# Combat Lifesaver vs. EMT/Medic



## armywifeemt

So is there anyone who has gone through combat lifesaver course, then gone through an EMT-B program? 

My husband went through CLS a little while back and it drove me nuts because he came home spouting off all this stuff about it and I am sitting there going "WTH" because it was nothing like anything I've been trained to do. 

I've grown curious what they actually teach you in CLS.

Anyone wanna give me a rundown on the differences?


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## Shishkabob

CLS is just that.  It's a few skills taught to all soldiers to be used in combat on the wounded.   It's, and I'm quoting them, the midway point between "self/buddy aid and a combat medic"

It's really only basic first aid taught to all military personnel, with the addition of IVs... and looking at their item list, Atropine and Diazapam.

CLS doesn't have any actual education on anything beyond combat wound care from what I see.  Their entire medical training in basic is 23 hours.  Not even the FR level if you want to compare it to something.


It's not equatable to EMT.  The Army's combat medics ARE trained NREMT-B's.


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## akflightmedic

Having taught several of these programs while in Afghanistan because the courses are contracted out to civilian instructors in theater, Linus is mostly correct.

It is a very short first aid class with some advanced skills added in. We teach a lot of mnemonics, memory aids and we drill it over and over. There is no time to teach "medicine", this is the most cookbook program you will ever see.

They are taught IV's (sorry, large bore IV in AC for everything with liter of fluid), they are taught chest needle decompression, and they get airway skills by practicing with King Lts or combitubes. 

They do carry morphine and the typical nerve agent pharmacy (atropine).

Then there is lots and lots of time spent on bandaging and splinting, every soldier carries a CAT. This is a base wide mandate where I am regardless of which nation you are from.

They also get to spend hours in the simulator. It is a darkened room (all walls, ceiling painted black), the floor is covered in gravel, loud music (war combat sounds) and I do mean loud is blasted while they tend to several victims as a result of explosives or overturned vehicle. There is also a HUMVEE and MRAP overturn simulator.

While most would view this as inadequate, a lot of lives have been saved by putting everyone through the course as directed by the US Army. Mostly due to bleeding control and rapid recognition, however it is still effective. The negative is you end up with a lot of guys claiming to be medics at times when what you really need is a real medic.


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## MrBrown

I suppose that would drive you nuts.  Almost like our sixteen week Technicians who tell Intensive Care officers not do to something they've probably been doing for twenty years!

However, I suppose we can't find fault with thier way of doing things; thier modality suits the situations they encounter; I haven't encountered anybody yet who has had several limbs or thier guts blown out as a result of an IAD out there on the civillian street.

Speaking of the CAT, we have that now.  Tourniquets here were not the norm or a formal procedure however they were used for severe, uncontrollabe bleeding and made out of a pillow case.  Never seen one used yet.


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## EMSLaw

Tourniquets are back in the NREMT standards as of recently, IIRC.  And right after direct pressure - no more "absolute last resort because it will cause amputation.".


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## mycrofft

*would love to read a CLS instructor's teaching manual,*

...or the course proposal when it was first set up.
Knowing why stuff is taught is to me like being interested in why a certain procedure is done, not how to do it. Take away the motivation and dumbing-down aspect and tell me what was seen and what is being done and why.

Cold War post-1980 (check me on this OG's) we had two concepts which seem now to be pretty well gone: FEBA (which was obsolete when chemical munitions were proliferated starting about 1976), and the FOUR ECHELONS:
I: Self-AID/Buddy Care; in the "battle area" (formerly known as "the front").
II: Called "Echelon Two", this was filled by units designated as tactical clinics, tactical dispensaries, and I suppose some still had their "aid stations" and "dressing stations". At or near the FEBA, forward edge of battle area. Supposed to be mobile to follow it, yet hardened enoujgh to resist Bio/Chem attack. Yeah, right. HAd docs, flight surgeons. Theoretically had nurses, but DESERT STORM did not send USAF nurses to them.
III: Theater medical centers, like at Ramstein, Little Risington, etc. Supposedly out of harm's way but less than one whole day's air transport. Inpatient services.
IV: Stateside, Scott/Travis/Andrews AFB's, maybe more.


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## ExpatMedic0

My CLS course was less than a week. I still have the certificate from the army, it says it was "40 hours" but it was less. I do not recall being trained in chest decompression or anything advanced at all other than IV's, and we where not trained in any airway procedures beyond an OPA. 
All soldiers carry atropine and the other nerve agent antidote. It was in our pro mask holster. We all got trained in that, its in the soldiers manual of common task skill level 1.

CLS was a very basic first aid class focused only on trauma, no medical and with our only advanced skill being able to give IV's. It sounds like maybe there is more to it now, unless the instructors are just adding there own criteria into the program. It did come with a large a medical book we where encouraged to reference, %100 cook book. The book may have contained advanced procedures and walked a average joe through how to preform them step by step, I do not recall.

The idea behind it I gathered was buddy-aid is better than no aid at all in  combat, there is only 1 medic per infantry platoon (some times less) so in an MCI he can only do so much. We tried to have 1 CLS per squad. There is no way in hell they would have gave us morphine! Of course I never went to Iraq, might make since there. Anyway....
One example would be If someone was bleeding out another solider could stop the bleeding and start an IV until the real medic got there, or if he was dead until another medic arrived.

I carried OTC meds in my bag, 800mg motrin, a sam splint rolled up, at least 2 IV bag setups, some bandages, gauze, foot powder, mole skin, occlusive dressings, a few OPA's some gloves, and a face shield. and a 9 line medevac cheat sheet, Thats it. The CLS bags we where issued where small, about the size of a fanny pack. I wore mine on the back of my LBV above my buttpack or in place of it sometimes.


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## xgpt

Linuss said:


> CLS is just that.  It's a few skills taught to all soldiers to be used in combat on the wounded.   It's, and I'm quoting them, the midway point between "self/buddy aid and a combat medic"
> 
> It's really only basic first aid taught to all military personnel, with the addition of IVs... and looking at their item list, Atropine and Diazapam.
> 
> CLS doesn't have any actual education on anything beyond combat wound care from what I see.  Their entire medical training in basic is 23 hours.  Not even the FR level if you want to compare it to something.
> 
> 
> It's not equatable to EMT.  The Army's combat medics ARE trained NREMT-B's.



Just curious, do you know about the different levels of army medics?

I'm sort of considering enlisting as a medic once I get certed and want to know about the different paths there might be...


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## ExpatMedic0

Unless your sec ops all field medics are trained to the civilian NREMT-B level with additional skills for trauma similar to an intermediate like intubation, iv fluids, morphine, IO, ect... They have more training and skills than an NREMT-B but are only allowed to test for there NREMT-B. I think its because the army mainly trains them for trauma of young men and hygiene. They do not get much medical, cardiac, obgyn, ect

Spec ops medics like the 18D are trained to the NREMT-P level with additional training.



xgpt said:


> Just curious, do you know about the different levels of army medics?
> 
> I'm sort of considering enlisting as a medic once I get certed and want to know about the different paths there might be...


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## xgpt

schulz said:


> Unless your sec ops all field medics are trained to the civilian NREMT-B level with additional skills for trauma similar to an intermediate like intubation, iv fluids, morphine, IO, ect... They have more training and skills than an NREMT-B but are only allowed to test for there NREMT-B. I think its because the army mainly trains them for trauma of young men and hygiene. They do not get much medical, cardiac, obgyn, ect
> 
> Spec ops medics like the 18D are trained to the NREMT-P level with additional training.




I guess that makes sense, they certify you at the minimum standard, and then add on the things the military needs, leaving out useless things like battlefield OB


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## usafmedic45

> It's, and I'm quoting them, the midway point between "self/buddy aid and a combat medic"



As a former CLS instructor, that's pretty much the best description possible.



> Unless your sec ops all field medics are trained to the civilian NREMT-B level with additional skills for trauma similar to an intermediate like intubation, iv fluids, morphine, IO, ect... They have more training and skills than an NREMT-B but are only allowed to test for there NREMT-B. I think its because the army mainly trains them for trauma of young men and hygiene. They do not get much medical, cardiac, obgyn, ect



Actually I don't believe the standard "medic" was taught to intubate under the US Army (this may have changed in the past seven years) but rather were taught to rely on non-visualized airways such as the OPA, NPA and Combitube.  Well, they may be taught it, but I don't recall them being allowed to do it outside of the crews assigned to the aeromedical helicopters.  Endotracheal intubation has no place as a first response skill in the combat setting because the skills are too perishable, ET tubes are too easily displaced during movement and the signs of displacement are too easily missed.


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## ExpatMedic0

in 2002 at Ft. Carson CO I saw our field medics with laryngoscopes and ET tubes practicing on manikins in a classroom setting. I am not sure if this was added to there scope of practice or just for training purposes.


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## usafmedic45

schulz said:


> in 2002 at Ft. Carson CO I saw our field medics with laryngoscopes and ET tubes practicing on manikins in a classroom setting. I am not sure if this was added to there scope of practice or just for training purposes.


