Revamped Flight Medic Training
Good news. Enhanced Flight Medic Training Begins
After over a decade of urgent calls for upgraded training of Army flight medics, it has begun. This article provides some details of what is involved. As noted, Army statistics have long shown that wounded troops rescued by National Guard MEDEVAC crews have a 66% higher chance of survival than if they were rescued by Regular Army MEDEVAC crews. This difference is directly attributable to the level of training attained by the crews and prior trauma experience. Most National Guard flight medics are paramedics in their civilian life, so they have more extensive training as well as daily contact with trauma victims. Even civilian paramedics, however, need additional training to handle military war casualties.
The other area of good news is that flight medics also will be trained for en route critical care of stabilized patients. What most people don’t realize is that a huge percentage of MEDEVAC flights entail the transfer of wounded troops from one level medical treatment facility (MTF) to another. These patients often are hooked up to various types of medical/life sustaining equipment which the typical flight medic is not trained on or certified to use. As a result there is a substantial risk to many patients during the transfer flight that their condition may seriously deteriorate. The Army attempted to address this with the assignment of en route critical care nurses, but as was reported by Col. Robert Mabry in his after action report in 2011 – those nurses had not been properly trained (indeed, many were unaware that they would be assigned to helicopter rather than ground transfer duties) and suffered from weak leadership in the field.
These much delayed positive changes should be acknowledged and applauded. However, I was informed by someone close to the MEDEVAC program that no special program was in place to assure that Regular Army MEDEVAC flight medics scheduled to deploy to Afghanistan in the next year would be enrolled in the enhanced training program before deployment. It is interesting that the early enrollees appear to be among the National Guard crews already providing the higher level of care and achieving the higher survival rates for their patients. Wouldn’t have made sense initially to maximize the number of Regular Army flights medics getting this training – especially those going to the combat zone? [If someone can provide updated information about enrollment policies and timelines, I would appreciate it.]
Note the comment from Army Master Sgt. Kym Ricketts, chief medical non-commissioned officer with the Army National Guard, “It’s advanced, pre-hospital medical care.” The term pre-hospital care is relatively unknown but includes all the medical care provided to the wounded from the time of injury to the time the patient is in the hands of medical staff at a medical treatment facility. MEDEVAC is but one portion of the spectrum of pre-hospital care for the wounded. As discussed in How the Army is slow to meet MEDEVAC Challenges in the 21st Century this also covers Tactical Combat Casualty Care training and doctrine, as well as pre-hospital care trauma registries that track the wounded and their care discussed in US Army Report: 2011 After action report blasts MEDEVAC shortcomings.
The article follows:
Army National Guard medics among first to attend revamped flight medic program
By Army National Guard Sgt. 1st Class Jon Soucy
National Guard Bureau
ARLINGTON, Va. – Medics from the Army National Guard are among those taking part in a pilot program designed to revamp the training that flight medics throughout the Army will receive.
Taught at Fort Sam Houston, Texas, the program will provide flight medics with additional paramedic and critical care training and certifications.
“A paramedic provides a higher level of care,” said Army Master Sgt. Kym Ricketts, chief medical non-commissioned officer with the Army National Guard. “It’s advanced, pre-hospital medical care.”
Currently, to be a flight medic, a soldier must be a qualified combat medic and be in a flight medic slot, but since flight medics operate under different conditions those requirements are changing to reflect that.
“The medics need additional training as flight medics as they do a higher standard of care and in a different environment than a line medic on the ground,” Ricketts said.
The program is designed to emphasize that fact and focus on training soldiers on those additional skills needed as a flight medic.
As part of the pilot program and proposed changes, soldiers go through three phases of training specific to flight medic duty.
“The first one is the flight medic phase,” Ricketts said, adding that it can be waivered in lieu of on-the-job training. “Phase two is the nationally registered paramedic [course], which is the longest phase, and phase three is the critical care transport piece.”
The push for making changes to flight medic requirements came from a number of elements, including a study done on a California Army National Guard medical evacuation unit that deployed to Afghanistan with full-fledged paramedics in flight medic positions.
“[The study found that with] having flight paramedics in the back of an aircraft there was a 66 percent higher survivability rate than with a straight [combat medic] that wasn’t paramedic trained,” Ricketts said.
