r/TacticalMedicine • u/sloth_uprising • May 09 '25
TCCC (Military) Army Medic Scope of Practice
Are there any major differences in the scope of practice of a 68W Combat Medic Specialist vs. 18D Medical Sergeant? Differences in the procedures and care they can provide, not the other parts of the job as one is a regular army medic and the other is a SF medic.
EDIT: I’m a firefighter and medic. I was on the SWAT team at my old department as a SWAT medic. I’ve been seriously considering joining the military for a few years as some form of medic because I’m interested tactical medicine, I love being outdoors, hunting, fishing, and camping. I’m 28 and realize I’m at the point in life that it’s now or never if I enlist.
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u/zangief137 May 09 '25
If you dig around you’ll find documents that SOCM uses to call their certification ATP(advanced tactical practitioner). It’s about as high as the army can push a scope of practice to a PA level without being one. 18D has the broadest scope, some have done battle field surgeries to get guys up and gunning again. They feed into the unit better than W1s with batt experience but both open the door.
Regular army medic is vehicle maintenance and medical profiles as well as telling dudes to drink water and change their socks to avoid trivial issues.
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u/Kershaws_Tasty_Ruben May 09 '25
What isn’t being considered here is that 18D medics have a larger mission. The SF mission in general is one of training indigenous people to become better fighters. That starts with good health. SF medics have a broad mandate from infectious disease control to dentistry and even more interestingly some surgical procedures. You could very well have an ODA team go into an area where in one village the team is testing water wells for pathogens only to move to the next village to assist in childbirth. Then, on to the next location where they set up a vaccination program.
I worked with then 91 alphas or bravos that were fantastic with intubation and trauma jobs. But ask them to pull a tooth or complete a plan to immunize a village against smallpox or malaria and their eyes would cross.
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u/EasyAcresPaul May 09 '25
Former 68W here. It'll be up to your PA/NP, whatever and whomever's your working under and what they trust you to do.
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u/Sky_Torch313 May 10 '25
I've been an 18D for almost 10 was an 11B in the 82nd before that. Making comparisons between that of a 68W, 18Ds, W1s....pointless. Figure out what it is you want to do, and just go do that thing man. They're all different missions. The 101st, 82nd, insert your favorite army unit here, doesn't get the "most" trained medics because they aren't out there doing austere things with next to no support. That doesn't mean that don't have access to skilled medics though. Taking personal antidote out of the conversation, the Army will invest in their medics as much as the medics want invested. Most units will send their guys to the NRP program if the medic or unit supports it. Bragg has their own that they run. The weird "68ws are to Paramdics as 18Ds are to PA" is entirely colloquial and untrue.
As some of the comments have alluded, everyone has their experience one way or another. "Man every 68W i know and worked with were garbage", " I've personally seen 18Ds shooting up their own shit", "My buddy saw an Assault Medic to open heart surgery on an operator, saved his life man". Who cares.....though the last one might have some semblance of truth. Point is, you're going to run into the extremes, left and right, with any route you choose. The first conversation i have with every junior I've had has been this: We're not "basically" PAs or anything else. We're definitely not doctors/surgeons. Identify the injury/illness, treat how we've been trained, and get them to higher care. We avoid teamroom medicine at all costs. I would call myself your "average" 18D. What does that mean? Nothing. My averageness has saved several lives on and off deployments. I've also forgotten the correct sequence of treating crush during refresher. So have Ranger medics. You get out of it what you want to put into it. Ive worked with several 18Ds and Assault medics that have forgotten more about medicine that I'll ever know, but that doesn't mean I won't chub out an inexperienced doc who hasn't put in a chest tube since residency. I'm also aware that if, for some weird reason, I'm looking at a cardiac rhythm with a working Paramedic that I don't listen to what that person has to say. None of us, save your Assault medics and maybe line Ranger medics, do medicine often enough to be considered gods gift to anything.
