Page 126 - Journal of Special Operations Medicine - Fall 2014

assistance by a physician was only available within the country’s medical support during operations. He is also responsible for
borders, where “casualty collecting points” were established. The medical care to the units’ warriors during all training phases
wounded were then evacuated to the nearest Israeli civilian hos- and for all other daily medical care. Those various responsi-
pital. However, since the 1950s, physicians were integrated into bilities demand extensive knowledge in prehospital emergency
the combat teams, in SF units across the IDF, 34,35 and were able and trauma care, sports medicine, primary care, and mental
to operate and to save lives under fire. 36,37 Gradually, a system for health. In some units, specialized medical knowledge, such as
recruiting, training, and integrating physicians to SF units was diving or aerospace medicine, is also required. The unit’s se-
established. Therefore, in 1966, the IDF surgeon general claimed: nior physician is also responsible for dental, physical therapy,
“Paratrooper physicians join the forces in combat. This is the na- and mental services for the unit. Thus, he relies on profes-
ture of that unit, where officers that do not operate under fire are sional consults from the different specialized medical advisors
not welcome.” This concept was rapidly adopted by other non- of the IDF MC.
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SF IDF units. Some years later, during one of the most influ-
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encing Israeli SF raid at Entebbe (“Operation Thunderbolt”), SF Military Sport Medicine
physicians were already integrated at all team levels and a unique Due to understanding of the similarity between training elite
medical system for treating and evacuating was operating. 40 athletes and SF warriors, the IDF MC encourages the field of
military sport medicine and recently established a medical cen-
ter, specially designed for SF warriors. 43
Combat Medics
Combat medics were part of the nonregular fighting forces Combat Medical Support
before the deceleration of Israel and part of the IDF since its Providing medical support in the combat areas, including un-
beginning. They are integrated in every SF unit, as members der fire, is regarded as being of great importance in the IDFs’
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of each team, and provide basic life support measures. SF community. Thus, all units are obligated to provide proper
tactical training to their physicians, to the level of the units’
SF Physicians warriors. Furthermore, during the past few years, many units
At the age of 18 years, most Israelis are drafted into military ser- adopted the model of “medical squads” (MS) within their
vice, while some volunteers are accepted to medical school be- teams. The MS are typically composed of one combat physi-
fore the formal military service. After finishing medical school cian, one combat medic (or paramedic), and an additional one
and 1 year of internship, these volunteer young physicians are or two unit warriors, for close-cover, communication, etc. The
recruited into the military. Following basic military training and MS mission is to provide a relatively permissive environment
after officers’ academy, they are positioned in infantry battal- under fire, for medical treatment.
ions. Few of them may later be selected to serve in SF units.
Moreover, physicians assigned to SF units should attend a uni- Medical Evacuation
fied introductory course to Special Operations medicine. This The IDF has no military hospitals; thus, all military wounded
course is composed of academic lectures and hands-on training are evacuated to civilian hospitals. Due to the short evacua-
regarding the different unique medical aspects of Special Op- tion distances and time, it is a common practice to plan for
erations. Subsequently, specific tactical training is then given to a “scoop and run” type of evacuation, directly to the nearest
each physician, by its unit, allowing him to integrate and oper- civilian trauma center, while physician care is provided along
ate at the teams’ level. This extra tactical training can last six the way, addressing the wounded’s urgent needs. This concept
months or more. After 2 to 4 years of active service in the unit, is also known as “threat during transport” (T&T). However,
physicians leave their units but continue to serve as “reserv- other challenges require different approaches. 44
ists” for many more years. Additionally, warriors who decide
to study medicine after they end their service can return to the Chain of Command
units, as reservist physicians. Therefore, an IDF SF unit may Within the IDF SF units, medicine is regarded as a “tactical
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typically have some “active” and several “reserve” physicians. support”; thus, the unit’s senior physicians always subordinate
They subordinate to the unit senior physician (USP) who offici- directly to the unit commander. However, professionally, the
ates as the “medical commander” and “medical director.” units rely on the IDF MC. This close interaction allows medi-
cal knowledge sharing between units, reassignment of medical
Paramedics personnel, integration of unified medical doctrines, and more.
For the past two decades, some units willing to upgrade the Among the important advances for Israeli SFM, during the
professional level of its medics, started also to train warriors past years, are the establishment of the Israel Special Units
as “team paramedics,” in a 1-year training course. Those para- Medical Administration (ISUMA), by the IDF MC in 2004,
medics are usually integrated into the teams, in addition to the the formation of the Trauma and Combat Medicine Branch
unit physicians. Typically, the paramedics are authorized to of the MC, and the “Depth Command” medical division, in
provide advance life support measures, under physician guid- 2012.
ance. Lately, these were expanded to include the administra-
tion of tranexamic acid (TXA) and freeze-dried plasma (FDP). Unique Medical Equipment
The Israeli SF and military medical communities are quick
Medical Duties to adopt new technologies and prepare for improvisations.
The USP is the commanders’ medical advisor. USP responsibil- Thus, It is interesting to mention few examples: improvised
ity includes planning the medical part of all operation plans, tourniquets known in Israel for many years as the “Russian-
providing medical training to the unit warriors, and providing tourniquet,” which later developed into a commercial
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118 Journal of Special Operations Medicine Volume 14, Edition 3/Fall 2014