How military medics can transition to civilian EMS
Licensing requirements and varying degrees of experience can make it difficult for returning servicemen to find jobs, but programs are emerging that can help
As a Navy corpsman assigned to a Marine Corps battalion from 2004 to 2008, Brandon VanWagoner did two tours of duty in Iraq.
On missions in and around Fallujah, he treated gunshot wounds, blast injuries from improvised explosive devices and other traumas. And as part of a U.S. military medical team that provided humanitarian care to Iraqi civilians, he treated everything from broken bones to burns, in addition to helping care for Marines’ everyday illnesses.
Yet when he returned to civilian life, VanWagoner found his military medic credentials weren’t much help in finding a job. He applied for positions as an EMT, an ER tech and a nurse’s aide, but he couldn’t get hired.
So he took a job at a local mall.
“It was quite frustrating,” says VanWagoner, a 19-year-old from Fostoria, Mich., when he enlisted. “I took care of people who were sick and injured — very, very injured. I knew I was competent at splinting and taking vital signs and providing basic care, but there were licenses and certificates needed that I didn’t have.”
VanWagoner is far from alone. In fact, the difficulties that former military medics and veterans often have in finding jobs that enable them to put their medical training and experience to use is of growing concern to the federal government and many in EMS.
For would-be EMTs and paramedics, the issues are two-fold: Colleges aren’t sure how to interpret training and experience from military transcripts, so former servicemen and women have to repeat coursework in topics such as trauma that they already know a lot about, costing them time and money.
The other major issue is licensing: State EMS offices have certain requirements that returning service members have difficulty fulfilling. That can include paying fees or undergoing background checks; but it can also include more onerous requirements.
For example, some states won’t grant “reciprocity” for an EMT license unless the license comes from another state, which of course military medics don’t have, so they have to go through a review process with the state in order to get licensed. Other states might require would-be paramedics to be sponsored by an EMS agency before granting a license.
“Despite having valuable military experience, veterans frequently find it difficult to obtain formal private sector recognition of their military training, experiences, and skill sets through civilian certification and licensure,” reads The Fast Track to Civilian Employment: Streamlining Credentialing and Licensing for Service Members, Veterans, and their Spouse, a report issued by the White House in February 2013. “This also makes it difficult for the private sector to capitalize on the resources and time spent training and educating service members.”
To address these issues, last April, First Lady Michelle Obama hosted the White House Forum on Military Credentialing and Licensing, in which stakeholders from several industries — EMS among them — were invited to a series of roundtable discussions about streamlining civilian credentialing and licensing of service members, veterans and their spouses.
“It was very clear that the message to the partners was, ‘We need to do something about this,’” says Dia Gainor, executive director of the National Association of State EMS Officials (NASEMSO), who attended the forum. “Michelle Obama was very pointed in expressing her expectations that we would cut the outdated bureaucratic red tape to accommodate separating service members and veterans.”
Job forecast: Cloudy
According to the White House report, about 844,000 were unemployed as of January 2013, including 252,000 post-9/11 veterans. Statistics from the Council of Economic Advisers show that the unemployment rate for veterans of post-9/11 wars was 10 percent, significantly higher than for non-veterans in a similar demographic group.
And the problem may get worse for unemployed servicemen and women. Between 240,000 and 360,000 leave the military annually. With the drawdown of the war in Afghanistan, 1 million service members may be returning to the civilian world over the next several years — any of whom are young men and women in need of jobs.
Yet even with widespread support for helping service members more easily transition to civilian jobs in EMS, there are significant questions for educational and licensing entities to grapple with, including figuring out to what extent military training and clinical experience are applicable to civilian EMS jobs; figuring out where the gaps are in training and education and finding ways for military medics to receive that training; and deciding whether it’s safe or prudent to waive civilian licensing requirements to make it easier for military medics to make that transition.
One of the challenges for civilian entities in figuring out how military training and experience map to civilian requirements is that there are many types of military medics who do many different types of jobs, ranging from combat medicine to X-ray technician, explains Ret. Lt. Colonel Ben Chlapek, a former Army medic and chair of the National Association of Emergency Medical Technicians’ military relations committee.
The vast majority of military medics are in the Army. Known as 68 Whiskeys, Army medics in recent years have been required by the military to maintain National Registry of Emergency Medical Technicians (NREMT) certification at the EMT-basic level. (The Army also requires its special ops medics to take the National Registry paramedic exam.) The Air Force also requires its medics to pass the National Registry exam, though not to maintain certification. The Navy at one time required the National Registry exam but no longer does, says Severo Rodriguez, NREMT executive director.
Typically, 68 Whiskeys have more training than their civilian EMT-B counterparts in areas such as trauma, and many also have significant hands-on experience in caring for patients. At the same time, military medics might be short on other training applicable to civilian populations, such as geriatric or pediatric skills. That’s what Dennis Lizotte, a former Army Airborne medic from northern Maine who enlisted right out of high school and served two tours in Iraq, faced when he got out of the military in 2012.
“I knew a lot about trauma, but I didn’t know much about trying to decipher between EKG rhythms. I can tell you how to assist someone with a broken leg or someone who was shot, but I couldn’t tell you how to help with a heart attack,” says Lizotte, now 27. “Our patient population is a 20-year-old healthy male, whereas the population on the civilian side could be anybody.”
Adding to the complexity, all of the branches (except the Marines, which use Navy corpsmen) have medics with even more specialized training.
“A special operations medic or a Navy independent duty corpsmen might be doing things like intraosseous infusions, IV medications, invasive procedures, both conscious and general sedation, even independent surgeries such as an emergency appendectomy on a submarine or ship,” Chlapek says. “Yet when they got out, they were having to go through a complete paramedic course, which could take a year and a half before they were able to take the National Registry EMT-P exam.”
