Medical Services restructuring...

[vr]

I'll wade in with my own frustrations.

The Reserve side of the CFHSG is concentrating on increasing it's numbers of civilian trained personnel, Drs, RNs, EMAs, et al.  They are doing this by no longer recruiting (? for time being) non-civilian qualified personnel.  My unit's stream of new recruits has practically dried up while the 20% attrition continues unabated.

We non civvy qualified 737-M's are very limited in what we are allowed to do.  As far as going overseas in our trade, forget it.  There are still openings as amb drivers but those are few and far between.  The LFWA guidelines for medical coverage basically state that anything not requiring a paramedic can be covered by a SFA qual troop.  So another opportunity to gain employment and support our fellow soldiers is gone.  It is very frustrating to some of us older troops that the only time we can get on taskings is to drive Cpls around.

The reserve-trained Med-A is the backbone of the Reserve units.  These are the people who attend the exercises, parades and do all the sh#tty little jobs that make units go.  It is my personal experience that due to the nature of their employment civvy medical personnel are irregular paraders.  The most dedicated and hard-working members of Reserve units are being marginalized and they know it.

Apparently this whole PHTLS thing came about as a result of Reserve CO's pressing for it at OP-Med.  It was news to my CO.  PHTLS has absolutely no footprint in this province.  None.  It's not taught or practiced anywhere whereas with BTLS we have access to the resources or our paramedic schools.  It is going to be a royal pain (expensive!!!!) to train instructors, train and retrain the troops.

My real question is what is the advantage of PHTLS over BTLS?  Will we have to keep doing SFA/AMFR-2/PHTLS/BTLS over and over again?  We are saving lots of money on FOA out of this though. :dontpanic:

 

[old medic]

I can't accurately answer the PHTLS question, so I'll stay away from that one until someone digs up some answers on it.
Renewal of SFA/ BTLS etc is a constant thing. That will never change. I'd be afraid of anyone who takes it once and doesn't
want to do a renewal or refresher. Mosty civy medical trades have alot longer list of yearly renewals than your average 711/737.

Your comment about first aid vs. Paramedic coverage is interesting. Do you think that was a result of the lack of civy qualified paramedics in the  units? I would think a EMR qualified R711 would be better to have than a first aider. I know I'd want the highest possible level of care. Is that list of first aid coverage only activities just a way to save a few dollars? It's probably also a way to ensure training actually takes place, while there is a shortage of civy qualified pers.

I'm curious to hear a few more gripes.  Of course, lets start throwing around a few ideas on fixing the problems too.  What training would you change for the reserve Med-A right off the street (not a civy paramedic)? How should the reserve Fd Ambs provide coverage and support to the brigade units?  What skills and equipment changes would everyone like to see?  I'd like to see some new NATO light box ambs myself, I have nothing good to say about the five-quad remounts on the LSVW.

In Arduis Fidelis

 

[Fraser.g]

Gripes first

The above posters are right on several points
1. The onus is on recruiting qualified and practicing medical professionals but they parade infrequently or are on the PRL.
2. The reserve medic is being marginalized out of existence because they are not given the skills, training or scope of practice that makes them any better than a first responder
3. The equipment that we are using is outdated and in some cases illegal to use on Civi Street. A regular medical professional would take one look and RUN!


Suggestions

1. Call a spade a shovel. For the most part the reserve units are Plt and Coy sized units. We should amalgamate in to regional field hospitals and not pretend we are something we are not. Think of the savings in Salaries alone.
2. Local PRL should affiliate with the unit.
3. If a unit is a Coy then kit it out as a Coy, Medical Equipment, Ambs, SMP the works. If it is a Plt then the same applies and the equipment waxes and wanes as numbers change. Talk about incentive! Recruit or we will take away your toys!
4. Where is our Regular force staff? They have been pulled out of the units, not replaced, and funding for the positions held back so that Class B back fills are not possible.
5. Train the members up to at least the Combat First responder as laid out by the 10th Mountain Div Surg office (See Attachment)
6. Reserve spots on the PCP courses held across Canada. They cost approx $2000 per candidate and would give our own medics clout on civi street as well as giving our medics a chance to gain valuable civi side exp. Paying for the course would be less expensive then paying for their salaries for the same time period.
7. Become self sufficient with instructors BTLS, BTLS Advanced, PHTLS, ACLS, AED, SFA, CPR-C. Not only will this save the units money by not having to go to out side agencies but give the troops a chance to gain skills that they can use on civi street.
8. Set up manned Mir's within the garrisons. Why are we going to civi agencies to have recruiting and promotion medicals done when we have medics, NOs and MOs in the units????
9. Sync up the LFWA and medical coverage papers so that they need at least a QL 3 Medic for all ranges and live training. We are there to support the brigades so make it so that we have to.
10. Give 4 qualified medics a OTC med course so that they can dispence items such as Tylenol and Motrin out of the back of their ambs. You would be surprised what will happen to unit trust in the medical corps when a troop comes to one of our medics felling sick or hurt and laves feeling better.

