# Scope Of Practice & Experience



## Kaiba (Oct 8, 2015)

I have done an intro but real quick, I am an EMT-B volunteering at hospitals when I can. I want to become a Emergency Room Physician (DO but I hear DO's get shafted on rotations) as a civilian. Also I am college student going for Bachelors in Biochem. I have completed A&P I and am in A&P II now for a back up plan. Im in the process of enlisting in the Army for 68W or 18-X contract. I mainly want experience. I also have no money... Air Force PJ is my second. I like both for the humanitarian aspects.

In the essence of the prominent learning I have for Medicine, the interest in the military, and an older thread I did not wish to resurrect, I would like to see how in depth all of your training is. I know bits and pieces from what the internet and books have to offer. I am more interested in personal experiences in this. Now to make this less broad. As far as residencies go, what would you like to be or are you to specialize in? Amongst enlisted/reservists, the head line more pertains to you. I only have basic knowledge that I'm allowed as a civilian to learn about Army Special Forces (specifically 18-D) because I was really into the diagnostic medicine side, besides trauma. Like this. This is freaking sweet: (Raider Corpsmen Study Tropical Infectious Diseases - ShadowSpear Special Operations). I would also like to know if diagnostic medicine is in your scope specifically. I don't want to be short sighted with just liking 18-D, so this may peak an interest in what you are doing.

So whats your scope like? What are your favorite personal experiences from medical training and what did it teach you? Any Pharmacology to add? Add anything else you want :) The only thing I ask is you use medical terminology.


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## policemedic (Oct 8, 2015)

I'm not really sure where you're going with this.  Your post is more stream of consciousness than coherent linear thought.

First, your comment about enlisted/reservists.  One can be both, you know.  I would also argue that some reserve component and National Guard enlisted medics are superior to their active duty counterparts because their full-time job is likely also in medicine.  Civilian paramedicine grants a different perspective than military medicine does (to various degrees that are MOS-dependent).

Next, I'll address what I think is the core of your question.  ALL level of military medics diagnose illness and injury.  It's true that specificity and sensitivity both increase proportionately with the level of training one has, the types of equipment and investigations available.  Here I would say that a good history and physical is key; a good differential diagnosis can often be reached on clinical and history findings.  But that being said, a newly graduated Army 68W (a nationally registered EMT-Basic with a somewhat expanded skill set) can and does diagnose because one cannot determine treatment without diagnosing.  That diagnosis may be refined or even corrected as the patient sees more advanced providers, but that does not take away from the contribution of the first medic.

I will say that the 68W program is weak in pharmacology.  Note that this does not mean one should assume all 68Ws are weak in that area.  This is also not reflective of other programs.  I occasionally get the opportunity to see students in the Pararescueman pipeline during their clinical rotations and they have a very firm grasp of pharmacology.

My experience was scope of practice as a 68W in an Infantry outfit was dependent on your Bn surgeon's opinion of your clinical skill and judgment.  Some Whiskeys had what would be considered a very broad scope; there were others I did not allow to carry abx or certain other drugs.

I will leave discussion of the 18D program to those qualified to do so.  I will say that I have had the pleasure of working with, around, and learning by, with and through Special Forces Medical Sergeants and I have always been impressed by the breadth of their knowledge.

Keep in mind that it is often said that as a specialty emergency medicine is a mile wide but only an inch deep.  It is an amalgam of every other specialty.


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## Muppet (Oct 8, 2015)

What Policemedic said....

M.