Are they assigned to ambulances (ground or helicopter) or are they company medics assigned to combat units?  If I recall correctly, one of the largest "Dustoff" units is based out of Ft. Carson.


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## MrBrown

The NZ Defence Force medics come in three flavours; junior, intermediate and senior and more-or-less follow the civillian training for Ambulance Officers,

A junior medic has a 12 week course + 40 weeks on the job experience and is able to do basic emergency care.

Intermediate medic has another 14 weeks of training and can do some intermediate level skills like introsseous, intravenous fluid etc.

Senior medic has the two-year Diploma in Military Medicine (the military equivalent of our old ALS qualification) and is considered advanced life support.

While the military training is quite thorough and very good it does not touch on many aspects of the civillian workd; for example military medics do not carry around GTN for grandad's angina or salbutamol for asthma because they never see those things in the military.  They are also taught to decompress chests and do intraosseous infusions quite early on and this is at odds with the civillian system because those are advanced skills.

Like you guys, at the moment military medics cannot transfer to the civillian world but with our upcoming qualification changes that's probably going to chance and they will have a bridge program.


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## mycrofft

*Sociological aspect.*

After about eight years of war and occupation in SWA, ther are many, many former medics, and people with basic EMS training plus experience, in our population. This sort of influx in the past has affected finance, the arts, and, yes, EMS.


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## armywifeemt

Interesting as it is to hear how things are in NZ again, I had really directed this question solely at US Armed Forces members... because my question was specific to the course offered to OUR service men and women... as my curiosity was purely born of my husband taking that class. 






MrBrown said:


> The NZ Defence Force medics come in three flavours; junior, intermediate and senior and more-or-less follow the civillian training for Ambulance Officers,
> 
> A junior medic has a 12 week course + 40 weeks on the job experience and is able to do basic emergency care.
> 
> Intermediate medic has another 14 weeks of training and can do some intermediate level skills like introsseous, intravenous fluid etc.
> 
> Senior medic has the two-year Diploma in Military Medicine (the military equivalent of our old ALS qualification) and is considered advanced life support.
> 
> While the military training is quite thorough and very good it does not touch on many aspects of the civillian workd; for example military medics do not carry around GTN for grandad's angina or salbutamol for asthma because they never see those things in the military.  They are also taught to decompress chests and do intraosseous infusions quite early on and this is at odds with the civillian system because those are advanced skills.
> 
> Like you guys, at the moment military medics cannot transfer to the civillian world but with our upcoming qualification changes that's probably going to chance and they will have a bridge program.


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## ExpatMedic0

armywifeemt said:


> Interesting as it is to hear how things are in NZ again, I had really directed this question solely at US Armed Forces members... because my question was specific to the course offered to OUR service men and women... as my curiosity was purely born of my husband taking that class.



Well I told you how it was in 2002 on active duty for an infantry guy at Ft. Carson since I was a CLS. I also deployed to Egypt and Israel as one. You might also want to check out this http://www.scribd.com/doc/3460095/US-ARMY-is0825-Medical-Course-Combat-Lifesaver-Course-0825CC

its the OFFICIAL course content/ expectations. Also please keep in mind this course is for someone with no medical background and is less than a week long. Its for us to patch each other up as best as possible until a medic can get there. It even says in the manual "a combat lifesaver is a non medical solider who provides life saving measures as a secondary mission as his primary combat mission allows until the medic is available"


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## Afflixion

Ok to clear things up cls do not carry atropine and diazepam but in autoinjectors used for CBRNE purposes as atropine was originally designe by the army to counteract nerve agents...just a tid bit of information. CBRNE Stands for chemical, biological, radioactive, nuclear and high yield explosive (formally NBC) as for the airways the only airway that cls use is are npa's and opa's. Cls are no longer taught iv's as of february 2010, as every single cls person tries to use an iv prior to any care even when it is not warrantred.

As it stands now cls is managment of hemorrhaging, basic airways, and extrication techniques.

As for morphine only medics carry morphine or more commonly used now fentanyl or ketamine nasal spray (for those w/o IV access)  medics e4 and below use king lt unless taught by their bn surgeon how to properly intubate. (As every good bn surgeon should)

Ps sorry for misspelling typing this on my cellphone prior to class


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## MrBrown

What has the military experience with ketamine been?

Our civillian HEMS and Intensive Care Paramedics (ALS) have been using it since 2005 and 2007 respecitvely to excellent effect


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## Dre

*CLS/EMT/Medic*

Ok, that is the same as First Responder, EMT-B and EMT-P or Paramedics. The difference isnt much. Just a few classes. I like the CLS course, cause it saves me from having to do IV's or a lot of work. I love Paramedics cause they still have to do all the work. So, if you ask me, I will sit back and enjoy their struggles. LOL

But yeah, if you have an EMT, you will be in an 8 week refresher. Have them submit it as a CORE class for NJ. As for a Paramedic in the Army, that is really stupid. Drop the EMT Basic or NREMT and make all medic Paramedics. Cause if I go back in, I'm gonna have the instructors pissed! 6 years as an EMT and have already had my NREMT, I would have to show them short cuts. And the best unit is Specialty Care if you are an EMT!!!

But you cannot compare the 3. I would not even argue with a Paramedic. And I'm a medical assistant/ER Tech. Oh yeah, the difference you CAN argue about Paramedics are standing orders. Most Paramedics have to call in orders. I doubt the Army Medic will really do that. I think they are closer to a CCRN than a Paramedic, in terms of their operations.

Oh, and I would never take a CLS serious, unless he really has information that I don't know. And if they are cool, I would teach them a lil more!


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## Veneficus

Dre said:


> I would have to show them short cuts. And the best unit is Specialty Care if you are an EMT!!!!



You are comparing the combat specific aid training for people in combat to that of a civillian EMT?

That just somehow doesn't seem like a good idea to me?


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## Dre

I'm actually a NJ EMT. I also was apart ofvthe CLS course before it was mandatory. That's how come I was good at drawing blood. In addition, I was about to take the 2 year course as a paramedic. I don't know the entire SF Medic course, but the key training is ACLS in addition to others. Had I take T-EMS, I would have been ready as a combat medic in the Army. I think I can basically make at least a general comment on the training. Civilian EMS was adopted after the military. ie MAST was a combat shock garment that was passed down to civilians. In addition to the tourniquets. So. If I shoot from the waist, I have enough ammo! 

My dad was a combat medic.


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## Dre

Also, my point was that the degrees in comparison to civilians training is how it is looked at. I'll look at the PDF of the cuurent doctrine online and compare it to the 2001 course I took.


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## rwik123

There's a major distinction between the CLS and even a basic emt. The CLS course does not go into much of the physiology on what it happening. It's just a sign by sign course which addresses the leading causes of death in the battle field.. Which are obviously airway and hemorrhaging. Like it was said earlier, this is the extent of the course.. Therefor it is not applicable in the civilian world because the scope is so narrow and limited to traumatic injuries on extremely healthy young individuals. No ob, environmental, or extrication skills that would be needed by a basic.


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## Dre

A CFR or Certified First Responder are basically police and fire. They are trained in putting oxygen on and C-Spine stabilization. One an Ambulance, they can only do as directed with instructions. Basically, it's the person who said "can I help". Again, the civilian EMS is the same as the military with state regulations. My point was to say to civilians that read this, these are the levels. Just that CLS can do IV's. Paramedic and EMT-I's can. NJ has a small CFR program and no EMT-I.


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## Veneficus

rwik123 said:


> The CLS course does not go into much of the physiology on what it happening.



Neither does EMT class.

I am eagerly watching the latest Mr.Brown thread and discovering that as textbook as it is, apparently not much is taught in paramedic class in the way of pathophysiology either.



rwik123 said:


> It's just a sign by sign course which addresses the leading causes of death in the battle field.. Which are obviously airway and hemorrhaging. Like it was said earlier, this is the extent of the course.. Therefor it is not applicable in the civilian world because the scope is so narrow and limited to traumatic injuries on extremely healthy young individuals. No ob, environmental, or extrication skills that would be needed by a basic.



Are you saying it cannot be compared, or that one is superior to the other?

I really can't see how a civillian EMT is going to show shortcuts and teach the instructors a little more, especially considering the knowledge and experience of some of the self identified instructors on this board.

I cannot imagine Basic EMTs Showing anyone the best way to decompress chests or apply a TK with as often as it is done in the civilian world. 

I commend the comparison of the MAST as something handed down by the military. Especially since its purported mechanism doesn't work, and what really makes it useful is the pneumatic compression of the abd aorta in a very small subset of pathology.

I also respectfully request a more articulate argument than "my dad was a medic" doctor, grand pubah, whatever. I have heard it phrased many ways before and it always sounds pityful.

My dad was a combat infantryman and a steelworker. You know what special information and skills that confers on me?

Nothing.

Just like my wife, daughter, mother, sister etc. have no special medical knowledge granted to them.


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## Dre

Well, I have to wait. The just changed the entire EMS protocols for NJ. I'll check NY's. Thats the only Paramedic program NJ follows, that I know. But it's a college course here.


