# Advice for career in tactical EMS



## Lazer (Mar 10, 2013)

I originally wanted to pursue a career in the fire service, began studying EMS and loved it, now I want the medic patch and I'm interested in tactical EMS. If someone with some insight on the subject could point me in the right direction training and certification-wise, it would be greatly appreciated. 

Thanks,


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## Veneficus (Mar 10, 2013)

There have been lots of threads on this.

I would consult Luno for specific advice, but I can tell you there are not many spots, many applicants, and nobody is going to hire a person who doesn't have lots of experience. 

You can also expect peak physical condition as a requirement.

In the meanwhile, you may want to get a job in a busy trauma center. You will get much more experience and education than you will in EMS.


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## ExpatMedic0 (Mar 10, 2013)

on a side note I see the BCCTPC is coming out with a tac-med cert. http://www.bcctpc.org/Tactical/TacticalCertification PressReleaseSept.pdf


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## Veneficus (Mar 10, 2013)

schulz said:


> on a side note I see the BCCTPC is coming out with a tac-med cert. http://www.bcctpc.org/Tactical/TacticalCertification PressReleaseSept.pdf



You and I need to come up with a standard for something like working overseas and then market the :censored::censored::censored::censored: out of it.

edit: We should also develop a 16 hour course to "train" people in it too.


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## ExpatMedic0 (Mar 10, 2013)

NAEMT-ET National Assostion of Emergency Medical Technicians-Expatriate Trained. You can be the medical director and I will be the program director. We will charge $900 for the 2-3 day course than $300 for the test we make.
Lets just make it online though, F5 CECBEMS approved. It will also allow us to charge an extra technology fee on top of everything even though its easier and less work for us


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## Veneficus (Mar 10, 2013)

schulz said:


> NAEMT-ET National Assostion of Emergency Medical Technicians-Expatriate Trained. You can be the medical director and I will be the program director. We will charge $900 for the 2-3 day course than $300 for the test we make.
> Lets just make it online though, F5 CECBEMS approved. It will also allow us to charge an extra technology fee on top of everything even though its easier and less work for us



Excellent. I like it.

But instead of "Expatriate-Trained" let's call it something like "Basic International Life Support" That way we can make an "Advanced International Life Support," and an "Advanced International Life Support Experienced Provider" class too and really cash in.


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## Lazer (Mar 10, 2013)

Veneficus said:


> There have been lots of threads on this.
> 
> I would consult Luno for specific advice, but I can tell you there are not many spots, many applicants, and nobody is going to hire a person who doesn't have lots of experience.
> 
> ...



I've read all of the threads with related tags and I didn't find anything specific about training and certification other than that TCCC certs are good to have and I figured there could be more. I sent Luno a private message and never received a reply. 

I don't expect to be hired by the swat team right out of EMT-B but I do expect to become a good candidate over the next ten years or so (I'm 25) which doesn't seem completely impractical as long as I spend that time doing something that prepares me for that line of work. So you say a trauma center ay? I currently volunteer in two EDs twice a week, what kind of position should I look for in a trauma center?

Thanks for the replies folks, much appreciated.


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## Veneficus (Mar 10, 2013)

Lazer said:


> I've read all of the threads with related tags and I didn't find anything specific about training and certification other than that TCCC certs are good to have and I figured there could be more. I sent Luno a private message and never received a reply.
> 
> I don't expect to be hired by the swat team right out of EMT-B but I do expect to become a good candidate over the next ten years or so (I'm 25) which doesn't seem completely impractical as long as I spend that time doing something that prepares me for that line of work. So you say a trauma center ay? I currently volunteer in two EDs twice a week, what kind of position should I look for in a trauma center?
> 
> Thanks for the replies folks, much appreciated.



You should get you medic as soon as possible and then look into getting a tech job in a trauma center so you can put your hands on patients. 

Generally they are teaching facilities so there will be an overall environment of fostering education that will be of benefit. Plus you will see many more sick patients than you would working in EMS. In addition to knowledge, it will also enhance many of your skills.


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## ExpatMedic0 (Mar 10, 2013)

Veneficus said:


> You should get you medic as soon as possible and then look into getting a tech job in a trauma center so you can put your hands on patients.
> 
> Generally they are teaching facilities so there will be an overall environment of fostering education that will be of benefit. Plus you will see many more sick patients than you would working in EMS. In addition to knowledge, it will also enhance many of your skills.



I don't know if I agree with this, I think putting his time in a busy 911 ALS system, and getting an AAS could help him better in his career goal. However, I really have no idea I am just guessing. Other guess's I could throw out there would be to become a police officer and a Paramedic or to join the military and get a SOCOM field medic posistion like 18D in the Army for example or PJ in the AF.


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## Veneficus (Mar 10, 2013)

schulz said:


> I don't know if I agree with this, I think putting his time in a busy 911 ALS system, and getting an AAS could help him better in his career goal. However, I really have no idea I am just guessing. Other guess's I could throw out there would be to become a police officer and a Paramedic or to join the military and get a SOCOM field medic posistion like 18D in the Army for example or PJ in the AF.



A busy EMS system transports all of their critical patients to the hospital. 

Being in the hospital means you have a chance to see many more critical patients in a shorter amount of time. 

Also, many reputable hospitals have tuition assistance as part of their benefits packages. Which means it will also help pay for that AAS. Most places I know of in the US offer $1000-$1500 a semester in tuition reimbursement. That is very substantial if used at a community college and even takes a big bite out of universty tuition at a state school.


