Paramedic vs Combat Medic: What’s the Difference?
In this article, we’ll be discussing the differences between a civilian paramedic and a United States Army combat medic. There’s a great deal of information to consider when choosing either profession, and that choice may prove to be overwhelming at times.
“Is this field for me?” or “would I be any good this?” are common questions for a great sum of individuals endeavoring toward a career in healthcare. However, if the above qualities apply to you, rest assured you are off to a promising start as a medic.
So what’s the difference between a paramedic vs combat medic? Well, to figure that out, we first must define the basic differences between EMT’s, Paramedics, and eventually U.S Army Combat Medics (68W).
Emergency Medical Technicians
Think back to a medical emergency you’ve had or witnessed in the past. There were likely police officers, firefighters, bystanders, and a host of other personnel working to resolve the emergency. Undoubtably, an emergency medical technician, or EMT, was working to provide the best standard of medical care on what may have been the worst day in the patient’s life.
What is an Emergency Medical Technician?
An emergency medical technician, or EMT, is a highly-trained individual capable of providing the necessary medical interventions and transport for the patients accessing their emergency medical service. EMTs typically operate in the pre-hospital setting with the standard ambulance equipment.
All EMTs are not made equal; there are levels to their certifications. Through the National Registry of Emergency Medical Technicians, or NREMT, the most junior certification is that of an Emergency Medical Responder.
This certification is typically earned by individuals working closely and frequently with senior medical personnel; these positions include but are not limited to police officer, medical assistant, and emergency department technician. An EMR performs emergency medical interventions with minimal equipment.
At the top end of the EMT spectrum is the paramedic, or EMT-P, the highest designation an EMT can earn. A paramedic is responsible for providing advanced medical intervention with an arsenal of equipment at their disposal.
History of the Paramedic
While the origin of the EMT is still left undecided from a unanimous viewpoint, the establishment of the first paramedic school in the United States is a bit easier to pin down. In 1966, “The White Paper” is presented to President Lyndon B. Johnson wherein it provided recommendations for standardized emergency medical practices; the recommendations were primarily geared toward curtailing the number one killer of adults in the first half of their life expectancy – car accidents.
After over a decade, the first accredited EMT-P program is born in Los Angeles, California at the UCLA Center for Health Services in 1980.
Becoming a Paramedic
Throughout this article, the NREMT has been referenced, and it is important to note the National Registry certifies that each individual demonstrates the necessary knowledge and skill to be considered generally competent at the level corresponding with the certificate earned.
However, as cited on the NREMT website, NREMT certification alone does not render an EMT legally ready to begin saving lives. State-specific licensing is required, and the level of additional training required by each state will vary. The goal is to become nationally certified and state-licensed.
Though, the general path a candidate takes is as follows:
1) Graduate with a High School Diploma or GED
Each candidate must be at least 18 years old in addition to obtaining their high school diploma or equivalent.
2) Complete an Accredited Paramedic Program
The candidate will need to choose an accredited program to learn the knowledge and skills necessary to meet the requirements of the NREMT cognitive and psychomotor exams.
Some paramedic programs may have additional prerequisites potentially such as an Associate’s degree, experience in the EMT field, and an EMT-Basic certificate or higher.
3) Complete the Paramedic Psychomotor Competency Portfolio
This assessment evaluates each candidate’s ability to apply the learned skills to realistic scenarios.
4) Pass the NREMT Paramedic Exams
Each candidate is required to pass two exams before being rewarded certification through the National Registry. The cognitive exam is an adaptive computer examination which evaluates the candidate’s ability to apply knowledge to written scenarios; as the candidate performs successfully, the questions become more probative of the candidate’s critical thinking capacity.
The psychomotor exam evaluates each candidate’s ability to appropriately utilize standard equipment and adjust interventions as new information is gathered.
There are various ways to prepare for these exams, including taking NREMT practice tests.
5) Receive State Licensing
The NREMT-certified candidate will research EMT licensing requirements for their desired state and obtain the required licensing.
6) Get Compensated for Your Skills
At this time, each candidate is ready to begin their career as a trained paramedic ready to medically intervene on behalf of their patients.
7) Continue Training
Aside from continued education units, or CEUs, being mandatory for certification and license renewal, each candidate will want to remain knowledgeable regarding new developments in their field.
