civillian vs military trauma treatments

[mycrofft]

HAHA danged spellcheck!

Yes, EMTYLIFE

 

[Doczilla]

We do not delineate "professional soldier" at enlisted and officer, my friend. Having a batchelors degree in basketweaving and arguing comparative religeon during ROTC does not "vet " someone into the profession of arms.

 

[ShannahQuilts]

We do not delineate "professional soldier" at enlisted and officer, my friend. Having a batchelors degree in basketweaving and arguing comparative religeon during ROTC does not "vet " someone into the profession of arms.

I'm still having trouble wrapping my head around the idea that nursing might be a vocation rather than a profession, but this does speak to how I feel about degrees.

If I need someone to wire up a network, I'd rather have someone with no degree and a CCNA than someone with a 4-year, or even a master's, in psychology or ancient military history.

If I need skilled nursing care, I would consider someone with a 4-year degree and a couple of years' solid experience to be a professional, even if they are working in concert with other medical professionals. Sure, doctors hand stuff off to them to do, just as other professionals in multidiscipline endeavors do. When a skyscraper goes up, people hand off parts of the building to other people.

I think the idea that a 4-year degree automatically makes someone a professional is optimistic.

 

[CCNRMedic1982]

I think the idea that a 4-year degree automatically makes someone a professional is optimistic.[/QUOTE]

I agree.

 

[mycrofft]

A profession is a defined area of expertise with some self control etc. I am NOT going further over that event horizon, see earlier threads.

A professional is someone who does something for a monetary living, often in a profession, but not necessarily.

Professionalism is treating what you do a one would a profession: ethically as well as legally obligated to do the job to your best ability for the client, and pass it up or over if you can't hack it. Etc.

Professions (as did trades like woodcarvers and ceramicists) used to make their news members serve an apprenticeship then a journeyman period. Modern education claims to have taken care of that level of training already....<_<

 

[EMSpursuit]

I have always heard what the military practices (especially new techniques) happens first then is implemented to civilian....hear the same?

 

[mycrofft]

(Read prior responses).
Yes, but then science goes and disproves some, while more civilized ways of doing some are found.
MANY wartime "discoveries" have turned to sawdust under scrutiny, or were found to be too narrowly useful for generalized use.

 

[Akulahawk]

One of the biggest differences between Military and Civilian medicine is that there's little (if any) fear of being sued for doing your job. Also, they can try other procedures that are more experimental than is normally found in Civilian medicine because they function in a more specialized environment. As mycrofft said, some stuff works, some doesn't, and some just never quite translates between worlds because of their differences.

 

[Veneficus]

One of the biggest differences between Military and Civilian medicine is that there's little (if any) fear of being sued for doing your job.

or not doing what you should.

 

[Luno]

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.

Wha??? Please reference the Soldiers' Creed....

I am an expert and I am a professional

 

[RustyShackleford]

The soldiers creed usually goes out the window once there's a few beers involved...

 

[RocketMedic]

You're not active duty, are you Luno?

 

[joeshmoe]

I dont think the civilian world should go too far emulating military medicine, at least as far as EMS is concerned. There seems to be a mistaken belief that being a medic in the military means youve seen it all. In reality, a civilian EMS provider probably sees and treats a much greater variety and number of medical and trauma emergencies. Those medical emergencies military medics do occasionally treat are generally things you rarely see in the civilian world, and virtually all of their patients are otherwise healthy, relatively fit younger males, not exactly widely representative of the typical civilian EMS patient.

In the Marine Corps I recall Corpsman generally being about as useful as tits on a boar. I hate to say that, and it flies in the face of the hollywood image of the combat doc who is an indispensible member of the unit, but to most of us they were little more than mobile motrin dispensers who spent most of their time sitting around a branch aide station giving vaccines and finding ways to get out of formations, work details, and PT.

A civilian paramedic and EMT sees sick and injured patients pretty much every shift they work. A military medic generally doesnt gain a whole lot of experience, and what experience they do gain isnt necessarily applicable to the civilian world.

 

[Doczilla]

The military is a large clock... A lot of moving pieces. Each part needs to do its job for the whole machine to work. Unfortunately, at least in the army, there's a lot of dudes who skate by with the bare minimum , because thats the easiest way through their enlistment.
But army medicine isn't about liability, or medical ethics as much as it is about keeping our family alive. Doing the right thing, at the right time for your brother in his time of need is more of a motivation than fearing legal repecussions or malpractice. If you mess up, you won't have a QA screening, you wont get sued, you won't get fired.