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## RocketMedic (Mar 10, 2013)

Veneficus said:


> You and I need to come up with a standard for something like working overseas and then market the :censored::censored::censored::censored: out of it.
> 
> edit: We should also develop a 16 hour course to "train" people in it too.



Count me in,  I like money!


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## BeachMedic (Mar 10, 2013)

Lazer said:


> I originally wanted to pursue a career in the fire service, began studying EMS and loved it, now I want the medic patch and I'm interested in tactical EMS. If someone with some insight on the subject could point me in the right direction training and certification-wise, it would be greatly appreciated.
> 
> Thanks,



Well, California actually has an official Tactical Medic Cert. You can start with the state EMS website. I know a few guys who have taken the course but I don't think it increases job prospects any.

http://www.emsa.ca.gov/personnel/Tactical_Medicine.asp

Here is the standardized training recommendation.
http://www.emsa.ca.gov/personnel/files/TacticalMedicine.pdf

The AMR division San Mateo has an official TEMS team. Had to work a few riots in Oakland with them and their bullet proof vests. They can get sort of Ricky rescue though.

Other than that, you'll probably have to become a Cop to get in with any law enforcement agency. Every department has different requirements for Tac Medics as well. If they even have them.


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## RocketMedic (Mar 10, 2013)

Lazer said:


> I've read all of the threads with related tags and I didn't find anything specific about training and certification other than that TCCC certs are good to have and I figured there could be more. I sent Luno a private message and never received a reply.
> 
> I don't expect to be hired by the swat team right out of EMT-B but I do expect to become a good candidate over the next ten years or so (I'm 25) which doesn't seem completely impractical as long as I spend that time doing something that prepares me for that line of work. So you say a trauma center ay? I currently volunteer in two EDs twice a week, what kind of position should I look for in a trauma center?
> 
> Thanks for the replies folks, much appreciated.



Lazer, I would strongly recommend that you step back and look at what _exactly_ you want to do. If you want to be a 'medic' in the 'tactical' sense, you've got three options.

1. Join the military, active-duty. Not a bad gig, and as a male you've got a decent chance of ending up in an infantry unit, but with the current budget situation, I strongly suggest that you not make this your primary bet.
2. Join the military, reserves. It's a decent compromise, but it's not quite going to be your best option. 

3. Law Enforcement: If you want to get out and do 'tactical' stuff with less of an emphasis on medicine, look into law enforcement with an outdoor emphasis- Fish and Game, Forest Service, etc, or possibly a municipal department or county sheriff. It's going to be better pay and will realistically get you closer to 'tactical medicine' than being just another wannabe EMT. 

Look at it this way. There's lots of underemployed and unemployed EMTs and paramedics who want to be 'tactical medics' and live up the perceived adrenaline rush that my generation's veterans have. There's also lots of unemployed veterans who have prior combat experience (and many of whom also hold EMT certification) looking for law enforcement/ SWAT/ 'tac medic' jobs because it's one of the few things that military training and experience carry over into. This is only going to get more pronounced as the force shrinks.

Getting to what you tell us you want via medicine is possible, but it's not anywhere near as easy.


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## Lazer (Mar 24, 2013)

> Lazer, I would strongly recommend that you step back and look at what _exactly_ you want to do. If you want to be a 'medic' in the 'tactical' sense, you've got three options.
> 
> 1. Join the military, active-duty. Not a bad gig, and as a male you've got a decent chance of ending up in an infantry unit, but with the current budget situation, I strongly suggest that you not make this your primary bet.
> 2. Join the military, reserves. It's a decent compromise, but it's not quite going to be your best option.
> ...



Well ok, I have slight problem with this analysis. I consider myself a pretty aware fellow, I'm deeply interested the socio-political/socio-economic/economic-industrial/military-industrial-economic facets of secular society. This being the case I know that there is an inherent problem with modern combat veterans in the workforce, or at least a perceived problem, and that is that many veterans who have served recent combat tours in the middle east are coming back with major psychological problems and many business owners are unlikely to employ them to manage a fax machine, let alone an automatic weapon under stressful conditions that may closely parallel traumatic events experienced in military combat. The fact exists that there are stark differences between conventional military combat, and tactical/strategic armed resource utilization. A few of those that may affect a combatant psychologically might be the level of brutality and carnage, constant fear of attack, inhumane acts carried out under official command, the frequency, severity and nature of military combat wounds (amputations). These factors, whether we would like to admit it or not, are some of the reasons vets coming home from the mid-east are subject to psychological damage that is difficult to treat, and often renders them unemployable, especially in paramilitary or law enforcement roles. That being the case it makes sense that many combat medics, PJs etc have difficulty finding domestic employment even in roles that would seem to suit them, like tactical medic. I think what will end up being of most value and relevance is experience treating the types of injuries most likely to occur in the domestic tactical environment and training designed for providing care in that environment, not experience from the military battle field, and I would reckon that's what I would want my medic to have if I was on a tactical team with a medic.


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## RocketMedic (Mar 24, 2013)

Lazer, while insightful, I respectfully disagree. A veteran who intelligently leverages their skillset is going to have a practical and organizational advantage over you. Keep in mind that the law enforcement community is fairly pro-veteran and is no stranger to PTSD. Will they hire Sgt. Frustratedandscreamsateveryone? Possibly. Will they hire Sgt. FormerPJ with three Afghan Excursions, a few cool medals and no or controlled PTSD over a civilian medic with no experience at all in controlling violence in anything other than self-defense? Probably. 

