Q&A with Patrick Thibeault, FNP
Patrick Thibeault grew up as an Army brat, moving from base to base every couple of years, living in Germany for 10 years and graduating from high school in Seoul, South Korea. He joined the Army in 1989 and became a paratrooper medic. He served with the 160th Special Operations Aviation Regiment in Desert Storm, during which time he realized he really did enjoy helping others and saving lives. After Desert Storm he continued serving in as a medic in the Army National Guard and in 2004 deployed with the 76th Infantry Brigade to Afghanistan. He retired from military service in 2011.
In My Journey as a Combat Medic: From Desert Storm to Operation Enduring Freedom, Thibeault details his original training and deployment, as well as the roles he’s played through two wars. Thibeault pulls no punches as he describes life as a combat medic, and the impact of his service on his civilian life, including battling PTSD.
In an exclusive interview with EMS World, Thibeault talks about his journey and how combat medicine relates to civilian EMS. Learn more at www.ospreypublishing.com.
How long have you been writing, and how did you come to publish My Journey as a Combat Medic?
My Journey as a Combat Medic is my first book. I wrote it because I wanted to share my experiences with others. I have had some pretty unique circumstances and wanted to share that with the rest of the world. I initially self-published the book before I sent it to publishers, where it was accepted by my publisher, Osprey Publishing. I also wrote My Journey as a Combat Medic to share my story of dealing with post-traumatic stress disorder, or PTSD. I found that writing is a good way to control the rage and PTSD I still deal with.
You served as a combat medic in two wars. How did the nature of combat medicine change between when you served during Operations Desert Shield and Desert Storm in the early 1990s to when you served in Operation Enduring Freedom in 2004–05?
The role of the combat medic as the first medically-trained soldier a wounded soldier sees has not changed greatly, but the manner in which we evaluate our wounded has changed tenfold. Initially, while I was at Fort Sam Houston learning to be a medic, we learned Airway with c-spine control, Breathing, Circulation, Disability and Exposure—the basic ABCs that all medical EMS folks have learned, which are still true.
But now that’s even changed, with more emphasis on tactical combat casualty care, or TC3. The medic now learns that suppressive fire can be an asset to help save lives, the first line of treatment in a tactical environment is using tourniquets to control bleeding, and there is less emphasis to pump a wounded soldier full of IV fluids. And medics are no longer trained to apply a neck brace on a wounded soldier for c-spine control because we have learned soldiers rarely suffer from neck injuries during routine combat operations and firefights.
The operational aspect of emergency medical care has also changed from when I was a wet-behind-the-ears medic in Desert Storm to when I served as an older, seasoned medic in Afghanistan. We now have the ability to send an encrypted medical evacuation request using a satellite radio to command, which can be literally hundreds of miles away. Medical evacuations are more well-coordinated and controlled using computer technology. This results in wounded soldiers having a greater chance of survival from traumatic wounds. Sadly, this often ends in amputations, but before the result would have been death.
The tools of the trade have changed, too. I was trained to use old fashioned emergency field dressings to help control bleeding. I used these dressing in Desert Storm. Now, combat medics have access to compressible dressings that also act as a direct pressure dressing, and combat medics now carry field packs of agents which help stop arterial bleeding almost instantly, thus saving wounded from going into shock from blood loss.
I was amazed at how military emergency medicine had changed when I had to go through my basic EMT and army medic retraining several years ago. In some ways I felt like I was still in the dark ages in how I learned to approach wounds.
What kinds of qualities are required to be an effective combat medic, and how does that differ from civilian EMS (beyond the obvious)?
The combat medic has a more integrative role when it comes to providing medical support to the combat forces he or she is caring for. This means the combat medic goes on patrol with infantry forces and is one of the guys or gals when engaging the enemy. In My Journey as a Combat Medic, I write about the duality of the combat medic: we are trained to save but we belong to an organization that excels in destruction. For that reason, it is important that combat medics know how to operate—with proficiency—every weapon system used by the unit he or she belongs to, because fire power means saving lives.
The combat medic also has to be able to stay up and ahead of the soldiers he or she provides medical care for—mentally and physically. The combat medic is the chief medical advisor to the commander on the ground, so all decisions medically-related are made by the medic in real time. The situation does not always allow for clarification from higher medical command to do something to save a soldier’s or civilian’s life.
The major difference, in my humble opinion, between the combat medic and civilian EMS is that, at times, the combat medic does not have back-up en route. The combat medic must make those decisions and he or she must remember that the mission of the unit comes before anything else.
