A lot of people here are trying to process the relationship between civilian EMS and combat medicine in terms of certification level, which I suppose is something we've been primed to think in terms of since our certification level is one of our major personal choices as EMS practitioners. However that isn't a very good way to break down the differences between combat medics and civilian EMTs because each practices emergency care differently from the other.
I've received combat medicine briefings, not certifying training but rather knowledge provided to me as an Air Force ROTC cadet in the spirit of AFROTC's new emphasis on an expeditionary warrior ethos, albeit the briefings were conducted by combat medics. I also have civilian FR and EMT-B certifications, and in my observation it's different equipment, different protocols, and different decision-making by the practitioner. Combat medicine, at least in my exposure to it, is all trauma care.
Equipment:
- Pre-assmbled tourniquets designed to be applied by the victim using a single arm and sometimes built into a soldier's uniform
- Quick-clot powder
- Israeli trauma bandages which are gauze padding, a roller-bandage type cloth, and a plastic clip all already assembled together
Those seem to be three staples of combat medicine not found in civilian EMS, at least not as standard equipment. Military equipment seems to be designed to be rapidly applied, in a way that a victim with use of a single arm can apply the equipment to themselves, and in a way that medics provide their essential patient care while spending as little time on the patient as possible.
Protocols:
As a FR, I was told bad FRs used tourniquets and good FRs didn't. The EMT program was a little more relaxed about their use, but nothing like the way the military uses them. Tourniquets are basically life to combat soldiers, and the military uses them routinely and has been developing their ability to get victims into hospitals soon to be able to revive the limb distal to the tourniquet. Traumatic amputations are common among soldiers.
Decision-making:
My EMT training certainly taught me to say "scene safety", but little more was really said about it. For combat medics, this is a really big deal because victims are victims often because they got shot, and if they got shot where they are, you probably will too. It's a trade-off between safety and patient care, and it's something combat medics have to think a lot about whereas it seems to be an understandably foreign concept to a lot of civilian EMS. A wrong decision can turn one casualty into two or more, and many times the medic gets more injured than the initial victim. Even as a simple checklist technicians, combat medics and EMTs have different mnemonics that perform different tasks. I don't understand there to be a SAMPLE or OPQRST for combat medics, and instead soldiers learn things like how to make a 9-line MEDIVAC request.
Hopefully this is a good reflection of the kind of differences between combat medicine and civilian EMS, which some users have summarized much more briefly already. Civilian EMS focuses much more on medical emergencies such as myocardial infarctions, and in a normal civilian job medical calls will some, if not most of the emergencies you respond to. What's been said earlier about more advanced trauma care such as lines and tubes being EMT-P skills is definitely true, but I hope you understand that there are trauma care skills at all EMT levels.
If it's the idea of performing very advanced care that appeals to you, EMT-Ps certainly do perform advanced care. You might also consider becoming a nurse or doctor, since those individuals carry out far more types of care than EMTs are permitted to.
