Combat medic
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Combat medics are trained military personnel who are responsible for providing first aid and frontline trauma care on the battlefield. They are also responsible for providing continuing medical care in the absence of a readily available physician, including care for disease and battle injury. Combat medics are normally co-located with the combat troops they serve in order to easily move with the troops and monitor ongoing health. In 1864, sixteen European states (referring to themselves as "High Contracting Parties"), adopted the First Geneva Convention to save lives, to alleviate the suffering of wounded and sick military personnel, and to protect trained medical personal as civilians, in the act of rendering aid.
Chapter IV, Article 25 of the Geneva Convention states that "Members of the armed forces specially trained for employment, should the need arise, as hospital orderlies, nurses or auxiliary stretcher-bearers, in the search for or the collection, transport or treatment of the wounded and sick shall likewise be respected and protected if they are carrying out these duties at the time when they come into contact with the enemy or fall into his hands." Article 29 reads "Members of the personnel designated in Article 25 who have fallen into the hands of the enemy, shall be prisoners of war, but shall be employed on their medical duties insofar as the need arises."
According to the Geneva Convention, knowingly firing at a medic wearing clear insignia is a war crime.[1]
The International Committee of the Red Cross, a private humanitarian institution based in Switzerland, provided the first official symbol for medical personnel. The first Geneva convention, originally called for "Amelioration of the Condition of the Wounded and Sick in Armed Forces in the Field," officially adopted the red cross on a field of white as the identifying emblem. This symbol was meant to signify to enemy soldiers that the medic qualifies as a noncombatant, at least while providing medical care.[2] Islamic countries use a Red Crescent instead. During the 1876-1878 war between Russia and Turkey, the Ottoman empire declared that it would use a red crescent instead of a red cross as its emblem, although it agreed to respect the red cross used by the other side. Although these symbols were officially sponsored by the International Federation of Red Cross and Red Crescent Societies, the Magen David Adom ("MDA"), Israel's emergency relief service, used the Magen David (a red star of David on a white background). Israeli medics still wear the Magen David. To enable MDA to become a fully recognized and participating member of the International Red Cross and Red Crescent Movement, Protocol III was adopted. It is an amendment to the Geneva Conventions relating to the Adoption of an Additional Distinctive Emblem and authorizes the use of a new emblem, known as the third protocol emblem or the Red Crystal. For indicative use on foreign territory, any national society can incorporate its unique symbol into the Red Crystal. Under Protocol III, the MDA will continue to employ the red Magen David for domestic use, and will employ the red crystal on international relief missions.
In modern times, most combat medics carry a personal weapon, to be used to protect themselves and the wounded or sick in their care.[3] When and if they use their arms offensively, or carry arms that qualify as offensive, they then sacrifice their protection under the Geneva Conventions.[4]
Combat Medical Technicians (CMTs) in the British Army are members of the Royal Army Medical Corps.
History
Surgeon Dominique Jean Larrey directed the Grande Armée of Napoleon to develop mobile field hospitals, or "ambulances volantes" (flying ambulances), in addition to a corps of trained and equipped soldiers to aid those on the battlefield. Before Larrey's initiative in the 1790s, wounded soldiers were either left amid the fighting until the combat ended or their comrades would carry them to the rear line.
