A study of healthcare career progression: Policy paper on producing battlefield medical specialists in conflict and peacetime

Cord W Cunningham, The University of Texas School of Public Health


Background: Tactical Combat Casualty Care and theater trauma registry data has highlighted the importance of prehospital battlefield care on overall survival and the area requiring most attention to improve overall battlefield mortality. Despite emphasis on damage control resuscitation and complex procedures such as fresh whole blood transfusions, freeze dried plasma administration, and anti-thrombolytic therapy there has not been a corresponding advancement in the medical technical expertise in the majority of Army Combat Medics (68W’s) as they progress in rank and level of responsibility. This paper is a review of current models of medic and field healthcare provider career advancement as well as a recommendation for producing Army battlefield medical specialists. Methods: Using multiple combinations of the search terms advanced, military, prehospital, medic, career, training, progression, and advancement within the Cochrane Database of Systematic Reviews 2005 – 2014 did not reveal any reviews. A medline search with the terms combat medic, advanced, casualty care and training resulted in 88 peer reviewed articles. Additional articles were generated through google scholar and the military and government collection database through EBSCOhost/Athens using similar search terms. Current US Army doctrine and organizational limitations were researched through other military references. There is no uniform consensus to the best approach to military medical personnel sustainment, progression, and advancement but this review was used as the basis for recommendation of a different model. Results: All US Special Operations Medics have attained qualifications in advanced battlefield medical care, but due to resource constraints these courses cannot be applied to the force at large. Current Army 68W training attains EMT as well a large part of AEMT training except for clinical patient encounters. Although currently unregulated, the Australian and U.K. model of shorter intensive didactic courses with clinical practicum provides the best model of advanced paramedic provider training for practice in remote and austere locations. Conclusions: Using a combination of centralized AEMT training with junior NCO development courses with distance learning can minimize time aware from station and unit. Further advanced training can be accomplished locally with central support. A comprehensive organizational approach, structure, leadership, and funding are other critical components.

Subject Area

Public Health Education|Medicine|Public health|Health education|Military studies

Recommended Citation

Cunningham, Cord W, "A study of healthcare career progression: Policy paper on producing battlefield medical specialists in conflict and peacetime" (2015). Texas Medical Center Dissertations (via ProQuest). AAI1597641.