Research Paper on Military Emergency Medical Services
This research paper is a thorough discussion of the Military response and management to emergencies. It covers the understanding of the organizational hierarchy, which governs the deployment of emergency management and response in the discussion of Special Forces. The different procedures in handling emergencies are discussed in the section entitled Military Echelons of Care. Emergency response and injured management are differentiated and defined in Tactical Combat Casualty Care, Weapons of Mass Destruction and Triage. Lastly, the military emergency management is compared and contrasted civilian emergency management in the section Civilian verses Military Emergency Medical Services Casualty Management. A Bibliography page lists all the references that were used and referred to in this report.
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The word “special forces” loosely describe a relatively small focused group in the military trained for special operations and adjuncts the otherwise traditional branches of the military (Army, Navy, Marines, Air Force). Today, there are several special forces within each traditional military branch and are unified under one command, the United States Special Operations Command (USSOCOM). However, the formation of USSOCOM was only in 1987, after a series of restructuring and Senate intervention into the US Military. Nevertheless, the roots of USSOCOM traces back in history, whenever the principle of forming an elite group for an adhoc task was required.
AS early as pre-World War I (WWI), the need for soldiers that are focused on specialized operations been demonstrated. During the Napoleonic wars, men specialized in rifles and mine detection was doing just that, and not committed to the battlefield. In WWI, Italian forces formed a select tactical unit tasked to break enemy defenses for full infantry penetration. For the United States, the formation of “special forces” began during World War II (WWII) when the Rangers were formed. These elite forces were key to eventually breaking down Allied defenses and winning the war. That was to be the start of the formation of several other Special Forces such as the Green Berets, Delta Force and The Iraqi Special Forces.
In 1980, during Desert One, a C-130 crashed in Iran that left eight soldiers dead. This was later on to be investigated as a terror attack from within the Army. With such a worsening state of intelligence, the Department of Defense formed the Special Operations Forces, and with further restructuring by Commanding General Edward C. Meyer, the Special Operations Command was formed in 1982. Five years later, after a series of restructuring and intervention by the Senate, President Ronald Regan approved the formation of the USSOCOM in 1987. With such variety of focus in special operations, a Special Forces Support Group was formed in 1989 called the US Army Special Operations Command (USASOC) to enhance the readiness of Army Special Operations Forces and streamline the command, to control of US Army Reserve Special Operations Forces and to support the USSOCOM.
The USASOC has six subordinate commands: (1) United States Army Special Forces Command (USASFC)(Airborne); (2) United States Army Civil Affairs and Psychological Operations Command (Airborne) (USACAPOC(A)); (3) The United States Army John F. Kennedy Special Warfare Center and School (USAJFKSWCS); (4) The 75th Ranger Regimen; (6) 160th Special Operations Aviation Regiment (Airborne) (SOAR); (6) The Special Operations Support Command (Airborne) (SOSCOM). Among the six, the USASFC in partnership wth SOSCOM provide support to all Special Forces Operations, including medical emergency services.
The USASFC hey train to perform five doctrinal missions: Foreign Internal Defense (FID), Unconventional Warfare (UW), Special Reconnaissance (SR), Direct Action (DA) and Combating Terrorism (CBT). In each of the mission, a Special Forces Group (Airborne) is formed and with each Special Forces Group, a Support Company (SPT CO) operates to enhance their mission.
The SPT CO is comprised of a Company HQ, Service Detachment, Military Intelligence Detachment, Medical Section, Signal Detachment, and Personnel Section. The Medical Section provides Emergency Medical Services for Special Forces Operations Battalion (SFOB). Within the Medical Section of each Support Company, military echelons of care, tactical combat casualty care and triage are conducted.
Military Echelons of Care
During the American Civil War, a system of immediate medical attention was needed for the casualties. Thus, Major Jonathan Letterman created and put into action America’s first effective ambulance corps system for the removal of wounded from the battlefield and their hospitalization during the Civil War. The Letterman System remained the basic concept in use in Viet Nam. Major Letterman, U.S.A., is memorialized in the Letterman General Hospital in San Francisco, one of at least two dozen major hospitals named for Jefferson alumni.