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## rwik123

Veneficus said:


> Neither does EMT class.
> 
> I am eagerly watching the latest Mr.Brown thread and discovering that as textbook as it is, apparently not much is taught in paramedic class in the way of pathophysiology either.
> 
> 
> 
> Are you saying it cannot be compared, or that one is superior to the other?
> 
> I really can't see how a civillian EMT is going to show shortcuts and teach the instructors a little more, especially considering the knowledge and experience of some of the self identified instructors on this board.
> 
> I cannot imagine Basic EMTs Showing anyone the best way to decompress chests or apply a TK with as often as it is done in the civilian world.
> 
> I commend the comparison of the MAST as something handed down by the military. Especially since its purported mechanism doesn't work, and what really makes it useful is the pneumatic compression of the abd aorta in a very small subset of pathology.
> 
> I also respectfully request a more articulate argument than "my dad was a medic" doctor, grand pubah, whatever. I have heard it phrased many ways before and it always sounds pityful.
> 
> My dad was a combat infantryman and a steelworker. You know what special information and skills that confers on me?
> 
> Nothing.
> 
> Just like my wife, daughter, mother, sister etc. have no special medical knowledge granted to them.



there two different animals. Obviously an EMT isnt going to be able to do half the stuff a guy that has taken a CLS class can do. And the other way around, a guy who has taken a CLS course does not have some of the knowledge that we have. So they are each better at their own discipline, but not truly comparable or able to switch places. 

"I cannot imagine Basic EMTs Showing anyone the best way to decompress chests or apply a TK with as often as it is done in the civilian world. "

ok?.. I cannot imagine a CLS certified soldier showing how to backboard someone or birth a child. Your comparisons are flawed because they are not comparable certifications.


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## Veneficus

rwik123 said:


> ok?.. I cannot imagine a CLS certified soldier showing how to backboard someone or birth a child. Your comparisons are flawed because they are not comparable certifications.



Fair enough, but I was trying to find an example that was something that could have a definitive outcome with the skills available. 

We know that backboarding and childbirthing may not mke any difference at all.

Bt my point was that an EMT cannot start telling people trained specifically to their very narrow environment the best way to do things with the skills and knowledge that they have at their disposal.


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## rwik123

Veneficus said:


> Fair enough, but I was trying to find an example that was something that could have a definitive outcome with the skills available.
> 
> We know that backboarding and childbirthing may not mke any difference at all.
> 
> Bt my point was that an EMT cannot start telling people trained specifically to their very narrow environment the best way to do things with the skills and knowledge that they have at their disposal.



yeah i totally agree with the ending point.. if I got shot i would want to be cared by someone with someone who has less knowledge in general, but a higher amount of speciality instead of being cared by say an emt who has a broader range of skills but is not familiar with that situation and less trained on that specific situation with less interventions at their disposal


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## Combat_Medic

Dre said:


> Just that CLS can do IV's.



Don't know if this was mentioned before but IV's were removed from CLS traning.  All IV supplys have also been removed from all CLS bags.


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## MackTheKnife

*Cat*



MrBrown said:


> I suppose that would drive you nuts.  Almost like our sixteen week Technicians who tell Intensive Care officers not do to something they've probably been doing for twenty years!
> 
> However, I suppose we can't find fault with thier way of doing things; thier modality suits the situations they encounter; I haven't encountered anybody yet who has had several limbs or thier guts blown out as a result of an IAD out there on the civillian street.
> 
> Speaking of the CAT, we have that now.  Tourniquets here were not the norm or a formal procedure however they were used for severe, uncontrollabe bleeding and made out of a pillow case.  Never seen one used yet.



CAT works well but the MET tourniquet is better IMHO. The windlass on the CAT is plastic and some tended to break when being applied.  The windlass on the MET is aluminum.


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## MackTheKnife

*No sh*t?*



Combat_Medic said:


> Don't know if this was mentioned before but IV's were removed from CLS traning.  All IV supplys have also been removed from all CLS bags.



They removed IV's?  Did they give a reason?  I wonder if CLS is going more the route of TCCC?


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## MackTheKnife

*Correction*



rwik123 said:


> There's a major distinction between the CLS and even a basic emt. The CLS course does not go into much of the physiology on what it happening. It's just a sign by sign course which addresses the leading causes of death in the battle field.. Which are obviously airway and hemorrhaging. Like it was said earlier, this is the extent of the course.. Therefor it is not applicable in the civilian world because the scope is so narrow and limited to traumatic injuries on extremely healthy young individuals. No ob, environmental, or extrication skills that would be needed by a basic.



Just as an FYI, it's uncontrolled extremity hemorrhaging (approx 67% of preventable battlefield deaths), undiagnosed/untreated tension pneumothorax (approx 30%), and lastly airway (approx 6%).  The remaing 1% is non-combat related.


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## Akulahawk

MackTheKnife said:


> Just as an FYI, it's uncontrolled extremity hemorrhaging (approx 67% of preventable battlefield deaths), undiagnosed/untreated tension pneumothorax (approx 30%), and lastly airway (approx 6%).  The remaing 1% is non-combat related.


Given the armor that is worn, I would certainly expect to see extremity hemorrhage, tension pneumo, and airway issues being the major causes of battlefield death where the person wasn't immediately killed. 

Body armor doesn't cover the extremities and can easily make tension pneumo difficult to detect until the signs become overt by hiding an external wound...

IV's seem to have been removed from the CLS because too much time was spent dealing with IV stuff and treating preventable causes of death needed to be addressed more. Let the unit medic/corpsman do the IV. Those folks know enough to not flood the patient with fluid...


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## EMT11KDL

As I was just an instructor for the CLS class this past week for my Unit, I did have them to IV's.  Because you never know when you (as the medic) might need help getting a line established on a patient or help spiking a bag.  Or you might be one injured.


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## EMT11KDL

MackTheKnife said:


> They removed IV's?  Did they give a reason?  I wonder if CLS is going more the route of TCCC?



The reason why IV were removed is actually pretty simple.  The CLS guys in the field were spending to much time worrying and attempting to gain access via IV instead of treating there patient.


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## Afflixion

Sorry to jump into this a little on the late side but, first off the CAT is starting to be replaced by the SOFT-T as it is more reliable and will actually stop hemorrhaging from femoral bleeds. The majority of light infantrymen have muscular thighs and the CAT will not fit around or will snap prior to stopping bleeding.

Secondly, the true reasoning why IV resuscitation was removed from the CLS is a few reasons, the most importantly as I have personally seen is CLS like to think of IVs as their "core skill" and will try to start an infusion prior to any other care even on the CUF (care under fire.) Now CLS is focusing on proper patient assessment more than anything else, which is what CLS personnel truly needs. One more reasoning is people going into circulatory overload in their barracks room after drinking heavily that night trying to sober up before morning PT, which still happens quite frequently. IV's are not some arbitrary skill that anyone who knows how to stick can do, you must learn the proper hemodynamics of the vascular system along with the different reasonings and uses for different fluids. Which brings me to another point if you push to much fluid and raise systolic BP above 93mmHg you will blow any clots formed with trauma patients which is something that is not taught to CLS and is still rarely taught to line medics. If you are still teaching IVs to CLS there is a proper reasoning why it was removed and because you feel you know better than an entire board of physicians and NP/PAs you are sorely mistaken. As we say in the military's "murphy's laws of combat" If it looks stupid and works than it isn't stupid.

Finally, one cannot compare CLS or even military medics to any form of CLS, their scope of practice and methods of doing things are completely different. If CLS were taught enough civilian medicine then don't you think the Army would certify them as EMRs ,with the "new" army being so focused on civilian education now? CLS is exactly what the name states someone who may be able to save a life under battlefield conditions, nothing more and nothing less.


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## NSW1979

Afflixion said:


> first off the CAT is starting to be replaced by the SOFT-T as it is more reliable and will actually stop hemorrhaging from femoral bleeds. The majority of light infantrymen have muscular thighs and the CAT will not fit around or will snap prior to stopping bleeding.





Afflixion said:


> . One more reasoning is people going into circulatory overload in their barracks room after drinking heavily that night trying to sober up before morning PT, which still happens quite frequently.



Afflixation is dead on about the soft -t vs CAT. I was deployed most of 2010. During that time, I had to use a C.A.T. after an IED blast. I use the C.A.T. in the soldiers IFAC (little personal aid bag that is carried on all soldiers) on his L leg which was riddle with shrapnel and bleeding profusely. The damn windlass snapped in half. Luckily I had a SOFT-T on my IOTV. Saved the day and his life. Turns out his femoral artery was severed right above the knee. Never again have I used a C.A.T. 

IV's was taken out becuase like some stated, the soldiers who are non medics, would go straight for the IV before controlling the hemorrhaging. The Barracks was another issue as well. I do stay in the barrack and I am authorized to give IVS to drunks, but only when the soldiers platoon sergeant gives the go ahead. With evac times in most cases are 15 mins or less in iraq then main focus for care is stop the bleeding and start the breathing. HABC's at its finest. Plus Hextend is a dangerous thing when it comes to those who don't know what it does or how to use it right. A fool with an IV is sometimes more dangerous than the enemy with a weapon. (i see PT's come in from the field with circulatory overload because the non medic was so focused on ivs.


