Changes to HS Res Tng

[Donut]

Last night we got a brief from our CO and RSM, just back from Ottawa, and they announced some changes to the res tng for medics.  Just in case people haven't been getting this info, I thought I'd throw it out here and see what people think.

QL 3 and 4 are being lengthened.  They will, together, comprise the non-PCP portion of the reg QL3. So a res QL4 with PCP will have a direct equivalency to a Reg F QL3.  A three week bridge program will be running in Borden summer 06 to bring people over to the new standard, which will mean a decrease in recruiting and QL3 tng for the remainder of the 05-06 tng year.

Reg F PCP positions will be opened to "vetted" Res mbrs starting in Sept 06.

There is a proposal, with some support from higher, for the Reg Fd Ambs to take reservists on contract, give them their PCP, or reimburse them for it, send them on a deployment, and then offer direct CT into the Reg F.

Overseas deployments for reservists are (again) being considered in 30 or 90 day blocks, as well as the above scheme.

Anybody heard anything different? 
What are peoples thoughts on this?

DF

 

[Armymedic]

Not to piss on the parade,

But the reg force doesn't need anymore QL 3 PCP qualified pers that can't do any taskings. We have all sorts. What we are missing is QL 5 Qualified Cpls and up.

Also there is still a whole wack of Reg F non PCP qualifed Med Techs around, so I must assume they are not going to make them go do PCP once they have thier 5s.

But atleast they are doing something so that reserve medics may deploy somewhere sometime.

 

[Donut]

We received a brief last evening from the HS Group Res  CWO.

Here's the run down, from memory, I won't comment on the employability of a Reg F QL3 as that would be outside my lane.

QL3 and QL4 will both be lengthened by one and two weeks respectively.

This will give Res Medics 13 weeks in Borden, or the complete Reg F QL3 less the PCP, so Res mbrs with a PCP will be a Reg F QL3. ( I'm not sure when in this 13 week package the AMFR2/EMR tng is to be delivered.  If it's 13 weeks total, and 13 weeks is the non-emergent Reg F QL3...PLUS the PCP, when do res medics get their emergent care tng? Does this include a Dvr Whl?  A medic who can't drive isn't very useful)

Those already QL3, 4, 6A, SLC will ALL have to return to Borden for a 15-day bridge course running this summer.  Those that elect not to will not be able to participate in patient care.  All Res Mbrs who are clinically employed must have AMFR2 or PCP credentials by summer 06 (no indication as to whether that's a licence, or a course).  Reg F members will be encouraged to seek licensure in their home province.  Have fun with that.

Reg F mbrs transferring to the Res will keep their credentials at the level they received. ( I wonder what requirements that will create for Res Fd Amb MCSP.  How many intubations can you get on Cl A days?  How to "maintain" a non-practicing PA? who teaches those classes?)

Reg F PCP positions will be opened to res mbrs in (hopefully?) Sept 06.  Funding has NOT been secured.

Res Medics will be deployed.  The fact that 1CMBG (ergo 1 Fd Amb) are supporting back to back TF, as well as the Role 3 HSS deployment, means that the HSS cannot meet our commitments without deploying Res medics.  I'll believe it when I see it.

Kit and equipment is, again, on it's way.  Again, I'll believe it when I can touch it, teach it, use it on a patient.

And that the kind of day it was...

DF

 

[Armymedic]

Res Medics will be deployed.   The fact that 1CMBG (ergo 1 Fd Amb) are supporting back to back TF, as well as the Role 3 HSS deployment, means that the HSS cannot meet our commitments without deploying Res medics.   I'll believe it when I see it.

Yes, Role 3 is being taken care of by 1 CFH for TF 2&3.
As for Fd Ambs covering back to back tours, we in bet have done it twice in the last 3 yrs (plus a DART mission).

Sounds like a good plan, hopefully they get the money and kit to see it thru.

 

[Donut]

I originally posted this in the thread "Canadian Reserve Forces Vs US Reserve Forces" in The Canadian Army forum, to illustrate that while we need to find solutions to our Res employment/deployability problem for the CF as a whole, not just the health services, the solution for one may not be the solution for all branches of the forces.

I'm posting it (edited, cleaned up a bit) here in the CFMG group on request of the group mod.

There's certainly been a growing realization, over several years, that the CF must make better use or our reserves.  This spawned a discussion of the relative merits and differences between the CF and the US reserve programs.  I thought I'd take a couple of minutes to illustrate some of the key differences in the health care realms between the Armed Forces of the two nations.  Here is a (slightly less) quick and dirty comparison of the health care components of the USAR/NG/USMCR with the CF HS Res, employment, tng, deployability, complementary civi skills, etc.