Furthermore, candidates will need to enroll in additional training in order to specialize in a particular discipline of paramedicine; specialties include flight, shipboard, critical care, and firefighting.
The time frame for this entire process will vary greatly depending upon what path the candidate takes leading up to their application for a paramedic program, what curriculum schedule is followed, and what state licensing is required. With all things considered, becoming a paramedic will typically take 1 to 2 years.
The financial commitment for paramedic training is just as variable as the timeframe. Pricing for candidates will vary due to the institution, books, uniforms, exams, and miscellaneous charges.
Paramedic Career Growth
Becoming a paramedic takes a great deal of training, time, and dedication; that’s just to become one. Building oneself to become an exceptional paramedic takes years of professional development and a personal conviction to go beyond the call-of-duty. For this reason, paramedic is the end-goal for many people in their careers.
Where does that leave those with residual ambition?
Those left wanting more after they obtain designation as a paramedic can become specialized in a discipline as discussed previously. Other options include becoming an EMT instructor, enrolling in medical school, becoming a police officer, or serving in the military. All of the aforementioned employment options provide the paramedic the opportunity to use the skills they worked so hard to earn.
Paramedics: An Average Day
Paramedics typically work 8-hour or 12-hour shifts; the average shift length will vary depending on the work tempo for the area. Rural areas are likely to operate on the Kelly Shift Schedule system or the 48/96-hour schedule system. Daily personal tasks like eating and showering are performed while waiting on calls.
You might wonder what a typical day looks like for an ambulance paramedic.
Following your morning routine, you will greet your team who no doubt has become family after working long hours, navigating critical situations, and saving lives together. Depending on the previous shift, a debrief may be necessary for a smooth hand-off. The first order of business will be checking your ambulance to ensure that all equipment is stocked and ready to be pulled into action. As you settle into your shift, your team may use this time to conduct mandatory skills training.
During the day, you will eat when time allows, barring any emergencies. Calls come at any time of the day or night, so a consistent sleep/wake schedule is never guaranteed. In addition to balancing nutrition and sleep hygiene, a paramedic must also find time to stay physically fit.
EMTs across the board are physically taxed on a daily basis. Lifting, reaching, crouching, kneeling, bending, hiking, running, walking, and climbing are just some of the physical movements a paramedic can expect on a typical work day.
Documenting the interventions implemented and the equipment used is an essential part of a paramedic’s job. Because the patient will be transferred to a care facility, a member of your team will call ahead to alert the receiving facility of the situation; at this time, that team member would relay information such as age, sex, injury or illness, condition of the patient, and the estimated time of arrival. The paramedic has the responsibility of relaying all pertinent information to the receiving treatment team.
Call tempo and type will vary greatly between departments and regions. Contributing factors may include population size, number of ambulances working on the shift, and time of day.
Paramedic Compensation
According to the U.S. Bureau of Labor Statistics, the average salary for a U.S. paramedic was $36,650, or $17.62 an hour, in 2020. Additionally, in 2020, 46% of all EMTs worked in the ambulance setting, 28% worked with the local government excluding hospitals, 19% worked in hospitals, and the remaining 7% worked in an unpaid capacity.
As we surface from the depths of the civilian paramedic profession, let us prepare to dive into the world of the United States Army Combat Medic.
U.S. Army Combat Medic (68W)
Before we begin discussing the intricacies of the combat medic profession, we must recognize the required first step – military enlistment.
As you reflect on what it means to be an American Soldier, you may reference publicized war stories, a ceremonial event, a loved one who served, an Army Strong commercial on the telly, or maybe you think of a specific holiday. Whatever comes to mind, we can all agree that military service is a sacrifice that very few in this nation have the willingness, ability, and privilege of making.
History of the Combat Medic
Battlefield medical intervention has been documented for many centuries; for the purpose of this article we will venture into history a mere few decades. Despite the condensed timeframe, the last century has ushered huge progression in battlefield medicine, also known as Tactical Combat Casualty Care (TCCC).
Between WWI and WWII, many advancements in combat casualty care were established. The medical field saw an explosion of antibiotic discovery and development, further development of battlefield medicine best practices, and established continuity of care from the battlefield to rehabilitative health centers. All these improvements culminated to a drastic decrease in preventable deaths on the battlefield and greatly improved post-treatment prognosis.