To the OPs original point, don't just look at the medicine. Look at the job. I didn't choose the Delta path bc I wanted to be a surgeon. I wanted to be able to get my friends from the POI to the operating table alive.....and do hood rat SOF things. Im transitioning away from the Delta rile as my primary job, but I'll always keep current on my creditable and attend refresher until I retire. It's a cool gig. Rangers seem to enjoy their lives as well, they just suffer from not having the same longevity at Ranger Regiment as we do in Group. Don't join to be an Army Medic. You'll be disappointed with your described experience. Take a careful look at both the Active and NG. We have NG groups that won't require you to forfeit your firefighter career.
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u/battle_bandaid May 09 '25
In real world casualty situations, scope of practice in the Army is kinda fake. Do whatever is necessary to save a dude without causing further harm and be reasonable about your own capability and procedural knowledge. I'm a paramedic and have worked with a bunch of W1 guys. The 18Ds/38w/160th flight medics have a ton of knowledge and get trained on more advanced procedures, but the use case for a lot of those is so slim that for the large majority of patients, a really squared away medic is going to be pretty similar. W1s have also gotten in sticky situations before by doing things like amputations on local civilians, and normal 68Ws have saved lives by doing pretty advanced procedures. So it's very situational and to a certain extent comes down to the individual. Hell, I worked a clinic once with a 68w that before joining the Army had been a full blown doctor in a foreign country, but his schooling and certs were not honored when he immigrated here. SOCM is a huge asset and a great leap in tactical medical capability, but at the end of the day it doesn't really affect scope much as long as you're treating green suiters.
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u/SuperglotticMan Medic/Corpsman May 09 '25
To put it into perspective a 68Ws scope of practice and knowledge is closer to a paramedic while an 18D is closer to a PA.
68Ws from my experience, and I was one, lack a lot of education and experience with medical emergencies but do have a heavy emphasis on trauma. I believe an 18D wouldn’t have that problem due to SOCM but I also have never worked with any 18Ds.
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u/lookredpullred Medic/Corpsman May 09 '25
I don’t know if I would compare a 68w to a paramedic. If we’re talking strictly trauma, then maybe. However broad medical knowledge and scope of practice definitely goes to paramedics.
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u/SuperglotticMan Medic/Corpsman May 09 '25
Yeah it’s a weird middle ground because they do all the stuff for trauma but then ask them to identify a rhythm and treat it and most 68Ws won’t be able to. Which in the defense of the military, ACLS isn’t relevant to the battlefield.
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u/Zix375 Medic/Corpsman May 09 '25
68Ws are closer to a paramedic. The largest disparity is cardiology and pharmacology. This gap can be bridged given the right duty stations or clinical settings. I had the opportunity to work with the large hospital on base and get my ACLS cert, and broaden my knowledge on pharmacology. Unfortunately, it is not a requirement to be maintained for recert, and the army will not prioritize it.
There are several duty stations with whiskeys i would not let out of the motor pool.
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u/DocGerald EMS May 09 '25
I’d say 68Ws are AEMT level. When I went to medic school after leaving active duty I realized how limited my knowledge was.
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u/What-the-fudge-T65 May 09 '25
I used to say the same thing having spent time in both hospital and infantry units. Then I went to paramedic school. 68Ws are not on the same level as paramedics.
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u/Zix375 Medic/Corpsman May 09 '25
You won't find paramedics in infantry units. You find clinical and nursing experience in hospitals and paramedic experience with 18Ds and dust off units.
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u/What-the-fudge-T65 May 09 '25 edited May 10 '25
The new ASI 3P, as well as the Army's lessons learned from Ukraine is placing a large focus on ground medicine. They want 68W3Ps in R1 and R2s. I also have a few 68W3Ps attached to various units from infantry to Artillery.
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u/czcc_ May 10 '25
What do the 3P and ASI 3P mean? I'm quite well versed in the US military system, but apparently still not enough.
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u/What-the-fudge-T65 May 10 '25
Additional Skill Identifier (asi) and 3P means they are paramedic certified.
