military medics versus paramedics

[newmee]

Putting this one out there for opinions. I am a civilian paramedic as well as a returning combat medic with the US army. In my humble opinion I find the military medics good for trauma only but very limited and poorly trained for medical issues. I saw time and time a again combat medics clueless when dealing with medical issues. I also found time and time again that the combat medics were quick to do skills (IV's mainly) but not so quick or good with the basic stuff of stopping the bleeding. They were often dependent on an IV line over good basic care for the wounded (holding pressure to a wound). Even in medical situations I saw them quick to start a line put on a monitor but looking to others to read the ekg strips. I deployed with a national guard unit and I remember one of my combat medics who was regular army starting a line and putting a patient that arrived with a chest pain on the monitor but had to search and find me to read the ekg and instruct what he needed to do next. As I said in the beginning I feel the combat medics are good in trauma but poor in medical issues. I feel that the army is not doing soldiers any justice putting out half trained medics and even calling them medics. I feel they need to revamp the program even more than they have already.

[chbare]

Oh brother... :roll:

First, there are many different levels of medical education in the Army. You have entry level providers, to LPN's, to special operations medics, to 18D's. I would be very careful when shooting out sweeping generalizations regarding all "medics."

Next, do you honestly think a line medic needs to worry about dealing with chest pain following an IED explosion with multiple causalities and an unsecured scene? Many people are coming back home alive due to improved point of wounding trauma care. ( Aggressive hemorrhage control and timely evacuation.) It only makes sense to focus on what saves lives in theater.

In addition, we need to consider the demographics of these line units. Younger and generally more fit than the average Joe US citizen. So, in depth medical issues are not as emphasized. Also, seriously ill or injured people will be evaced to a MTF if the front line provider cannot care for the problem in most cases.

You need to appreciate that there is a delta between the "field" we work in and the "field" that military medics work in. Remember, at the MTF, there will be nurses, docs, and support people that can deal with medical problems.

Finally, I know several medics that are actually quite good with medical subjects. Their ambulatory medicine knowledge is actually top notch.

Please correct my erroneous thinking if I am in fact way off base here.

Take care,

chbare.

[Dustdevil]

I agree that this is a totally out of context discussion. I mean, I notice that most dermatologists suck at obstetrics too. Most wildfire fighters don't know anything about structural tactics either. Duh!

Turning it around, most civilian medics don't know dick about medical emergencies either, beyond EKGs (if they're lucky) and when to administer D50. I recently saw a ten year paramedic treat Shingles as an AMI. How many EMT-Ps do you know that even know where to start when trying to determine the cause of nausea, vomitting, diarrhoea, or abdominal pain? All they know is IV, O2, and transport. Does that mean they are inadequate for their job? Well, okay... you probably could make that argument. But the point is, that is not what their system deploys them for. Similarly, we don't deploy Whiskeys for practising cardiology on mostly healthy males under 30 years old. That's what battalion surgeons, nurses, and the occasional competent PA are for.

Turning 18 year old field medics into jacks of all trades is no more realistic than turning cardiologists into field medics. It's a preposterous propositon. They would so very rarely use their EKG skills that they would dangerously deteriorate. There just isn't enough call for that in a combat unit.

As for calling them "medics," they were using that name for about fifty years longer than we were in the civilian world. In fact, civilian medics stole that name from them strictly out of laziness, because it is just too much of an inconvenience to say the full word, "paramedic". I have yet to see an NR or state paramedic card that actualy says "medic" on it, so it's a little disingenuous for us to presume to lay claim to that term.

Incidentally, this "problem" you describe is more evident in the Army than elsewhere. I am impressed with the quality of the Navy Corpsmen I work with daily, as well as the Air Force medical specialists. They get a lot more of a clinical focus in their school. But then, you'd probably say they suck because they aren't trauma gods like Army medics.

[Richard B the EMT]

Dust, would you agree with my assessment that what the civilian Paramedic does nowadays, is originally based on procedures developed by in-the-battlefield Army Medics and Navy Corpsmen, from at least the First World War, to today?

If I asked this of you before, I apologize for repeating myself.

[Eydawn]

I love it! "Wildland firefighters suck at structural tactics and most dermatologists suck at obstetrics... DUH..."

Dust, you always make me laugh!

Wendy

CO EMT-B

[FormerEMSLT297]

I served as a Corpsman in the USN. During my 8 years, I only had 2 medical emergencies.

1. Anaphylactic reaction from a bee sting, and

2. a reservist that collapsed from an undiagnosed medical problem.

Everything else was either trauma, or influenza, sick call type stuff.

