r/TacticalMedicine • u/codyfire226 EMS • Feb 05 '25
TCCC (Military) Combat Medic Vs Combat Paramedic
I have the Deployed medicine app on my phone and I was wondering if someone from the military could tell me about whats makes someone a Combat Medic vs A Combat Paramedic?
I looked at the skills list and both roles are very similar with the exception that a Combat paramedic can intubate and a Combat Medic can't not, I am a civilian Paramedic with a heavy interest in Combat medicine, I have taken TECC with plans to take the TP-C once I complete my Associates degree
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u/beefy_whale Medic/Corpsman Feb 05 '25
I’m a Paramedic with the Air Force and teach these TCCC courses all of the time. I’ll try my best to explain.
There are a few main differences between these tiers as TCCC breaks it down.
First, “Combat Medic/Corpsmen”, also known as “Tier 3” Like you described this role has a decent scope of practice, more in line to a civilian paramedic than EMT-B. This is to help reflect a lot of the extra training that the military will do for its basic medical providers that they don’t get credentialed on. Depending on your agency, Air Force, Army, Navy etc. This role is intended for medical personnel with a variety of different levels of education, typically anyone from EMT-B, AEMT, RN or even RTs. The course teaches you skills, medication dosages and knowledge in an easier and straightforward way, like standard dosages for medications and simple steps and algorithms for skills. This role doesn’t really have a lot if autonomy when it comes to medical decisions, it’s all based on following algorithms.
When it comes to “Combat Paramedic/Provider” or “Tier 4”, which is typically meant for your Nationally Registered Paramedics, PAs, NPs, and MDs/DOs (Depending on the agency again, they may allow/disallow different careers into this level depending on what theyre trained on or certs they have) This course is where you’ll see a lot more autonomy afforded to the Tactical Provider. If you read through the course you’ll see a lot where they mention different choices when it comes to skills or medication dosages, mostly based on your judgement as a clinical provider and if you’ve been trained on it before. Ex: Needle thoracostomy, Finger thor, or chest tube. Overall yes it does allow for a few more skills over the “Combat Medic” but the main difference is that level of decision afforded to the Tactical Provider.
It can definitely get confusing at times, in the military the name “Medic” can reflect a huge variety of different career fields in medicine, and the point of the “Combat Medic” training is to try to bring them all together on the same level.
I hope this helps clear some things up.
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u/thedesperaterun 68W (Airborne Paramedic) Feb 05 '25 edited Feb 05 '25
Combat Medics are 68W EMT-Bs or EMT-As with the same amount of time spent studying for their NREMT-B also spent on an additional "Whiskey Phase", which is 95% trauma in military applications with some limited primary care that results in a significantly increased skills scope of practice.
Combat Paramedics are Medics who went through the San Antonio Combat Paramedic Course and are now Paramedics.
TCCC is not including Flight Medics (Paramedics with CC-P) when it specifies Combat Paramedics because Flight Medics have their own protocols (SMOG).
But not all Paramedics in the Army are Combat Paramedics. Take me, for instance: I, despite having gotten my Paramedic license in the Army, am not technically a "Combat Paramedic", as I did not go through the San Antonio pipeline. Instead, I have a separate identifier (ASI:3P), and am a "Nationally Registered Paramedic". Still "Tier 4" and combat-cool, but called differently.
Were you interested in actually joining, or were you just looking at TECC, TCCC, and Tactical Paramedic on your own?
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u/SFCEBM Trauma Daddy Feb 05 '25
All SOF medics become NRPs and fall into tier 4.
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u/Beautiful_Effort_777 Medic/Corpsman Feb 06 '25
Eh seal medics and pjs are more like tier 3.5. Ifykyk
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u/codyfire226 EMS Feb 05 '25
I am 33 YO, I am not quite interested in joining, if I did join it would be the National Gaurd so I could be a Flight Medic, but I am a civilian paramedic and I have an interest in "special operation medicine( not to be confused with the military special operations)) I have a interest in USAR, Prolonged care, and Tactical EMS and Community Paramedicine, I have the app mainly to just learn and understand new things not to mention, although I am not a conspiracy theorists I am planning for SHTF situations, plus I like to learn new things, I was genuinely curious on what the difference between a combat Medic and a Combat Paramedic was, I absolutely love all aspects of EMS! And I am working toward obtaining my associates degree so I can hopefully teach one day,
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u/AdministrativeBat310 Feb 05 '25 edited Feb 05 '25
Im an active duty 18D. Our scope and autonomy is absolutely leaps and bounds ahead of a civilian pre-hospital professional. Realistically because of our unique skill set and capabilities, the civilian sector has no true equivalent to what we bring to the table. We practice independently overseas, as we have advanced schooling in pathophysiology, A&P, pharmacology, and what truly separates us is our clinical pathology, lab interpretation and surgical/anesthesia skills, as well as our ability to legitimately maintain a multi system trauma patient for multiple days, as we are one of the few providers who can take a patient from point of injury through TFC, and into prolonged casualty care to sustain them. We are able to perform select surgical procedures and have to administer our own anesthesia for those as well.
