Army Dustoff Medics Unprepared
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“After more than 9 years of conflict and more than 40 AAR’s recommending the evolution of MEDEVAC to current civilian standards, no institutional change has been made. Continuing the legacy model has resulted and continues to result in documented sub-optimal outcomes and increased deaths among patients transported by helicopter in the current conflict.”
Robert L. Mabry, FS, EMT-P
Lieutenant Colonel, MC
JTTS Medical Director, Enroute Care
23 February 2012
The United States Army has failed with extraordinary dexterity while executing the helicopter MEDEVAC plan in Afghanistan. On the surface, the Army advertisement campaign sells a story that their performance is exemplary and unprecedented in the history of war. The press machine churns out sound bites, which are picked up in major media without the barest pretense of auditing. For instance, senior Army officers saying and committing to writing that the Army has achieved a 92% success rate on MEDEVAC. The Army peddles this message, and yet nobody says, “Show me the money. Where do you get these figures?” There is growing evidence that the 92% figure is hollow and fraudulent.
For instance, in an internal memorandum, the issue of poor or nonexistent tracking is repeatedly hammered:
“Further, no systems exist that capture adverse outcomes, protocol violations or sub-standard care outside of the individual MEDEVAC unit or GSAB. Lack of patient care documentation in the medical record and trauma databases is the greatest hindrance to developing data needed to drive improvements in MEDEVAC care.”
Just how the Army derives a “92% success rate” (whatever that is) with data that it fails to track is unknown.
Another Army talking point is that the Dustoff MEDEVAC community is “purpose built” for MEDEVAC, and are the crème de la crème providers in Afghanistan. Yet this same memorandum states in clear terms that of the three principal MEDEVAC/CASEVAC providers in Afghanistan (Dustoff, Air Force Pedro, British MERT), the Army comes in last place with substandard, archaic procedures and woefully undertrained flight medics.
Excerpted highlights:
**US Army flight medics, credentialed at the National Registry of Emergency Medical Technician-Basic (EMT-B) level, are not trained to perform critical care transport or aggressive advanced resuscitation at the point of injury like their civilian flight paramedic counterparts operating in CONUS [Continental United States].
**Current MEDEVAC staffing model is outdated and based on Cold War / Vietnam [era] doctrine.
**The current capability gap has been documented in more than 40 AAR’s [After Action Reports] since 2002 in both Iraq and Afghanistan. Lack of advanced flight medic capability has directly resulted in poor outcomes in multiple cases and was the impetus for the deployment of critical care nurses to fill this capability gap as well as the deployment of a physician medical director. A recent study that compared critical care trained flight paramedics from a US Army National Guard air ambulance unit versus the conventional MEDEVAC systems operating in OEF [Afghan War] showed a 66% reduction in death at 48 hours post-injury in severely injured patients. Several recent cases illustrate the complexity and acuity of patients currently being managed by a single EMT-B flight medic. [Dustoff flies with a single medic. Air Force Pedro flies with a minimum of two medics per bird (often three) who are on average more highly trained.]
** Discussion: Significant variability in unit capability performing MEDVAC exits in the AO [Area of Operations]. The operational units have attempted to fill the capability gaps of our current MEDEVAC model with ad hoc methods that are not standardized and often have significant operational limitations. This creates a situation where different units/personnel have to be used for different missions. Further, no US Army standard treatment protocols exist, as these are significantly variable across different units. This variable capability degrades the MEDEVAC commander’s flexibility to respond appropriately across the full spectrum of missions.
**National Guard flight medics are often credentialed paramedics with extensive training/experience in critical care transport able to operate across the entire mission profile.
**Regular Army flight medics with EMT-Basic credentials and are not trained to transport post-op or intubated patients, nor are they able to perform advanced airway or resuscitative interventions from the point of injury.
**Medics in RC-S [Regional Command South; based in Kandahar] (101st ABN Div) attended an abridged paramedic program before this most recent deployment. Only 15% of the medics passed this accelerated program and while the remainder are “paramedic trained” they not credentialed as EMT-P’s. They have an expanded Advanced Life Support scope that #2 lacks, but still are not trained in advanced airway management / critical care transport skills.
**Air Force PJ’s (PEDRO) are credentialed paramedics that operate in pairs but lack critical care transport skills and cannot transport ventilator patients. They are allowed to perform Rapid Sequence Intubation and administer blood products but these skills are rarely used or sustained.