Echelon one, the first level of care, is geared towards the objective to stabilize the patient and allow for evacuation to the next echelon. The administration of care is done by the individual himself (self-aid) or by any personnel on the field, who are part of the combat units that have medical responsibilities. A combat buddy can administer immediate aid, say applying pressure on a profusely bleeding wound, when the individual himself cannot administer self-aid. Another personnel, a combat lifesaver, are also tasked to provide immediate medical aid. He is a soldier who is trained in advanced first aid, more than the basic first-aid techniques such as CPR. He is capable for example, to intubate bodily fluids, like paramedics do, or to restore breathing through advanced airway management. If the medical training of soldiers is not sufficient for the patient, then a Combat Medic is called in. He is a soldier doctor, professionally trained to administer first-aid and trauma care. Lastly, in areas where there is an established camp, Battle Aid Stations (BAS) provide for the first echelon. Note that BAS are not medical hospitals on the field. They are simply a defined area for medical triage and stabilization may be set up in a van, truck, ambulance, tent, building, or even under the sky.
In echelon two, the care administered is geared towards soldier restoration, or for severe trauma, stabilization for evacuation, similar to echelon one. Army. The Army provides second echelon medical care at medical companies. The Army medical companies are found within forward or main support battalions (FSB/MSB) assigned to combat divisions, regiments, or separate brigades. FSBs are composed of a company headquarters, and evacuation platoon, and a treatment platoon. The evacuation platoon is tasked to wheel out patients from the BAS. The treatment platoon receives injured soldiers in a clearing station to perform triage and medical treatment. Surgery under local anesthesia is the common service administered, unless FSB has a forward surgical team (FST). An MSB is assigned to each division and provides medical aid to combat support units and backup support to the forward medical companies in the field. An MSB medical company has a larger staffing (ambulance platoon, larger treatment and dental sections) and capability to hold multiple patients (as much as 1,200 patients). It operates with a preventive medicine section, an optometry section, a mental health section, and a Division Medical Supply Office (DMSO) that manages all medical materiel for the division. The Division Medical Operations Center (DMOC) assigned to the Division Support Command (DISCOM). Comparable MOCs coordinate medical company employment within combat regiments and separate brigades. Such organization is required in echelon two, because in this level of care, the soldier is desired to be back in the field within one to three days, or stabilized for at least seventy two hours prior to transportation to the next level of care.
At echelon three, the patient is treated in a medical treatment facility staffed and equipped to provide resuscitation, initial wound surgery, and post-operative treatment. Patients who are immovable due to their medical condition may receive immediate surgical care in a hospital in a mobile Army surgical hospital (MASH). Modern day combats no longer use MASH units but are replaced by deployable FSTs.
The combat support hospital (CSH) typically set-up to provide tertiary care through robust facilities as operating rooms, intensive care units, dental surgical care and neuropsychiatry care. Two to three CSHs can be required to support a military division.
In echelon 4, the level of medical care is geared towards reconditioning and rehabilitation for return to duty. A Medical Field Hospital is an example of a medical unit in echelon four. Such set-up has a more stable facility and provides for prolonged rehabilitation services such as psychiatric division for soldiers and prisoners of war. During the Iraq War, several field hospitals were set-up with their own “specialty”, and one particular hospital holds psychiatric patients who are enemy prisoners of war (EPW) in Tikrit, Iraq.
The highest level of care, echelon 5 provides long-term medical care for soldiers that are not expected to return to duty. A typical facility is called the Continental United States Base Support (CONUS). The medical facility is set-up to be more permanent than the lower levels of care and is usually serving peacetime soldiers. The Navy Hospital at Camp Lester, Okinawa, Japan is an example of an Echelon 5 CONUS.
Below is a table summarizing the typical amenities in each level of care.
Table 1. Comparison of amenities and mobility found in each echelon.
Mobile, at the field
Mobile, at support division at the field
Semi-permanent, at support divisions at field
At least 426
At least 8, advanced
Permanent, away from battlefield, within the Military Base
Tactical Combat Casualty Care
Tactical Combat Casualty Care (TCCC) is a method of handling pre-hospital patients for military personal with medical responsibilities. This is part of the training of a Combat Medic in the US Army. According to Geibner, et. al, of the Committee on Tactical Combat Casualty Care (COTCCC), the TCCC has three goals: treatment of the casualty; prevention of additional casualties; and completion of the mission (2003).
Stages of Care
In the treatment and management of casualty, the medics’ response to the trauma situation is dictated by the battle situation. AS such, three stages of care must be considered in combat casualty care to ensure the medically correct response is provided at the right time, in the right set-up.
