Physician Assistants in Tactical Medicine Training Programs Chapter 21 PHYSICIAN ASSISTANTS IN TACTICAL MEDICINE TRAINING PROGRAMS Felipe Galvan, PA-C, MPAS; Todd P. Kielman, PA-C, MPAS; Robert M. Levesque, PA-C, MPAS; Michael Holloway, APA-C, MPAS; Walter Engle, PA-C, MPAS; and David W. Broussard, PA-C, MPAS Introduction To support the US Army warfighter, physician assistants (PAs) provide instruction and oversight to tactical medicine training programs in multiple organizations. Medics, nurses, PAs, and physicians receive training on initial entry to the military or as part of deployment or sustainment training. The branch assignments officer selects the PAs assigned to these organizations based on their qualifications and combat experience. Department of Combat Medic Training The Department of Combat Medic Training (DCMT) annually trains 6,500 soldiers to become healthcare specialists (military occupational specialty 68W). This makes DCMT the second largest military occupational specialty training program in the US Army. The training curriculum is 16 weeks, divided into 7 weeks of Emergency Medical Technician-Basic (EMT-B) training and 9 weeks of tactical medicine training. The tactical medicine segment is subdivided into limited primary care (used during sick call) training and tactical combat casualty care (TCCC) training (Figure 21-1). 1 In addition to conducting training, DCMT frequently assists with the capabilities assessment of related equipment and practice innovations. 2 273
US Army Physician Assistant Handbook Figure 21-1. A student training during the care under fire phase of tactical combat casualty care. Photo by Jose E. Rodriguez, Army Medical Department Center and School Public Affairs Office. Organization Structure and Role of the Physician Assistant DCMT is aligned under the Defense Health Agency and the Medical Education and Training Campus at Fort Sam Houston, Texas. It is headed by an emergency medicine physician with emergency medical services certification. The deputy director is an active duty PA. The DCMT deputy director serves in multiple leadership roles within the department, focusing on battlefield medicine. He or she works with training team leaders, critical care and emergency room nurses, instructors, noncommissioned officers (NCOs), and paramedic-certified civilians to ensure students receive optimal training experiences. 274
Physician Assistants in Tactical Medicine Training Programs Physician Assistant Prerequisites Those seeking a position as a DCMT PA require: the rank of captain with completion of the Army Medical Department (AMEDD) Captains Career Course (CCC); a history of assignment to a battalion, squadron, or team PA position for 4 years or more; and experience in combat trauma or prior certification as a paramedic. Brigade Combat Team Trauma Training Brigade Combat Team Trauma Training (BCT3) is a 5-day course that teaches advanced point-of-injury care to healthcare specialists (68W) and flight medics within their 90-day predeployment window, 3 in accordance with Department of the Army Executive Order 096-09, Mandatory Pre-Deployment Trauma Training (PDTT) for Specified Medical Personnel. 4 BCT3 deploys mobile training teams to train active duty units at their home installations and reserve component soldiers at Camp Bullis, Texas. BCT3 training focuses on saving lives and addressing the three most common causes of preventable death on the battlefield: hemorrhage from extremity wounds, tension pneumothorax, and airway compromise (Figure 21-2). 1 BCT3 also teaches current tips, techniques, and practices derived directly from lessons learned in the operational environment. The team trains 46 to 48 weeks per year. In addition to conducting training, all members of the team must remain current on emerging point-of-injury trauma techniques and recommendations from the Committee on Tactical Combat Casualty Care. 1 Organization Structure and Role of the Physician Assistant BCT3 is led by a PA who supervises a mobile training team consisting of active duty and reserve medical NCOs in the rank of staff sergeant and sergeant first class. The PA and senior NCO must have at least two combat tours each. The PA is supervised by the director of the Department of Tactical Medicine, who stands by to assist with guidance on matters related to training and the efficiency ratings of the NCOs on the team. 275
US Army Physician Assistant Handbook Figure 21-2. Students treating hemorrhage using the principles from tactical combat casualty care. Photo by Jose E. Rodriguez, Army Medical Department Center and School Public Affairs Office. Physician Assistant Prerequisites Those seeking a position as a BCT3 PA team leader require: the rank of captain with completion of the AMEDD CCC; a history of assignment to a battalion, squadron, or team PA position for 4 years or more; and 2 or more years of experience in combat trauma. 276 Tactical Combat Medical Care Course The nationally recognized Tactical Combat Medical Care (TCMC) course provides the PA, physician, nurse practitioner, and senior medical NCO with a practical working knowledge of how to manage injured patients in a combat environment from point of injury to Role 1 or Role 2. The course information is based on TCCC, known trauma resuscitation methods, lessons learned from combat, and newly developed technology. Training consists of didactic lecture and hands-
