# Efmb



## 82nd medic (Apr 3, 2011)

anyone here done the EFMB recently?

first went through it in 2005 and the overall consensus among everyone there that wasnt a hospital/clinic medic was that it was a waste of time because it was 1: civilian medicine in combat scenarious, 2: violated the TC3 guidelines (according to the POGS from ft sam, tourniquet was still a last resort, etc), and 3: was well below the standards set by 68W ait (let alone the standards for medics set at unit level). i know it was the same in 2008 (those of us with CMBs didnt have to go but our cherries still had to), has anyone been since then? CLS finally evolved from bs to what actually works not too long ago, so kinda hoping this has too.


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## ffemt8978 (Apr 3, 2011)

82nd medic said:


> anyone here done the EFMB recently?
> 
> first went through it in 2005 and the overall consensus among everyone there that wasnt a hospital/clinic medic was that it was a waste of time because it was 1: civilian medicine in combat scenarious, 2: violated the TC3 guidelines (according to the POGS from ft sam, tourniquet was still a last resort, etc), and 3: was well below the standards set by 68W ait (let alone the standards for medics set at unit level). i know it was the same in 2008 (those of us with CMBs didnt have to go but our cherries still had to), has anyone been since then? CLS finally evolved from bs to what actually works not too long ago, so kinda hoping this has too.



Hmmm...something with a pass rate of 15.3% in FY2008 is a waste of time and is below the standards set for 68W AIT?  That doesn't make any sense.

For those of our members that don't know what the EFMB is, here is a wiki page for it: http://en.wikipedia.org/wiki/Expert_Field_Medical_Badge


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## 82nd medic (Apr 3, 2011)

ffemt8978 said:


> Hmmm...something with a pass rate of 15.3% in FY2008 is a waste of time and is below the standards set for 68W AIT?  That doesn't make any sense.
> 
> For those of our members that don't know what the EFMB is, here is a wiki page for it: http://en.wikipedia.org/wiki/Expert_Field_Medical_Badge




Have you attended it?


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## ffemt8978 (Apr 3, 2011)

82nd medic said:


> Have you attended it?


Nope, wrong branch.


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## 82nd medic (Apr 3, 2011)

ffemt8978 said:


> Nope, wrong branch.



Ok so then I take it you don't know that as far as line/field medics go most purposely fail out so they get to go home early? Especially in times of war when the CMB is what matters, not the EFMB? Or that the only medics that really take it seriously at all are hospital medics who've been spending the last X amount of years working more as a janitor/litter carrier than doing actual medical skills?


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## ffemt8978 (Apr 3, 2011)

82nd medic said:


> Ok so then I take it you don't know that as far as line/field medics go most purposely fail out so they get to go home early? Especially in times of war when the CMB is what matters, not the EFMB? Or that the only medics that really take it seriously at all are hospital medics who've been spending the last X amount of years working more as a janitor/litter carrier than doing actual medical skills?



And you don't know that either.  I've seen a lot of comments that so far, you have been unable to factually support.  You seem to think that your experiences in the military are the standard for everyone in the military, and that's just not the case.  So how about some facts to support your position?


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## 82nd medic (Apr 3, 2011)

ffemt8978 said:


> And you don't know that either.  I've seen a lot of comments that so far, you have been unable to factually support.  You seem to think that your experiences in the military are the standard for everyone in the military, and that's just not the case.  So how about some facts to support your position?



This is the only comment I've seen from you so far (not that ive spent hours scanning these boards or anything) and it's about a course you never even attended... Not sure it's correct to point fingers about what you can or can't support with this. I'm pretty sure that someone that's been to a course would know more about it than someone who hasn't.
I have an entire brigades worth of medics to go off of... What are you basing your assumption that medics do want to attend it? 
I never said the standards I had was the only one in the military.