**Enroute Critical Care Nurses are able to transport intubated patients from Role II but are not allowed to go to a Battalion Aid-Station or a Shock Trauma Platoon to pick up an intubated patient as these are considered Point of Injury.
**British MERT (Medical Emergency Response Team) is able to bring a full resuscitation team to the Point of Injury and provide aggressive treatment to severely wounded casualties but their response time is sometimes longer than Army MEDEVAC or PEDRO.
**Unit flight surgeons lack the clinical skills, experience and credentials to supervise and train flight medics.
**Discussion: Every GSAB flight surgeon currently deployed to Afghanistan is a PGY1 general medical officer with no additional training in out-of-hospital care, trauma management, medic training, in-flight critical care, or medical oversight of a helicopter EMS system. In most cases, the experienced flight medics have more knowledge of enroute care than the physician supervising them.
**Further, no systems exist that capture adverse outcomes, protocol violations or sub-standard care outside of the individual MEDEVAC unit or GSAB. Lack of patient care documentation in the medical record and trauma databases is the greatest hindrance to developing data needed to drive improvements in MEDEVAC care.
**Conclusions: After more than 9 years of conflict and more than 40 AAR’s recommending the evolution of MEDEVAC to current civilian standards, no institutional change has been made. Continuing the legacy model has resulted and continues to result in documented sub-optimal outcomes and increased deaths among patients transported by helicopter in the current conflict.
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Comments
It's time for a change. The Red Cross MUST be removed. As should all those in the brass who have so far refused to do it.
Show me the money: You either have it, or you don't. Without the study in hand, it's a hollow claim.
Our calls are not just to remove Red Crosses; that's only the most obvious and common sense step. Anyone who defends keeping on the Red Cross will be dismissed as a crackpot or a stooge/mouthpiece. Arming the helicopters is a separate matter. Removing the red cross is just common horse sense.
MEDEVAC is a very complex issue and with many dirty corners.
What is your stance on removing the red cross?
As to removing the red crosses I am not opposed to doing so - they are only visible at a closer range than is normally used for targeting (bull's eye is a term everyone loves to use that belies their real visibility from the ground anyway).
Arming them, IMHO, will NOT shorten response time nor add much in the way of measurable improvements. BUT, I do not have "facts" to back that up - only an opinion.
Where will the extra crew members to man the guns come from? Force Structure is a "zero sum gain" - there MUST be a "bill payer" from some other type of unit if DUSTOFF is to "gain" a third crewmember to man the weapons. That's a "Cold Hard Fact" of life when you start to design new unit manning.
AND, when the medic lands, he/she MUST attend to the patient - manning the weapon becomes untenable (unless you have that third crewmember - see above)
Don't make me laugh! I'm in the plans office at my unit, a unit whose entire mission is to train Soldiers, and you would not believe (or maybe you would APPROVE) the loads of Army Mandatory Training tasks we have to stuff into the schedules or require the Soldiers to complete between their regular work and lunch. Warfighting? How about the annual "always keep your work area impeccably secure and never let anyone cyber-bully you or the guy at the next desk might be targeted by a Finnish Phishing Scam that is the DoD's Absolute Number One Priority just now" training, or the training to be alert to possible "insider threats" like rednecks or dissatisfied housewives with gambling issues, (which meanwhile reassures us that Islam has to be twisted Jonesville-wise to pose any plausible threat in CONUS), until it's all we can do to make sure we know what WE are training on before we see our trainee units, a couple of weeks a year, ever....
EVERY dollar? When male Army PT instructors are now having to wear mommy-boobs and preg-Nancy tummies for part of their freakin' "Sensitivity Training"? What lives are saved there?
Well, back in the Civil War, when they were hacking limbs off in a tent with a stick to bite on, the Surgeon General was no-doubt saying "Army medicine is the finest it's ever been, we have a 60% survivability rate, the highest in wartime ever!"
Everyone needs to start sending emails and making calls to their Congressional reps. Michael has done the hard work of getting the information and documenting it concisely.
Acutally, the reality having worked in the Army Medical Department, Patient Evacuation Coordination Centers, and with MEDEVAC units, the 8% are almost always non-survivable wounds (GSW to head, major thorasic invasive blast injuries, high percentage burn injuries, etc...) These are injuries that are not survivable even if they happened on the doorstep of a major surgical ward. Get your facts correct before rendering an opinion.
