What it’s like to transition from combat medic to civilian EMS
Career paths for a U.S. Army MOS 68W (health care specialist)
The process to become an enlisted Army medic begins with the ASVAB exam (a standardized test that reveals areas of strength and ability in science, math and language) and your career counselor at the Military Entrance Processing Station (MEPS). Traditionally, the U.S. Army MOS 68W (health care specialist) career choice would require above-average ASVAB scores. However, score requirements may vary depending on the needs of the Army.
After you sign your contract, you are sent to basic training – this is where everyone’s training begins. You will go through basic training with many other soldiers with different career paths. My bunk-mate was a communications specialist, and one of the guys a couple of bunks down was an air traffic controller.
The training to become a soldier is standardized; you learn customs and courtesies such as how to march, dress and how to address superiors. You will be constrained into a disciplined lifestyle of eating on a strict schedule, physical training every morning, and being verbally and physically (in the form of PT) reprimanded. You also learn how to fire various types of weapons and you are issued your own personal rifle for the duration of training. Basic training lasts approximately 10 weeks.
Advanced individual training
After basic, you attend advanced individual training (AIT), which lasts 16 weeks. The first 7 weeks of healthcare specialist training consist of an accelerated civilian-style EMT course, where you sit for the national registry at the end of the 7-week period.
After this period, the remainder of the training is focused on combat medic training, which focuses on care of the traumatically injured, austere environments and tactical casualty care. During this time, you revert back to the lifestyle that you experienced during basic training, and you adhere to a strict, controlled way of life.
Combat medic roles
When you arrive at your assigned unit, medics typically operate as line medics or they work in the clinics and hospitals on base. There are pros and cons to both paths, and you typically don’t have a choice in what type of medic you become. I was a line medic assigned to a cavalry troop, and line medics typically assume the roles of the combat units that they are assigned to in addition to their medic responsibilities. You are considered a “grunt,” because if you are not performing your role as a medic, you are typically doing the job of the grunt or infantry, cavalry scout, etc.
It is your responsibility to provide medical coverage to your platoon, and you gain the trust of the soldiers who may call you “doc.” It is the battalion headquarters’ responsibility to train the line medics, typically led by a senior non-commissioned officer medic and a physician assistant (PA), so that the line medics are well prepared to care for their soldiers.
Experiences vary drastically depending on the unit that you are assigned to, the leadership structure and the emphasis that is placed on medical readiness. Some of the experiences that you may encounter are unparalleled training, as you may get opportunities to attend tactical casualty combat care courses led by combat-experienced providers, live swine labs and interprofessional training during field training operations.
Other roles medics may perform are similar to technician jobs at clinics and hospitals on base. You typically act as a medical assistant by drawing labs, assisting with medical procedures, rooming patients, restocking supplies and other tasks assigned by your leadership. You typically work closely with PAs or physicians. These medics may be considered more medically knowledgeable, as they have exposure to the clinical side of things and have the ability to learn from their assigned provider. By experience, you tend to pick up on different types of medications, incision and drainage procedures, and basic clinical workups.
I’ve performed both roles at some point during my time as a combat medic, and they both have their advantages and disadvantages. Namely, as a line medic, it may get tiring living the basic training lifestyle all the time, living up to high expectations from your command, getting smoked (constructive PT) for unacceptable performance, spending long hours in the motor pool inventorying vehicles, going out to the field and living off MREs.
Working in the clinic, you learn to miss the outdoors and playing in the mud, so to speak. The work may seem mundane, with healthy young soldiers coming into the clinic with non-emergent complaints such as knee and joint pain and sexually transmitted infections. You find yourself taking those field experiences for granted, and especially in retrospect, you appreciate the discipline you were instilled with and the high expectations set by your leadership. You learn to appreciate your seniors, especially in a combat setting where your leadership has vast amounts of combat experience – it provides you with a sense of safety going into combat with them.
Transitioning to civilian EMS
Transitioning into civilian EMS is very different.
You leave the Army with an EMT-B certification, which, most of the time, qualifies you to work in special events or as part of an ILS crew (non-emergent responses or interfacility transfers only). Although your experiences as a combat medic exceed EMT-B, an experienced AEMT in a busy 911 system has exposure to a much wider population of patients and experiences than the combat medic who specializes in trauma and sees only military-aged, otherwise healthy adults. Leaving the Army, I thought I was good at IVs, until I ran on a patient who was a former IV drug user and had no palpable veins. That’s when I discovered the need to look at the fingers and feet for vascular access.
I started paramedic school as an EMT-B with experience as a combat medic with a combat deployment. I recall sitting among several AEMTs who had 2-3 years’ experience in their respective 911 response agencies, and I remember how intimidated I felt overhearing their “war stories.” One particular AEMT was talking about a call he and his partner ran, where this patient with an asthma exacerbation was circling the drain and how they had to hang “mag” to turn them around in addition to inline DuoNeb on the CPAP.
Other lingo that was completely unfamiliar to me included “9 echo” (cardiac arrest), STEMI, breather, “drop a tube.” This all sounded like an entirely different language, and I genuinely felt like I was behind and maybe I shouldn’t be there.
I quickly became employed at one of those 911 agencies and gained some street experience. And, come to find out, many of the stories that I would overhear were the AEMTs passively learning from the paramedics they worked with, and their actual scope of practice was pretty limited. In other words, I found myself cleaning the gurney and driving.
Today, I am a third-year medical student and a critical care transport paramedic.
There are two morals to this story:
- Jump into opportunities and don’t be intimidated. Sometimes, all you need is a little experience to build on your background. Approach situations with confidence and trust the process of learning and getting the hang of things.
- Every experience is a learning opportunity. This has been my method of learning from being an EMT to now an MD candidate in medical school. Along every step of the way, I learned to be grateful for the knowledge that I had gained from previous experiences. It has allowed me to approach medical school with greater confidence and a higher level of clinical acumen than my counterparts.
Author’s note: My discussions regarding the career paths of combat medics refers to the U.S Army MOS 68W (Health Care Specialist), and does not necessarily reflect the experience of other frontline medical careers of other branches (e.g., Navy corpsman or Air Force paratrooper). My experience of transitioning to Las Vegas EMS and the systems established in this metropolitan area do not necessarily reflect the experience one would gain in a rural setting.