Care Under Fire
This is the first stage of care and is the administered at the occurrence of the injury usually during combat. The medic is equipped with both a first aid bag and a pistol to protect himself or to suppress hostile fire. In doing so, the proper care to the wounded can be administered without the disturbance of battle. When hostile fire has subsided and the medical administration can be safely executed, the medic is still expected to haul the victim to cover to ensure that both he and his patient is protected from ensuing battle. If hostile fire is not immediately suppressed, the medic is to lay motionless until the situation permits medical care administration. The medic should not administer care while battle is ensuing as it may attract enemy firing target, thus endangering the both his and his patient’s life. Thus, the first order of business for a medic providing care under fire is to secure himself and the victim.
When the medic is confident that both he and the victim are secured, he goes on to administer primary care. In most battlefields, wound injury prevails. Thus, exsanguinations avoidance is a fundamental skill and response that the medic provides. Death from bleeding is the cause of more than 2,500 casualties in Vietnam (2003) thus is the main focus in this stage. Airway injuries are typically minimal at this stage and thus must be deferred to treatment upon evacuation. The main means of giving wound care under fire is by applying pressure. Doing so may need the aid of a tourniquet to ensure that further bleeding is prevented until such a time when the wound can be properly dressed. There are dangers though to prolonged use of tourniquet that may lead to damage of the blood vessels being suppressed. However, ischemic damage is less lethal than exsanguinations. Thus, the medic should ensure that soldiers that are severely bleeding should be prioritized during tactical field care.
Movement of the casualty is the next challenge that the medic will face. Ideally, immobilizing the spine is the standard care for moving the injured. However, this maybe difficult at the height of battle. Given the required to immobilize the spine is at least 5.5 minutes, according to Geibner (2003), it maybe too long for the medic to successfully execute the immobilization without endangering himself and his patient to open fire. Unless the injury came from obvious spine debilitating incidents such as a parachuting fall or severe neck injury, care under fire response should depriroitize immobilization prior to evacuation. In the end, it will be the medic’s judgment on the best immediate care for the injured. Standard stretchers for patient evacuation may not be onsite for evacuation of casualties. Alternate tools such as ponchos or rope with a snap link can be used to haul the casualty away. Vehicle screens may also be used to protect the evacuation, as in the use of tanks to screen casualties in Iraq.
Part of casualty care under fire is the psychological alleviation of the injured from the fear and anxiety of death. In this case, the medic should exude calm and composure to be able to convey reassurance to the victim, despite their injuries. Encouraging the victim to resist pain and muster the will to stay alive requires the medic to communicate strength of character in such unstable situations.
In summary, the medic’s focus in administering care under fire is to protect himself, his patient, prevent life-threatening exsanguinations, successfully evacuate and reassure the patient of recovery.
Tactical Field Care
Tactical Field Care rendered when the medic and the casualty are no longer under effective hostile fire, whether it is a temporary cessation or there was none at all to begin with. Though more time is available in this type of situation, it can be as little as minutes during a temporary ceasefire or hours of waiting for medical helicopter rescue. Within such a wide range, the stability of the injured is the primary concern of the medic.
Action plan for stability will depend with a thorough evaluation of the patient. If the injured is unconscious, it is most likely a result of hemorrhagic shock. Use the chin-lift or jaw-thrust maneuver to open the airway. Note that if the injured is well capable of breathing independently, then respiratory stabilization is not required. If spontaneous respirations resulted from opening the airway, then continuous respiration can be achieved with the insertion of nasopharyngeal airway. The patient should also be placed in the recovery position: the mouth is downward so that blood can drain; the chin is well up to keep the epiglottis opened; arms and legs are locked as to keep the position; In order to remove all obstructions to stable respiration. Should an unconscious patient develop an airway obstruction, endotracheal intubation. However, under a battlefield situation and with limited instances for intubation practice, the success rate of endotracheal intubation is low according to Geibner (2003). Alternatives are the Laryngeal mask airway (LMA) and the Combitube®. These airway devices have been found to provide adequate ventilation without the need for illuminated laryngoscopy required during endotracheal intubation. Another procedure that can be safe for unconscious resuscitation is cricothyroidotomy. This is a procedure that intubates the trachea through cricothyroid, a thin membrane between the chin and the neck that when opened up, provides access to the trachea. This technique is also appropriate when access to the mouth and the nose are impossible due to maxoillofacial injuries.
As soon as regular respiration is achieved, capability of the injured for voluntary breathing should be restored. If there is penetrating chest trauma, place the injured in a sitting position and dress the wound allowing for air to circulate. Commercially available Asherman Chest Seal® can be used. If air build-up in the lungs is observed from difficult and irregular breathing, the chest must be decompressed. To decompress, insert a catheter at one side of the chest and monitor the patient for improvement or non-response. When non-responsive, a second incision and catheter maybe inserted, adjacent to the first insertion.