Your assessment is based on extremes and assumptions. Most vets dont have PTSD. Most of us are a little more in-shape, much more familiar with weapons, and are more disciplined than our peers. Will being a vet hurt me looking for a job in Berkeley, CA? Not as much as the negative affirmative action associated with Straight, White Male. Anywhere else, especially in Flyover Country, military service is a fast track to employment.

Employment problems for us come from lacking equivalent certification in civilian medicine.


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## Veneficus (Mar 24, 2013)

Rocketmedic40 said:


> Lazer, while insightful, I respectfully disagree. A veteran who intelligently leverages their skillset is going to have a practical and organizational advantage over you. Keep in mind that the law enforcement community is fairly pro-veteran and is no stranger to PTSD. Will they hire Sgt. Frustratedandscreamsateveryone? Possibly. Will they hire Sgt. FormerPJ with three Afghan Excursions, a few cool medals and no or controlled PTSD over a civilian medic with no experience at all in controlling violence in anything other than self-defense? Probably.
> 
> Your assessment is based on extremes and assumptions. Most vets dont have PTSD. Most of us are a little more in-shape, much more familiar with weapons, and are more disciplined than our peers. Will being a vet hurt me looking for a job in Berkeley, CA? Not as much as the negative affirmative action associated with Straight, White Male. Anywhere else, especially in Flyover Country, military service is a fast track to employment.
> 
> Employment problems for us come from lacking equivalent certification in civilian medicine.



I would also add that many civil service positions give bonuses to veterens, no matter what branch or MOS. Some places as much as 10% points.


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## ExpatMedic0 (Mar 24, 2013)

Veneficus said:


> I would also add that many civil service positions give bonuses to veterens, no matter what branch or MOS. Some places as much as 10% points.



Ya, I always got "5 points" in Oregon, you got "10" points if you had a service connected disability.


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## Lazer (Mar 24, 2013)

Well I don't know, maybe the tax benefits do outweigh the potential liability. 

There was actually a 2006 study published in the _International Handbook on Psychopathic Disorders and the Law_ *(seen here books.google.com/books?isbn=0470066431)* that showed that the prevalence of positive screening results for mental health problems was 19 percent among returning Iraq vets and 11 per cent among returning Afghan vets.

That study also showed that among OIF/OEF veterans seen at VA healthcare facilities, 25 percent received mental health diagnoses Among the rest, there are still a number of vets who have underlying problems that aren’t discovered through the screening process. I don’t believe it to be the case, but assuming you are correct and the current job market isn’t yet reflecting these outcomes, the critical conclusion I believe would have to be that it eventually will. I realize this is a sensitive subject I don’t mean to discount any of you folks who may be combat veterans. This is just my personal opinion on the matter.


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## Lazer (Mar 24, 2013)

_ "and 11 per cent among returning Afghan vets."_

And that study was conducted in 2006, before the Afghan war had really picked up.


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## Luno (Mar 24, 2013)

Son, you are really pissing up the wrong tree right now.


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## Lazer (Mar 24, 2013)

Luno said:


> Son, you are really pissing up the wrong tree right now.



Like I said it's not my intention to put anyone down. I didn't create the data.


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## DrParasite (Mar 24, 2013)

become a cop.  then join their SWAT team or ERT unit, or one at the county or state level.

I know quite a few people who are "certified" as tactical EMTs and paramedics.  but unless you are on an EMS agency that supports the Tac Team, and kiss the right butt to get on, all you become is an educated medic, who doesn't do much to do with tactical medicine.

you know what they call a tactical paramedic on an ambulance?  a paramedic.


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## Handsome Robb (Mar 25, 2013)

DrParasite said:


> become a cop.  then join their SWAT team or ERT unit, or one at the county or state level.
> 
> I know quite a few people who are "certified" as tactical EMTs and paramedics.  but unless you are on an EMS agency that supports the Tac Team, and kiss the right butt to get on, all you become is an educated medic, who doesn't do much to do with tactical medicine.
> 
> you know what they call a tactical paramedic on an ambulance?  a paramedic.



I don't see this meeting the OPs end goal. I think Luno, along with another person if I remember correctly, gave a great run down of what TEMS really is/does in another thread.  In short it's quite often preventative/primary care type stuff and planning with the occasional medical emergency, traumatic injury or field pronouncement during SWAT call outs but that's generally pretty rare from my understanding.

It's not impossible to become a TEMS provider. With that said, it's not a career except I a very select few, if any, agencies.

I've said it in almost every single TEMS thread. You're a medic first and a TEMS Medic second or in same places a Cop first and a SWAT medic second. I'm
Not sure about bigger cities but here all the SWAT guys are normal patrol officers that respond to SWAT calls when their team gets activated. Same goes for the medics. You work a regular street shift then go if you're on duty and they request TEMS or if you're on-call while off duty from your normal medic shift.

I don't think any of our TEMS guys are even "EMT-T" certified. They all have TCCC and STORM training but I've never heard "EMT-Tactical" anywhere except for on this website and when I googled it after it was mentioned.


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## Luno (Mar 25, 2013)

Lazer said:


> Well ok, I have slight problem with this analysis. I consider myself a pretty aware fellow, I'm deeply interested the socio-political/socio-economic/economic-industrial/military-industrial-economic facets of secular society. This being the case I know that there is an inherent problem with modern combat veterans in the workforce, or at least a perceived problem, and that is that many veterans who have served recent combat tours in the middle east are coming back with major psychological problems and many business owners are unlikely to employ them to manage a fax machine, let alone an automatic weapon under stressful conditions that may closely parallel traumatic events experienced in military combat. The fact exists that there are stark differences between conventional military combat, and tactical/strategic armed resource utilization. A few of those that may affect a combatant psychologically might be the level of brutality and carnage, constant fear of attack, inhumane acts carried out under official command, the frequency, severity and nature of military combat wounds (amputations).