You said in the book that you’d wanted to be a combat medic since you were a child. How did reality live up to your expectation, and would you have done anything different?
Reality exceeded my expectations. I got to serve as a medic both on the ground with infantry and paratrooper forces, and as a flight medic in the back of a helicopter. I got to save the lives of wounded prisoners of war when I was a teenager. Looking back, I saw each step in my career as a learning experience to prepare me for the next adventure. I would do nothing to change where my journey has taken me.
You cover a lot of ground in the book, from basic training through PTSD from the perspective of combat medicine. Why will EMS providers—both civilian and military—be interested in this book?
Regardless of what uniform we wear or where we serve, we are EMS providers. Be it in the back of an ambulance in New York City or while going on patrol in the mountains of Afghanistan. I think the first thought we all share when we have wounded is that no one dies while they are under are initial care and treatment. This is true for a local paramedic or EMT, as well as the combat medic. My experiences provide the perspective from the point of view of the combat medic.
These shared experiences also result in PTSD. I wanted to talk about PTSD because, let’s face it, we see some pretty bloody and ugly things that happen to people. We maintain our composure while saving those in our care, but I believe all EMS folks have had to deal with some form of PTSD. I wanted to share my experience in dealing with PTSD, to help me personally come to terms with what I deal with, and so others can understand and know that they are not alone.
What kind of reactions has the book received so far from the EMS world?
It’s exciting to read, providing a perspective from one of our own that cannot be read elsewhere. And it’s enlightening to know that combat medics and local EMS both have similar thoughts and feelings when they are working to desperately to save a patient.
What advice would you give to people in EMS, or their relatives, who feel they have something to say or experiences worth sharing?
Share your experiences, write down what happens each night and keep a journal of events. Write about the good things, the bad things and, of course, the funny things that happen. It is these shared memories that are important. Typically, we do not ever take pictures of our wounded, but nothing stops us from writing about those experiences. Families would love to read about those experiences to “see first-hand” through the written word about what happens in the back of a rig during an emergency situation. I also write poetry based on my own experiences and encounters with the people I have worked on during my combat operations. I find that poetry is a good way to express and help.
Excerpt from My Journey as a Combat Medic: From Desert Storm to Operation Enduring Freedom
Chapter 4—Medical Training
I could have had any job in the military, but I chose to become a medic. I would see the Army medics in action when I was a boy and my father was stationed at Fort Bragg, North Carolina. I had a dream one night when I was a teenager that I will never forget. I dreamed that I was fighting with the 82nd Airborne Division. My unit was in the desert and I was caught in the middle of a firefight. It was hot, dusty, and bloody − a bad situation. My uniform was soaked in sweat and caked with sand. The sand and the sweat would get into my eyes as I was trying to shoot the enemy. I was not sure who enemy was but they were screaming in some foreign language. The platoon medic was behind me, trying to save a wounded soldier. I quickly glanced back to see the condition of the injured soldier but I felt confident knowing the medic was going to save the man. I turned back around and I was shot in the chest. I looked down at the wound and saw my blood seep through my uniform. I stumbled back and fell down into the sand. I saw myself looking up at the clear blue sky, my vision was becoming blurry, and everything seemed so peaceful. I woke up from this dream, drenched in sweat.
I felt as if I had really experienced this event and gave some serious thought as to what the dream could possibly mean. I knew that I was going to join the Army after I finished high school, and I always thought that I would be an infantryman in the 82nd Airborne Division. I decided after that dream that I was going to become a paratrooper medic.
The starting point for almost every medic in the US Army is Fort Sam Houston, in San Antonio, Texas. I started my medic training after I finished basic training in November, 1989. We took a bus from El Paso, Texas to San Antonio, Texas, where I spent ten weeks in advanced individual training (AIT) to learn how to become a medic. I was eager to get started. We had drill sergeants at the school, but they were more laid back than the basic training drill sergeants. They did not train us in how to become medics but were there for discipline and to keep the medic students in line. They marched us to class every day and were waiting for us when our classes ended. We did physical training (PT) in the afternoons with the drill sergeants. It was more fun than the PT we did in basic training; we even played duck-duck-goose a few times. We went running in formation about twice a week. We wore our BDUs and put on running shoes instead of the Army physical exercise uniform.