A panel of AMEDD trauma experts in consultation with an Office of Armed Forces Medical Examiners forensic pathologist reviewed 558 Died of Wounds cases from the period October 2001 through June 2009. Their conclusion? 51.4% of DOW wounds were classified as PS (potentially survivable).
As you know, DOW is a classification assigned to wounded troops who survive long enough to be delivered to a Role 2 or higher medical treatment facility.
If you die of your wounds on the battlefield, or while waiting for or being evacuated you are classified as KIA. Had SPC Chazray Clark died just a few minutes earlier, instead of being a DOW he would have been considered KIA. Depending on which survival rate number you are using (the DoD/DMDC has several)the reclassificatio n as KIA would yield an improved DOW number.
There is a documented huge gap in tracking what happens in the post wounding, prehospital phase of a soldier's experience. NATO and some in the AMEDD have highlighted this as a deficiency blocking the essential analysis of policies, practices and procedures affecting MEDEVAC missions.
Dang -- you are throwing out straw men which I and others have knocked down months ago. Many of your straw men get knocked flat by reading this dispatch, and if not this one, others such as "Fool's Gold and Troops' Blood": http://www.michaelyon-online.com/pedros.htm
Just say the simple thing: If nothing else, the Army is mistaken to leave on the Red Crosses. If they make no other changes whatsoever (which would be a crime), they should at least remove the Red Crosses. No commander will garner respect by defending the Red Crosses. He will lose credibility the moment he defends the practice. Doesn't matter who he is. He will lose moral credibility, at minimum.
They have a news article entitled " Devil Ray dustoff teach patient extraction procedures" if you look at the red cross on the helicopter shown in the picture it sure looks to me like theres three bullet holes inside the red paint of the cross on the nose of heli. What a perfect target for the enemy to aim at.
Too bad that it has been ignored.
Pararescue EMT-Paramedic Training, Kirtland Air Force Base, New Mexico - 22 weeks
This course teaches how to manage trauma patients prior to evacuation and provide emergency medical treatment. Phase I is 4 weeks of emergency medical technician basic (EMT-B) training. Phase II lasts 20 weeks and provides instruction in minor field surgery, pharmacology, combat trauma management, advanced airway management and military evacuation procedures. The airmen are then sent to Tucson, Arizona for hands-on medical training. Trainees work along side paramedics with the Tucson Fire Department as well as local hospitals. Graduates of the course are awarded National Registry of Emergency Medical Technicians-Paramedic (NREMT-P) certification.
Army Flight Medic training is a 4 week course for existing Army medics. It is similar to portions of the AF course.
All Army medical skill competencies are at the EMT-Intermediate / Paramedic level. All tasks encompass skill levels 1, 2, 3, and 4 soldiers. [CONTRADICTED ABOVE!]
"HN" wrote: "- Statistics absolutely prove that Reserve and NG units have better patient outcomes than our Active Duty. I completely agree. I was a part of that research and saw it first hand. The Army has now started to fly ICU/Trauma Nurses with DUSTOFF until the Flight Medic training is up to par. Even after the Army Flight Medic reaches the EMT-P standard, the Nurses will continue to fly. In the same way that the PJ team often flies with a Flight Surgeon when they fly CASEVAC on PEDRO."
So it is clear that Army flight medic training has long been deficient and the proof is twofold. The Army is changing their training this Spring) to come closer to the PJ standard and they are augmenting the Army flight crews with more highly trained nurses.
If so I would really like to get my hands on this paper/document. I've done pretty extensive searching of different medical literature databases and have been unable to find this document.
I ask for this not as a skeptic. I believe there is a significant difference in survival when comparing patients treated by EMT-B vs EMT-P. I want to use the article as support for needed changes at a faster rate on a lower level.
This paper would prove very beneficial. If you could post a link or give directions to it here that would be greatly appreciated.
He or she said that both the Guard and Reserve had higher success rates. It makes perfect sense if you know who serves in these Guard and Reserve units. They are often people who are medical professionals in civilian life and/or supply MAST support to areas in our country.
