Got selected as an SRT Medic!

[JAustin316]

Congrats!

[TacMedic556]

Congratulations.

I am in my 8th year as our team medic. Get some good TCCC and LETCC courses. If it does not involve life like scenarios that include distractions and simunitions, don't waste your time.

Pack lighter and smarter. When I started, my kit had everything. I carried too much medical gear. That kit ended up too heavy and was often left in the armor.

It took a while to "disconnect" my tactical medicine from regular street medicine. I won't get into the kit here, that would take up too much. Basically I have a more than your typical IFAK on my non pistol leg, with a larger team kit in a pack I got from Chinook Medical (They can hook you up.)

Train, train, train. Some teams initially question the docs abilities. You can overcome this hurdle by showing, not talking. Stay in shape, run, do lots of push ups, be positive, be quiet and listen. The time to joke with them and mesh will come with time on the team.

Our team has the medic in the stack. Often, this is towards the back, however situations are always different and evolving. There are times where the team is split into two elements, or it is a patrol, etc. and the medic is up towards the front. Being the medic is just another skill set. I liken it at times to the skill sets of sniper, or breacher/scout, shotgunner and so on. Your primary position is TEAM MEMBER. You are another gun. And as we learn, often the best medicine is fire superiority. There will be times where good medicine is bad tactics and bad tactics can get everyone killed. Do not become a casualty yourself trying to give aid to a brother in the fight. Finish the fight, then give aid. Self aid, buddy aid, medic aid.

It would be exciting to share more with you, but we can do that another time and in PM with any direct conversations you want to have.

I am stoked for you. Enjoy this new facet of training and experiences. The change in environment, the challenges, the service and the camaraderie is priceless.

It is often my favorite part of my career.

[mkmckinley]

I'm not an SRT but I've been an Army medic for a bit. You sound like you have apretty good handle on what you're doing and what further training to look into. The thing I wanted to add that I tell our new medics is in addition to all your TCCC stuff make sure you have some basic sick call meds available. What tends to happen is you have a brand new hard charging medic with his kit all squared away for TCCC then one of the guys will ask him for some Afrin or topical for poison ivy and he doesn't have it and everyone thinks he doesn't have his shit together. Other than that test everything, all the time, do real, no shit pre-mission checks and make sure you stay up on your training.

[Hmac]

Good point. We always had a wide variety of meds, prescription and non-prescription, stocked as part of our main kit. Also, all the stuff necessary to suture minor lacerations and remove foreign bodies (ticks, for example). That's useful in preventing trips to the ER.

[chuckman]

My teams (I was on 2) had a 'main bag' that stayed CP-bound, had all the meds, environmental care stuff, dental stuff, etc., then my bag was a true entry trauma bag. And then every cop had an IFAK. The team MD on one was a cardiologist; the other, and ED doc and my biggest job was convincing them we did not need the kitchen sink (the ED doc had a kit with rib spreaders).

[Hmac]

?.... (the ED doc had a kit with rib spreaders).

Sounds prudent. SRT operations imply a greater-than-average risk of penetrating trauma. A thoracotomy in the field might be life-saving.

[chuckman]

Sounds prudent. SRT operations imply a greater-than-average risk of penetrating trauma. A thoracotomy in the field might be life-saving.

I was never assigned to a FRSS or BAS, but to my knowledge the FRSS did not do thoracotomies. Maybe that was because of the volume of penetrating trauma you get in war, triage and all. It was my observation that this particular doc was like some of the other docs I know who "play" in the field who do not understand the limitations of what one can do out-of-hospital and possibility vs probability. The need to do a thoracotomy is a high-risk low-volume event with a very low probability. You may disagree, and I respect that.

[Hmac]

It was my observation that this particular doc was like some of the other docs I know who "play" in the field who do not understand the limitations of what one can do out-of-hospital and possibility vs probability. The need to do a thoracotomy is a high-risk low-volume event with a very low probability. You may disagree, and I respect that.

The guy's an ER doc, you said. I know very few ER docs that don't know how to do a resuscitative thoracotomy. It's covered in both ATLS and CALS and is part of the curriculum for virtually all ER physician residencies. I certainly agree that resuscitative thoracotomy is a low volume, low probability event , but....many people on this forum carry a gun every time they leave the house. The need to defend your life with lethal force,...? That's a low volume event, yet many of us train and equip ourselves, obsessively, for that highly unlikely occurrence. Good lord, this forum is vastly populated with ...."enthusisasts"....who want to be prepared for a wide variety of fantasies with far lower probability than a SWAT officer taking a round in the chest. The odds are against that ever happening but if the need arises, the survival rate for emergency thoracotomy for penetrating trauma is somewhere between 20% and 30%.

I should emphasize that emergency thoracotomy survival depends on it being done by someone who knows how to do it. I mention that in case various forum members get the idea that they should be adding a Touffier retractor to their "gunshot wound blowout" kit.

