Long Term Sustainability of EFMB
By: Leader Development
Tags: Leadership, Medicine, Army, Defense, Military

Written By Captain Alyssa Noltner

An EFMB candidate and support personnel evacuate a casualty during CTL3

The Expert Field Medical Badge (EFMB) test as it exists today is not sustainable long term from a resourcing perspective. The extensive testing requirements disadvantage Army Medical Department (AMEDD) personnel due to low pass rates and taxing resource requirements on medical units. In order to be sustainable and acceptable to Army senior leaders, the EFMB must change. The resource burden on the host unit and installation needs to be decreased and there must be an acceptable pass rate that more closely aligns with that of the Expert Infantry Badge (EIB) and the Expert Soldier Badge (ESB)*.

As the FY19 I Corps EFMB OIC, one message I repeatedly received from non-AMEDD senior leaders was, “Why invest the time, personnel, and resources into conducting a training event for a skill badge that results in less than 10% of the competitors earning the badge? It isn’t worth the time or the manpower.” This is a message that is not uncommon and has been voiced even within the AMEDD for many years. The 2019 I Corps EFMB required 273 support personnel, the requisite logistics support area (LSA) sustainment, construction of scenario-based combat testing lanes (CTLs) and land navigation courses, OICs and evaluators, and many others. In comparison, the USAIS Pamphlet 350–6, Expert Infantryman Badge, recommends 133 support personnel to conduct an EIB for a battalion sized element.

Background

AMEDD personnel have distinguished themselves beyond the battlefield by earning the EFMB since 1965. There have been many evolutions of the EFMB requirements, but the standards have remained rigorous, making the EFMB one of the most difficult special skill badge to earn. In March of 2019, the EFMB standards changed again simultaneously increasing the logistical and support requirements and making the badge more difficult to earn. Since the introduction of the new standards in March of 2019, the EFMB has been awarded to an average of 8% of the candidates: a decrease from a 13% average pass rate in FY18. In comparison, the Expert Infantryman Badge had an average pass rate of 30% in CY18 and the recent combined ESB / EIB held at JBLM had a 37% pass rate.

With the introduction of the ESB, Soldiers of all Military Occupational Specialties (MOS) now have the opportunity to earn a special skill badge. The EIB and ESB share 85% of the same tested tasks and have identical standardization and testing structures. AMEDD Officers and 68-Career Management Field (CMF) Soldiers are not eligible to compete for the EIB or ESB; they are only eligible to compete for the EFMB. The EFMB should align with the other Expert skill badges and follow the same overall validation, standardization and testing procedures. This would require all CMFs to meet similar standards when earning their respective skill badge and allow installations to combine resources to host the Expert skill badges concurrently.

An EFMB candidate crosses under a wire obstacle during CTL3

Many of the recent changes to the EFMB standards were implemented in a veiled attempt at “replicating” the other skills badges. While the expert weapons qualification, physical fitness test and land navigation requirements now replicate the other skills badges, the EFMB’s testing lanes and written test do not. The result is that the EFMB remains a skill badge more difficult to earn than its counterparts, disadvantaging the Army medical community.

For the purpose of this article, I will discuss each event of the EFMB in sequential order and highlight areas for improvement. The intent is to provide recommended changes to more closely align the EFMB with the other skill badges while maintaining the major medical components.

Fitness Test

The first event during EFMB testing week is the Army Physical Fitness Test, for which candidates must score 80 points in each of the three events. The addition of a fitness assessment was much needed; however, the current requirement is not optimal. Ideally, an EFMB physical fitness test should involve medic-specific components. Potential options include:

EFMB candidates kick off test week with an APFT

1. The APFT with a score of 70 points in each event. (70 points in each event is proposed because the EIB Physical Fitness Assessment Standard requires all candidates to score 70 points for push-ups and sit-ups at the 18–21yr old male standard.)

2. An EFMB Physical Fitness Assessment: hand release push-ups; sprint, drag, carry (with casualty instead of weights); and a 2 mile run.

3. The Army Combat Fitness Test (ACFT) at MOS/AOC Standard. (Though it will not be discussed in any more detail here, a full ACFT has the potential to introduce additional resource requirements rather than reducing resource requirements.)

