Medical Services restructuring...

[Brad Sallows]

The establishment I was using for planning and other purposes for several months is still (last I heard) a "draft"; it lists 135 (might be off by one or two) unrestricted positions (ie. available assuming full funding).  Funding constraints will of course cause that number to be reduced.  I would expect each unit to have a different target strength set which weighs factors including: current strength, available funding, historic attrition, availability of indiv training courses.

It is sometimes worth doing the arithmetic to find out if your higher- or self-assigned goals are achievable.  There is no point shooting for an all-rank strength of 100 if your annual attrition is 15% and you are limited to 10 course vacancies annually for, say, QL3 and BCT.  (Caveats: you can work on reducing attrition, or hope that people will stick around long enough until you get some extra vacancies one year.)  Over-recruiting just aggravates attrition in two ways.  New people leave in disappointment if they don't get courses within a reasonable time window.  Other people leave because the resources which might be used to further their training (and interest) are wasted to recruit and train other people up to the bottleneck course level.

(Number of critical course vacancies) divided by (attrition rate) = sustainable steady-state strength.

By critical courses, I mean the ones required to get a soldier / officer trained to an employable level: BMQ(R), SQ(R), MOC (QL3); BOTP(R), CAP(R), BCT.

For example (just pulling some figures which may be close to reality), if there are 7 serials of QL3 offered annually with a maximum course load of 24 each, the total number of reserve medics nationally should be about 930, or about 65 per reserve field amb.

 

[Fraser.g]

Brad,

The choke point that we are experiancing is not with the number of QL3 Courses put on the brick each year by CFMG it is the number of BMQ/SQ slotts that the Army and CFMG have agreed on. I have many more interested bodies than I have positions to get them trained.

Last year we had people that wanted to join as medics but were discouraged at the recruiting center or CFRC becasue of lack of vacancies.

I had put forward the question as to why we could not fund and run our own BMQ/SQ in the summmer and was told that it was an ARMY course therefore only they could run one.

Is your unit exp the same limitaitions.

 

[Brad Sallows]

The specific bottleneck may vary with time.   Over the past few years in LFWA I found the bottleneck to be QL3; we had no difficulty attracting sufficient recruits willing to endure the entire recruiting process, and between summer ARTS in WATC and local CITY courses within 39 CBG there were sufficient QL2 courses.   I should note there is nothing inherently bad about the presence of a bottleneck in one of the gateway courses; absent unlimited funding, such a restraint will always exist.   It is important to recognize the restraints and plan accordingly.

What must first be established is: how much freedom of manoeuvre does the CO have?   It can vary subtly (or quite overtly) from year to year.   If a unit is assigned all its gateway course vacancy numbers and a list of constraints which tells it how to spend every Class A funded day, there is very little latitude to tailor a unit's training to suit the situation.   Otherwise, it is clearly possible to address different shortfalls from year-to-year - recruits, junior leaders, drivers, collective BTS, etc.   I never saw a training directive (from higher) that was completely achievable given the current state of the unit and the assigned resources, but we always seemed to have difficulty articulating "We can't do all of this" to higher.

If MOC/QL3 is not the bottleneck, that's actually a good thing: virtually anything else you can influence, whereas I have always found QL3 vacancies to be nearly impossible to influence.   (This applies to any highly centralized training, but there is less pressure to take the more advanced courses quickly.)   If you need BMQ or driver wheeled courses, commit instructors and funds to participate in CITY courses run by your supported brigade.

The directive to recruit more civilian professionals is both a bane and a boon.   In the short term the time and expense (lost income) of getting over the "learn to be green" hurdle is considerable for them, so attraction is difficult.   Advantages are that we compete less for recruits with other units, we are less tied to the army's recruiting and training cycle, and the mobility of the target audience should be less than for students.

[Add: it helps to be working from some sort of long-term planning concept - call it a 3 or 5 year plan, if you wish.  Set the end-state (eg. a trained platoon and company-level HQ).  Determine, based on attrition, what you believe your course requirements per year and collective BTS workup/evaluations are to maintain that steady state.  Work to bend and tweak the system to address your requirements, not necessarily all at once...]

 

[MedCorps]

Are all of the Res Fd Amb NCO posn's MOC 737?  Do they many allowances for Svc Sp Pl? / Dental Pl  / HQ (Sig Ops , MSE Ops, Cooks, V Techs, Supply Techs and the like)?

Good to see some Medical talk here..

Cheers,

MC

 

[Brad Sallows]

There are non-7xx positions in the (draft?) establishment HQ and service support elements.  I can't recall offhand how many are unrestricted, but the number is only a few.

(When the 737 change was originally announced, we thought it was to include the R711s.  Then there was official hesitation, and AFAIK reservists are still R711.)

