SAN ANTONIO — Army Spc. Daniel Hutchinson once sliced a man's throat to keep him breathing.
He knows how to slip a needle between a patient's ribs to re-inflate a lung. He fastened tourniquets on dozens of shredded limbs during 12 months in Iraq.
Saving lives set him up for not much more than minimum-wage work at home. Combat medics, the Army's largest specialty after infantry, are hindered in the job market by a military that doesn't fully document their skills and a hodge-podge of state licensing laws that don't account for armed-forces experience.
Recruits who grew up hearing the Army slogan "Be All You Can Be" are finding unemployment among Iraq and Afghanistan veterans outstrips the civilian rate. Military engineers, truck drivers, machinists and information technologists face obstacles like those that medics encounter. Many use federal benefits to pay for civilian schooling in skills they've already mastered, said Rep. Jeff Miller, a Florida Republican and chairman of the House Committee on Veterans' Affairs.
"We are literally wasting millions of tax dollars requiring someone to attend training they have already completed, which could be spent on more advanced qualifications," Miller said in an email.
Veterans cost the Defense Department $942 million in unemployment compensation last year, and the number of post- Sept. 11 veterans using education benefits through the GI Bill climbed to 555,329. The total tuition cost to taxpayers was $8.1 billion, according to the U.S. Department of Veterans Affairs.
The unemployment rate for veterans in Hutchinson's age group, those 25-34 years old, was 9.7 percent in July compared with 8.2 percent for non-veterans, according to the Bureau of Labor Statistics. Joblessness among vets under 24 hit 19.9 percent that month, compared with 15.5 for their peers who didn't serve in the military.
"It seemed like any medical profession that I wanted to get into required at least a year of training to learn stuff that I had already done and trained other soldiers to do," said Hutchinson, who eventually gave up on becoming a paramedic or nurse and started a veterans' support group.
His struggle shows the hurdles U.S. policymakers are trying to eliminate to bring more veterans into the workforce.
Soldiers, sailors and air men perform at least 20 manufacturing-related jobs such as welding and machine repair without the civilian credentials that would help secure jobs outside the service, according to the Obama administration. While Congress approved a law July 14 declaring military training sufficient for many federal job licenses and certifications, the measure won't help vets who specialized in health care because their credentialing falls under states' jurisdiction.
Another piece of legislation, the 2011 Vow to Hire Heroes Act signed by President Barack Obama on Nov. 21, ordered the Labor Department to work with states to standardize a patchwork of differing cross-border requirements. The department is working on a contract to study the problem, according to an email from Ismael Ortiz, acting assistant labor secretary for veterans' employment and training.
Army medics and their Air Force counterparts are certified as basic emergency medical technicians, not better-paid paramedics, even though they practice some skills reserved for paramedics in civilian life. Navy corpsmen lack even that basic certification because they don't take a required civilian test when they finish training.
Volunteers fill about half the basic EMT jobs nationwide, according to the National Registry of Emergency Medical Technicians, a Columbus, Ohio-based organization that offers uniform exams and certification recognized in 45 states. Basic EMTs who do get paid sometimes earn as little as minimum wage, said June Iljana, California's deputy director for emergency medical services.
Paramedics, who hold higher-level licenses, can earn about $45,000 a year, she said. They respond to emergency medical calls, assess patients and administer life-saving first aid en route to hospitals.
The Labor Department estimates the United States will need 120,800 more EMTs and paramedics over the course of this decade.
At Fort Sam Houston, in San Antonio, Texas, the armed services turn out about 12,500 combat medics, Navy corpsmen and Air Force medical technicians a year. About 20,000 serve on active duty in the Army and 20,000 in the National Guard and Reserves.
These "docs," as they're called, manage pain and injuries on the battlefield, treat colds and stomach aches, and distribute medicine. They also learn paramedic skills, including how to re-inflate a collapsed lung, insert breathing tubes and administer morphine.
Training culminates in 11 days of war games on undeveloped land north of San Antonio. In June, sweat dripped from soldiers' faces by 7:30 a.m. Green grenade smoke obscured the Texas sun as temperatures climbed toward 98 degrees Fahrenheit.
"Boomer out!" Staff Sgt. Jason Jackson shouted, a warning that blank artillery was about to explode close enough to rattle the barracks. "Get down on the ground for crying out loud!"
A medic pushed a five-inch tube up her training partner's nose and down his throat, a procedure called intubation that can keep unconscious victims breathing. Nearby recruits debated how much morphine would be appropriate as they treated simulated gunshot wounds and amputations. Civilian EMTs certified at the basic level aren't allowed to give prescription narcotics or intubate patients.
"Coming this route, you get way better training than if you take the courses in the civilian world," said Pfc. Brian Driggs, 22.