Regardless of the form it ultimately takes, the fitness assessment should follow two days of “Commander’s Time” as the EIB does, which will be discussed at the end of this article.

Written Test

The second tested event in EFMB is the written test, which currently has a 20% first time pass rate. Using a written test that forces recall of minutia from five separate manuals totaling 1,408 pages is neither efficient nor effective in assessing mastery of practical skills. Neither the EIB nor ESB has a written test. The written test has no place in the EFMB: this is a field medical badge.

EFMB Candidates begin plotting their land navigation points

Land Navigation

The EFMB land navigation standards were modified in March of 2019 to align more closely with the EIB conditions and standards. However, EFMB failed to adopt some crucial details from the EIB standards. For example, for EIB “If the course contains dense vegetation/limited visibility and the moon luminosity/weather conditions are poor, each point may be marked with a single blue glow stick at night”, which is not authorized for the EFMB. EFMB land navigation requirements should be exactly the same as the EIB and ESB standards, which would allow EFMB and EIB candidates to share the same course when competing for their respective badges.

Combat Testing Lanes

While EIB and ESB testing lanes evaluate individual tasks at dedicated testing stations, EFMB conducts three complex scenario-based CTLs. The EFMB CTLs incorporate Tactical Combat Casualty Care (TCCC), Evacuation, Communication, and Warrior Skills Tasks into an operational mission. These lanes are resource intensive, requiring personnel to serve as litter bearers, casualties, team members, and Opposing Forces (OPFOR). The TCCC lane relates directly to medical expertise: providing care under fire, tactical field care, and patient triage. The TCCC CTL should remain effectively the same. The TCCC CTL’s operational mission, type of tasks being tested and sequence of tasks should not change from one test site to another.

Support personnel demonstrate decontamination of their personal equipment for EFMB candidates in preparation for CTL2

The other two CTLs, commonly referred to as the CBRN and evacuation lanes, should be converted to EIB and ESB station-style testing. In fact, with a few changes to the tested tasks, EFMB candidates could use exactly the same testing stations as the EIB Patrol Lane. The additional Warrior Skills and Evacuation Tasks not included in the Patrol Lane would form the third EFMB station-style test lane. This would create an EFMB model comparable to the EIB and ESB. With these overlapping test requirements, multiple special skill badge events could be run simultaneously or consecutively, using the same resources, evaluators, and training area.

12 Mile Foot March

Finally, all three badges already use similar standards for the 12 mile foot march. The only differences are the EFMB requirement for the protective mask to be worn around the waist or attached to the fighting load carrier (FLC), and the EIB requirement to clear, disassemble, assemble, and perform a functions check on an M4/M16 immediately following the foot march. Eliminating the former and adding the latter to EFMB standards would standardize this event across all three skill badges.

Resourcing Requirements

EFMB resourcing requirements are greater than those for EIB or ESB. These requirements stem from three interrelated areas: the scenario-based CTLs, the validation process, and the LSA. Because of the scenario-based CTL model, establishing the testing site for the EFMB requires significantly more time, personnel, and supplies than either the EIB or ESB. Lane OICs/NCOICs must coordinate dig assets to excavate ditches, engineers to build walls, and extra manpower to emplace concertina wire and construct obstacles. The EFMB CTLs also require dozens of personnel to serve as casualties, litter bearers, and OPFOR. Furthermore, CTLs require pyrotechnics to make the three lanes as “combat realistic” as possible. It is worth noting that no medical unit has enough pyrotechnics in its annual ammunition allocation to independently run the EFMB.

An EFMB candidate crosses over a wall during CTL3

After lane construction, evaluators and support personnel spend approximately 10 days memorizing, standardizing and rehearsing dozens of pages of tasks and subtasks to ensure every candidate receives the same instruction and evaluation. EFMB cadre must then demonstrate the standardized tasks to the satisfaction of the EFMB test board and Test Control Officer. Any changes mandated by those authorities require more time (one to three days) spent rehearsing. The validation process for one scenario-based CTL and two station-style testing lanes would greatly reduce both the personnel and the time requirement during the validation process.