It was during the American Civil War that Surgeon Jonathan Letterman, Director of the Army of the Potomac, realized a need for an integrated medical treatment and evacuation system. He saw the need to equip this system with its own dedicated vehicles, organizations, facilities, and personnel. The Letterman plan was first implemented in September 1862 at the Battle of Antietam, Maryland. The United States Army’s need for medical and scientific specialty officers to support combat operations resulted in the creation of two temporary components: the US Army Ambulance Service, established on June 23, 1917 and the Sanitary Corps, established on June 30, 1917. Officers of the Sanitary Corps served in medical logistics, hospital administration, patient administration, resource management, x-ray, laboratory engineering, physical reconstruction, gas defense, and venereal disease control. They were dedicated members of the medical team that enabled American generals to concentrate on enemy threats rather than epidemic threats. On August 4, 1947, Congress created the Medical Service Corps.[5]
During World War II (and before the implementation of the 1949 revision to the Geneva Convention made it illegal), there was an unwritten law of ethics between Allied and German forces whereby soldiers would not knowingly fire at a medic treating a wounded comrade.[citation needed] This was in stark contrast to the policy of the Japanese forces, who regarded medics as primary targets, resulting in Allied medics removing or covering their insignia and carrying personal weapons to protect themselves.[citation needed]
In the United States, a report entitled "Accidental Death and Disability: The Neglected Disease of Modern Society (1966)", was published by National Academy of Sciences and the National Research Council. Better known as "The White Paper" to emergency providers, it revealed that soldiers who were seriously wounded on the battlefields of Vietnam had a better survival rate than those individuals who were seriously injured in motor vehicle accidents on California freeways. Early research attributed these differences in outcome to a number of factors, including comprehensive trauma care, rapid transport to designated trauma facilities, and a new type of medical corpsman, one who was trained to perform certain critical advanced medical procedures such as fluid replacement and airway management, which allowed the victim to survive the journey to definitive care.
Equipment
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Standard Issue Equipment
The Combat Medic is commonly referred to as a "soldier medic." With a combat unit, they function as a member of an infantry platoon up until the point that one of their comrades is wounded. Therefore, the Medic carries the same basic load as a rifleman. His basic equipment is usually (to use the United States Army as an example):
- Full Body armor
- 180-210 rounds for their primary weapon.
- Ballistic helmet
- Army Combat Uniform or the uniform of their service
Weapons
Combat medics are not usually heavily armed, but usually carry an assault rifle, such as an SA80 or M4 Carbine. Some also carry a pistol, such as the M9 pistol, in addition to/or in place of their rifle. The US Army Medics carry the 5.56mm M-16 A4 or the variate 5.56mm M4 A1 assault rifle, while British Medics are armed with SA80 bullpup rifles. Medics of the Norwegian army, depending on their role, carry a 5.56mm HK-416 as their primary weapon, and a Glock pistol sidearm. Having both weapons is usually for the medics in the infantry, serving alongside riflemen, and Evac-personnel accompaning the mechanized infantry or as an ambulance service who will face the frontline, should the need arise. If stationed on a mobile aid station or a field hospital, it's common to have only a Glock or no weapon, though assault rifles may be stored in a PBU room in a hospital for example, depending on level of threat in the area.
Medical Equipment
A combat medic will typically carry a backpack styled bag known as an "aid bag." Aid bags are available from many different manufacturers, in many different styles. Depending on the unit and their standard operating procedures, the medic may have to follow a strict packing list, or may have the liberty of choosing their kit depending on the mission at hand. A typical aid bag will include:
Fluid Resuscitation
IV fluids and tubing. The amount will depend on the length of mission. Normal Saline/Sodium Chloride, Hetastarch/Hextend, and Lactated Ringers(LR) are usually carried.
18, 16, and 14 gauge IV catheters.
FAST 1 intra-osseous fluid administration kit. The FAST 1 is a quick way to administer fluids when peripheral and external jugular venous access is unavailable due to massive blood loss, burns, or loss of limbs.
Hemorrhage (Blood Loss) Control
CAT, SOFT-T or improvised tourniquets. Tourniquets are used for the care under fire phase of tactical combat casualty care, to stop massive life threatening hemorrhage.
Israeli Dressings, or Emergency Trauma Bandages, a newer version of the first aid pressure dressing.
Kerlix guaze, for stopping hemorrhage, or creating a bulky dressing.