As many as 95 percent of Fort Sam students pass the basic EMT exam, said Don Parsons, deputy director of combat medic training at the base. That compares with 66 percent overall, according to data from the National Registry group.
Maria Aliftiras, 34, a Fort Sam instructor who spent 11 years in the Army Reserves then earned her civilian paramedic's license, said about half her 1,200 hours of courses and clinical work through San Antonio College repeated what she already knew about physiology, anatomy and trauma. Advanced cardiac care was "the only real challenge," she said.
"If I was going to recommend anything to the Army, I would raise the level of certification that they are getting," said Jeff Bailey, director of San Antonio College's Emergency Medical Services program. Last year, he relied on two Navy corpsmen in his basic EMT class to help teach. "They have the skill set, they just can't use it."
Aliftiras spent $3,500 and more than a year on her paramedic education. The cost rises to $8,950 for California students who enroll in the National College of Technical Instruction, a for-profit company that bills itself online as "the largest paramedic and EMS training institute in the United States." NCTI's tuition varies by location, said Karin Gasch, a spokeswoman for the school.
Even the most accomplished combat medics may need additional training for such tasks as inserting an IV into an elderly patient with fragile veins or treating someone in diabetic shock, said Bill Brown, executive director of the National Registry of EMTs. Veterans should complete the full range of paramedic courses through civilian schools, no matter their experience, he said.
"We have to handle all age groups and all diseases," Brown said.
Before licensing paramedics, states typically require them to ride along on ambulance calls and work in hospital emergency rooms. The San Antonio College program requires students to spend at least 480 hours on such clinical training, for example.
While military personnel get such experience once they're assigned to a unit, the skills they add in the field usually aren't documented, according to instructors at Fort Sam. The void leaves vets unable to prove their ability to civilian employers.
One workaround would be to allow veterans to take placement tests gauging how much additional education they need to earn a paramedic's license without starting from scratch, an approach that Representative Miller said he might support.
"If a medic or corpsman can pass those tests, I see no reason why they shouldn't be licensed," Miller said.
Obama's plans to reduce U.S. ground forces worldwide are expected to return more than 1 million service members to civilian status in the next five years. To ease the veterans' transition, the administration in May created a task force to work on closing the gap between military training and civilian work requirements.
The panel, which is starting with 20 manufacturing specialties covering 126,000 service members, started pilot certification programs with the American Welding Society, the Society of Manufacturing Engineers and the Manufacturing Skills Standards Council.
In July a small group of Army engineers began six weeks of training that will culminate with the society's civilian certification exam, said Lori Dick, spokeswoman for the trade organization.
Many Army candidates are expected to pass on their first try, said Tony Stamilio, the Army's deputy assistant secretary for civilian personnel and quality of life.
The task force plans to turn to health-care professions next, according to the Obama administration.
The American Legion and the Veterans of Foreign Wars are focusing on winning recognition for military EMTs and commercial truck drivers. Both occupations are licensed or certified at the state level.
"These two are consistently at the top of the list," for action, said Ryan Gallucci, deputy legislative director for the VFW. "You have a work force that you believe has certain skills, but they are not able to apply them in the civilian sectors."
So far 27 states agreed to recognize military experience for veterans seeking work as commercial truck drivers.
To help veteran medics, the administration amended a grant program for nursing schools to favor those that give academic credit for military training. In fiscal year 2011, the program awarded more than $102 million. A similar incentive program is available for schools that train physician's assistants.
For Hutchinson, such steps come too late to foster a career in emergency medicine.
Upon his return to Columbus, Ohio, he looked into working for Rural/Metro Corp., an ambulance company owned by New York- based private equity firm Warburg Pincus, and discovered they didn't pay basic EMTs enough to cover his monthly bills, he said. The company pays between $18,300 and $34,600 for basic EMTs in Ohio on a 44-hour week, said Rural/Metro spokeswoman Liz Merritt.
More research into the demand for health-care workers led Hutchinson to enroll in community college as a step toward nursing school. There, the man accustomed to attending gunshot wounds and damage wrought by improvised explosive devices found himself overwhelmed. Crowded classrooms and chatter in foreign languages reminded him of Iraq, stirring episodes of post- traumatic stress. He dropped out and applied for Veterans' Administration benefits.
"It was real difficult," he said. "I just locked my door and shut my curtains."
Today he lives with his sister and uses his partial disability check to fund Ohio Combat Veterans. The group connects former soldiers with one another, helps them find jobs and navigate federal bureaucracy.
The home page on Hutchinson's website quotes Theodore Roosevelt: "A man who is good enough to shed his blood for his country is good enough to be given a square deal afterwards."