civillian vs military trauma treatments

[kindofafireguy]

Some military things work. Some do not. But doing something the military does "because the military does it," is just stupid.

Some ideas are also followed because there is this crazy civilian idea if the military does or uses something it must be superior.(Law enforcement is notorious for this, but it is not limited to any industry)

No, that's not unduly harsh. However, I wasn't saying I agreed with it, either. I was simply making a small point about the nature of civilian EMS. It doesn't matter whether it's necessarily best, at least not to many of the people in charge (read: not all, but still enough). Unfortunately, our field tends to get dragged into what's "latest and greatest" before we've even caught up to what it really means.

We're seeing it now. Military said hemostatic agents were in - civilian EMS started carrying them. Now hemostatics are out, tourniquets are in. Same idea.

It's a pattern. One we should break, but probably won't for quite some time.

EMS is not a profession, it is a vocation.(full stop) It has the potential to be a profession, but blindly implementing military equipment and procedures in the civilian world will not help that.

Fair enough. We're often a contributing factor (as providers) as to why we're not considered a professional field. But again, I wasn't advocating blindly following the military (hence my comment on liking the concept, rather than the followthrough), just commenting on the nature of EMS today.

I think in some ways we've grown up faster than we should have, and in others we're still running behind trying to catch up.

Sorry if I got a little soap-boxy there.

 

[Hemostatic]

Regarding trauma treatments, I didn't know that you'd need two tourniquets for a thigh. Is that always true? Also, any thoughts on the SWAT-T tourniquet? I've been looking into different TQs, and it came up as an inexpensive, effective alternative to the CAT and MAT.

The SWAT-T is a nice tool to have in the bag, I carried a couple with me while I was overseas. However, it was definitely not my first line, "need-it-right-now" TQ. A lot of that had to do with what I was practiced on and comfortable with.

One of the cool things about the SWAT-T is that you can use it as a pressure dressing, or almost like an ACE wrap, by simply not pulling it as tight.

For me, in a TQ situation, the SWAT-T was too slow compared to the other options I had available (CATs).

As with any other type of medical equipment, the key to tourniquets is to practice. A lot. Know your gear, what it is capable of, what it's intricacies are, and what it's limits are. And then go practice some more.

Professionals (not to be confused with career soldiers) in the military are all officers.

Enlisted rates are all vocations.

Ouch.

 

[CCNRMedic1982]

EMS is not a profession, it is a vocation.(full stop) It has the potential to be a profession, but blindly implementing military equipment and procedures in the civilian world will not help that.

Professionals (not to be confused with career soldiers) in the military are all officers.

Enlisted rates are all vocations.

If you want to be a professional, you will need many of the same requirements the military requires, like a 4 year degree.

Overtreatment is a medical error. We don't do CABGs on everyone with chest pain. We should not be implementing surgical intervention (like a TK) on a massive scale when it is not needed. (I accept in emergency medicine some over treatment is required, but not all the time)

A professional understands and practices (to use a military term) economy of force. "Don't use a cannon to kill a mosquito."
.

Is this your opinion that soldiers in the military are not professionals? I would like to know the person that told you that and what military they are in. A degree absolutely does not make you a professional. As you stated the ability to understand and practice among other things make you a professional. If you had an interaction with Someone in EMS that had a poor attitude or handled a situation inappropriately you would say they were unprofessional. Enlisted and commissioned soldiers are all expected to conduct themselves as professionals regardless of education. If people consider EMS not a profession then it's because they consider the persons within the system unprofessional. Unfortunately that is largely the case due to personal opinion and education nothing that can be fixed over a thread that has to start at home. However as for myself I do have a 4 year degree was active military and currently in reserves enlisted and am absolutely a professional at everything I do and work in what I consider a profession.

 

[Veneficus]

Is this your opinion that soldiers in the military are not professionals? I would like to know the person that told you that and what military they are in. A degree absolutely does not make you a professional. As you stated the ability to understand and practice among other things make you a professional. If you had an interaction with Someone in EMS that had a poor attitude or handled a situation inappropriately you would say they were unprofessional. Enlisted and commissioned soldiers are all expected to conduct themselves as professionals regardless of education. If people consider EMS not a profession then it's because they consider the persons within the system unprofessional. Unfortunately that is largely the case due to personal opinion and education nothing that can be fixed over a thread that has to start at home. However as for myself I do have a 4 year degree was active military and currently in reserves enlisted and am absolutely a professional at everything I do and work in what I consider a profession.

I think you are equating professional conduct (behavior) with being recognized as a profession. (having a unique body of knowledge, choosing your own members, etc.)

They are not the same.

 

[kindofafireguy]

Not to stir up too much drama, but I think to call EMS only a vocation is too simplistic. We can agree to disagree if you like, but a paramedic is not the same as a welder. I don't feel that the length of education, or the fact that it's often carried out at VoTech schools, can be enough to classify it that way.

That being said, I do understand your analogy of officer vs. enlisted.

