View Full Version : Got selected as an SRT Medic!
citizensoldier16
05-19-14, 19:46
Well, I've been a medic for about 4 years now, and finally got selected to start training as an SRT medic with my local sheriff's department! I'm pretty psyched about it. Any seasoned SRT medics have any advice? We started the military version of PHTLS today.
SpankMonkey
05-19-14, 19:48
No advice but congrats man.
Advice as an SRT medic no, but as a guy who's on the assault/entry team yes. I'm not sure what your dept.'s SOP's are, but when the guys are breaching and making entry stay out of the way. Stay close, but don't try and beat them through the doorway. Every Team is different. Our Dr. hangs back by the vehicles, but I've seen other Teams in our area give their Dr.'s guns and throw them into the back of the stack. Good luck and stay safe.
soldier_twiggy
06-04-14, 05:13
Put pressure on the red stuff?
essayons
Advice as an SRT medic no, but as a guy who's on the assault/entry team yes. I'm not sure what your dept.'s SOP's are, but when the guys are breaching and making entry stay out of the way. Stay close, but don't try and beat them through the doorway. Every Team is different. Our Dr. hangs back by the vehicles, but I've seen other Teams in our area give their Dr.'s guns and throw them into the back of the stack. Good luck and stay safe.
I was Medical Diector for our 6-member Tacticsl EMS team. We provided support to the TAC Team as well as the Bomb Squad and Dive Team. We were always armed, actually did the entries with the entry team. A few years ago the state Attorney General issued an opinion that the Tactical medics shouldn't be armed, so I quit doing the entries (and carried concealed instead) hanging back at the van or command post, and we'd send two medics in, armored but not armed. My decision not to do the entries also coincided with new OSHA rules that everyone who did the entry on an active meth lab had to be decontaminated on-site. Stripping down outside while a fire department team hosed me down didn't appeal to me, this being Minnesota and all.
I did that for 15 years. It was a blast. We got to shoot all kinds of cool weapons, qualify on an M113 APC, do rappelling, learn the rudiments of explosives...we even trained to do helicopter assaults (marijuana grow operations with the DEA, THAT was a hoot). Things are a big more tame now. New Sheriff, new political climate, new tools, more money, but it's still a hoot.
No advice...every team is different with different rules and protocols. We required that all the medics be qualified as Tactical Paramedics (TCCC, CONTOMS, or a couple of other high quality Tactical EMS courses around the country). I'd recommend TCCC these days.
I was a tac medic for a few years. Most fun I have had outside of the mil. Enjoy it...eyes and ears open, PT your butt off, be part of the team, and don't be 'that' guy. You will have a great time. Coastal NC? Where?
citizensoldier16
07-11-14, 22:16
Use to be in Wilmington working for NHRMC. Now in Columbia, SC. Finally got around to changing my location in the profile.
I need to work on strengthening my core. Unfortunately they only supply us with armor plates in the front. That plus the medical gear I'm required to wear up front makes my armor very front-heavy and I ended up with pretty bad back pain after an 8 hour training session at North American Rescue a few weeks back. Any suggestions on how to work those muscles? I'm hopeful they'll eventually supply the medics with hard plates front and back...but that wont be until next budget year if at all. Any thoughts?
Any suggestions on how to work those muscles?
Deadlift and pullups.
...and burpees, planks, and bear crawls. How long were you with New Hanover? Good friend was a medic there for a while...Mark Bennett.
JAustin316
09-23-14, 21:58
Congrats!
TacMedic556
09-23-14, 23:38
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
09-25-14, 08:15
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.
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.
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).
?.... (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.
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.
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.
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.
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.
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.
Thanks for your perspective. Docs are like everyone else (well, actually they are not, but you understand what I mean...), the whole bell curve: some are awesome, most are pretty good, some are walking disasters. My experience has had all three. The best TEMS medical director? A neurosurgeon (not my team, sadly). The worst? An ED doc (for our team, sadly). Go figure. What I appreciate about this forum, and others, is the ability to share perspectives and ideas with advanced providers because we come from such differing backgrounds.
^^ wonders which pouch will hold a Tuffier and fit on a plate carrier. How about a double shingle that would hold both a Tuffier and a tactical speculum. :cool:
Great discussion guys.
^^ wonders which pouch will hold a Tuffier and fit on a plate carrier. How about a double shingle that would hold both a Tuffier and a tactical speculum. :cool:
Great discussion guys.
OMG...I wish I had thought to velcro a vaginal speculum, or better yet a rigid proctoscope, to my chest rig at a training exercise. I'm thinking the proctoscope over the back, in a scabbard Ninja-sword style. That would have been hilarious.
http://www.proctoscopeexam.com/Medical018as.jpg
^^ wonders which pouch will hold a Tuffier and fit on a plate carrier. How about a double shingle that would hold both a Tuffier and a tactical speculum. :cool:
I'm putting mine just left of my Gold, commemorative ARFcom Tourniquet in a kryptek camo pouch!
I weep for the lost opportunity. Of all the practical jokes I pulled on those guys over the years, I can't believe I missed that one.
It takes time to really click with the PD guys, it'll happen just don't try and force it. Ours love and respect our "docs" as they call us but they don't care about "you" for a while. Just like being new anywhere else, you have to prove yourself and to them it's a much higher/different standard. You'll love it though, awesome times
If you do not have one already pick up a copy of the ranger medic handbook. It has been echoed here already but the text will give you some great ideas on how to streamline your gear (biggest bang for your buck).
Use to be in Wilmington working for NHRMC. Now in Columbia, SC. Finally got around to changing my location in the profile.
I need to work on strengthening my core. Unfortunately they only supply us with armor plates in the front. That plus the medical gear I'm required to wear up front makes my armor very front-heavy and I ended up with pretty bad back pain after an 8 hour training session at North American Rescue a few weeks back. Any suggestions on how to work those muscles? I'm hopeful they'll eventually supply the medics with hard plates front and back...but that wont be until next budget year if at all. Any thoughts?
If it is just balance you want you could buy a training plate or cheap steel plate to go in the back. Or a cheap and heavy ceramic so you get balance and protection.
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