When the patient is able to sustain voluntary respiration, the next area to address is significant bleeding previously uncontrolled. Absolute minimum clothing is removed, only to expose the area. Use direct pressure with pressure dressings to control bleeding or commercially available haemostatic agents such as HemCon® and QuikClot®.
When exit of bodily fluids have been controlled, replacement of fluids through Intravenous (IV) access should be the next course of action. Geibner recommends the use of a single 18-gauge catheter for ease of starting fluid resuscitation (2003). The volume of fluid introduced during resuscitation is more significant than the kind of fluid used. The Advanced Trauma Life Support (ATLS) training did not find significant response in the recovery of an injured soldier with intravenous resuscitation though traditional combat response conferences agree that the response is sound. With the assumption that resuscitation is a sensible care response, the strategies discussed will be on the kind of fluid used and the administration procedures.
Lactated ringers are default IV solution for civilian emergency medical response. However, for tactical field resuscitation, the recommended solution is to use hetastarch-based solutions. As compared to LR, a saline based solution, hetastartch is a liquid volume expander that has the capability to expand fluid by as much as four times as compared to a LRs. In addition, HTS-based solutions are retained in the body for up to 8 hours vs. a limited 1 hour as compared to LRs. Geibner (2003) recommends, procedural application of resuscitation strategy is dependent on the direction of the Medical management of the tactical combat care team. An example of the strategy is used by the 10th Infantry Light Mountain Division of Fort Drum are the following:
1. Superficial wounds (>50% of injured): No immediate IV fluid resuscitation required, however, oral fluid intake should be encouraged.
2. Any significant extremity or truncal wound (neck, chest, abdomen or pelvis) with or without obvious blood loss or hypotension irrespective of blood pressure:
a. If the soldier is coherent and has a palpable radial pulse, blood loss has likely stopped.
b. Start a saline lock; hold IV fluids; re-evaluate as frequently as situation allows.
3. Significant blood loss from any wound and the soldier has no palpable radial pulse or is not coherent (note: mental status changes due to blood loss only, not head injury):
a. Stop the bleeding by direct pressure-hands and gauze rolls, with or without adjuncts like Ace bandages, hemostatic dressings (HemCon®), or hemostatic powder, (QuikClot®), is primary when possible. Extremity injuries may require temporary use of a tourniquet. However, > 90% of hypotensive casualties suffer from truncal injuries unavailable to these resuscitative measures.
b. After hemorrhage is controlled to the extent possible, obtain IV access and start 500ml of Hextend®.
– If the casualty’s mental status improves and a palpable radial pulse returns, stop IV infusion, maintain saline lock, and observe for changes in vital signs.
– If no response is seen, give an additional 500 ml of Hextend®. If a positive response is obtained, stop IV fluids, maintain saline lock, and monitor vital signs.
c. Titrating fluids is desirable but may not be possible given the tactical situation. Likewise, the rate of infusion is likely to be difficult to control. Based on the effective volume of Hextend® versus lactated Ringers and coagulation concerns with increasing amounts of Hextend®, no more than 1000ml of 6% Hetastarch should be given to any one casualty (approximately 10 ml/kg).17-20 This amount is intravascularly equivalent to six liters of Ringers lactate. If the casualty is still unresponsive and without a radial pulse after 1000ml of Hextend®, consideration should be given to triaging supplies and attention to more salvageable casualties.
4. Based on response to fluids, casualties will separate themselves into responders, transient responders, and non-responders.
a. Responders: casualties with a sustained response to fluids probably have had a significant blood loss, but have stopped bleeding. These casualties should be evacuated at a time that is tactically judicious.
b. Transient and non-responders are most likely continuing to bleed. They need evacuation and surgical intervention as soon as tactically feasible. If rapid evacuation is not possible the medic may need to triage his attention, equipment and supplies to other casualties as determined by the tactical situation. Remember: no more than 1000ml of Hextend® should be given to any one casualty.
5. Head injuries impose special considerations. Hypotension (SBP<90mm Hg) and hypoxia (SpO2<90%) are known to exacerbate secondary brain injury. Both are exceedingly difficult to control in the initial phases of combat casualty care.
Combat Casualty Evacuation Care (CASEVAC) is the care rendered during casualty evacuation. It can be conducted in an aircraft, vehicle, or boat. These means of transportation are equipped with additional medical personnel and equipment to enable of casualty management.
