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military medics versus paramedics

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Posted · Report post

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.

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Posted · Report post

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.

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Posted · Report post

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. :lol: 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.

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Posted · Report post

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.

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Posted · Report post

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

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Posted · Report post

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.

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Posted · Report post

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.

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Posted · Report post

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.

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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.

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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).

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Thank you, DustDevil and AnthonyM83, for your responses to my question.

Dust, my mom, reading over my shoulder, considers you to be political. Really?

Anthony, I am unsure of this information, but I think the Dublin type response you described was also done, either in the late 1960s or early 1970s, just before I started in the field, with a unit out of St. Vincent's Hospital, Manhattan, NY, but they also transported.

Mom was still reading over my shoulder and commented, on reading about Harbor General, but not reading to the end, and commented that it sounded like "Ramparts General", the On Line Medical Control for LACoFD's "Squad 51".

Also, early on, wasn't that about the time Seattle, Washington's Medic One program got started?

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Dust, my mom, reading over my shoulder, considers you to be political. Really?

LOL! Well, I do consider myself politically astute, in that I recognise the political component in all social and professional interaction. I suppose it was my recognistion of the "special interest group" role of the fire service in EMS. It's a valid label. And similarly valid political analogies can be found in all aspects of human interaction. In fact, it is equally applicable to the animal world too. Politics is the way of the world. The more you understand them, and the better you are at identifying them, the more successful you will be in living with them.

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Dublin type response you described was also done, either in the late 1960s or early 1970s, just before I started in the field, with a unit out of St. Vincent's Hospital, Manhattan, NY, but they also transported.

Mom was still reading over my shoulder and commented, on reading about Harbor General, but not reading to the end, and commented that it sounded like "Ramparts General", the On Line Medical Control for LACoFD's "Squad 51".

Also, early on, wasn't that about the time Seattle, Washington's Medic One program got started?

Yeah, when LA's system started there were already a few others in existence, but I don't know how similar/different they were. I've never watched an episode of Emergency! but from what I've heard "Ramparts General" was meant to be Harbor General Hospital (including the screen shots they used). We transport there often. Apparently, you could sometimes heart radio transmissions in the background to St. Francis Hospital....that was actually a second MICN station they used.

I don't know any of Seattle's history, though...

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Yeah, when LA's system started there were already a few others in existence, but I don't know how similar/different they were. I've never watched an episode of Emergency! but...

There is no reason (other than the poverty that is rampant in EMS) for any EMT or Paramedic in practice today to have not seen at least the pilot episode of EMERGENCY! This should take up the entire period of your first day in paramedic school. It is a great primer on the history of the LA programme, and the paramedic system in the US in general. I seriously encourage all of you to go out and buy Season 1 on DVD. It's twenty bucks well spent, and you'll come away knowing more about our history than most of your colleagues. You know what they say about history; you can't know where you are going until you know where you came from.

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Dust:

I like what you're saying, but I don't think you're taking it far enough. Ever since becoming a medic I have always said that you should be able to watch all of Emergency and all of MASH and that qualifies you as a medic.

Everything you need to know is on those two shows :D

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You can all feel free to mail me said series :)

I have watched MASH a few times when I was home sick in HS

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I used to be in the Army and I know a bit about combat medicine. One of my personal interests is the history of civillian EMS which has its beginnings with the French during the Napoleonic War if I remember correctly.

The Royal New Zealand Army Medical Corps (RNZAMC) teaches our medics along the same track as our civillian Paramedics, emphasising a clinical knowledgebase and competency in emergency and trauma care. I think it's necessary to know both sides of the equation - i.e. general medicine (treating a sore tummy or foot full of blisters from too much PT) and also traumatic combat injuries.

Note I said combat medicine because that is different than military medicine. I differentiate the two because on base in the military you don't get a lot of people with major trauma, gunshot wounds, ordaniance embedded in various bodily cavities etc. You can go along to the doctor and he'll take an exam, maybe take some bloods and give an Rx (and if you're lucky a day or two off PT). Out on the line there are people who have had limbs blown off, thier chest ripped open and insides shredded, who are bleeding profusely etc etc.