Some are dedicated individuals who go outside the Army to obtain training and certifications at higher levels than their MOS requires. Often, this is at their own expense and on their own time. Owing to their selflessness, we can expect a higher level of care from many Reservists and Guardsmen.
I arranged for our SF medics to spend time in the ERs of local hospitals. Nothing beats hands-on experience. You can't restrict yourself to only what the Army offers when you know that the job requires more.
Hopefully "HN" or someone else will contact you.
He could be an eloquent spokesman on this subject and much of the Army medical training takes place in Texas.
This is about delivering a standard of care and saving lives. If, down the road that means replacing slick Blackhawks with Pave Low helicopters, so be it. We can sacrifice some other system to be able to fulfill our solemn obligation to our troops. One thing is true. This is a case of priorities and no American should put anything above troop care both in war and after it. I do recall, that beginning in WWII, before we began bringing back all our wounded as fast as possible, we did justify going to extraordinary lengths to rescue downed pilots because it used to take time and $250,000 to train them.
Now we do it because few pilots and soldiers wish to sign up for one-way trips.
"Serge" I sincerely hope that you do not hold any responsible position in an organization which is directly involved in this subject matter. Your type of thinking is alien to American values.
Consider if you will that the standing defense forces follow the orders of the POTUS and Congress in terms of fighting our nation's wars.
If we want that GC guidelines changed, then IMHO the "buck stops" with Congress and the Commander in Chief.
To my knowledge nobody above the pay grade of the Chairman of the JCS has issued an order/directive allowing the Armed Services to NOT follow the GC.
Once that gets altered, I believe all manner of changes could be effected possibly to effect shorter response times, etc.
However, that's not happened - nor is any effort being taken to get Congressman Akin to take that on as a mission - instead, the "Monday morning quarterbacking" continues.
Yes, we need better training - no doubt - We've been fighting that war since Moses was an PFC.
The International Red Cross site on the GC has a nice commentary just in this point at paragraph 3 item 2 at http://www.icrc.org/ihl.nsf/COM/365-570005?OpenDocument
Your dismissal of the quality of training has not been around since ..... The Army has been bragging about Title 10 and the quality of their in-flight medics and it has been a lie. The individuals are great, but they have not been trained properly. Therefore,the wait for the adequate treatment of a Class A casualty is not merely the time until the chopper arrives. It is the time it takes to get him to a medical facility because the Army in-flight medic is limited by his/her training.
Monday morning quarterbacking is long overdue. Until Michael publicized this issue, no one was talking openly about this training issue and our troops have not been receiving "the best possible medical care" as so many generals have assured us. They are either ignorant or have been lying.
I agree that the system that trains the medics is inadequate. That has been an issue for some time that has been identified. Dr. Mabry is not the first to point this out. In fact, there was a very detailed article published by the AMEDD detailing this very fact and oulining how to fix the problem. Training the flight medics to the EMT-P level is not that difficult. Maintaining them at that level is far more challenging as the ongoing commitment of time, money, and resources is enormous.
I agree that there are many things to fix with the medevac system. The undertraining of the flight medics is a recognized problem that is being addressed the best way possible in the short term while the long term solutions is being worked out. Why it has taken the Army a decade to start to work out the problem is up to people that make a lot more than me.
As personnel is rotated in and out, the attributes of the individuals and the group as a whole dynamically change. But how is it possible that what was reported was an acceptable situation? How did that pass muster?
There are a number of articles that state that the ECCN situation is still bad. And some readers with current knowledge hint that TACEVAC with Afghanistan has continuing issues.
I have found AMEDD articles dating back to 1999 which clearly state that the training of combat and flight medics should be upgraded. The same basic argument was published again and again in the AMEDD Journal throughout the past decade. So, thirteen years to modify a curriculum owned by the AMEDD! Since 2005 AMEDD has had the responsibility of providing training for medics of all services at a rate of 20,000 per year. So there wre 6yr x 20,000 medics being trained at less than desired/recommended levels of skills. Why? Who up the chain of command was aware of this? Did this ever get to the JCS? Secretary Gates? Secretary Panetta? If not, why not?!
The revised AMEDD training regimen has just started but is limited to incoming new medic candidates. Why not include those existing flight medics scheduled to be deployed starting in xx months? Wouldn't that make sense??
