Page 70 - Journal of Special Operations Medicine - Winter 2014

time challenge the maintenance of their medical skills. JSOMTC conducts the 2-week SOCMMSC at Fort
The aims of this study were to identify the attitudes, Bragg, North Carolina, on an ongoing basis. With
perceived barriers, and self-efficacy of SFMS about their classes starting every 2 weeks, the course focuses on re-
current medical sustainment training and their opinions freshing and sustaining the tactical trauma skills taught
on the need to make changes to the current program. during the Special Operations Combat Medic (SOCM)
course. While all SFMS attend the SOCM course as part
of their Qualification Course (Q-Course), non-SFMS
Background
medics also attend this course (e.g., Soldiers with the
The last major revision to the medical sustainment MOS 68WW1 SOCM). SOCMs are taught “. . . the
program followed a 1994 needs-based assessment that knowledge and skills required to manage combat casu-
investigated the high rates of SFMS attrition and the alties from initial point of injury through evacuation”
medical sustainment program. The results of this study and how “. . . to prescribe appropriate treatments for
4
led to the decentralized teaching of general medical top- diagnosed diseases in accordance with tactical medical
ics to the group level, justified the placement of board- emergency protocols and their corresponding formu-
certified physicians into Special Forces battalion surgeon lary.” The scope of SOCM care is focused on prehos-
1
positions, guided the development of the Joint Special pital trauma management, and the SOCMMSC sustains
Operations Medical Training Center (JSOMTC), estab- this training through a combination of didactic lessons
lished a 2-week medical skills refresher program, and and hands-on casualty simulation scenarios. Notably,
eliminated the point-based tracking system used to vali- SOCMMSC meets the biennial requirements for med-
date sustainment training. ics to maintain their Advance Tactical Paramedic (ATP)
certification, a deployment requirement for all SFMS.
The current SFMS medical sustainment program has
undergone no significant changes since those introduced NTMs are directed and coordinated at the Group level
after the 1994 survey. The medical sustainment program under the supervision of each Special Forces Group Sur-
currently comprises three training events/requirements geon. Required every 2 years, these modules provide a
that are designed to maintain the medical knowledge venue for tailored sustainment training at the organi-
and skills of SFMS in different areas: Medical Profi- zational level. This training has historically included
ciency Training (MPT), the Special Operations Combat modules on preventive medicine, physical therapy, vet-
Medical Skills Sustainment Course (SOCMSSC), and erinary medicine, dental medicine, and behavioral health
nontrauma modules (NTMs). and been delivered in a variety of formats. NTMs are
6
intended to sustain the many medical skills not covered
MPT focuses on clinical and hospital-based medical care during MPT or SOCMMS but are required to maintain
and must be conducted for 2 weeks every 2 years (or competency in performing the SFMS critical tasks out-
for 4 weeks every 4 years) at a local hospital or clinic. lined in STP 31-18D34-SM-TG/C1, Soldier’s Manual/
During this training, SFMS are on temporary duty away Trainer’s Guide MOS 18D Special Forces Medical Ser-
from their units and participate in the delivery of hos- geant Skill Levels 3 and 4 (with Change 1). The require-
7
pital/clinic-based medical care under the supervision of ments for maintaining other tactical and combat skills
a physician or physician assistant. This training is de- (e.g., weapons training, special skills, language) and the
signed to refresh and sustain general medical and surgi- current operational tempo have limited the frequency and
cal skills that the SFMS do not normally perform while attendance at NTMs. Given the continued emphasis on
8
serving in garrison. Due to the high operational tempo Special Forces and their ability to support the national
5
of the past 12 years, however, it has been difficult for security strategy with a light-footprint approach, it is un-
SFMS to find the required time to attend MPT. Instead, likely that the tempo of their operations will decrease. 3,9
alternative credit has been granted for medics who “vol-
unteer” at US military medical facilities while deployed. The challenges of maintaining medical skills in an op-
Because of the focus of combat operations, training in erational context, however, are not unique to the Special
deployed medical facilities has focused on trauma and Forces medical community. The military medical estab-
emergency care instead of basic primary and traditional lishment, in general, has wrestled with the right tech-
hospital care, and fails to sustain the medical skills niques to sustain competency in medical skills in both
needed to provide care in nontrauma situations. While garrison and deployed environments. Deering et al., for
10
previously managed at higher levels, recent changes to example, conducted a large survey of military physicians
the MPT program have aligned specific Groups with lo- who were deployed overseas, to measure their perceived
cal military and civilian hospitals. These changes have degradation of surgical and clinical skills. They con-
11
decentralized the programs to the Group Surgeons for cluded that most hospital-based physicians perceived a
implementation in an effort to improve the quality of decrement in their skills when deployed for more than
instruction and rotational objectives. 6 months and required 3 to 6 months upon their return

60 Journal of Special Operations Medicine Volume 14, Edition 4/Winter 2014