Yes some of these procedures can be taught to a monkey through repetition, but understanding the “why” behind what we’re doing is another huge divider between us and everyone else. Understanding WHEN to perform these advanced procedures is even more crucial, vs doing them because “MOI + 1= procedure!”. The knowledge we must retain is overwhelming and very much makes you understand why medicine is compartmentalized at the provider level in the civilian world. But a good 18D is constantly learning, reading, studying and practicing daily to maintain proficiency and knowledge.
The hardest part is that this isn’t even our primary job. Lethality is number one. I still have to be fluent in my target language and test annually. I’m also the level 1 sniper and have to maintain that skill, and teach it to the rest of the team.
I’m not saying we are physicians or anything. It’s just a unique, versatile skillset that has vast applications. If I’m ever unsure you bet your ass I’m doing telemedicine with a real adult like a surgeon, neurologist, whoever is needed.
TLDR: the knowledge and skill gap between a 68W and an 18D is absolutely massive. This is not a dig against 68W, who have exactly what they need to be successful combat medics, just trying to make you understand the big jump from tier to tier.
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u/Dependent-Shock-70 Medic/Corpsman Feb 05 '25
Fair to say that your scope of practice and autonomy is higher than a civilian paramedic. But your level of experience is nowhere close to that of a civilian paramedic working in an urban center and especially not that of a critical care flight paramedic. Reading something in a book/being taught how to do it and maybe doing it a couple times when you guys do EMS/hospital shifts is great but it pares in comparison to a paramedic seeing critical patients and using their skills almost every day.
Just wanted to clarify that difference. Not taking away that you guys are very highly trained. But training and experience are two very different things. This is something that's been brought up on the PFC Podcast in the past and is important for any SOF level medic to understand.
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u/AdministrativeBat310 Feb 05 '25 edited Feb 05 '25
I agree with you that we absolutely are unable to get the valuable daily hands on live patients that those you mentioned receive. To that point is why I brought up the other responsibilities I’m required to perform, which is also our greatest pitfall as 18Ds vs say Ranger Medics or JSOC support Medics. Where other medics or civilians who are purely medics through and through, we wear many hats and are expected to perform highly in each of those additional categories.
I bring up the level 1 sniper certification specifically because it is the premier sniper course in the US Military and gives us an ASI which allows us to shoot low percentage targets 1 mil off friendlies/ hostage scenarios (no other sniper course gives you this capability outside of JSOC). The technicality and proficiency needed to sustain that skill demands almost as much practice and study time as my medical skills because if called upon I must be ready in that moment with the utmost precision, same as our medical skill set.
So I agree with you we absolutely don’t get as much hands on as we need and the rotations and refreshers just can’t cut it but we don’t have the time to dedicate to it unfortunately with operational requirements.
This isn’t a justification for lack of experience or an argument with you, it’s more of a gripe about the way the system works for us.
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u/cjrjjkosmw Feb 08 '25
A good civi paramedic will beat the brakes off most 18d with medicine and procedural skill. Best advice to the Socm and 18d who actually like medicine would be pick up some prn paramedic shifts somewhere. It wont all transfer but it will make you better.
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u/Basicallyataxidriver EMS Feb 05 '25
Non-military here, but i’ve don’t a bunch of research on the enlisted medical roles as Im currently enlisting, but I am also a civilian paramedic.
My guess is that it’s referring to training level. For the Army a 68-W is a “combat medic” and receives an EMT-B For corpsman in the Navy they aren’t required to get one, but they are able to too.
“combat medic” basically receives EMT-B with a expanded scope.
There’s a few jobs in the military which actually send you to paramedic school and get the same national registry we do.
Airforce PJ, Army 18-D, Navy SARCS.
The military has SOCM which is their Sof medic school, which i believe also gets them a NRP.
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u/AdministrativeBat310 Feb 05 '25 edited Feb 05 '25
We (18D) don’t get sent to paramedic school. We just take the test at the end of SOCM. We have to study for it on our own time as civilian medicine is slightly different and as you’re aware more geared towards ACLS, diabetics, geriatrics and obstetrics and their issues. I posted a comment here with a better explanation of our scope. Even after SOCM we have another course for additional clinical, lab and surgical/anesthesia training.
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u/Basicallyataxidriver EMS Feb 05 '25
I appreciate the insight, I knew a few of you guys got them, didn’t know that it was an extra thing you had to do on your own.
