutes. By that time they should be MEDEVAC'd to a CSH where they'll receive higher level of care from a PA, M6's and RN's. In that first 20 minutes there's hardly any time for medical assesments and there aren't too many drugs they'll be pushing, except maybe morphine. Stop the bleeding, secure that airway, move out.
> That's also why they're emphasising Hextend. They're probably going to be dealing with some major blood loss considering the injury is probably from trauma. 1 or 2 bags of Hextend is my first choice as opposed to 4 L of NS, absent radial pulses.
> I wish we could abolish the NREMT requirements, but that's a political/fiscal decision.


I'm not a 68W by any stretch, I'm a Paramedic that hasn't gone through TCCC (PHTLS yes) but 20 minutes is a LIFETIME in terms of amount of time to do an assessment. Really. Open an airway, check for and stop life-threatening bleeding, head to toe, secure an airway, start a line, have someone call in MEDEVAC, package for transport... Ok, now about that next 10 minutes?

Hextend is being emphasized for (IMO) one reason: it's light and small in volume for the plasma expansion you can get from it. You can fit more bags of the stuff in your pack than you can of Normal Saline. Can you precisely control the amount of expansion that will occur once the hextend is infused? Can you guarantee that said volume expansion won't cause clots to pop, leading to further hemorrhage and thus you needing to administer another bag of hextend? 

Doczilla and Rocketmedic40 are right... and sometimes, you won't be able to get that person out in 20 minutes for lots of reasons, not the least of which is that the area you're in is too dangerous/risky for the MEDEVAC to occur at that time...


----------



## RustyShackleford

I had to make sure I read the "20 minutes" part correctly.  A cat A doesn't have 20 minutes prior to air to be stabilized.  Any cat A that I ever saw unfortunately died within the first 5 min from being categorized as such.  Hextend isn't a god send, I'm not sure what they brainwashed new 68w with but there is lots of literature on its "actual" efficacy in the field which isn't propped up by the military.  So you better learn that 20 minutes in the field is a decade in real time, you had better learn to work and do assessments in less than 5 minutes because unfortunately that is all some poor soul including yourself may be faced with one day.


----------



## Doczilla

20 mins blows by when you're still in heavy contact. Time warps when bullets are whipping the leaves in the trees around you.


----------



## RustyShackleford

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


----------



## RocketMedic

Doczilla said:


> 20 mins, eh? If you're lucky. Air assets are finicky. Had to sit on someone for 14 hours who got stitched up by an AK, and while we were doing transfusions, RSI, F.A.S.T exams, treating arrythmias, placing two chest tubes,the " whiseys" were standing around bull:censored::censored::censored::censored:ting.
> 
> Thats what continuing education if for, because if youre only good for 20 mins, your spot is better filled by a SAW gunner.
> 
> 
> I



[SARCASM]That's all Doc-level stuff, I only need to worry about TC3![/SARCASM]

Don't be too mad, Doczilla. Most of them aren't in it for good medicine.


----------



## Doczilla

RustyShackleford said:


> 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 

Sent from my SCH-I510 using Tapatalk 2


----------



## EMT11KDL

The 20 also includes packaging the patient for transport. 

Sent from my SCH-I510 using Tapatalk 2


----------



## 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

Rocketmedic40 said:


> 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.

Sent from my SCH-I510 using Tapatalk 2


----------



## 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


----------



## TheMidnightPhilosopher

*Yep*

The last two statements are accurate in my book, the best Corpsman and Medics I have served with were force multipliers in many different facets. Medicine is just one piece of the pie.


----------



## RocketMedic

Doczilla said:


> 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.



True, but far, far too many of our 68Ws put more importance into weapons than medicine.


----------



## airborne2chairborne

Last I checked the best medicine is preventive medicine, and in combat that's your rifle. 
There's also far far too many medics who don't place enough importance on tactical skills, mainly ones that believe they shouldn't be in firefights unless things are going wrong.


----------



## RocketMedic

And how exactly does 'fire superiority' = preventative medicine?


----------



## airborne2chairborne

The national library of medicine defines preventive medicine as "A medical specialty primarily concerned with prevention of disease and the promotion and preservation of health in the individual." Anyone who's spent a day in combat training, let alone a combat unit, could tell you that fire superiority not only wins battles but keeps your guys alive. It allows you to control the situation, prevents the enemy from maneuvering, and hinders their ability to get off accurate shots. In brief: it's preventive medicine because it's a measure taken that preserves yours and your unit's health. 