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## Whiskey Medic

*Wow*



NSW1979 said:


> I do stay in the barrack and I am authorized to give IVS to drunks, but only when the soldiers platoon sergeant gives the go ahead.



Since when are platoon sergeants medical officers. Just sayin'


----------



## 82nd medic

even medical platoon leaders arent medical providers, they're just admin officers.


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## Afflixion

82nd medic said:


> even medical platoon leaders arent medical providers, they're just admin officers.



You sure your in the army? He said PSG not PL, a PL is a Medical Service Officer the military equivalent to a hospital administrator, a PSG in a medical platoon is a 68W40, which is a E7 with extensive medical knowledge, though they are typically not directly involved with patient care.


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## armedic

akflightmedic said:


> Having taught several of these programs while in Afghanistan because the courses are contracted out to civilian instructors in theater, Linus is mostly correct.
> 
> It is a very short first aid class with some advanced skills added in. We teach a lot of mnemonics, memory aids and we drill it over and over. There is no time to teach "medicine", this is the most cookbook program you will ever see.
> 
> They are taught IV's (sorry, large bore IV in AC for everything with liter of fluid), they are taught chest needle decompression, and they get airway skills by practicing with King Lts or combitubes.
> 
> They do carry morphine and the typical nerve agent pharmacy (atropine).
> 
> Then there is lots and lots of time spent on bandaging and splinting, every soldier carries a CAT. This is a base wide mandate where I am regardless of which nation you are from.
> 
> They also get to spend hours in the simulator. It is a darkened room (all walls, ceiling painted black), the floor is covered in gravel, loud music (war combat sounds) and I do mean loud is blasted while they tend to several victims as a result of explosives or overturned vehicle. There is also a HUMVEE and MRAP overturn simulator.
> 
> While most would view this as inadequate, a lot of lives have been saved by putting everyone through the course as directed by the US Army. Mostly due to bleeding control and rapid recognition, however it is still effective. The negative is you end up with a lot of guys claiming to be medics at times when what you really need is a real medic.



put a broad band-aid on a big boo boo. it is worthwhile but i hated watching soldiers walk out of my class thinking they were the new unit medics.


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## Afflixion

armedic said:


> put a broad band-aid on a big boo boo. it is worthwhile but i hated watching soldiers walk out of my class thinking they were the new unit medics.



I hate watching medics walk out of classes thinking they are medical providers, To many medics these days think they know everything and do not like to learn more about medicine. Hence the "forever specialist"


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## Combat_Medic

I've seen some really good medics but I've also seen medics I wouldn't trust with a band-aid.  Thats one reason I hang around here.  I don't post a lot but I try and learn all I can.  I want to earn my title as Medic.  Not just have it handed to me.


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## Afflixion

Combat_Medic said:


> I've seen some really good medics but I've also seen medics I wouldn't trust with a band-aid.  Thats one reason I hang around here.  I don't post a lot but I try and learn all I can.  I want to earn my title as Medic.  Not just have it handed to me.



It is true, like in every profession you have some that are good and continually striving for more and then you have those that hold some sort of disdain for what they do and try to drag others down.


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## RocketMedic

+1 to that. My CLS guys are trained to do everything my PA says they can do...and what I think they can handle. A huge tool I use in my classes is graphic pictures and examples of dead Americans. "This man died because his buddies messed up here, here, and here" tends to focus a lot of my students.

The Army really needs to focus on continuing education for all levels- CLS, medics, NCOs, and leaders/providers alike. I haven't had any official continuing education in three years- I've had to get it myself.


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## Combat_Medic

Damn you haven't had in continue ed from the army in 3 years.  I thought all medics had to do table VI training every year to keep MOS Qed.  I think I've done over 300 hours in the last 18 mos.  My unit even sent me to an ACLS class.  The hospital on post should have some class you can jump in if you call them.


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## RocketMedic

I've gone out and gotten my own from WBAMC and civilians, but the only things we've done are the mandatory live-tissue labs and stuff. Grr @ 3-41 IN!


----------



## Combat_Medic

Well I haven't got to do the live tissue lab yet Grrr Korea :angry:.


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## LoneStarSoldier

Honestly, you can't compare CLS to EMT-B. They treat patients/casualties in completely different environments. Combat Medics are trained to the NREMT EMT-B level at a minimum before they even learn the combat side of field medicine. Combat Medics are a kind of hybrid, they know and can do more than an EMT-B but they're not quite up to the Paramedic level. Also, I have been told that CLS no longer teaches IVs, I'm not sure if this is true though but in my unit we have not been teching any skills other than CAT application/bleeding control and neddle chest decompressions.


----------



## Dre

Most of the EMT training has changed. I don't know what it is for CLS and Medic. NJ is mostly ran by Paramedics and Nurses who think most emt's are too stupid to do chest tubes. We can't even get them to give us LMA's. We can assist with some medications and everything we do, has to be a protocol, weeks of training and then still have to wait for the state to roll over and accept it. 

I'm a Medical Assistant, CERT, and EMT. I can't even do have the things I am trained without a paramedic.... And I worked SCTU. So I know how these things work now. 5 years it is ok, next 5 it's bad for the patients.


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## Afflixion

Dre said:


> Most of the EMT training has changed. I don't know what it is for CLS and Medic. NJ is mostly ran by Paramedics and Nurses who think most emt's are too stupid to do chest tubes. We can't even get them to give us LMA's. We can assist with some medications and everything we do, has to be a protocol, weeks of training and then still have to wait for the state to roll over and accept it.
> 
> I'm a Medical Assistant, CERT, and EMT. I can't even do have the things I am trained without a paramedic.... And I worked SCTU. So I know how these things work now. 5 years it is ok, next 5 it's bad for the patients.



I'm sorry but I wouldn't let most EMTs near me with an IV cath much less a scalpel required to do a chest tube. a chest tube does not do much more than a NCD in a field environment without a vacuum and time it is not going to do much. There is no reason for EMTs or paramedics to use one in a prehospital environment.


----------



## ZootownMedic

From serving in special operations units, being an EMT-B currently and also currently attending Paramedic school heres how I would break it down and its pretty common sense. EMT-B's can handles just about anything a combat medic would. Their training is about equal and that is what 68W's are certified too anyways. In the order of people I would allow to care for me:

First Responder
CLS
Combat Medic
EMT-B
Special Operations Medic (18D, SOCM graduate)
Paramedic

I won't argue the reasons but its pretty simple. EMT-B's and Paramedics are trained in trauma and medical emergencies. Combat medics are trained to quickly handle emergency battlefield injuries. Slapping on tourniquets, starting IV's, maintaining the airway, triage, transport, and the like are all things that Combat medics AND EMT-B's can do. EMT-B's can also handle a wide variety of medical emergencies that I think many Combat medics learn how to handle and then never practice or study again. Spec Ops medics like my best friend (18D) are amazing especially at PT assessment and trauma emergencies. They are however NOT certified to the NREMT-P standard despite what many say. My friend however who was a 18D just graduated from Paramedic school and his internship was waived and he was able to sit for the NREMT test immediately after class because Ft. Bragg SOCOM is recognized by the NREMT to the Paramedic level. Hope this clears things up a bit, and it is just my opinion based on vast experience with care providers at all of those levels.


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## RocketMedic

Combat medics get a good initial education, but the follow-on is very inconsistent, and there's no real formalized career progression in terms of patient care. By the time most medics get good at it, they're promoted to E-5/6 and positioned in administrative roles.


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## ZootownMedic

Exactly rocket. Continuing training in the military sucks especially when it comes to 'advanced' medicine. Probably 99% of combat medics couldn't trace the blood through the heart. Not a knock on them....they don't need to know it.


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## LoneStarSoldier

I'm going to have to disagree with the statement that EMT-Bs and Comat Medics are similar. Yes they're both technically EMT-Bs, but a Combat Medic is more of a hybrid between and EMT-B an EMT-I. EMT-Bs cannot start IVs (at least by NREMT standards, might be different by state), Combat Medics can. Combat Medics can issue and assist with a wide variety of meds (with PA approval) while EMT-Bs can only assist with the administrative of select medications. I do agree though that the retention of knowledge for medics is really sub-par. I can barely remember some of the stuff we learned at EMT training. Most of the things that are engrained in my mind are the things we actually use (i.e. transporting, starting IVs, wrapping sprains/strains, bandaging, etc.)


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## RocketMedic

Exactly, LoneStar. The system as-is really doesn't help with knowledge retention- every bit of military training is on tangentially-related subjects like weapons, tactics, vehicles, or the dreaded "Soldier/NCO development". Being told that WLC would make me a better medic was pretty funny though.

Some programs like MPT and the live tissue labs are steps in the right direction, but MPT is just utilization of other skills (they aren't allowed to assess or treat, at least at WBAMC) and Live Tissue/BCT3 is a short course. The only way to stay proficient is to moonlight.

BTW, did you ever get that issue straight? I ran into the gentleman you were asking about at Wal-Mart and he damned near sold me on his place- I heard they might be getting the El Paso County 911 contract.