Google "opinion on EFMB", I'm far from the only one who thinks it's irrelevant to actual medics


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## ffemt8978 (Apr 3, 2011)

82nd medic said:


> This is the only comment I've seen from you so far (not that ive spent hours scanning these boards or anything) and it's about a course you never even attended... Not sure it's correct to point fingers about what you can or can't support with this. I'm pretty sure that someone that's been to a course would know more about it than someone who hasn't.
> I have an entire brigades worth of medics to go off of... What are you basing your assumption that medics do want to attend it?
> I never said the standards I had was the only one in the military.
> 
> Google "opinion on EFMB", I'm far from the only one who thinks it's irrelevant to actual medics


I'm not the one making unsupported, blanket statements about a program.  I asked a question, which you've conveniently decided to side step answering by questioning whether or not I've attended the program.


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## 82nd medic (Apr 3, 2011)

In fact to quote from the military.com boards:

"I think the way they do EFMB is a load or crap, the way they grade it and what they grade you on is bogus. Some of the best medics I have ever had the pleasure of working with have not made it, and some of the worst have...

They have a set way they want you to do things, when when I went through; it wasn't the wrong way, but it wasn't the way we do things now. And if you deviate from they way they want it, like do things the way you where trained in AIT you will fail. Most of the people I have seen get their EFMB where not medics, had no prior medical training, or just didn't remember their training.."

Like I said before: it tests your ability to memorize, not your actual medical ability. It's like if they had a course for firefighters and in it they said to douse a fire with gasoline... Would you have any real desire to pass or would you rather get out early and go back to actually doing your job?


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## 82nd medic (Apr 3, 2011)

ffemt8978 said:


> I'm not the one making unsupported, blanket statements about a program.  I asked a question, which you've conveniently decided to side step answering by questioning whether or not I've attended the program.



And your question was?


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## ffemt8978 (Apr 3, 2011)

ffemt8978 said:


> Hmmm...*something with a pass rate of 15.3% in FY2008 is a waste of time and is below the standards set for 68W AIT?*  That doesn't make any sense.
> 
> For those of our members that don't know what the EFMB is, here is a wiki page for it: http://en.wikipedia.org/wiki/Expert_Field_Medical_Badge





82nd medic said:


> And your question was?


I'm just having a hard time believing that a course that difficult is below the standards of a program for people straight out of boot camp, referring to AIT.


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## 82nd medic (Apr 3, 2011)

ffemt8978 said:


> I'm just having a hard time believing that a course that difficult is below the standards of a program for people straight out of boot camp, referring to AIT.



talking from personal experience, the trauma lanes they put you through in AIT were harder than the ones they put you in during the EFMB.

read up on any collective group of opinions on it, and i garuntee you'll come across atleast 1 person pointing out that those fresh out of AIT have an easier time passing than those who are experienced medics. 
the actual injuries they give you arent hard: from what i remember one guy with an amputation, one whos unconcious and blocked airway, one with a head injury, and one with a closed fracture. you do a quick triage then get to work...including holding pressure on the amputation for several minutes.

the reason why i say its below standard is because (atleast as of 2008) it wasnt using the TC3 standard that all medics go by. it was using the standard of treatment that the military moved away from (the civilian standard of ABC with turniquets as a last resort after you've already wasted time trying other things) because its well documented that the treatment order of MARCH saves more lives.


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## 82nd medic (Apr 3, 2011)

its not that the course is really all that difficult for what SHOULD be its target candidates (line/field medics). the written test is easy, the land nav course can be completed in 1/3 of the time they give, and the other skills are basics. keep in mind that theres pretty much 2 types of medics attending though (line/field and hospital).
line/field medics strive towards the CMB and you cant wear both on your uniform... not that that really matters because the CMB is from actually saving lives and the EFMB isnt. FROM MY EXPERIENCE, no field/line medic really wants to be there. i doubt its limited to just the overall consensus of a brigade's worth of medics, we didnt recieve some "this course is BS" speech before we went though i could be wrong. 
to hospital medics its really the only medical badge they can get, but hospital medics arent keeping up on those basic "combat unit" skills and a lot of them fail out at the 12 mile road march... marching is easy when you're doing it weekly, its a pain when its something you rarely if ever do though.


