New 68W Training

airborne2chairborne

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

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

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

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

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Many incorporate it in the program.

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

Akulahawk

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

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

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

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

Finally, my patient care is fine. I know my way around tactical and sick call medicine, on the other hand I'm pretty sure you made a pretty piss poor line medic simply because of your view of medics as combatants... Your infantrymen deserved better than someone who wasn't willing to cover their ***.
A Paramedic, straight out of school, has a bit more than 16 weeks of medical education. That Paramedic has also been through some clinical experiences and field experiences that have prepared that Paramedic to do what they do. While ACLS is a lot of what I do as a Paramedic, so is PHTLS. What I do even more of is basic care. Put me through TCCC and give me a little time to learn how to do Military Sick Call stuff and I'm sure I'll do quite well.

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

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

TheMidnightPhilosopher

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

EMT11KDL

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

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

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

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

airborne2chairborne

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

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

airborne2chairborne

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

airborne2chairborne

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

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

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

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

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

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

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

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

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

ffemt8978

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

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RocketMedic

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

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

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

I am surrounded by idiots...
 

Doczilla

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

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

Akulahawk

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This was definitely a macrodrip set with the chamber cut in half.
"Esophageal perforation" means nothing.
A macro drip set with the chamber cut in half does seem to have a higher flow then a 14gauge Angiocath. Even though such a setup would work, I worry greatly about that "esophageal perforation" thing... I would consider such an improvised device only as a last ditch, no other options/equipment available for a cric. You'd better believe that I'd have to document the heck out of that kind of thing because where did I use up all the other equipment that could be used for a needle cric or a surgical cric (if that's available too)??? A whole lot of stuff would have to happen for me to even consider doing a cric with a macro drip set....
 
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RocketMedic

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

EMT11KDL

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

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