A method for training combat medics during stability and support operations

Military Medicine, Apr 2002 by Dombroski, Todd

Regardless of the conflict situation, highly trained combat medics (medics assigned in maneuver units) are a combat multiplier for military operations. Keeping medics (and physicians) well trained and motivated has many challenges, and we propose a program of instruction in six different nationally recognized courses to address these concerns and achieve the objective of providing medical training in this environment. We tested our program during our recent deployment to Kosovo. A total of 138 certifications were given during a 30-day period to 90% of our population of 120 medics.

Introduction

With the current global political climate, the majority of U.S. military operations have not been the high-intensity conflict scenario that dominated preparations and exercises during the cold war. Currently, the majority of our military operations are stability and support operations (SASO). The operational tempo of Table of Organization and Equipment (TO&E) units has increased dramatically in the past 10 years with the overall decrease in the force and the increased involvement of the military in SASO.1 TO&E units are field maneuver units and field support units. Fixed-facility units that do not deploy intact are Table of Distribution and Allowances units. TO&E units often deploy for 6 or more months on missions in austere environments. Critical medical skills and knowledge can atrophy2 without periodic training and practice (assuming that all medics were trained to standard on their critical trauma-related skills before the deployment). We assert that the training of medics assigned to field maneuver units before and during SASO will have a positive effect on their competence, which could translate into increased confidence in their knowledge and skills as medics. Significant expense and effort was dedicated to the construction and maintenance of weapons ranges in Kosovo to maintain weapons proficiency. A similar program needs to be adopted for other perishable skills.

We propose one method of training combat medics during deployment for a SASO mission to an imminent danger zone (Kosovo).

Background

The U.S. armed forces have been deployed for SASO beginning in Kuwait, then in Haiti and Bosnia, and now in Kosovo. Many reports have documented that the civil infrastructure of these regions ranged from a state of disruption to a complete absence.3 This environment makes it very difficult to rely on a civilian health care system to serve as a backup for military medical personnel on the ground. Given this environment, the combat medic should have a higher level of medical skills than would be required in garrison.4

The high operational tempo and instability of the regions undergoing SASO has made such training difficult to arrange within the scope of ongoing operations. Commanders operate under a troop-to-task ratios that often does not allow them to release a medic from the mission for more than a few hours to a few days. This makes intensive medical training of the medics more challenging to perform. For example, when the authors approached the battalion task force commanders in Kosovo to propose a training course for the medics, the commanders would not release medics from their daily support missions on patrols and checkpoints for a 4-week Emergency Medical Technician-Basic (EMT-B) course. These commanders' rationale was that such a long training event would pull medical personnel from ongoing operations, leaving the combat elements without adequate medical support. This was a risk that they were not willing to accept. Although combat medics should ideally be trained to standard in all manual medic-specific skills before deployment, this seldom happens as a result of time, personnel, funding, course availability, and mission constraints. This was noted in both brigades of the Ist Infantry Division before their deployment to Kosovo (BG R. Sanchez, personal communication).

During discussions with the deputy commander for clinical services of the 67th Combat Support Hospital, it was proposed that the combat medics in Kosovo be released to the echelon III hospital (the 67th Combat Support Hospital) in country to establish a program similar to the medical proficiency trainings done in garrison. Such a program normally lasts 60 to 90 days in garrison. Although this model program is an excellent way to increase the knowledge and skills of individual medics in garrison, it was not a practical option for the deployed forces in Kosovo. The number of medics who would benefit from this type of program during a single deployment was very small, compared with the overall number of medics in theater, thereby diluting the impact of such training. This proposal was also dismissed by the line commanders because of the length of time a medic would be absent from the unit in the field.

Based on personal discussions with a physician assistant who was deployed to Bosnia (1LT M. Curtis-Mathews, formerly C Company, 201st Support Battalion) and a Medical Service Corps officer (CPT B. O'Leary, formerly C Company, 201 st Forward Support Battalion) who deployed to Albania under Communication Zone West, the only medical training they observed during that time was in the form of informal instruction by the physicians based on the patients who presented for treatment. Although this form of instruction is excellent and forms the backbone of modern physician training in medical centers throughout the world, the population of medics working in the battalion aid stations was only a small percentage of the entire medic population. This was essentially the same report from the SASO to Haiti (COL M.A. Pasquarella, personal communication). There was not a program that targeted the majority of the medic population with a nationally recognized course of instruction in medical and trauma-related skills.