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 Utilizing outdated protocols as compared to the latest military medicine.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.

[Gutshot John]

Well it appears I've butt hurt a Paramedic.... figure the odds. Do note I caveated with "finite time & $$ allotment".

For the time spent away from ones primary job earning $$, the time spent learning outdated IMO modalities of treatment, and the cost associated with course fees.. not to mention travel or lodging requirements.. I think Paramedic is a waste. It is a course/cert, and Standing Orders of treatments, designed to carry one through a highly litigous work place.. not to prepare one for the rapid assessment and treatments required in armed conflict.

There are shorter, more direct, cost effective ways of getting relevant training suitable for austere enviornments & conflict. As all thing in life.. you get what you pay for.

I would prefer to have a trained assaulter (not even a SOF medic) with one to two weeks of high level med skills training scoop my ass off bullet ridden streets than a Paramedic. How many live amputations, broken spines, gunshot wounds to assorted areas, needle decompression, burned airways, smashed airways & cricks ON LIVE TISSUE have Paramedics done in their training... NONE vs several for members of highly trained units.

If your not a Corpsman ( I was a Paramedic) I wouldn't compare your "scope of practice".. really are you serious.. you did notice 1) there is a war going on they get a little work 2) military medicine isn't stagnated by the lawsuit driven civilian protocols 3) are you even aware of the scope a Corpsman has v Fleet Marine Force (FMF) Corpsman, vs A Spec Ops Independent Duty Corpsman (IDC) vs a Submarine IDC vs.. get the drift

Wow...I guess I butt-hurt an 18D...what are the odds? Funny how that cuts both ways? You made it personal when it really didn't have to be. Your statement doesn't really add to your credibility only the smug level. I'm quite aware of the differences between the scopes of practice. I've been both (yes with the FMF, yes in remote settings). I'm proud of being both. You made it about civilian v. military. Most here are civilians so what do you think is more relevant here? So please, spare us the bluster.

First, I'm quite aware there is a war on, but 18Ds invariably are in support of their team not in daily contact with patient-care especially traumatic patient care. Big difference. Similarly the individual I know at GORGRP who did their hiring/training didn't look for guys with 18D certification, he looked for guys with REAL operational medical experience though some were indeed 18D, others aren't. This means daily experience in patient care. Even if you have that, what skills exactly are you using on a daily basis that a corpsman/paramedic isn't? Seriously dude, you and I both know that the life of an 18D isn't filled with cool, extravagant healthcare techniques on a daily basis. Similarly as a civilian paramedic I've done needle decompression, needle crikes, emergency crikes, assisted with chest tubes by radio command, handled traumatic amputations, more than a few (drastic understatement) spinal cord injuries including an internal decapitation etc..etc..etc. So what? You'd still prefer someone who's had the training instead of someone with that experience? I guess that makes sense.

Second, please tell me what high-speed skills you use regularly as an 18D that Corpsman/Paramedics don't? I'm guessing that most of the time you're not doing much more than either of the latter, let alone an EMT-B. You're doing venous cutdowns...how often exactly? Weekly? How often are you doing hour long plus transports? I've done quite a few, in the military and out.

Third, I've seen lots of guys with lots of high-speed training come out of the military and when faced with civilian car accidents, pediatric trauma, GSW trauma who shit the bed. Training is definitely not the same as experience and experience treating actual patients is far more valuable than all the high-speed training in the world that you may or may not actually get to do. If you prefer training to experience, well that's your preference, I disagree.

Fourth (and maybe most importantly) if you had read my original post you would have seen that I added as many caveats as you did. I never argued that an EMT-P was the most cost-effective method of training...but if a civilian is going to spend $2K on a 3 day TCCC class (that's not going to be relevant to 99% of the people here) well I'm sure you can figure the rest out. If you're going to spend that kind of money, you can get lots of good training/experience in an EMT-P program. If not, than this conversation becomes academic.

Check your ego at the door brother. This isn't about you or me this is about what's going to be effective for those here that are neither 18D, paramedics nor corpsman. Please try and read everything I wrote, it might avoid some of the confusion above.

[Decon]

Your looking for this:

http://deploymentmedicine.com/dmi/dmoc.html

oops!!

[STAFF]

Gutshot John, becareful in your comments. Dano5326 is a SME on this forum and there are VERY few of them so take that as clue that they have been there and done that.

[NinjaMedic]

When I was working as a paramedic, after having been an military medic I was surprised to find the limits of the scope of practice. Sutures, needle decompression, chest tubes, antibiotics for gross battle wounds, etc.. Nope.

Dano, while I agree with the point you are attempting to make I think you are overgeneralizing the pre-hospital community. Just as there are varying KSA's amongst the military personnel assigned to medical duties, very few paramedics among different agencies will have the same experience, training, equipment, capabilities and scope of practice. You might be surprised to learn that as a civilian only paramedic I have been trained on each of the skills/procedures you list above, and depending on the medical director many systems have these in their protocols. While I think TCCC training is the way to go if you primarily expect to see traumatic injuries, comparing it to the broad spectrum medical training and experience with actual patients that you gain through paramedic training probably doesn't do justice to either program.