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u/AdministrativeBat310 Feb 05 '25
No problem! Just to clarify It IS required to fully complete SOCM and the schoolhouse covers the cost of all fees and stuff it’s just they won’t specifically prepare you for it if that makes sense
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u/crazyki88en EMS Feb 05 '25
The Canadian military is about to split the med tech trade into combat medic and paramedic. Combat medics will be equivalent to EMRs, with a broader scope than civvy side. Most current med techs who go combat medic won't notice a huge change in their scope. Combat medics will be employed pretty much everywhere the CAF goes.
Paramedics in the CAF will have a PCP licence and will work mainly on airfields and ships, and some field settings. They will also be the pipeline for SOF medics. The split has not happened yet, in that they haven't started teaching the new curriculum but all current med techs had to elect whether they wanted to apply to be paramedic (highly competitive, with numbers something between 1:8 and 1:10 vs combat medic).
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u/Anduril912 Feb 06 '25
Interestingly, most military “medics” (army 68W, AF 4Ns) are certified as EMT-Bs, but their scope and training more closely resembles that of an AEMT (formerly emt-intermediate). In our joint army/AF EMS protocols, these roles and AEMT are all interchangeable; EMT-B is actually the skill level below, and paramedic is the skill level above (in terms of the protocols). These are our in-garrison ambulance protocols. As others have alluded to, the formulation can be slightly different in the TCCC/field context. —military EMS and TCCC medical director
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Feb 05 '25
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u/thedesperaterun 68W (Airborne Paramedic) Feb 05 '25
this is not true.
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Feb 05 '25
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u/thedesperaterun 68W (Airborne Paramedic) Feb 05 '25 edited Feb 05 '25
skills-wise, EMT-Bs have a hugely expanded scope relative to their civilian counterparts, that's right, and one of the reasons why Fort Sam needs to dedicate a little more time on the didactic side to Medic education so 68Ws can walk out with their EMT-A, a certificate I think much more in-line with their skills AND with what they are expected to know in order to care for a casualty in a prolonged field care scenario.
but it is NOT the "same education" as a paramedic. I say that as someone who has gone through 68W AIT and then later through a Paramedic course.
If you had your EMT-B license in your pocket and got hired as a Paramedic and were telling people you were a Paramedic, then holy shit Daytona.
But telling people that Army 68Ws are paramedic level out of AIT and can expect to be hired as such "depending on what state" is absolutely wild.
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u/Big-Medo-Syrup-3698 Feb 05 '25
When/how did you work as a paramedic without a certification from NREMT as an EMT-P?
Was this decades ago?
Or were you employed as an ED Tech or a similar term and referred to as a Paramedic within the ED?
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u/Dangerous_Play_1151 EMS Feb 05 '25
I'm a civilian flight paramedic (FP-C/NRP) with non-medical experience in the military, and have worked with a lot of military folks doing TEMS on the civilian side for many years. If you approach this from the perspective of "what skills can you do," then you have a point that 68W may be closer to what some civilian paramedics are doing than what some civilian EMTs are.
That said, there's a lot more to paramedicine than the skills. There's a large knowledge gap in topics like cardiology, neuro/stroke care, the vast majority of pharmacology, and entire demographics that you weren't responsible for as a 68W. It's interesting that you were hired as a "paramedic" in an ED without a state cert (if that's what you're saying?), but arguably the paramedic's true role is outside the hospital practicing more or less autonomously, vs. an in hospital role which is perhaps closer in principle to nursing practice.
It's cool to see the various levels of advanced providers that the military is now implementing--some of this came about because the Army recognized that patients who were cared for by reservist flight medics who were also civilian paramedics had better outcomes. That is completely aside from the large body of paramedicine that's not relevant to the combat role.
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u/Unicorn187 EMS Feb 05 '25
This isn't always true. It depends on if or when that medic did a hospital rotation or three, and where. The ones that do, especially on larger bases that see a lot of dependents and retirees get a lot of experience in those areas as well.
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u/Dangerous_Play_1151 EMS Feb 07 '25
Hospital rotation is a great adjunct to a military medic's training, but it does not correlate to prehospital civilian experience.
I've worked with a lot of them and it's just not true that a 68W is the equivalent of a civilian paramedic. In the same way, a civilian medic wouldn't expect to walk into a tactical environment and function effectively without additional preparation.
It's a fantastic starting point for medic school but not a replacement for it.
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u/Unicorn187 EMS Feb 07 '25
I didn't say it was the same as a paramedic. I meant that it didngiventhem some of the experiences as an EMT ("basic").
