Military Medics/Civilian Qualifications.

[twistedpupchaser]

Reading another thread I was reminded about the differences between Military medicine for want of another term and the Civilian world. In the Military we have a demographic of younger, fitter people with a lack of chronic illness giving us a narrow spectrum of experience. For example, I never had trouble throwing in an IV until I started in a hospital setting trying to cannulate little old ladies, the morbidly obese, IV drug users with no (usefull) veins or the vascularly compromised.

My thought is that Military Nurses and medics should spend time working in a civilian medical facility, either in a block of time that is repeated at intervals or as a part of the normal working week. As an extension of this idea is that military qualifications (more so for medics/corpsmen) are brought into the mainstream, ie: this type of medic receives the equivalent of the Paramedical Science Degree, this type of Corpsman receives qualifications as a Registered Nurse. It would require an extension of training over a number of years but to my way of thinking this extension of training would give them more knowledge to do their job better and would reward those who stay in for longer with usefull qualifications, (without the debt).

Don't get me wrong, I know that there is a lot of things that Military Medicine does that is not covered anywhere else but how often could a military medic be asked to provide humanitarian assistance or happen upon civilians while on operations that require help?

Any thoughts?

[Honnête et Sérieux]

Eh...keep it simple.

Have them practice on the population they will be working on.

The cost of training them in non-traditional venues doesn't really justify preparing them for the more rare exceptional situations they may encounter.

Plus, military folks are often masters of improvisation.

And as a former military medic, the actual classroom training was merely a basic foundation for practice. The real training came at the duty station.

And the military doesn't have the motivation to provide skills that exactly match civilian countertypes; it could actually result in a departure of providers. My military experience provided me with 15 college credits and a civilian EMT certification. I was pleased with that.

Good thoughts, though.

[wtbcrna, MSN, DNP, CRNA]

The military does provide civilian experience for many of its providers unfortunately it is almost exclusively on the commissioned officer side. All military nurses will ,almost exclusively, do their rotations on the civilian side, and military physicians (even the ones that go through USUHS and military residency) will go through several rotations on the civilian side.

There are also programs like C-Stars that helps prepare medical providers for trauma cases through formalized classroom training mixed with clinicals at large civilian trauma centers. http://www.sg.af.mil/news/story.asp?id=123062514

[Honnête et Sérieux]

True...but this is usually because the military has limited capacity to provide the advanced clinical exposure that they need.

And it seems as though we have programs similar to what twisted is looking for.

Good deal.

[Cursed Irishman]

What about law suits regarding enlisted soldiers injuring the public? I know some of the medics I've worked with along the way did things that, retrospectively, were very foolish and wouldn't fly when working w/ the public. Soldier's can't sue soldiers, but what happens when you let joe "practice" on the public and errs? As good an idea as it sounds, there are too many tangents that distract from the purpose of medics.

[wtbcrna, MSN, DNP, CRNA]

What about law suits regarding enlisted soldiers injuring the public? I know some of the medics I've worked with along the way did things that, retrospectively, were very foolish and wouldn't fly when working w/ the public. Soldier's can't sue soldiers, but what happens when you let joe "practice" on the public and errs? As good an idea as it sounds, there are too many tangents that distract from the purpose of medics.

As long as a you are practicing in your scope of practice for the government there really shouldn't be a problem. Military providers have been training at civilian institutes for years. Although AD can't sue their dependents can. The overall truth is that the military needs these civilian training opportunities, because we seldom see a lot of things that are more or less common practice in civilian hospitals.

[olderthandirt2]

"Don't get me wrong, I know that there is a lot of things that Military Medicine does that is not covered anywhere else but how often could a military medic be asked to provide humanitarian assistance or happen upon civilians while on operations that require help?"

It is my understanding that when deployed OCONUS (OEF,etc) at least half of the pt. population are "nationals" with common civilian maladies.

And, medics ARE involved in humanitarian mission which are 100% civilian populations (I have participated on 2 "joint-military/ngo missions).

c.

[twistedpupchaser]

It is my understanding that when deployed OCONUS (OEF,etc) at least half of the pt. population are "nationals" with common civilian maladies.

And, medics ARE involved in humanitarian mission which are 100% civilian populations (I have participated on 2 "joint-military/ngo missions).

c.