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## ZootownMedic

Yeah I guess I can see your point. True the average EMT doesn't start IV's but here in Colorado you have to be IV certified to even get hired by the ambulance companies. I guess my point was that if it was a trauma related injury than I'd rather have the combat medic but if it was for chest pain and Im a 60 YOM i'd rather have the civilian EMT-Basic. In the end though I would still rather have a civilian paramedic than just about anything else. The level of training, knowledge, and experience in both trauma and medical emergencies is at its peak. They are the most balanced with the most things I guess is what it boils down to.


----------



## LoneStarSoldier

Rocketmedic40 said:


> .BTW, did you ever get that issue straight? I ran into the gentleman you were asking about at Wal-Mart and he damned near sold me on his place- I heard they might be getting the El Paso County 911 contract.



No I'm still waiting to hear back. It was the company owner's call to put a hold on any more shifts for 3rd riders, not the fleet managers. It's true though, the company is trying to get the county contract, which would hopefully mean more money and more shifts.


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## RocketMedic

Recommend it? I've always thought they looked a lot more professional than WBAMC/UMC or Life in El Paso- every company has its issues, but they seem to handle them well.

Life I would rather not work for.


----------



## Afflixion

SmokeMedic said:


> From serving in special operations units, being an EMT-B currently and also currently attending Paramedic school heres how I would break it down and its pretty common sense. EMT-B's can handles just about anything a combat medic would. Their training is about equal and that is what 68W's are certified too anyways. In the order of people I would allow to care for me:
> 
> First Responder
> CLS
> Combat Medic
> EMT-B
> Special Operations Medic (18D, SOCM graduate)
> Paramedic
> 
> I won't argue the reasons but its pretty simple. EMT-B's and Paramedics are trained in trauma and medical emergencies. Combat medics are trained to quickly handle emergency battlefield injuries. Slapping on tourniquets, starting IV's, maintaining the airway, triage, transport, and the like are all things that Combat medics AND EMT-B's can do. EMT-B's can also handle a wide variety of medical emergencies that I think many Combat medics learn how to handle and then never practice or study again. Spec Ops medics like my best friend (18D) are amazing especially at PT assessment and trauma emergencies. They are however NOT certified to the NREMT-P standard despite what many say. My friend however who was a 18D just graduated from Paramedic school and his internship was waived and he was able to sit for the NREMT test immediately after class because Ft. Bragg SOCOM is recognized by the NREMT to the Paramedic level. Hope this clears things up a bit, and it is just my opinion based on vast experience with care providers at all of those levels.



Sorry bro but your information is wrong I was a civil affairs medic and we all were certified as NREMT - P level, along with 18D who I sincerely doubt was a true 18D because there is less than 40 18Ds in all SF groups at any given time and they typically never leave. Civil affairs medics ranger medics and soar medics and sf medics are all trained well beyond your normal medic mill paramedic. I was completely immersed in emergency medicine for 14months 7 days a week 10hours a day while going through class. All USSOCOM medics are required to maintain their NREMT-P


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## RocketMedic

Afflixion said:


> Sorry bro but your information is wrong I was a civil affairs medic and we all were certified as NREMT - P level, along with 18D who I sincerely doubt was a true 18D because there is less than 40 18Ds in all SF groups at any given time and they typically never leave. Civil affairs medics ranger medics and soar medics and sf medics are all trained well beyond your normal medic mill paramedic. I was completely immersed in emergency medicine for 14months 7 days a week 10hours a day while going through class. All USSOCOM medics are required to maintain their NREMT-P



"Ranger Medics" are NOT trained to NREMT-P, you are thinking of the 68W1 ASI, which is trained to that standard. There are plenty of non-paramedic 68Ws in Ranger assignments.

I've never seen the SF or CA or SOAR medical training, but I have no problems believing that they learn more than the average paramedic. That being said, it's all job-oriented...I think that a civilian paramedic receives a more balanced education in terms of medical emergencies, whereas an SF medic is nearly a PA in terms of effective training and scope (dependent on assignment).

The real odd duck is people like me- conventional Army 68Ws in conventional units who happen to be paramedics. I got written up once by an E5 for not transporting a wrist injury with deformity and loss of sensation secondary to a fall from standing in full spinal restriction...that was an entertaining night.

Seriously, paramedics and the regular Army don't usually mix.


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## ZootownMedic

Afflixion said:


> Sorry bro but your information is wrong I was a civil affairs medic and we all were certified as NREMT - P level, along with 18D who I sincerely doubt was a true 18D because there is less than 40 18Ds in all SF groups at any given time and they typically never leave. Civil affairs medics ranger medics and soar medics and sf medics are all trained well beyond your normal medic mill paramedic. I was completely immersed in emergency medicine for 14months 7 days a week 10hours a day while going through class. All USSOCOM medics are required to maintain their NREMT-P




Um...sorry to you bro but he was a 18D and he just finished the Paramedic course at my local college. He is currently serving as a medic on a WPPS contract overseas. Not all 18D are Paramedics, just like not everyone who graduates from the SOCM course are NREMT-P certed. As far as your claim that there are 40 18D's your dumb. Every A team has a 18D(medic), 18C(engineer), 18B(weapons), 18E(intel) etc etc. You civil affairs dudes aren't even SOCOM so check your facts before you try to correct those of us who are.


----------



## ZootownMedic

Afflixion said:


> All USSOCOM medics are required to maintain their NREMT-P



Also untrue. Lets take a look at SOCOM unitis. Special Forces, MARSOC, Naval Spec War, 75th Ranger Regiment, SOAR, Air Force SOF. 

The guys that were in 3rd Ranger battalion with me were all 68W's who attended and graduated SOCM as well as Ranger School. Some of them could have been paramedics as well but it was not a requirement at all. 18D's are not trained to the Medic standard. They do not spend time learning how to read ECG's or learning PALS or geriatrics....why would they? My buddy that just graduated from P school got his internship signed off by USSOCOM at Ft. Bragg. He didn't have to do his 500 hrs and could immediately sit for his NREMT-P exam. PJ's are the only unit I know of that are ALL trained to the NREMT-P level. I would be surprised if Civil affairs medics even went to SOCM....in fact ive never heard of them going.


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## RocketMedic

On the active side, CA medics were standard 68ws pulled from the bsb..


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## Afflixion

If you have a asi of w4 or w2 you are paramedic certified which ranger medics have If fmq'ed.

But we can pretend I'm not at Bragg currently assigned to a USSOCOM unit. And still argue this fact. I have plenty of contacts in sf, soar and rangers for example I personally know the regimental senior medic in the 75th and the 160th.


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## ZootownMedic

Afflixion said:


> If you have a asi of w4 or w2 you are paramedic certified which ranger medics have If fmq'ed.
> 
> But we can pretend I'm not at Bragg currently assigned to a USSOCOM unit. And still argue this fact. I have plenty of contacts in sf, soar and rangers for example I personally know the regimental senior medic in the 75th and the 160th.



Bro, I understand...I wasn't trying to belittle you. I just know from the 18D's I have talked to, and with the one being my best friend, they werent NREMT-P certed. Its weird because I think that maybe they should be, if only so when they get into the civilian world they can transition to a related field without having to do a Paramedic course. At least my buddy didnt have to a do a 500 internship like everyone else. Thats one pretty sweet advantage to being a SOCOM medic in itself since NREMT recognizes Ft. Bragg....


----------



## Nerotik

I have a question. I am trying to get into PMC/PSC work and was told the best way to get your foot in the door without SF training or a friend on the inside is to become a medic in addition to my 30+ years of shooting experience. Even though I have been shooting all my life trained by my dad a former cop/marksman and gunsmith, I should also take some combat Handgun, Mid rang rifle, defensive shotgun and precision rifle classes so that I have those skills certified on paper. What I was wondering however is exactly which path to take in the EMT field? My options are EMT - basic, Intermediate and advanced as well as Paramedic but that is more of a college course and comes with math, reading and writing classes attached to it as well. So would EMT Advanced combined with multiple certifications for combat and home/self defense handgun, fighting rifle and 1000m+ precision rifle certifications make me a competitive applicant for PMC/PSC work here and over sea's? By the way I'm 33, yes I have been shooting since I could walk. Everything from MAC-10's to M-14's to Barrett .50 cal's, I have killed an Elk at 867 yards cross canyon shot in wind and rain, been studying martial arts of various styles since I was 7 and I have been shot at a few times and I didn't freeze up or freak out. Anyway I digress, best EMT rating to have to get a PMC/PSC job? or what combinations of certs other than paramedic which will take too long to get, I want to get to work ASAP.


