Page 47 - Journal of Special Operations Medicine - Summer 2015

inconsistent, and not part of many organizations’ and Emergency Medicine or operational medi-
battle drills and tactical planning. Medical evacu- cine fellowship program could be one method
ation doctrine is not taught, provided, or even to provide this skillset. Furthermore, the as-
discussed in the curriculum of our Warfighters signments process often fails to match those
professional military education courses. with the most relevant training and experience
c. Medical leaders to these critical operational, prehospital roles.
2. Discussion
1) The Army Medical Department (AMEDD) a. Commanders. The required importance of organi-
BOLC (for Health Professions Scholarship zational standards and competencies in prehospi-
Program physicians) is 7 weeks long, while In- tal care are not formally taught to our Warfighters.
fantry BOLC is 17 weeks. The Navy’s Officer Subsequently, line commanders must rely on
Indoctrination School is 6 weeks in Newport the expertise, leadership, and advocacy skills of
News, Virginia. The Navy Basic Medical De- their assigned medical personnel. If non-medical
partment Officer Course follows it, and is 12 leaders don’t make battlefield trauma care a pri-
hours of online training. The Navy’s 2-week ority for their units, then it won’t be a priority
Advanced Medical Department Officer Course for their units. Only by demonstrating the value
is designed to improve the hospital administra- of evidence-based process improvements will we
tion, competencies, and Bureau of Medicine achieve the necessary support from line leadership
management skills. The curriculum does not as ultimately, they are responsible for enforcing
include operational medicine.
2) Many medical officers in the DoD do attend the standard of care and requiring the standard of
performance from their operational medics.
the Combat Casualty Care Course (C4), which b. In order to effectively integrate the battlefield op-
focuses on battlefield (including prehospital) erations system of military health care into the
trauma care. However, TCCC Guidelines have battle space, Tactical Combat Casualty Care must
been inconsistently and incompletely incorpo- be integrated at all levels within maneuver forces.
rated into the C4 training curriculum. Navy This must occur within the Services’ professional
Medical Corps officers generally do attend the military education courses at all levels from initial
C4. Army Physician Assistants and Air Force entry training to the senior service academies.
Medical Corps officers may attend, but are not c. Tactical Combat Casualty Care and medical evac-
required to do so.
3) Medical Corps of the Army may attend the uation doctrine is a method to sustain combat
power with the battlefield operating systems of
AMEDD Captain Career Course. However, combat service support (CSS). Tactical and opera-
the target officer is a Lieutenant Colonel, as tions proficiency of the TCCC competencies is an
the course is required for promotion to Colo- asset to maneuver forces that must be integrated
nel. Additionally, there is a systematic problem into the Warfighters common operational picture.
with a lack of Medical Corps officer seats in To be effective, the TCCC must be part of a coor-
the class. The Navy has no formal professional dinated combined arms action.
military educational track for career progres- 3. Findings
sion after initial entry training.
4) Junior officer physicians and physician assis- TCCC and medical evacuation doctrine is not routinely
trained, educated or integrated into the professional
tants are most often assigned as the senior staff military education system. Nor, is the practice of TCCC
medical members to tactical units (battalion or or medical evacuation doctrine a formally evaluated
brigade surgeon) without any prior staff train- competency of the individual Warfighters or leaders.
ing or experience as a staff officer.
Operational medical leaders are not optimally pre-
5) Medical Leaders. Most medical curricula are pared to recognize the importance of a robust, pre-
forced to train to time vs train to standard. hospital care system, or equipped with the requisite
None effectively focus on or develop prehos- knowledge, skills, or experience to build or sustain such
pital care or oversight as specified competen- a system within their unit.
cies, particularly as it pertains to the systematic
delivery of prehospital care. Some course of- Facilities
ferings fail to target the appropriate audience
of attendees to best ensure proficiency for 1. Observations
those most likely to be assigned to operational None
medicine roles. Nor, are there structured ca- 2. Discussion
reer pathways to develop and sustain expertise None
in the realm of prehospital care and systemic 3. Findings
oversight. A combined Aerospace Medicine None

Saving Lives on the Battlefield (Part II) 37