Utilizing medics

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    • #116184

        Hey yall, i wasnt really sure where to put this post so i figured this one would be as good as any. If not, let me know and i can redo it in another forum. If this is a pp3st that has already been made, i apoligize. I did search for something similar but couldnt find it. Anyways, onto the topic.

        We have all read and trained(hopefully) about TC3 and thankfully most have agreed to the need for a medical kit and eveyone knowing how to use said medical kit. But what further can we do? I am in paramedic school and ive read the experiences of other guys in this forum working in EMS/fire. But how can we bridge the gap between our medical knowledge aand use of tactics and turn ourselves into “civilian tactical team combat medics?” Do we act as conventional army medics and stay behind everyone with the leadership and provide medical treatments necessary and act as pack mules for ammo distrubution? Do we only bring the medical kits that everyone knows how to use, ignore our medical knowledge and only work as an “infantryman?” I feel like this option is an extremely wasted use of a specialty especially because medical knowledge is so overlooked and in such short supply. Do we adopt a “lone survivor” role and act as medic/sniper? I realize that was a reconnaissance mission not a patrol or direct action mission. How have the guys in this group with prior military leadership under their belts used medics in small groups? Im not familiar with any literature on how to maximize the use of medics in small teams of 3 to 8 personnel or how/if the role changes based on the mission. Speaking of mission, how/do we provide aid to injured noncombatants as a guerilla force? Im sure that would help local public perception during a large scale event. Any disussion on this topic would be greatly appreciated. Feel free to discuss other specialties such as team commo or a civilian equivalent of a weapons team etc
        (i know Max has touched on this one with the suggestion of replacing a 249 gunner with a battle rifle utilizing accurate fire in place of sustained fire) that we as civilian tactical teams (really trying to stay away from the dreaded “m” word) can employ in an effective manner to help ensure mission success. Or am i just overthinking it and letting my inner millenial larper come out?
        If there is anything i need to clarify, let me know. Thanks yall.

      • #116189

          you’re essentially describing a SF medic (currently an 18D, 18 Delta). In VietNam, SF medics were used for village healthcare. If you want the best information for this (IMHO), grab a copy of the SF Medic’s Handbook – https://www.amazon.ca/U-S-Special-Forces-Medical-Handbook/dp/0873644549?SubscriptionId=AKIAILSHYYTFIVPWUY6Q&tag=duc12-20&linkCode=xm2&camp=2025&creative=165953&creativeASIN=0873644549

          EMT-Basic, EMT-Intermediate, and EMT-Paramedic are essentially only good for well-developed EMS systems. Think of BLS v ALS (Basic Life Support, Advanced Life Support). That life support is ONLY designed to buy you time in getting the patient to a higher-level of care, i.e hospital.

          If everything goes to crap, how long do you think those Level I Trauma Centers are going to stay open? Remember that EMS has 2 meaning – Emergency Medical Services (FD and EMS or ambulances) and Emergency Medical System (meaning ALL of it).

          SMHO (been a FF since 1981, EMT-P since 1984), a better option is Wilderness First Aid (or similar), https://www.nols.edu/en/coursefinder/courses/wilderness-first-aid-WFA/ this course discusses making decisions and treating patients when resources are 2 days away.

          Its all in understanding what you want to accomplish – in this case, sounds like you’re wanting to be a healthcare resource for local citizens.

          Coming from a SWAT Medic perspective (EMT-Tactical), we were initially kept back “at the van” to stay out of the way. As we morphed, we were “tail-end charlie” but quickly found this to be a dumb decision – when SHTF and the call “medic up” goes out, whose going to cover the team’s 6?? Yeah, that lasted for 1 callout. What we ended up with was door guy, entry guy, cover guy, TL, medic, then 2 more, with door guy (breacher) being tail-end charlie. This allowed medics to flow either way, easily. And yes, there were times I ran point (EVERYTHING is mission-dependent), sweeping people off the porch to allow entry team access.

          One of the things we learned was – BG goes down, I’m working on him while FD/EMS is called for transport. Team member goes down, I’m working on him in the back of the van while being driven to trauma center or to meet the helo (helped that I was also a flight nurse/medic, so had direct access/comms to the helo for coordinating movements, and 3/4 of my pilots were retired 160th SOAR).

          Again, all the above assumed an intact EMSystem!

          Get to MVT for training!! Max actually will run some of these scenarios in certain classes. Basic 1st Aid means an end point. Stabilization is life-saving, but then what?? In my world (EMS) and sounds like in yours, if you haven’t heard this phrase you will – the definitive therapy for medical event is medicine; the definitive therapy for trauma is surgery (which is why we don’t dick around on the scene)….

          Mission drives EVERYTHING!!

          To your point specifically – every member carried a small booboo kit (90-95), and no we weren’t using TQs. I carried an aid bag that had advanced airways (ET tubes), IV bags (2L NS), and basic meds (epinephrine, Rocephin, Benadryl) and bandages, still no TQ or chest seals (I did carry 14 ga needle for chest decompressions though we now know aren’t long enough). This was also back when we punched IVs and flooded a trauma victim (that ain’t done anymore, can you say “hemodilution”?). What I did find was that ~ 90% of my job was preventative, meaning small observations and notifying my LT to keep my guys healthy to begin with – the biggest being “put them sleeves down!” (NW LA, humidity 90%, guys all rolled their BDU sleeves but the vast majority of our injuries were soft-tissue to the forearms…rolled the sleeves down and voila!! no more soft-tissue issues)

        • #116213

            Thank you for the VERY informative reply. I completely agree with everything you said. At least, the parts i am familiar with.