The instructors crammed as much information as they could into those ten weeks. The first classes started out with basic human anatomy and physiology. We learned each body system, one at a time, but it was compressed and fast-paced, like taking an entry-level anatomy and physiology class. Our training lasted eight hours a day but we had to study in the evenings after going over the vast amount of material that we covered during the day. The medic training was a good way to decide if you had an interest to pursue a career in healthcare, beyond that of being an Army medic. In my years of experience I have learned the learning never ends. Some people try to equate the human being to a car; in many respects, it is a decent analogy, but the human body is far more complex than any automobile. The only major disappointment about my initial medic training was we never worked on any real patients. We never had any live clinical time; instead we practiced our newly learned skills on each other.
A portion of the medic training included Emergency Medical Technician (EMT) training. This is the same training that a basic EMT goes through at a local fire department or community college. A lot of what we learned as an EMT could be applied to working as an Army medic; however, the Army medic has a different frame of reference and has to learn and practice more complex skills. The Army medic is a generalist and does much more than the EMT. Typically an EMT is limited to the confines of an ambulance. The Army medic can be assigned to work in a direct action combat unit, a hospital unit, or almost anything in between. The Army medic may end up working on an ambulance at a motor pool and not see much action, or he or she could go on patrol with an infantry platoon in the jungle or desert. Some medics work as part of the ambulance service for an Army post. I think the best job for a medic is when the medic gets to work both in the field with combat forces and in a clinical setting. The best medics had medical leaders who took the time to teach them real-world tactics.
The ten-week medic training did not cover everything that we needed to learn to become good medics but we learned the basics. Some skills are not covered in medic training; they need to be taught by the senior medics and physician assistants when new medics arrive to their units. Medics need to learn about the following: suturing wounds; specific treatments for illness and injury; minor surgical procedures; basic diseases; different medications; basic women’s health; basic pediatrics; and advanced airway procedures. I had two different drill sergeants during my medic training. The first drill sergeant was tall, very slender, and very by the book. He reminded me of Big Bird, from his bird-like chest and the way he swung his head side to side when he walked. This drill sergeant had been stationed at Fort Bragg, North Carolina, in the helicopter medical evacuation unit before working at the medic school. He proudly wore those aviation crewmember wings, but he was a leg – a non-airborne soldier. Fort Bragg is home to the 82nd Airborne Division and various Special Forces units, but I guess it did not matter that he was a leg. I assumed that he was a good medic; flight medics are some of the best medics in the Army.
He would call us names such as “knucklehead” and “hero.” I didn’t like it when he used those derogatory terms, because it made him look like an idiot. Those were terms that came from the World War II era and I guess he wanted to carry that tradition forward. We did some rather silly training on the weekends when we were not going to class. He made us practice some of our basic soldiering skills. I remember we had to say, “Halt, who goes there? Advance to be recognized!” We did this training in our open barrack bays and would use a broom as a pretend weapon. Our other drill sergeant was a female staff sergeant. She was in charge of us for the second half of our medic training. We did more of the fun physical training with her in the afternoon. She did not have long formations like our first drill sergeant. As the training continued, we began to have weekends off.
Some soldiers did flunk out of medic training. The school gives you a chance to study again and take another version of the test. If a soldier fails a second time, then they are kicked out of school and sent elsewhere. A soldier who flunks out of school goes to basic infantry school or learns how to drive a truck. I remember one of the soldiers that I went to basic training with was sobbing because he flunked out of medic school – I did not feel sorry for him at all because we had a physical altercation in basic training and we didn’t get on. Only a handful of soldiers flunked out of medic training; granted school was very fast-paced, but we had plenty of time to study in the evening instead of goofing off. I guess some decided to goof off too much. Life is funny though. I ran into this particular soldier again; he was with the 101st Airborne Division as a truck driver during Desert Storm when we were staging out of Rafha, near the Iraqi border. We both let bygones be bygones and it was nice to see someone from my basic training platoon again.
The two primary instructors I had at Fort Sam Houston were laid back, very well versed in teaching, and they added their own real-world experience as we learned how to become medics. The training included the use of slideshows – once the teachers dimmed the lights in the classroom it was hard to stay awake.
The senior instructor was a sergeant first class and the other was a staff sergeant. The staff sergeant would go off on tangents about his experiences in the field. One time he talked about how to defecate in the field using only the toilet paper that came with the Army Meals Ready to Eat package. He said since these meals are naturally constipating, they had too much paper to clean with. He cut the paper in a square inch and laughed. He talked to us about the days when he was in Germany living in his M-113 ambulance (a lightly armored ambulance that had tracks on it like a tank instead of wheels) and other endeavors when he was in the field. He was the comic of the two, and they were both good instructors.