In that situation it's (arguably) not necessary to know how to treat a medical problem such as a sore tummy because this guy who has lost 1/2 of his blood volume probably and is seriously hypovalemic probably doesn't care. All he wants is some blood, those funny looking blow up MAST pants which seem to be used less and less these days, and a spot on the chopper to a MASH.

Now in saying that not every waking second of combat is er, combat. So if you've got said sore tummy in your foxhole at 2am then yes, I would want my co medic to be able to tell if I had a bleeding ulcer, appenditicis or a perforated colon due to the mystery meat we ate at chow.

There is a place for both but figuring out why my tummy is sore and how to treat me when I am shot up and bleeding.

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Posted · Report post

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Order today and watch them all in the next month.

Season Four will be released on DVD at the end of January! :headbang:

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Posted · Report post

Seaon FOUR! Just now?

Must've needed a lot of editing...

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Seaon FOUR! Just now?

Must've needed a lot of editing...

It's been out on VHS for quite awhile though.

But, with over half of the cast, producers, and creator dead now, it's gotta be a pretty big job to put together any "extras" for a DVD. There aren't any with Season 1. I haven't watched Seasons 2 or 3 on DVD yet.

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I beg to differ on something here. One cannot base any training on watching a TV drama or dark comedy, although one can perhaps use it as a training supplement. Also, as both Emergency! and M.A.S.H. were, respectively, set in then contemporary 1970s LA, and an early 1950s South Korea war zone, surely, some things must have changed in the way they were done, to the way they are now done.

And don't call me Shirley.

Even the training films have changed. In 1974, the emergency childbirth training film used in my training showed an early First Responder Engine Company pull up at a house, and the Captain with one fire fighter, assisted in the delivery of a baby in what appeared to be a 1950s bomb shelter! They never showed the mother and child being moved to a hospital.

In 2007, in my refresher class, the newest film shows an actual ambulance respond, and deliver the baby in a comfortable appearing bedroom.

In an "Act 2" of the newer film, they even showed the ambulance crew stopping on the way to the hospital for an "in transit" delivery.

Again, things change. What would you think of someone using the original model of stethoscope? You know, the rolled paper tube? At least it was an improvement on the original way of listening, putting one's ear directly on the chest. (Then, again, if Dolly Parton was the patient...)

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Posted · Report post

Emergency! and M.A.S.H. were, respectively, set in then contemporary 1970s LA, and an early 1950s South Korea war zone, surely, some things must have changed in the way they were done, to the way they are now done.
Lemme check...hmmm...nope not too much...carry on.

:lol:

BTW, I'm sure you realized he wasn't saying to use it as an actual medical training film for learning skills and such, Richard...

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Yes I do realize that. Anyone else here remember how the skin flick "Deep Throat" from back in the mid to late 1960s supposedly was a "training film" for one specific type of sex act, due to some of the activity Linda Lovelace "performed" in the movie? (If you are "Curious, Yellow", it probably is somewhere on Youtube.)

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I beg to differ on something here. One cannot base any training on watching a TV drama or dark comedy, although one can perhaps use it as a training supplement. Also, as both Emergency! and M.A.S.H. were, respectively, set in then contemporary 1970s LA, and an early 1950s South Korea war zone, surely, some things must have changed in the way they were done, to the way they are now done.

And don't call me Shirley.

Even the training films have changed. In 1974, the emergency childbirth training film used in my training showed an early First Responder Engine Company pull up at a house, and the Captain with one fire fighter, assisted in the delivery of a baby in what appeared to be a 1950s bomb shelter! They never showed the mother and child being moved to a hospital.

In 2007, in my refresher class, the newest film shows an actual ambulance respond, and deliver the baby in a comfortable appearing bedroom.

In an "Act 2" of the newer film, they even showed the ambulance crew stopping on the way to the hospital for an "in transit" delivery.

Again, things change. What would you think of someone using the original model of stethoscope? You know, the rolled paper tube? At least it was an improvement on the original way of listening, putting one's ear directly on the chest. (Then, again, if Dolly Parton was the patient...)

:shock:

I'm surprised there was someone who didn't see my tongue planted firmly in my cheek!

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