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## pardus (Oct 8, 2015)

Kaiba said:


> I have done an intro but real quick, I am an EMT-B volunteering at hospitals when I can. I want to become a Emergency Room Physician (DO but I hear DO's get shafted on rotations) as a civilian. Also I am college student going for Bachelors in Biochem. I have completed A&P I and am in A&P II now for a back up plan. Im in the process of enlisting in the Army for 68W or 18-X contract. I mainly want experience. I also have no money... Air Force PJ is my second. I like both for the humanitarian aspects.
> 
> In the essence of the prominent learning I have for Medicine, the interest in the military, and an older thread I did not wish to resurrect, I would like to see how in depth all of your training is. I know bits and pieces from what the internet and books have to offer. I am more interested in personal experiences in this. Now to make this less broad. As far as residencies go, what would you like to be or are you to specialize in? Amongst enlisted/reservists, the head line more pertains to you. I only have basic knowledge that I'm allowed as a civilian to learn about Army Special Forces (specifically 18-D) because I was really into the diagnostic medicine side, besides trauma. Like this. This is freaking sweet: (Raider Corpsmen Study Tropical Infectious Diseases - ShadowSpear Special Operations). I would also like to know if diagnostic medicine is in your scope specifically. I don't want to be short sighted with just liking 18-D, so this may peak an interest in what you are doing.
> 
> So whats your scope like? What are your favorite personal experiences from medical training and what did it teach you? Any Pharmacology to add? Add anything else you want :) The only thing I ask is you use medical terminology.



As a new enlistee who wants to become a Dr, three things spring immediately to mind.
1, Why would you want to become a DO and not an MD?
2, Forget 68W, go for 68C.
3, what @policemedic said.


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## Muppet (Oct 9, 2015)

pardus said:


> As a new enlistee who wants to become a Dr, three things spring immediately to mind.
> 1, Why would you want to become a DO and not an MD?
> 2, Forget 68W, go for 68C.
> 3, what @policemedic said.



I have personal experience with D.O.'s v/s M.D.'s, both as a paramedic. I have 2 medical directors, 1 is an M.D. and 1 a D.O. I can see a different view on how assessments are preformed, both I agree with. I also watched as Kim was in the I.C.U. not waking up. I watched the M.D.'s walk in, all of them, students, attendings, fellows. They all grab the chart, talk for 5 mins and walk out, not to be seen for another hour. My 1 medical director, a friend and man that sat with me in the waiting room while I sobbed and held my hand, walk into Kim's room and sit there with her, hold her hand, preform some obscure neuro tests and start asking questions to the attending that even the attending said they did not think about (um, weird). I will say that D.O.'s are more hands on  if you will, not bashing M.D.'s at all, they both do special things. 

M.


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## policemedic (Oct 9, 2015)

I've worked for and been treated by both D.O.s and M.D.s; generally speaking I find both equally capable but with a different approach.


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## TLDR20 (Oct 9, 2015)

If I were to want to become a Doc, I would certainly go the DO route. So that I understand. You want to be an 18X, because of the humanitarian reasons? Kid, that is naive to say the least. You are more likely to go to combat than do a humanitarian mission as an SF guy. You may hand out MRE's but that isn't our gig so to say. 

If I were giving out advice, which I am, I would say you should become a Civil Affairs medic. You will get the same training as any SOCM medic, and then extra training in preventative Med, and some other stuff. CA medics used to be 18D's but that is done now. 

You may have to cut your teeth as a medic in the regular army before becoming a CA medic, I'm not well read on it, but I think it is a NCO position.


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## Totentanz (Oct 9, 2015)

TLDR20 said:


> If I were giving out advice, which I am, I would say you should become a Civil Affairs medic. You will get the same training as any SOCM medic, and then extra training in preventative Med, and some other stuff. CA medics used to be 18D's but that is done now.
> 
> You may have to cut your teeth as a medic in the regular army before becoming a CA medic, I'm not well read on it, but I think it is a NCO position.


The most effective route to the above is to apply for CA and then apply for SOCM.  There are no guarantees of success with either of those.

There are a few SOCM-trained 68Ws still around, but the branch is trying to get away from that route, and go to 38Bs with W4 identifier.

All 38-series MOS's on active duty are non-accessions jobs - you have to apply once you're in (the most junior I've seen going through the course were SPCs, most were SGTs or SSGs).  IIRC are some options for 68Ws within 85th CA BDE as well as the reserve CA units, but that's a different story (and won't put you through SOCM, which is kinda the point of what TLDR20 is saying).