The sergeant first class was more formal in his way of teaching. He wore the Expert Field Medical Badge. Soldiers would often fall asleep during his lectures; it was early in the morning, the lights were dimmed, and it just happened. He would smack hard on the desk of a soldier who fell asleep and would have him or her stand up. I started to drink coffee in the morning during our breakfast meal to stay awake. Want to disrespect a sergeant? Fall asleep in his or her class. Repeat offenders were introduced to an isometric exercise that involved holding up the wall with their backs and bending their knees. The muscles started to burn after a few minutes. Sometimes I got sleepy, but I had enough sense to stand up myself.
The EMT portion of the class covered how to do cardiopulmonary resuscitation, doing a primary survey on the patient, applying different dressings to control bleeding, and basic splinting techniques. We never had the opportunity to go on an ambulance to put our training into real practice. We learned a lot of material relevant to being an EMT assigned on an ambulance, but a lot of the knowledge did not apply to being a soldier medic. As an example, we watched a video about learning how to drive in a civilian ambulance; I did not even have my driver’s license yet. The most nerve-racking class at the time was the intravenous therapy class. We practiced on a dummy arm a few times to learn the basics. After that we would practice sticking each other. I got stuck several times during this part of my training. The testing portion was quick-paced also. We had to demonstrate how to spike the bag of fluid, but we didn’t start any fluids. We just stuck each other until we got a good IV in. Some soldiers passed out as they were getting stuck; others just bled profusely. I enjoyed it; it was fun. Learning to start on IV on someone is what being a medic is all about!
We practiced on training manikins for the skills that we could not do on each other such as applying tourniquets, airway management, needle decompression, and learning to assist mothers during childbirth. Those manikins are not the same as real life, but it was a good starting point. I was sure I did not want someone putting a tourniquet on or sticking me in the chest with needles! The field portion of our medic training was one week long. We marched a few minutes to the field site every morning that week. It was late February in 1990. The weather in San Antonio was warming up but the training area was really muddy. During the course we wore the old-style steel pot helmet; the insert was made of steel. Back in the day, soldiers used these helmets as a sink to hold water while in the field. They were nicknamed steel pots. The newer helmets are Kevlar helmets, but they got the name K-pot for short. The Kevlar provides a higher level of protection than the old steel pots did.
A good portion of the field training included mixing the medical Basic Non-Commissioned Officer Course (BNCOC) sergeants with our basic medic class. These sergeants were already seasoned medics, and the training they were going through was more advanced and they were learning more army leadership skills. A few of us followed this BNCOC medic around and she told us what to do; she taught us field skills that were not in the book. As part of the course we had specific training lanes that we had to go through. The lane I enjoyed the most was the massive casualty exercise: we had about a dozen wounded people and we went through the motions of evaluating and stabilizing them. We applied neck braces, splints, and dressings − nothing invasive in the field, but it was still fun.
After we stabilized them, we put them on the green army litters for evacuation. Once the wounded were on the litters, we had to evacuate them through a litter obstacle course. The course was exhausting. Four of us had to carry our wounded soldier up and down muddy trails. We low crawled with the litter through the mud, and it was scary when we had to carry our pretend wounded over some higher obstacles. It took a lot of teamwork.
The drill sergeants eased up on us after the first six weeks of medic training. Our weekends were free. It was fun to explore San Antonio. I visited the Alamo, went out to local dance clubs, and hung out at the River Walk – a popular tourist attraction and pedestrian walkway, home to a number of bars and restaurants alongside the San Antonio River. We would rent hotel rooms and a bunch of us would spend the weekend in the city. I avoided hanging out with soldiers who were too rowdy or troublemakers.
The majority of the soldiers in my platoon were prior service, meaning that they had served in the military doing a different job and went to medic training to become a medic; they were not new to the military. I was not prior service, but I joined the Army as a private first class because I had taken high school Reserve Officer Training. I felt like I was prior service sometimes, having grown up as an Army brat. We had a mix of active Army, National Guard, and Army Reserves in our platoon. There was a man in his early fifties who was in school with us to be an Army medic. He had served in Vietnam with one of the Special Forces groups. He earned his Combat Infantry Badge, Special Forces tab, parachute wings, and had a Special Forces Group combat patch. The drill sergeants did not mess with him. He was in the National Guard and was retraining to become a medic in the military.
We learned about the different medic bags that Army medics have used throughout the years. My favorite bag is the M-5 medic bag. It is a green rectangular-shaped bag, about 20 inches long by 16 inches wide and 10 inches high. It has a zipper flap and small pockets on the inside portion of the cover. The bag has two cloth pockets located inside. It has one long external pocket to store supplies. It was easy to stuff the M-5 in a rucksack and take it out when you needed it.