Who are the patients that military medics will see most, 18-25 with blast, burn and GSW, not the 50 y/o MI or 70 y/o CHF patient. So, I don't see the need to reinvent the wheel with regard to military medics. Now, that being said, if the medics are working on a base ambulance, or in a civilian clinic, than maybe they should be given additional training in medical cases. I was fortunate enough to be able to obtain my EMT-I was in the Navy, and that certainly helped, but I think a military at war, needs to focus on blast, and burn and GSW injuries, not worry about reading an EKG.

[Dustdevil]

Dust, would you agree with my assessment that what the civilian Paramedic does nowadays, is originally based on procedures developed by in-the-battlefield Army Medics and Navy Corpsmen, from at least the First World War, to today?

If I asked this of you before, I apologize for repeating myself.

Sure. That's where the original EMT and Paramedic programmes came from. I believe it was Detroit (though I may be wrong. I know Rid mentioned this recently.) that first decided to take some unemployable minority types, train them in first aid and IVs, like early military field medics, and call them "paramedics" just as an experiment. That's where it all started. At that time, a lot of medics were coming home from Vietnam with no hopes for a civilian job, and it was hoped that this would keep them off the unemployment rolls, and fill a need here at home. Then some fire chief facing a budget crunch in Kalifornia decided, "Hey, why give that money to unemployable, homeless, minority Vietnam veterans when we could have it!?" And right then and there, the first "special interest group" in EMS was born. Fast forward thirty-five years, and here we are, with that same special interest group refusing to let the profession grow because then they'd have to give up their piece of the pig that has allowed them to fatten up their budgets, salaries, and pensions at our expense.

But yes, it initially grew out of a perceived need for advanced trauma care in the streets. All this other stuff, like cardiac care, was a later outgrowth of that original concept. Back in the day, people hardly called for anything except accidents and injuries. Chest pains and SOBs almost always went by POV, unless they were bedridden to begin with.

[AnthonyM83]

I think there were two different concepts started at different times. From WWI came the makeshift ambulances staffed by civilian volunteers. From WWII came servicemen with specific training to transport casualties to the doctors/nurses. From the Korean War came the specific serviceman designation of field medic who was actually doing things on-scene. At some point during this, mortuaries were using their hearses as transport vehicles to hospitals with a few dedicated ambulances.

Then, there was the separate concept that started in Belfast, Ireland where nurses/doctors responded to coronary events to defibrillate (no transport). Idea spread to Tampa???, Florida, then to a few other places, then was picked up by Los Angeles County FD with Harbor General Hospital that sent nurses (Mobile Intensive Care Nurses) out with trained paramedics (still just for cardiac events) and eventually no MICN's in the field, only by base contact. That was popularized by the show Emergency! and spread from there.

Eventually, their scope (at least in LA) grew as the Firefighter Medics reported the different situations they were actually encountering in the field. Los Angeles (City) FD then started transporting in vans (which led to conflict with ambulances already in service...I think they were just staffed with "ambulance attendants"?).

Not sure when the names came into play. I assume with the Wedworth-Townsend Act creating the official EMS program?

That's the best I've been able to piece together, anyway.

[NREMT-Basic]

Im guilty of this myself from time to time, but: MEDIC does not equal PARAMEDIC. Two different beings altogether. Medic is a military/paramilitary "slang" for one type of emergency health care prover or another. Paramedic is the guy (or girl) with all the neat initials after their name and all the bling on their uniforms, who generally complete their interventions in the box of a nice clean ambulance. A medic is not only pre-hospital but is also somewhat of an expert in austere medicine. Many agencies or EMS regions dont teach or barely touch on things like suturing, etc. To me, a medic is someone operating in the field whether a CLS or 68W or what have you. A paramedic is part of an ambulance crews. USCG rescue swimmers are considered medics, but the training they really have is advanced Basic with the addition of some invasive airways, some pain killers. Im not saying its right and that it may not be misleading, but I have seen some DMAT teams call their providers, whether ALS or BLS Medics. I have also seen SWAT teams with a EMT-Basic who has uptrained to being able to start a line and the back of his uniform says Medic.

[AnthonyM83]

The part about various civilian positions calling themselves medics actually fits in with the military definition. It's my understanding that MEDIC is a general (originally military) term for the person rendering emergency medical assistance in the field. PARAMEDIC is the healthcare professional who fits into a specific definition put for by D.O.T.

So, when someone calls "meeeediiiiiiic", they're basically using the term correctly and calling for whoever/whatever the emergency medical assistance at the scene is (basic/intermediate/paramedic/68W/DMATGuy/SWATFirstAidGuy/etc).