MAG Medical Skills Matrix: Mapping Coverage Across Your Group

How to Use This Matrix

The medical skills matrix is an audit tool. It answers one question: across your group, who can do what? The gaps it reveals become your training priorities.

Fill in the matrix with your group members' names across the top. Mark each cell with the member's current competency level:

• T = Trained (has certification or completed formal instruction)
• P = Practiced (has done the skill under supervision)
• F = Familiar (has read or watched but never done)
• N = No exposure

For critical skills, aim for at least two T ratings across the group. For high-priority skills, at least one T with multiple P ratings.

Tier 1: Essential — Every Adult Member

Every adult in the group should achieve these before the group has a training gap in this tier. These skills are the baseline — not the ceiling.

| Skill | Certification Path | Recommended Training Hours | |-------|-------------------|--------------------------| | Basic CPR and AED use | Red Cross CPR/AED, AHA BLS | 4-8 hours | | Bleeding control (direct pressure, wound packing) | Stop the Bleed course | 2 hours | | Tourniquet application (CAT or SOFTT-W) | Stop the Bleed, TCCC Lay Responder | 2 hours | | Choking response (Heimlich, infant choking) | Red Cross First Aid | 2 hours | | Shock recognition and positioning | Red Cross First Aid | 2 hours | | Burn assessment and initial treatment | Red Cross First Aid | 2 hours | | Fracture immobilization basics | Red Cross First Aid | 2 hours | | Anaphylaxis recognition and epinephrine use | Red Cross First Aid | 2 hours | | Basic wound cleaning and dressing | Red Cross First Aid | 2 hours | | Heat and cold exposure management | Red Cross First Aid | 2 hours |

Total time investment for Tier 1 competency: 16-24 hours (a standard Red Cross First Aid/CPR course covers most of this)

Tier 2: Core — Aim for 2-3 Members Per Group

Tier 2 skills require more training time and judgment. These are the skills that matter most when professional medical care is unavailable for 24 hours or more.

| Skill | Certification Path | Notes | |-------|-------------------|-------| | Patient assessment (head-to-toe exam) | WFR, WAFA, TCCC | The foundation for all other decisions | | Spine injury management and evacuation | WFR | Controversial in modern EMS, but relevant in austere environments | | Dislocated joint reduction (shoulder, fingers) | WFR | Reduce only with specific training — wrong technique causes nerve damage | | Long bone fracture traction splinting | WFR | Femur fracture requires traction to control blood loss | | Wound closure (steri-strips, skin staples) | WFR, TCCC | Suturing is Tier 3; basic closure is Tier 2 | | Hypothermia treatment protocols | WFR | Afterdrop risk, cardiac arrhythmia, rewarming sequence | | Altitude illness recognition and descent protocols | WFAR or WFR | Relevant in mountain regions | | Lightning injury management | WFR | Reverse triage applies | | Improvised evacuation (litters, carries) | WFR | Moving injured patients without a gurney | | Pediatric emergency assessment | WFR | Pediatric vital signs differ significantly from adults | | Pregnancy emergency basics | WFR | Premature labor, eclampsia, field delivery basics | | Dental emergency management | WFR | Pain control, lost filling, tooth avulsion | | Eye injury assessment and irrigation | WFR | Chemical exposure, foreign body | | Epipen administration protocol | Red Cross, WFR | Including dosing, monitoring, follow-on care | | Oral rehydration therapy | WFR, field medicine courses | Critical in diarrheal illness scenarios |

Recommended certification: Wilderness First Responder (WFR) — 70-80 hours, covers all Tier 2 skills

Tier 3: Advanced — 1 Member If Available; Never Assume

Tier 3 skills require professional-level training and often professional licensure. If your group has a physician, nurse practitioner, paramedic, or RN, these skills may be present. If not, know what you don't have and plan around that gap.

| Skill | Training Background Required | Equipment Required | |-------|-----------------------------|--------------------| | IV access and fluid administration | Paramedic, nurse, physician | IV catheters, tubing, saline/LR | | Wound suturing (simple and complex) | Medical degree, PA, NP, or supervised instruction | Suture kit, local anesthetic | | Chest decompression (needle or finger) | Paramedic, physician | 14g angiocath, chest tube kit | | Airway management (intubation, surgical airway) | Paramedic, physician | Laryngoscope, ET tubes, scalpel | | Medication prescription and management | Licensed prescriber | Controlled substance storage issues | | Urinary catheterization | Nurse, PA, physician | Foley catheter kit | | Nasogastric tube placement | Paramedic, nurse | NG tube, suction | | Lab interpretation (point-of-care testing) | Medical background | i-STAT, glucometer, urinalysis strips | | Dental extraction and nerve block | Dentist, dental training course | Extraction forceps, local anesthetic | | Obstetric delivery (complicated) | OB, midwife, paramedic | Delivery kit |

Key planning note: Having this equipment without this training is dangerous. Tier 3 supplies should only be stocked if you have trained personnel or a plan for how they would be used under direct medical guidance (Satellite phone consultation with a physician, for example).

Group Gap Analysis Template

After filling in the matrix, use this summary to identify training priorities:

| Priority | Skill Category | Current Group Coverage | Target Coverage | Training Needed | |----------|---------------|----------------------|-----------------|-----------------| | CRITICAL | Bleeding control/tourniquet | 3 of 8 members trained | All 8 adults | Stop the Bleed for 5 members | | HIGH | Patient assessment | 1 WFR in group | 2 WFR minimum | 1 member enroll in next WFR course | | HIGH | CPR/AED | 5 of 8 certified | All 8 adults | 3 members need certification | | MEDIUM | Wound closure | 0 trained | 1-2 trained | WFR course covers this | | LOW | IV access | 0 trained | 1 trained if possible | Identify if any member has clinical background |

Work through the CRITICAL and HIGH priority gaps first. Don't buy advanced supplies until you have trained personnel to use them.

Recommended Training Courses by Skill Tier

Tier 1 (All members):

• American Red Cross First Aid/CPR/AED — 4-8 hours, widely available, ~$30-80
• Stop the Bleed — 2 hours, free in many communities, sponsored by ACS
• AHA Basic Life Support (BLS) — slightly more rigorous than Red Cross for CPR

Tier 2 (2-3 members):

• Wilderness First Responder (WFR) — 70-80 hours, ~$700-900, valid 3 years. Offered by NOLS, Wilderness Medical Associates, SOLO
• Wilderness First Aid (WFA) — 20 hours, intermediate option between Red Cross and WFR
• NAEMT TCCC (Tactical Combat Casualty Care) — Military-developed trauma protocol, 16 hours
• Dark Angel Medical Trauma Course — Practical trauma care outside the hospital setting

Tier 3 (Professionals or intensive supplemental training):

• Any licensed medical professional has relevant training
• Advanced Wilderness Life Support (AWLS) — physician-level wilderness medicine
• Remote Area Medical (RAM) Training — Practical field medicine, varies by course
• Pre-Hospital Trauma Life Support (PHTLS) — Advanced trauma, typically for EMS providers

Skills Maintenance Schedule

Training certifications expire. Skills degrade without practice. Build maintenance into the group training calendar:

• CPR/AED: Recertify every 2 years (Red Cross) or annually for BLS
• WFR: Recertify every 3 years (70+ hours) or recertification course (16-20 hours)
• Stop the Bleed: No formal recertification, but practice tourniquet application quarterly
• Skills practice: Monthly training meetings should include hands-on repetition of critical skills — tourniquet application, wound packing, CPR, patient assessment. Muscle memory requires repetition.

The matrix is only useful if it's current. Update it after every certification, every training event, and every new member joins.