Ditch medicine

[Ursula]

Looking for any redirects to good information or training programs for a civilian to learn good ditch medicine. Am doing EMT studies but want to learn more about what to do in trauma situations when there is no medic bag available.

All suggestions are appreciated.

-U

[Kolt]

Hi,

I am an EMT also.
I was formerly involved in Search and Rescue before I joined the Army.

What kind of 'educational' materials are you looking for?

I can recommend a few books if you'd like ,but hands on training is always the best.

Take your EMT courses through all of the levels up to EMT-P.

There are also wilderness EMT courses for non-urban enviroments that are good for the outdoors and rural areas.

Many colleges and universities offer medical couses that anyone can take also.

Once you get your EMT certification, you will be required to take a certain amount of 'continuing education' hours to keep current so take advantage of this too.

It all depends on the environments that you plan to be in.

If you ask some more specific questions, maybe I can be of more help.

So ask if you'd like. I'm more than willing to answer.
Emergency medicine is an important field.

Kolt

[Ursula]

Kolt, thanks for the reply.

As for what I'm looking for--books, classes, etc. Anything that will provide knowledge of medical skills that one would need in a remote, hostile environment where a medic's bag/kit may not be available.

I plan to finish my courses through EMT-P. Then, I'll do Wild. First Responder through WMI which will automatically bump my EMT up to Wilderness EMT. After that, I'm assuming remote medicine simply requires more creativity with limited supplies than urban medicine. It's just that you can't find any classes in this area on how to provide medical skills in third-world countries when people are shooting around you and few medical supplies are available. http://www.specialoperations.com/ubboard/wink.gif

If you can recommend any books or training programs available to civilians beyond EMT and wilderness medicine I'd appreciate it.

thanks-

-U

[recce_o]

1. Approximately how many hours of classes and practical experience does it take to attain the EMT-P level?

2. In the U.S. is the certification done at the federal or state level?

[recce_o]

Ursula,

There is some type of tactical EMT certification. If you plan to be helping the sick and wounded which being shot at, the Heckler and Koch academy offers a course. Their site is http://www.hecklerkoch-usa.com/

What I think would be very useful is if an 18D were to post the break down, by hours of the different subjects studied while on the SFQC. There was an article in the journal "Military Medicine" about this a few years back, but I seem to have misplaced it.

And finally, a few books I have found very instructive, and I'm speaking from a theoretical perspective here, not having ever had to use this stuff, are:

Medicine for Mountaineering (Wilkinson?)
Special Forces Medical Handbook (U.S. SF manual)
Emergency War Surgery (NATO manual)
The Merck Manual
Any of the Mosby manuals on pre-hospital trauma care.

Hope I told you something you don't already know.

[Kolt]

OK, now that I know a bit more about what you are talking about, here are a few suggustions.

First off, your medical kit should not be more limited in a rural environment. Especially if people are shooting at you. You are going to need the right materials and instruments and PLENTY of them in a hostile enviornment.

Two books I can recommend are:

Brady's Tactical Emergency Care : Military and Operational Out-of-Hospital Care

Ditch Medicine by Hugh L. Coffe

Both are available at Amazon.com

Another book on remote medicine is called Where There is No Doctor

There are several older emergency medical texts footnoted in Ditch Medicine throughout the different chapters so order what is required for your particular area.

Bottom line is that you can't improvise when it comes to emergency medical treatment. You can't make an IV, or an E-tube, or substitute many of the drugs needed. There are plenty of mail order companies to get the proper equipment from if you have to buy it yourself and/or your company does not pay for it. Most of it is a one time use in a trauma situation so you will need plenty if you are operating in a combat situation.

The H&K Tactical Medical course already recommended is good too. I have spoken with two people who went through that course and they highly recommended it.

The BEST training you are going to get is experience. Ride alongs and time in the hospital ER are going to be the best training you will ever get. Reading books and taking classes is nothing until it comes down to the real thing.

When a life is on the line, you don't want to have to recall steps 1-9 out of a book for getting a line in (IV). You want that to be the least of your problems because you have already done it 50 times in practice so you can move on to stablizing the patient. In the medical field, it's all about doing it (experience) and doing it right the first time. Unlike other fields there is no time to go back and look it up in a text. You need to know it.

So reading books and taking courses will give you the basics, but you need to get out there on the streets and get all of the experience you can.

As far as hours for EMT-P, it varies by county. Each county has there own test and requirements.

Once you pass a county test, your certification is good for the state that the county is in.

You can not however just go take a paramedic course and then take the test. You need to work your way up the ladder from basic to intermediate (in some cases) and on to paramedic. In most cases you will need a minimum of 6 months experience as a basic before you can begin taking a paramedic course. Then once you take the paramedic course and pass it, you still need OJT in order to be recognized as a paramedic to work on your own. This usually takes another 6-8 weeks. There are certain 'hands on' requirements you need to preform in the field before you are recognized as a paramedic. So the longer it takes you to accomplish these tasks, the longer your probationary period will last.

There is an organization called NREMTP (National Registy of Emergency Medical Technicians Paramedics) whose test and requirements are supposed to be above the hardest level of any county so if you pass their test you can be certified in multiple states that recognize that test. At this time I don't think all 50 states recognize it yet.

I hope this helps.

Any more questions, feel free to ask.