 

[Fraser.g]

It seems that CFMG is hesitant even to hold and maintain their own vehicles let alone higher cooks, MSE ops, sigs and the like.
This meens that we are still beholden to the old bregade system for most of our support. So much for seting up an indipendeant command structure.

 

[Brad Sallows]

Most reserve units with which I had some acquaintance were never capable of much integral support.  (There were exceptions, if a unit managed to acquire and hang onto a switched-on cook or veh tech.)  I wouldn't worry about the non-med positions (particularly if all it does is pull people away from the local service battalion) until I had a very healthy number of medics on strength.

 

[Fraser.g]

Granted,
There is little need for full integral support in most reserve field ambs. With that said I believe we have to control our own equipment and have the resources to maintain that equipment at the first line level.
As of now all our MSE are controlled by and dispatched from the local service Bn. This means that we have to ask them to dispatch our own ambs or ask them for the lift to deploy to the field. If that equipment is tasked for Svc bn use or at the Brigade level then we have to adapt and make due not the brigades that we support.

If we are going to be independent in our own Group then we should be able to deploy independent of the units we are supporting.

Yet another two cents.

 

[Brad Sallows]

If you look into it, I believe you will find the vehicle situation is due to the way 38 CBG chooses to manage vehicles.  By comparison, in 39 CBG the vehicles are not centralized in the service battalions.  However, no-one ever seems to have as many trucks (serviceable) as they desire, so there is still a need to plan ahead and borrow/share.  I don't know when or if equipment will be transferred from army ownership to CF H Svcs Gp ownership.  If it is, you are still going to have to establish between yourselves and the service battalion (or the ASU) a process for maintenance.

It is good to have sufficient ownership to manage "your" vehicle allocation, but you might find you don't really want responsibility for first-line maintenance.  Operator maintenance alone (if done properly) can be challenging if you are deficient in people, tools, or facilities.

 

[vr]

Heres my question to throw into this topic:

Are Reserve Field Ambulances being transformed into PRL holding units??

The new benchmark for any meaningful medical work is as I read it the QL-5 or civilian equivalency.  Here in BC that is the new PCP course or registration as a paramedic.  I believe there is an equivalency for nurses, but am unsure.  This is the requirement set for many medical supports to training.  The requirement for  supporting anyother training is an SFA ticket and a safety vehicle.  The QL-3/QL-4 Reserve Med A is somewhere in between.  During the recent Bde ex medical personnel had to be imported from back east (41 Bde) to fulfill requirements for support.

QL-3/4 (MCSP/BTLS) Med A's going to Op Peregrine last summer were not permitted any patient contact unless they had the equivalent civilian qualification.  If they had 404's they got to drive the ambulance; no 404's they got a shovel.  It has been my personal experience in training with Reg Field Ambs that those with civilian quals are weeded out for patient care and those who did all the training that the Army told them they had to do were shunted off to the side.  This is especially true for any member wishing to go on deployment in trade.

Much has been made of the delivery of the new Sim-Man trg aid to the Reserve Fld Ambs.  While these are awesome pieces of kit, one of their primary functions is to allow civilian-trained mbrs to practice as part of the PRL.  The operator's course for these is, according to the msg, only open to those with the requisite civilian quals.  This further marginalizes a number of senior, keen, and available members.

All would be well if there were plans afoot to bring all Reserve members up to this standard.  Prove me wrong, but at present there are none.  The only recognized standard that the Reserve Med-A will continue to have is the AMFR-2/BTLS which is the standard taught to civilian police/fire personnel.  If the powers that be were to commit to the long-term program of bringing Reserve Med-A's up to civilian EMA standards they would be rewarded by a longer-term committment from the members.  The 15% annual attrition quoted earlier is an extremely conservative estimate.

Lastly the recent long-term recruiting plan put out to the units has made it quite clear that the sole priority will be recruiting civilian qualified health care workers into the Reserves.  Non-qualified applicants will still be accepted but will not be actively sought out.

This is my theory.  Any comments.

As a secondary point, how successful do you think we will be in recruiting & retaining civilian trained personnel.

"There is no art to killing with the point."

 

[starlight_745]

As a member with civilian qualifications, my opinion is that CFMG will never get anywhere near the number of civilian qualified personnel they are looking for.  Unless they get their act together and start getting better equipment and resources to get the job done, people will not stay around.  As cool as the sim mans are, 30000 bucks would have bought a lot of new tail gate equipment, monitors, pulse oximeters etc.  Stuff for real patient care that is sadly lacking in the majority of units. 

 

[Fraser.g]

Recruiting civi qualified pers is not a problem with targeted efforts but as Starlight says keeping them is going to be a pain. Once they see the state of equipment their parade rate will dwindle until they release.