Take a West Point grad, for example. He goes through 4 years of education, leadership, and military training. Then he's commissioned and will go through his respective Basic Officer Leadership course (or BOLC). Compare that to the BCT and AIT of an enlisted person, and it does make for some glaring differences.

But again,I think that isn't really enough grounds to say that it's not a profession. I think EMS is not considered a true profession yet because we have not yet managed to grow out of the training wheels, so to speak.

I think we need to step back and look at ourselves, the providers, as the root of the problem (unless we're talking about my marriage).

Again, we can agree to disagree though. If my opinion was the only one that mattered, we'd be screwed.

 

[Hemostatic]

Enlisted vocations

Sir,
PM received. My post count is not high enough to allow me to send PMs. :glare:

I will get back to you shortly.

 

[Veneficus]

Not to stir up too much drama, but I think to call EMS only a vocation is too simplistic. We can agree to disagree if you like, but a paramedic is not the same as a welder. I don't feel that the length of education, or the fact that it's often carried out at VoTech schools, can be enough to classify it that way.

That being said, I do understand your analogy of officer vs. enlisted.

Take a West Point grad, for example. He goes through 4 years of education, leadership, and military training. Then he's commissioned and will go through his respective Basic Officer Leadership course (or BOLC). Compare that to the BCT and AIT of an enlisted person, and it does make for some glaring differences.

But again,I think that isn't really enough grounds to say that it's not a profession. I think EMS is not considered a true profession yet because we have not yet managed to grow out of the training wheels, so to speak.

I think we need to step back and look at ourselves, the providers, as the root of the problem (unless we're talking about my marriage).

Again, we can agree to disagree though. If my opinion was the only one that mattered, we'd be screwed.

A profession governs itself, as long as there is need of a medical director that holds another professional degree, EMS cannot be a profession.

 

[mycrofft]

Stray shots

NO medical measure is uniformly safe except maybe reassurance after a thorough eval and/or during tx.

Don't use a belt for a TK, nor a length of lamp cord...h34r:

If "high speed/low drag" means unflappable, fine. If it means cool/dynamic/bravura-prone, then look out.

(This from the guy whose FD handle was "Dr Gofast").

Remember military COMBAT triage is MIDE ("minimal, immediate, delayed, and expectant", to get troops back on the line to avoid being overrun) when you want to get all starry-eyed about military medical .

It's fertile ground, but as in all fertile ground, the lumps tend to be bulls#$t.

PS: we have reams of discussion about "professionalism" versus "being a profession". And military medical officers are shunted around military professional schools like West Point or USAF's Colorado Springs.

 

[bigbaldguy]

Is this your opinion that soldiers in the military are not professionals? I would like to know the person that told you that and what military they are in. A degree absolutely does not make you a professional. As you stated the ability to understand and practice among other things make you a professional. If you had an interaction with Someone in EMS that had a poor attitude or handled a situation inappropriately you would say they were unprofessional. Enlisted and commissioned soldiers are all expected to conduct themselves as professionals regardless of education. If people consider EMS not a profession then it's because they consider the persons within the system unprofessional. Unfortunately that is largely the case due to personal opinion and education nothing that can be fixed over a thread that has to start at home. However as for myself I do have a 4 year degree was active military and currently in reserves enlisted and am absolutely a professional at everything I do and work in what I consider a profession.

I think you might have misunderstood his intent.

 

[kindofafireguy]

A profession governs itself, as long as there is need of a medical director that holds another professional degree, EMS cannot be a profession.

So, would you consider nursing a profession?

It's an interesting concept, and one that I haven't really thought about.

We could probably argue about this forever. I do appreciate the food for thought though.

 

[bigbaldguy]

A profession governs itself, as long as there is need of a medical director that holds another professional degree, EMS cannot be a profession.

Hmm I think my definition of profession and yours are different. You're saying that a true professional is a person who is a pinnacle provider of their craft with no oversight from a higher provider?

 

[kindofafireguy]

Hmm I think my definition of profession and yours are different. You're saying that a true professional is a person who is a pinnacle provider of their craft with no oversight from a higher provider?

It's an interesting concept, isn't it? However, I think it oversimplifies things a little too much. There are many fields people consider professions that are still subject to oversight. Nursing is one I can think of. But then, I'm probably oversimplifying things as well.

 

[EpiEMS]

It's an interesting question: what is a profession?

Certainly one can be professional without being a professional, if that follows.
But to be a true profession, there must be self-governance, including policing the ranks and making up rules, specialized education requiring high levels of intellect, and total autonomy for decision making (with gradations in autonomy for your apprentices). And in no way should a professional be unionized - the professional must be independent and free to offer his/her own judgements.
I am unsure whether nursing is necessarily a profession - it isn't necessarily autonomous, doesn't have the same level of prestige as the classical professions, and is not necessarily a monopolistic group. On the other hand, medicine is most certainly a profession – the MD/DO provider is totally autonomous, highly prestigious, requires exceedingly specialized and lengthy education, and is one of the most effective monopolistic groups we know today.

 

[EpiEMS]

Hmm I think my definition of profession and yours are different. You're saying that a true professional is a person who is a pinnacle provider of their craft with no oversight from a higher provider?