State licensing hurdles
Another challenge for former military medics seeking civilian jobs is securing licenses from state EMS offices. After the White House event, “we were instructed to develop work plans subject to White House review and approval about what states would do to facilitate the expeditious licensure and credentialing of separated service members and veterans,” Gainor says, noting that one idea is to develop a matrix that outlines the details of military training so that states would have a single reference to determine the credentials they already have vs. those they still need.
At its December 2013 meeting, the Federal Interagency Committee on EMS made working with state EMS offices to support the transition of military EMS providers to civilian practice one of its key focus areas.
“As we work together with NASEMSO, the Department of Defense and members of the military branches, the trick is to develop a system in which the education and training of the military are honored by the civilian sector, but in which we still make sure it’s done in a way in which there are protections for the public,” says Drew Dawson, director of the National Highway Traffic Safety Administration’s Office of EMS.
NREMT is working with the military on a program to make sure that separating military medics have their NREMT credentials renewed just before they leave the service, giving them two years to make the adjustment to civilian life before they’re due for re-certification.
“It’s not the end-all be-all solution, but that life transition from military life to civilian life has been identified as a very stressful time. They have to think about where they’re going to live, getting a job, their family,” Rodriguez says. “What we’re trying to do is support them so they have more options.”
Michelle Obama also called the National Governors Association to take legislative in helping troops get the credentials they need to transition into the civilian world. Several governors, including in Illinois, responded by issuing executive orders directing state agencies to take steps to develop policies and procedures to apply military experience to licensing standards. In other states, such as California, legislation has been introduced that would also institute regulations to accept military education, training and experience.
Yet Gainor cautions against blanket overrides of state licensing requirements, which are established to protect the public.
“Of course these are individuals we want to do everything possible to assist, but the devil is in the details,” Gainor says. “As you begin to navigate the requirements, the challenge is defining what’s in place to protect the public vs. trust and faith that the individual who served their country poses no risk from a competency or public welfare standpoint.”
Lansing Community College: A national model
While working at the mall, VanWagoner enrolled in the biology program at the University of Michigan-Flint, which had an active student veteran’s resource center. He got involved with mentoring other former servicemen and women on campus and other volunteer work in his community. He became a Tillman Military Scholar, a scholarship given by the Pat Tillman Foundation in honor of the NFL player who enlisted in the Army after 9/11 and was killed by friendly fire.
But his volunteering and studies had to take a back seat when his wife had their first baby, born 13 weeks prematurely. Between trips back and forth to the NICU and his wife unable to work, VanWagoner left school and stepped up his hours at the mall, becoming assistant manager and then manager of the retail store to support his family.
But as his daughter’s health improved, VanWagoner thought it feasible to return to college. A veteran’s representative at the University of Michigan mentioned a military medic to paramedic bridge program at Lansing Community College, about 90 miles from Detroit. VanWagoner eagerly applied.
“One of the things that made this very, very appealing is that its quick pace allows us to start a career soon,” he says.
The Lansing Community College program was initially envisioned more than a decade ago as a military medic to nursing program, until an analysis of the military medics’ training found it most closely resembles that of civilian paramedics, says Lisa Ferris-McCann, program director for EMT and paramedic programs and a paramedic instructor at Lansing Community College.
“They had a tremendous amount of experiential learning and military training, but it didn’t transcript to college courses and it didn’t always fully represent the training they in fact had,” Ferris-McCann says.
With the help of a state workforce development grant of $190,000, Lansing Community College developed a curriculum and launched its first pilot program with five former military medics in January 2012. The curriculum was refined during a second pilot, which graduated 10 medics. They found military medics had from 40 to 60 percent of the training they needed to become paramedics, enabling them to condense the paramedic course from 13 to six months.
To determine precisely what each student needs, military medics start with two days of rigorous testing of their practical skills and knowledge, including hands-on tests of specific clinical skills and a written exam. From there, instructors can tailor the curriculum to the individual.
To help with finances, the college grants all students in-state tuition, while military training or experiential credits are also granted free of charge.
“These folks have earned it,” Ferris-McCann says. “They took time out of their lives. They did what was honorable. Now it’s time for us to do something for them.”
Putting military medic skills to work
With two pilot programs under their belt, Lansing Community College was ready to roll out the program on a wider scale. The third class of 26 medics started in August 2013 and will be graduating soon. The fourth class of 40 medics will begin this month. Students are coming from Connecticut, California, New Jersey and as far away as Guam.
Some graduates have gone on to jobs as paramedics, often with the agency that they intern with as part of the program, while others have gone to nursing school or physician’s assistant programs.
After getting out of the military in 2012, Lizotte went back to Iraq working as an EMT for a civilian contractor. With his wife working on her Ph.D. at Michigan State and a 7-year-old daughter at home, he’s eager to get a job as a paramedic, and then possibly continue on to nursing school.
“You’re taking people who have seen the worst of the worst injuries and putting them on the streets of America and letting them help, any way they know how, which is with compassion and caring,” Lizotte says. “We definitely have received the tools and experiences that allow us to be fit for the opportunity to do that.”
To attend classes at Lansing, VanWagoner makes a 75-minute drive from his home in Burton, Mich., four days a week. He hasn’t decided yet if he’ll remain a paramedic, join the fire service or continue his education to become a nurse or physician’s assistant. But he knows he’s off to a good start.
“I feel that I am beginning to lay an actual foundation for a career and a life that will allow me to care for my family,” he says. “Military medics have a love for medicine and a love for taking care of people, and we want to take care of our families and continue to serve our communities in a different way. Although we don’t wear our military uniforms, we still have the desire to serve people.”