Considering that you obviously don't know TCCC protocol in both medical and tactical areas and you don't know how fire superiority prevents your guys from getting injured I feel the need to ask again: are you sure you've done any combat medicine for real?


----------



## RocketMedic

*Pretty sure that "fire superiority" means very little against an IED or in a situation where ROEs prohibit effective use of firepower*.

Unless your unit rolls around machine-gunning every rock, lump, and guy they see...

It's people like you who give 68Ws a horrific reputation and reinforce failure.


----------



## EMT11KDL

i have to jump in. as both a line medics and a civilian medic. i would much rather have my guys having hands on doing pt assessments. visualizing real patients and having to do basuc life support with me in the rig or with anyone than just trying to teach them in a classroom setting.

now regarding weapon issues. the reason why we gain fire superiority is so that the the person that is going to get him and pull him to cover has a less chance of getting injured. now if you truly know ur tccc like u say u do u would also know that you would be instructing him to do self aid or buddy aid if possible. and yes i do know my tccc :censored::censored::censored::censored: since i do instruct the medic tables.


----------



## EMT11KDL

and fire superiority actually has nothing to do with preventive medicine. you have two jobs as a medic in a line unit. first as a soldier second as a medic. in a firefight u have to return fire. once u are able to stop and provide medical aid u do so. also if ur in the middle of giving aid and u need to start returning fire you do so because you are a soldier and primary mission as a soldier is to be superior on the battle field.


----------



## airborne2chairborne

Is every casualty from an IED? Nope. Is every disease that comes around something you can get a vaccine against? Nope. Same deal. You might as well try arguing that the hepatitis A vaccine isn't preventive medicine since it doesn't protect against HIV. 

I've never had an ROE that prohibits effective use of firepower, if you've ever taken an ROE/EOF class you'd know that lethal force is allowed in any situation where military personel's lives are at stake. I've been in situations where "oh this would be much easier if we could simply call in arty" but I've never been told I couldn't use any weapon that my unit currently had at it's disposal if we made enemy contact nor in a situation where what we could use was absolutely ineffective. 

Who says you have to roll around "machine gunning" every rock lump etc? You make PID or take contact, you contribute to fire superiority. its simple.

I disagree. It's people like you who make 68Ws look like idiots who don't know their own protocol, are afraid of getting in the fight, and don't know effective use of combat medicine. If anyone is reinforcing failure and giving us a horrific reputation, it's you. You don't even know the basics of TCCC, that's just flat out pathetic and disgusting considering that that is the dogma of military tactical medicine. Perhaps next you'd like to argue that tourniquets shouldn't be applied to extremity arterial bleeds... at the rate you're going I'm half expecting that sooner or later. 

And I take your silence as a "no, you have never been in combat as a medic"


----------



## airborne2chairborne

EMT11KDL said:


> i have to jump in. as both a line medics and a civilian medic. i would much rather have my guys having hands on doing pt assessments. visualizing real patients and having to do basuc life support with me in the rig or with anyone than just trying to teach them in a classroom setting.
> 
> now regarding weapon issues. the reason why we gain fire superiority is so that the the person that is going to get him and pull him to cover has a less chance of getting injured. now if you truly know ur tccc like u say u do u would also know that you would be instructing him to do self aid or buddy aid if possible. and yes i do know my tccc :censored::censored::censored::censored: since i do instruct the medic tables.



I agree with the top statement in the sense that real patient care always teaches more than trauma lanes/dummies. 

I don't think what you'd tell the casualty to do was ever the argument here, the argument was whether or not a medic is a rifleman or not and about basic TCCC guidelines such as breathing management.


----------



## airborne2chairborne

EMT11KDL said:


> and fire superiority actually has nothing to do with preventive medicine. you have two jobs as a medic in a line unit. first as a soldier second as a medic. in a firefight u have to return fire. once u are able to stop and provide medical aid u do so. also if ur in the middle of giving aid and u need to start returning fire you do so because you are a soldier and primary mission as a soldier is to be superior on the battle field.




Perhaps this is just my take, but doesn't superior mean being the surviving side? The main point of fire superiority might not be to attempt to prevent further casualties but it is a nice little side effect.