This is the point I was trying to make, there are a lot of instances where medics are treating the civilian population. I know of a senior Army medic, (Australian) who was handed a Dying infant while on deployment and apart from the very basics had little idea how to help. Without exposure/training the medic is not going to know the baseline for small children or how quick they can deteriorate, add a language barrier and I believe that an unhappy situation could easily develop. I have toured the USS Mercy and am aware that her mission is often purely humanitarian in third world countries and wonder at the pre-deployment training with civilian casualties. If the training is similar to ours then couldn't the medics be compromised? ie: feelings of guilt for not being able to help someone.

I conceed that the Commisioned officers, Nurses and MO's get hospital training yet how often do they "refresh" their skills and practice outside of the Military. I have seen here in Australia both Medical and Nursing Officers working in Hospital settings on their "days off" just to keep their hand in. In our system there is an Ad Hoc arrangement with some hospitals for medics to have placements with little chance to use or practice most skills due to discrepancies between Military and Civilian qualifications. A good example of this is that as a Registered Nurse I could not cannulate until I had done the hospitals' education package, my qualifications and years of experience as an Army medic did not count in the "Real World".

[Cursed Irishman]

As long as a you are practicing in your scope of practice for the government there really shouldn't be a problem. Military providers have been training at civilian institutes for years. Although AD can't sue their dependents can. The overall truth is that the military needs these civilian training opportunities, because we seldom see a lot of things that are more or less common practice in civilian hospitals.

I'm not addressing the officer side of the house. I agree O's need the added experience of working w/ public institutions for a broader foundation to pull from. As already addressed, these programs exist.

I'm questioning what occurs when the enlisted medic from an infantry bn, who is used to having very little oversight and a wide latitude, is attempting the same treatments they would do in a line unit on the public. The op's idea is good from a certain viewpoint, but would only distract from the intent of having medics and add to an overburdened op-tempo. The military's purpose is not as a conduit for degrees and certifications.

[olderthandirt2]

"This is the point I was trying to make, there are a lot of instances where medics are treating the civilian population. I know of a senior Army medic, (Australian) who was handed a Dying infant while on deployment and apart from the very basics had little idea how to help. Without exposure/training the medic is not going to know the baseline for small children or how quick they can deteriorate, add a language barrier and I believe that an unhappy situation could easily develop. I have toured the USS Mercy and am aware that her mission is often purely humanitarian in third world countries and wonder at the pre-deployment training with civilian casualties."

Yup, and that is why the missions try to have a good "mix" of skill sets, i.e. Peds trained RNs, Post-op RNs, ICU RNs (military and non-military). And these RNs then participate in "on-site" teaching to other RNs AND MEDICs.

I can only speak of my experience on the USNS Mercy and USS Peleliu, we frequently discussed and planned (with ALL the medical staff) how we would treat the surgical and day clinic patients. This means "mini or impromtu-skills days" and scenarios for different patient populations. Infact the whole mission is a tremendous learning experience for everyone involved. And it worked fabulously.......And so, the humanitarian missions continue to be scheduled.

c.

[twistedpupchaser]

I can only speak of my experience on the USNS Mercy and USS Peleliu, we frequently discussed and planned (with ALL the medical staff) how we would treat the surgical and day clinic patients. This means "mini or impromtu-skills days" and scenarios for different patient populations. Infact the whole mission is a tremendous learning experience for everyone involved. And it worked fabulously.......And so, the humanitarian missions continue to be scheduled.

c.

I only mentioned the Mercy because I was aware of her Humanitarian Missions, I in no way meant that there was poor planning or preparation for the medics. My thought was in line with the Medics possibly lacking a depth of knowledge in caring for some population groups and not to suggest I knew what their training was.

Our Irish mate mentioned that the Military should not be a conduit for degrees or certification and suggests that this extra training would distract from the operational tempo, I agree to a point but question wether a deeper knowledge and understanding would be more beneficial in the long term than "protocol driven" knowledge, ie; understanding why something is done not just doing it because the protocols say so.

I knew that this thread would have as many viewpoints as posters, it is very interesting to see differing views on this subject and how people come by their views. I was a medic for many years and only after learning pathophysiology, (deeper) anatomy and physiology and pharmacology during my nursing degree did I understand why some things "were".

[Honnête et Sérieux]

I could be mistaken, but I thought that the Mercy was often staffed with a large, maybe even majority of reservists who very likely have a significant exposure to civilian clinical settings.