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## airborne2chairborne

a couple of corrections from just this page (not going to go back and read the whole thing)
1: there are A LOT more than 40 18Ds. Each ODA has at least 1 18D, if you think there are only 40 ODAs in the entire army you're watching too much Rambo.
2: ALL ranger medics go through the W1 course, and they have been required to do so since at least 2005 (since that is when the army switched the medic mos from 91W to 68W) 
http://www.soc.mil/75th Ranger Regiment/Perm_Party_RMED_Application_06.pdf
3: If by "medics pulled from the BSB" for CA you mean for assignment just for deployment, then yes that happens a lot. However active CA (which is an SOF btw) does have their own medics who go through the Civil Affairs Medical Sergeant course, for which W1 is a prerequisite 
https://www.atrrs.army.mil/atrrscc/prerequisites.aspx?fy=2013&sch=331&crs=300-F20&phase=&clsflag=
4: 18Ds are most certainly trained to the paramedic level and they receive their paramedic cert

Now to the original question- CLS is not a very good course, having taught it to at least a 1,000 students (if you include recert classes) as a medic I can honestly tell you that I would consider that little 5 day course a HUGE success if everyone of my students could put on a tourniquet, treat a pneumothorax, secure an airway, and know what shock looks like at the end of it. CLS can do certain procedures an EMT cannot (needle decompression for example), however CLS is not taught everything that an EMT is. Mainly because we do not have patients with diabetes/CHF/COPD/cardiac issues/seizure issues/stroke issues/or other issues that old/chronically sick/unhealthy people have. Their patients are all in the military. They're all relatively young and relatively healthy, and for the most part their entire demographic of medical emergencies are trauma based. Also CLS are not meant to work alone, their purpose is to either assist their medic when available (like BLS assists ALS), or keep a patient alive until the medic can get to them (like BLS would with a patient while waiting for ALS). It would be great to send all of my CLS (meaning the entire platoon) to an EMT-B course so they could learn more, however I can honestly say that the only things I've ever needed a CLS to do was secure an airway, treat pneumothorax, and stop bleeding. Everything else is either something that can wait 1-2 minutes for me, or something that can't be treated with the gear a military medic carries anyway. 

As far as the list smokemedic listed-
CLS has no civilian cert, and gets only 5 days of training
an EMT has a civilian cert
a 68W is certified as an EMT and has additional 68W training
Comparing paramedic to 68W- 68W can do a few things a paramedic cant (depending on unit, every unit has a different provider and therefore a different  scope, but just going off of my old unit vs paramedic national scope) and their protocol is most likely where ITLS will be in 5 years, however they are not trained on the medical emergency side that paramedics are.
ALL special operations medics go through the W1 course, which includes paramedic school, then follow on training.


----------



## Ace 227

Nerotik said:


> I have a question. I am trying to get into PMC/PSC work and was told the best way to get your foot in the door without SF training or a friend on the inside is to become a medic in addition to my 30+ years of shooting experience. Even though I have been shooting all my life trained by my dad a former cop/marksman and gunsmith, I should also take some combat Handgun, Mid rang rifle, defensive shotgun and precision rifle classes so that I have those skills certified on paper. What I was wondering however is exactly which path to take in the EMT field? My options are EMT - basic, Intermediate and advanced as well as Paramedic but that is more of a college course and comes with math, reading and writing classes attached to it as well. So would EMT Advanced combined with multiple certifications for combat and home/self defense handgun, fighting rifle and 1000m+ precision rifle certifications make me a competitive applicant for PMC/PSC work here and over sea's? By the way I'm 33, yes I have been shooting since I could walk. Everything from MAC-10's to M-14's to Barrett .50 cal's, I have killed an Elk at 867 yards cross canyon shot in wind and rain, been studying martial arts of various styles since I was 7 and I have been shot at a few times and I didn't freeze up or freak out. Anyway I digress, best EMT rating to have to get a PMC/PSC job? or what combinations of certs other than paramedic which will take too long to get, I want to get to work ASAP.



All I can say is, without military experience, good luck.  Companies have so many vets to choose from there isn't much of a need for anyone else.


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## airborne2chairborne

and before anyone gets up in arms, no I'm not saying 68W is on the same level as paramedic when comparing overall ability or education. 

If you compared a paramedic with equal training time as a medic from a good unit, I would say they are on par when it comes to trauma patients. There is a reason why civilian trauma medicine is based off of military trauma medicine.  However that's where it ends. 68Ws have absolutely no training with medical based emergencies or the treatment of pediatrics past the EMT-B level.


----------



## RocketMedic

Nerotik said:


> I have a question. I am trying to get into PMC/PSC work and was told the best way to get your foot in the door without SF training or a friend on the inside is to become a medic in addition to my 30+ years of shooting experience. Even though I have been shooting all my life trained by my dad a former cop/marksman and gunsmith, I should also take some combat Handgun, Mid rang rifle, defensive shotgun and precision rifle classes so that I have those skills certified on paper. What I was wondering however is exactly which path to take in the EMT field? My options are EMT - basic, Intermediate and advanced as well as Paramedic but that is more of a college course and comes with math, reading and writing classes attached to it as well. So would EMT Advanced combined with multiple certifications for combat and home/self defense handgun, fighting rifle and 1000m+ precision rifle certifications make me a competitive applicant for PMC/PSC work here and over sea's? By the way I'm 33, yes I have been shooting since I could walk. Everything from MAC-10's to M-14's to Barrett .50 cal's, I have killed an Elk at 867 yards cross canyon shot in wind and rain, been studying martial arts of various styles since I was 7 and I have been shot at a few times and I didn't freeze up or freak out. Anyway I digress, best EMT rating to have to get a PMC/PSC job? or what combinations of certs other than paramedic which will take too long to get, I want to get to work ASAP.



I would politely tell you that very few people care about your supposed hyperproficency with firearms, that you would not be a good paramedic if you only try it for the reasons stated, and that you honestly do not sound like a viable medic or security guard.

Seriously, is this real?

Close ambush is under how many meters, what do you do? Far ambush?
EOF=?


----------



## Handsome Robb

airborne2chairborne said:


> and before anyone gets up in arms, no I'm not saying 68W is on the same level as paramedic when comparing overall ability or education.
> 
> If you compared a paramedic with equal training time as a medic from a good unit, I would say they are on par when it comes to trauma patients. There is a reason why civilian trauma medicine is based off of military trauma medicine.  However that's where it ends. 68Ws have absolutely no training with medical based emergencies or the treatment of pediatrics past the EMT-B level.



All I'll ask is why did the Army decide to make NREMT-P a requirement for all 68WF3s after the NG 1/168th DUSTOFF unit showed up and ran clinical circles around the other DUSTOFF units?


----------



## Nerotik

Rocketmedic40 said:


> I would politely tell you that very few people care about your supposed hyperproficency with firearms, that you would not be a good paramedic if you only try it for the reasons stated, and that you honestly do not sound like a viable medic or security guard.
> 
> Seriously, is this real?
> 
> Close ambush is under how many meters, what do you do? Far ambush?
> EOF=?



I don't care what people (who are not considering me for employment) think about my firearm proficiency as there is nothing "supposed" about it. I by no means am the best in the world or even talented enough for a professional exhibition or shooting competition, I will leave those tasks to professional target shooters. However much like Dale Earnhardt Jr. who grew up around NASCAR I have had firearms of all types in my life, all my life, and as such they are a natural tool for me to use and I adapt to new ones quickly and easily. You make the assumption that what very few and basic reasons I mention for being interested in becoming a Medic are not only a reflection of my character but also show a lack of drive, talent or ability to become a Medic and/or Security Guard. I am truly amazed you can glean so much from so little especially when that little was in the form of questions, some rhetorical, some jokes and all meant to gather information not to make a statement of any kind. As for your little quiz: a near ambush is under 200 meters but most people consider it to be when both the friendly forces and Op-for are close enough swap grenades. The best action to take when hit by a near ambush is put your face in the dirt and get your body as low low low as possible, send a few rounds back at them in an effort to suppress their fire then find a way to slink out of the line of fire and behind some good cover, regroup your unit and counter attack before the Op-for has a chance to press their advantage and use any other surprises they may have waiting for you. You also say that you can tell I would not be a viable Security Guard or Medic based on the reasons I gave. The only problem is, i didn't really give any reasons and if I had they would have mentioned how my dads fiance was ripped from his arms one day while they were at the beach and she was pummeled by waves causing massive internal hemorrhaging. Or how my grandmother came to live with us when I was 17 because her dementia was so bad, one morning I noticed her sitting in her recliner with her head back, not breathing. I spent 20 minutes doing CPR and dealing with the idiot on 911 who didn't understand I needed both hands. Grandma died in my arms anyway. or when my cousin almost drowned if I hadn't grabbed him and pulled him out of the surf in time. There have been so many close calls in my life that I really want the knowledge to be able to help more if the need arises and to help others who can't help themselves. This road I choose to take as a career for my life not because of some crap you read but because I want to make a difference and spare someone else from having to watch their grandmothers shirt get ripped open and those self adhesive pads be stuck to her in an attempt to get heart function back but with no success. I also want to spare anyone from having to watch their little sister who was only 22, stand up and her eyes roll back in her head then a small seizure until she collapses. She had some type of rare birth defect with her neuro pathways similar to Moya Moya but her brain ruptured and she died, 2nd youngest of 4 kids and mother of two young girls. So when I leave a very short post and most of it is me just asking questions, maybe making a few statements and trying to slowly get to know some people please use some self control and try to reserve judgement until you actually get to know me.
Thanks,
Nerotik


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## Handsome Robb

Wow. 

I'm sorry you had a rough run but attacking longstanding, respected members isn't going to get you anywhere. 

