Comparison of the Scope of Practice of the Army Combat Medic Specialist and Civilian National EMS Certification Levels

Abstract

Introduction

The transition of Army Combat Medic Specialists (Military Occupational Specialty Code: 68W) from military to civilian emergency medical services (EMS) is challenging, and the pathway is not clearly defined. Our objective was to evaluate the current military requirements for 68W and how they compare to the 2019 EMS National Scope of Practice Model (SoPM) for the civilian emergency medical technician (EMT) and advanced emergency medical technician (AEMT).

Methods

This was a cross-sectional evaluation of the 68W skill floor as defined by the Soldier’s Manual and Trainer’s Guide Healthcare Specialist and Medical Education and Demonstration of Individual Competence in comparison to the 2019 SoPM, which categorizes EMS tasks into seven skill categories. Military training documents were reviewed and extracted for specific information on military scope of practice and task-specific training requirements. Descriptive statistics were calculated.

Results

Army 68Ws were noted to perform all (59/59) tasks that coincide with the EMT SoPM. Further, Army 68W practiced above scope in the following skill categories: airway/ventilation (3 tasks); medication administration route (7 tasks); medical director approved medication (6 tasks); intravenous initiation maintenance fluids (4 tasks); and miscellaneous (1 task). Army 68W perform 96% (74/77) of tasks aligned with the AEMT SoPM, excluding tracheobronchial suctioning of an intubated patient, end-tidal CO₂ monitoring or waveform capnography, and inhaled nitrous oxide monitoring. Additionally, the 68W scope included six tasks that were above the SoPM for AEMT; airway/ventilation (2 tasks); medication administration route (2 tasks); and medical director approved medication (2 tasks).

Conclusions

The scope of practice of U.S. Army 68W Combat Medics aligns well with the civilian 2019 Scope of Practice Model for EMTs and AEMTs. Based on the comparative scope of practice analysis, transitioning from Army 68W Combat Medic to civilian AEMT would require minimal additional training. This represents a promising potential workforce to assist with EMS workforce challenges. Although aligning the scope of practice is a promising first step, future research is needed to assess the relationship of Army 68Ws training with state licensure and certification equivalency to facilitate this transition.

Author Contributions

CBM, MB, and ARP conceived and designed the study. CBM, MB, JRP, JDK, and ARP analyzed the data and drafted the manuscript. All authors contributed substantially to the interpretation of the data and revision of the manuscript. CBM takes responsibility for the paper as a whole.

Disclosure Statement

The authors report there are no competing interests to declare.

Institutional Clearance

This manuscript is approved by Army PAO and OPSEC for public dispersal. The views expressed are those of the author and the authors alone and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the U.S. government.

Previous presentation

These data were presented at the 2020 NAEMSP Annual Meeting (January 10, 2020; San Diego, CA) and the 2020 AMSUS Annual Meeting (December 6-10, 2020; Virtual).