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## 82nd medic (Apr 3, 2011)

anyway this has gotten a bit off topic, perhaps it would help if i refrased:

Has anyone attended the EFMB course recently? i'm interested to know if its changed its standards to that of the current TC3 guidelines? (hope that clears up what i meant by "sub standard")


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## Veneficus (Apr 3, 2011)

If I might just make an outsider's observation?

I have never been a medic in the military, but this thread looks a lot like what experienced basics say when they get to paramedic class. 

In both the institutions I have taught medic class in, this population represents the largest group of fail outs and struggling to pass as long as records at either institution were kept. 

The tag line of "it's not all this book learnin' that matters in the field" is exactly the same excuse they always use when put on academic probation. 

It would seem from the comments here that the field medics attending the course may have a precourse bias against it which then manifests itself as a consensus opinion. Those who think otherwise are somehow not part of the group and therefore lesser.

From the educational standpoint, that type of attitude usually inhibits learning, which prevents students from taking into account what is presented and then applying that theory in some way to their specific area of practice even if it is not directly translatable. 

In the civillian world, there is lots of diversity in the types of positions paramedics may find themselves in. But they are all still responsible to the basic curriculum irrespective on the environment they go to work in.

I acknowledge that the program may have been set up prior to the country being in multiple wars, designed for people who had not yet seen combat. The military is exceptionally slow at change, considering it usually prepares for the next war on the experience from the last. 

But where I am from, a fail is still a fail, and the only explanation is that the participant didn't do what it takes to pass.

I have also witnessed this exclusive class attitude between civillian field paramedics and hospital ED techs who are also medics. Interestingly enough, without the other one, both are useless. The patient needs to survive to the hospital, but once there somebody needs to carry out the tasks that are no less a part of patient care and saving lives.

Thank you for the indulgence.


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## mycrofft (Apr 3, 2011)

*Half seriously...*

Maybe this also reflects the lowering recruitment standards we keep hearing about?


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## 82nd medic (Apr 3, 2011)

Veneficus said:


> If I might just make an outsider's observation?
> 
> I have never been a medic in the military, but this thread looks a lot like what experienced basics say when they get to paramedic class.
> 
> ...



I get what your saying but it's different than what you're describing. It's not the difference between "field right" vs "book right" it's a difference of "book right" and "outdated for almost a decade". The "book right" for the army is TC3 which is pretty specific about treatment guidelines. As of 2008, the EFMB was not operating on the TC3 guidelines. To put it into civilian terms, it's like if you attended any medical program and they told you that maggots were the preferred method of fighting all visible infections. It may have been right at 1 point in time, but it's well documented that it's not right today.

the overall consensus about the course comes from that, that it's not what you do according to not just your senior medic's experience but also what you don't do according to the book.


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## 82nd medic (Apr 3, 2011)

mycrofft said:


> Maybe this also reflects the lowering recruitment standards we keep hearing about?




Not really. The body fat %s of recruits out of basic are a good example of that, this is from the years of 2005 and 2008, and badges don't really have anything to do with recruitment standards.
Also considering that 75% of Americans are not eligeable for military service I thin the "lower standards" thing is a bit over dramatized


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## Veneficus (Apr 3, 2011)

82nd medic said:


> I get what your saying but it's different than what you're describing. It's not the difference between "field right" vs "book right" it's a difference of "book right" and "outdated for almost a decade". The "book right" for the army is TC3 which is pretty specific about treatment guidelines.



I understand. The same thing happens in civillian medicine, especially in trauma guidlines. 

But we have to sit through the classes and we do. We say the magic words they want to hear, do what they want to see. We get our card with a new expiration date on it, then go drinking and talk about what BS it is and what we would really do. But most of the preceptors are extremely knowledgable people and always have something worth hearing. We all still pass.




82nd medic said:


> As of 2008, the EFMB was not operating on the TC3 guidelines. To put it into civilian terms, it's like if you attended any medical program and they told you that maggots were the preferred method of fighting all visible infections. It may have been right at 1 point in time, but it's well documented that it's not right today..