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u/PaintsWithSmegma Feb 05 '25
I was a 68-w and am a flight paramedic FP-C, CC-P. The stuff the Army teaches you is EMT basic with a variance for IV meds. It's really its own thing with a little bit of everything thrown in. To say it's basically the same thing as a paramedic license is categorically untrue. As an Army medic, I didn't need to know anything about ACLS, cardiology, pediatrics, vent management, acid/base theory, geriatrics, or basically anything besides trauma first aid.
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u/Unicorn187 EMS Feb 05 '25 edited Feb 05 '25
Have you done any hospital duty at a larger base/post supporting a large retiree population, as well as dependents and their kids? Some of the medics I've known learned a lot about those topics while working at the ED of their post hospital. I'm not saying it's the same, especially responding in an ambulance, but some do learn a lot more than those who only spend their time with infantry or engineers or armor.
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u/PaintsWithSmegma Feb 05 '25
I did one 6 month deployment with a forward surgical team that ran a bit more medicine heavy. My other two were in Iraq in 06 as an infantry medic and Afghanistan in 09 as a flight medic. You definitely get more on the job training in the military, but the base education still isn't comparable to paramedic school. I'm not trying to sell medics short. Their job has a lot of unique skills that a street medic doesn't have. I've never had to call for fire or dig a latrine as a civilian medic, but I definitely learned to do those as an Army medic.
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u/Unicorn187 EMS Feb 05 '25
Even that probably doesn't give you the skills that a medic who is assigned to Madigan, Blanchfield, or Womack. They are seeing everything from kids, to 80 year olds, to 450 pound spouses. Seeing a lot more than what someone who does a single enlistment attached to a group of 18-40 year old fit people will see.
But again, I'm not saying it's the same as you see in an ambulance on a call. I doubt any interpret a 12 lead, or do defibrillation (manual) or pericardiocentesis (ok, this isn't a national skill, it's allowed by some in my state though), or any central venous line acces or insertion.
I mean even some basics... hell in some areas EMRs are going to do things very few 68Ws have rarely done. Not a lot have helped birth a child, or transported someone with a VAD, and because of the population they likely haven't had to do much with giving even glucose.
What kind of sucks for a lot of medics, even the ones who were SOF and paramedic, was that EMS pay in general sucks unless you're working for a fire department. I'm talkiing at the highest end a medic is making like $32 while an EMT is only making like $22 or maybe $24.
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u/PaintsWithSmegma Feb 05 '25
Paramedics in my area start around 32 an hour. I make $50. If you want to do EMS professionally, you need to be a paramedic. My other unpopular opinion is there should be no EMT's running 911 calls. They simply aren't equipt for it.
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Feb 05 '25
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u/PaintsWithSmegma Feb 05 '25
If I didn't pay attention in class, I probably wouldn't have made it past table 8s.
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u/howawsm Medic/Corpsman Feb 05 '25
Not one ounce of combat medic school was dedicated to cardiac interventions outside of CPR, management of respiratory conditions, intubation or meds that aren’t painkillers or antibiotics. All fundamental components of paramedicine. It’s NOT the same.
In some trauma related ways my scope far outstrips the paramedics I work with on the outside, but in the key ways for the patients we actually see 90% of the time requiring ALS intervention, combat medic school didn’t cover it at all other than to say “COPD is this and it exists”.
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u/Dependent_Skill_6509 Feb 05 '25
Bro the army education is nowhere near paramedic level. Skills wise it somewhat scratches the surface but you can train a monkey to intubate with enough repetition. What makes a paramedic a paramedic is their knowledge of pharmacology, pathophys, cardiology, airway management and disease processes all of which need to come together with good thinking to actually understand what you’re doing and why you’re doing.
Army medics at a base are atrocious on the why part outside of march
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Feb 05 '25
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u/Dependent_Skill_6509 Feb 05 '25
I disagree yes skill wise it’s similar but you have so many more abilities as a paramedic than a 68w. And again like I established skills don’t make a paramedic what really makes a paramedic is the knowledge
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u/sleepercell13 Old Army Fart That Teaches Feb 05 '25
One is very overrated and not worth the expense of keeping.
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u/False-Armadillo8048 Feb 05 '25
Its kind of weird... the para prefix in medical terms means alongside, beside or resembling... So the paramedic must be someone working alongside the medic - meaning assisting the medic? I currently work as a civillian "medic" on and offshore, background is nurse with icu speciality and crna on top.. Just language missmatch or?
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u/NeedHelpRunning Medic/Corpsman Feb 05 '25
The average combat medic in the army does not have their NREMT-P. Only their EMT-B. The two roles are meant to highlight the additional autonomy and knowledge that a paramedic qualified clinician brings to the field.
I’m a paramedic but I’m NG so I don’t use my full scope here. I believe combat paramedic has RSI, additional medication options (IV Fent, versed, etc) and weight based dosages compared to the army standard doses.