(NB: you can come in as a 68-something (W, C, whatever), and then apply for CA)

Are you more interested in the Active or Reserve components?


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## Kaiba (Oct 9, 2015)

Let me begin with saying sorry... I actually had surgery yesterday to remove a Pilonidal Cyst (Out patient.) I think had a weird reaction to the anesthesia. I barely remember writing this. Its kinda weird to read acutely... I mean my writing is not strong but geez. I do remember wanting to ask something along these lines before surgery because I will actually have time to ask while I rest from taking classes. I am going to do my best answering you guys seeing as I am still a bit groggy.
A little backroad to clear it up why I chose the jobs. Yes, I am a humanitarian. Not traditionally though. I believe there is more than one way to save someone. That is medicine but also the conclusions of combat. I mean there are sick people out there that just won't stop. Does that make sense?



policemedic said:


> I'm not really sure where you're going with this.  Your post is more stream of consciousness than coherent linear thought.



I know what you mean police medic. Again, sorry about that... But the rest of what you said most definitely answered my question. The reason I was confused is when I went to research the pipelines, my incorrect perception was that you were only trained in trauma care. But I understand. Using 68W as an  example again, If I was attached to a unit in Afghanistan, out on a mission with no Doc present, then diagnostic skills are imperative. 
Therefore, choosing 18-X (I want 18-D) for being in charge of and opening clinics and combat. 
PJ because they lend aid in clinics (sometimes) under supervision I believe, relief efforts like Katrina and I know they do more but thats totally okay. Im just directing to my "humanitarian" comment.



pardus said:


> As a new enlistee who wants to become a Dr, three things spring immediately to mind.
> 1, Why would you want to become a DO and not an MD?
> 2, Forget 68W, go for 68C.
> 3, what @policemedic said.



1, "DOs combine today's medical technology with their ears to listen caringly to their patients, with their eyes to see each patient as a whole person, and with their hands to diagnose and treat patients for injury and illness." Basically the wholistic approach.* 
*
2, I wanted to be be attached to a infantry or airborne unit for combat.



TLDR20 said:


> If I were to want to become a Doc, I would certainly go the DO route. So that I understand. You want to be an 18X, because of the humanitarian reasons? Kid, that is naive to say the least. You are more likely to go to combat than do a humanitarian mission as an SF guy. You may hand out MRE's but that isn't our gig so to say...



I believe I meant 18-Detlas specifically. Like opening clinics and such. Am I still naive to believe that? If so, please tell me. I really enjoy the extensive medical training they get (After SOCM first phase.) Also ill look into CA medic! 

Side Question: Would I have time to go to classes and finish up a degree while in Special Forces? You know, when not training? I was told by the Air Force that I could do that as a PJ but ill have to ask one to verify.



Totentanz said:


> Are you more interested in the Active or Reserve components?



I would like to go active. More frequency with hands on experience. Plus depending on which branch and job, I can finish up my bachelors while I'm in!


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## Kaiba (Oct 9, 2015)

@policemedic, that second paragraph was suppose to go above... :wall:


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## amlove21 (Oct 10, 2015)

Kaiba said:


> Let me begin with saying sorry... I actually had surgery yesterday to remove a Pilonidal Cyst (Out patient.) I think had a weird reaction to the anesthesia. I barely remember writing this.
> 
> 
> Side Question: Would I have time to go to classes and finish up a degree while in Special Forces? You know, when not training? I was told by the Air Force that I could do that as a PJ but ill have to ask one to verify.


Uhhhhhhh, Ok?

Point one- that's honestly the weirdest excuse I have ever read, I think. You want to be (at this point) any number of career fields which are extremely hard to get into and harder to be successful in, yet your decision making today was "post under the influence looking for life advice then apologize for it later." :-/

You will have time to go to classes and complete a degree while in every job in the DoD, it just matters exactly how much you care about it. After an 18 hour day of training are you going to have the intestinal fortitude to study, engage, and complete assignments on an online school that might not be the "brick and mortar" choice you'd prefer? 