I would take someone who has proven themselves under fire over any clown that has an EMT merit badge and considers themselves "smart." 


> These factors, whether we would like to admit it or not, are some of the reasons vets coming home from the mid-east are subject to psychological damage that is difficult to treat, and often renders them unemployable, especially in paramilitary or law enforcement roles. That being the case it makes sense that many combat medics, PJs etc have difficulty finding domestic employment even in roles that would seem to suit them, like tactical medic.




Lazer, one thing you may wish to remember, EMS is a small community, I can't count how many times there is less than 3 degrees of separation are on this board, there are people on here that I feel I know more about their lives because even though I've never met them, I know way too much about them from people they know.  

That being said, as you can probably tell from the lack of people volunteering their personal experience in TEMS, the TEMS community is smaller by orders of magnitude.  Your postulation of things that you lack any substantive knowledge of should be curtailed or there will probably be some significant challenges to your success in this field.  Most full time TEMS know each other or have at most two degrees of separation...  



> I think what will end up being of most value and relevance is experience treating the types of injuries most likely to occur in the domestic tactical environment and training designed for providing care in that environment, not experience from the military battle field, and I would reckon that's what I would want my medic to have if I was on a tactical team with a medic.



And please tell me how you have any basis in reality...

Oh yeah, Robb, originally EMT-T designated CONTOMS graduates....


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## Lazer (Mar 26, 2013)

Luno said:


> I would take someone who has proven themselves under fire over any clown that has an EMT merit badge and considers themselves "smart."
> 
> 
> 
> ...



Well first of all I don't think I deserve the insults. Showing mutual respect is a matter of integrity and I believe it speaks volumes about character. Secondly I hope all of the references to the "close knit" TEMS community weren't meant to intend your ability to somehow influence my personal advancement in the field, if that’s the case I don’t believe I’m the one with their head in the wrong place. 

As I made sure to reiterate throughout this conversation, I’m not speaking from experience.  The basis on which I situate my perspective is one of the larger picture revealed through objective scientific scrutiny, which was established by the scientific community to be much more reliable than subjective analysis oh somewhere around the turn of the 3rd century.

My point is simply this: The data has proven beyond a doubt that the war in the middle-east is doing severe psychological damage to a significant number of returning combat veterans and because of that those veterans are having difficulty finding suitable employment. This is a fact mind you. This being the case, I believe that the institutions who had traditionally sought to employ combat veterans are starting to look elsewhere for this very same reason, and the data supports that. The psychological damage done to combat veterans in the Iraq and Afghan wars is not something you’ll hear about on media rotation. These veterans are hidden. It’s something they don’t want you to hear about or talk about, partly because there are just so many of them.

In any case, I believe common sense is all that’s required to see the potential for problems when placing a psychologically damaged combat veteran behind a swat vest, and if there is a die-hard military man heading up a tactical unit somewhere who is willing to overlook that potentiality simply for the sake of adhering to a certain sense of military pride or what have you, I’d say I hope I’m never taken hostage in his jurisdiction.


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## RocketMedic (Mar 26, 2013)

Lazer said:


> Well first of all I don't think I deserve the insults. Showing mutual respect is a matter of integrity and I believe it speaks volumes about character. Secondly I hope all of the references to the "close knit" TEMS community weren't meant to intend your ability to somehow influence my personal advancement in the field, if that’s the case I don’t believe I’m the one with their head in the wrong place.
> 
> As I made sure to reiterate throughout this conversation, I’m not speaking from experience.  The basis on which I situate my perspective is one of the larger picture revealed through objective scientific scrutiny, which was established by the scientific community to be much more reliable than subjective analysis oh somewhere around the turn of the 3rd century.
> 
> ...



You have never done this for real, have you?

I have. Ive been blown up, shot at, and yes, I've shot someone. It wasnt a thing I enjoyed, but it happened, and I dont regret it. No one I cared about died or got hurt, so its good on my end. Unavoidable situation with a jihadi who refused to surrender and tried to shoot us. Did that break me psychologically? No, it didnt. I intimately understand the consequences of actions, and unlike the vast majority of Americans and first-worlders, I know I can pull a trigger if I need to. For me, its not academic. 

You have literally no idea what you are talking about. You are currently an untrained wannabe who wants a position doing very, very serious things and expects your entitlement, naitivity (?) and unearned sense of superiority to fast-track you to a position that you are too cocky and lazy to earn. Then you expect that to somehow qualify you for work that involves extraordinary amounts of danger and requires the swift, effective and decisive application of overwhelming force to neutralize threats ahead of someone who has identical civilian certifications and real-world experience.

When it comes down to brass tacks, you (and most other civilian EMTs), are not qualified to be tactical medics, regardless of certification level. A 68W who knows how to do water checks, treat a sprain, dispense NSAIDS and treat injuries (and more importantly, coordinate evacuation with proper medical assets) and knows how to operate as an infantryman is far, far more qualified to fill a SWAT team stack than most police officers, much less some arrogant EMT who thinks a few minutes with a Glock is 'training'. I bet you think penetrating trauma = spinal restriction, IV fluids and O2 too. 

You should really change your attitude before you try for civilian EMS, much less law enforcement.