            I will definitely check out the sf medics handbook. I always wondered if books like that (military manuals from paladin press) were legit or if they were were just bs “bubba” guides.

            As far as EMS goes, yeah i realized real quick after getting in the field that it would fall apart real quick without the modern medical system and ROL. Its a fragile system like pretty much everything else in the US. Ill definitely look into the wilderness 1st aid class as im always looking to expand my medical knowledge.

            My primary goal honestly is just to generate conversation between those of us that are at least a little medically inclined because we WILL be expected to provide medical care to our “tribe” when theres nothing else but us. For me specifically my kids are 1st priority. (I dont currently have a team of dudes i trust my life with) Only when they are taken care of would i ever consider being a healthcare resource. If my situation changes and i do find a tactically competent tribe or at least willing to become tactically competent then my, and im sure others in my position, priorities also include them and their families in trauma, preventative medicine and any other areas of medicine that they may need it regardless of how little we may actually know. (At least, thats been my experience working on an ambulance. Family, friends, and the general public all think the 1 semester that you took to become an emt qualifies you to reset bones and provide advanced medical care.)

            Anyways, getting back on track, I am coming to a class as soon as i am finished with “p school” EMT’s dont make enough money to live without pulling stupid amounts of over time. (Max if you’re reading this I can only imagine how aggrivating it is to read that someone will come to class “later” but I honestly do try to support MVT with smaller purchases and getting the word out as much as possible)

            On to your last point, i gotta ask why Rocephrin? Thats something we used in the TMC back in the rear followed by an extended time out of the field. Our medics only ever brought cold packs,a few 500ml NS, baby and foot powder and iv supplies put to the field and the occasional bandage. Epi was considered a personal responsibility if you had allergies because our BN doctor didnt feel like signing off on the request for meds. Regardless, that gives me some ideas for my own personal “med pack” that ill eventually put together. Our biggest problem in ft polk was getting dudes to not be lazy and chamge their socks.

          • #116216

              My kid was a toddler. My flight radius was 150 miles. While your small hospital might only see meningitis twice a year, I was flying at least 1 kid a week in with it (to the point that CDC did an cluster investigation around Longview TX), so my biggest fear for my kid was……meningitis. I was able to get my Med Director to sign off on it (my Med Director for SWAT was also my Med Director for flight…. NOT a coincidence, I established the SWAT medic program at my agency)…most would just nod their heads but those who knew what we were seeing knew why…..symptoms of meningitis?? Pop her Rocephin 1g and haul her butt to the ED – but bacterial meningitis can kill in less than 12 hours…..My airway kit also coincidentally had her size tubes B-)

            • #116217
              Joe (G.W.N.S.)

                In VietNam, SF medics were used for village healthcare. If you want the best information for this (IMHO), grab a copy of the SF Medic’s Handbook

                Thats an outdated version.

                What you need is the Special Operations Forces Medical Handbook.

                The current addition is only available through the Government Printing Office and is currently sold out.

                I have a early 2000 something version which is superior to the SF version. I’ll see about reposting.

              • #116219
                Joe (G.W.N.S.)

                  The following are some PDF’s that should be useful.

                  Special Operations Forces Medical Handbook is a must have IMHO.

                  Link to the 1 June 2001 edition in PDF.

                  The newest version (11 December 2012) is difficult to find online, but is available from the Government Printing Office for $59.00 looseleaf binder format, $9.99 for E-book, and $6.25 for a CD-ROM.

                  2d edition. A comprehensive reference designed for medics in the field, it is also a must-have reference for any military or emergency response medical personnel, particularly in hostile environments. Developed as a primary medical information resource and field guide for the Special Operations Command (SOCOM).

                  Defines the standard of health care delivery under adverse and general field conditions. Organized according to symptoms, organ systems, specialty areas, operational environments and procedures. Emphasizes acute care in all its forms (including gynecology, general medicine, dentistry, poisonings, infestations, parasitic infections, acute infections, hyper and hypothermia, high altitude, aerospace, dive medicine, and sanitation.)

                  Printed on tear-resistant, water-resistant, synthetic paper. A 5.25 inch by 8.5 inch quick-reference guide with a three hole punched ring binding.

                  I believe the $59.00 format is worth the price, but if you are not familiar with this check out the free 2001 PDF to get a feel for them. The 2012 2nd edition is of course updated much of it from the latest GWOT experience.

                  Emergency War Surgery is available in MOBI/EPUB/PDF at this link. This is an excellent resource.

                  Note: [ERRATUM: Please note that Table 31-1 on p. 451 has an error. Hourly volume for children up to 10 kg should be 4 mL/kg, not 10 mL/kg. This has been corrected on the PDF version.]

                  Hesperian Health Guides publishes many useful books and is most known for “Where There Is No Doctor” and “Where There Is No Dentist.” The “A Book for Midwives” is definitely worth having.
                  To take advantage of the Free PDF’s each chapter is a separate PDF, not ideal but free. Of course they can be purchased from many sources.

                  Beware of the very early versions (pre 2000) as they truly outdated.

                • #116220

                    :good: :good: :good:

                    Echo the Where There is No …… series….very good, IIRC, they were designed for missionaries so going to 3rd world countries….

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