We need to be trained to the PCP level at a minimum. If CFMG approached the civi training facilities and block booked two seats per course this would be manageable. The problem lies with the fact that we have no way of holding them once they are trained. There are no contracts in the reserve and so I forsee many pers taking the training and then saying thanks and leaving.

The other possibility is that we use the post secondary education fund to assist members in taking their PCP on their own. Perhaps we could set up class A days for study or in some way assist them beyond the 50% cost of the PSE funding. By the way, that fund is a tentative go but the monies will not be released or confermed until after the election.

Another thing that would be beneficial to the reserve medics is to get them into practicums in civilian hospitals and local EMS. I would be more than happy to mentor medics in the ER where I work on civi street but we need to work out liability insurance, scope of practice, supervision, not to mention authorization from CFMG.
It is great to teach a member the skills to treat a patient but if those skills are not used continuously they will be lost. This goes for the Regular force and Reserve members of CFMG alike.

 

[Armymedic]

Retention is our (reg force)  problem too........

Even with the PCP qualified QL 3's, people still are having to wait 3-4 yrs to get their QL5 course, and only then being fully employable in the UMS or firstline medical support roles.

Also we have to resign people who have 3 yrs in the military who have only been at the unit for less then a yr, because they sat on PAT platoon in Borden for too long waiting for their QL 3 course.

The good ones are getting out, going back to school, or looking for avenues where they aren't wasting their time waiting for another course.

 

[Fraser.g]

I think that by increasing our relationship with the civi health care sector we can maintian the skills that will be needed on the present battle field or operation other than war as well as keep the interest and therfore decrease the attrition rate in both the regular and reserve forces.

Grant

 

[starlight_745]

I think a good example of this type of program is the US Air Force Top Star training run out of St. Louis.  (I forget what the acronym stands for).  It is a two week course where NO/MO/and Med Techs rotate through and each has a different skill set to refresh in.  For example Med Techs do EMT refresher, ICU/Emerg rotations and ambulance ridealongs, Nurses do TNCC/ABLS and rotations etc.  There's not that many people in CFMG so if everyone could rotate through a program like this every couple of years it would probably work, combined with some other local unit level  coned.

 

[Armymedic]

Problem with sending people off for course is that we are toos short staffed right now to replace them...

With the PCP Bridging, we send 5-7 pers pers course away. Right now we have 14 MCpl-ptes away. Who cannot be backfilled because we are already way short of QL 5 Cpls and MCpls at Fd Amb.

At my UMS we are 50 percent short staffed, with 1 pers on course 1 MCpl posn vacated and 3 Cpl posn vacated, with no sceduled replacements.

So how can we afford to send more away, for whatever course, medical, leadership or otherwise?

 

[Fraser.g]

The answer to this is reserve back fill into the Field Amb. There are many members of the reserve medical world that are PCP qualified. Why not use them?

This would serve two fold:

1. Increase the strength of the working relationship between the regs and reserve forces (Total force)
2. Facilitate increased retention in both the Regular forces and Reserve due to availability to go on courses and OJT for the reservists.

We have to start thinking outside the box on all levels if we are going to fix the problems in CFMG

 

[starlight_745]

I think the problem with using reservists to backfill is that most of the reservists ( or anyone who isn't a student for that matter) who have civilian qualifications can ill afford the time off work to fill a position for say 2-6 months while someone is on course.  I have a helluva time just attending all unit training as well as my career courses and keeping of top of admin such as PER's etc.  Without any type of job protection it would be very difficult for most people I know to backfill unless it was perhaps an operation.

 

[Soon to be Medic]

 
  I am wanting to join the Regular force being a medic. Should I be qualified? Before entering, if training is an issue.that I have been reading in this forum?

 

[Armymedic]

You hit the nail one the head:

I think the problem with using reservists to backfill is that most of the reservists ( or anyone who isn't a student for that matter) who have civilian qualifications can ill afford the time off work to fill a position for say 2-6 months while someone is on course.  I have a helluva time just attending all unit training as well as my career courses and keeping of top of admin such as PER's etc.  Without any type of job protection it would be very difficult for most people I know to backfill unless it was perhaps an operation.

And just because they are PCP qualified, does not mean they can work as a QL 5 in a UMS.

So Nurse as needed ( I couldn't resist  ) while you suggestion is valid for filling Pte QL 3 positions at medical company, which by the way there are no shortage of, how do we back fill those QL 5 Cpls, and MCpl positions?

Soon to be Medic,
Quick answer...No. To be PCP qualified thru college its is a 2-3 yr course, paid from your own pocket of course. If you are looking to get in soon, don't bother, because the military will train you to that standard eventually, and you will get paid to do it. Worry more about getting into good shape and reading about biology, anatomy,  and chemistry. Truthfully, being a good medic is not about qualifications, but knowledge and abiity to use it wisely.