Sometimes we would carry it on our shoulders as the bag had shoulder straps for this. One task that a medic learns to love is to pack his or her aid bag. The medic is really nothing without their aid bag – in some instances the aid bag is more valuable than a weapon. Man, I loved that bag.
There is really no universal packing list for an aid bag; every medic is different and has different skills, likes, and dislikes. I packed my aid bag based on what I knew how to do as a medic. My packing list changed with experience. I initially made the mistake of over packing medical supplies, which made my bag pretty heavy. I packed some cool stuff, but it was not mission specific. But over time I learned to pack only what I needed. I found an easy way to disperse the load of all the heavy bags of IV fluid I carried on me – I made several emergency kits that included a 500ml bag of IV fluids with all the stuff I would need to start an IV. I made a kit for each soldier to take into the field or on patrol in the woods. If a soldier went down, I used their emergency kit first to stabilize them. I made a point to tell my junior medics to pack only what they needed for the mission.
The M-5 medic bag also made a nice pillow when in the field. I would pack a few bags of IV fluid just right and it was like having a water pillow for my head.
The learning never stopped. After I graduated from medic school, I continued to grow as a medic. My active duty unit provided me with a chance to expand my basic medic skills both in the clinical setting and in the field. Every day was a training day when I worked at our medical clinic. We primarily saw patients from our own unit, but sometimes I worked at the aviation medical clinic and helped with sick call. The first thing I learned was to gather all the subjective data when a patient came in with sickness. It helped me to weed through what was going on with the patient. Repetition is a great way to harness those skills I learned in medic school. As a new medic, I was not that good at drawing blood or inserting an IV. Every day I was getting better at drawing blood and starting IVs on sick soldiers. Soldiers always needed to have physicals and that involved a lot of blood work. The physicals would be done to make sure that the soldiers are healthy, it involved doing a complete head to toe physical exam on them, blood work, and chest x-rays. Soldiers are also notorious for getting dehydrated from either working out too hard or drinking too much the night before. I started seeing patients with the doctor in my unit, and all the medics in our medical section listened as the doctor gave a quick lecture about each patient’s condition. We had a lot of hands-on clinical experience and I coupled that with my own readings.
Every medic needs a good medical reference; the first one I bought was the Merck Manual. I took as many Army correspondence courses as I could get my hands on to expand my knowledge. It wasn’t enough for me to know how to apply a tourniquet to stop arterial bleeding – I wanted to know what was actually going on and why.
I was in an all-male unit but we did attend to some of the wives and, on rare occasions, some of the children of our unit. Though the doctor had a more active role in those cases, it did expose me to the basics of pediatrics and women’s health. The doctor ordered X-rays and he explained how to read them and in this way I learned about the basic types of fractures. We ordered a lot of X-rays, as, being in an Airborne unit, soldiers would get fractured from parachuting all the time.
I started to develop a good base of medical knowledge. I was lucky as a medic – I gained good clinical and field experience. It’s not the same as going to medical school by any means, but it was good, hard training.
The 1st Battalion of the 75th Ranger Regiment Medical Section hosted the Expert Field Medic Badge (EFMB) in September 1990. The Senior Ranger Medical Sergeant asked our section if any of the 160th medics wanted to participate. Since another fellow medic and I were not deploying right away to Operation Desert Shield we said yes. We were “voluntold.” The sergeant said something I will never forget: “You will get into better shape, and you might learn something, and if you earn your Expert Field Medical Badge, well that’s good too. But if not, you still will be in better shape and you will have learned something.” I liked that attitude and I looked forward to the training. It would help me when I went off to war.
In the EFMB competition, Army medics must perform field medical tasks, common combat soldier tasks, a day and a nighttime land navigation course, and a 12-mile road march in less than three hours. A medic who passes the course earns the Expert Field Medical Badge, a military badge that can be worn on both the dress and field uniforms. All these tasks have to be performed according to the strictest Army standards. It was a three-week course that the Rangers had laid out for us.
We trained hard every day on the common soldier tasks until they became second nature; we had both classroom and field training; we trained on the radios and even watched videos to supplement the training; we went to the weapons range to shoot our weapons; we trained by doing long road marches in our full chemical protective suits with our gas masks and rucksacks on; we trained hard on every event in accordance with the standards of the course. The training went beyond the standard, and I was glad. I was becoming a better soldier and a better medic.
