Reviewing the Efficacy of EFMB through an Analysis of the 2019 USAREUR EFMB
Written By Captain Sebastian Coates
The Expert Field Medical Badge (EFMB) was designed as a special skill award for recognition of exceptional competence and outstanding performance by field medical personnel and approved by the Department of the Army on 18 June 1965. The Expert Field Medical Badge may be awarded to all officers assigned or detailed to an Army Medical Department (AMEDD) Corps; Army officers in training at the Uniformed Services University of the Health Sciences; Army officers enrolled in the Health Professions Scholarship Program; warrant officers who have an AMEDD primary military occupational specialty (MOS) controlled by the Surgeon General; warrant officer pilots that have a special qualification identifier “D” (Aeromedical Evacuation Pilot) and are assigned to an air ambulance unit; and enlisted personnel who have an MOS in the 68- Career Management Field (CMF) as well as an AMEDD primary MOS, MOS18D, or 38BW4 (AMEDDC&S HRCOE Pamphlet №350–10). According to the EFMB Test Control Office, only eight percent of the current AMEDD community possess this prestigious badge.
421ST Medical Battalion (Multifunctional) (MMB) hosted the 2019 U.S. Army Europe (USAREUR) Expert Field Medical Badge event in April 2019 at Grafenwohr Training Area (GTA), Germany. It was only the second EFMB executed under the new AMEDDC&S HRCOE PAM 350–10 standards which was officially published on 1 March 2019. Several changes included candidates qualifying expert on their assigned weapon prior to the event, taking an Army Physical Fitness Test (APFT) at the event, shorter time for land navigation testing, a longer written test, and several other unique requirements. 421st MMB learned lessons about the preparation, resourcing, and execution of the USAREUR-wide event that are worth sharing with the force.
Overview
260 candidates, to include 35 internationals candidates, started standardization. 249 candidates started testing. Nine candidates, to include one international candidate, graduated (3.6% success).
A USAREUR level EFMB is a resource intensive undertaking: logistically, financially, and manpower. Although candidates received outstanding training through standardization, and the host unit trained on multiple Mission Essential Tasks (METs), the cost of EFMB is severely disproportionate to the number of badge holders gained. To many leaders, smaller scale EFMBs (Brigade level) are a better way to conduct EFMB testing. The EFMB Test Control Office has been advocating for this model long before the low success rate as it has a multitude of benefits: less resources are required, it is more manageable and flexible for units with high operational tempo (OPTEMPO), and it affords candidates more individual attention during standardization.
Resourcing and Preparation
The 2019 USAREUR EFMB was one of the biggest, if not the biggest, EFMB event conducted during the past few years. This measure is not just in the number of candidates but also in how resource intensive the event was. 337 support personnel were tasked from units across USAREUR for 30 days and 260 candidates were pulled for 14 days. The logistical requirements, which include personnel movement, equipment movement, and life support, cost over $270,000.
Results
Only nine of the 249 candidates (3.6%) who started testing earned the coveted badge under the new standards. Most of the attrition was a result of the APFT (46%) and land navigation (33%). Both of these events require stringent candidate screening and preparation at their units prior to attending the event. The primary eliminator during the APFT was the push-up event; many candidates did not perform a sufficient number of repetitions with proper form (77 candidates-31% fail).
Break Down of Results
APFT
- 134 out of 249 candidates (54%) passed the APFT to the 80–80–80 standard. (Those who failed one event did not move on to the next.)
- 172 passed push-ups (69% of overall EFMB candidates) (77 failed)
- 141 passed sit-ups (57% of overall EFMB candidates) (31 failed)
- 134 passed the run (54% of overall EFMB candidates) (7 failed)
- One failed height/weight (passed APFT)
- 133 out of 249 candidates (53%) advanced to the written test (evening of testing day 1)
Land Navigation
- 98 of 133 passed day land navigation- (74% of remaining candidates)
- 50 of 98 passed night land navigation- (51% of remaining candidates)
Combat Testing Lanes (CTL) and Written Test
- 1st written test- 36 of 133 passed (27% of remaining candidates)
- 12 of 50 candidates passed enough tasks during CTLs (24% of remaining candidates)
- Of the 12 remaining candidates, five had to retake the written test. Two of the five passed.
Road March
- Nine candidates started the road march and nine completed it successfully.