Additionally, proposed changes to the flight medic requirements also mean that graduates of the program walk away with national certifications as paramedics. That provides additional benefits including a greater flexibility with integrating with local, state and other agencies in a disaster situation, she said.
“A citizen-soldier can do their wartime mission as well as their peacetime mission of taking care of their community,” Ricketts said, adding that those certifications are the same received by civilian paramedics.
But the important part, she said, is simply providing the best care possible.
“The benefit is the best battlefield medicine and care that a soldier can get,” she said.
“With the forward surgical teams that are out there casualties are actually having surgical intervention on the ground at the point of injury,” Ricketts said. “Combined with these medics that are able to have this training … the [casualty] will be getting the best standard of care.”
The pilot program wraps up later in the year and will then go through a review process.
“It’s still a pilot program and once the pilot program is through we’ll do an analysis to see what works best,” she said.
Ricketts remains positive about the results of the program.
“These medics are going to affect so many people,” she said. “Not just American forces, but coalition forces as well, and that’s amazing.”
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A 66% increase in survival rate seems incredibly exaggerated to me. I would love to challenge the source of that statistic to see how they derived their numbers for this story. I don’t doubt that the survival rate is higher for trauma patients when care and in flight interventions are provided by an EMT-P (Paramedic), but to throw a number like 66% out there is almost laughable to a point where one with any knowledge if the business would automatically discount the story in its entirety. Having flown this mission for years, I would guess the number to more in the range of a one to five percent increase in survival for trauma patients. Where the Paramedic qualification will certainly help is the post surgical movement of patients from a forward based surgical stabilization unit (Army FST or Navy STP) to the next higher echelon of care. The gap is currently being filled by Enroute Critical Care Nurses in several areas of operation, but not in all of them. For evacuation from the point of injury, the medic (be they a Paramedic, PJ, or EMT-B Flight Medic) has little time to do anything more than stabilize those interventions placed in the field, evaluation for additional injuries, attain a basic set of vitals, improve the packaging and stabilization of traumatic injuries, and manage blood pressure before they land. Not much can be don in the span of 10 – 15 minutes during a rapid evacuation off the battlefield.
Andy – First of all, thank you for your service.
You raise a number of interesting points. I agree it is a startling statistic, but it is one that is quoted by some reputable people with skin in the game:
“The current capability gap has been documented in more than 40 AAR’s 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 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.”
This is from the 2011 After Action Report by Colonel Robert Mabry detailing his observations about MEDEVAC operations in Afghanistan in late 2010-early 2011. The full report can be read by either clicking on the link in the 4th paragraph of the post, or by typing “66%” into the search box on this page and selecting the post “US Army Report: 2011 After action report blasts MEDEVAC shortcomings”. The Colonel’s credentials follow the report. He seems to be a credible source for this information, but I will continue to search for a copy of the research.
In this same After Action Report he addresses his observations about the en route care duty being split between flight medics and ECCNs. At the time of his report, it was not a pretty picture.
Your description of what care is possible aboard a helicopter is very important. The environment is far from conducive to providing escalating care from what was provided by the combat medic and flight medic before liftoff. The noise, cramped spaces, vibrations and movement of the helicopter, difficulty in accessing and using instrumentation, etc. all serve to limit the delivery of care. (As a side note, the Army purchased a fleet of UH-72A light utility helicopters to provide among other services, MEDEVAC in non-combat environments. The configuration of the helicopter is such that only 6.5″ of space separates the two litters, there was inadequate light in the rear patient area, and there were no ceiling attachments for IV bags, etc. No in-flight care could be rendered to patients by flight medics. The initial post-purchase report by the DoD declared the helicopters incapable of performing the MEDEVAC mission as required.)
The basic MEDEVAC doctrine in Iraq and Afghanistan these wars has been buddy care/combat medic care at the point of injury (POI) and stabilize the patient with assistance of a flight medic for transport. Then move them within an hour of the injury to a Level 2 or Level 3 medical treatment facility. There the patient will receive more stabilizing care and initial surgical treatment of the wounds. Then they are moved again to another facility in country specializing in the specific wounds or to Germany with 1-3 days. It all about stabilizing for transport at each level of care. Given this overall plan, it is a little confusing why there is reported to be a lack of care standards in the pre-hospital phase of care. You would think that the work would be consistent across Regional Commands and MEDEVAC units.