The Ranger Battalion Chief Medical Officer was a hardcore physician assistant. He had been a Special Forces medic before he went to school to become a physician assistant. He deployed on several combat operations throughout his career. The training was physically intense, and as predicted I was getting into pretty decent shape. It was an honor to be in the presence of these Rangers. Many of the medics from the Ranger Battalion had parachuted in Panama back in December, 1989. I was still wet behind the ears compared to these medics, but none of the medics gloated about having a combat jump or about having the Combat Medical Badge. (The Combat Medical Badge is awarded to combat medics during war who do their job while being engaged or engaging the enemy.) They had to go through Expert Field Medical Badge just as I was doing.
We did physical training every morning in order to start the day with a fresh mind and a fresh body. I remember this tall Ranger medic specialist who was a hard-ass, but he also cared about our training. He ran next to me and he played, or at least he tried to play, mind games with me during the run. I was not a fast runner. As we headed toward the finish line with about a mile left to go, he told me and another slower runner that if he beat us back to the line, he was going to smoke us hard afterwards. The slower runner let the challenge go to his head, and he slowed down even further. I, on the other hand, started to sprint, but no matter how hard I tried, with all of my intestinal fortitude, I could not catch up with this fast-running medic. It was beyond my physical endurance. I finished the last mile about 30 seconds behind him, and after I crossed the line, I proceeded to vomit my brains out for a few minutes. After catching my breath, I was ready to take the smoking I was warned about. The medic knew that we were not going to beat him in the race, but he wanted to see what we were made of. The other soldier had stopped and he was half walking and jogging. I gave it my all, but I was never going to be that much of a runner. I always like a challenge and I was sure as hell not going to wimp out because my chest was burning from running so hard. The Ranger medic patted me on the back as I was doing my pushups and told me I did well because I didn’t quit, even though I didn’t have a chance in hell of beating him. I learned a valuable lesson that morning during the run − a lesson more about life than some badge: never quit, always give what you do 100 percent, because even if you fail, if you tried your hardest, then there was nothing else you could do.
I remember the muscle pain and cramping in my legs after that run, and it felt good. The medical training I received from the EFMB was both by the book and from the experiences of the sergeants and the physician assistant. We reviewed how to apply a field dressing, pressure dressing, and a tourniquet, all of which was in the accordance with the standards of the course. The real learning took place when these combat-hardened medics showed us tricks that were not in the regulations, such as using a cravat and an unopened field dressing as an indirect pressure dressing. This indirect pressure dressing could be applied to the upper and lower extremities to slow down the flow of blood to the limbs. The physician assistant reviewed how to insert chest tubes in the field. One medic asked him about pain medication before doing this, and he responded in a typical Special Forces fashion, “They either live with the pain or they die.” The physician assistant was a no-nonsense leader. He gave us quick pop quizzes over the fresh material. An incorrect answer meant we had to get into the front-leaning rest position and start doing push-ups until we remembered the answer. After about 50 push-ups, it was amazing how we got those correct answers.
He gave us a lecture about pain, blood, and deformity. Typically Ranger units do assaults under the cover of night with stealth and surprise, so the Ranger medics do not have the luxury of sunlight to assist them in the stabilization of the wounded. The best things to look for in the wounded are pain, blood, and deformity. If a wounded soldier is not breathing on the battlefield, it is already too late for him or her; on the other hand, if you rub your hands against their chest and they moan, that means they are alive. Pain can also be an indicator of where a wound is located; it hurts when someone touches you where you have a cut. The presence of blood means there is a wound nearby. The medic must use his or her sense of smell and sense of touch to find blood. Fresh blood has a distinct metallic smell to it and it is still warm when it comes out of the body; the medic will feel that warmth. Soldiers can be saved on the battlefield if the bleeding can be controlled. At the same time that he or she is checking for pain and blood, the medic needs to check for deformity. This could be a hole in the chest, or an extremity that is out of regular contortion. The medic feels for these deformities by quickly pressing the wounded body. Some deformity is obvious such as a femur fracture; other forms of deformity can be gradual at first such as an abdominal cavity slowly filling with blood.
The hardest part of earning the Expert Field Medical Badge was the compass course. I had a hard time walking in a straight line; I tended to drift to the right a little bit too much when I walked. I could plot the points down on a map easily and I knew how to use the compass, but the application of this, doing the actual course, was hard for me. My glasses would fog from all the sweat coming off my body. I walked through the woods not watching my footing, tripping over vines and falling flat on my face − even on my back. One time I fell so hard that my glasses fell off, and it was worse at night when I would lose my glasses. Everything looked like a green blur to me, with no chance of reading my compass to get my bearing. All I could do was laugh, and try to find where my glasses had landed. I learned to treat my eyeglasses like any other valuable piece of combat equipment. I tied them down when I went on the compass course and kept a washcloth in my cargo pocket to keep my glasses free of sweat. I learned to take smaller steps on the course and forced myself to walk in a straight line. My confidence in doing the compass course improved. Mostly, I learned to trust my compass and to trust myself. I missed one point on the daytime compass course and I beat myself up over that, but it was passing and that is all that mattered. The nighttime compass course was easier; I passed all the points with flying colors. From that point on, any other land navigation or compass course that I went through was a breeze.