----------



## EMT11KDL

how i teach it both in the medic tables and cls classes is fire superiority is classified as being in control of the tactical situation. if this means heavy ground fire to gain control than its that. if its firing a few shots and bound forward than its that. each situation will be different. and sometimes its just moving your vehicles into more of an offensive position will allow you to gain control which would allow you to change from care under fire to tactical field care.


----------



## airborne2chairborne

different strokes for different folks, personally I wouldn't go from care under fire to tactical field care if rounds were still flying unless they were only our rounds (aside for a few pop shots) or if it was an immediate life threatening injury that needed to be treated that minute and it wouldn't put myself in danger or take away from my teams security; but yes situation dictates is really the only absolute truth of combat medicine.


----------



## RocketMedic

Chairborne, slavish adhederance to doctrine is the refuge of the uninformed. Yes, TC3 makes sense for priorities, but it is literally all that 68Ws are trained in, with no critical thinking or assessment required beyond identifying which cookie-cutter patient they have and treatment by rote. You claim TC3 is the be-all of "combat medicine" and go on a tangent about fire superiority, I see no difference in military and civilian care- if there's rounds flying, things are situationally-appropriate, and I react as needed. 
I'm arguing that only teaching our soldiers TC3 is a waste of potential that yields inferior medics, you say "hooah" and accept mediocrity. I use my experiences both as a military line medic and a civilian Paramedic to shape shat I say, you go by claims of DZ medic and deployment time.

Find me the relevant portion of TC3 that describes how to ventilate a patient and choose/use an airway, and compare it with a well-taught civilian AEMT or medic class. Show me 68Ws fresh from school who can calculate medication doses or recognize trends and things other than penetrating trauma. You give the hooah answer, I'm saying our patients deserve better care than hooah NCOs like yourself can provide.

Also, BTDT as a line medic, it was awesome, earned my CMB in a little exchange of gunfire where I actually got to play a bit.


----------



## airborne2chairborne

And disregard for it tends to be the practice of those who think they know more than the doctors and surgeons who came up with it. Are you telling me you don't follow your county and state protocol as a paramedic? No difference here, it's a protocol you follow unless you have a reason not to.

No it's not all that W's are trained in. It makes up the vast majority of AIT but not the entirety of it and in unit training is a whole different matter. I don't say hooah, don't put words in my mouth I don't put them in yours. And I don't accept mediocracy by any means. There is a difference in military and civie care not oy because of resources but also demographics of the major killers. And yes, I speak from my experience, just like all medical personnel do 

And sure, soon as you can show me a paramedic straight from school who's only had a total of 16 weeks of medical training who can. You're comparing apples to oranges, and I might as well fire back with "show me a paramedic straight out of school who can perform chest tubes," since it's a skill set that involves different training.

Penetrating trauma is the main demographic of preventable deaths in the military, just as heart failure is the main killer in the civilian world and hence the high focus of ACLS in paramedic school.

Finally, my patient care is fine. I know my way around tactical and sick call medicine, on the other hand I'm pretty sure you made a pretty piss poor line medic simply because of your view of medics as combatants... Your infantrymen deserved better than someone who wasn't willing to cover their ***.


----------



## RocketMedic

Yet you tolerate inferior training of your soldiers by endorsement of the limited, lowest-common-denominator TC3 the Army teaches.


----------



## airborne2chairborne

Lowest denominator TC3 is CLS, not whats taught at medic school. No I endorse it for being what should be taught for AIT since that's the only skills a brand new medic will ever perform in a situation where he won't have someone to turn to for help or guidance. In a clinic he'll have senior medics and his PA easily available. In a hospital he'll have nurses and doctors as well. Even if he's working the line and pulling sick call on some remote PB where he's the only medical personnel around he can still reach his PA by radio. In combat though there is no dispatch or medical supervisor to hit up. Therefore he should be taught what he absolutely needs to be able to perform alone. Too bad paramedic school didn't teach common sense you obviously need some.


----------



## airborne2chairborne

And again: AIT teaches you enough to be able to go to your unit and learn. Medic school isn't taught in the same way as paramedic school. Scope of practice is dictated by unit, not national or state, and they're not going to send trainees out on ride alongs in afghan to refine their skills with hands on care...


----------



## airborne2chairborne

Finally, what exactly is wrong with teaching a simple base knowledge first? I'm sure you'd agree that you should be a basic before a paramedic, so your high horse aside what exactly is the difference here? Start with base knowledge and build off of it, the basics are never "inferior".


