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Thursday, April 24, 2014

ARMY 68W (68 Whiskey) Army Combat Medic


Thanks to “SB TUCKER” for the Update!! This info is from a 68W!   –D/C– Oct 26, 2011

Description

 

The main role of the 68W10 in the United States Army is to provide medical treatment to wounded soldiers. Whiskeys are staples in the functionality of the US Army, as every squad is required to have a whiskey in attendance when going on any hazardous mission. [Line medics are typically assigned by platoon or battery, not by squad.  Thus, one medic may be responsible for 40 or 50 Soldiers in a combat arms (infantry, field artillery or engineer) unit.  These medics are not just assigned by mission – they live and work with those Soldiers day in and day out.  They conduct formal sick call for their “joes,” and they also spend a significant part of their day talking to and monitoring those Soldiers.  They can tell you what allergies each Soldier has, their meds, their past medical history, and also the names of their wife and kids.  they play a mental health role, as well as advising those Soldiers on medical matters “off the books” – as combat arms Soldiers are notoriously reluctant to go on sick call for injuries and ailments.]   They are found in every stage of medical treatment in a combat zone. Whiskeys initiate medical treatment at the accident or injury location, maintain medical treatment during evacuation to healthcare facilities, and provide medical treatment in the medical facilities themselves. 68W10s are highly trained to perform medical duties in hazardous and challenging atmospheres.

 

68W10s work alongside Army PAs, or doctors under their respective jurisdiction and licensure. Their work can range from the administration of immunizations and collection of fluid samples to obtaining vitals and initial information from patients/casualties and treating trauma to surgical assistance and suturing. The 68W10, oft times, must work in the absence of medical professionals or healthcare providers through BLS (Basic Life Support) monitoring and maintenance. [PAs and MDs are pretty scarce.  They establish a formulary and the medic’s scope of practice – whatever the PA signs off on, you can do.  But the line medic may only see one every few weeks, and of course, the Army doesn’t send its doctors “outside the wire”, so you’re on your own a lot of the time.   Unfortunately, doctors in theater rotate out every three months, so the medic’s scope of practice may change quarterly.  Within field medical units like aid stations, forward surgical teams, and the Triage/EMT (ER) section of a CSH, medics provide almost all of the medical treatment.   Nurses primarily supervise and assist with charting and patient flow, and doctors only see those patients who require that level of care.  For example, in an EMT section, the standard is one medic per two patients, and one nurse per two medics.  In larger facilities, like the wards in a CSH or fixed facility hospital (Walter Reed,  BAMC, etc) medics tend to be used more as orderlies].

 

The 68W health care specialist will and can also work as the senior enlisted person in a clinical setting, as well as the Platoon Sergeant of a medical platoon in field units. As senior personnel, the 68W will have various collateral assignments that must be performed, such as daily, monthly, annual training and counseling sessions for soldiers to better help them in assisting with the treatment and education of patients who visit the clinic along with self improvement. There are constant expansions initiated to the 68W MOS in order to improve the capabilities of the healthcare specialist. [Within medical units, 68W NCOs fill all the normal leadership roles.  In fact, in some medical units, like Combat Support Hospitals, you must be a 68W in order to be First Sergeant of the unit.]

 

Currently, the only civilian equivalent for 68Ws is Emergency Medical Technician – Basic, or upon completion of courses prescribed through MSU (Mountain State University), they may receive an Associate’s Degree in medical assisting. There are educational programs at some universities which offer a technical degree in the Emergency Medical Sciences, and allow the 68W to grow in the medical field. Many 68Ws go on to become Physician Assistants, Nurse Practitioners, Registered Nurses, Doctors, and Healthcare Administrators with extra training through continuing their education.[There has been much discussion in the Army EMS community about translating the 68W scope into a comparable civilian scope.  NREMT has considered creating an “EMT-M” scope that specifically describes the capability of a 68W, but it’s a tough sell to the civilian community.  The 68W is a trauma specialist, but civilian EMS practice is predominantly medical.  Starting January 2012, the NREMT is changing their skill levels.  The new levels will be EMT, Advanced EMT, and Paramedic.  As of May 2011, NREMT was considering grandfathering all 68Ws as Advanced EMTs, but this has not come down as doctrine yet.]