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u/Zix375 Medic/Corpsman May 09 '25
Unfortunately, that is a 10-20 year project with how the army implements curriculum. I still can't send my regular whiskeys to the paramedic course because there "isn't a justification"
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May 11 '25
Where are you at that you're hearing this? My old unit was routinely sending "regular whiskeys" to Paramedic school every year (Fort Bliss) as professional development. I know Fort Bragg is doing it as well, and there are multiple centralized courses for it in the Army.
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u/0-ATCG-1 May 09 '25
You can't just say the disparity is "just Pharmacology." Paramedics have to learn the A&P behind each medication so they can medically justify giving it or not giving it and by extension considerably more A&P as well.
Also, ACLS does not mean you know Cardiology. That's ridiculous. It's a train track algorithm. A list you check off and follow. And not even a progressive one.
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u/Zix375 Medic/Corpsman May 09 '25
I can, and did, because pharmacology encompasses that knowledge. I said I got my ACLS cert, not took cardiology. Settle down, bucko. No one's trying to take you off your high horse.
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u/PerrinAyybara May 10 '25
At best it's an AEMT, definitely not a paramedic. The scope is massively different and the knowledge base is as well.
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u/0-ATCG-1 May 09 '25
You're trying to be reductionist every chance you take because you yourself are on one. You just don't like others pointing it out so you accuse them of being on a high horse to defend your own
Pharmacology barely covers the systemic relationship behind what you're giving. That understanding comes from a base of A&P knowledge outside of it.
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u/Zix375 Medic/Corpsman May 09 '25
Just because you took a half ass pharmacology course doesn't mean everyone else took the same. Reduce your ego. You'll get farther in the long run.
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u/0-ATCG-1 May 09 '25
As opposed to the pharmacology taught in Whiskey school? Got lots of instructor experience in Paramedic school to compare them?
You're a classic example of someone who just doesn't know how much they don't know. But you're confident about it. And when it's pointed out, you blame ego.
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u/Zix375 Medic/Corpsman May 09 '25
Who's referencing whiskey school as the paramedic standard? If you care to read, I make my point of obtaining further experience outside of the baseline education. I reference dustoff and hospitals, not standard AIT.
Again, take a breath, read, and reduce your ego.
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u/0-ATCG-1 May 09 '25 edited May 09 '25
Then where do you draw the line if by scale a Paramedic also will obtain further experience? You're trying to blur lines that exist in specialties for a reason. A CNA can go obtain a WFR and TECC, does that make them similar to a 68W? It's ridiculous to argue scalability by continuing education as an excuse to say their scopes are similar. A Paramedic that audits the ATLS for continuing education and can do finger thoracostomies does not mean all Paramedics have a remotely similar scope or knowledge to a Doctor.
Once again, you're trying to blur the lines by being reductionist.
Also, as I understand it, dustoff trains you to obtain a Paramedic cert anyway. So that is not a relevant reference. Those are certed Paramedics as well as 68Ws.
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u/EnvironmentalPop9391 Medic/Corpsman May 09 '25
Even your really good standard 68Ws aren’t really that close to a good paramedic. There’s just an unfortunately large gap that is bridged by A&P, pharmacology, pathophysiology, pharmacokinetics, and rote repetition of advanced/critical care practices, and that gap is hard to express to people who haven’t been exposed to it.
Source: A 68W who went to paramedic school
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u/SuperglotticMan Medic/Corpsman May 09 '25
I agree. It’s just hard to call them AEMTs because a good 68W can handle a polytrauma patient the same way (or even better) than most civilian medics. I said in another comment how they’d all fail ACLS, not to mention most other medical complications that you just wouldn’t see in groups of 20 something year old men but you’d see everyday working civilian EMS.
I used to tell my healthcare friends that army medics are like “trauma EMTs”
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u/0-ATCG-1 May 09 '25
Trauma EMTs is absolutely the moniker I would go with. And I agree with your assessment on polytrauma as well.