Seriously, this is boggling. Stateside "medics" (EMT-P's) have been convinced for years that the Army dudes have the $#!^! We've been convinced that the birds were outfitted with portable vents, sinthetic volume expanders, all the cool stuff, and that the Army "medics" were closer to MD's than EMT's.
I did 16 years on private ambulances, and - from what I read above - *our* "B's" (basics) were trained better! Hell, *I* could train them up on advanced airways, IV, and vent! Oh, wait, maybe those 10 pound portable vents would be too heavy!
And some bonehead above is quoting about PECC?! Come on, Man! This is LIVES, here, not bureaucracy! 2 weeks, that's what I'd need to train 'em! And they'd DEFINITELY pass at better than 15%!
OMG, I'm seriously nauseous thinking about this.
Michael, keep on 'em. I think you got 'em by the short and curly's! Contact the staff at JEMS - Journal of Emergency Medical Services, about training levels, accelerated programs, and current practice. We got some awesome stuff from the military R&D guys the last few years, but it's now apparent it wasn't from Army MEDEVAC.
I refuse to go back over the Afghan/ISAF bureaucracy and risk aversion wgich delays our MEDEVAC responses. The other issue is the stupidity of clinging to red crosses and unarmed helicopters when we have been fighting nations and enemies which have never signed the GC and now are fighting folks who can't even read the treaty. The inability of AMEDD to pull its head out of its 4th point of contact is astounding. If you read the Treaty, the wording hasn't been relevant to our form of MEDEVAC since we started to use helicopters in the Korean War. Even in WWII, the red cross meant nothing most of the time. It certainly did not protect our medics and corpsmen.
You should be ashamed to don the uniform in the morning.
We have all these wonderful parts and pieces, yet as they are still all developed and maintained within their separate services, they don't fit together. The Army system is designed to operate only with Army parts - I see the other services work harder to fit together, but just as in the SOF Medic process, AMEDD is one big sabot in the machine.
That "stupidity" that you refer to may not protect MEDEVAC aircraft, but if you remove them, that aircraft will be used to haul mail and ammo, not casualities. Plus, add guns, ammo, and gunners, you will add time and weight to the aircraft that will reduce the amount of patients and equipment that can be carried to safety.
Plus, Ron, if you had an idea what it takes to actually change things in terms of training development you would keep your thoughts on that to yourself.
If the Army cannot expect an Aviation BDE CDR to follow orders and keep his hands off MEDEVAC assets without red crosses then the Army is more screwed-up than it now appears. Are we plagued with renegade commanders? However, you make an interesting point. Without the red crosses, an outward-bound dedicated MEDEVAC chopper could carry water and ammo on board IF and only if those supplies were at the launch site. Let's think a little outside the box.
On training issues, I guess you don't want to count working on the no defunct Army Training Board (TRADOC)and rewriting the Army Infantry School Advanced Course POI as relevant. Besides, I recommended copying the Air Force lesson plans. How hard is that? AMEDD has had 10 years to get off its fat ass! This will create some bumps in the pipeline - tough, the troops come first.
I profoundly respect the personnel and performance of the MEDEVAC Company, but you are wrong; our system is not the best. That's like saying if you get the patient to a medical facility within the Golden Hour - that is good enough. Some casualties do not have that much time. Active Component flight medics are inadequately trained. Ask yourself, why do Guard and Reserve MEDEVAC units have higher survivability rates? The answer is in the AMEDD LTC's Memorandum For Record and in the Guardsman's explanation of the training that they themselves pay for and the two Guard units which have a MAST role.
With all due respect, PEDRO is the best in the world unless you prefer the British system which delivers the hospital to the patient. And, I have no idea what the Marine's data would show, but a Navy Corpsman's training is way superior to today's Army Flight Medic. If the Army in-flight care was the best in the world, we wouldn't be putting nurses, PAs, and doctors on flights now. Pride in unit is one thing, blindness is another. In the LTC's MFR, we learn that patient outcomes aren't as good as they could be and that 92% only means that they are alive on the table when you deliver them. He suggests that if they had better en route care, the outcomes would be better. We have to take the data further. This ain't Vietnam (thank God) and we should not be so overwhelmed with casualties that we can track and record and analyze outcome at each stage. I do thank you for your dedication.
1. the reserve MEDEVAC companies were JUST stood up and mostly still un-manned...they do not even really have survival rates yet.