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## Veneficus (Mar 26, 2013)

Lazer said:


> Well first of all I don't think I deserve the insults. Showing mutual respect is a matter of integrity and I believe it speaks volumes about character. Secondly I hope all of the references to the "close knit" TEMS community weren't meant to intend your ability to somehow influence my personal advancement in the field, if that’s the case I don’t believe I’m the one with their head in the wrong place.



I don't think that is what he meant. 

I think what he was trying to say is if you go around making presumptions that all former combat vets are suffering from a mental disturbance that you are going to create a negative reputation for yourself within the community you are trying to be a part of.

Nobody is threatening to ruin you, and Luno has given you considerable insight so that you don't sabotage yourself.

There is nobody on this website, or perhaps in the US, more credible than him on this matter. You would do well to take his advice.




Lazer said:


> As I made sure to reiterate throughout this conversation, I’m not speaking from experience.  The basis on which I situate my perspective is one of the larger picture revealed through objective scientific scrutiny, which was established by the scientific community to be much more reliable than subjective analysis oh somewhere around the turn of the 3rd century.



I am going to just take a guess...Psych major?



Lazer said:


> My point is simply this: The data has proven beyond a doubt that the war in the middle-east is doing severe psychological damage to a significant number of returning combat veterans and because of that those veterans are having difficulty finding suitable employment. This is a fact mind you.



This has always been the case after war. It is not unique to the recent ones. 



Lazer said:


> This being the case, I believe that the institutions who had traditionally sought to employ combat veterans are starting to look elsewhere for this very same reason, and the data supports that.



You have data that says returning veterans have difficulty finding a job?

That is not news either.

In general, many military skills do not directly translate over into the civilian environment. Many of the traits employers look in military vets are "soft" skills
like discipline, ability to put up with large amounts of BS, courtesy, how to dress, etc.

I would also point out that many industries that traditionally hire vets are shrinking. 

I think you may be mistaken and assigning correlation as equal to causation.  



Lazer said:


> The psychological damage done to combat veterans in the Iraq and Afghan wars is not something you’ll hear about on media rotation. These veterans are hidden. It’s something they don’t want you to hear about or talk about, partly because there are just so many of them.



Sorry, do you live under a rock?

There is more attention on the psych damage to combat vets of these latest wars than ever before in history. Much more than the Vietnam conflict, which many psych PTSD experts consider the original cases. 

Prior to that there were "readjustment" difficulties for Korea vets, as well as WWII. I was raised by this generation, and I can tell you from experience, many of these people went through a readjustment period, many did not ever readjust, and they maintained a strong group cohesion. So strong in fact that when persons who actually fought on opposing sides met they wouldn't see an enemy, but a member of an unspoken fraternity.

Despite obvious shortcomings in post deployment psych care, there is more now than there ever was. It is in the news almost everyday. How much media coverage was there on "shell shock" as was once called?



Lazer said:


> In any case, I believe common sense is all that’s required to see the potential for problems when placing a psychologically damaged combat veteran behind a swat vest,.



There are problems when you put any psychologically damaged person behind a SWAT vest, it is not unique to minitary vets. A desire to right the wrongs of the world, dole out justice, get the bad guy, pretend to be in the military fron somebody who has never been, the list is endless.

The goal in the hiring procedure is to pick the most adjusted ones, not put any vet that applies into a position because there is a gun and shooting involved. You have an evident lack of knowledge on the process you are making claims as an expert to. Your position is very one dimentional and seems to be rooted in a preconceived belief that you have selected data to back. (that is called pseudoscience by-the-way and it is very widespread in psychology, which is why credible psychologists have so much difficulty gaining the respect they deserve)



Lazer said:


> and if there is a die-hard military man heading up a tactical unit somewhere who is willing to overlook that potentiality simply for the sake of adhering to a certain sense of military pride or what have you, I’d say I hope I’m never taken hostage in his jurisdiction.



It is evident you do not know what a "die hard" military veteran looks like, what they act like, or What they believe.

The professional soldier/sailor/marine is not some psychotic Rambo figure. They are very composed. For them, killing people isn't a want or a desire, it is just the job they do. The "pride" as you are calling it is from being part of something larger then themselves. From having demonstrated their character and ability in one of the most challenging environments humans face.

You find that same pride and comraderie in other professionals who face challenges, from police officers, to firefighters, mercenaries, "contractors," spies, athletes, and even politicians.  In its worst form becomes ethnocentrism, and it is certainly not unique to the military.

If I am ever taken hostage, I want a SEAL team to come and help me. You keep the negotiator and your intellectual civilian law enforcement. I want it to be the guys who do it day in and day out. Who spend the time they are not doing it practicing it. Who see it so often that it is nussance and want to be doing something else.

It is a time for calculated, practiced, and definitive action. Not an academic or intellectual exercise.

A living arrested perpetrator with his rights intact who will face trial and a dead hostage is not a win. 

The only win is a living hostage. If the perpetrator is not killed, that is a bonus, not a requirement.

I am not a combat vet. But I have been fortunate to have many experiences in many places as well as spending a few days in school, and a few days interpreting data. Maybe I have PTSD or am just generally unhinged?

P.S. I don't want to be on a SWAT team or pretend to be a soldier.


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## RocketMedic (Mar 26, 2013)

Any big-city firefighter who has done interior attack or rescue has been in just as much risk as a combat infantryman in Iraq or Afghanistan when hot. Carrier-deck work is a whole new level of danger.


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## ExpatMedic0 (Mar 26, 2013)

Rocketmedic40 said:


> Any big-city firefighter who has done interior attack or rescue has been in just as much risk as a combat infantryman in Iraq or Afghanistan when hot. Carrier-deck work is a whole new level of danger.


