Page 87 - Journal of Special Operations Medicine - Summer 2015

or data. The military has a unique mission that is not of Combat medics bolsters training while building man-
comparable to any civilian facility in the United States power resources within our healthcare system.
and thus applying civilian standards is inappropriate.
Additionally, the majority of military medics have some
Medics obtain a wide variety of training during mili- form of civilian certification (EMT-B, EMT-P, FP-C,
tary indoctrination, but little of this is used in the gar- CCP-C, and so forth) in addition to the military train-
rison setting. The military expects medics to perform ing. While this may provide a framework for their func-
all these duties competently in the deployed setting. tions and duties, the civilian constraints do not apply to
This incongruence in the use of Combat medics in the the military combat environment, which is where our
deployed setting versus the contiguous US MTF setting medics have proven most valuable. Despite EMT-B limi-
is potentially detrimental to combat casualty care. tations, the scopes of battlefield functions are broader
when functioning under TCCC guidelines. This must be
The importance of various procedural skills has been considered when addressing their scope of practice at
clearly demonstrated throughout the course of the the garrison military hospitals.
Iraq and Afghanistan campaigns. Medics are often ex-
pected to perform their duties in remote areas without
any direct supervision available. The conditions under Limitations
which they must perform these duties require the ut- This study has several limitations that must be considered.
most competency. Common procedures such as wound First, this data set was only obtained at one MTF. This
care management, medication administration, splinting, MTF consists mostly of junior Soldiers and their families,
vital sign measurements, suturing, and vascular access who may have different perceptions than those at facili-
are recurring procedures that can be delegated to the ties that have more senior ranking Soldiers and a higher
medic with provider training and supervision to enhance retiree population. Second, the study was voluntary, so
related battlefield skills. Less-common procedures, such self-selection may have occurred on the part of those
as placement of airway devices, have direct benefit to surveyed. Last, patients or accompanying adults com-
saving lives on the battlefield and may be useful for the pleted the surveys during their time in the ED. Despite
medics to perform in the garrison military hospitals. assuring respondents that the survey would not affect
5
This data set demonstrates that patients support using their care, the presence of uniformed personnel may
medics for job-specific tasks. have inadvertently affected responses.

There is a growing body of medical professionals push-
ing the aviation safety model into medicine. 7–11 Pilots Conclusions
in training undergo simulation training followed by a Patients support Combat medic use during clinical care.
substantial number hours of actual flight under the di- Patients agree that Combat medic use should be a core
rect supervision of a more experienced pilot. The time mission for MTFs. Further research is needed to opti-
to train a fighter pilot takes even longer. Comparatively, mize Combat medic integration into patient healthcare.
all 50 states require that a physician have at least an
internship prior to practice and it is increasingly uncom-
mon for a physician to practice without a residency. The Disclosure
reason for this training under both direct and indirect We have no conflicts to report.
supervision is the growing complexity of modern medi-
cine. If this level of supervised and controlled training
is required of aviation and medical professionals, then References
similar actions should be afforded to the Combat med- 1. Gerhardt RT, Hermstad EL, Oakes M, et al. An experimental
ics who will be expected to perform lifesaving tasks on predeployment training program improves self-reported pa-
the battlefield. Much of the training for medical prac- tient treatment confidence and preparedness of Army combat
tice is based on repetition of cognitive and procedural medics. Prehosp Emerg Care. 2008;12:359–365.
actions. 2. Schmitz CC, Chipman JG, Yoshida K, et al. Reliability and va-
lidity of a test designed to assess combat medics’ readiness to
perform life-saving procedures. Mil Med. 2014;179:42–48.
As healthcare costs continue to grow, we must seek 3. Sohn VY, Miller JP, Koeller CA, et al. From the combat medic
innovative measures to provide high-quality health- to the forward surgical team: the Madigan model for improv-
care and find targeted methods for cost savings so that ing trauma readiness of brigade combat teams fighting the
money may be allocated to prioritized activities. Under- Global War on Terror. J Surg Res. 2007;138:25–31.
standing the importance of maintaining a deployment- 4. Mabry RL, Apodaca A, Penrod J, et al. Impact of critical care-
trained flight paramedics on casualty survival during helicopter
ready Combat medic force requires actively engaging in evacuation in the current war in Afghanistan. J Trauma Acute
clinical care on a regular and recurring basis. The use Care Surg. 2012;73(2 Suppl 1):S32–37.

Combat Medics in Emergency Departments 77