By the way, that idiot on the other end of the 911 call was trying to help. Also, those "adhesive pads" were the only chance your grandmother had at converting her heart into a perfusing rhythm. 

Show a little respect and don't start throwing names and what not around until you actually understand how EMS and the 911 system works. 

This isn't a **** measuring contest of "I've seen more than you so I have a better reason to want to do this."

You really want to make a difference and learn about medicine? Work in a 911 system. Contracting isn't going to fulfill what you've described wanting as far as "saving lives" and being able to help people and "make a difference".


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## Nerotik

Robb said:


> Wow.
> 
> I'm sorry you had a rough run but attacking longstanding, respected members isn't going to get you anywhere.
> 
> By the way, that idiot on the other end of the 911 call was trying to help. Also, those "adhesive pads" were the only chance your grandmother had at converting her heart into a perfusing rhythm.
> 
> Show a little respect and don't start throwing names and what not around until you actually understand how EMS and the 911 system works.
> 
> This isn't a **** measuring contest of "I've seen more than you so I have a better reason to want to do this."
> 
> You really want to make a difference and learn about medicine? Work in a 911 system. Contracting isn't going to fulfill what you've described wanting as far as "saving lives" and being able to help people and "make a difference".


I wasn't attacking anyone, he made a somewhat snyde remark and I responded with truthful, factual information in an effort to express my point better. Yes, I know what "The adhesive pads" are for I am just too damned tired to type it all out and I understand 911 operators are just trying to do a job but this one was truly an idiot. Trying to engage me in conversation which had absolutely no bearing on the emergency at hand, she was complaining about her mouse pad for Christs sake and every time I tried to set the phone down on the hardwood floor (I assume she heard the clunk sound it made) she would yell repeatedly until I picked up the phone again and asked her 'what?' then she would tell me help is on the way again and go back to peeling her mouse pad or w/e


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## RocketMedic

Robb said:


> All I'll ask is why did the Army decide to make NREMT-P a requirement for all 68WF3s after the NG 1/168th DUSTOFF unit showed up and ran clinical circles around the other DUSTOFF units?



The 68W scope is increasing, and the military is a business. Recruiting RNs to go onto birds to run IV pumps, vents, etc is prohibitively expensive, while simply uptraining EMTs would still lack some critical core knowledge. Paramedic school does patch that hole, and is a low-cost recruiting measure to boot when it gives soldiers and NCOs something of real value to their careers. "Reenlist for six for paramedic school" happens every day.

Doing this job is a privilege and something a lot of people strive for, and a 68W who wants it will go through a lot to get it.


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## RocketMedic

http://lonelymachines.org/mall-ninjas/
http://www.armystudyguide.com/content/EIB/EIB_Related_Battle_Drills/battle-drill-4-react-to-a.shtml
And thats all Ill say about that.


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## Luno

OMG, it has been a long time since I read Gecko45...   Still just as funny.


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## chaz90

The legend of the mall ninja remains one of the funniest things I've read on the internet. It's a perfect example of a troll turning out to be a comedian that truly missed his calling.


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## MackTheKnife

Nerotik said:


> I wasn't attacking anyone, he made a somewhat snyde remark and I responded with truthful, factual information in an effort to express my point better. Yes, I know what "The adhesive pads" are for I am just too damned tired to type it all out and I understand 911 operators are just trying to do a job but this one was truly an idiot. Trying to engage me in conversation which had absolutely no bearing on the emergency at hand, she was complaining about her mouse pad for Christs sake and every time I tried to set the phone down on the hardwood floor (I assume she heard the clunk sound it made) she would yell repeatedly until I picked up the phone again and asked her 'what?' then she would tell me help is on the way again and go back to peeling her mouse pad or w/e



If you want to be a PMC, without quals or experience, contact Dyncorp or Triple Canopy, etc., and get into their WPPS course. If you get in and pass, you might be able to get a PSD job. The EMT level at a minimum is EMT-Intermediate or EMT-Paramedic. Don't start telling anyone if you pursue this about grandma or your shooting expertise. You'll be laughed at and blown off.


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## Walter Sobchak

I went through CLS before my third deployment. my instructor was a former member of my reserve unit who was a Paramedic in his civilian job and had reclassed after his first deployment for the Invasion.  It was basically WFR with IV and QuickClot class.   while deployed, i was a first responder to many VBIED's as the PsyOp Team Leader.  I took EMT-B and i would say a CLS in Astan is seeing more trauma, but no MI's or child births.  its apples and oranges, IMO.


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## Walter Sobchak

Rocketmedic40 said:


> I would politely tell you that very few people care about your supposed hyperproficency with firearms, that you would not be a good paramedic if you only try it for the reasons stated, and that you honestly do not sound like a viable medic or security guard.
> 
> Seriously, is this real?
> 
> Close ambush is under how many meters, what do you do? Far ambush?
> EOF=?



:rofl:


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## airborne2chairborne

Robb said:


> All I'll ask is why did the Army decide to make NREMT-P a requirement for all 68WF3s after the NG 1/168th DUSTOFF unit showed up and ran clinical circles around the other DUSTOFF units?



Can you provide a citation for that claim?

To quote AMEDD "AMEDD will develop and implement a plan to integrate EMT-P as the minimum professional standard of training for the US Army Flight Medic IOT to improve the medical proficiency of en route care and foster a community of trust ."


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## airborne2chairborne

Nerotik said:


> I have a question. I am trying to get into PMC/PSC work and was told the best way to get your foot in the door without SF training or a friend on the inside is to become a medic in addition to my 30+ years of shooting experience. Even though I have been shooting all my life trained by my dad a former cop/marksman and gunsmith, I should also take some combat Handgun, Mid rang rifle, defensive shotgun and precision rifle classes so that I have those skills certified on paper. What I was wondering however is exactly which path to take in the EMT field? My options are EMT - basic, Intermediate and advanced as well as Paramedic but that is more of a college course and comes with math, reading and writing classes attached to it as well. So would EMT Advanced combined with multiple certifications for combat and home/self defense handgun, fighting rifle and 1000m+ precision rifle certifications make me a competitive applicant for PMC/PSC work here and over sea's? By the way I'm 33, yes I have been shooting since I could walk. Everything from MAC-10's to M-14's to Barrett .50 cal's, I have killed an Elk at 867 yards cross canyon shot in wind and rain, been studying martial arts of various styles since I was 7 and I have been shot at a few times and I didn't freeze up or freak out. Anyway I digress, best EMT rating to have to get a PMC/PSC job? or what combinations of certs other than paramedic which will take too long to get, I want to get to work ASAP.



A PMC won't hire you simply for having your paramedic cert. it's great you've been shooting weapons and took a few classes (are they even from reputable sources or are they NRA/local yokal?). You have no real combat training, no combat experience, no high risk VIP security experience... Go check out triple canopy's website, you don't have what PMCs are looking for.


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## RocketMedic

airborne2chairborne said:


> Can you provide a citation for that claim?
> 
> To quote AMEDD "AMEDD will develop and implement a plan to integrate EMT-P as the minimum professional standard of training for the US Army Flight Medic IOT to improve the medical proficiency of en route care and foster a community of trust ."



They are, and fairly aggressively. Two good friends of mine are scheduled for paramedic school late this year on their return from Astan @ Factory Sam.


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## airborne2chairborne

Good stuff, hopefully it'll have a trickle down effect and 68Ws will start to get certed for AEMT


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## RocketMedic

I hope so. Ive always thought EMT-A should be NCO prerequisite and senior leaders should be paramedics.


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## airborne2chairborne

68W might as well get AEMT during AIT, there's not that much in the scope that's not covered during AIT anyway. It would make sense for NCOs or SNCOs to get their P but most of them don't do anything medical anyway at that point, would kind of be a waste


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## Ace 227

With the way the training is now, I think Basic adequately describes what most new 68W10s are actually retaining. Yea you add in the IVs and meds and crics, etc. but a lot of it goes out the window after validations are complete.  

I was fortunate enough to be an EMT when I enlisted and that, in my opinion, made a world of difference in what I was able to learn at Ft. Sam.

So I guess what I'm saying is, if whiskeys are to be worthy of the AEMT title, they'll need to extend and overhaul the training pipeline or, as was said, make it an NCO prereq(I like this idea).


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## airborne2chairborne

The same knowledge retention could be said for EMTs until they land a job and start doing those skills. I think that's generally the same with everyone though. "if you dont use it you'll lose it"


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## Ace 227

While I certainly agree with you, I'm specifically talking about retention while they're still in training. They cram in to 6 weeks what normally takes 3-4 months to learn and then if you fail your national registry, you still move on to LPC and whiskey side while trying to study for the EMT side, making it harder to actually remember anything. All I'm saying is, if we're going to increase the NREMT level given to newly qualified medics, I think the training needs to be more adequate.


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## Household6

Ace 227 said:


> With the way the training is now, I think Basic adequately describes what most new 68W10s are actually retaining. Yea you add in the IVs and meds and crics, etc. but a lot of it goes out the window after validations are complete.
> 
> I was fortunate enough to be an EMT when I enlisted and that, in my opinion, made a world of difference in what I was able to learn at Ft. Sam.
> 
> So I guess what I'm saying is, if whiskeys are to be worthy of the AEMT title, they'll need to extend and overhaul the training pipeline or, as was said, make it an NCO prereq(I like this idea).