Kolt

[Ursula]

Thanks, Kolt, for the great info. Will follow up on some suggested information and let you know how things are going.

To clarify on the urban vs. rural med kit, if the supplies are available we'll have them. There have been and will continue to be situations where we're in an area with basic med kit, the #%@$ hits the fan, and we find ourselves in a trauma situation with trauma care 30-60 minutes out. Not your normal run of the mill work, I know. That's why I'm asking here. And what a good idea it was. The information you've provided will be a huge help.

Thanks!

-U

[Kolt]

OK, glad I could be of help.

Please clarify one thing for me as far as your working environment goes.

You mentioned three different environments: rural, third world country, and combat. Granted all three can be describing the same thing, so I'm not exactly sure of where you are working.

I might be able to advise more clearly if I knew more specifically where you were working. At the same time, I don't want to violate any OpSec so just a general set of circumstances.

Like I said, my background is in the urban environment as well as rural search and rescue and also in the wilderness. But I also try to learn about operating in any area under any conditions, just in case the situation ever presents itself.

I've got some other book titles that may help you provided they fit your situational criteria. Once you tell me that, I'll know what to reccommend.

Take care,

Kolt

[Ursula]

I'll clarify what I can. I teach and train in and for all of the environments I mentioned. Sometimes during training, real-world things happen and the training ends and the real-world starts up again, usually with bad timing. The only thing that's predictable in these environments is the lack of predictability of what's going to happen throughout the day. Groups being trained include domestic and foreign civilians and military personnel both here and abroad.

At this point the work is primarily survival, security, and humanitarian-aid in nature. We're looking at providing medical courses in the future, so any and all information will help staff as well as "customers".

Again, thanks for your help.

-U

[Kolt]

OK, here are a few more books that will probably help you in your situation and will also be good reference books.

These are general Emergency Medical books, they are VERY complete, but they are also rather expensive.

The first is: Emergency Medicine: A Comprehensive Study Guide by Judith Tintinalli

The second is: Clinical Procedures in Emergency Medicine by James Roberts

The third is: Emergency Medicine : Concepts and Clinical Practice by Peter Rosen

All of these books cost over $150 and are over 1000 pages.

If you can afford them, great. They are great reference books for emergency medicine.

If you're like me and you don't have all that much money, the local library might have them, but for sure a college/university library with a medical program will have them. That's where I got a hold of them.

They obviously take a while to read and you don't need to read all of them, but they do contain a lot of useful information not found elsewhere.

I just photocopied all of the useful information and put it in a 3-ring binder.

As to equipment, instruments, and supplies I really don't know what to say.

What I would suggust is this: Keep a full set of everything you would need for a real world situation packed away in ready bags and just leave it there. Then use up all of your other expendable supplies for your training. That way if a real world case does occur, you will have the supplies needed on hand and they wont all be used up in training. Good training is important, but not as important as a real world when it comes to medical issue. It's just a suggustion though. Having plenty of supplies and equipment for both training and real world is optimal, but you don't always get that.

I hope all goes well for you.

Kolt

[recce_o]

Kolt,

How much background study of anatomy, physiology, pathology etc. did you do before you felt that you were able to understand these texts?

[Kolt]

As far as my background in the subjects that you mentioned, I took anatomy and physiology courses when I was in college. No pathology though.

Basically I started off really slow and then worked my was up the ladder in the medical field. Each step was a building block. I started with basic first aid and CPR. Went on to advanced first aid. Then to First Responder. After that I started the EMT courses. Each step I took prepared me for the next.

If you jump in the pool at the deep end, it all seems too tough to handle, but if you start slow and work your way into it, the information makes a lot of sense.

Plus I ask A LOT of questions, to everyone about everything. Almost to the point of being annoying, but I do learn this way.

I believe that you can learn something from everyone, so I try to learn all I can from people with different experience than my own.

I talked to all of the doctors, nurses, medics, and lab technicians about everything I could and I still do this when I get a chance with the medics and PAs here in the Army.

There is no way you can learn this information both fast and effectively. So it is better to learn it slow and retain the knowledge than learn it fast and brain dump it in a few weeks. Plus I constantly reveiw what I already know just to keep it fresh in my mind. If you don't constantly use this information, you forget it quickly.

Now to answer your question, as far as background info needed to understand the texts, what I didn't understand when I read it, I looked up and researched furthur until I did understand it. I still do this. I only really know about emergency medicine. The medical field is so vast with so many specialties that you can never know everything even for your own field. Plus there are new things in each field happening every day. I still do not know it all, nor will I ever. So in the meantime I just keep studying, practicing, talking to people, and researching.

Hope this provides a bit of insight.

Kolt

[starlight1]

recce_o

Are you a MEDA in the CF? I'm a civilian
paramedic and I'm in the process of joining
the CF. I'd appreciate any inside tips
you could give me.

[recce_o]

Starlight1. Sorry, I'm not a med-A. E-mail me and I will hook you up with one: recce_o@hotmail.com

[Ursula]

Kolt,

Thanks again for all the info. Will follow up on all leads and check out the books.

Found out there is a Tactical Emergency Medicine course right in my backyard, so to speak. Will complete my EMT courses and WFR and then get in on one of the TEMS courses through the agencies I work with.

Thanks again. You've been a big help!

-U

[Kolt]

OK, Glad I could help.

Good luck in your training.

It's tough, but not impossible.

Take care,

Kolt