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u/0-ATCG-1 May 09 '25 edited May 09 '25
68Ws are not similar in scope to Paramedics. Most 68Ws I met cannot in sequence set up pressors on a pump, RSI, then program the vent settings while taking into consideration underlying causes and pH, and attach the patient to the vent. Then troubleshoot the vent based on the alarms. Then explain in depth to the physiological and pharmacological reasons why they did or did not choose certain medications, fluids, or routes of interventions. These things are not uncommon for Paramedics in services for my area. In fact, POCUS is even getting common here.
Being able to do skills like cric, intubate, and start IVs with fluids or getting your ACLS (a very non progressive algorithm and barely even scratches Cardiology) does not make you similar in scope to a Paramedic.
That would be as ridiculous as a Paramedic saying they are similar in scope to a PA just because they can do a couple procedures.
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May 09 '25
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u/0-ATCG-1 May 09 '25
I wish but that's been a popular talking point for a long time now with no success. Last I heard, they were trialing getting 68Ws certified as AEMTs to try and bridge that issue.
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u/DisastrousRun8435 EMS May 11 '25
I worked with a former 68W when I was a basic. From what he told me, the training is pretty similar to that of an AEMT, but they get less exposure to common civilian emergencies (CVA, MI, etc) since they typically work with other members of service who are generally healthier then the 80 year olds with a laundry list of meds and complex medical conditions that civilian EMS provides are used to.
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May 09 '25
Bottom line is it’s what you make of it and the standard you set for yourself. Unpopular opinion: a good whiskey is better than your average 18D. Average ranger medic is better than your best of either. The deltas I’ve worked with think they’re God’s gift to medicine but never train it, don’t stay up to date and send stuff they shouldn’t. Saw a delta get a clean kill intubating someone in Syria as well as a few other mistake so maybe I got the wrong impression but I hear the same from other reliable people that are much smarter than me. The whole “basically a PA” goes out the window cause they end up focusing on breaching, sniper school, etc, which is dope, but if you care about medicine, not the way. Ranger medics are dedicated medics, do trauma lanes constantly to time standards, and are tip of the spear. A lot of TC3 is based on their trial and error.
Don’t join though man. Promise it’s a lie and none of us actually do real medicine just admin, layouts, and getting shat on by brigade and division leadership. 10th mnt still goes to the Middle East but it’s a clown show. From what I’ve heard, the only people doing real deployments are JSOC. If you wanna learn army skills, most of it is available on YouTube and can be self taught. Most dudes ik wanna get out and be fire medics, trauma nurses, PAs, Er docs… maybe try that route or get a job in a bigger city. If you want, can DM and share more experiences or tactical medicine.
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u/AdministrativeBat310 May 09 '25
Don’t know what team that was, but your one experience with some dipshit 18D and your friends of friends who say “most of their experiences are the same” are goobers. I do not believe I am gods gift to medicine. I understand well what I am capable and not capable of doing. I’ve been to SF sniper, and still maintain that, my other core skills and still study medicine daily because I give a shit. All the Deltas in my battalion hold each other accountable at every level of medical capability.
Your best 68W is not even remotely close to your “average” 18D. Which is sad considering I agree with your sentiment that we have an incredibly vast amount of proficiencies to maintain OUTSIDE of a large scope of medical practice, while 68Ws just do… freakin medicine. Every single 68W I’ve ever had to work with and train hasn’t known his ass from his foot, especially SFAB. I keep out of this stupid debate that comes up on here every 2 weeks but your comment did absolutely stir me up.
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May 10 '25
Just for more context, had a close friend on another outstation get basically adopted by a delta and let’s just say he was taught how to have fun with certain medications and that delta was basically a crackhead.
Also had the situation I mentioned, plus these dudes didn’t carry TXA or Calcium gluc cause it “took up to much space and wasn’t time sensitive”. They never knew medication dosages and would cop out with “all I do is trauma” including keppra. Worked on a bed with a delta on a blast injury and I had to remind him to place a pelvic binder before rolling which he said the guy didn’t need, also had to remind him to check the back after I rolled the guy, also saw him cover both of a dudes eyes when one was injured... Not trying to be petty but I could keep going with other little things. Could be I’m missing something, but I wasn’t impressed and neither was the doc I worked with and he was super solid. This is also coming from someone who thought that deltas were all gods gift till I actually met some.