Employment:  As discussed, the USAR etc. deploy as a formed unit, whereas the CF HS Res deploy (few)individual augmentees to add numbers, but not new capabilities, to ops.  These augmentees are of dissimilar military skills, including wpns handling, MAT, nav, AFV Recognition.  Some have deployed without a working knowledge of the wpns they will be handling in theater.

Training:  USAR etc. training is identical across reg/res spectrum, CF HS Res is now beginning to move to a QL3 equivalent (-) skill set.  Achieved in approx 4(!?!) years of Res F tng.  The CF will provide all tng except the Primary Care Paramedic credential to make a res mbr deployable.

Equipment:  USAR CSH units are equipped almost identically to their USA counterparts. CF HS Res units don't even come close.  It's very hard to train on kit you've never seen.

Range of Skills:  A USAR etc.  Cbt Support Hospital will have a wide range of skills, including anaesthesia, lab, x-ray, physio, PMed, NBC, psych, a couple of PA's, a general surgeon, perhaps on orthopod, etc.  A CF HS Res Fd Amb considers itself lucky to have an RN or a couple of paramedics.  There are virtually no PAs in the Res, no surgeons, no anaesthesia, no lab, no x-ray, no respiratory therapists, no pharmacists. 

Deployable?  USAR etc:  Big YES.  CF Res Fd Amb-God, I hope we're never in that bad shape.

Fitness:  USAR (esp USNR seconded to USMCR) Extremely high.  Mbrs are released or disciplined if it drops below standard, with loss of benefits.  CF HS Res: about as good as most reservists, but these people didn't want to face the rigours of Cbt Arms experience for the most part.  Their fitness level speaks to that, too.

Health Care experience: USAR virtually every mbr works in a civi health care facility, full time, with most having gained their clinical credentials through the military.  CF HS Res: Very few work in a clinical setting, those that do obtained their credentials on their own, and "own" those credentials, with no loyalty owed to the CF as a result of them.

WRT mandated training ( the original discussion brought up an idea that 4-6 weeks of mandated annual tng wold go a long way to resolving the Res-Reg tng delta), that's all well and good, but lets keep a couple of salient points in mind here:
Our HS Res has already handed down an annual training plan.  As a result, many of our troops are expected to parade 3 out of 4 weekends most months.  It's not exactly the "Thursdays and one weekend a month" they enrolled under, and they know it.

Now, most health care professionals have a few problems with this: Shift work, to start with.  Professional competence, for another.  If I don't do a couple of good (ie a pt trying hard to leave this world)  ambulance calls a month, I notice skill fade fairly quickly, a little slower to get to a treatment plan, a little more hesitant on my sticks, a little less aggresive in my interventions. 

If you take a surgeon out of his OR for 6-8 weeks to go live in a tent at WATC and try to simulate what he's been doing for 60 hours a week for the other 45 weeks of the year, you think he might have the same issues?

That being said, taking the surgeon from TO who's had 6 thoracic GSW's on his table this week and dropping him in K'Har is a Good Thing, likewise with his anaesthesiologist, the medic doing the pickup at the CCP, the nurse flying him to Germany, etc.  HS Res can provide a level of clinical currency that the Reg F has to work extremely hard to maintain, having to fit it in around all the other day-to-day soldiering as, even if clinically employed on base, you just don't see the right injuries show up on the average sick parade.

I'm not saying the CF Res isn't in rough shape, but a one-size-fits-all solution isn't around the corner.

DF

 

[Armymedic]

One thing I noted from my time working with USANG troops in Afghanistan is the almost every single one of them served time with the active duty troops before releasing and moving onto the NG.

The training they recieved as active duty was carried on during thier NG training. Also many, as mentioned above, work civ side in the medical fd keeping both sides of thier training current.

 

[Donut]

Absolutely, AM.

The USMCR WILL NOT (afaik) commision someone without reg time.

 

[Fraser.g]

ParaMedTec,

Well thought out and discussed. Your conclusions on the side of the CF reserve with out clinical involvement are accurate IMHO as well as your observations on the regular force members with out tactical/ deployment/ civi experience.

Now, what do we do about it?
We know what is broke, how do we make it go? We know that TFA is going on and building momentum (I am slated for somewhere between Aug and Dec 06).

Do we go for the 50% Clinician?
Do we go for 100% Clinician?
Recruit from the same base as the rest of the reserve?
Only go for the PRL option?

What do you think?

GF

 

[Donut]

To be honest, I'm not sure what the solution is.  I think some of it is in the works, we are seeing some changes in the right direction, will they go far enough? Remains to be seen.  I'm almost of the opinion that we need to let the situation stabilize for a bit before we implement any more drastic changes.

In the past, we've demonstrated, pretty well I think, that the delta from clinician to "army" is substantially smaller then the delta in the other direction, which mitigates towards more clinicians then "army" practitioners, and a "train to need" tactical training approach for them to deploy.

