Page 105 - JSOM Spring 2026

A moment from the conference featuring a contribution from the ISTC
Commander.

That alliance-wide perspective was reinforced by SSG Tom
Sharp, Allied Special Operations Forces Command, Joint
Medical Division (SOFCOM JMED) Senior Enlisted Medi-
cal Advisor, who provided a concise JMED Medical Advisor
update. SSG Sharp described how SOFCOM’s medical staff
structure supports functional oversight across the NATO SOF under persistent drone threat defined as the primary limiting
medical lines of effort and emphasized five enabling themes factor in survival and a major contributor to Role 1/2 overload.
connected to concrete outputs in doctrine, policy, and interop- He highlighted some practical implications: focused assessment
erability products: awareness, coherence, development, ed- with sonography for trauma (FAST) has limited utility for frag-
ucation, and architecture. His most actionable message was ment patterns, imaging pathways at Role 2 need to evolve, and
direct: SOFCOM can provide free professional development prolonged tourniquet time pushes limb viability toward ne-
and training opportunities for SOF medical leaders, planners, crosis and amputation, often compounded by seasonal factors
and senior medics, and nations should leverage these pathways (i.e., infection burden in summer or hypothermia and frostbite
to standardize readiness across the alliance rather than dupli- in winter).
cate efforts in isolation.
MAJ Artemenko presented a series of tourniquet cases that
Irregular Warfare sharpened the point: outcomes are often decided not by whether
COL Pierre Pasquier, of the French Army, briefed attendees on a tourniquet was placed, but by where it was placed, whether it
medical support in irregular warfare, capturing an undeniable was reassessed, whether conversion/removal was feasible, and
truth: medicine is increasingly both a survival function and how long evacuation was delayed. His examples illustrated the
an influence lever in gray-zone competition. He described a brutal spread of clinical trajectories when evacuation is con-
return to low-signature, mobile, sometimes clandestine care, tested, ranging from recovery with timely reperfusion to shock/
where evacuation is uncertain and medical assets may be tar- sepsis-related death or amputation after prolonged ischemia.
geted. His operational strategy emphasized far-forward blood,
damage-control resuscitation/surgery (including in-flight ca- Together, the takeaway is not use more tourniquets or con-
pabilities), and drone-enabled resupply and evacuation as pos- vert earlier. It is that LSCO care cannot rely on single-solu-
sible tools to bridge prolonged field care. tion standardization. It requires practical protocols built for
delayed evacuation, clear authority and training for reassess-
Strategically, he framed disinformation and misuse of medical ment, robust hemorrhage control and transfusion pathways,
information as threats that can undermine public trust, force and diagnostic/surgical decision-making that remains adapt-
legitimacy, and operational freedom of maneuver. His train able under contested conditions.
as you fight call was not about harder training; it was about
training that is tactically congruent, where logistics, signature Building on this, MAJ Jeremy Kaswer and LCDR Eric Akrish
management, and medical decision-making are practiced as a used Ukraine as an LSCO stress test for resuscitation doctrine,
single integrated problem. contrasting GWOT-era assumptions with the emerging base-
line of hours-to-days evacuation, intermittent communica-
Ukraine as a Stress Test for LSCO tions, and heavy reliance on self/buddy aid. Their de- identified
If the symposium had a central forcing function, it came synthesis, drawn from multiple data streams and field observa-
from the Ukrainian speakers. MAJ Ihor Palii and MAJ Valerii tions, highlighted a central bottleneck: survivability is increas-
Artemenko delivered complementary testimony that directly ingly limited not by the absence of tactical medicine concepts
challenges Global War on Terror (GWOT)–era assumptions but by delayed access to definitive hemorrhage control and
and clarifies what Large-Scale Combat Operations (LSCOs) fragmented Role 1/2 capabilities, compounded by incomplete
are likely to demand of SOF medicine. injury registries that hinder feedback and standard setting.
The presenters argued that future resuscitation protocols
MAJ Palii framed first person view drones as a dominant driver must move beyond reactive fixes and toward succinct, rap-
of high-energy fragmentation injuries, with delayed evacuation idly implementable prolonged field care adaptations focused

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