A bit of an exaggeration I think. 

I am quite familiar with trauma guidlines all over the world, and the latest ones, which are usually done by consensus, are still easily 10 years behind with only a few changes. So I am not really sure how out of date it could be?  



82nd medic said:


> the overall consensus about the course comes from that, that it's not what you do according to not just your senior medic's experience but also what you don't do according to the book.



If I could humbly point out?

All of the senior surgeons and intensivists I know are quick to point out that there is no one right answer.

The textbooks I use now basically say "here is all we know, best of luck in your decisions."

In those same textbooks, they talk about the history of various treatments including the failed and impractical ones, because seeing where you come from helps you get where you are going.

Some of the topics I am researching have not even become recognized as possible, and are far from mainstream. 

The higher you go in medicine, the less definitive answers there are. Even from the most experienced.

There is no such thing as education that is a waste of time. But there is education that is wasted on people who cannot or do not use it.


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## 82nd medic (Apr 3, 2011)

Veneficus said:


> I understand. The same thing happens in civillian medicine, especially in trauma guidlines.
> 
> But we have to sit through the classes and we do. We say the magic words they want to hear, do what they want to see. We get our card with a new expiration date on it, then go drinking and talk about what BS it is and what we would really do. But most of the preceptors are extremely knowledgable people and always have something worth hearing. We all still pass.
> 
> ...



If this was a certification or qualification of required to do your job or increase your scope of practice I'd agree whole heartedly. But it's not, all it does is get you a badge which is replaced by the CMB the second you treat a casualty in combat. It has no bearing at all on your job. Even if it taught you something new I would agree but it's just a test of the skills that medics were taught from the 90s or earlier. 
Look up "tactical combat casualty care", it has a good list of why the current protocols are in place.
Yes it is a bit of an over exaggeration but it gets the point across. Maggots would help clean a staph infection, and holding someones arm for 5 minutes would slow blood loss from a distal location on the arm, but it's so outdated and there's so much documentation suggesting other treatment, that's it's pointlessly innefective if any other means (antibiotics with landing and packing or in tc3s case getting a tourniquet on the limb). The difference is that in combat if you're holding someones arm you can't shoot back, and that can get more people hurt. So yes, there is no absolute right, but this is as close as absolutely right gets.


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## Veneficus (Apr 3, 2011)

82nd medic said:


> Look up "tactical combat casualty care", it has a good list of why the current protocols are in place..



I get to see the draft versions, it is not bad.


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## usafmedic45 (Apr 3, 2011)

> But it's not, all it does is get you a badge which is replaced by the CMB the second you treat a casualty in combat



Even non-trauma docs are eligible for it simply by virtue of being in a hospital in a combat zone that is ever under some sort of direct or indirect fire.  If you're willing to play around with anecdotal evidence,  I know a psychiatrist who has the CMB for more or less sleeping through a mortar round landing on the other side of the compound.  It's arguably the easier of the two to earn.  As one of my 68W friends put it, it's the "thanks for showing up" badge for medical personnel.  I don't know many people who look on it as prestigious or anything.  Then again, most of the folks I know care less about the decorations and more about doing their job.  Your mileage apparently varies....

See: http://www.army.mil/symbols/CombatBadges/medical.html  Caveat #4 is the primarily pertinent one here:



> Subsequent to 11 September 2001 – Personnel outlined in (1) and (3) above, assigned or attached to or under operational control of any ground Combat Arms units (not to include members assigned or attached to Aviation units) of brigade or smaller size, who satisfactorily performed medical duties _while the unit is engaged in actual ground combat_ provided they are personally present and under fire.  Retroactive awards are not authorized.