BUT

We need a capacity to deploy tactically qual'd, "army" current HS pers on short notice, which means we need to maintain, in the Reg F, mbrs that are both, and up to speed on both skill sets.  We do this, it seems, by increasing the number of clinical tng spaces avail to Reg F HS pers, and then aggressively building their tactical skill sets: perhaps a "stand-by" QRF unit could work 2 weeks on car/ER, 2 weeks Tac Ops, 2 weeks MIR, two weeks of admin?

I'm also hesitant to rely to a huge extent on reservists, of any flavour, without a means to enforce attendance and deployments.  As was pointed out in the original discussion, we can't rely on potential fair-weather soldiers, people who might decide that the conflict-du-jour is not something they want to be part of for whatever reason.

One solution that I think merits discussion (and before my Reg F brethren jump on me, it came from a Reg PA) was to reverse the skill sets:  Train the reg f medics to a basic, "field appropriate" level (EMR with a TCCC skill set?), and leave the majority of prehospital tasks to the HS Res, continuing the movement towards more civi employed health care professionals in the res. 

If this needs a mandatory period of service attached to Res F education benefits, fine. As far as I can tell, even the Res mbrs loaded on the Reg PCP in Chilliwack have no obligatory service attached, the one who has gone through has stated he'll stay in his current Cl B job for at least one year, but that's a personal decision which we may not see others make.

I, personally, think that the PRL offers the best combination.  Making reg force service a prerequisite (or, how about any Cbt Arm to the rank of Cpl) would not put me out, either.
Build army skills in the P Res, or the Reg F prior to medic training, and then the delta is much shorter when it needs to be bridged.  Offer an education benefit with an attached period of mandatory service in the PRL.  If you're a health care professional, the PRL ought to want you.  We can't afford it any other way.

Enact legislation to protect reservist jobs and make it illegal to ask a prospective employee what he does evenings and weekends? Or find a means to make supporting the CF with their employees a significant benefit to the health care employer. (I mean, if it is a single payer system, we ALL work for the Canadian taxpayer at the end of the day).

Recruiting from the same base as the rest of the reserves is probably not going to bring us the people we need, but I know we're having less-then-stellar success attracting (suitable) clinical professionals.

And now it's late, and tomorrow might just start early.

my names in for tavs <90 days, fwiw.

DF

 

[Armymedic]

The only thing I want to comment on is:

Train the reg f medics to a basic, "field appropriate" level (EMR with a TCCC skill set?), and leave the majority of prehospital tasks to the HS Res, continuing the movement towards more civi employed health care professionals in the res. 

There is nor has there ever been a problem with the level or quality of training for Reg F med techs (perhaps for some, quantity is an issue but that is being corrected)...the problem is that we do not have enough Jr Med Techs to maintain tempo.

 

[Fraser.g]

The only thing I want to comment on is:

There is nor has there ever been a problem with the level or quality of training for Reg F med techs (perhaps for some, quantity is an issue but that is being corrected)...the problem is that we do not have enough Jr Med Techs to maintain tempo.

Nor enough hands on or clinical experiance with the one thing that should be the nuts and bolts of the army medic. TRAUMA.

You can take as many courses and attend as many seminars as you wish but it will never replace the hands on contact with real patients in a real environment.

The fact is that the Army population is relativly a healthy one. There is not alot of actual trauma to gain experiance with. Personaly I do not want the medic taking care of me being exposed to the first trauma in the the theater of operations..

I also believe you said in an earlier thread that there were plenty of QL 3 Qualified medics, the problem was the lack of QL 5s. Perhaps you can elaborate or clarfiy the above statements.

GF

 

[Armymedic]

I also believe you said in an earlier thread that there were plenty of QL 3 Qualified medics, the problem was the lack of QL 5s. Perhaps you can elaborate or clarfiy the above statements.

QL 5 Cpls and MCpls are the Med Techs I am refering to. Jr is Mcpl QL 5 and below, Sr is Mcpl 6A and up.

Nor enough hands on or clinical experiance with the one thing that should be the nuts and bolts of the army medic. TRAUMA.

You can take as many courses and attend as many seminars as you wish but it will never replace the hands on contact with real patients in a real environment.

I agree fully with your statement. We get clinical experience. All med techs do civ ride alongs, more now then when I was a new medic. QL 3 are now mandated to do simulator training. All QL 5 Cpl work in first or second line facilites.
I saw 2 traumas this am...buddy injured his leg this am on PT, another slipped on ice and injured his back. (minor, but it is trauma)

In my world, nobody wants us medics to see serious trauma, hence the lack of good blood and guts experience. The problem has been noticed and is being rectified thru the use of Mediman (Sim Man) simulation senarios. Also the new MCSP for Reg F is mandating I do (yes, as a QL 6 Sgt) a 5 day med simulator tng,  80 hrs on car, and 120 hrs of emergent care facility time every 2 yrs, in addition to overseas operations and courses. My point is that we are getting the experience. The days of spending 2 yrs of checking panniers and changing oil are over.