Sure as a PJ you could finish up your degree, it's encouraged, like pretty much every where else in the military. 

The question should really be, "I want to finish up my degree- with that in mind, would I actually be able to complete any number of SOF selection programs without devoting the necessary attention to it?"

Let me alert you to your tone here- you're basically reading as if you're saying, "yeah, I mean I have my pick of jobs, no issue there. SF, PJ, CA medic, etc- got it. But once I do this first easy step, what will those career fields be able to provide for me personally?"


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## Kaiba (Oct 10, 2015)

amlove21 said:


> Uhhhhhhh, Ok?
> 
> Point one- that's honestly the weirdest excuse I have ever read, I think. You want to be (at this point) any number of career fields which are extremely hard to get into and harder to be successful in, yet your decision making today was "post under the influence looking for life advice then apologize for it later." :-/



Haha, yeah... Like I knew what I was doing sense I was "under the influence." I highly doubt I was thinking of apologizing seeing as that day was a blur. It was the first time I have been put under. I did not know what to expect. You can think what ever you want, man. It is not going to bother me. Lets not waste either of our time talking about hat anymore... 
I do appreciate you posting anyway, despite your opinion of me. Really. I do appreciate it. Im not being sarcastic. It is hard to get emotion in text. 



amlove21 said:


> You will have time to go to classes and complete a degree while in every job in the DoD, it just matters exactly how much you care about it. After an 18 hour day of training are you going to have the intestinal fortitude to study, engage, and complete assignments on an online school that might not be the "brick and mortar" choice you'd prefer?
> 
> Sure as a PJ you could finish up your degree, it's encouraged, like pretty much every where else in the military.
> 
> ...



Knowing time being devoted like you are directing at is telling me I probably would not want to finish it up. There is not a lot of info saying how long training will be a day after one finishes up the pipeline. Obviously the first ~2 years ill focus on all that. But after that.
Heres were I'm at with "devoting the necessary attention..." Yes. I could. I mean if I pass Indoc that is. Finishing degrees, the money, and all the other benefits are great. But first and foremost I want experience. On what you ask? Well, a little bit of medicine as you could probably tell and anything else. Either way it'll help me later on sometime I am sure.
The recruiter told me I would be able to attend the Air Force Community College. Sense you did not mention that, I am assuming there would not be enough time to attend classes as a PJ. Again, I mean after the 2 years.


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## policemedic (Oct 10, 2015)

You don't know what you don't know.


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## amlove21 (Oct 10, 2015)

Kaiba said:


> Haha, yeah... Like I knew what I was doing sense I was "under the influence." I highly doubt I was thinking of apologizing seeing as that day was a blur. It was the first time I have been put under. I did not know what to expect. You can think what ever you want, man. It is not going to bother me. Lets not waste either of our time talking about hat anymore...
> I do appreciate you posting anyway, despite your opinion of me. Really. I do appreciate it. Im not being sarcastic. It is hard to get emotion in text.


Well, this has went poorly. Just because I am a super nice guy and idealistic at times, I'll handle you with kid gloves here. Mainly because-


policemedic said:


> You don't know what you don't know.



I don't believe I said anything about how I think/feel about you, @Kaiba  because I don't. Go re-read my post and quote the section that says anything about my opinion. I wanted to let you know, after reading thousands of posts on this site, that you're falling into the misstep of those that don't think before they post and then don't take direction when corrected.

Here's my opinion/feeling- I don't care if you don't take that advice. I also don't actually care if you appreciate it, either. Just want to let you know that's how you're being perceived.



Kaiba said:


> The recruiter told me I would be able to attend the Air Force Community College. Sense you did not mention that, I am assuming there would not be enough time to attend classes as a PJ. Again, I mean after the 2 years.


So let's get some assumptions out of the way. Maybe that will help.

I assume you don't know what the CCAF is (Community College of the Air Force). It's not actually a school that you attend; it's an organization that can grant you career field specific associate degrees honoring your military training. You can use CCAF credits earned in military service towards other degrees. Many schools are recognized by the CCAF and you must get your CCAF Degree for career advancement as a PJ.