The objectives of CASEVAC care are to adjunct Tactical Field Care and sustain the stable condition of the casualty until the point of destination. At this point, the combat medic is replaced by the additional medical personnel that are in the vehicle of transport. The medic may go with the CASEVAC team, especially if it is a company evacuation, but will serve as a guide and history reference to the CASEVAC medics. It is also important that a fresh and focused CASEVAC medic take over the casualty management as the field medic may be exhausted from administering primary field care or can be injured himself.
Pruet (2003) recommends a two-man team accompany the evacuation vehicle. An aviation medic who is familiar with that particular airframe and a physician or physician assistant with as much recent trauma or critical care experience as possible. Although there may be times when more than two people would be useful, two is probably the most reasonable number because of space constraints within the evacuation asset and a scarcity of specialized medical personnel in theatre.
Within the evacuation vehicle, additional medical equipment is present with the CASEVAC team. As such additional diagnostic procedures can be conducted for better injury management. Monitoring equipment for blood pressure, heart rate, pulse and carbon dioxide level. Oxygen can now be administered as well. Patients with controlled hemorrhagic shock can be revived with a more aggressive concentration of hestarch-based solution, since the aid correct blood pressure can be monitored through the use of diagnostic equipment. Patients with chest wounds should still not recommended for resuscitation. In this stage of care, it is also not recommended to repair wounds unless bleeding is yet to be controlled. The instability of a moving vehicle, especially the helicopter is not ideal for proper administration of permanent wound care and management.
With three levels of care applicable to the situation on the battlefield, the key to a successful medical response is the ability of the head medic to decide the best medically applicable response. The composure, speed of thinking and medical skill of the medical personnel on the ground plays a major role in the outcome of the medical emergency.
Weapons of Mass Destruction
Weapons of Mass Destruction (WMD) are organic and inorganic substances and processes that destroy massive organic life (people, animals and plants) and property at a single discharge. In the history of warfare, many a wars were won through the use of WMDs. Thus, it continues to exist today because of man’s incessant obsession to master the world and one another. There are three popular types of WMD’s and they will be briefly discussed in each sub-section. The final portion will discuss how the military is mandated to handle the presence and activation of weapons of mass destruction.
Biologic Warfare Agents
Biological warfare is the use of microorganisms that destroy people, animals, crops and any organic life as a means of war. The first evidence of biological warfare was during the French and Italian Wars, when military leaders attempted to spread small pox to Native Americans. Though the Geneva Convention prohibited the use of biological agents in warfare, the recent spread of anthrax in postal mail post 9/11 is evidence of the presence of prevailing threat.
Chemical Warfare Agents
Chemical warfare is the employment of inorganic materials for the purpose of destroying destroys people, animals, crops and any organic life as a means of war. Releasing flammable gas in a confined space and igniting it is an ancient form of chemical warfare seen during the Greek wars. In WWI, poison gas was spread through the air is a traditional form of chemical warfare. The ban on chemical warfare agent was also included in the Geneva Convention. In 1993, a convention of 160 countries ratified an agreement to destroy and refrain from keeping stockpiles of chemical weapons that can cause mass destruction. Though no recent evidence will show the presence of chemical warfare agent deployment, there is evidence gathered by the British Government that Iraq is keeping weapons of mass destruction, thus the invasion.
Wikipedia defines a nuclear weapon is a weapon which derives its destructive force from nuclear reactions of either nuclear fission or the more powerful fusion. As a result, even a nuclear weapon with a relatively small yield is significantly more powerful than the largest conventional explosives, and a single weapon can be capable of destroying or seriously disabling an entire city (2006). This is the most modern type of WMD.
In February of 2006, five years after the terrorist attack at the World Trade Center, the US Department of Defense has published a National Strategic Plan for the War on Terrorism. The forty-page document details the government strategy to deny terrorist the ability to deploy weapons of mass destruction to the US and to the globe using three key elements: protect and defend the homeland; attack terrorists and their capacity to operate effectively at home and abroad; and support mainstream Muslim efforts to reject violent extremism. This document signals an effort to have a systematic way of addressing and responding to WMDs as the main instrument of terrorism.