Please feel free to add or comment. We all have to push togeather if this thing is going to get better instead of worse.

 

[old medic]

Good Post Sir,

I wouldn't play with the Pl, Coy, Fd Amb thing at all. That was tried before (1954 and 1965) with horrible results.  A reserve Field Amb will never parade peace time at full (wartime) strength. In 1939 many of the reserve Fd Ambs had an effective strength of about 20 all ranks,
but the establishments and entitlements enabled them to jump to 150 - 180 men. If the Fd Ambs were only Platoons or Companies,  they wouldn't be as useful.  I would also suppect the meager bugets would take further cuts.

I'm curious about your second point.  My understanding is that local PRL has to affiliate with the closest medical unit. Are there places this hasn't happened?

Equipment side, the more kit the better. you'll have a hard time recruiting or keeping anyone with borrowed (read Svc Bn) or missing gear. CFHS should also have control of their own vehicles as far as I'm concerned.  Also, if you have regional Field Ambs or Field Hospitals, then you wind up with only one set of kit spread out all over the country.  Ambs in one city, Panier sets in another etc. It would also turn a unit level exercise into an area wide event.

Training I agree with as well. I do agree with recognizing the distinction between civy and non-civy qualified members. There should be some upgrading for the members who came up through the QL system. In Ontario, the EMA's were able to take training courses to upgrade their skill set to the PCP level. Although the PCP's with the sheep skin are still considered the senior medic when working with an EMA.  An upgrade course, such as your suggestion on OTC's, and your thought about holding spots in the local colleges for PCP upgrading would be easy to do.

Is your unit not self-sufficient with instructors already?

The MIR thing I completely agree with, and I've seen such arangements in the past.  My only comment there is funding.  The funding has to be there from the recruiting system to support it, otherwise the unit budgets will take a hit on man days.

I think the biggest retension problem is keeping medics employed in trade.

 

[Fraser.g]

Old Medic

From Old Medic I wouldn't play with the Pl, Coy, Fd Amb thing at all. That was tried before (1954 and 1965) with horrible results.  A reserve Field Amb will never parade peace time at full (wartime) strength. In 1939 many of the reserve Fd Ambs had an effective strength of about 20 all ranks,
but the establishments and entitlements enabled them to jump to 150 - 180 men. If the Fd Ambs were only Platoons or Companies,  they wouldn't be as useful.  I would also suppect the meager bugets would take further cuts.[/font]

I do not propose that we flush up to war strength but instead we hold the position for one higher. This way if you parade a Platoon full strength then you have another Coy as Holding or expanding. Not kitted but there on paper. The difference is that we are now calling a platoon or two a Field Ambulance.
As for them not being as usefull, I disagree, we are only as usefull as our equipment and training. That is to say if we have a platoon worth of medics or even a platoon each in two locations why the heck are they called a Field Ambulance. Also when in the history of war has their been two or three Field Ambulances in a Brigade organization weather Op Com or not. Take the example of 38 Bde, They now have OP COM three Field Ambulances. Each parading at Plt with attached HQ strength. How does this make sense.
Now on to the budget, Task the medics as you want them to function. Now they are asking us to function as a Fd Amb with only a Coy or Plt strength. We do not have an Amb Plt, We do not have a Maint or HQ Plt, We do not have our own trucks!

Our mission is to provide 1st and limited 2nd line medical support Give us the kit to do that and not more. That means ALL the kit. MSE, Canvas, Panniers if a reg med plt has it we have it. This way it is not a shock when they finally realize that they have way over extend the Reg Fd Ambs and need augmentation.

[color=Red]Old Medic I'm curious about your second point.  My understanding is that local PRL has to affiliate with the closest medical unit. Are there places this hasn't happened?[/color]
They can be but do not have to be. As a matter of fact we have experienced some difficulty in getting the names of local PRLs from CFMG.

[color=Red]Old Medic Is your unit not self-sufficient with instructors already? [/color]

We were in a limited capacity we needed to send more pers on instructor courses. Now that they have changed to PHTLS we have to start from scratch again. The other problem is that PHTLS is not recognised in Sask or Manitoba. We will probably have to go to Ontario for the initial bridging and Instructor training. Talk about a waste of money.