I also assume your recruiter isn't a PJ, and probably isn't a PJ with more than 2 years in a beret. I am. I also have 2 CCAF degrees and about 140 credits I have earned towards my 4 year degree, all the while as a PJ. I told you point blank that yes, with the proper time management and motivation, you can get whatever degree you want. Your response to this information was, in essence, "LOL, yea bro, whatever I get it so I can't get a degree."

TL;DR

Read more, post less. And it's "since", not "sense" as you wrote above several times. Seems like a small thing, but professionals care about the small things.


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## Kaiba (Oct 10, 2015)

I may have taken this...


amlove21 said:


> Uhhhhhhh, Ok?
> Point one- that's honestly the weirdest excuse I have ever read, I think. You want to be (at this point) any number of career fields which are extremely hard to get into and harder to be successful in, yet your decision making today was "post under the influence looking for life advice then apologize for it later." :-/



...In the wrong context. Seemed like you were saying I made it up like some 5 year old. It was perceived as insulting. My apologies if it was not in that tone.

To what you said above: Roger that. Trust me I get I don't know pretty much anything involving this. That is why I am here. 
Also, thanks for the correction on "sense." As you can tell my grammar and writing need work.


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## x SF med (Oct 11, 2015)

Kaiba said:


> I may have taken this...
> 
> 
> ...In the wrong context. Seemed like you were saying I made it up like some 5 year old. It was perceived as insulting. My apologies if it was not in that tone.
> ...




Kaiba...  just a quick piece of advice....  shush.   Put down the e-tool when the fighting position is chest deep, any further and you are working on a grave.

You are arguing with someone who has many years as a PJ and will most likely be one of your senior instructors in the pipeline...  is this a good idea?


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## TLDR20 (Oct 11, 2015)

Kaiba said:


> I believe I meant 18-Detlas specifically. Like opening clinics and such. Am I still naive to believe that? If so, please tell me. I really enjoy the extensive medical training they get (After SOCM first phase.) Also ill look into CA medic!
> 
> Side Question: Would I have time to go to classes and finish up a degree while in Special Forces? You know, when not training? I was told by the Air Force that I could do that as a PJ but ill have to ask one to verify.
> 
> ...



As an 18D you are a member of a Special Forces Team! You do the same combat missions as everyone else. You are not there to set up clinics, that is something you may do, but it is not your main effort.

As for getting a degree...? Sure anything is possible. However I think it is unlikely that you will find personal and professional success if you load too much on your plate at one time.


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## Kaiba (Oct 11, 2015)

TLDR20 said:


> As an 18D you are a member of a Special Forces Team! You do the same combat missions as everyone else. You are not there to set up clinics, that is something you may do, but it is not your main effort.
> 
> As for getting a degree...? Sure anything is possible. However I think it is unlikely that you will find personal and professional success if you load too much on your plate at one time.



Okay I have a better understanding now of the 18-D's parameters. 
With what you and amlove are saying it just depends on downtime and if one has the willing to go forward to do what it takes to complete classes. But that time being devoted can take away from other things. 
By the way Civil Affairs Medic, from what I have read up on, is very interesting. Thanks for putting me in that direction.


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## Red Flag 1 (Oct 12, 2015)

j


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## medicchick (Oct 12, 2015)

Red Flag 1 said:


> I just could not let this pass. I waited because I was spending my own time as a hospital patient.
> 
> Let me begin with saying sorry... I actually had surgery yesterday to remove a Pilonidal Cyst (Out patient.) I think had a weird reaction to the anesthesia. I barely remember writing this. Its kinda weird to read acutely... I mean my writing is not strong but geez. I do remember wanting to ask something along these lines before surgery because I will actually have time to ask while I rest from taking classes. I am going to do my best answering you guys seeing as I am still a bit groggy.
> 
> You likely had a normal reaction to anesthesia. I read somewhere that patients should not drive, make important decisions for the first 24 hours after surgery and anesthesia; out patient or inpatient. If you were caught driving a car, you would have been DUI. That you were posting here, well was PUI. *Now, there is another name for Pilonidal Cyst, It is military related, and if you get it right, you win a cookie.*



I will say I learned something new today.  I'd heard the term but never followed it up.


