Page 135 - Journal of Special Operations Medicine - Spring 2014

The Tyranny of Distance:
Protracted Care in a Resource-Constrained Environment/

Looking for a Way Out

he application of patient care, particularly in military interested in reviewing drafts and manuscripts further-
T(or any austere or nonpermissive) environments, con- ing the conversation and evidence regarding prolonged
tinues to suffer in a fashion similar to the application of and critical evacuation care. Whether tailored or com-
military force itself. Strength diminishes with distance. plete, knowledge about resources and innovations in
Kenneth Boulding referred to this phenomenon as the prolonged care in the combat environment is critical to
“Loss of Strength Gradient” and showed reciprocally the discussion.
how the forward projection and staging of assets miti-
gated the amelioration of strength over distance. Tacti- The world will not diminish in size, conflicts will not be
cal medicine has borrowed from this concept, pushing less expensive, and hostilities show no sign of abating.
higher levels of care ever closer to the X. Despite this, Our patients deserve clinicians who use the best emerg-
crucial work is needed in the arena between stabiliza- ing evidence to develop and deliver care at all levels.
tion and evacuation—especially when no fixed facility
or higher level of care is available. Special Operations clinicians are the touchstone by
which military medicine tests advances in care. Over the
The Journal of Special Operations Medicine previously past decade-plus, we have pushed the envelope tremen-
published articles addressing select components of pro- dously. Lest we lose the benefit of collective knowledge
longed care, which has been and will continue to be an and our innovations stagnate as untold anecdotes, the
increasingly prevalent issue. Our editorial staff is keenly professional action is to publish.

There I Was

ow that we are coming out of our 12th year of war, unshared, incomplete, or unprotected, the immeasur-
Nthere are many stories to be told. Breakaway Media able value of their experiences will be lost forever, to
is looking to compile and publish your stories, be they the detriment of not only the SOF community but also
humorous, lessons learned, or an event or patient who conventional military and civilian trauma science. When
left an impact on you. practitioners’ experiences are formally conserved, those
who have borne witness become de facto historians.
Relevant best evidence is acquired first by accumulat- Their histories must be collected and recorded, to pre-
ing stories of expertise and clinical anecdotes. Provid- serve phenomena of interest to educational, scientific,
ers who ignore the histories and stories of those before and research entities. The only permanent and irrefut-
them in favor of concrete evidence alone do so at their able evidence on which other clinical constructs can be
own peril. SOF clinical literature is primarily of the in- built is the safeguarded narrative experiences of SOF
terpretive paradigm, which means evidence is generated clinicians.
from contextual experiences that are shared by narra-
tive transmission—essentially; lessons learned are talked Your submissions can be as long or as short as they need
about among those in practice. SOF is unparalleled in to be to tell your story. If you have any questions, please
the clinical world for this type of sharing via multiple do not hesitate to contact us.
methods (lessons learned, after-action reviews, etc.).
If you have a story, send it to editor@JSOMonline.org.
Veterans of combat are the biographers of their lived
experiences. If archives of SOF clinical narratives are

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