The field portion of our training was exciting. Most of the training participants parachuted into a drop zone at Fort Stewart, Georgia. The scenario being played out was a Ranger assault on a building, and the medics were needed to take care of the wounded. As we were patrolling in the woods with our medical bags and litters, just waiting for the action to start, I heard a big explosion − our cue that it was time for the medics to stabilize the wounded. Although this was training, it seemed real. We rushed to the building and found about a dozen soldiers lying on the ground. It was dark, and the light we had was limited to hand-held chemical sticks. The Ranger physician assistant took charge of the situation as all the medics started to evaluate the wounded. He came to each medic and asked us questions about the wounded we examined. We stabilized the injuries as best we could before it was time to get the hell out of there − Rangers never stay in one place too long. The physician assistant ordered all the medics to take off our black belts. He showed us how they could be used as a strap to take the load off our hands and arms when we put the wounded onto the litters. The Ranger medics had collapsible litters that folded into a carrying bag, which were easier to carry around than the regular litters.
We carried the wounded several kilometers down a dusty dirt road until we reached the landing zone where the helicopters were going to pick us up. Typically, my unit, the 160th Special Operations Aviation Regiment (Airborne) would come to pick up the Rangers in a situation like this. This did not happen on this particular night because my unit was preparing to deploy to Saudi Arabia for Operation Desert Shield. The helicopters fly best at night, but the helicopter unit that was going to pick us up had to wait until the sun came up. It was fine with me; I got a little nap in while we waited. The helicopters landed as the sun rose. Half exhausted and half excited, we loaded our wounded into some old-style Huey helicopters, sat down in the back, and enjoyed the scenic ride back to our base at Hunter Army Airfield, Georgia. We had only one more event for the Expert Field Medical Badge competition. It was the 12-mile road march. After doing everything else those past three weeks, the road march was going to be a piece of cake.
The standard combat uniform with rucksack and weapon must be worn when doing the road march. The event started at 0400 hours but I woke up at 0300 and walked a few miles with all my gear just to get to the starting point, as I did not have a car at the time. When the march began, I started walking fast and then my pace turned into a slow jog. The secret to the road march was to do each mile in less than 15 minutes. As the march dragged on I got a little tired and then slowed down. It did not help that the night before I had eaten pizza and drunk cola instead of eating something healthier. They had people at each mile marker to tell us our time. Though I was sweating up a storm, I was going to make it. Sweat was pooling where I tucked my pants into my boots as I was strolling along. My uniform was soaked. I managed to get across the dehydrated, though. One of the Ranger medics drove me back to their medic station and they pumped me with 4 liters of IV fluid. That IV fluid felt so good. I came around, but I was still a little wobbly. The ground seemed uneven as I walked.
All the participants that had passed all the events lined up to have our Expert Field Medical Badges awarded to us. The senior Ranger medic held us from behind, and the Ranger physician assistant pinned the badge on us and then punched it into our chests. I have heard horror stories about Army medics who have tried out ten times for their Expert Field Medical Badge, but have never earned it. They always seemed to mess up on something, or they don’t pass the soldier skills like using the radio or the road march. I worked really hard for three weeks for this badge, but I could not imagine having to go through that training more than once. The Ranger Battalion course was hard and intense, but it made me a better field medic. I learned to challenge myself physically; it was a case of mind over matter. I proudly wore my Expert Field Medical Badge above my parachute wings.
The Army flight medic is considered by all to be the elite of the Army medics. I received my orders to go to flight medic school in the summer of 1991, when my unit had just returned from the war in Kuwait. This school is conducted at Fort Rucker, Alabama. The Army aviation community calls this base Mother Rucker because it is where all the Army helicopter pilots first learn to fly. The course was a month long and it covered the history of aviation medicine, the role of the flight medic, specific competencies of the flight medic, and general aviation concepts.