Perhaps no higher provider who is not in their field –:censored:i.e. a medical resident is still a professional, but he/she is a journeyman of sorts, rather than a master.

 

[kindofafireguy]

It's an interesting question: what is a profession?

Certainly one can be professional without being a professional, if that follows.
But to be a true profession, there must be self-governance, including policing the ranks and making up rules, specialized education requiring high levels of intellect, and total autonomy for decision making (with gradations in autonomy for your apprentices). And in no way should a professional be unionized - the professional must be independent and free to offer his/her own judgements.
I am unsure whether nursing is necessarily a profession - it isn't necessarily autonomous, doesn't have the same level of prestige as the classical professions, and is not necessarily a monopolistic group. On the other hand, medicine is most certainly a profession – the MD/DO provider is totally autonomous, highly prestigious, requires exceedingly specialized and lengthy education, and is one of the most effective monopolistic groups we know today.

This is an interesting thought. However, I think this is too simple in its own way as well. For example, your later example uses residents as journeymen (and full MD/DO's as Masters, I would assume).

Plumbers are autonomous, and have no oversight. But most would consider that a vocation.

I know that's an extremely simplistic comparison, but you see what I mean? I don't know that there is any right answer. Hell, maybe EMS can't be a profession. At least not in that sense.

 

[Veneficus]

Hmm I think my definition of profession and yours are different. You're saying that a true professional is a person who is a pinnacle provider of their craft with no oversight from a higher provider?

No, I am saying that the professional is governed by other similarly credentialed professionals.

A paramedic in the US currently must be governed by a physician medical director, who may or may not be or have ever been a paramedic.

They cannot do their own research and decide what treatments they use based on it.

It would be like saying that even though you are a mason, you still have to answer to the carpenter.

It does not refer to hierarchies of a system or chain of command.

 

[Veneficus]

It's an interesting question: what is a profession?

Certainly one can be professional without being a professional, if that follows.
But to be a true profession, there must be self-governance, including policing the ranks and making up rules, specialized education requiring high levels of intellect, and total autonomy for decision making (with gradations in autonomy for your apprentices). And in no way should a professional be unionized - the professional must be independent and free to offer his/her own judgements.
I am unsure whether nursing is necessarily a profession - it isn't necessarily autonomous, doesn't have the same level of prestige as the classical professions, and is not necessarily a monopolistic group. On the other hand, medicine is most certainly a profession – the MD/DO provider is totally autonomous, highly prestigious, requires exceedingly specialized and lengthy education, and is one of the most effective monopolistic groups we know today.

In the same category as lawyers and priests actually.

I think that nursing is a profession, though it may not always act in a professional capacity.

As I understand the purpose of nursing and indeed its history is to help people take care of basic necessities of life.

They can do that without any type of oversight outside of nursing.

There is nothing in this world that stops a nurse from going to a person's redidence and helping them bath, eat,ambulate, toilet, help them take their prescribed meds, etc. without oversight from a physician or anyone else who is not a nurse.

However, as nurses have increased their scope, in order to increase value and marketability, their profession has found a majority of thier positions available in an environment which does require medical oversight at some level.

I wouldn't say that makes them less of a profession, only that they are in some capacities functioning outside the core tennants of their profession.

Which as a point important to EMS is why there is so much friction between nurses and EMS, particularly when they interact in areas that are (for lack of a better term) nursing strongholds.

Medicine is not one big continuum of care. We like to think it is, but even among medical professionals, there are definitive lines in the sand.

(I never thought I would find myself defending the nursing profession)

back on point, military medicine doesn't always translate well to civilian medicine.

 

[mycrofft]

One of EMTLIE's black holes: "Is EMS A Profession"

Once it pops up everything gets sucked into it.
Here's one of our go-rounds:

http://emtlife.com/showthread.php?t=27659&highlight=ems+profession

Historically, many EMS measures for trauma (as well as some for public health an our allies, civil engineering) have been tried or dreamed up under the necessity of meeting a mission and having novel challenges, limited resources, or both. Some measures, as with some people, have been thrust to the forefront by these anecdotal successes, and only some survive the test of time and civility.

 

[firetender]

Please, Sir, it's EMTLIFE!

Though that could be a website of its own.

 

[RocketMedic]

Is this your opinion that soldiers in the military are not professionals? I would like to know the person that told you that and what military they are in. A degree absolutely does not make you a professional. As you stated the ability to understand and practice among other things make you a professional. If you had an interaction with Someone in EMS that had a poor attitude or handled a situation inappropriately you would say they were unprofessional. Enlisted and commissioned soldiers are all expected to conduct themselves as professionals regardless of education. If people consider EMS not a profession then it's because they consider the persons within the system unprofessional. Unfortunately that is largely the case due to personal opinion and education nothing that can be fixed over a thread that has to start at home. However as for myself I do have a 4 year degree was active military and currently in reserves enlisted and am absolutely a professional at everything I do and work in what I consider a profession.

I'm active-duty and I can safely and clearly say that the vast majority of soldiers are not professionals. The United States Army is a vocation.