Andy, can you talk about (1) whether the Tactical Combat Casualty Care training and field implementation has played a role in improving the care in the first 30 minutes at the POI? and (2) how consistently is information being captured and entered into the Pre-Hospital Trauma Registry? Thanks.
While those who have “skin in the game” may have come up with those statistics, we must recognize that statistics can be interpreted and reported unfairly when used to make a point. If these stats are directly attributed to negative patient outcome at wounding plus 48 hours, I would have to question where those patients were injured (RCs South and Southwest areas have a higher post-surgical infection rate than RC East), types of injuries (some RCs have more amputations than longer range GSWs). A National Guard unit with majority of paramedics as their crews may be in one RC with less frequency of exceptionally traumatic injuries would skew the data when a Active Duty unit is in the area where patients are more likely to suffer greater complex trauma cases. I read LTC Mabry’s report and I agree with much of it. But we have to remember that the system to gather the data needed to determine the outcomes of patients, and definitively tie those to an increase in training is still in its infancy. At the end of the day, the Army is doing a great thing by increasing the training for the Flight Medics. A win for the patients. That being said, I would still personally challenge the 66% statistic and I would bet that others who have worked extensively in these units, both active and guard, would shed serious doubt in this number as well. There has been plenty of back and forth hand-over between active and guard units over the years. I would be quite interested to see if the “survivability wave” would ebb and flow with the exchange in specific regions along with the change of compo.
Thanks for the feedback. I am continuing to seek the original report that offered the analysis and statistic. I have pinged some folks that might be able to point me in the right direction. The Army and DoD do have a penchant for keeping these type of reports underwraps, so I’m not sure if and when I might get a copy to review. If anyone reading this blog has access to the report mentioned by Colonel Mabry and others elsewhere on the difference in survival rates between Army and National Guard MEDEVAC units, please share it with us. Thanks.
There is no argument on the ill advised purchase of taxpayers’ dollars to attain the H-72. While it may be a fun aircraft to fly, it is far from ideal for use as a MEDEVAC platform. Several of our medics have been crewmembers in the H-72 and describe the inadequacies. One patient is the max that they would attempt to treat. Anything advanced in nature would require more space. A poor choice all around and you will get little argument from anyone in the field.
You asked about the Tactical Combat Casualty Care training and if field implementation has played a role in improving the care in the first 30 minutes. I can’t say that I’m the expert to speak to that, despite having served for a number of years in the units. Has the training for the medics improved over the years? Yes and no. That would depend on how much of a focus TC3 was for that specific unit and on their non-combat their operational tempo in the year or two before they deployed. Many units are low on the number of medics they have until just before they deploy, then they have non-trained medics thrown at them to quickly get ready. Many of these don’t even have the Flight Medic Course under their belt. The Aviation Branch community doesn’t exactly need medics when not deploying. Ask any unit who has had to give up their medics for any and every range run in a brigade, or whenever soldiers are needed for a non-maintenance task. Aviation leaders cherish mechanics, but bastardize medics when not at war. Actual medical training suffers when not deployed or deploying. I’ve heard of units having to implement and fully progress half of its medics to be fully trained Flight Medics in less than 60 days. Not what one would call ideal conditions.
As to your question about information being captured and entered into the Pre-Hospital Trauma Registry, when our unit was in Afghanistan, we captured all the mission data in terms of critical times (notification, launch, in-flight, drop-off and the like), and the medics had to fill out perperwork after each mission, but I don’t recall a patient registry. I had heard rumors that they were working on a centralized patient AAR database, but nothing was in a useable state or managed while we were there.
One percent or 66 percent= better chance of survival. To bad it took the army 10 years to figure this out.
What really bothers you about the 66%? Is it that they are paramedics or is it that they are National Guardsmen? Regular Army ran the stats. I think it’s a silly point to hone in on. LTC M has some real experience as a W1 in Somalia and now a Provider in the highest levels of prehospital care for the Army. I don’t think he would rely on weak data.