 

Skill Levels

 

  • 1 is the basic entry level Combat medic (e.g. 68W10)
  • 2 is a combat medic with the rank of Sergeant (E-5)
  • 3 is a combat medic with the rank of Staff Sergeant (E-6)
  • 4 is a combat medic with the rank of Sergeant First Class (E-7)
  • 5 is a combat medic with the rank of Master Sergeant/First Sergeant (E-8) or Sergeant Major (E-9)

 

Skill Identifiers

 

  • F6 is an Army Flight Medic
  • M6 is the Army’s Licensed Practical Nurse
  • P6 is an orthopedics specialist (clinical)
  • Y8 is an immunization-allergy specialist (clinical, lab)
  • N3 is the Army’s Occupational Therapy Assistant (clinical)
  • N9 is a physical therapy technician (clinical)
  • Y2 is the code used to identify those who have not finished the upgrade classes.
  • W1 is a special operations combat medic (SOCM)
  • P3 is an optometry specialist (clinical)

 

[On 1 October 2012, almost all of these Additional Skill Identifiers are going away.  Soldiers holding those ASIs will once again have their own MOS (for example, 68WM6  will revert back to 68C).  Those Soldiers will no longer complete medic school prior to their specialized training.  The only Soldiers who will complete medic school are Combat Medics (68W) and Civil Affairs Medics (68WW).  Under a program started in 2011 by LTC “Doc” Mabry (“Blackhawk Down”), all Flight Medics will be trained as Paramedics (civilian school), then complete civilian and military training as a Critical Care Flight Paramedic.  At the conclusion of their training they will hold that civilian credential.]

 

History

 

Recently known as 91W, the MOS was changed effective October 1, 2006. Formerly known by the MOS codes 91B (9 1 Bravo) and 91A (91 Alpha).The Department of the Army Deputy Chief of Staff for Personnel issued a notice for future change for the MOS 91B&C in September 1999. This notice established the transition to 91W to begin on 1 October 2001 and end on 30 September 2007. During this period all 91B&C will be given the identifier of Y2 until they complete the transition to 68W. To complete their transition to 68W many 91B&C must complete EMT-B which was offered but never required for any medic until now. Failure to conform to these standards has resulted in some medics having to reclassify into another MOS.

 


Training

 

groups. The SOCM 68W is currently the most independent-duty enlisted medical personnel in the CMF 68 field. SOCM medics work relatively independent through specific protocols in a limited scope of practice that may be enhanced during the complete Upon the completion of their basic training, future 68W10s are shipped to Fort Sam Houston where they undergo Advanced Individual Training (AIT) for 16 to 68 weeks, depending on their identifier training time. During these weeks, soldiers will attend many courses that teach them the various medical tasks that they require in their military career. To maintain their MOS they must also obtain and maintain an EMT, and CPR certification. To provide the necessary hours for their re-certification many medics go through extensive ongoing training for the rest of their military career. [At a minimum, they complete a 48 hour skills training session annually that concludes with a skills test under simulated combat conditions.]  As with any medical career or profession, the medical personnel must be willing to be educated throughout their career which may consist of many hours of research.

 

In addition to skills taught at the AIT level, 68W’s may, at the request of their unit’s Physician’s Assistant (PA), attend any number of requested advanced topics. These topic are generally prescribed per each units functional role. For example a front line combat medic (aka “line medic”) may learn about advanced trauma treatments including venous cutdowns, placement of chest tubes, or use of specialty hemorrhage control methods such as Chitosan patches or “Quikclot”. [Actually, venous cutdowns, chest tubes, suturing, endotracheal intubation, and administration of blood products are taught formally at the E-6 level, (except for 18Ds and Flight Medics, who get it as part of their basic training).  However, any medic can perform these skills with the authorization of his PA or MD.  Advanced hemorrhage control, fluid replacement therapy – including volume expanders, but not blood - needle chest decompression, and surgical cricothyrotomy are basic skills taught to every 68W in AIT.  Quikclot and Chito are no longer used.]  In the case of those attached to medical units, they may learn and administer medications which result in more definitive treatment than their civilian counterparts are allowed to. Unknown to most, field hospital units don’t usually have a large amount if any 68WM6 (LPN) so they use the combat medic who is readily available and partially trained. Hopefully the future will allow for an independent duty medical team or personnel to conduct operations in the absence of qualified health care providers. [Actually, there are more M6 slots in a field hospital unit than there are 68W slots.  The M6’s staff the wards, working under RNs.  One or two 68Ws are assigned to each ward to assist.  The EMT section of the hospital is staffed exclusively by 68Ws, a few RNs, and a PA or MD.  Army field hospitals are unique, in that they are both a hospital and a military unit (usually a Battalion) at the same time.  So there are two chains of command – one exclusive to the hospital and its sections, and one for general administrative control.  For example, I am currently the Wardmaster of the Specialty Clinic at a CSH.  So I am the NCO in charge of the Specialty Clinic Section.  I am also the platoon sergeant for a group of about 50 Soldiers, officers and enlisted, that include my section (Specialty Clinic) and several other sections.  As a platoon sergeant, I am responsible for accountability, general military training, and discipline as it pertains to Company/Battalion functions.  As Wardmaster, I am only responsible for those Soldiers within my section, but I am responsible for their medical training and patient care within that section.   Both M6s and 68Ws fill leadership roles within the hospital, serving as Wardmasters of their respective sections and as platoon sergeants and squad leaders in the non-medical, administrative side.  The senior M6 in the hospital is the Chief Wardmaster, essentially the First Sergeant of the hospital. while the First Sergeant of the Company or Battalion is a 68W.]

