Two pair of boots.

Although at present I am a desk-riding, coffee swilling, paper-pushing, lamentable Pogue, I haven't always been. I have had the fortune of experiencing two very different worlds. I am a Medic, and I am also a Paramedic. When I say "Medic", I mean: ["Doc", Corpsman, Combat Medic, Healthcare Specialist, Medical NCO], that is to say, Military trained, combat tested. When I say "Paramedic" I mean the obvious. I am both. This is not to say this is rare, but it is certainly not the norm. The majority of my EMS counterparts have not seen the types of things I've seen as a Medic. On the other hand, not many of my Medic colleagues have the training, or the experience, or the background of dealing with the things we see and treat as an Advanced Life Support Provider on the streets.

The two worlds are very different, and not necessarily complementary. As a matter-of-fact, none of my jobs, though related, are necessarily complementary, but that's not the point right now...

My counterparts in both careers frequently discuss the advantages of being dually trained. For Me, it works. I enjoy both, I try to excel at both, I get a little taste of everything. However, I don't necessarily believe that being dually trained will make you better at either job.

Combat Medicine is, imagine this, predominately Trauma. Penetrating. Burn. Blast. Primary, Secondary, Tertiary impacts. Barotrauma. Life. Limb. Eyesight. Every incident is approached with Triage, and mass-casualty potential. GSW to the thigh? Hold pressure, self-aid/buddy-aid, return fire, I'll get there when I can. Scene safety is a little different in these parts. Quit whining, put rounds downrange. Suppressive fire for your buddies, gimpy. If you let them down, I have more patients.

Medical problems exist, but they are not the bulk of the load. Heat Exhaustion, Behavioral Emergencies, the occasional First Sergeant with Chest Pain. These are exceptions to the rule.

Street Medicine, as you all know, is Medical ailments, with the occasional trauma mixed in. ABD Pain, Asthma, COPD, CHF, CP, Diabetes, DOE, DK, FDGB, GIB, HA, LOL, N/V/D, SOB, Syncope, TMB, SI, NAD, WTF. Trauma is generally a small slice of the pie. And what trauma we do get for the most part is MVCs, assaults, Falls, various blunt trauma, and the occasional penetrating trauma.

Trench Medicine resides somewhere between where [PHTLS, ITLS, BTLS] left off, and ATLS begins. The Medic is trusted to do whatever it takes, in the absence of orders. Your assignment is to save lives. If you don't have a PA, or a MD, or a Senior Medic, you're It.

Street Medicine = ACLS + PALS + DOT + PEPP + AMLS + Protocols + OEMS x 'Handcuffs'. Patient needs a surgical crich? No way. Bougie? Not in your Protocols. This post is not about protocols though. They have their place, and they have their reasons. Besides, Rogue Medic does a better job talking about them.

To me, the differences between these two Worlds is abundantly obvious, crystal clear. Yet it seems to some folks, the difference between Urban and Rural medicine is more apparent than the difference between Military Medicine and Street Medicine.

Civilians, for the most part, don't suffer from shrapnel wounds. Their MVC wasn't caused by an explosive-formed projectile from an improvised explosive device.

Soldiers, for the most part, shouldn't have underlying cardiac conditions. They are not diabetic. They've never even heard of Fibromyalgia. They are otherwise healthy-ish, and between 17 and 40 (for the most part...)

Civilian ailments require thought. Differential diagnoses. (Sorry...clinical impression...) Their illnesses and plights run the gamut. Soldier's life threats are typically pretty obvious.

Trauma vs. Medical. Action-Thought vs. Thought-Action.

Discuss?