Combat Lifesaver vs. EMT/Medic

[armywifeemt]

So is there anyone who has gone through combat lifesaver course, then gone through an EMT-B program?

My husband went through CLS a little while back and it drove me nuts because he came home spouting off all this stuff about it and I am sitting there going "WTH" because it was nothing like anything I've been trained to do.

I've grown curious what they actually teach you in CLS.

Anyone wanna give me a rundown on the differences?

 

[Shishkabob]

CLS is just that. It's a few skills taught to all soldiers to be used in combat on the wounded. It's, and I'm quoting them, the midway point between "self/buddy aid and a combat medic"

It's really only basic first aid taught to all military personnel, with the addition of IVs... and looking at their item list, Atropine and Diazapam.

CLS doesn't have any actual education on anything beyond combat wound care from what I see. Their entire medical training in basic is 23 hours. Not even the FR level if you want to compare it to something.


It's not equatable to EMT. The Army's combat medics ARE trained NREMT-B's.

 

[akflightmedic]

Having taught several of these programs while in Afghanistan because the courses are contracted out to civilian instructors in theater, Linus is mostly correct.

It is a very short first aid class with some advanced skills added in. We teach a lot of mnemonics, memory aids and we drill it over and over. There is no time to teach "medicine", this is the most cookbook program you will ever see.

They are taught IV's (sorry, large bore IV in AC for everything with liter of fluid), they are taught chest needle decompression, and they get airway skills by practicing with King Lts or combitubes.

They do carry morphine and the typical nerve agent pharmacy (atropine).

Then there is lots and lots of time spent on bandaging and splinting, every soldier carries a CAT. This is a base wide mandate where I am regardless of which nation you are from.

They also get to spend hours in the simulator. It is a darkened room (all walls, ceiling painted black), the floor is covered in gravel, loud music (war combat sounds) and I do mean loud is blasted while they tend to several victims as a result of explosives or overturned vehicle. There is also a HUMVEE and MRAP overturn simulator.

While most would view this as inadequate, a lot of lives have been saved by putting everyone through the course as directed by the US Army. Mostly due to bleeding control and rapid recognition, however it is still effective. The negative is you end up with a lot of guys claiming to be medics at times when what you really need is a real medic.

 

[MrBrown]

I suppose that would drive you nuts. Almost like our sixteen week Technicians who tell Intensive Care officers not do to something they've probably been doing for twenty years!

However, I suppose we can't find fault with thier way of doing things; thier modality suits the situations they encounter; I haven't encountered anybody yet who has had several limbs or thier guts blown out as a result of an IAD out there on the civillian street.

Speaking of the CAT, we have that now. Tourniquets here were not the norm or a formal procedure however they were used for severe, uncontrollabe bleeding and made out of a pillow case. Never seen one used yet.

 

[EMSLaw]

Tourniquets are back in the NREMT standards as of recently, IIRC. And right after direct pressure - no more "absolute last resort because it will cause amputation.".

 

[mycrofft]

would love to read a CLS instructor's teaching manual,

...or the course proposal when it was first set up.
Knowing why stuff is taught is to me like being interested in why a certain procedure is done, not how to do it. Take away the motivation and dumbing-down aspect and tell me what was seen and what is being done and why.

Cold War post-1980 (check me on this OG's) we had two concepts which seem now to be pretty well gone: FEBA (which was obsolete when chemical munitions were proliferated starting about 1976), and the FOUR ECHELONS:
I: Self-AID/Buddy Care; in the "battle area" (formerly known as "the front").
II: Called "Echelon Two", this was filled by units designated as tactical clinics, tactical dispensaries, and I suppose some still had their "aid stations" and "dressing stations". At or near the FEBA, forward edge of battle area. Supposed to be mobile to follow it, yet hardened enoujgh to resist Bio/Chem attack. Yeah, right. HAd docs, flight surgeons. Theoretically had nurses, but DESERT STORM did not send USAF nurses to them.
III: Theater medical centers, like at Ramstein, Little Risington, etc. Supposedly out of harm's way but less than one whole day's air transport. Inpatient services.
IV: Stateside, Scott/Travis/Andrews AFB's, maybe more.

 

[ExpatMedic0]

My CLS course was less than a week. I still have the certificate from the army, it says it was "40 hours" but it was less. I do not recall being trained in chest decompression or anything advanced at all other than IV's, and we where not trained in any airway procedures beyond an OPA.
All soldiers carry atropine and the other nerve agent antidote. It was in our pro mask holster. We all got trained in that, its in the soldiers manual of common task skill level 1.

CLS was a very basic first aid class focused only on trauma, no medical and with our only advanced skill being able to give IV's. It sounds like maybe there is more to it now, unless the instructors are just adding there own criteria into the program. It did come with a large a medical book we where encouraged to reference, %100 cook book. The book may have contained advanced procedures and walked a average joe through how to preform them step by step, I do not recall.

