View a video interview with Nicholas Miller below this article.
You could say that Nicholas Miller, BS, CCEMT-P, I/C, is a bit of a medical historian, but with a twist. The paramedic and EMS instructor has been teaching for the past seven years and saw the need to develop a modern transition program, a bridge, if you will, for experienced combat medics. His goal was to create a program that would allow them to bring their skills back to the states after discharge to pursue a career in EMS. But such a program didn’t exist.
So following the historic roots of the military medic, Miller, an education coordinator at the National EMS Academy (www.nationalemsacademy.com), set out to create a bridge program that would provide the additional skills and education necessary for these medics to capitalize on their superior military medical training in a civilian world.
“The EMS profession learned about EMS from the military; however, over time, the civilian EMS model and the military models diverged,” says Miller. “The military model is more task focused, where the civilian paramedic model is broad and comprehensive. Military medics in each branch are NREMT Basic certified. After that, each branch of service provides their medics with limited advanced skills to address specific mission needs.”
Because the military has such high training standards, it only stands to reason that they should form the foundation for such a program.
“The military is really the master of trauma management, so medics get a lot of advanced training, depending on what type of medics they are and their branch of service,” says Miller. “And many of the advanced military medics, such as the Air Force independent duty medic technicians, are taught advanced physician assistant skills so they can run clinics independently in deployment areas. The problem is that because they are task focused, they don’t get extensive training in such areas as cardiology or pediatrics. This means that when they return to the civilian world, they don’t have all the training necessary to function as a paramedic.”
Addressing the Gaps
Once in the civilian world, these medics find they have gaps in their education and clinical training that prevent them from finding gainful employment in the EMS field as a paramedic. Miller wanted to change that and set about creating a streamlined bridge program that would effectively fill in those gaps.
“These guys would come home with all this advanced training and combat trauma experience, but since they didn’t have the rest of it, they were stuck,” he says. “And most of them weren’t about to go through another one- to two-year program to relearn a lot of what they already knew.”
So the National EMS Academy pursued the idea of creating a model that would meet the standards of the Louisiana Bureau of EMS, the NSC curriculum and the U.S. military. With Miller driving the initiative, the Military Medic to Paramedic Transition course was born.
“The first thing we had to look at was who could be bridged, and what was the lowest level of military medics that were bridgeable, because there are several different medic designations.” Miller says. “We decided that level was the Army’s 68W.”
The 68W, which is often pronounced ‘sixty-eight whiskey,’ is the military occupational specialty for combat medic. The 68W military training is rigorous, well-
documented and high quality. In a combat zone, they’re found at every stage of medical treatment.
It was determined that military medics with more training than this model would be eligible to be admitted into the bridge program; anyone with less training would not be eligible.
Constructing the Curriculum
Next came the decisions about classroom instruction. Given tight time frames and other logistics, the Academy had to determine what information could be left out.
“We got the curriculum for the 68W and looked at it hour by hour. We looked at what we could and couldn’t transfer in,” Miller says. “We determined there was approximately 400 hours of advanced level care, separate from the EMT level portion of the class that we could bridge in.”
Miller and his team concluded that in order to include everything that was needed, in terms of didactic and clinical skills, it would take students at least 14 weeks to qualify as Nationally Registered paramedics. “It was the shortest time we could do it in,” says Miller. “We divided it into eight weeks of didactic and five weeks of clinical study, six days a week, with one week of test prep.”
The clinical curriculum also had to be determined. “Even though the medics have a lot of field experience, they may not have done any clinicals,” Miller says. For example, a combat medic in an infantry unit may have seen a lot of trauma or worked in a mobile army surgical hospital (MASH), but they may have never worked in a civilian emergency department or for an ambulance service.
“We had to determine how much credit we could give them for their clinical experience,” Miller notes. “They already knew how to do patient care, but they didn’t get any pediatrics, so they have to do the entire pediatric round. They didn’t get labor and delivery, so we’re going to have to do the full L&D rotation.”
Deciding what to leave in and what to cut out, while still maintaining the minimum focus on core areas, required almost laser-like precision. “We had to get them oriented to the ER and ambulance service, so we had some discussions with the Army about that,” says Miller. “We decided to give 112 hours of credit, in lieu of two years of documented full-time experience as a military medic. The rest, 354 hours, they would still have to complete.”
Then the timeline for the entire course was scrutinized. Most paramedic courses are a minimum of 1,000 hours. “We had to demonstrate that the hours of training we were providing were going to be the equivalent of a full paramedic course,” says Miller. “So we went over the curriculum line by line, hour by hour, to create the lesson plans.”
Student ability was also a factor. No matter how streamlined the curriculum, students still have differing learning styles and abilities. The program is designed to help strong and weak students succeed, and every effort is made to achieve that goal.
“We are bridging paramedics in three-and-a-half months,” says Miller. “We knew some students would have trouble, and we had to be ready for that. Some of these students may not have been in school for several years, and this is very much a high-speed, low-drag class, so we had to build in a lot of student-
individualized attention, or SIA,” says Miller. SIA is built-in remediation for students who have trouble passing the block tests to make sure they’re up to par. Each student has to have a score of 75% or better in each core section to pass.
Piloting the Program to Success
The pilot program started last fall with 10 U.S. Air Force Independent Duty Medic Technician (IDMT) students. “We had to demonstrate that this program equals a complete paramedic class and that they can pass and be ready to roll … and they did,” he says. “They were outstanding in their clinicals; they really showed their stuff.”
All 10 students graduated from the pilot program, held at the National EMS Academy campus in Lafayette, La., and are now back at their respective bases. Miller has now set his sights on launching the next class.
“I’m trying to get this [program] to the point where medics who are no longer in the military will have a chance to come and take this course,” Miller says. “I get two phone calls a week from people in the military, and I’ve been in contact with a community college in Michigan that’s working on a similar program.”
Designing and implementing this first-of-its-kind program in the U.S., and the first to receive approval from the Army’s Department of EMS is, indeed, gratifying for Miller. But his drive to take the idea from concept to execution is more born out of a compassion and desire to support the men and women who are putting their lives on the line every day.
“I’ve always been supportive of defending those who defend us, helping those who protect us,” he says. “I am amazed at the level of commitment and sacrifice these people have for our nation, and I want to help them have a career when they get out so they can feed their families and move into a medical career. For me, it’s definitely something worth doing.”