And don't try to tell me that every paramedic sees serious trauma often. Because we do those ride alongs we know real severe trauma isn't an everyday occurance, infact most who do thier 40-60 day ride alongs get to see only one, two if they are lucky.

But I agree, the first real trauma should NOT be in a theater of operations. But in civilain life, a civilian paramedic's first real trauma is in the fd, how is that much different?

 

[Brad Sallows]

I infer from some of the above comments that the US is able to maintain strong health care reserves because it has a strong and steady stream of people moving through health care in its regular forces.

If true, that's the problem Canada has to solve. The public health care system and CF reserve should be receiving a strong and steady stream of people who have done some time in our Reg F.  Instead we seem to be having difficulty attracting people.  Why the difference?

 

[Donut]

Medics wear any of the 3 element uniforms, ... there is a reluctance to let QL 3's on deployment.  Having said that many have gotten to go but usually as drivers and not as medics.  I know for the deployment with 2 RCR in 2007, right now no QL3's will be going.
Kirsten

So much for the "we really need you guys to deploy as medics" speaches?

DF

 

[Armymedic]

KL is correctly speaking of the past and what she currently knows.
For the tour going in Aug (TF 03-06) we have 40 med techs from Fd amb slated on the role 1 TO&E. 3 posns need to be filled nationally, 10 just returned from Afghanistan in Aug. 5 Sr Cpls are going to be WSE to MCpl. 13 are QL 3's going in a med tech posn. (at the unit right now, its not if you'll get to Afghanistan, its when)
There are roughly 50 med techs (Sgt to Pte) from 1 CFH going over as role 3.

So much for the "we really need you guys to deploy as medics" speaches?

If we maintain our current deployment schedule for more then a yr....we will, especially in role 3. PCRI won't help.

 

[Donut]

Thanks for clearing that up, I thought we might have a situation of the left hand not knowing what the right hand wanted, again.

DF

 

[Cansky]

Thanks for clearing that up, I thought we might have a situation of the left hand not knowing what the right hand wanted, again.

DF

Not the case at all.  Every base is doing what they want to do with the reg force 3's.  No QL 3 Med Tech in Gagetown in going on deployment in Afghanistan as things are today.  But the Field Ambulances do what they can to fill the gaps.  I know of many in 1 Field Amb who have gone over seas.  The biggest problem right now is the restructuring to PCP.  There are so many obstacles that it has breed many different opions.  Many believe that experience is nothing (old QL 5) and will take the QL 3 over the experience because of the PCP.  I've even heard a MCpl PCP (about 14 years in) tell a Sgt non PCP (20 years in) that they (the MCpl) was more trained and better than the Sgt.  Who cares that the Sgt has done more tours and seen more crap than this MCpl.  Worst this was said in front of PCP Pte's.  Who really think just because they are PCP they are better than the rest.  I personnally feel (and I'm PCP) that no matter what you can't put a value on experience. 
Just my thoughts.
K

 

[Armymedic]

Many believe that experience is nothing (old QL 5) and will take the QL 3 over the experience because of the PCP.  I've even heard a MCpl PCP (about 14 years in) tell a Sgt non PCP (20 years in) that they (the MCpl) was more trained and better than the Sgt.  Who cares that the Sgt has done more tours and seen more crap than this MCpl.  Worst this was said in front of PCP Pte's.

Thats just wrong in so many ways...Sounds like there is a MCpl that needs to be sorted out.

K,
sounds like your old unit...that would be slammed down here. I dare that MCpl to come say that to my non PCP qualified face, and I don't know a Sgt here that would allow that. Something about 6A always trumps 5B, regardless of the other courses they take.

 

[Cansky]

Thats just wrong in so many ways...Sounds like there is a MCpl that needs to be sorted out.

K,
sounds like your old unit...that would be slammed down here. I dare that MCpl to come say that to my non PCP qualified face, and I don't know a Sgt here that would allow that. Something about 6A always trumps 5B, regardless of the other courses they take.

The MCpl was sorted out very quickly.

 

[medicineman]

Not to slam all  Paramedics, but just a few of them (and we all know the one's I mean):

Q - What's the difference between God and a Paramedic?

A - God's know's he's not a Paramedic.

    Seriously though, I had a rather similar episode happen here - the person was wondering why they couldn't order an XRay and I could - they were a PCP after all.  I rather calmly looked at them and told them that it was within my scope of practice, and oddly enough, it wasn't within their scope as a 5B or as a PCP either military or civilian.    And worse, I'm hearing this more frequently within circles that should know better.  I'm about to go off on a rant, so I'll bite my tongue for a bit.

MM