 

In order to take their training to the next level many medics opt to become EMT-I or EMT-P certified. The Army also has a IPAP which is oriented toward helping medics become PAs through a two year school program. And yet fewer medics choose to become 18D which is the Special Forces Medical Sergeant, these medics are required to become EMT-P. Some medics choose to enter special operations through the Special Operations Combat Medic (SOCM) course and are awarded additional skill identifier “W1″. SOCM-qualified 68W personnel serve in the 75th Ranger Regiment (Ranger Medic), 160th Special Operations Aviation Regiment (SOAR Flight Medic), 96th Civil Affairs Battalion (CA-Med SGT), Special Operations Support Command, and in support positions of the special forces absence of a medical officer. SOCM medics assigned to special operations units attend unique advanced medical and military training to enhance their interoperability with other special operations soldiers.

 

  • EMT Basic
  • ATLS
  • BTLS/PHTLS
  • Trauma-AIMS

 


Responsibilities

 

  • Provide cover fire to incapacitate an enemy
  • Accompany every patrol to provide immediate medical coverage for all soldiers in combat
  • Initial stabilizing treatment and triage
  • Plan and conduct Evacuation from the field of battle and en route life support
  • Preventive medicine
  • Field sanitation
  • Clinical medicine
  • Supportive Care in the event of delayed transport
  • Plan and Provide instructions for unit Combat Lifesaver programs

 


Plan and conduct Combat Lifesaver training

 

CLS (combat lifesaver) trained soldiers are non medic soldiers in their unit (such as infantrymen or engineers) who receive moderate amounts of extra emergency medical training in order to provide point of wounding care and to act as a link between “buddy aid” and the standard Combat Medic. The 68W trains the Combat Lifesaver.

 

Combat lifesaver skills are exactly that, for use in combat conditions. However, skills may be applied in non-combat conditions where soldiers are concerned. The combat lifesaver is instructed in various techniques to treat and stabilize injuries related to combat. To include, but not limited to, blast injury, amputation, severe bleeding, penetrating chest injuries, simple airway management, and evacuation techniques. The combat lifesaver doctrine was developed as an effort to increase survivability in combat environments where the combat medic may not be readily available. The combat lifesaver is a bridge between self aid or buddy aid and the combat medic. The combat lifesaver can augment the combat medic as the situation necessitates.

 

[Every Soldier in the Army goes through CLS training as part of Basic Training.  68Ws conduct regular CLS refreshers, and are still teaching initial courses for those who didn’t get it in Basic or pre-deployment.  The CLS scope no longer includes IVs, as the Soldiers seemed to get fixated on starting them, and tended to neglect things like bleeding control and airway while they tried to get the stick.  However, individual medics will single out Soldiers in their units who show particular interest and aptitude, and will teach them additional skills – unofficially.  Smart medics also teach all of their Soldiers how to spike a bag, open sterile packaging correctly, and similar tasks that help free their hands when things get busy.]

 


Skills of the Combat Lifesaver

 

  • Basic casualty evaluation
  • Airway management
  • Chest injury and tension pneumothorax management
  • Controlling Bleeding
  • Intravenous Drip therapy
  • Requesting medical evacuation

 


External links