That would have to be one hell of an overhaul.. How training on medical emergencies are whiskeys actually given? My CLS was almost 100% trauma, not even CPR was taught.. I'm just wondering what would the point be in teaching the medical side to a group of 68Ws who are probably never going to even entertain the idea of, say, geriatric emergencies? Do you know what I mean? Pediatric emergencies, even ped traumas, dialysis patients. That's a side to the EMT that's not useful in a combat scenario, and it would be a waste of time and a waste of money. 

"You're going to the 'Ghan, so today lets practice aspirating Humulin."

It's not Uncle Sam's responsibility to prepare any soldier (education-wise, or otherwise) for their life after their ETS. That's what the GI bill is for. Combat medic skills should be combat. 

I could possibly see educating a Corpsman, but they have a rate that puts them in hospitals where they treat civilians and dependents. I dunno, is my thinking wrong on this?


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## Ace 227

I agree with you. My argument was, since we aren't training the medical side, don't award the AEMT.


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## Luno

Household6 said:


> I could possibly see educating a Corpsman, but they have a rate that puts them in hospitals where they treat civilians and dependents. I dunno, is my thinking wrong on this?



Yep, it's wrong... There is a reason the Army went from Medic to Healthcare Specialist... They treat alot of dependants and civilians.


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## Household6

Luno said:


> Yep, it's wrong... There is a reason the Army went from Medic to Healthcare Specialist... They treat alot of dependants and civilians.



So there's a new and improved AIT for that MOS? What do you know about it? Longer, shorter, different skills? Have you gone through it? *legit curious*


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## Ace 227

Not sure how "new" or "improved" it is, but LPC, Limited Primary Care, is a 1-2 week phase of training between EMT and Whiskey phase where they teach the "hospital skills" I.e. blood draws, vaccinations, med math, etc. Again, my argument is that too many students aren't learning much from this phase because they are either taking a mental breather after having just passed NREMT, or they're stressing over their next attempt at it.


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## Luno

LPC was pretty weak as I remember it, the catch all that the Army uses is "your provider will teach you."  Basic blood draw, immunizations, meds were covered in LPC.


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## Household6

Ace 227 said:


> Not sure how "new" or "improved" it is, but LPC, Limited Primary Care, is a 1-2 week phase of training between EMT and Whiskey phase where they teach the "hospital skills" I.e. blood draws, vaccinations, med math, etc. Again, my argument is that too many students aren't learning much from this phase because they are either taking a mental breather after having just passed NREMT, or they're stressing over their next attempt at it.



Yaaaa.. IDK how I feel about that.. It just seems to me that tactical emergency care has it's own special and unique specialized niche that doesn't (or maybe shouldn't?) overlap too much with civvy medical treatments.. 

I like my coffee black, my cigarettes unfiltered, and my 68Ws trained for combat. Maybe I'm an closed-minded old hag, but I think if E's and O's want to treat civvys, they should join the Navy.


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## Luno

OMG, I think I almost spit my black coffee and unfiltered cigarette on my 68Ws...   I'm stealing that line for my signature!!!


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## Ace 227

Household6 said:


> Yaaaa.. IDK how I feel about that.. It just seems to me that tactical emergency care has it's own special and unique specialized niche that doesn't (or maybe shouldn't?) overlap too much with civvy medical treatments..
> 
> I like my coffee black, my cigarettes unfiltered, and my 68Ws trained for combat. Maybe I'm an closed-minded old hag, but I think if E's and O's want to treat civvys, they should join the Navy.



I agree with your sentiment, however the reality is 68W is the second largest MOS in the Army and is a jack of all trades in the medical field. The amount f combat your typical 68W sees is very, very small compared to the amount of routine illness and injury he sees as a line medic. Hospital and TMC medics see even less and CSH and BAS medics see a lot of trauma, not so much combat. But, as the saying goes, you'll learn it at your unit. Go to a hospital, learn meds and sutures, etc. Go to a line unit, go to classes like ITLS, PHTLS, ATLS, etc.


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## RocketMedic

Household, even an infantry medic has far more in common with a medical assistant than an EMT or paramedic.


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## Household6

Rocketmedic40 said:


> Household, even an infantry medic has far more in common with a medical assistant than an EMT or paramedic.



Because infantry medics and MAs can follow orders. :rofl: 

I keeed, I keeed..

I do appreciate all yous taking the time to answer my questions. I never was (and still am not) involved with the medical unit on post. I was a sparky, DH is a tanker. Now that I'm the Household 6, my duties are limited to FRG meetings and uniform alterations.


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## NeverSayDie

I graduated out of Ft. Sam in November, and LPC was 2 weeks. Actually still have my LPC workbook that I've going back through studying for the EFMB. curriculum was:

basic abdominal primary care
basic ortho primary care
basic resp. primary care
basic wound primary care
sterile technique
injections & venipuncture
pharmacology and meds administration
sick call & medical documentations

obviously not a LPN degree, but I liked it. If anything it was too watered down.

As far as the AEMT qualification goes, I say do what SOCM does for the 18Ds and W1's that want their NREMT-P: List us as AEMT's in "the state of DoD" or whatever it is in the NREMT system and let us challenge for it out of pocket. Just a thought.


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## Handsome Robb

Household6 said:


> Because infantry medics and MAs can follow orders. :rofl:



I know your kidding but I've never understood this whole argument...in EMS all we do is follow written and sometimes verbal orders just like any MA, RT, LPN or RN does...we just generally don't get them directly from the doctor's mouth, rather their hand/keyboard.


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## Vegasmedic

When I was in Iraq in 05 we didnt have a medic assigned to our unit since I was with XVIII ABN corps (Im an infantryman who was tasked out). Since I was the only CLS who was a civi EMT I was made the unofficial medic. Was cool being able to do more medical stuff than your avarage CLS and yet still be an up gunner during convoys and patrols.


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## hogwiley

Combat lifesaver vs EMT/Medic?

In a cage match my money is on the combat lifesaver. In a civilian EMS job I'll stick with the EMT/medic.


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## Akulahawk

hogwiley said:


> Combat lifesaver vs EMT/Medic?
> 
> In a cage match my money is on the combat lifesaver. In a civilian EMS job I'll stick with the EMT/medic.


I would suggest to you that there is a large difference between a paramedic and someone who has combat lifesaver. I was just looking through a combat lifesaver course and found that there is nothing in the the course that is out of my scope of practice as a paramedic.

In my humble estimation, I would expect that a paramedic that has taken or at least understands the concepts of tactical casualty combat care would be able to implement all of the care necessary that a combat lifesaver can, and then some.

After all, combat lifesaver was designed to be an adjunct to the combat medic. As such, the combat medic (not paramedic) has a greater understanding of what is necessary to provide care in the tactical environment.

The EMT Basic does not have authorization to provide some skills that the CLS trained provider can, namely intravenous lines/locks and the needle decompression. Obviously, this does not extend to all types of EMT Basics, but the NREMT-B skill set does not normally include those.

Therefore, in a situation that would call for someone to be able to provide care at or greater than the level of the CLS, I would put my money on the paramedic. As for EMT vs. CLS, if it does not involve intravenous line placement or needle decompression of a chest, it would probably be a wash.

In the civilian world, CLS is woefully inadequate.


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## Highlander

Not sure if any one has info but the swat teams near me are hiring paramedics and training them in something called tactical medicine.


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## RocketMedic

Luno and Veneficus dissected this concept a long time ago and found it wanting.


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## Biggs

sounds interesting.


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## Akulahawk

The tactical medic idea is not a bad one, but it's very easy to poorly execute. I think a lot depends upon the expected mission. The TM could be tasked with _only_ providing care the the team, or they could be tasked to provide care to anyone around them. I wouldn't be surprised if the basic idea was adopted from the Army or Marine Corps where Medics or Corpsmen are embedded with ground combat units, and the TM would be similarly embedded and expected to perform similar casualty-aid tasks. Another issue with the TM idea is that unlike the Combat Medic/Corpsman whose tasks & mission is essentially the same no matter where you go, the TM can embedded with the team as a shooter, non-shooter, placed in the "warm zone" with a very short response time, staged out away from the scene and called in as needed. Which role is the TM expected to fill? If you think about it, that's a LOT of different types of schooling that a TM would have to go through to understand _that_ assignment or role for that team. You just can't cookie cutter train TMs for one role/profile and expect that they'll do well in the others. 

Then there's this whole scope of practice issue to talk about. Is the TM expected to be "just" a Paramedic, or will the scope of practice be extended to other procedures? What authorization would they have if state law doesn't allow for extensions of their scope? 

As I said, TM is one of those ideas that sounds good, has some upsides, but is just way too easy to foul up and implement poorly.


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## Carlos Danger

Akulahawk said:


> *The tactical medic idea is not a bad one, but it's very easy to poorly execute. *



This times 10,000,000,000,000


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