2. The Navy sends corpsman to the flight medic course.
3. PEDROS are so incredibly overrated it is not funny; they might be able to transport a patient if they can take off without hitting something.
4. All critical care transport standards include a doc, nurse or PA, since any sole provider would be incapable of providing "the best" care
Finally, how about we focus on the morons setting IEDs and suicide bombs, that require MEDEVACs to happen in the first place.
I really appreciate this discussion. You will not find it in the main stream media. ----- No one questions the bravery, dedication of our military pilots and crewmen. As a Vietnam Veteran and American, I am concerned about about the lives and well being of each of our soldiers.----- Michael Yon's story brought up a lot questions about crosses on the dust-offs, response time, etc. And you can see from the responses that there is a divergent of opinions. I wish forums like this existed for those of use who served in Vietnam. I always hope the right decisions are made by our commanders for our soldiers who "are in the fight."
http://ricks.foreignpolicy.com/
He told me that he is a good friend and admirer of Michael
Yon's work.
"A recent study that compared critical care trained flight paramedics from a US Army National Guard air ambulance unit versus the conventional MEDEVAC systems operating in OEF showed a 66% reduction in death at 48 hours post-injury in severely injured patients."
2. You ignored my point. A Corpsman is like a SOF medic and is trained to do stitching, etc. They are as well-trained as AF PJ's who approximate SOF medics.
3. That's very silly and detracts from the validity of anything that you say. A friend of mine is the SEAL medic of the year and he admires PJs who occasionally accompany SOF units. The highly sophisticated avionics in AF and SOF Pave Low helicopters assist the pilots in avoiding somethings.
4. The Army acknowledges your point and puts additional medical professionals on flights to augment the flight medic for critical patients. This has been covered on this blog. PEDRO flights carry 2 to 3 PJs to perform medical care. Not sure about the Marines, but the care is provided by a least one Navy Corpsman.
We focus on what we can improve in our operations.
Forgive me,Vietnam have seen what mass casualties can mean. I would think that we are over-manned at our medical facilities with plenty of downtime from emergencies. Thank God, we just do not have that many casualties compared to other wars.
Lastly, please go back on this blog to where some MEDEVAC pilots, PEDRO pilots, and medics refute the concept of how many casualties can be carried in this war. They suggest that one medic would be stretched to handle 2 patients of equal severity. I seem to recall that the PJs can squeeze two patients in. So I defer all such issues to them. I take your point about guns and medical gear and different missions orientation; but thanks to your unit and others PEDRO is highly competent in this arena and we should be happy to have them. Not many downed pilots these days.
The other thing that I do very aggressively is to point out the reasons why we cannot succeed in Afghanistan and urge that we get out ASAP. That would remove the requirement for MEDEVAC for conventional forces. What are you doing, if I might inquire?
Some that I suspect:
1. Civilian certification is only relevant to a civilian mission. A civilian mission is a secondary role for ANG PJ units, but may be a distraction for ADAF PJ units.
2. Civilian certification may be difficult, impossible, or simply a distraction for units which are deploying regularly to far off places where US civilian authorities don't exist and US civilian certified continuing education is impossible to obtain.
3. Graduating certified Paramedics is expensive. You need certified instructors and a civilian certified curriculum. You're requiring your war-tested instructors to maintain, or regain, a civilian certification which is meaningless in a warzone.
4. Operational Security. If you don't have a civilian certifying authority looking over your shoulder, you don't need to worry about the equipment you use or the techniques you teach being leaked out anywhere.
PJ's far eclipse Army flight medics, and you know it. It is merely your own fragile ego that prevents you from accepting it.
As for no OJT? Bullshit. Both PJs and SOF medics do far more than any Army flight medic. Far more. It is intellectually dishonest of you to assert otherwise--unless you are just stupid or misinformed.
As for other skill sets, yes, both PJs and SOF medics do things other than just medicine. The real question is, why are Army flight medics so pathetically trained, when they do not do half of what AF special ops and Army special ops medics do?
Seriously. Army flight medics are not distracted by the need to train on methods of infiltration or warfighting skills. So why do you suck so much?
I will tell you why. Because that absurd building on Ft. Sam Houston has festered in its attitudes towards doing business the same way since I attended 91B AIT in 1980. By contrast, the SOF community has repeatedly revised its curriculum, and the current courses bear little resemblance to the old 300F1 course, OJT, and Med Lab.