For good reason, a large sum of medical equipment and procedures were developed through analysis of battlefield medicine including the advantages and disadvantages therein. Amongst these innovations are antibiotics, amputations, tourniquets, and the use of blood products in the emergency setting. Partly through observation and implementation of battlefield medicine, we have arrived at our current standard of medical care. The medical community, both military and civilian, continues to evolve through continued analysis of historical TCCC scenarios.
What is a Combat Medic?
A combat medic is a Soldier, first and foremost; his or her first priority will always be to support and defend the Constitution of the United States of America against all enemies, both foreign and domestic. In additional to soldiering, a combat medic is a highly-trained and mentally resourceful professional capable of rendering medical aid in combat and humanitarian environments alike.
68W is the alphanumeric code associated with this Military Occupational Specialty, or MOS. An MOS translates to “job title” in the civilian sector. That code will accrue additional identifiers as you grow through the profession. For example, once promoted to Sergeant, the code reflects “68W20” indicating an advancement in professional competencies.
Do Combat Medics Have Ranks?
Combat medics make up just one of the many jobs an enlisted service member can choose or be appointed. As with the rest of the military service, there is indeed a rank structure. Most of the time, higher rank indicates more experience and leadership capability.
The combat medic does develop through the ranks, and each Soldier will eventually graduate into the administrative side of military service within their field, barring special assignment or adverse administrative action.
Becoming a Combat Medic
Of course, like with anything, there are myriad ways to arrive at this profession. One of the greatest aspects of military service is the willingness to train. For many MOSs, the Army will recruit you with zero experience and train you up to be a proficient practitioner of nearly any line of work. There are a few MOSs that require background knowledge in the subject; 68W is not one of them.
The general path a 68W candidate takes is as follows:
1) Graduate with a High School Diploma or GED
Candidates for military service must have completed the high school requirements for their state and be at least 18 years old, or 17 years old with the consent of the candidate’s legal guardian.
2) Complete the ASVAB
The Armed Services Vocational Aptitude Battery, or ASVAB, evaluates each candidate on a variety of skills. The candidate will earn a score out of 99 which indicates where they rank amongst all other military applicants; a score of 99 indicates that a candidate has higher aptitude than 99% of all other military applicants.
The test results are also broken down into 10 knowledge areas such as word knowledge, arithmetic reasoning, and mechanical comprehension. This information is used to predict the candidate’s success in any particular MOS. Thus, ASVAB scores will determine what job options are available to each candidate, so do your best.
3) Meet with a Recruiter
Candidates must go through an Army recruiting office before enlisting. At this stage, candidates will review their complete life history to ensure their eligibility for military service. This information will include medical history, employment history, criminal history, drug history, and family history.
Honesty is imperative; if contradicting information surfaces after the candidate has enlisted, a fraudulent enlistment may be declared. The candidate could face discharge and legal action taken against them.
4) Endure MEPS and Enlist
Military Entrance Processing Stations, or MEPS, is the final stop before the candidate ships to Basic Combat Training. MEPS personnel will conduct a thorough evaluation of each candidates fitness for duty.
Then, the candidate is sworn in under oath. Enlistment contracts are typically 3 to 6 years. Depending on the contract, the contract may start immediately or only after AIT is complete.
5) Basic Combat Training
Basic Combat Training, or BCT, is approximately 10 weeks and will take palce at 1 of the 4 locations available. Every Soldier must successfully complete BCT, regardless of their rank or MOS.
During that 10-week period, civilians are deconstructed and Soldiers are built. Recruits learn everything they need to know for a great start to a rewarding Army career.
6) Advanced Individualized Training
Advanced Individualized Training, or AIT, is where Soldiers acquire the specific skills necessary to fulfill the MOS which they selected. For a 68W, training is 16 weeks long and is conducted at Fort Sam Houston in San Antonio, TX. If you’re going in the Summer, I hope you like the heat.
To start, candidates will spend roughly 8 weeks preparing for the NREMT exam. After passing the exam, Soldiers move into the field-craft phase; in this portion of their training, each Soldier will apply what they have learned in the civilian EMT training to their broadened scope of practice as an Army combat medic.
Future medics will learn things like how to treat casualties under live combat stress, how to triage in a mass casualty situation, and how to tactically move a casualty to an evacuation point.
