Tactical Combat Casualty Care

[Gutshot John]

If your looking for combat or trauma medicine training, and have a finite time $$ alotment.. Paramedic is a waste of time. A Paramedic works within narrow Standing Orders of the city/county.. and a 10-20 minute ride to a trauma center. Utilizing outdated protocols as compared to the latest military medicine. As a life experience.. it will teach you alot...

Waste of time? I think you're overstating your case a bit. It may not be suitable for everyone, but it's hardly a waste of time/money, especially when you get people charging $2k for a 3-4 day class. That's a completely waste of time money. It may teach you some skills, but if you don't get to practice those....well they are perishable skills. That said suggesting a paramedic class was only by comparison to the overpriced class above not as an end-all be-all solution.

Military medics have a broader scope of practice, but they don't always get the field experience (current 18Ds I know acknowledge this) that paramedics get. The venous cutdown training is great, but not applicable to 99% of those here. Similarly I've done extrications/transports that lasted hours as a civilian so I'm not sure your 10-20 minute window is universally true. True in your case perhaps, but not true for everyone.

Though I don't know what happens in CA/TX, here the protocols are not developed by the county/city, they're developed by EMS Physicians who then give command to their paramedics. My scope of practice as a civilian paramedic was not that much narrower than as a Corpsman, by virtue of the proximity. Similarly my scope of practice exceeded RNs/BSNs who weren't even allowed to intubate patients.

As you said having hands-on with an actual patient is far more worthwhile than getting a bunch of high-speed skills you may get to apply 2-4x a year as opposed to 2-4x a week. PHTLS in itself will add significantly to your tactical knowledge unless you're already a high-speed/low-drag 18D type.