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.