Hemostatic agents, such as QuikClot, QuikClot ACS+, QuikClot Combat Gauze, WoundStat, Celox, Celox Applicator, Celox-D, Celox Gauze, Hemcon bandages, and others. Some hemostatic agents (QuikClot and QuikClot ACS+) are controversial due to their thermodynamic nature, which can cause collateral damage if the user is not properly trained.
Airway Management
14 gauge catheter, at least 3.25 inches long, for needle chest decompression.
Asherman chest seal, or Hyphin chest seal, as an occlusive dressing for sucking chest wounds.
Nasopharyngeal Airway (NPA)w/surgilube or "nasal trumpet." This flexible tube secures a nasal airway when the casualty does not have, or may lose their ability to keep their own airway open. Contraindicated by signs of skull fracture.
Oropharyngeal Airway, a hard "J" shaped plastic device that secures an oral airway, and can also be used to keep the teeth open for a more permanent airway device.
King LTD, a simple tube airway with an inflatable cuff to create a sealed airway.
Combitube, like a King LTD, but designed to be able to function almost no matter how the tube is placed due to the dual lumen tube design.
Surgical Cricothryroidotomy kit. Many different styles and kits exist, the choice is up to the individual medic's supply or preference. The most simple is a scalpel to open an airway, and to use a #7.0 ET tube to keep the airway patent.
Assorted Equipment
Nitrile gloves
Alcohol or Providine/Iodine swabs
Crevats (muslin bandages, Triangular bandages)
Assorted gauze bandages
Adhesive Bandage Strips (Band Aid)
Assorted sizes of tape mainly 3 inch
Coban, a stretchy, self clinging wrap
Ace Bandages
Assorted hypodermic needles and syringes
Field Medical Card
SAM Splint, a flexible, reusable splint with a metal core covered in closed cell foam.
Water Jel burn dressing
Small sharps shuttle
Trauma Shears
Safety pins
Battlefield Medicine
First Line antibiotics
Narcan, a narcotic antagonist, to counter morphine's respiratory depressing effects in case of overdose.
Phenergan, an anti-emetic treatment, which also increases the pain reducing effects of morphine.
Epi-Pen, epinephrine in an auto injecting "pen" to counter anaphylactic (severe allergic) reactions.
A combat medic is generally expected to care for the needs of the soldiers in his group, including their every-day ailments. A medic will usually carry a small amount of what are referred to as "sick call meds."
Tylenol, anti-pyretic and analgesic.
Naproxen, Motrin, different NSAIDS which reduce pain and inflammation.
Diphenhydramine (Benadryl), an antihistamine with a sedative side effect.
Sudogest (Pseudoephedrine), a nasal decongestant.
Mucinex, a cough expectorant.
Loperamide (Imodium AD) an antidiarrheal.
Pepto-Bismol tablets, to settle upset stomachs, treat diarrhea, and heartburn.
Colace (ducosate sodium), a medium strength stool softener.
A Combat Medic may also carry other supplies as the mission dictates. A stethoscope, blood pressure cuff, pulse oximeter, otoscope, ophthalmoscope, and thermometer may help the medic treat his/her soldiers or civilians on the battlefield (COBs) while on an extended mission, as space dictates.
Modern Day
Traditionally, medical personnel did not carry weapons and wore a distinguishing red cross, to denote their protection as noncombatants under the Geneva Convention. This practice continued into World War II. However, the enemies faced by professional armies in more recent conflicts are often insurgents who do not recognize the Geneva Convention and readily engage all personnel, irrespective of noncombatant status. For this reason, most modern combat medics are armed combatants and do not wear distinguishing markings.
See also
External links
- Corpsman.com, A Site run by Doc's for Doc's, of all US Military Services.
- 90th Infantry Division Preservation Group Medical section showing equipment of US, German and Japanese Medics.
- http://home.att.net/~steinert/ WWII medics
References
- STP 8-91W15-SM-TG SOLDIER'S MANUAL AND TRAINER'S GUIDE, MOS 91W, HEALTH CARE SPECIALIST, SKILL LEVELS 1/2/3/4/5