Life-Saving Skills at Risk: Army Flight Paramedics Identify Barriers to Readiness

A new study explores the balance between requirements and the specialized clinical training needed for Critical Care Flight Paramedics to maintain peak readiness. 

Three military personnel in camouflage uniforms carry a simulated patient on a litter toward a simulated helicopter fuselage, where a Navy instructor in camouflage kneels in the doorway to observe the training scenario.
Military medical personnel transport a simulated patient during the Advanced Combat Medical Experience
(ACME) field exercise at Uniformed Services University. A recent study co-authored by a USU medical
student highlights the critical need for realistic, high-intensity training to maintain the perishable skills of 
Army Critical Care Flight Paramedics. (Photo credit: Tom Balfour, USU)

January 23, 2026 by USU News Blog Staff

Inside the cabin of a medevac helicopter, the difference between life and death often relies on split-second decisions and muscle memory. For the Army’s "F2" Critical Care Flight Paramedics, the mission is to provide advanced prehospital emergency care that links injured soldiers on the battlefield to survival. 

However, the path to maintaining that level of expertise is a constant race against time. The military's top prehospital providers struggle to maintain vital clinical skills due to significant systemic barriers, according to a new study published in November led by Army 2nd Lt. Matthew A. Sovine, a first year student at the Uniformed Services University’s (USU) School of Medicine, as well as Dr. Titus J. Rund, Dr. Cara Olsen, Dr. Cord W. Cunningham, and Dr. Ramey L. Wilson. 

The study, “Army Flight Paramedic Perceptions and Beliefs in the Current Medical Sustainment Model,” identifies these medics as a vital link in the “chain of survival.”  As the only providers capable of managing patients with full autonomy during transport, they bridge the gap between the battlefield and the hospital. Because patients are often at their most vulnerable during this phase, the pressure on an "F2" paramedic’s proficiency is immense.

"When I exchange a critically ill patient with a flight paramedic, I need to have absolute confidence in their ability to care for that patient in the ultimate “austere” environment—the back of a helicopter. They are a critical link in the care chain and we owe it to them to have every opportunity and protected time to keep those perishable competencies razor sharp,” said retired Army Col. Dr. Ramey L. Wilson, a 2002 and 2015 graduate of USU.


The Challenge of Clinical Mastery

The role of the flight paramedic has evolved significantly. In 2012, Congress directed the Army to upgrade medics from EMT-Basic (F3) to nationally registered paramedics (F2). This transition was designed to drastically raise the level of care available during casualty evacuation missions. 

However, maintaining these advanced "perishable competencies" alongside standard military duties presents a complex logistical challenge. The study suggests that while paramedics are eager to remain "ready on demand," the current sustainment model faces pressure from competing operational demands. 


Voices from the Force

To understand the reality on the ground, the research team surveyed more than 100 Army flight paramedics. The responses paint a picture of a workforce that is committed but constrained.

"Every second spent in meetings or on some non-clinical requirement, no matter how well intentioned or valuable, comes at the cost of their readiness and, potentially, the blood of our fellow brothers and sisters in arms," said Wilson.

The survey highlighted three key areas of focus:

  • Confidence Maintenance: Respondents noted that infrequent clinical exposure can impact their confidence in performing high-acuity medical tasks compared to previous benchmarks. 
  • Optimizing Training: Paramedics indicated that current simulation modules and refresher modules could be further refined to better mirror the complexities of modern operational environments. 
  • Balancing Requirements: The study identified a tension between routine unit taskings and the intensive time required for high-level clinical skills maintenance. 

"As an Army Flight Paramedic, you recognize how quickly clinical sharpness can diminish without regular patient interaction," added Sovine. "Our goal is to ensure our actual clinical proficiency consistently matches our briefed capabilities."


Protecting the Time to Train

The data indicates that maintaining advanced medical skills in tactical environments requires more than just a training manual; it demands a framework of institutional support. While the training process itself is safe, the study suggests that the true risk lies in potential skill degradation—making consistent, high-quality sustainment a vital safety priority.

Ultimately, refining these training pathways  ensures that when the call comes, every paramedic has the mastery to deliver elite care.  Prioritizing this specialized training is more than a recommendation– it is a fundamental pillar of modern operational readiness and a strategic investment.