----------



## RocketMedic

I don't agree paramedics should be basics first, nor do I agree with most military "protocols". In the civilian sector, poor protocols are avoided by many of us, and leave the agency open to lawsuits if they are found lacking (hypothetically)


----------



## airborne2chairborne

Thats funny, most paramedics i know as well as most paramedic training programs seem to disagree. I guess you know more than them. Well agree or not either way paramedics still perform the same basics that EMT-Bs do (i.e. ABCs) and it's still built around the same principles. 

The protocols for TC3 were formed by MDs, PAs, surgeons, and special operations medical personnel and are the result of researching thousands of casualties.What exactly is your base for disagreeing with it?

Last I checked ignoring DOT/state/county protocols in the civilian sector not only opens you up to lawsuits but also to losing your lisence.

Edit: actually I don't know ANY paramedic program aside for the D course that allows you to attend a paramedic program before you have your basic. Do you?


----------



## usalsfyre

Many incorporate it in the program. 

What's humorous is I remember Rocketmedic having similar attitudes to AB2CB when he first joined. I'm proud we've played some role in bringing his thinking forward!


----------



## Akulahawk

airborne2chairborne said:


> And disregard for it tends to be the practice of those who think they know more than the doctors and surgeons who came up with it. Are you telling me you don't follow your county and state protocol as a paramedic? No difference here, it's a protocol you follow unless you have a reason not to.
> 
> No it's not all that W's are trained in. It makes up the vast majority of AIT but not the entirety of it and in unit training is a whole different matter. I don't say hooah, don't put words in my mouth I don't put them in yours. And I don't accept mediocracy by any means. There is a difference in military and civie care not oy because of resources but also demographics of the major killers. And yes, I speak from my experience, just like all medical personnel do
> 
> And sure, soon as you can *show me a paramedic straight from school who's only had a total of 16 weeks of medical training who can*. You're comparing apples to oranges, and I might as well fire back with "show me a paramedic straight out of school who can perform chest tubes," since it's a skill set that involves different training.
> 
> Penetrating trauma is the main demographic of preventable deaths in the military, just as heart failure is the main killer in the civilian world and hence the high focus of ACLS in paramedic school.
> 
> Finally, my patient care is fine. I know my way around tactical and sick call medicine, on the other hand I'm pretty sure you made a pretty piss poor line medic simply because of your view of medics as combatants... Your infantrymen deserved better than someone who wasn't willing to cover their ***.


A Paramedic, straight out of school, has a bit more than 16 weeks of medical education. That Paramedic has also been through some clinical experiences and field experiences that have prepared that Paramedic to do what they do. While ACLS is a lot of what I do as a Paramedic, so is PHTLS. What I do even more of is basic care. Put me through TCCC and give me a little time to learn how to do Military Sick Call stuff and I'm sure I'll do quite well. 

The protocols that were posted in this thread, I found them fairly simple, easy to understand, and cookie-cutter. The only dosage calculations I saw in that document were those that have to do with burn resuscitation. A Paramedic, fresh out of school, can easily do that. Any equipment that I'm not familiar with right now, I could easily learn through in-service training. 

I'm not a Military Medic by any stretch, but I tend to agree with RocketMedic40 and Doczilla...


----------



## TheMidnightPhilosopher

In combat you want protocol to as simple as possible, TCCC is short and sweet and effective. I agree with all new medics having a basic understanding of clinical care before hitting the field, however it's a skill that is honed by experience and continuing education. Combat medicine and EMS care are similar but at the same time wildly different. However it looks like tactical EMT protocols are mirroring Military Medicine more and more.