Prior to this documented strategy to address weapons of mass destruction, the Emergency Research Institute has published documentation on the guidelines for Biological and Chemical Warfare Emergency Response. Authored by Executive Director Clark L. Staten (1997), below is the summary of the action plan to be executed by the local emergency management team and are as follows: (1) Incident “Size-up” and assessment; (2) Scene Control/establishment of perimeter(s); (3) Product Identification/information gathering; (4) Pre-entry examination and determination/donning of appropriate protective clothing & equipment; (5) Establishment of a decontamination area; (6) Entry planning/preparation of equipment; (7) Entry into a contaminated area and rescue of victims (as needed); (8)Containment of spill/release; (9) Neutralization of spill/release; (10) Decontamination of victims/patients/rescuers; (11) Triage of ill/injured; (12) BLS Care; (13) Hospital/expert consultation; (13) ALS care/specific antidotes; (15) Transport of patients to appropriate hospital; (16) Post-Entry evaluation examination of rescuers/equipment; (17) Complete stabilization of the incident/collection of evidence; (18) Delegation of final clean up to responsible party; (19) Record-keeping/after-action reporting; (20) Complete analysis of actions/recommendations to action plan.
Wikipedia defines triage as a system used by medical or emergency personnel to ration limited medical resources when the number of injured needing care exceeds the resources available to perform care so as to treat the greatest number of patients possible. In the battlefield, where the resources and medical personnel are limited, the timeliness of care provided to the injured soldier is key to maximum rescue (2006). A Simple Triage and Rapid Treatment (START) system was initiated in California in 2003 to have a system of executing medical care during emergencies such as earthquakes or major vehicular accidents.
The START system separates the injured into four groups: (1) DECEASED who are beyond help; (2) IMMEDIATE in need of urgent transportation to a care facility; (3) DELAYED, who can survive deferred transportation; and (4) MINOR, who have lesser injuries and can voluntarily sustain critical life support. The military has a different triage as the civilian system.
In military triage, the underlying assumption is that the general health of injured personel is good, though most suffer from hunger and fatigue. Thus, the medical response will depend on the severity of the physical injury and no necessary steps to test the state of the patient will be conducted. It is also assumed that rescue will be delayed, thus, transportation within the golden hour is not usually available. Lastly, it is a fact that mass casualty is expected in the battlefield, thus the strict need to follow protocol during triage.
There are three categories in military triage. First, MINIMAL corresponds to minor wounds that can be treated in the field. The second category is SERIOUS injuries that require tactical care with CASEVAC. The last category is the EXPECTANT, which are the injured whose treatment may in the end be also futile. Among the three, the SERIOUS category will require the medic’s attention.
The SERIOUS category is further broken down to different levels of response, similar to the civilian triage, only that there are three types. Those classified as URGENT have injuries, which are life-threatening and will require immediate stabilization and resuscitation when in a medical facility. Those who have life-threatening injuries but are stable and can withstand medical intervention even as long as 2 hours of arrival at the hospital is classified as IMMEDIATE. Lastly, the DELAYED injuries that are not serious such that delaying care will not deteriorate status of the patient.
Civilian vs. Military Emergency Medical Services Casualty Management
Because an emergency is a situation requiring immediate response out of the ordinary, civilian and military EMS both share a systematic approach in the organization of response. The first-aider, a civilian trained in fundamental injury stabilization the first to respond on the ground. The same is true for the military. Each soldier is trained in first-aid, thereby qualifying each of them as first-aiders in the battlefield. A redundant buddy system and Combat Medic is also on the ground for immediate response.
A triage system is also common between the civilian and the military. Though the actual implementation may differ, the principle behind instituting and using the system is significant and a point of similarity.
Apart from the two, military and civilian EMS differs. Firstly, the chain of command in Military EMS originates, ultimately to the central USSOC. While in Civilian EMS, apart from the mandate of civil services such as the police, fire department and emergency responders, Civilian EMS is different for every State, sometimes, even cities, if the size and population are significant. This is advantageous, in a way, because the kind of response to the emergency can be more customized vs. having a standardized way of doing things, as in the military. However, accountability to system breakdown may also be lost, when there is no centralized form of governance for EMS. Thus, there is a big difference between New York’s response to 9/11 vs. New Orleans’ response to Katrina.
Military EMS in a way is also more tolerant than civilian EMS. In the field, when the IMMEDIATE SERIOUS is prioritized for medical response, there is understanding and tolerance among the corpse that the medic has the authority to classify the injured and that one’s classification should be accepted. In civilian EMS, there is always a danger of litigation for mismanagement of an individual or the situation. Although the medical provider’s training includes skills against emergency mismanagement, the very situation of an emergency opens up the opportunity for misses.
Despite the differences, there is an underlying principle that ensures effective management in an emergency situation. The cooperation between civilian and military emergency response will provide a robust solution and immediate response to a widespread emergency.
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