Hmmm... I am not sure I agree with that one. Shall we compare morbidity mortality rates between the 2? I was on burial duty after I came home I buried over 10 guys within 1 year, just from my infantry battalion. That was by no means the total number, and also excluding those who where disabled. 

My friend who was a riflemen in 3rd I.D had worse luck. His platoon took %50 casualties/wounded.

Anyway.... I don't wanna go off topic here....


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## RocketMedic (Mar 26, 2013)

schulz said:


> Hmmm... I am not sure I agree with that one. Shall we compare morbidity mortality rates between the 2? I was on burial duty after I came home I buried over 10 guys within 1 year, just from my infantry battalion. That was by no means the total number, and also excluding those who where disabled.
> 
> My friend who was a riflemen in 3rd I.D had worse luck. His platoon took %50 casualties/wounded.
> 
> Anyway.... I don't wanna go off topic here....



Well, theres always outliers, and pitched battles like Fallujah or anything from WW2 are riskier...but for the most part, deployment is no more dangerous than, say, FDNY using 1980s policies.


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## ExpatMedic0 (Mar 26, 2013)

After September 11th, since the start of the invasion, How many firemen have died on duty in the past 10 years? 8,000? 
http://icasualties.org/


I could be wrong, but i highly doubt any morbidity mortality rates for U.S. firefighters compare.


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## ExpatMedic0 (Mar 26, 2013)

In fact... here you go, not even close, even including september 11th from 1977-2011 a little more than half as many firemen have died on duty compared to service members in the past 10 years. Whats more interesting is that the stats show the majority of those fatalities are "volunteer firefighter" "on duty heart attacks"

http://apps.usfa.fema.gov/firefighter-fatalities/fatalityData/statistics


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## abckidsmom (Mar 26, 2013)

Back on topic, everybody.


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## RocketMedic (Mar 26, 2013)

Rgr that...Lazer, your reply? I eagerly await your wisdom.


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## Lazer (Mar 26, 2013)

Rocketmedic40 said:


> You have never done this for real, have you?
> 
> I have. Ive been blown up, shot at, and yes, I've shot someone. It wasnt a thing I enjoyed, but it happened, and I dont regret it. No one I cared about died or got hurt, so its good on my end. Unavoidable situation with a jihadi who refused to surrender and tried to shoot us. Did that break me psychologically? No, it didnt. I intimately understand the consequences of actions, and unlike the vast majority of Americans and first-worlders, I know I can pull a trigger if I need to. For me, its not academic.
> 
> ...



Well ok, I think my assertions have been misconstrued a bit, so I’ll start by addressing that. I’m not saying that every combat veteran returning from these wars is has a psychological problem, what I’m saying is that the numbers of them that do tell me two important things:

1)	Probability of death and dismemberment aside, if I enlist in active duty military service and I am deployed to the mid-east, I stand a decent chance of coming home with a debilitating psychological illness that may well defeat the purpose of joining the military in the first place.

2)	From the perspective of someone who is not a member of the armed forces, I feel it’s only logical to assume that anyone looking to employ a combat veteran would at least consider the possibility of an underlying psychological disorder, and whether they consider it or not, the fact remains that the probability that one exists is heightened in combat veterans in contrast to their civilian counterparts in EMS.

Things I am NOT saying are:

A)	That lack of military combat experience alone makes a civilian candidate more competitive

B)	That you are personally not qualified to be a tactical medic on the basis of your combat experience

C)	That I know more than you or any other combat medic

When it all boils down any military combat medic was once a student before using his learned skills in combat. Not one of you in opposition has explained yet why the same can’t be done outside of the military institution. There is no limit to what one can learn. Maybe it’s my lack of a comprehensive understanding of military service but I don’t understand why you all are so keen to believe that this gap between knowledge and application must be bridged on the military battlefield, which I would imagine is just as dangerous if not more so than a domestic tactical setting.


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## Lazer (Mar 26, 2013)

Veneficus said:


> I don't think that is what he meant.
> 
> I think what he was trying to say is if you go around making presumptions that all former combat vets are suffering from a mental disturbance that you are going to create a negative reputation for yourself within the community you are trying to be a part of.
> 
> ...



Well I do sort of live under a rock in many ways haha, but what I meant by that was that the problem is far more pervasive than the media woudl have us believe.

I don't claim to "know it all", in fact I know little more than what I have read about this particular subject and I feel I've made a considerable effort to convey that. 

You bring up interesting points about the characteristics of military combat vets that lend themselves to tactical EMS roles. Who knows, maybe I'll reach that point and find it really isn't for me. Maybe I'm not their "type". I do come from a military and LE family but have nver served myself. In any case I don't believe I'll be signing up any time soon and if that ends up being the reason I don't achieve a career in TEMS well there are plenty of other opportunities out there for dedicated medics that I'm sure I'd be suited to.

I really appreciate all of the responses by the way, really great, thank you.


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## Veneficus (Mar 26, 2013)

Lazer said:


> 1)	Probability of death and dismemberment aside, if I enlist in active duty military service and I am deployed to the mid-east, I stand a decent chance of coming home with a debilitating psychological illness that may well defeat the purpose of joining the military in the first place.



I think this is very true. But with all things in life, nothing ventured, nothing gained.

one of my favorite quotes:

"A risk is a chance you take; if it fails you can recover. A gamble is a chance taken; if it fails, recovery is impossible." 



Lazer said:


> 2)	From the perspective of someone who is not a member of the armed forces, I feel it’s only logical to assume that anyone looking to employ a combat veteran would at least consider the possibility of an underlying psychological disorder, and whether they consider it or not, the fact remains that the probability that one exists is heightened in combat veterans in contrast to their civilian counterparts in EMS.



