Army Flight Paramedic Perceptions and Beliefs in the Current Medical Sustainment Model

Army Critical Care Flight Paramedics-commonly referred to by their additional skill identifier, F2s-are the key capability connecting different roles of care and essential links in the chain of casualty survival across the evacuation spectrum. In 2012, the Army was instructed by Congress to enhance prehospital delivery of care by advancing the capabilities of Emergency Medical Technician Basic Flight Medics (F3) to the higher level of care defined by Nationally Registered Emergency Medical Technician Paramedics (F2) at a cost of $70 million. Sustaining that higher level of capability, however, has been challenged because of a lack of centralized support that meets the needs of F2s locally. This independent, descriptive, cross-sectional study collected F2 perceptions on their sustainment program as part of a needs assessment and program evaluation. More specifically, this study explored: the perceived confidence F2's had to perform their combat mission on a no-notice deployment; their confidence in the current sustainment program; the perceived barriers to sustainment training; a cross-sectional analysis to Special Forces Medics; and their desired characteristics of an ideal skill sustainment program.

After institutional review, an online-based survey was developed and validated through survey best practices.

The response rate of this survey was 22%. Of the 105 respondents, 54.3% had deployed at least once as a F2. F2's report spending 3.4 hours/week to sustain their medical skills. F2's scored lower confidence to perform their duties on a no-notice deployment compared to providers evaluated in 2014 with a similar scope of practice and evaluated in the same manner, with the comparative 70% to 89% respectively (P < .001). F2's report that the current medical proficiency training program requires "quite" a lot to "extreme" change (mean: 4.4; 95% CI 4.2-4.5) and Medical Simulation Training Centers (MSTCs), F2 Refresher, and Nontrauma modules require "moderate" to "quite a lot" of change. Less than 5% reported, no change at all was needed. Respondents identified unit taskings (CQ, Staff Duty, Gate guard), operational tempo, and administrative requirements as significantly interfering with medical sustainment training.

Military flight paramedics in the military have special sustainment requirements. This survey provides objective, repeatable metrics available to unit commanders and decision makers. Measurable failures have been identified and can be corrected by understanding the complex requirements of an F2's scope of practice and the removal of barriers to medical sustainment.The changes in code of federal regulations (CFR) seen in Afghanistan was a direct result of the skills and professionalism of competent flight paramedics, not just the helicopter platform. World-class medical care is sustained the same way our pilots and providers sustain skills, with hands-on practice with the goal of mastery. Failing to prepare our flight paramedics is not just an operational recommendation but a strategic imperative.