----------



## EMT11KDL

Akulahawk said:


> A Paramedic, straight out of school, has a bit more than 16 weeks of medical education. That Paramedic has also been through some clinical experiences and field experiences that have prepared that Paramedic to do what they do. While ACLS is a lot of what I do as a Paramedic, so is PHTLS. What I do even more of is basic care. Put me through TCCC and give me a little time to learn how to do Military Sick Call stuff and I'm sure I'll do quite well.
> 
> The protocols that were posted in this thread, I found them fairly simple, easy to understand, and cookie-cutter. The only dosage calculations I saw in that document were those that have to do with burn resuscitation. A Paramedic, fresh out of school, can easily do that. Any equipment that I'm not familiar with right now, I could easily learn through in-service training.
> 
> I'm not a Military Medic by any stretch, but I tend to agree with RocketMedic40 and Doczilla...



ill add more to this. once u get to ur unit u do training. also they send u to classes to learn additional skills. my unit does 7-8 different topics a month. and we ask what topics our medics want to cover. i taught a soap note class not to long ago. we also have done heent classes. pediatric classes. advanced air way. ekg. the list goes on.. if you have a good nco staff there are always classes going on through out every month. just like the civilian side we are constantly learning. now along with medics just out of ait.  they can handle a trauma pt. most i should say. there not taught stay and play. there taught stop bleeding. secure airways. establish breathing. and circulation, basis iv io therapy. they also go through a basic emt class.


----------



## airborne2chairborne

The point of bringing up 16 weeks was to show the difference in time of training and therefore a need to focus more on what's immediately life threatening. If the army was ever able to have a medic program the length of most paramedic schools (about 10 months) and keep up with the demand for new medics then by all means more should be taught in the 68W program. However the current length is 16 weeks, and the classes are primarily students with 0 medical experience or training at all. Hence the focus on what's basic and simple.

TCCC is by no means something complicated or hard. It's designed to be simple, and the reason why civie tactical medicine is changing towards military medicine is because it's effective. Any line medic will tell you it's important to be able to think for yourself, however in cases where that is impaired (such as being in the truck that just got hit), you can't dedicate your primary attention to the patient (such as when you're making sure you're not going to get shot), or even for a brand new medic who's in combat for the first time, it's a lot better to have something you can do by muscle memory than just stand there :censored::censored::censored::censored:ting yourself. Any experienced line medic would by no means treat an injury as cookie cutter just because TCCC gives a cookie cutter example for that injury.
Sick call isn't all that hard either, it's 10% knowledge 90% medical common sense.


----------



## airborne2chairborne

EMT11KDL said:


> ill add more to this. once u get to ur unit u do training. also they send u to classes to learn additional skills. my unit does 7-8 different topics a month. and we ask what topics our medics want to cover. i taught a soap note class not to long ago. we also have done heent classes. pediatric classes. advanced air way. ekg. the list goes on.. if you have a good nco staff there are always classes going on through out every month. just like the civilian side we are constantly learning. now along with medics just out of ait.  they can handle a trauma pt. most i should say. there not taught stay and play. there taught stop bleeding. secure airways. establish breathing. and circulation, basis iv io therapy. they also go through a basic emt class.



I couldn't agree more, rocket for some reason seems to think that basic TCCC is all we train for. Either he never served or his unit sucked medically.


----------



## RocketMedic

airborne2chairborne said:


> Thats funny, most paramedics i know as well as most paramedic training programs seem to disagree. I guess you know more than them. Well agree or not either way paramedics still perform the same basics that EMT-Bs do (i.e. ABCs) and it's still built around the same principles.
> 
> The protocols for TC3 were formed by MDs, PAs, surgeons, and special operations medical personnel and are the result of researching thousands of casualties.What exactly is your base for disagreeing with it?
> 
> Last I checked ignoring DOT/state/county protocols in the civilian sector not only opens you up to lawsuits but also to losing your lisence.
> 
> Edit: actually I don't know ANY paramedic program aside for the D course that allows you to attend a paramedic program before you have your basic. Do you?



Holding EMT-B certification and _being_ an EMT-Basic are two very different things, and I really don't believe it's vital to "serve time" as an EMT if you want to be a paramedic.

I don't ignore protocols, but I do base part of my employment search on the agency's protocols. If those protocols are antiquated, overly-restrictive, or too conservative, then I'm going to take that into consideration and more than likely decline to work for that service or system (for example, I will never work in LA County). Protocols as the military knows them are literally only TC3 doctrine. I won't argue that TC3's tenants or interventions aren't effective- they are- but I will argue that there is a lot more to being a medic, even a line medic in a combat situation, than TC3. For example, TC3 is excellent at teaching you how to handle new, penetrating trauma- but what about managing shock? What about management of older wounds? What about recognition and first-line treatment of TBI? What about anything more advanced than tourniquets, or airway management (short of the very, very undertaught crike) or practically _anything_ on ventilatory management?