I agree most whiskeys don’t know their ass from their elbow, but the ones I’ve worked with who have high aspirations or experienced backgrounds impressed me more than those dudes did by far. Good to know it’s not universal though. Not tryna argue whiskeys are better than deltas just sharing my experience.
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u/Kinetic_Raptor Medic/Corpsman May 09 '25
The closest example to this and easier to research is the difference between a Corpsman and and Independent Duty Corpsman (IDC).
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u/LeonardoDecaca Army Critical Care Paramedic May 09 '25
I think simply talking about civilian scopes of practice, I would say a 68W is a little bit closer to an EMT – a, as some of the skills and scope of practice are a little more mirrored close to that. I wouldn’t say it’s a one to one translation, but the comparisons could be made.
SOCM and W1, to include the level of 18 D, there is a much broader and liberal scope of practice that allows for a lot of your standard trauma, and normal paramedic level skills, but also a lot of the limited primary care and advanced skills more closely associated with a PA.
You also have to think about the environments, and mission set that the two deviate from. Standard 68W is going to be more broadly supported by other elements, whereas other practitioners to include 18 D work in austere environments needing more capability pushed out.
And that is without including any of the additional skill identifier that 68W can possess, because we do have the 3P identifier which denotes a combat paramedic, and then there’s also the F2 that would be a critical care flight paramedic.
It obviously all depends on the type of training, unit, and mission set that you get aligned with that dictates it. But more or less I agree with the comments that we’ve seen above that the skill levels between a 68W and an 18D there’s really no comparison other than the fact that they both wear US Army tapes and generally have experience in trauma medicine.
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u/thrillhousevanhouten May 10 '25
Dude go 18x. That’s the one you will truly regret not doing
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u/sloth_uprising May 10 '25 edited May 10 '25
I don’t know, I love being a fireman at my department and I get married in less than a week and want to be around to raise my kids. So regular NG may be the thing for me. EDIT: I’m going to talk to a recruiter when I get back from my honeymoon. I had a really rough spot with a bunch of awful calls when I got my medic, used EAP and talked to a therapist. I might have said I had some suicidal ideations. I’m all good now but I read that can disqualify you from service if they pull that record.
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u/thrillhousevanhouten May 10 '25
Depending on your state you can get a REP63 contract which is the NG equivalent of 18x. You can usually get a contract where your fallback MOSis 68W in case you don’t pass SFAS. That way you can at least be in the pipeline to try before you get too old and still be set up for what you’d like. Usually only hospitalization for suicidal stuff is a factor. It’s important to just be open and honest when asked. You should talk to a SF recruiter to get the answers you need- there is a website for every state and team with contact info. The guard teams also host SF Readiness Evaluation events for civilians and if they think you’re a good fit they can get you into the right contract at the event.
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u/Trixxare4kids17 May 10 '25
18D is as medically trained as one could get in the army without being a PA or Doctor. Gets you to less than a year of civilian PA med to become a PA. However you'd have to get selected first and get a slot to be a D which is a path and a half in its own right.
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u/Low-Landscape-4609 May 16 '25
Here's as simple as I can put it. An army combat medic is a basic EMT with a little bit of extra training in trauma. They can do iv, needle decompression, Crics etc.
They don't have the knowledge of a civilian paramedic but they don't really need to have that knowledge. They are there to treat combat injuries on the battlefield.
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u/SEF917 May 22 '25
Open your aperture and consider other services. I have been a Navy Corpsman for nearly 15 years and our options to serve in air, on land and sea are amazing. Seriously boundless options in the SOF space, Marines, or Navy. Aviation or ground. Look into SARC or SMT Corpsman. The 68W equivalent in the Navy is Fleet Marine Service Support (L04A), also known as Fleet Marine Force.
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u/dudesam1500 Medic/Corpsman May 09 '25
Individual scope of practice for a 68W will usually depend on BN surgeon/PA, but yes, 18D/38W/W1 generally are acknowledged to have a wider education and scope.