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## Tommerag (Apr 4, 2011)

82nd medic said:


> Not really. The body fat %s of recruits out of basic are a good example of that, this is from the years of 2005 and 2008, and badges don't really have anything to do with recruitment standards.
> Also considering that 75% of Americans are not eligeable for military service I thin the "lower standards" thing is a bit over dramatized



I would tend to disagree with you on that. You should have seen some of the people I was at Basic and AIT with. They were some major Dbags all around. And where are you getting the 75% of Americans are not eligible for military service? I dont think the "lower standards" is over dramatized.


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## 82nd medic (Apr 4, 2011)

usafmedic45 said:


> Even non-trauma docs are eligible for it simply by virtue of being in a hospital in a combat zone that is ever under some sort of direct or indirect fire.  If you're willing to play around with anecdotal evidence,  I know a psychiatrist who has the CMB for more or less sleeping through a mortar round landing on the other side of the compound.  It's arguably the easier of the two to earn.  As one of my 68W friends put it, it's the "thanks for showing up" badge for medical personnel.  I don't know many people who look on it as prestigious or anything.  Then again, most of the folks I know care less about the decorations and more about doing their job.  Your mileage apparently varies....
> 
> See: http://www.army.mil/symbols/CombatBadges/medical.html  Caveat #4 is the primarily pertinent one here:



I never said anything along the lines of decorations meaning more than doing your job... I believe I even stated that many personel purposely fail out of EFMB so they can actually get back to doing their job. Also my whole issue with the EFMB is that it has nothjng to do with actually knowing your job. You on the other hand have said that you believe that attending thr EFMB means being up to par though, perhaps you'd like to take a second look at your statement since your entire opinion of what the standards for "army field medicine" are is based off of a course that only badge chasers take seriously? Yes just like anything it can be pencil wipped, I don't know any medic that actually earned it that doesn't take some pride in it. If you think it doesn't mean anything, go find someone who survived a combat injury and ask him what he thinks of his medic's CMB. also you failed to read the whole article or you dont know how deployments work. a hospital medic technically wouldnt be eligeable for one since deploying hospitals (CSHs for example) do not fall under the command of a combat arms unit of brigade or smaller size. they could get one pencil whipped but by regs they are ineligeable to earn the CMB. 



Tommerag said:


> I would tend to disagree with you on that. You should have seen some of the people I was at Basic and AIT with. They were some major Dbags all around. And where are you getting the 75% of Americans are not eligible for military service? I dont think the "lower standards" is over dramatized.


You've seriously never seen this? Wow...
http://www.missionreadiness.org/PAEE0609.pdf


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## Tommerag (Apr 4, 2011)

You do realize that, it says 17-24 right? There for that is not 75% of Americans. You should check your facts before throwing out numbers.



> If you think it doesn't mean anything, go find someone who survived a combat injury and ask him what he thinks of his medic's CMB.



Whose to say it was the medic that saved his life? Could have been another guy with CLS training.


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## 82nd medic (Apr 4, 2011)

Tommerag said:


> You do realize that, it says 17-24 right? There for that is not 75% of Americans. You should check your facts before throwing out numbers.
> 
> 
> 
> Whose to say it was the medic that saved his life? Could have been another guy with CLS training.



Whose to say it's not the medic? That's just throwing out a "what if" for a far reach to disagree. CLS is a decent course since it switched to TC3 standards but what though do you think is going to kick in for most infantrymen? Something they train once a month in or what they're taught since day 1 of OSUT? (that's "shoot your weapon"). Medics exist for a reason, I don't know any infantryman who has a problem letting his medic treat while he shoots back.

And sorry my bad: 75% of the military's main demographic age range for new recruits. I'm sure if you factor in those outside of the age range you'd come to 75% total... Since people seem to like to nit pick here

Also af: I dint know why your bragging about a friend getting a CMB pencil whipped: sleeping isn't performing medical duties.


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## boingo (Apr 4, 2011)

82nd medic said:


> Ok so then I take it you don't know that as far as line/field medics go most purposely fail out so they get to go home early? Especially in times of war when the CMB is what matters, not the EFMB? Or that the only medics that really take it seriously at all are hospital medics who've been spending the last X amount of years working more as a janitor/litter carrier than doing actual medical skills?



