military medics versus paramedics
Posted 20 December 2007 - 12:12 AM
Posted 20 December 2007 - 01:06 AM
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.
Posted 20 December 2007 - 03:39 AM
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.
Posted 20 December 2007 - 10:37 PM
If I asked this of you before, I apologize for repeating myself.
Posted 20 December 2007 - 10:42 PM
Dust, you always make me laugh!
Posted 20 December 2007 - 10:45 PM
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.
Posted 21 December 2007 - 01:44 AM
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.
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.
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.
Posted 21 December 2007 - 05:01 AM
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.
Posted 21 December 2007 - 05:41 AM
Posted 21 December 2007 - 05:51 AM
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).
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