As it sits now, a new 68W (or an old one living off of AIT memories) isn't much more than a CLS who has been shown IVs, crikes, vital signs, and a few different ways of bandaging holes. There is very little critical thinking, patient assessment, or medical treatment beyond first-level interventions. The only second-level intervention I can think of is IV fluids via saline lock, and I've rarely met a 68W of any rank who can intelligently explain anything other than  various bolus rates.

Military medics aren't comparable to civilian EMTs, despite a longer-than-average skills sheet. A military medic may see a handful of patients in a week, and has a low likelihood of those patients actually being critical- generally, it's primary care, and if it's trauma, they'll usually be "hurt" or "dead". When those critical patients are seen, that 68W will likely only use BLS interventions, plus an IV. They'll do this a few times in a career and call it good, and themselves competent. They'll assist in a lot of primary care, and sometimes perform it themselves, but once again, this is the exception.

A civilian EMT will assist another EMT or paramedic with a 68W's average weekly patient load by their first lunch. If they're in a busy 911 system, they'll see more critical trauma patients in a month than most combat medics in an infantry regiment see in a year (excepting really, really unlucky units, SF, or deployments to places like Korengal Valley). 

A civilian paramedic will blow practically any 68W away with their training, skillsets, and attitude. That's not an endorsement of civilian paramedic training- I am nowhere near knowing enough to consider myself good. It's just a marker that 68Ws are horrifically undertrained.

You've made TC3 a foundation of this debate. Most of TC3 is performed at the CLS level- control bleeding, support an airway, evacuate. Bleeding control is entirely CLS level across the world- military and civilian. Airway support for a CLS is an NPA, it's an NPA/OPA/supralingual/crike for 68Ws. Most 68Ws have barely held a BVM, much less used it, and TC3 really doesn't go too far into ventilations and breathing. Civilian-side, we start with good BVM and take it to RSI, ventilators, etc. Circulation support for (some) CLS is an IV, for 68Ws it's a saline lock + predetermined boluses of crystalloids or Hextend. For civilians, it ranges from predetermined boluses to calculated rates of crystalloids, generally titrated to effect and assisted by experience. Evacuation for a military medic is a nine-line (trained to shout it unintelligibly fast in most cases) followed by a (somewhat) better-trained medic arriving to do basic things like shut off the IV, or perhaps litter carriage or ground transport to an aid station, CSH, or something. (This part works really well most of the time). Evacuation for a civilian EMS crew is generally our bread and butter- we stay with our patients and evacuate them ourselves the vast majority of the time, and often transfer them beyond our first-level care to definitive care. 

A military medic is generally pretty good at BLS trauma management. Eveything else is rough at best. Relying on units to train personnel to acceptable minimums is something that I consider unacceptable- civilian-side, although they're new, most new paramedics can do their jobs with their school educations alone most of the time. Civilians, would your companies hire someone who only knew the barest minimums of your job, and thought they were able to manage an unstable airway "because I criked Fred a few times"? Mine wouldn't.

Finally, yes, I understand that the course is limited by class size and time constraints. That's what needs to change. Your entire point about in-service training is rendered moot by the quality of the students coming out- some are legitimately ready to learn advanced skills and critical thinking, but most new 68Ws are barely competent with CLS-level skills, and not focused on improving even those skills, to say nothing of their knowledge base! To add insult to injury, the ones who are in a position to learn are often blessed with a sergeant who emphasizes personal experience and a "mastery" of the basest fundamentals (often a false mastery) over professional knowledge, a solid clinical base, and diverse experiences. I won't even bring into this the utter glossing over of anything that's not traumatic, the lack of understanding that not all patients are evacuated easily or quickly, or the total lack of continuing education.

In my Army, all NCOs would be required to pass an evaluation by civilian EMS agencies as EMT-Intermediates/AEMTs, and eventually (say, by 2017) to be certified as AEMTs. Senior NCOs would be required to pass similar evaluations as a paramedic, and be certified as Paramedics by 2017. Failure to comply would be met by removal from the force.

What it boils down to, Airborne, is that we, as 68Ws, do not do our best for our patients. Yes, we do a decent job of saving people most of the time, but we still let salvageable patients die for lack of training, and we don't hold ourselves to a very high standard. We can change this, if we change our (your) attitudes and start to work towards higher standards. Those higher standards will save lives at home and overseas.


