• EDUCATION & TRAINING (see Medical Education & Training)

The combat medical technician (CMT) is a key member of the Army Medical Services (AMS) team. As a career group it makes up the majority of the soldiers in the AMS and, importantly, it is responsible for a large proportion of the patient interaction with the wider military population, be that in the UK in the ‘firm base’ or overseas on operations and exercises.

However, over the years, it has been a real challenge to define a medical identity for this vital career group, especially when trying to draw comparisons with civilian peers. The most common comparator has been the paramedic, which although comparable in terms of delivery of prehospital care, does not embrace the wider role of the CMT in the delivery of other capabilities such as primary care, environmental health and logistical/equipment support. Recent operations, especially in Afghanistan and Iraq, have highlighted the key roles CMTs play in healthcare delivery, and their performance has undeniably enhanced the reputation of the cadre and greatly developed the confidence of the wider AMS.

Although the CMT contributes to healthcare in many ways, there are two major clinical roles, the first, in the delivery of prehospital emergency care (PHEC), and the second in the provision of primary health care. Delivering in these roles also generates the requirement to maintain clinical competencies and currency. Unfortunately, this is where frictions start to surface for the CMT; for when in the UK, apart from exercises, there is little opportunity to maintain PHEC skills except through observing on civilian ambulance shifts or attachments into hospitals. Similarly, unless posted to a medical centre focussed unit (such as Regimental Aid Post) it is often difficult for CMTs to achieve primary care placements. These frictions are not new but, with evolution in clinical governance and the lessons identified from recent conflicts, currency is a key metric required for all in healthcare delivery.

In recent years, steps have been taken by the Army Medical Directorate, through the training team and previous head of cadre, to add coherence to the CMT role and gain recognition of their skills. A baseline is now being established, with civilian equivalence for both Class 2 and Class 1 CMTs with the intent that CMTs emerge as a defence medic with an emergency medical technician qualification. This is a huge step forward and although this civilian qualification still does not encompass the full CMT skillset, especially primary care, it now provides an easier route for CMTs to maintain their PHEC clinical skills through placements in civilian organisations which will formally recognise their qualifications. In terms of primary care, there is no civilian equivalent to the CMT, although there are similarities with a primary care healthcare assistant. Overall, the CMT has a greater scope of practice. Additionally, that scope of practice and role is very different to that of a practice nurse who works under his/her own registration. However, as the military operates its own primary care centres, these provide an opportunity for the continuing development/maintenance of primary care skills for the CMT while still delivering a service. The Army 2020 development plan will see CMTs fall into three clinical categories: supporting (CMT2), autonomous (CMT1), and registered practitioners (Paramedic). This structure will facilitate an effective clinical governance framework in terms of scope of practice while establishing a clear pathway for progression and development of clinical skills.

Other challenges that have faced CMTs are the wide range of roles they can find themselves in and the frequency of change. These can sometimes limit the opportunities for CMTs to develop a deep understanding and experience in a particular field. Looking to the future there is work in progress to establish three broad clear career streams for the CMT. The first will be a general duties pathway which will see individuals continue their career in a variety of clinical/management roles based in regimental duty, including experience in logistic/equipment support and culminating with the potential to be a Regimental Sergeant Major for an AMS medical unit. The second will be a clinical pathway culminating in a civilian paramedic qualification. These individuals will then fill paramedic positions within the new Army 2020 structure in AMS medical regiments. The third will be a primary care stream in which individuals will focus on a career based in primary care delivery, culminating in the opportunity to be a practice manager or seek a career in Medical Information Systems in a military primary care environment. These three streams already exist to a certain extent; however, a more formal structuring of these pathways will allow individuals to adjust their careers to develop more extensive expertise and experience in these different areas.

These plans for the development of CMT career streams will have direct read across to the reserve CMTs, in line with the ‘One Army’ concept of integrated reserve and regular forces. However, there is still continuing work to establish how best to deliver commensurate training to a reserve soldier with no medical experience, and also how to bridge the gap between a reserve CMT who is already a healthcare professional and the competencies required to support the wider military.

The CMT within the AMS has unique skillsets, military and clinical. In an ever-evolving world of military and civilian healthcare delivery we must ensure that CMTs keep pace with the requirements of professional development as well as clinical governance, and that they are also recognised and rewarded for the vital role they play in the delivery of patient-centred and safe clinical care within the Army.