I am a Special Amphibious Reconnaissance Corpsman who was currently deployed in a Middle Eastern country. This was my first unit and first deployment that I have ever been on. So, everything I was used to was straight from the JSOMTC curriculum. When I was deployed, I was advising and assisting our partner forces (PNF) in Tactical Combat Casualty Care (TCCC) training. Prior to assisting in the training for TCCC, I found out that there was no certified standard or SOP for TCCC in all the armed forces that were there. During the prior team’s deployment cycle our predecessor reached out to a host nation (HN) non- profit organization in hopes to help with the conduction and standardization of medical training for the PNF. In this article, I will discuss some of the lessons learned while trying to conduct standardized TCCC training for a PNF in a foreign country.
So, let’s talk about deployment. Better yet, let’s talk about the first time you’ve been to a foreign country. For most people, we all have a common impediment. I’m of course talking about the infamous language barrier. Now for most of us, in this day and age, we have technology with translating capabilities. But for something like battlefield medicine, in a foreign country, that language barrier becomes more of a hindrance. The instructors from the organization that I worked with were fluent in both English and Arabic. The problem didn’t necessarily arise from the language translations being utilized during hands – on applications. The problem was when you put something on paper in black and white and it had to be written out, read, and interpreted by the students. Most of the students in these TCCC courses didn’t typically take written tests. This became a problem when we wanted to certify people and teach people medicine on slides that weren’t in their native language, or when the students were expected to memorize the MARCH pneumonic in a language that was foreign to them. Not to mention the fact that they were supposed to understand it proficiently. In my humble opinion, I think we should generate Committee on Tactical Combat Casualty Care (CoTCCC) certified slides. I am highly impressed by their willingness to create their own slides in their own language. However, I think that slides from CoTCCC pre-generated in several foreign languages will allow for no loss in the interpretation of knowledge. Once we formulate translated slides, we will be creating a solid foundation of material for these students to now study, and by doing so, we will increase their chances of passing the written tests and certifying them. As for the MARCH pneumonic dilemma, I think the best solution would be an Arabic algorithm that teaches same principles as the American CoTCCC MARCH pneumonic.
Next, I would like to talk about the certification process. For the longest time, in this particular country, other SOF medics have been training these forces on what they prefer to do….. or not do. Therefore, there is a huge variation in the level of skill each “medic” has. Until recently, there has been no certified training that has occurred. Due to this, groups of “voluntold” guys would get training on whatever med training the SOF medic was in the mood for teaching. The SOF medic would typically teach these forces what ways worked for him and how he would perform certain interventions. This took away the standardization and implementation of foundational skills of TCCC training for these forces to learn. There is now a “level” based spectrum of training for the medics in this country. Level one, the lowest level, consists of basic treatments geared towards all combatants in the armed forces of this country. Level three, the highest level, consists of invasive treatment instruction/ prac- app, didactic learning exercises, and clinical rotations at local treatment facilities. This is a definite win, in my opinion. There are now levels and certifications that go with these levels. There are set standards that you must meet and ascertain to acquire these levels and certifications. However, the problem is that there are still some units that aren’t even familiar with the level system that has been generated. They are just passing down the teaching of what the previous SOF medics taught/ didn’t teach them. I think this issue will soon be resolved by having more people go to these courses and evolve. They will eventually go through an instructor certification course. This will then certify them to teach and certify other people in their unit. This would meet the goal for them to operate independently, and develop a level of autonomy in medical training.
Lastly, the supply… or lack thereof. The deficiency in medical training, which has been reoccurring over time, was largely due to supply and logistical purposes. Many guys weren’t able to learn how to perform interventions such as needle thoracentesis without decompression needles. They weren’t able to learn the significance of hemostatic agents without actually putting them to the test and their effectiveness when compared to simple Kerlix. Students couldn’t learn proper placement of junctional tourniquets when they didn’t even have any of them to place. I can continue to go on with supplies which they were missing, and how it impaired their training but I think you guys get the point. A potential solution for this quandary, is an impelling proposition that could be pitched toward the right set of host nation logistical services. This service would have to not only supply, but also be continuously resupply these forces with equipment for training. The way this proposition will entice the benefactor, is by stressing its importance through statistical data, as well as it’s relation to all other aspects of military training. Whoever pitching this proposition could compare medical training to other critical aspects of military training.
In conclusion, there was a lot done for this country’s medical training issues. But, there’s a lot that still needs to be done. The most important thing is that we are now on the right direction, and with a good speed toward our destination. That set destination is to raise these forces to operate on their own, and continue to grow on their own, without us needing to step in and help operationally, logistically, or administratively. This will be done by generating teaching material in this country’s respected language, standardizing medical training throughout all the forces in the country, and by finding a perpetual supplier for medical training supplies.
By Louis the SARC