[Gutshot John]

Gutshot John, becareful in your comments. Dano5326 is a SME on this forum and there are VERY few of them so take that as clue that they have been there and done that.

Perhaps you should take it up with him. Both before and after he offered his patronizing tone, I continued to refrain from personal commentary, something the "SME" failed to do. All I had said was he was "overstating" his case. He made it personal. When I did respond, I used the EXACT same language he used, mostly as a way of making a point. If my words were out of line, his definitely were. Moreover as an SME, his observations about scope of practice of civilian paramedics were flat incorrect. He did not qualify any of his comments by saying "in my community" etc. He made a blanket generalization about something of which he had no direct knowledge which is something I thought this forum frowned upon.

As for being an "SME" I know a thing or two about both military medicine and civilian EMS, in fact I have nearly 20 years experience combined. If you think my comments were incorrect, I'd be happy to answer specific questions, but being careful about one's comments should apply as much to the SME as others, in fact probably more so.

I give as much respect as I am given.

[NinjaMedic]

Also I would argue Gutshot that your comparison is like saying that a Larry Vickers class is as expensive as some community college peace officer programs. A police academy will teach you when and how to safely employ deadly force within the confines of the LEO's responsibility, Larry Vickers will teach you how to best employ deadly force with a sidearm. Yes a police academy will teach you to shoot a pistol but you will be more proficient after the Vickers class. Paramedic school will teach you the pathophysiology behind a tension pneumothorax and tell you that that you should prevent it or fix it. A good TCCC class will teach you the best ways to fix a tension pneumothorax. Different philosophies, methods, and focus'.

BTW - Gutshot and Dano, for what its worth I respect both of your opinions but I think you both need to take a step back and look at how you are presenting your thoughts. I think both of you took inappropriate approaches to presenting your opinions and as a result you got very little useful info out to anyone else. We are all trying to share our thoughts, opinions, knowledge and experience for the benefit of ourselves and the other members of the forum. Thank you both for your service and dedication.

[Gutshot John]

Also I would argue Gutshot that your comparison is like saying that a Larry Vickers class is as expensive as some community college peace officer programs. A police academy will teach you when and how to safely employ deadly force within the confines of the LEO's responsibility, Larry Vickers will teach you how to best employ deadly force with a sidearm. Yes a police academy will teach you to shoot a pistol but you will be more proficient after the Vickers class. Paramedic school will teach you the pathophysiology behind a tension pneumothorax and tell you that that you should prevent it or fix it. A good TCCC class will teach you the best ways to fix a tension pneumothorax. Different philosophies, methods, and focus'.

The point was that for $2K, that a paramedic class would actually give you MORE technical skills, and more opportunity to practice them. The class mentioned above was primarily geared to military/LEO personnel so probably not appropriate to most here, especially given that TCCC can't really be applied on an individual level. By definition it requires a system of care above the individual. As I said in the post #2, there is a lot of confusion about what TCCC is and is not. The treatment techniques of TCCC aren't really that much different. They essentially treat a tension pneumo the same way with minor variations in order of operations.

I don't see Larry Vickers offering a three day class for $2k, but maybe others know something I don't. That said the average person here is not going to be doing decompression on themselves or others. Unlike the reputation/stereotypes about cops and shooting that I've heard here (and in a Vickers class for that matter), a far greater percentage of paramedics I know take great pride in their craft/skills and have to continually train for CMEs. I don't know if PD have an equivalent to CMEs, but they should.

BTW - Gutshot and Dano, for what its worth I respect both of your opinions but I think you both need to take a step back and look at how you are presenting your thoughts. I think both of you took inappropriate approaches to presenting your opinions and as a result you got very little useful info out to anyone else. We are all trying to share our thoughts, opinions, knowledge and experience for the benefit of ourselves and the other members of the forum. Thank you both for your service and dedication.

Fair enough, but if you go back and read, all I said was that he was "overstating" his case. Something I think you concurred with. I don't know of anyone that responds well to being patronized.

Please forgive my weakness and if it will help everyone involved...I apologize.

[K.L. Davis]

And this one took a wrong turn somewhere. The Staff can open it back up if they want, but it is my opinion that the majority of the content has nothing to do with the original topic, better luck next time.

[KevinB]

I am not going to open this at this junction of time.

However I will point offer that Live Tissue work is a necessity for learning trauma, and how to treat it.

Very few schools offer live tissue testing, and I don't know of any open classes that do. I know of some private instruction give to elements, and they are very very expensive.

Having taken both a week long Combat First Responder class, and a 3 week TCCC type course, I learned more in a 1 week hands on Live Tissue Trauma class than I had in the others.

Secondly having had both civilian ParaMedics and 18D and other mil 'medical professionals' (*not a slight I am just refering to PJ, and other SOF medics) on teams I have worked on, I know which I would prefer.


Any TCCC class better be having a field segment, where the student (if not a Infantry/SOF guy) learns the Combat side, as winning the firefight is #1.

Self Aid, Buddy Aid, Medic Aid, Med-Evac to Hospital Care.


I have a Trauma kit - but thats a hangover from a previous life. I'm not going to be doing needle decompressions, or emergancy tracheotomies at the range or a CCW encounter.