 

[old medic]

I'm surprised about the PRL problem.  I remember years ago seeing a print out of everyone on the SRR/SHR in my area.
I would have thought CFMG units would have a listing of CFMG assets in their area.  That certainly needs fixing.

No matter what a unit can effectively muster on parade, your unit establishment should have all the positions for a full Field Ambulance. Some of the positions should be listed as restricted so that you can't fill them during peace time This is probably where your Maint Pl is. 
When I said "not useful" earlier I meant from a wartime planning perspective. If you have a Pl that you bump up to company strength, then your going to need alot more Medical Companies when it comes time to create a full Field Ambulance.

The Reserve Brigades are really bad examples to use here. A brigade is 3 Infantry Regiments, supported by one Field Ambulance. 38 CBG has five Infantry Regiments.  The Reserve Brigades are more about Geoghrapic areas for training and administration than they are combat formations.
When you consider strategic planning for the 51 reserve Infantry Regiments, you actually need to plan for 17 reserve Field Ambulances. Meaning we're short.  You must also consider that even though 38 CBG has 3 units to support 5 units, Ontario has 3 units to support 23.
In a real wartime situation, CFMG would assign the Field Ambs whereever they are needed. Likely not in support of their local area units.

When you consider the strategic plan for the reserve, then the Fd Ambs make alot of sense. I hope that explains what I was trying to get across.

As for the budget points and instructors, once again we completely agree.

Cheers

 

[Fraser.g]

Wow I was trying to make my previous post more readable with font and color. Now FUBAR is about right. wont try that again.

Now back to the discussion;

I understand what CFMG is trying to do by re-naming all the reserve units. They wish to hold a small reserve name in place so that in case of general call up they have an infrastructure to fill into. The problem is that in the next breath they don't give us enough kit to fill out a platoon, heck I was contacted by an Ontario unit because they did not have enough panniers to kit out a section!

They then say that it is going to be all about civi maintainable skills and for us to recruit medical professionals but we don't have a thing that they may be interested in doing. Does an ACP medic want to go out and work with a bunch of out dated equipment and no courses that they may be able to get that would maintain their skill set.

We have to update, improve our skill set and increase our participation with both our reserve brigades and with our public health care systems in our areas or become extinct!

 

[old medic]

Your Right on the money,

The Reserve Field Ambulances need the vehicles, canvas and kit (read major medical gear upgrading) to function properly.

Any thoughts on changes to the medicial equipment entitlement ?  What kit would you like to see added? What would you toss right out the door?

 

[Fraser.g]

Things to get rid of:

MAST (I know that they are supposed to be out but I still see them once in a while)
Needled IV tubing and locks There are many systems out there that do not require breach with a sharp to add lines or push meds
Wooden Spine boards
Hope II oxygen systems
Self sheathing IV Cannula. I was teaching IV starts the other day and they were so dull it felt like I was canulating with a pencil lead  :'(


Things that are needed

Blood glucose monitoring kits
SAO2 Pulse oxymiter
Lifepack 3/5 lead cardiac monitor and defibrillator
Free flow O2 regulators to replace the Hope 2
Clave System for IV lines and Locks The last thing we need is unsheathed sharps in the back of a moving bus.
Med lock up for the back of the amb.
New jump bags and medic packs. We don't have enough of the old ones and getting replacements are like pulling teeth.



THE ABILITY TO TRAIN ALL THE MEMBERS OF THE UNIT TO AN ACCEPTABLE LEVEL SO THAT THEY CAN USE THE EQUIPMENT!!!!!!!!!!!


These are off the top of my head, I am sure there will be more as I dwell on the matter more.

 

[Donut]

This thread still going?   Holy Cr@p!

Ok, things to add:

BVM's with reservoir bags.   What a concept, I know.   How about disposable, while we're at it?
New jump bags, for sure.
New stretchers (I recently noticed the Brit ones come with 3 patient straps already attached to runners built into the METAL poles)
2-piece plastic spine boards, scoop strechers, SKED strecher/SKED drag
one-handed tourniquets
Entonox, or that Australian inhaled analgesic (name escapes me, big debate after Survivor burn)
Needle-less fluid and drug systems
Monitors (any new flavor will do)

I'm sure I'll have more to add after I catch up with the other threads, too.

DF

Edit:   I agree, we've got a #9, cats hairy bum that piece of kit
Big O2 cylinder in the cars
Suction
LMA

 

[old medic]

I remember going around to borrow proper backboards, scoop stretchers etc
from the local civy ambulance services before going out on no-duff coverage.
That's a pretty sad state of affairs now that I look back at it.

