As with any other military occupational specialty (MOS) in the Army, there's a hierarchy among enlisted medics, each of whom starts out as a lowly E-1, medic private. With time, accomplishment and ability, medics can rise up through the ranks to E-4 (specialist/corporal), E-5 (sergeant), E-6 (staff sergeant) and E-7 (sergeant first class). Another big -- and quite rare -- step up is to E-8 (master sergeant). The highest pay grade is E-9 (sergeant major).
At the battalion level, the most senior medic is usually an E-6 or E-7. These are key leaders who train junior medics of lower ranks. In addition to at least one medic of this rank, there will generally also be six to eight intermediate leaders (usually E-5s or E-6s), and about half a dozen E-4 medics. The rest are E-2s and E-3s [source: Parsons]. As medics increase in rank, they generally become increasingly tasked with administrative duties, training of lower-ranked medics and making sure that lower-ranked medics are carrying out the policies and initiatives decreed by those further up the military chain of command (and for an enlisted medic, there's always someone further up the food chain).
The most senior medic in the U.S. Army Medical Command is the command sergeant major. This is the top position an enlisted medic can achieve, and the command sergeant major serves as the senior enlisted advisor (SEA) to the Army surgeon general, the most senior medical officer in the United States Army.
This position is a connection between officers and enlisted medics. The command sergeant major reports to officers about "the situation on the ground" and carries out officers' orders as they relate to enlisted personnel.
When a senior officer gives orders relating to combat medics, it's the senior medic who makes sure those orders are carried out, and this obligation rolls downhill through each level of command. The command sergeant major also helps junior officers who have authority over enlisted personnel but are nonetheless short on experience.
The command sergeant major is in a unique position to affect the drafting of Army medical policies, as well as their implementation. And when this medic walks in the room, every other Army medic (as well as any other lesser-ranked enlisted soldier) pays close attention (while privately hoping that the same close attention isn't paid back in kind).
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