Physician Assistants in Tactical Medicine Training Programs on practical training conducted on Fort Sam Houston and Camp Bullis, Texas, where combat casualty management is taught in a simulated tactical environment (Figure 21-3). The course lasts 5 days and has 22 to 24 iterations per year. 3 Organization Structure and Role of the Physician Assistant Initially created by active duty PAs, TCMC currently employs two active duty PAs and three civilian PA instructors who plan, coordinate, and instruct the course. The senior active duty PA is also the officer in charge (OIC) of the section. 3 Physician Assistant Prerequisites Those seeking a PA position at the TCMC course require: the rank of captain with completion of the AMEDD CCC for those seeking the position of instructor; Figure 21-3. Students at the Tactical Combat Medical Care course treat a simulated trauma casualty in a simulated Role 1 aid station. Photo by Jose E. Rodriguez, Army Medical Department Center and School Public Affairs Office. 277
US Army Physician Assistant Handbook the rank of major for those seeking the position of OIC; a history of assignment to a battalion, squadron, or team PA position for 4 years or more; and 2 or more years of experience in combat trauma. Defense Medical Readiness Training Institute Combat Casualty Care Course The Combat Casualty Care Course (C4) trains 750 triservice and international medical officers annually in the TCCC curriculum, supporting prolonged field and prehospital care training and education. C4 is an 8-day course offered at the Defense Medical Readiness Training Institute (DMRTI), consisting of a classroom-based professional program and a prolonged field exercise. The professional program is targeted by the student s medical field: physicians, dentists, and some PAs receive Advanced Trauma Life Support Operational Emphasis; nurses receive Trauma Nursing Core Course Operational Emphasis; all others receive Pre-Hospital Trauma Life Support. The field training exercise is conducted in a forward operating base environment, in which C4 students must demonstrate medical proficiency in all three phases of TCCC (care under fire, tactical field care, and tactical evacuation care) while conducting mission-oriented exercises based on current combat theater scenarios or potential scenarios in other threat locations. Hands-on chemical, biological, radiologic, and nuclear training is included. The exercise integrates mission-oriented medical care in the following contexts: military operations in urban terrain, village stability operations, tactical evacuation care on a Sikorsky UH-60 Black Hawk helicopter simulator, a simulated Role 2 facility, a tactical medicine obstacle course, and a mass casualty situation. C4 is a faculty affiliate of the National Association of Emergency Medical Technicians. The course requires distance learning of the Joint Knowledge Online Emergency Preparedness Response Course Clinician Course. Organization Structure and Role of the Physician Assistant The DMRTI director is a physician from the Army, Navy, or Air Force. DMRTI is under the Defense Health Agency, which reports directly 278
Physician Assistants in Tactical Medicine Training Programs to the Assistant Secretary of Defense for Health Affairs. An Army PA serves as the C4 branch chief or deputy branch chief, and the staff consists of medics and corpsmen from the Army, Navy, and Air Force. The triservice role allows for joint staffing, training, and equipping to meet the requirements of TCCC training. Physician Assistant Prerequisites Those seeking a position as the C4 PA require: the rank of major; completion of Intermediate Level Education training; a history of assignment and deployment with a brigade or regiment PA position for 2 years; and experience in combat trauma. References 1. Committee on Tactical Combat Casualty Care. Tactical Combat Casualty Care Guidelines 29 April 2015. Tampa, FL: CoTCCC; 2015. 2. Defense Health Agency. Medical Education & Training Campus website. http://www.metc.mil/academics/dcmt/. Accessed July 14, 2016. 3. Headquarters, US Army. Army Training Requirements and Resources System website. https://www.atrrs.army.mil/atrrs2. aspx. Accessed July 23, 2015. 4. Headquarters, Department of the Army. Mandatory Pre- Deployment Trauma Training (PDTT) for Specified Medical Personnel. Washington, DC: HQDA; 2014. Executive Order 096-09. 279
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