If I am speaking Greek to you, maybe you should go sit in the corner and shut up and try to learn something.
Most of all, you should agitate within your own community for better training for flight medics. Most who simply rely on what they were taught are lame. They keep casualties company on the Blackhawk, and they look "real concerned" as they deliver the casualties to the CSH.
Yeah. Good work. Real elite. You jackass.
In recognition of your points about certification, USSOCOM has decided to bring all SOF medics up to the same standard and test them on it. a
After the initial exam, there will be continuing training and retesting every 2 years. Although current op tempo will keep 18Ds experienced, civilian paramedics are assured of experience every day.
Here is the best explanation from USSOCOM: http://tinyurl.com/7atg9p2
Here is an excerpt: In accordance with U.S. Code Title 10, Section 167, USSOCOM’s principle function is to prepare SOF for operations by organizing, training and equipping the force for its unique missions. Responsive medical education and training is fundamental to fulfilling this responsibility. When the medical needs of the modern day SOF were studied, it became clear that no existing certification program provided the advanced medical education, training and certification required. The need for the development of the ATP certification subsequently arose from the recognition that the current national civilian certification process, while working well for the civilian EMS sector, was not answering the requirements of SOF medics.
I think that you underestimate your skill in starting IVs and overestimate monkey skills.
The PJs are specialty trained and specialty equipped for a high intensity mission. Their training, capabilities, and equipment greatly exceeds what is required by the Army for a MEDEVAC mission. Furthermore, their mission cannot be delegated to a more generic asset, like an ordinary Dustoff bird. They cannot down-code their CSAR mission and hand it off to someone else.
You say you're an ARNG Flight Medic. So you understand Triage. You understand prioritization of resources. Simple Triage principles suggest that you match your problems with your available resources. The CSAR bird should take the CSAR mission and leave the MEDEVAC mission to a "lesser" asset to perform. You wouldn't expect a thoracic surgeon to do a job that could be done by a medical technician, when a thoracic surgery patient is waiting.
Sorry, I don't buy this bashing on the PJs business.
Is this about the PJ prioritizing the saving of one life over the saving of another? Thats a cold mechanical decision that falls under the heading of Triage. You learned this at Fort Sam. You had this reinforced at Fort Rucker. You know this.
However, this is not the PJ's decision, it is his desire. The senior pilot in command of the two-ship PEDRO flight will decide what those 2 choppers will do.It depends upon the criticality of the wounded trooper and what the pilot is saying (if anything) on his emergency radio. The pilot in command will consult with both crews because another pilot or PJ might have more experience than he/she does. This is the military and the decisions are neither simple or easy. This is why the officers get the big bucks. {;*))
BTW, suppose the squawk comes in when they are RTB with a critical patient? That pilot in command will consult his PJs for their evaluation of their patient. When you set up a case study - don't make it easy.
I was not trying to disparage the capabilities or training of either PJ's or SOF medics -- but the missions are entirely different, and in the medevac bird you need medics whose sole purpose in life is medical care.
I have met good folks from all services, and if the airforce can do the job better than the army - then let them. but the bottom line is that the Joe on the ground deserves the best medical care he can get
as for "agitating" for change in my own community it was my company that pushed the data to the Institute for Surgical Research and forced the army's hand in challenging the status quo on flight medic training -- we pushed that line for a decade to anyone who would listen (mostly on deaf ears) until our data finally backed it up
You still do not get it.
SOF medics, whether PJs or SOMED Ranger medics, SEAL or Navy Corpsmen or SF medics, are trained far in excess of any mere flight medic.
It is true that the respective missions of SOF medics and flight medics are different, but not in the way that you mean. The trauma management skills of SOF medics far eclipse yours. Further, they are trained in other specialties from obstetrics to veterinary skills. When I went through the SF Medic course in the early 1980's we did our own lab work using field kits by hand. It would be a huge waste of their expertise to stick them on helicopters to hold the hands of casualties, which is what you do, when you are not lounging around a ready room eating candy bars and playing X Box in your flight suit.
Ever been in a fire fight? I did not think so.
To state that Army flight medics are superior to special ops medics because "their sole purpose in life is medical care" merely underscores how misinformed and clueless that you are.