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## Kaiba (Oct 12, 2015)

Red Flag 1 said:


> I just could not let this pass. I waited because I was spending my own time as a hospital patient.
> 
> Let me begin with saying sorry... I actually had surgery yesterday to remove a Pilonidal Cyst (Out patient.) I think had a weird reaction to the anesthesia. I barely remember writing this. Its kinda weird to read acutely... I mean my writing is not strong but geez. I do remember wanting to ask something along these lines before surgery because I will actually have time to ask while I rest from taking classes. I am going to do my best answering you guys seeing as I am still a bit groggy.
> 
> You likely had a normal reaction to anesthesia. I read somewhere that patients should not drive, make important decisions for the first 24 hours after surgery and anesthesia; out patient or inpatient. If you were caught driving a car, you would have been DUI. That you were posting here, well was PUI. Now, there is another name for Pilonidal Cyst, It is military related, and if you get it right, you win a cookie.



I talked to the anesthesiologist and they saids it normal. I just need the remember to let the hospital know for next time. I did not drive either but PUI, yes. 

I believe you are referring to a "Jeep Seat" or "Jeep Riders Disease."


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## x SF med (Oct 12, 2015)

Kaiba said:


> I talked to the anesthesiologist and they saids it normal. I just need the remember to let the hospital know for next time. I did not drive either but PUI, yes.
> 
> I believe you are referring to a "Jeep Seat" or "Jeep Riders Disease."




So basically a boil on your ass...  you need to get out more.


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## Kaiba (Oct 12, 2015)

x SF med said:


> So basically a boil on your ass...  you need to get out more.



Haha, not basically. Literally. It can also come upon by trauma to the area multiple times. I play rugby and sit a lot for my classes. So yeah, blame my education for not letting me out more. Shame.


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## Diamondback 2/2 (Oct 12, 2015)

lol, had a boil just above the tail bone/ass crack. Very painful, however, I doubt anyone on here would have approved of the rusty pocket knife, sterilized with a cigarette lighter and pack of paper towels procedure used to "relieve" the pain... lol


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## Muppet (Oct 13, 2015)

I would have paid to see that though brother...

M.


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## AKkeith (Oct 13, 2015)

I had MRSA on my lower back the last month of boot camp. I didn't want to get dropped so I never said anything. I had an EMT in my class, who at the time, I thought had at the expertise to help me. It started out as a one time thing but at the end of boot camp became an every night occurrence. After lights out a couple guys would hold me down and shove a shirt in my mouth as the EMT lanced the MASSIVE bulge, as it shot out puss. Then he would clean it out with those long rifle q-tips and then dump purell in there and swirl it around. Needless to say it was extremely painful. The minute I graduated boot camp my family took me to the hospital and I had to go into surgery and get it cut off. Was told how dumb I was because apparently that stuff can get into your spinal cord and mess you up. Still have the massive scar.


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## Muppet (Oct 13, 2015)

M.


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## Red Flag 1 (Oct 13, 2015)

Kaiba said:


> I talked to the anesthesiologist and they saids it normal. I just need the remember to let the hospital know for next time. I did not drive either but PUI, yes.
> 
> I believe you are referring to a "Jeep Seat" or "Jeep Riders Disease."





Kaiba said:


> I talked to the anesthesiologist and they saids it normal. I just need the remember to let the hospital know for next time. I did not drive either but PUI, yes.
> 
> I believe you are referring to a "Jeep Seat" or "Jeep Riders Disease."



www.youtube.com/watch?v=OXA338ro1mo.


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## Red Flag 1 (Oct 13, 2015)

medicchick said:


> I will say I learned something new today.  I'd heard the term but never followed it up.



I've seen it in State Troopers who spend lots of seat time in their patrol cars.


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