Page 86 - Journal of Special Operations Medicine - Spring 2016

previously known as EMT-Intermediate). However, the MTFs. Priority should be given for implemen-
10
in contrast to their 11- and 18-MOS counterparts, this tation of high-quality courses designed to train and
quite often marks the pinnacle of their medical creden- certify lifesaving skills for Medics.
tials. The recent exception to this is the critical care flight 2. Change policy to reflect promotional credit for Med-
Paramedic and civil affairs Paramedic, who do attain a ics who achieve and verify advanced medical training,
higher level of medical training. This still occurs as part such as AEMT, Paramedic, or Critical Care Flight
of their initial MOS training and they suffer from a simi- Medic.
lar challenge of advanced skills sustainment. Nowhere 3. Establishment of clinical awards and a recognition
in the pathway are these Soldiers required or routinely system within units and MTFs that are designed to
allocated time to advance their medical training to move highlight the clinical accomplishments of enlisted
up in rank. Quite often the converse occurs. Prior to Medics.
11
reaching the NCO ranks, they are placed in jobs rang-
ing from quasi-medical positions that demand virtually If fully implemented, these and similar strategies can
no maintenance of skills all the way to long stretches achieve a strong swing within the clubs already in the
of guard or mail-room duty. Quite often, outside of bag, and, importantly, position the Medic to fully ex-
the Special Operations Forces (SOF) community, upon ploit the material advancements in the pipeline.
reaching the NCO ranks, they are placed into leadership
positions, pulling them away from direct patient care Acknowledgment
and into administrative positions that involve virtually
no use of medical skills. This almost certainly guaran- Special thanks to LTC Robert Mabry for his guidance
tees skill degradation because medical procedural skills, on this editorial and extensive research on this topic.
like any complex psychomotor skill, require repetition.

Disclosures
Unlike many military skills, application of medical skills
requires an even greater degree of cognitive performance The authors have nothing to disclose.
that stresses the more difficult “why,” even more than
the mechanics of the “how,” making degradation occur Disclaimers
at an even greater pace. In essence, the 68W is denied a
clinical ladder within the MOS that both recognizes and The opinions or assertions contained herein are the pri-
rewards advancement in lifesaving skills and proficiency vate views of the authors and are not to be construed as
in battlefield medicine. official or as reflecting the views of the Department of
the Air Force, the Department of the Army, or the De-
As the operational tempo trends downward, the mainte- partment of Defense.
nance of skills will become even more challenging. De-
spite repetitive senior leadership directives for military References
treatment facilities (MTFs) to use Medics within their
skill set, this guidance has not been embraced by the 1. Mabry RL. JFQ 76. Challenges to improving combat casualty
MTFs. This and the progressive drawdown in Medic survivability on the battlefield. Washington, DC: National De-
6
fense University Press; 2014.
scope of practice occur to the detriment of Medic skills 2. US Army Medical Department. Congressional special inter-
and battlefield medical care. est programs. http://mrmc.amedd.army.mil/index.cfm?pageid=
medical_r_and_d.crp.overview. Accessed 5 Nov 2015.
Equally important to MTFs embracing the need to take 3. De Lorenzo RA. Military and civilian emergency aeromedical
on the challenge of maintaining Medic skills is strong services: common goals and different approaches. Aviat Space
Environ Med. 1997;68:56–60.
consideration for revamping the 68W career progres- 4. De Lorenzo RA. Improving combat casualty care and field
sion pathway (clinical ladder). This change would need medicine: focus on the military medic. Mil Med. 1997;162:
to refocus the requirements to progression in medical 268–272.
skills, giving the senior Medics the advanced skills to 5. De Lorenzo RA. How shall we train? Mil Med. 2005;170:
train their subordinates, not the other way around. 824–830.
These issues touch closely on one of the SOF truths: hu- 6. Mabry RL, DeLorenzo R. Challenges to improving combat ca-
sualty survival on the battlefield. Mil Med. 2014;179:477–482.
mans are more important than hardware. 7. Schauer SG, Robinson JB, Mabry RL, et al. Battlefield analge-
sia: TCCC guidelines are not being followed. J Spec Oper Med.
We propose three strategies: 2015;15:85–89.
8. Eastridge BJ, Mabry RL, Seguin P, et al. Death on the battlefield
1. A follow-through on the warrior culture within (2001-2011): implications for the future of combat casualty
care. J Trauma Acute Care Surg. 2012;73(6 suppl 5):S431–437.
Medical Command that embraces advanced training 9. Mabry RL, Apodaca A, Penrod J, et al. Impact of critical care-
for Combat Medics in all units and especially within trained flight Paramedics on casualty survival during helicopter

70 Journal of Special Operations Medicine Volume 16, Edition 1/Spring 2016