I would like to see a flight medic cope with the culminating trauma exercise at what used to be called Med Lab. You would choke. You would choke because you would have no frame of reference for handling trauma of that magnitude on a live subject.
Again, you need to go sit in the corner. Your words are a waste of air. You add nothing valuable to this conversation.
If you want to be relevant, man up and volunteer for service in special ops. Until that time, shut the f*** up.
Thank you.
The question of curriculum is addressed on the Fort Sam website. This Spring, they are finally changing the program of instruction after talking about it for 10 years - fact.
You are bringing your civilian experience to the fight and that same memo says that National Guard and Reserve medical evacuation units have better statistics than Active Army units - fact. My assumption is that these units bring superior training and civilian experience. A few of the flight medics have chimed in and spoken about the additional training that they got, at their expense, in civilian life. The Army only pays for the outside training of the 2 Reserve Component MAST units.
The critical data NOT collected are the outcomes. What happens hours and days are the casualty is delivered to the higher treating facility. BTW, as you know, the "Golden Hour" is not a magic solution. If a soldier is bleeding out and it can't be stopped, the Golden Hour turns into ASAP. 15 minutes can make the difference. What is truly confusing about this subject is who makes the MEDEVAC dispatch/approval decisions. Part of the complaint has been the qualifications of the person manning the PEEC. Your description does not even mention a PEEC and your unit makes decisions at the appropriate level. Most of the gripes are about higher level decision making or not making. Some stories refer to waking generals up.
Lastly, there have been allegations by some, all the way up to the JCS, that 9 lines often exaggerate the severity of the casualty or the play down how hot the LZ is. If true, it is very sad, human, but sad as it affects other casualties' survival.
Final 2 cents. I agree about the red cross, and the weapons, its only common fucking sense. I also believe flight medics should get EMT-P as part of the standard, but only because it would help them after leaving the Army.
Also, the beurocracy doesnt hinder MEDEVAC launch the way some of you are implying. Our O-6 has NEVER been woken up to approve MEDEVAC. The launch decision lies with the BTL CPT. If the LZ is hot and we dont have an AWT that will make it there BEFORE we do, we will defer the mission to PEDRO. The ONLY time MEDEVAC is delayed waiting for escort is if its not up and PEDRO cannot take the mission. Even then, we find SOMETHING. We even had command allow us to count a B1B cruising over RC(S) as 'escort' so we could get Joe out in time. Before I get flamed for this, let me reiterate. I still think we should get weapons, any wait is too long a wait. Also, since many of you probably forgot int he course of my two-post diatribe. This is all coming from a 9 year EMT-P veteran. CURRENTLY working DUSTOFF in Afghanistan, as in I flew EARLIER TODAY. I have also talked to and had contact with the PEDRO guys. This information is up to date. Argue with me. Please.
Final side note: Coprsmen, really? I have no doubt any SEAL medic, 18D, W1 (SOCM) medic, etc. could run circles around me clinically and literally, but Corpsmen are not SOF. And as far as emergency medicine, in my experience, they are BARELY able to average up to todays 68W standard.
You have contributed greatly, but unless you check your facts first, don't critique other Service's medics. All the training these other Services require is available online. PJs for example do a tour in the ER at a Tucson hospital as part of their curriculum. Others on this forum have made similar mistakes when describing the training in other Services.
Corpsmen CAN get assigned to special units such as SEALS, etc., but they get more training for these assignments. Just as a 68W will go to SOCM school if assigned to the Rangers or the 160th, etc. These would be SOF Corpsmen, just as a 68WW1 (W1 being the SOCM ASI) is a SOF medic. The base job field of the Corpsman is NOT SOF. They do not at their base training level exceed standard Army 68Ws by any notable margin. They can both be assigned to an infantry unit, or a hospital. They may both be needed to provide primary care to the warrior for an extended time. Neither one of them are SOF.
Side note: secondary to this already similar standard of training, Corpsman school has recently been moved (or is shortly moving) to Ft Sam to be co-located with 68W school.
Question on the side: have gotten various information about a Marine who recently died from electrocution. (I believe there actually were two separate electrocution cases: the case I am talking about was apparently on base involving a vehicle.) Dustoff side of the house mentioned there was a slow dispatch on that. Got any info?
Thank you again...important feedback. (pls ditch the curses...kids come here.)
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