Finally, the EFMB requires an LSA with sleeping tents, study hall tents, kitchen and dining area, fuel and water resupply points, and sometimes even showers to support the candidates that stay in the field for the duration of the EFMB. The EIB/ ESB eliminate almost all of these logistical requirements by sending candidates home each night.

Potential Solutions

Overall, three major areas of change will make the EFMB test more efficient and effective: redesigning the scenario-based CTL model, minimizing LSA requirements, and allowing concurrent special skill badge testing by more closely aligning with EIB and ESB standards.

An EFMB candidate and support personnel move a casualty to a nonstandard evacuation platform during CTL2

First, transitioning the three current EFMB CTLs to only one scenario-based TCCC CTL and two station-style testing lanes would require significantly less time and fewer personnel, and would minimize the pyrotechnic requirements. With the proposed EFMB CTL model change, evaluators would only have to become experts in a few tasks, saving substantial time over the current model.

Second, allowing EFMB candidates to go home nightly, as their EIB/ ESB counterparts do, would drastically reduce the taxing LSA requirements on the host unit. Additionally, the EFMB should adopt the concept of “Commander’s Time” from EIB. Commander’s time allows candidates to study, eat, and rest at home for a full two days between standardization and testing weeks. This practice would undoubtedly improve success rates for EFMB candidates on at least the first tested event: the fitness test.

Finally, the greatest benefit of the proposed model would be the ability for an installation to run an EFMB concurrently, or consecutively, with an EIB and/or ESB, allowing an installation to maximize both time and resources. Recently, 2nd Stryker Brigade Combat Team, 2nd Infantry Division hosted the ESB in conjunction with the EIB at JBLM, WA. Candidates rotated through land navigation, weapons, medical and patrol lanes over the course of four days. With changes to the EFMB, all three Expert skills badges could be run together, drastically reducing the resource burden on any one unit.

With the proposed concept, EFMB holders and the medical unit could be responsible for the medical lane, and EIB badge holders for the weapons lane. Any Expert skills badge holder could run the other testing stations. Medical units would be responsible for the medical support required during the two weeks of standardization and testing. The land navigation course and 12 mile foot march would be a combined effort. If this concept were adopted, it would decrease the burden on any one unit and allow an installation to run more than one Expert Skill Badge competition annually. Multiple iterations of Expert Skill Badge testing on an installation allows units to send candidates when it is best suited with their unit training plan and gives candidates multiple chances annually to compete for the badge. The Proposed Testing Schedule could easily be revised based on the number of candidates competing, or competitions may be run consecutively instead of concurrently if throughput becomes an issue.

LT Joseph Cowen controls the bleeding of an axillary wound during the TCCC Combat Testing Lane

EFMB should be validated in the same way as EIB, with qualified units authorized to conduct testing following a 3 day validation process. If the EIB and EFMB were run in conjunction with one another, the EIB test manager could approve all common events — including the land navigation course and Patrol Lane — while an EFMB test manager would approve the TCCC lane.

Conclusion

The EFMB is an important part of the Army Medical Department, recognizing exceptional competence and outstanding performance by field medical personnel. The most recent changes to the EFMB test threaten its sustainability with historically low pass rates that have caused Commanders to question the value of conducting such a resource-intensive event. If changes are not made to decrease the resource burden and improve the overall pass rate, Commanders’ may not be willing to prioritize and resource future EFMB events over Department of the Army focused training.

*Note

The Expert Soldier Badge has a small set of data samples available. This article refers to two available data samples. The first Expert Soldier Badge: 21% pass rate and the JBLM Expert Soldier Badge: 37% pass rate

References

“AMEDDC&S HRCOE Pamphlet №350–10: The Expert Field Medical Badge (EFMB) Test.” AMEDDC&S HRCOE Pamphlet №350–10: The Expert Field Medical Badge (EFMB) Test. United States Army Health Readiness Center of Excellence, 01 March 2019.

“USAIS PAMPHLET 350–6: Expert Infantryman Badge.” USAIS PAMPHLET 350–6: Expert Infantryman Badge. United States Army Infantry School. 02 January 2019.