Lessons Learned
Here are a few key lessons learned from the 2019 USAREUR EFMB that can help in the planning and execution of EFMBs across the Army. The most prominent lesson learned concerned the APFT. Many candidates did not meet the 80 point push-up or sit-up standard. This was primarily due to units sending candidates who were not capable of performing the number of required repetitions to standard. Despite an in-depth brief on the APFT standards, there were still complaints about grading and form. We recommend host units conduct an APFT standardization which could consist of a diagnostic APFT or at least one minute of push-ups and sit-ups to ensure candidates understand the standard and whether their push-ups will count during testing.
Another recommendation is using the event as an external evaluation. The host unit was able to train several METs during EFMB. Headquarters and Headquarters Detachment, 421ST MMB, provided most of the support for the event and met all requirements to achieve their desired rating. With the OPTEMPO of many units across the Army constraining the amount of time available for units to train, this is an essential means of training a unit’s METs.
Summary of the USAREUR 2019 EFMB
Hosting the USAREUR EFMB was a great experience with an abundance of valuable information for future events. The new EFMB prerequisites such as an “expert” qualification weapons card and new EFMB standards such as 80–80–80 on the APFT at the event have certainly increased the difficulty of attaining the badge. Our experience hosting only the second EFMB executed under the new standards allowed me to really examine the value of the EFMB across the AMEDD and how changes to EFMB as well as Army Medicine can change the negative perception that some people may have about it.
Examining the Efficacy and Relevancy of Current EFMB Events
There are a wide variety of opinions across the Army on the importance and meaning of the EFMB. Advocates of EFMB tout its prestige stating that it is a discriminator among peers as only six percent of AMEDD enlisted and 12 percent of AMEDD officers currently possess the badge. However, opponents of this train of thought, or any emphasis on the EFMB, highlight the irrelevance of the tasks and lack of correlation with success at any particular position or daily duties across the Army, especially the AMEDD. Even though many of the tasks in EFMB are relevant to every Soldier, certain elements of EFMB lack relevancy to potential candidates because the current skills assessed during CTLs may be outdated, are not used regularly by most Soldiers who compete for the badge, and may lack relevancy in the current and future operation environments.
Updating certain CTL tasks will increase EFMB relevancy to more AMEDD Military Occupational Specialties (MOSs) or Areas of Concentration (AOCs) as Army Medicine shifts towards a more operational focus. We are all Soldiers first, regardless of MOS or AOC. EFMB is a way to keep those in healthcare benefit delivery looking towards the field and operational environments. To further increase relevancy, we can integrate Air Force and Navy evacuation platforms as well as those from other nations (most likely Europe and Asia) to improve interoperability with other services and nations. Sharing TTPs and training on different vehicle platforms and medical equipment is key in the event of conflict in this day and age. Regardless of what kind of change the AMEDD pursues, it must adapt to the skills required by the war fighter.
The Army has a variety of schools to attend and skill badges or tabs to earn. With so many different options designed to enhance Soldier, medical, and leadership proficiency, one must question how relevant the current EFMB tasks are to their specific MOS or AOC. Though I am a strong proponent of the fact that everyone is a Soldier first, with the AMEDD’s diversity, would AOCs and MOSs such as veterinarians, microbiologists, lab technicians, behavioral health technicians, food inspectors, and nutrition care specialists use the skills learned from EFMB at any point during their military careers? Soldiers, regardless of MOS or AOC, may need to treat a casualty, navigate, or call for medical evacuation. Maybe we should diversify medical tasks by adding tasks from each medical functional area (MFA) such as canine Tactical Combat Casualty Care (TCCC) to help mitigate the criticism about relevancy to someone’s MOS/AOC. Integrating certain MFAs such as Veterinary Services would be easier than MFAs such as Medical Logistics. Even some of the TCCC tasks in EFMB are out of date and should be updated as they are different from the skills medics learn in 68W Sustainment. Why are some tasks required to be completed in sequence during EFMB when in reality it does not matter how they reach the end state (one example is radio assembly)? Maybe the primary focus of EFMB is attention to detail versus the actual desired end state.
In contrast, 11 series MOSs (Infantry) utilize the skills they learn from the Expert Infantry Badge more often (weapons assembly/disassembly, tactical communications, etc…). On the surface, Ranger School is only seen as a small unit tactics school. However, in reality, it is a leadership school where all Soldiers, regardless of MOS, can learn how to interact with and lead others in tough conditions. These are just examples of schools that are clearly relevant to the target audience’s day-to-day activities and mission. As Army Medicine continues to transition towards a more operational focus, the focus on the importance of EFMB tasks may grow.