In the fire service and law enforcement, (and even some EMS agencies) the hiring process includes a psych eval. Some require it every couple of years.

Additionally, nobody starts off as "independant." I can't speak for law enforcement, but in fire for sure, and in all reputable EMS, there is a period of senior/junior learning and evaluation.

Between the selection process and "initial" aspects of employment, while somebody will always slip through a crack, it is very effective at finding mentally stable candidates. 

You are not talking about a private, profit driven employer. You are talking about public safety and police forces. They are under a public microscope, and even the slightest transgression can cause major issues. 

It is very unlikely that aperson would be able to effectvely conceal a psych illness until they finally snap. Obviously some will, but it is very difficult. 




Lazer said:


> Things I am NOT saying are:
> 
> A)	That lack of military combat experience alone makes a civilian candidate more competitive



But you did make it sound more desirable, like every combat vet was going to  be a danger to everyone around them.



Lazer said:


> C)	That I know more than you or any other combat medic



like I said in my post, your knowledge on this is obviously very limited. While you may have some study behind you, you made some very big proclamations. I really think you should look into the law enforcement field before deciding it is what you want. (I have never and never want to be a cop. I would not make a very good one for sure. My attitude is all wrong for it. It doesn't make me lesser.) 



Lazer said:


> When it all boils down any military combat medic was once a student before using his learned skills in combat. Not one of you in opposition has explained yet why the same can’t be done outside of the military institution.



It is not that it can't be done, it is a much more difficult way of going about it. One of the most common prerequisites for being considered for things like disaster response, SWAT, and al manner of highly demanding roles is experience. The military is the easiest way for the unexperienced to get it. 

Otherwise you have to find an entry level position, out-compete all those with experience or the same qualifications you have. (highly unlikely on the experience part as more and more soldiers return from war, just unlucky timing. If we were 10 or 20 years post war, your chances would be better)

Then starting out at the bottom, have to hope for this experience over time. If you are really unlucky, you will never have the opportunity. As Luno accurately pointed out, this is a game where reputation counts. Where highly qualified people who have proven their metal get jobs by word of mouth. The people considered are known quantities, with a record of performance. Beginners do not get selected.



Lazer said:


> There is no limit to what one can learn..



I have my doubts. I deal with people who have reached their limit all the time. Even more cannot make use of what they have learned. One of the byproducts of education is initially coming out with lots information without an idea on prioritizing importance or predicting what is most useful. The only way around that is experience.



Lazer said:


> Maybe it’s my lack of a comprehensive understanding of military service but I don’t understand why you all are so keen to believe that this gap between knowledge and application must be bridged on the military battlefield,



I don't think it has to proved specifically on the battlefield, there are lots of support positions in the military. 

But the battlefield is survival of the fittest. Perhaps sometimes the luckiest. But the military is still the most easily obtained entry level position, in the most likely palce to get you experience.



Lazer said:


> which I would imagine is just as dangerous if not more so than a domestic tactical setting.



Certainly it is. 

That is why you see military people put such a premium on it. These people have proven themselves in the most difficult environment. Where the stakes are life and death, not only for oneself. 

They are a known quantity. It is not that they are unbreakable. It is that their weaknesses are known and they have demonstrated the ability to overcome them.

You could spend your entire career in the civilian world and never be presented with the opportunity to even be tested, much less adopt the values inherently needed, like putting your partner's life or safety equal to or greater than your own.

Look at your classmates. Honestly, how many and which ones would put their life before yours or care if you made it home or not? How many will be there when you are at your worst? In 5 years? 10? How many would help you in a life or death situation even if they didn't like you because that is a requirement of the environment and culture?


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## RustyShackleford (Mar 26, 2013)

Lazer I think you are underestimating the lack of real world knowledge that comes along with a few combat tours in either Iraq or Afghanistan in the last 12 years.  You can make the assumption that book knowledge and simulation will get you through to the other side, but I bet you a lot of us vets around here were naive to think that as well before we were deployed.  

All the simulations and book knowledge in the world is great and all but to be a decent combat/tactical medic boils down to one thing "instincts".  That is something that can never be measured or tested until rounds are flying and men you have worked and lived with are dead or dying.  

I am not trying to be that jagged veteran, I just believe that combat veterans hold something above civilian trained combat medics as most of us have ran the gauntlet and the decisions we made and the way we performed can never be tested in a simulation.  Some of us had it some of us didn't and it is well documented in our military records I am sure.  Therefore going into tactical medicine and the "normal" circumstances that we are dealt in a "tactical medic" position fail to compare to some of our experiences, myself and others in Afghanistan and those of them that went to Iraq.  


If they have real experience treating priority patients on a deployment have been tested in the only true test that we have as combat/tactical medic's in the world these days and those of us that excelled in this area now have the advantage over civilians who yes may have tonnes of training and scenarios under their belt but we hold the advantage of being tested in those skills and some of us hopefully performing well.


Again I am not making the assumption that all of us are combat/tactical medic gods but if anything we have been tested and proven or merit one way or the other.

The other point you made about PTSD or other developed psychiatric issues in veterans is grossly generalized.  I suggest you do some research in the number of psychological casualties of far and when their symptoms usually come to a head and under what conditions.  I think you will find that very few reach the breaking point under stress, it is usually during the least stress that they try to revert to a state of "normalcy" back in their home lives that the emotions come flooding back.