----------



## RocketMedic

*The above is one reason I'm leaving the Army*


----------



## RocketMedic

airborne2chairborne said:


> I couldn't agree more, rocket for some reason seems to think that basic TCCC is all we train for. Either he never served or his unit sucked medically.



That's because most 68Ws come from their training unable to do 90% of their job.


----------



## airborne2chairborne

I never said serve time, although most reputable paramedic programs do require work experience as a basic. Even just on the licensing area: you're taught basic then advanced. Same as medics are taught basic at AIT then advanced at unit level. That was the entire point.

Military protocols are not just TC3, you have been misinformed. I suggest you look around AMEDD a bit there's a lot more than just that.

TC3 goes over shock management. Management of older wounds wouldn't fall under TC3, TC3 is combat medicine. For a medc that would be his PAs instructions back at the aid station. It goes over TBI also (did they never teach you MARCH?) ventilary treatment is covered under the medic tables. Let's see, secondary interventions: well you listed IVs already. Pain meds, other meds, splints, bandaging non life threatening wounds, checking primary interventions and adjusting or upgrading as needed, etc. even in civie EMS for critical patients all of that is done en route, and for military that is either done by a flight medic (who are paramedics btw) or is done in the back of a humvee or MRAP which isn't exactly the same as a bench seat and gurney.

Your right: 68Ws aren't comparable with EMT-Bs. 68Ws don't deal with geriatrics, terminal diseases, MIs, CVAs, etc etc etc. And EMT-Bs very rarely if ever deal with bast injuries, rarely deal with GSWs, pneumothorax, hemothorax, circumferential burns, multiple shrapnel penetrations, etc. they're 2 separate jobs with 2 separate medical focuses. You also seem to forget that all 68Ws are EMT-Bs. Thats nice EMT-Bs will have more calls, but I've worked civilian EMS and I know a good portion of those are complete BS calls. And last I checked BLS is still the bread and butter for paramedics too when it comes to PHTLS.:censored:

Well no :censored::censored::censored::censored: a new paramedic would blow a new 68W away with skills and knowledge. 10 months of training vs 16 weeks. A doctor would blow a paramedic away skills and knowledge wise, so I guess that makes paramedics incompetent by your reasoning. As for experienced medic vs experienced paramedic it depends on what specific area and what that medic got to do. As for attitude that depends on the person, and I've seen a lot of paramedics who's attitude is over inflated and tend to think that everyone but them is an idiot... Not that I'm going to point out any names here...

That's nice you do RSIs. King LTs do the same thing and they're much faster to place. Also with an RSI you have to ventilate the patient, meaning if the situation changed from TFC to CUF you have to choose between ventilating or protecting yourself. Ventilators are a moot point, I'll let you know when medics start carrying them in aid bags.:censored:

Medics come out of AIT at an acceptable minimum standard, at least in theory. Are there incompetent medics? Yup, we trained the ones we could and sent the rest somewhere else. Are there also incompetent EMTs and paramedics? You bet your *** there are. I had a paramedic try to tell me once that pulmonary edema was lower extremity swelling. Just because you passed an easy national registry test and skills test doesn't mean you're good at your job, look at nursing home nurses for a prime example.

You know just listening to you whine about how much military medics suck it sounds like you got a crap unit. That sucks for you, and that doesn't talk for the army as a whole. If it did then military medic to paramedic bridge programs wouldn't have the success rate they do. On the other hand I can say that showing up to learn at your unit works because mine does great with its new medics. In my first year there I got lessons and ran trauma lanes daily for months and they weren't just done by my senior medics they were done by my PA as well. I got to be the medic for PRC so I could learn SUTs and get hands on with illnesses and injuries, do shifts at the ER, shadow and learn from the brigade physical therapist to learn sports medicine and assessing joint injuries, spend time in the OR for experience with assisting with surgical procedures, do a rotation through SF's goat lab, get hands on experience on drop zones, attend the TCCC instructors course, and I was expected to be able to teach everything I learned. If I wasn't able to then I had to write a thousand word paper on it. Long story short: learn what your talking about in regards to whether or not military medics get to learn or not and if you feel like crying then call up your mom.

In "your" army medics wouldn't be combatants, and you place way too much weight on civilian EMS. In my army (and where I come from) if a medic said "if I'm shooting then things have gone wrong" then he'd mop the floors stateside and handle the morgue on deployment. Glad it's not your army cause it would be about as well ran as if Rainman was in charge.