Youll have a lifetime of guilt.

 

[Veneficus]

The military is a large clock... A lot of moving pieces. Each part needs to do its job for the whole machine to work. Unfortunately, at least in the army, there's a lot of dudes who skate by with the bare minimum , because thats the easiest way through their enlistment.
But army medicine isn't about liability, or medical ethics as much as it is about keeping our family alive. Doing the right thing, at the right time for your brother in his time of need is more of a motivation than fearing legal repecussions or malpractice. If you mess up, you won't have a QA screening, you wont get sued, you won't get fired.

Youll have a lifetime of guilt.

Not if you actually think you are doing the right thing.

In my observations most people who are doing something wrong actually believe they are doing the right thing. It happens in both civilian and military environments.

The trouble is in the military it goes unchecked.

 

[RocketMedic]

I dont think the civilian world should go too far emulating military medicine, at least as far as EMS is concerned. There seems to be a mistaken belief that being a medic in the military means youve seen it all. In reality, a civilian EMS provider probably sees and treats a much greater variety and number of medical and trauma emergencies. Those medical emergencies military medics do occasionally treat are generally things you rarely see in the civilian world, and virtually all of their patients are otherwise healthy, relatively fit younger males, not exactly widely representative of the typical civilian EMS patient.

In the Marine Corps I recall Corpsman generally being about as useful as tits on a boar. I hate to say that, and it flies in the face of the hollywood image of the combat doc who is an indispensible member of the unit, but to most of us they were little more than mobile motrin dispensers who spent most of their time sitting around a branch aide station giving vaccines and finding ways to get out of formations, work details, and PT.

A civilian paramedic and EMT sees sick and injured patients pretty much every shift they work. A military medic generally doesnt gain a whole lot of experience, and what experience they do gain isnt necessarily applicable to the civilian world.

Required reading. This is completely accurate.
Were it not for my extracurricular activities, I would be useless in EMS.

 

[EpiEMS]

Speaking to a specific treatment, do any prehospital services use Hextend? I was looking at the TCCC guidelines and the old CLS curriculum, and Hextend is used for traumatic injury with signs of hypovolemia, if I'm not mistaken. Why wouldn't we civy EMS folks use the fluid that the military uses for traumatic injury? (Of course, this question may just speak to my lack of knowledge about, say, acid/base balance or all those ALS-type fluid-y topics)

 

[Akulahawk]

Speaking to a specific treatment, do any prehospital services use Hextend? I was looking at the TCCC guidelines and the old CLS curriculum, and Hextend is used for traumatic injury with signs of hypovolemia, if I'm not mistaken. Why wouldn't we civy EMS folks use the fluid that the military uses for traumatic injury? (Of course, this question may just speak to my lack of knowledge about, say, acid/base balance or all those ALS-type fluid-y topics)

Use of colloids like Hextend is likely due to weight/volume considerations. You can pack more small bags of Hextend than you can for an equivalent number of saline in a given size bag... and the saline will be much heavier. One problem with colloids is that it may be harder to titrate to an SBP in the 90's to limit further blood loss by popping clots because you administer a certain amount and it'll draw fluids into the vascular space, but you won't have as much control over how much fluid ends up there as you do with just NS. Another issue is that some people may be allergic to the colloid used in Hextend... Would be poor form to give Hextend to someone allergic to it.

If I needed fluids in the civilian prehospital environment, all I need to do is just reach into my cabinet and grab another bag of NS... I don't have to consider weight and volume issues when stocking my ambulance with fluids.

 

[EpiEMS]

(A really great, detailed answer)

Thanks! Makes good sense!

It almost sounds like Hextend is to NS what Everclear is to beer

 

[Veneficus]

Speaking to a specific treatment, do any prehospital services use Hextend? I was looking at the TCCC guidelines and the old CLS curriculum, and Hextend is used for traumatic injury with signs of hypovolemia, if I'm not mistaken. Why wouldn't we civy EMS folks use the fluid that the military uses for traumatic injury? (Of course, this question may just speak to my lack of knowledge about, say, acid/base balance or all those ALS-type fluid-y topics)

Because it is shown to work no better than NS, but costs significantly more.

In the military if you may not want to carry around a bunch of liters of water you cannot drink, so for them it is a reasonable expense.