7) Transition to Duty Station
Following BCT and AIT, each combat medic will move to their new duty assignment where they will use their sharp skills to conserve the fighting force.
The timeframe for this training is approximately 26 weeks in total. This course is taxing by every measure of the word – physically, mentally, emotionally.
While the curriculum is difficult, the Army ensures that you can focus on just that; the Army covers the complete cost of training to include each candidate’s meals, housing, and uniforms. Through BCT and AIT, candidates are under near 24/7 supervision.
Combat Medic Career Growth
Regardless of the MOS, the military service can take the guess work out of career progression for those wanting a set path. As combat medics grow through medical experience and time in service, they naturally progress through the ranking structure. The promotion process can be accelerated or hampered based upon the degree of initiative shown by each candidate.
Combat medics have the opportunity to work with elite units like the Ranger Regiment and Special Operations, and those endeavors take an enormous amount of work and complete dedication to the Army profession.
When moving from the military to the civilian sector, the NREMT certification does transfer as well as a host of other earned college credits that can be accessed via the Joint Service Transcript, or JST.
Combat Medics: An Average Day
Combat medics are Soldiers 24/7, both in and out of uniform. Thus, a combat medic is essentially always on call. However, there are sleep requirements regulated by military doctrine.
A combat medic starts their day around 0500hrs, or 5 a.m., to conduct physical training. Afterwards, the unit allots time for each Soldier to complete their personal hygiene routine. Then, the real work day begins.
After inventorying their medical bag, each medic will restock on necessary materials and distribute medical supplies amongst the troops. Afterwards, the combat medic will issue a class on combat lifesaving to ensure all Soldiers are prepared to assist in medical intervention; this class also ensures the unit stays current on its mandatory training.
Then the medic will meet with other medics in the unit to train on more advanced medical interventions. At this time, combat medics also conduct psychomotor training to meet the CEU requirement for NREMT recertification which takes place every 2 years.
A combat medic may also have responsibilities which include but are not limited to administering vaccinations, working in the troop medical clinic, addressing non-emergent medical concerns, standing by as medical support during training events, and any tasks that are appointed by leadership.
A large portion of the combat medic’s job involves documenting care rendered. This documentation must be completed in a neat and thorough fashion to ensure optimal care is achieved throughout the casualty care process.
In combat, medics are expected to function as soldiers first, medics second. For example, in a hostile situation involving casualties, the medic will prioritize neutralization of enemy threats before rendering medical intervention to a casualty. Medics are tactically situated to decrease the likelihood of them becoming a casualty, but the risk of injury will never be completely eliminated.
Combat Medic Compensation
Compensation for a combat medic will depend upon their pay grade. Additional compensation can be awarded to medics operating on special assignments; for instance, hazardous duty pay will be awarded to all military members operating in an area of ongoing conflict.
Summary
Civilian paramedics and Army combat medics are both highly trained medical professionals that go above and beyond the call-of-duty to preserve life.
Though there are similarities, the two are not interchangeable. Aside from the civilian-military differences, a paramedic holds an EMT-Paramedic license while the Army combat medic holds an EMT-Basic license.
For the paramedic wanting to become a combat medic, BCT and AIT are the only major hurdles standing between them and success. On the contrary, the individual coming from combat medicine will need to endure the following: paramedic training, the NREMT exam, and state licensing.
Both career options are extremely rewarding for individuals who strive toward selflessly serving in the medical community, and both professions come with their respective bodily risks, including the potential for fatal injury.
Conclusion
Regarding both professions, the uniform stands as a beacon of light in the time of need. For the patient laying on the sidewalk in pain relieved by the arrival of the paramedic and for the Soldier laying on the ground in combat having renewed hope as their combat medic kneels beside them, their gazes rise to meet the uniforms of their mortal saviors. The patient’s trust is not only in the woman or man, their trust also rests with the institution represented by the uniform. Both professions are incredibly noble and require all of the aforementioned qualities.
At the start, we set out to explore and compare the worlds of the civilian paramedic vs combat medic, and thankfully, we’ve accomplished our mission in great detail. After reading this article, I hope that you leave here with a deeper understand of what it means to be a medic. Furthermore, I hope this article has allowed you to determine if this medical profession is, indeed, your call-of-duty.
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