----------



## ffemt8978

Knock it off...or both of you will end up in the forum brig.


----------



## RocketMedic

No problem ffemt, there's no point in trying to force a horse to drink.


----------



## airborne2chairborne

Agreed


----------



## RocketMedic

Direct quote from one of our "competent" NCOs, when teaching airways.

"You don't need to use a scalpel with a crike, just shove the IV piercing spike straight in and down through the hole."

I am surrounded by idiots...


----------



## Doczilla

Interesting. I've heard people say that before, I think they're confusing the "nu-trach" kits with IV tubing. Ive improvised crics using needles and a cap from a 5.0 ETT , but that was for KIDS


----------



## RocketMedic

This was definitely a macrodrip set with the chamber cut in half. 
"Esophageal perforation" means nothing.


----------



## Akulahawk

Rocketmedic40 said:


> This was definitely a macrodrip set with the chamber cut in half.
> "Esophageal perforation" means nothing.


A macro drip set with the chamber cut in half does seem to have a higher flow then a 14gauge Angiocath.  Even though such a setup would work, I worry greatly about that "esophageal perforation" thing... I would consider such an improvised device only as a last ditch, no other options/equipment available for a cric. You'd better believe that I'd have to document the heck out of that kind of thing because where did I use up all the other equipment that could be used for a needle cric or a surgical cric (if that's available too)??? A whole lot of stuff would have to happen for me to even _consider_ doing a cric with a macro drip set....


----------



## RocketMedic

We only train for surgical crikes in the Army, and we have plenty of blades.
That's what made it even stupider.


----------



## EMT11KDL

Rocketmedic40 said:


> We only train for surgical crikes in the Army, and we have plenty of blades.
> That's what made it even stupider.



Ill add. I have trained ett king lt combi and surgical cric and needle cric.


----------



## Akulahawk

My own training (of course non-military) included ETT, Combi-tube, LMA, KT, Needle Cric, EOA/EGTA. Surgical Cric would be just another skill...


----------



## EMT11KDL

Akulahawk said:


> My own training (of course non-military) included ETT, Combi-tube, LMA, KT, Needle Cric, EOA/EGTA. Surgical Cric would be just another skill...



We have an great pa that over sees us medics


----------



## RocketMedic

Like we've all said, there's no consistency in the Army. Even different AIT classrooms have different standards.


----------



## Akulahawk

EMT11KDL said:


> We have an great pa that over sees us medics


For the services I worked for, I would have enjoyed a good, close working relationship with the Medical Director... Mostly though, they were there so that the companies could acquire the medications and devices necessary. In all of my Sports Med gigs, I had a great working relationship with the team Physician and his/her PA if he brought one along. I'm glad you have that good relationship with your PA's and MD's in the Service. It can make some things so much easier when you personally know each other.


----------



## airborne2chairborne

Rocketmedic40 said:


> We only train for surgical crikes in the Army, and we have plenty of blades.
> That's what made it even stupider.



In AIT yes, at unit level we trained on needle crics and this one piece of equipment (can't remember the name) that's pretty much a 12g needle and metal cath with an end that can fit a bag, it looks kinda like it belongs on a key chain. I agree the IV spike thing is stupid, it would take more force to get through the skin than you'd be able to keep enough control with. Never tried it though.


----------



## DrankTheKoolaid

Sounds like your talking about the LifeStat device.  Great keychain item for sure.   ED doc I went to Tactical Medic school turned me on to them.


----------



## airborne2chairborne

Yup that's it, couldn't remember the name for whatever reason. They're really awesome, faster than surgical and smaller than the surgical cric kits we order. Used to just keep them on my vest, 1 less thing I gotta dig around in my bag for.


----------



## RocketMedic

They start EPFD third-rides tomorrow (2 at a time), hopefully they learn something about teamwork.


----------



## airborne2chairborne

Yup military doesn't teach anything about that


----------



## RocketMedic

Not here. 1/1AD is pretty crappy.


----------



## airborne2chairborne

Heavy units tend to be, if you go to light infantry there's an entire different focus on skills and training attitude. A good way to teach your medics teamwork for working on a patient is trauma tables. Even with simulated patients it's good training, PA takes the head and 1 medic each side of the table. They also can learn advanced skills directly from their PA then.


----------