The idea behind it I gathered was buddy-aid is better than no aid at all in combat, there is only 1 medic per infantry platoon (some times less) so in an MCI he can only do so much. We tried to have 1 CLS per squad. There is no way in hell they would have gave us morphine! Of course I never went to Iraq, might make since there. Anyway....
One example would be If someone was bleeding out another solider could stop the bleeding and start an IV until the real medic got there, or if he was dead until another medic arrived.

I carried OTC meds in my bag, 800mg motrin, a sam splint rolled up, at least 2 IV bag setups, some bandages, gauze, foot powder, mole skin, occlusive dressings, a few OPA's some gloves, and a face shield. and a 9 line medevac cheat sheet, Thats it. The CLS bags we where issued where small, about the size of a fanny pack. I wore mine on the back of my LBV above my buttpack or in place of it sometimes.

 

[xgpt]

CLS is just that. It's a few skills taught to all soldiers to be used in combat on the wounded. It's, and I'm quoting them, the midway point between "self/buddy aid and a combat medic"

It's really only basic first aid taught to all military personnel, with the addition of IVs... and looking at their item list, Atropine and Diazapam.

CLS doesn't have any actual education on anything beyond combat wound care from what I see. Their entire medical training in basic is 23 hours. Not even the FR level if you want to compare it to something.


It's not equatable to EMT. The Army's combat medics ARE trained NREMT-B's.

Just curious, do you know about the different levels of army medics?

I'm sort of considering enlisting as a medic once I get certed and want to know about the different paths there might be...

 

[ExpatMedic0]

Unless your sec ops all field medics are trained to the civilian NREMT-B level with additional skills for trauma similar to an intermediate like intubation, iv fluids, morphine, IO, ect... They have more training and skills than an NREMT-B but are only allowed to test for there NREMT-B. I think its because the army mainly trains them for trauma of young men and hygiene. They do not get much medical, cardiac, obgyn, ect

Spec ops medics like the 18D are trained to the NREMT-P level with additional training.

Just curious, do you know about the different levels of army medics?

I'm sort of considering enlisting as a medic once I get certed and want to know about the different paths there might be...

 

[xgpt]

Unless your sec ops all field medics are trained to the civilian NREMT-B level with additional skills for trauma similar to an intermediate like intubation, iv fluids, morphine, IO, ect... They have more training and skills than an NREMT-B but are only allowed to test for there NREMT-B. I think its because the army mainly trains them for trauma of young men and hygiene. They do not get much medical, cardiac, obgyn, ect

Spec ops medics like the 18D are trained to the NREMT-P level with additional training.

I guess that makes sense, they certify you at the minimum standard, and then add on the things the military needs, leaving out useless things like battlefield OB

 

[usafmedic45]

It's, and I'm quoting them, the midway point between "self/buddy aid and a combat medic"

As a former CLS instructor, that's pretty much the best description possible.

Unless your sec ops all field medics are trained to the civilian NREMT-B level with additional skills for trauma similar to an intermediate like intubation, iv fluids, morphine, IO, ect... They have more training and skills than an NREMT-B but are only allowed to test for there NREMT-B. I think its because the army mainly trains them for trauma of young men and hygiene. They do not get much medical, cardiac, obgyn, ect

Actually I don't believe the standard "medic" was taught to intubate under the US Army (this may have changed in the past seven years) but rather were taught to rely on non-visualized airways such as the OPA, NPA and Combitube. Well, they may be taught it, but I don't recall them being allowed to do it outside of the crews assigned to the aeromedical helicopters. Endotracheal intubation has no place as a first response skill in the combat setting because the skills are too perishable, ET tubes are too easily displaced during movement and the signs of displacement are too easily missed.

 

[ExpatMedic0]

in 2002 at Ft. Carson CO I saw our field medics with laryngoscopes and ET tubes practicing on manikins in a classroom setting. I am not sure if this was added to there scope of practice or just for training purposes.

 

[usafmedic45]

in 2002 at Ft. Carson CO I saw our field medics with laryngoscopes and ET tubes practicing on manikins in a classroom setting. I am not sure if this was added to there scope of practice or just for training purposes.

Are they assigned to ambulances (ground or helicopter) or are they company medics assigned to combat units? If I recall correctly, one of the largest "Dustoff" units is based out of Ft. Carson.

 

[MrBrown]

The NZ Defence Force medics come in three flavours; junior, intermediate and senior and more-or-less follow the civillian training for Ambulance Officers,

A junior medic has a 12 week course + 40 weeks on the job experience and is able to do basic emergency care.

Intermediate medic has another 14 weeks of training and can do some intermediate level skills like introsseous, intravenous fluid etc.

Senior medic has the two-year Diploma in Military Medicine (the military equivalent of our old ALS qualification) and is considered advanced life support.

