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Paramedic course upgrades flight medics' skills

Oct. 23, 2012 - 07:14AM   |   Last Updated: Oct. 23, 2012 - 07:14AM  |  
A flight medic lowers to the ground with a German soldier during rescue hoist training. The Army is graduating the first class of soldiers who got a broadly expanded training regimen.
A flight medic lowers to the ground with a German soldier during rescue hoist training. The Army is graduating the first class of soldiers who got a broadly expanded training regimen. (Army)
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Staff Sgt. Elena Clark, a flight medic with four war-zone deployments, said she can open a wounded soldier's airway, stop his bleeding or treat him for shock, but her training never told her why to take the steps she did — until now.

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Staff Sgt. Elena Clark, a flight medic with four war-zone deployments, said she can open a wounded soldier's airway, stop his bleeding or treat him for shock, but her training never told her why to take the steps she did — until now.

Clark is among the first flight medics to be trained in advanced skills as the Army seeks to give better care to patients on medical evacuation helicopters. To do that, the Army is turning 21 weeks of training into 55 weeks.

The service plans to train 950 flight medics, known by their Army designation as 68Ws, to become paramedics by 2018. The Critical Care Flight Paramedic Program's first class of 26 at the Army Medical Department Center and School in San Antonio graduated Oct. 16.

"The paramedic level is absolutely applicable downrange," said Clark, of the 10th Mountain Division. "We learned about anatomy and physiology, about cellular metabolism. It's more in-depth. It's why we give these drugs. This is what we're trying to get the heart and the body to do."

The need to upgrade training for flight medics was driven by the complex types of injuries emerging from Iraq and Afghanistan, multiple amputations, brain injuries and other kinds of blast trauma related to roadside bombs — and long distances they must fly to get advanced care, said Lt. Col. Robert Mabry, a pre-hospital care specialist and special operations medic who devised the plan.

"What these medics do [on the battlefield], and the complexity of what they do in helicopters, is just incredible, and the training ensures that they will be more competent and confident in the job," Mabry said.

While the Army's trauma care system and the civilian flight paramedic model have advanced, its medevac model hewed closely to its Vietnam-era roots, leaving a gap in care for troops and flight medics without the best tools, Mabry said. The new training fills the gap by bringing Army training in line with civilian standards.

An Army study recently published in the Journal of Trauma and Acute Care Surgery found that National Guard units whose medics were civilian paramedics had a 66 percent higher survival rate than helicopter evacuation units with standard personnel.

Most Army flight medics receive monthlong training, which includes EMT-Basic, the certification and training all ground combat medics must attain. The course trains troops to provide basic care but allows them to deploy without ever having treated a patient.

"In the civilian standard, you don't just roll in there as a flight medic. You need to have three to five years of varied, hands-on experience," Mabry said.

The new six-month course provides 1,100 hours more training, as well as hands-on experience with live patients. The students work with civilian flight paramedics in San Antonio and in the intensive care unit at Brooke Army Medical Center.

"Their 68W course is all simulations, and this gives them hands-on experience doing advanced en route critical care skills," said Dr. Brian Krakover, the director of the school's pre-hospital medicine branch.

Flight medics, after the training, can administer medicine and intubate a patient. Perhaps most significantly, they can administer blood products, staving off one of the most common and preventable causes of death, hemorrhagic shock.

"What we're finding with patients is they need blood transfusions and airway management at the point of injury," Mabry said. "We're learning if we're going to make a difference in these patients, it's got to be right at the point of injury."

Although the class compresses the typical yearlong paramedic training, graduates have to prove the same knowledge as civilian flight paramedics, and they receive the same EMT-Paramedic credentials, Krakover said.

All 26 graduates took and passed the National Registry of Emergency Medical Technicians exam, Krakover said.

Better critical thinking

The new course also aims to give flight medics better critical thinking skills and the autonomy to administer a broader range of care. Typically, a flight medic is trained to follow a predetermined course of action without an in-depth understanding of the science behind it.

"For now, EMTs and nurses have a set of protocols, and if the situation doesn't meet their protocols, they have to call for medical advice," Krakover said. "That's not always possible in the back of a helicopter."

Staff Sgt. Todd Barbin, a graduate of the course with four war-zone deployments, said he now has a better understanding of what happens when a patient goes into shock, which organs shut down first; and the rationales behind the treatment options.

He said two weeks of the course were dedicated to neurologic systems, which, given the numbers of traumatic brain injuries he sees, he would be sure to apply in the field.

"The biggest thing we got out of this class is the why — why this medication might work or why this treatment might work," Barbin said. "We can actually see a patient and know what's going on and what to do next if a treatment doesn't work."

Mabry said the broader skills will be better suited to an Army that is more versatile and expeditionary. He predicted that flight medics will be more apt to stay in the job, strengthening the Army's core capabilities.

To Clark, the training represents a departure from a perceived prejudice against medics — that as enlisted troops, they're not smart enough to provide comprehensive trauma care, or that they might use better training to leave the Army.

"There are people who think that flight medics are amazing, that the things they accomplish are incredible, and there are naysayers that say we put tourniquets on and throw them off at a hospital," she said. "For us, it was a great opportunity."

The new skills are welcome in light of the difficult work flight medics have, often flying into one horrific situation after another, said Sgt. 1st Class George Hildebrandt, the noncommissioned officer-in-charge of the course. The job can take a heavy toll.

"You can tell yourself that you'll be OK. But what we see isn't normal, and you won't get used to it," Hildebrandt said. "They will have feelings about what they see and what they're doing."

The makeup of the first class is an even three-way split among active duty, Guard and reservists. All have deployed previously, mostly as flight medics. The training was optional, Hildebrandt said.

Hildebrandt praised the spirit of the flight medics in the class. Some had been shot. Others have broken bones dangling from hoist cables. Still others entered the class fresh from deployments, knowing they would deploy again soon after.

"That's just the psyche of a flight medic, that they want to learn more and do more," Hildebrandt said. "They chose to be here."

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