Page 84 - Journal of Special Operations Medicine - Summer 2015

Emergency Department Patients Support
the Use of Combat Medics in Their Clinical Care

Steven G. Schauer, DO; Robert Mabry, MD;
Shawn M. Varney, MD; Jeffrey T. Howard, PhD

ABSTRACT
Background: As US military combat operations draw Keywords: medics, Combat; medics, Special Forces; patients,
down in Afghanistan, the military health system will emergency department; surveys
shift focus to garrison- and hospital-based care. Main-
taining combat medical skills while performing routine
healthcare in military hospitals and clinics is a critical INTRODUCTION
challenge for Combat medics. Current regulations al-
low for a wide latitude of Combat medic functions. Background
The Surgeon General considers combat casualty care
a top priority. Combat medics are expected to provide The US military has seen an unprecedented amount of
sophisticated care under the extreme circumstances combat in the Joint Theater over the past decade. The
of a hostile battlefield. Yet, in the relatively safe and large number of combat injuries has placed an emphasis
highly supervised setting of contiguous US-based mili- on the importance of the Combat medic (68W) and Spe-
tary hospitals, medics are rarely allowed to perform cial Forces medic (18D) in care required to administer
the procedures or administer medications they are ex- lifesaving treatments at the point of injury (POI). For
pected to use in combat. This study sought to deter- the purpose of this paper, Combat medic refers to both
mine patients’ opinions on the use of combat medics the 68W and 18D military occupational specialties.
in their healthcare. Methods: Patients in hospital emer-
gency department (EDs) were offered anonymous sur- Recent studies have highlighted the importance of con-
veys. Examples of Combat medic skills were provided. tinual training to maintain our Combat medic force in a
Participants expressed agreement using the Likert deployment-ready status. Predeployment training has
1,2
scale (LS), with scores ranging from “strongly agree” been shown to be beneficial for Combat medic readi-
(LS score, 1) to “strongly disagree” (LS score, 5). The ness. However, a limited amount of training can occur
3
study took place in the ED at Bayne-Jones Army Com- using simulations and live-tissue models. Thus, clinical
munity Hospital, Fort Polk, Louisiana. Surveys were experience must be a priority in the garrison setting. Ide-
offered to adult patients when they checked into the ally, training would occur as an ongoing process rather
ED or to adults with other patients. Results: A total of than a short predeployment course. Ongoing critical
280 surveys were completed and available for analysis. care experience has been linked to improved patient
Subjects agreed that Combat medic skills are impor- outcomes. Data suggest that there is poor adherence
4
tant for deployment (LS score, 1.4). Subjects agreed to Tactical Combat Casualty Care (TCCC) medication
that Combat medics should be allowed to perform guidelines at the POI. It appears unreasonable to expect
5
procedures (LS score, 1.6) and administer medications that medics will perform a procedure or administer a
(LS score, 1.6). Subjects would allow Combat medics medication under hostile conditions that they have not
to perform procedures (LS score, 1.7) and administer been trained to do in a controlled setting.
medications (LS score, 1.7) to them or their families.
Subjects agreed that Combat medic activities should be Importance
a core mission for military treatment facilities (MTFs)
(LS score, 1.6). Conclusion: Patients support the use of US Army Medical Command (MEDCOM) regulation
Combat medics during clinical care. Patients agree that 40-50 and Army regulation 40-68 outline the use of
Combat medic use should be a core mission for MTFs. Combat medics in the clinical setting. The regulations
Further research is needed to optimize Combat medic allow significant latitude in provider discretion on tasks
integration into patient healthcare. that can be delegated to the medics. However, there

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