I'd like to see a Ferno #9 or similar stretcher with the ambs. Just stick the cup posts on one of the bench seats.
As I mentioned earlier, the LSVW ambs were a big step backwards with an out of date box.  In the M886 and M1010 you
could put padlocks on cupboards and keep your more important items locked.  And the M1010 would take the installation
of a G or M oxygen tank as well, not to mention a long list of other, better features.

The last two posts are a good list. I'm sure I'll remember a few items once I sit down and think about it.

 

[Fraser.g]

Still going???

I only started it on the 19th bro. Perhaps you were looking for another thread with the same basic theme but not as much thought or eloquent posting ;D

ya got no beefs from me on your list.

How about a strap collapsible stretcher so that a medic could roll it away somewhere when dismounted.

By the way welcome home.



GF

 

[Donut]

I guess it just keeps coming back.

Thanks, man.

How about those US Stretcher dollies to move patients on, too
Jungle stretchers, too

 

[Fraser.g]

How about climate control in the back of the amb for summer and while we are at it a better way to communicate other that the ICS which is dubious at best and non-functional at worst.
The big problem is that there are so few reservists trained up in the new radios. There has only been one comms course run in Sask since the new 522s came into play and it was a joke due to lack of equipment.

Again give us the tools and knowledge and we will do the job.

 

[old medic]

There was a thread on restructuring in general, but this is reserve restructuring. 

What's out there for traction splints, still the older simple Hares?
Or have they replaced them with the multi-adjustable ones ?

 

[old medic]

How about climate control in the back of the amb for summer and while we are at it a better way to communicate other that the ICS which is dubious at best and non-functional at worst.

Yes... that was another step backwards. I miss the dual front and rear A/C of the 1010.  The LS ambs are sub-standard in venting,  heat and A/C.

 

[Fraser.g]

So we all know that the kit needs an extreme overhaul. This will cost a massive infusion of cash that we do not have right now.
So the other option is to train to a level of higher medical skill sets that require less kit or more simplistic kit that is already in the system or be relatively cheep to purchase like one handed tourniquets.

An option that I like it that of the Commbat first aider and Trauma Focused individual Training called T-FIT.
Please take a sec to look at the below link and then come back and discuss.
http://www.drum.army.mil/sites/tenants/division/CMDGRP/SURGEON/home.htm

It is all there, equipment lists, instructor programs, PPT presentations, Student checklists the whole shooting match.

Is it training up to the PCP Level...no
Is is more than we have now in the reserves...yes
Dose it make sense IMHO...yes

The progression would be
QL3 (AMFR2)
BTLS Advanced (PHTLS ?)DF, there was a message while you were away that said that the reserves was moving to the PHTLS.
T-FIT
Combat Lifesavers course
Combat (Ranger) First Responder
PCP (QL5)


GF

 

[old medic]

Just as a side bar, I noticed this statement on your link:

"The ratio of combat medics to war-fighting soldiers is 1:17. "

It would be interesting to see some figures for the CF. 

 

[Donut]

It certainly looks better then what we have now.  

I'll add a sidebar, too then    8).   Look at the sig at the bottom of the TTPC letter:   2LT, SP PHYSICIAN ASSISTANT. More applicable to the Reg, but a RESO PA program...


One thing that isn't being addressed here (although tie this to the sidebar.   The conclusion is left as an exercise for the student) is clinically oriented, primary care to our soldiers.   I've certainly seen several thousand more SICK people in my time in the CF then critically injured, whether that's the bleeding awfuls or a case of the sniffles, and we need our people to be able to sort the wheat from the chaff in these cases, too.

T-FIT looks an awful lot like BTLS, in fact slide 27 of TFIT corresponds exactly with the diagram on P175 of BTLS 4th Edition.   It does have a few additional points, though, and presents ALL the information on the ppt, not just the stuff the instructor is supposed to add TO.   Other then that...it's BTLS

For a basic trained part-time medic, it's really about as much as we can hope for (and far less then we'll ever get).   Add the OTC med package and some experience separating wheat from chaff and you'd have a fine company med-a.

WRT the BTLS/PHTLS difference, I really no longer care, so long as we can get SOME kind of training to our troops (btw,   the BTLS website now lists the BTLS Military edition for sale).   Besides, if I don't have to teach the damn course, that's only one uncompensated weekend q 3 years for me, not every year as it is now.

 

[Fraser.g]

OK so add the OTC pack to the 4s, send ALL the BTLS instructors on a week long all expenses trip to Ontario for the PHTLS conversion and we are good to go.

By the way, what is the da3n?

So the three of us are in support, how do we get the rest of CFMG on side so that we can offer some quality training and have a decent end product?

GF