Smaller EFMBs and the Selection of Candidates
USAREUR currently runs one EFMB per year (hosted by 30TH MED BDE) due to competing requirements and operational tempo across the AOR. Higher echelons may question the event’s value when the resourcing requirements are so high and it only produces nine badge holders who have the potential to support EFMB in the future. Conducting frequent, small EFMB events will yield more EFMB holders while economizing resources and forcing units to ensure candidates have the potential to earn the badge.
If units conduct smaller, local EFMBs with between 50–70 candidates and one lane per CTL, USAREUR could execute multiple events per year. BDE sized elements typically have the resourcing requirements to execute an EFMB locally. With a few rank requirement exceptions to policy (ETP), a medical brigade, or even brigade combat team, can run its own internal EFMB with little to no external support. There are so many different options for evacuation tasks that can reduce major vehicle requirements. Helicopter mock ups are even an option when certain vehicle platforms are unavailable. The test control office has been very helpful with ETPs that help enable EFMB execution as long as there is not any degradation to the standards. The resourcing requirements would be minimal with just a few badge holders for the medical CTL and key leadership positions.
A few years ago, USAREUR EFMB events averaged about a 50 percent success rate. The success rate can be attributed to the extensive training time conducted in conjunction with EFMB. Candidates benefited from about a week of training in the same area where standardization and testing was conducted with the same cadre providing instruction. A candidate saw the lane and land, to include the land navigation course, about four times before they started testing. An extra week studying tasks that were already standardized without distractions also contributed to the high success rate. The extended EFMB with a training week is not feasible given competing requirements in Europe since around 2015–2016. Pulling 335 support personnel for about five weeks and 260 candidates for three weeks would negatively affect many other missions across USAREUR. Support personnel and candidates are already reporting to EFMB directly from missions and training without any time back at home station.
Smaller EFMBs also require units to be more selective when identifying candidates to compete for the badge. Many candidates arrive ill-prepared or unmotivated because they are forced to attend. These candidates waste instructional time and study hall resources resulting in less opportunities for candidates who are adamant about earning the badge. At a smaller EFMB, candidates are able to receive more personal instruction from lane support personnel, thereby increasing their chances of earning the badge. The smaller, low-cost, and low-impact EFMB model executed frequently is supported by the EFMB Test Control Office as it is likely to produce better quality candidates who will most likely produce better results.
There is also a requirement for the unit to prioritize EFMB and the train up. This not only includes time and resources for training, but also emphasis on the importance of the event. Examples may include leaders scrutinizing the selection of personnel for other schools like Air Assault or rewarding TDY opportunities if the individual did not even attempt to volunteer for EFMB.
A Look to the Future
In December 2019, 421ST MMB will host a 30TH MED BDE EFMB that is only supported by personnel within 30TH MED BDE. Only 30TH MED BDE units will be allowed to send candidates, which will ensure there is a smaller number of about 60 candidates who will receive more quality instruction from the cadre. It is far less resource intensive. All events will take place in the local area and each CTL will only set up one sub-lane. Other than test board and CTLT OIC/NCOIC badge holder requirements, the event only needs four EFMB qualified personnel to grade medical tasks. All support personnel will be able to go home every evening as opposed to 30 days in the field with the current USAREUR EFMB construct.
Overall, EFMB is a key event within the AMEDD that ensures all personnel have the opportunity to practice tasks that would be required of medical personnel in an operational environment. Like any other event, it has its critics, can always use improvement, and needs to adapt to remain relevant as the operational environment changes over time. I look forward to the upcoming 30TH MED BDE EFMB and any feedback from this article.
CPT Sebastian Coates is the Commander of 557TH Medical Company (Area Support), 421ST MMB, 30TH MED BDE. Prior to taking command, he served as the lead planner for the 2019 U.S. Army Europe Expert Field Medical Badge. His previous assignments include: Medical Operations Officer for 2ND Battalion, 75TH Ranger Regiment; Medical Platoon Leader for 2–35TH Infantry Battalion, 3RD Infantry Brigade Combat Team, 25TH Infantry Division; and the Support Operations Medical Logistics OIC in 421ST MMB, 30TH MED BDE.
The views expressed in this article are the author’s alone and do not reflect the official position of the Medical Service Corps, the Department of Defense, or the US Government.