[chuckman]

The guy's an ER doc, you said. I know very few ER docs that don't know how to do a resuscitative thoracotomy. It's covered in both ATLS and CALS and is part of the curriculum for virtually all ER physician residencies. I certainly agree that resuscitative thoracotomy is a low volume, low probability event , but....many people on this forum carry a gun every time they leave the house. The need to defend your life with lethal force,...? That's a low volume event, yet many of us train and equip ourselves, obsessively, for that highly unlikely occurrence. Good lord, this forum is vastly populated with ...."enthusisasts"....who want to be prepared for a wide variety of fantasies with far lower probability than a SWAT officer taking a round in the chest. The odds are against that ever happening but if the need arises, the survival rate for emergency thoracotomy for penetrating trauma is somewhere between 20% and 30%.

I should emphasize that emergency thoracotomy survival depends on it being done by someone who knows how to do it. I mention that in case various forum members get the idea that they should be adding a Touffier retractor to their "gunshot wound blowout" kit.

No doubt he can do it; I know very well what ED docs can and should not do (and although ATLS is a doctor's club merit badge, Uncle Sam made me take it when I was a corpsman). My arguments with physicians are not what they can do but rather what they should do (in the field). Docs are usually accustomed to having what they want and need and the problem with some (and certainly not all) non-mil docs that I have seen in the TEMS environment is they think they can have it all. You can't. There is so much room in bags and kits and vehicles. What gets the boot? OK...so what's the back-up plan when you crack the chest, and the scene is hot and you cannot transport? What's the plan for follow-up care? Who is managing the airway? Where are you getting blood to transfuse? Many docs in the field just don't think like that because that's just not their training. When it happens in the ED the algorithm is very clear. I like to think I had the 'ying' to their 'yang' to make it work, in the same way I would not recommend an EVD kit.

I agree with you re: training for a lethal encounter, but even so, if you pull the trigger, the algorithm is almost over, and the follow-up is clear: scene safe, weapon away, call the cops, call a lawyer, shut your mouth. It does not depend on resource allocation, equipment availability, etc.

Maybe I was not clear in my posts...I in no way devalue a doc in the field, and absolutely support having properly-trained advanced providers in the field. My argument is what is and is not reasonable and prudent and logical regarding load-outs and treatment. Again I do not lump all docs together and mileage will vary.

[Hmac]

No doubt he can do it; I know very well what ED docs can and should not do (and although ATLS is a doctor's club merit badge, Uncle Sam made me take it when I was a corpsman). My arguments with physicians are not what they can do but rather what they should do (in the field). Docs are usually accustomed to having what they want and need and the problem with some (and certainly not all) non-mil docs that I have seen in the TEMS environment is they think they can have it all. You can't. There is so much room in bags and kits and vehicles. What gets the boot? OK...so what's the back-up plan when you crack the chest, and the scene is hot and you cannot transport? What's the plan for follow-up care? Who is managing the airway? Where are you getting blood to transfuse? Many docs in the field just don't think like that because that's just not their training. When it happens in the ED the algorithm is very clear. I like to think I had the 'ying' to their 'yang' to make it work, in the same way I would not recommend an EVD kit.

I agree with you re: training for a lethal encounter, but even so, if you pull the trigger, the algorithm is almost over, and the follow-up is clear: scene safe, weapon away, call the cops, call a lawyer, shut your mouth. It does not depend on resource allocation, equipment availability, etc.

Maybe I was not clear in my posts...I in no way devalue a doc in the field, and absolutely support having properly-trained advanced providers in the field. My argument is what is and is not reasonable and prudent and logical regarding load-outs and treatment. Again I do not lump all docs together and mileage will vary.

I agree with you about doctors in the field. They can be a pain in the ass. You are absolutely correct in that a well-trained paramedic in the field is far more valuable than a physician. When I was EMS Director around here, I instructed the Paramedics that if a doctor showed up on scene, they were to ignore him or her. We had too many issues with dermatologists and Family Practice doctors showing up at an accident and start issuing orders. This lack of physician field competence certainly isn't universal, but it's not something I wanted the EMP-Ps to ever have to worry about sorting out in the field. If I ever happened to show up at a scene, or ride-along, I always made a conscious effort to just stand there with my hands in my pockets and my mouth shut while those guys did what they do. I can't think of a time when any medic out in the field ever needed me for anything other than heavy lifting. They were always polite enough to ask if I had anything to add, but I was always smart enough to say "no'.

Now...I thought we were talking about thoracotomies. There might come a time, in the field, when something really dramatic occurs. Then, an ER doc who knows how to do thoracotomies might be valuable. As Tactical EMS Medical Director, I eventually stopped doing entries. In reality, I was probably more valuable sitting in the TAC van drinking coffee in case of the unlikely event something would happen, like penetrating chest trauma. First line EMS...that's not my strong suit. My biggest contribution to the team was my medical license, my willingness to take responsibility for the medics, and my ability to write protocols. My ability to do a thoracotomy in the field was just never very helpful, as it turned out over 15 years.