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## Lazer (Mar 26, 2013)

RustyShackleford said:


> The other point you made about PTSD or other developed psychiatric issues in veterans is grossly generalized.  I suggest you do some research in the number of psychological casualties of far and when their symptoms usually come to a head and under what conditions.  I think you will find that very few reach the breaking point under stress, it is usually during the least stress that they try to revert to a state of "normalcy" back in their home lives that the emotions come flooding back.



Wonderful point. I have read this same thing and I guess I forgot all about that. Thank you for bringing that up.

Well I certainly appreciate these compelling perspectives and in honesty I do feel differently having now discussed it with you all. 

I had initially taken what I knew about the general socio-economic difficulties facing a certain percentage of returning combat veterans seeking domestic employment and mistakenly amortized those projected difficulties equally across the entirety of the military sector, when in reality, as Mr. Shackleford was so keen to point out, it does likely affect the paramilitary/law enforcement prospects less. 

So, great points all. Very much appreciated.

Feel continue the conversation, I don’t mean this to be a conclusion, just announcing my prudence satisfied. Thanks again!


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## RocketMedic (Mar 27, 2013)

Well, I'm glad we got through to you.


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## Luno (Mar 29, 2013)

*Go on vacation, and this happens?*



Lazer said:


> Well first of all I don't think I deserve the insults. Showing mutual respect is a matter of integrity and I believe it speaks volumes about character. Secondly I hope all of the references to the "close knit" TEMS community weren't meant to intend your ability to somehow influence my personal advancement in the field, if that’s the case I don’t believe I’m the one with their head in the wrong place.


I didn't insult you, I insult my friends as a means of showing affection, you don't rate.  And your personal advancement in the field?  Give me a break, you don't even have an EMT merit badge yet, you have to start in the field to advance.


> As I made sure to reiterate throughout this conversation, I’m not speaking from experience.  The basis on which I situate my perspective is one of the larger picture revealed through objective scientific scrutiny, which was established by the scientific community to be much more reliable than subjective analysis oh somewhere around the turn of the 3rd century.


You aren't even speaking from objective scientific scrutiny as you have no basis to judge success or failure in the field.  You have decided to run with a flawed premise of which you have no basis in reality.  There is very little to no data that is available to the general public about success in TEMS as a veteran, so your conclusions are flawed, even in the 3rd century.


> My point is simply this: The data has proven beyond a doubt that the war in the middle-east is doing severe psychological damage to a significant number of returning combat veterans and because of that those veterans are having difficulty finding suitable employment. This is a fact mind you. This being the case, I believe that the institutions who had traditionally sought to employ combat veterans are starting to look elsewhere for this very same reason, and the data supports that. The psychological damage done to combat veterans in the Iraq and Afghan wars is not something you’ll hear about on media rotation. These veterans are hidden. It’s something they don’t want you to hear about or talk about, partly because there are just so many of them.


I welcome your data, but until you supply this, I'm going to call bull:censored::censored::censored::censored:.  I spend more than a small part of my time working with combat veterans and assisting them in finding employment, and your facts don't hold water... So please, cite your sources.



> In any case, I believe common sense is all that’s required to see the potential for problems when placing a psychologically damaged combat veteran behind a swat vest, and if there is a die-hard military man heading up a tactical unit somewhere who is willing to overlook that potentiality simply for the sake of adhering to a certain sense of military pride or what have you, I’d say I hope I’m never taken hostage in his jurisdiction.



You lack the resources and data to ascertain if/that the person in the vest is "psychologically damaged," and lack the ability to differentiate between psychological issues particularly as they affect not only veterans but also your average law enforcement officer.  I would welcome you to either provide your data, or kindly find your seat in your EMT class and get at least a completion certificate before you try to compare your opinions to those who have done this for a living.


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## Luno (Mar 29, 2013)

*Hitting back from the 3rd Century*



Lazer said:


> Well ok, I think my assertions have been misconstrued a bit, so I’ll start by addressing that. I’m not saying that every combat veteran returning from these wars is has a psychological problem, what I’m saying is that the numbers of them that do tell me two important things:
> 
> 1)	Probability of death and dismemberment aside, if I enlist in active duty military service and I am deployed to the mid-east, I stand a decent chance of coming home with a debilitating psychological illness that may well defeat the purpose of joining the military in the first place.



Again, data?  



> 2)	From the perspective of someone who is not a member of the armed forces, I feel it’s only logical to assume that anyone looking to employ a combat veteran would at least consider the possibility of an underlying psychological disorder, and whether they consider it or not, the fact remains that the probability that one exists is heightened in combat veterans in contrast to their civilian counterparts in EMS.


Again, this isn't "common sense," this is a subjective opinion based on what data?  You've alluded to "more pervasive" than what media would have you believe, and you believe this because?  I think it would be illogical to assume that you wouldn't consider a possible underlying psychological issue with anyone attempting a career in the safety services, but I'll buy that you could consider that with a veteran as well.


> Things I am NOT saying are:
> 
> A)	That lack of military combat experience alone makes a civilian candidate more competitive
> 
> ...



There is no limit on what one can learn, however you should consider that TEMS is largely affected by military experience and research.  There is very little that civilian experiences can contribute at this time.  There is a world of difference between running scenarios with simunitions and getting actually shot at, and until you're actually under fire, you don't know how you're going to act, and if you were on my time, I'd be far more concerned about that, than having to deal with a vet's PTSD.  That being said, I was former military, non-combat and made it in the field.  There is a way to make it happen, but it took a lot of effort, listening 100 times more than talking and keeping my opinions to myself until I had practical experience to base them on.


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