While the military training is quite thorough and very good it does not touch on many aspects of the civillian workd; for example military medics do not carry around GTN for grandad's angina or salbutamol for asthma because they never see those things in the military. They are also taught to decompress chests and do intraosseous infusions quite early on and this is at odds with the civillian system because those are advanced skills.

Like you guys, at the moment military medics cannot transfer to the civillian world but with our upcoming qualification changes that's probably going to chance and they will have a bridge program.

 

[mycrofft]

Sociological aspect.

After about eight years of war and occupation in SWA, ther are many, many former medics, and people with basic EMS training plus experience, in our population. This sort of influx in the past has affected finance, the arts, and, yes, EMS.

 

[armywifeemt]

Interesting as it is to hear how things are in NZ again, I had really directed this question solely at US Armed Forces members... because my question was specific to the course offered to OUR service men and women... as my curiosity was purely born of my husband taking that class.

The NZ Defence Force medics come in three flavours; junior, intermediate and senior and more-or-less follow the civillian training for Ambulance Officers,

A junior medic has a 12 week course + 40 weeks on the job experience and is able to do basic emergency care.

Intermediate medic has another 14 weeks of training and can do some intermediate level skills like introsseous, intravenous fluid etc.

Senior medic has the two-year Diploma in Military Medicine (the military equivalent of our old ALS qualification) and is considered advanced life support.

While the military training is quite thorough and very good it does not touch on many aspects of the civillian workd; for example military medics do not carry around GTN for grandad's angina or salbutamol for asthma because they never see those things in the military. They are also taught to decompress chests and do intraosseous infusions quite early on and this is at odds with the civillian system because those are advanced skills.

Like you guys, at the moment military medics cannot transfer to the civillian world but with our upcoming qualification changes that's probably going to chance and they will have a bridge program.

 

[ExpatMedic0]

Interesting as it is to hear how things are in NZ again, I had really directed this question solely at US Armed Forces members... because my question was specific to the course offered to OUR service men and women... as my curiosity was purely born of my husband taking that class.

Well I told you how it was in 2002 on active duty for an infantry guy at Ft. Carson since I was a CLS. I also deployed to Egypt and Israel as one. You might also want to check out this http://www.scribd.com/doc/3460095/US-ARMY-is0825-Medical-Course-Combat-Lifesaver-Course-0825CC

its the OFFICIAL course content/ expectations. Also please keep in mind this course is for someone with no medical background and is less than a week long. Its for us to patch each other up as best as possible until a medic can get there. It even says in the manual "a combat lifesaver is a non medical solider who provides life saving measures as a secondary mission as his primary combat mission allows until the medic is available"

 

[Afflixion]

Ok to clear things up cls do not carry atropine and diazepam but in autoinjectors used for CBRNE purposes as atropine was originally designe by the army to counteract nerve agents...just a tid bit of information. CBRNE Stands for chemical, biological, radioactive, nuclear and high yield explosive (formally NBC) as for the airways the only airway that cls use is are npa's and opa's. Cls are no longer taught iv's as of february 2010, as every single cls person tries to use an iv prior to any care even when it is not warrantred.

As it stands now cls is managment of hemorrhaging, basic airways, and extrication techniques.

As for morphine only medics carry morphine or more commonly used now fentanyl or ketamine nasal spray (for those w/o IV access) medics e4 and below use king lt unless taught by their bn surgeon how to properly intubate. (As every good bn surgeon should)

Ps sorry for misspelling typing this on my cellphone prior to class

 

[MrBrown]

What has the military experience with ketamine been?

Our civillian HEMS and Intensive Care Paramedics (ALS) have been using it since 2005 and 2007 respecitvely to excellent effect

 

[Dre]

CLS/EMT/Medic

Ok, that is the same as First Responder, EMT-B and EMT-P or Paramedics. The difference isnt much. Just a few classes. I like the CLS course, cause it saves me from having to do IV's or a lot of work. I love Paramedics cause they still have to do all the work. So, if you ask me, I will sit back and enjoy their struggles. LOL

But yeah, if you have an EMT, you will be in an 8 week refresher. Have them submit it as a CORE class for NJ. As for a Paramedic in the Army, that is really stupid. Drop the EMT Basic or NREMT and make all medic Paramedics. Cause if I go back in, I'm gonna have the instructors pissed! 6 years as an EMT and have already had my NREMT, I would have to show them short cuts. And the best unit is Specialty Care if you are an EMT!!!

But you cannot compare the 3. I would not even argue with a Paramedic. And I'm a medical assistant/ER Tech. Oh yeah, the difference you CAN argue about Paramedics are standing orders. Most Paramedics have to call in orders. I doubt the Army Medic will really do that. I think they are closer to a CCRN than a Paramedic, in terms of their operations.

Oh, and I would never take a CLS serious, unless he really has information that I don't know. And if they are cool, I would teach them a lil more!