Most of the training was indoors, in several classrooms, and experienced Army flight medics taught us. The term used for Army aviation medical evacuation units is “Dust-Off.” It was a call sign used in the early 1960s during the development of the aviation medical evacuations. I learned that the one factor in the development of the old Huey helicopters was they had to be wide enough to carry the old-fashioned wooden litters. In the Korean War, the wounded were carried on helicopters, but there were no cabins where the medic could stabilize the wounded. The pilots would just fly them from the battle zone to the field hospitals. No one could provide emergency care while in flight. The Huey helicopters enabled the wounded to be cared for while in flight.
The training I went through was mentally intense. We quickly reviewed anatomy and physiology and then went into basic trauma life support. Basic trauma life support is the foundation of medical care onboard the back of the helicopter. Controlling bleeding, preventing shock, and keeping the patient alive are the key components. We also reviewed in-depth, more advanced trauma life support measures to include inserting advanced airways, chest tube insertions, and advanced cardiac life support. The training started like any other day in the active Army: we woke up and did PT, but the physical training here was a little more laid back than normal. We played softball, volleyball, and ran a few times a week; it was a gentlemen’s class. There was no yelling or screaming or doing push-ups. There were only a limited number of medical aviation units in the Army, and the all medics in flight medic school want to be there – medics did not go to flight medic school and flunk out. I was no exception. We studied hard and passed everything. I had a hard time learning how to interpret basic cardiac strips, so I studied those even more. We reviewed basic skills such as starting an IV and we practiced on each other. I still hate being stuck with an IV, even in a training environment, but most of the medics who attended the course were seasoned. We had a field exercise doing litter carries all day, and we learned other methods of evacuating the wounded besides using a helicopter.
Fort Rucker, Alabama, was hot and muggy, much more humid than Savannah, Georgia. We had to wear our flight suits during the field exercise and that made it even hotter. The most fun came when we had a chance to go into the altitude chamber and take off our breathing masks. It was an oxygen-deprived, intoxicating experience. The higher in altitude a plane or helicopter goes, the more oxygen molecules in the air are spread out, so as we breathe, we get less oxygen in our system. The brain becomes oxygen-deprived and we do odd things. We performed everyday tasks such as adding simple numbers or writing sentences. When deprived of oxygen in the altitude chamber, it is much like being drunk or high.
Flight medic school was good additional training and added to the medic skills I had already obtained from the war. I learned a lot during my EFMB training, and in the day-to-day routine medical care we provided for our soldiers. I earned my aviation crewmember wings when I graduated from flight medic school. At this point I had my Expert Field Medical Badge, my aviation crewmember wings, and my parachute wings; this was pretty good for a young, 20-year-old soldier medic. We would have Combat Medical Badges awarded to us later on that year, and that meant that I could no longer wear the Expert Field Medical Badge.
My last medic training experience with the military came very late in my career. I had to attend a Basic Emergency Medical Technician and Army Medic course. I needed these classes in order to stay in the Army as medic. It did not matter that I had worked as a registered nurse in a medical intensive care unit or that I was a family nurse practitioner; I attended the training at Fort Knox in the summer of 2009. I had less than two years before I was going to retire, but the Army has its rules and regulations and I sat through these classes.
It was a good review of material and skills that were, at the most, very basic to me. In some respects it was a waste of time. But one thing I learned was how much the Army medical service has changed; for instance, combat medics are now sticking large bore needles into bones of the lower legs in order to infuse IV fluids in patients who are in shock. I also learned all about the advances in airway management that had been made since I went thought my initial training. I took the training seriously and listened to what the instructors had to say. We had a mix of active Army, Army Reserve, and Army National Guard medics in the classroom. The way to tell who was who was from our unit patches. One of the medics in the classroom worked as a drill sergeant at Fort Knox. He did not work in his job; instead he trained basic trainees on how to be soldiers. The EMT portion of the training was boring and dull, but the Army medic portion was a good refresher for me, as it brought me up to date on the newest trends in Army emergency medical care. The two classes were separated because the Army medic does more than the emergency medical technician does. Once I finished the classes, I had to take my emergency medical technician certification exam. I had considered studying for the exam, but I felt that if I could not pass this, then something is wrong with me. I took the test the same day and passed it. I was now certified to be an Army medic again!
I hear the choppers coming
They’re flying overhead
They’ve come to get the wounded
They’ve come to get the dead
Refrain: AIRBORNE (shoot, shoot, shoot, shoot to kill)
MEDIC (shoot, shoot, shoot, shoot to kill)
My buddy’s in a foxhole
A bullet in his head
The Army says he’s living
But I know that he’s dead
I ran to tell the C-O
About my buddy’s head
But when I got there
The C-O was dead
And now the battle’s over
The smoke is all around
We wanted to go home
Too much fighting all around
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