Earned mine in 92, it had about a 15% pass rate, in fact, I was the only medic in my battalion to earn it.  As for the CMB, that can be earned by sitting in a clinic in Kuwait or breaching walls in the Hindu Kush, it isn't a "test", you get it for showing up, weather involved in combat or not.  Coming from a line unit, I kind of felt that was wrong, but that was just my opinion at the time.


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## boingo (Apr 4, 2011)

Clearly times have changed, earning your EFMB was the way to promote, get selected for schools, etc... In fact, it was the non-combat types who pissed and moaned, failed PT, failed land nav, failed 12 mile road march and had no clue.  It was the same at air assault school, the REMFs cried and whined about everything, the field guys just soldiered on.


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## 82nd medic (Apr 5, 2011)

boingo said:


> Earned mine in 92, it had about a 15% pass rate, in fact, I was the only medic in my battalion to earn it.  As for the CMB, that can be earned by sitting in a clinic in Kuwait or breaching walls in the Hindu Kush, it isn't a "test", you get it for showing up, weather involved in combat or not.  Coming from a line unit, I kind of felt that was wrong, but that was just my opinion at the time.



If you're going by regs you have to be in combat or atleast under fire to get it. True you get it whether the patient lives or dies, but I don't know any medic that wants one of their platoon members to buy it. The point being that the CMB is atleast a representation of doing your job.



boingo said:


> Clearly times have changed, earning your EFMB was the way to promote, get selected for schools, etc... In fact, it was the non-combat types who pissed and moaned, failed PT, failed land nav, failed 12 mile road march and had no clue.  It was the same at air assault school, the REMFs cried and whined about everything, the field guys just soldiered on.



War changes things, so does a slow rate of badge courses updating to the current medical care regs. In theory it can be a good course, but in practice it's not (or atleast wasn't in 2008). If it actually tested medical and combat skills it would be one thing, but testing an archaic treatment standard is another.


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## Combat_Medic (Apr 6, 2011)

On my way to EFMB at the end of this month.  I will let you know if they are using the TC3 guildlines when I get back.


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## 82nd medic (Apr 6, 2011)

Combat_Medic said:


> On my way to EFMB at the end of this month.  I will let you know if they are using the TC3 guildlines when I get back.



Awesome thanks


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## usafmedic45 (Apr 6, 2011)

> Also af: I dint know why your bragging about a friend getting a CMB pencil whipped: sleeping isn't performing medical duties.



I wasn't bragging, just making the point that it's a more or less pointless exercise to argue that this badge means more than that one or that it's more coveted.


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## 82nd medic (Apr 6, 2011)

usafmedic45 said:


> I wasn't bragging, just making the point that it's a more or less pointless exercise to argue that this badge means more than that one or that it's more coveted.



I'm not sure your logic works. You're saying he had one pencil whipped because he didn't want it?
Or are you saying it means less because some troops who are a little shy of honorable recieve them when they clearly shouldn't? I've seen someone get a bronze star for doing a power point presentation so there's very few awards you can't say that of and see the above.
Or are you saying it means less because it's a badge that is earned by actually treating a patient under fire? Didn't you say earlier that doing your job meant more than badge chasing? Your logic fails there since the EFMB is just a badge and the CMB (atleast when it's actually earned) is from doing your job.

Your logic fails...


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## usafmedic45 (Apr 6, 2011)

> Your logic fails...



No, apparently your reading comprehension does.   

He technically earned it because he was in a combat zone as a medical provider, was under the rank of colonel and was under fire.  Welcome to the criteria for the CMB.  No "pencil whipping" necessary.  Beyond that, I have nothing further to say to you because you have your opinions and nothing anyone else has to say- regardless of their background or experience- is apparently sufficient to warrant your reconsideration.  Therefore, I have nothing more to say to you.


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## ffemt8978 (Apr 6, 2011)

That's enough of this one.  If you want to debate which badge is better, take it elsewhere.


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