Page 135 - Journal of Special Operations Medicine - Winter 2016

occlusive dressings, needle chest decompression, splint- [ tactics, techniques, and procedures]. We had rehearsed
ing, sternal IO [interosseous infusion (supplies)], limited our actions numerous times. Our partners in the 274th
fluid resuscitation, and analgesics. These treatments FST were former SOF unit members, which gave them the
worked fairly well in helping to stabilize the patients long same kind of familiarity with our equipment and setup.
enough to reach our surgical teams. During the flight, I think it is an important reminder that we have to train
treatments included establishing definitive airways using the way we expect to fight and that we should cross-train
rapid-sequence intubation, ventilator management, sur- with supporting units to enhance interoperability. Medical
gical control of internal hemorrhage, placement of chest planners also need to consider how to provide advanced
tubes, measures to reduce increased intracranial pressure, resuscitation and surgical stabilization in remote areas
blood transfusion, fluid resuscitation, antibiotics, analge- without a strong medical support and evacuation system
sics, and antiemetics. These treatments were continued in place. This will have significant relevance in our ongo-
at the Air Force hospital in Oman. The greatest challenge ing combat operations and relates directly to the work
after arrival at the MTF was repair of the subclavian artery SOF is doing to improve prolonged field care.
laceration, which involved multiple vascular surgeons and
massive blood transfusion. Tell us about your transition from military Special
Operations medicine to civilian (law enforcement)
How were the patients evacuated, and is there Special Operations medical support.
anything about the evacuation that is memorable? I knew that when I left the military I wanted to continue
The patients were evacuated by MH-60 from the point professionally supporting those that keep our nation safe
of injury to Rhino and then by C-130 to Oman. This was every day. During my last several years in the Army, I be-
a daylight mission and the C-130 engaged in significant came involved in efforts by the National TEMS [Tactical
evasive maneuvering due to antiaircraft threat warnings Emergency Medical Support] Initiative and Council to es-
while over Afghanistan, which resulted in a very chal- tablish minimum training standards for law enforcement
lenging environment for patients and medical providers Special Operations medical support, which introduced
alike. I still have a very vivid memory of blood and vomitus me to many of the leaders of the civilian tactical medi-
sloshing back and forth as the aircraft rolled from side to cine community. I was fortunate enough during my final
side. Medical aid bags that were not properly secured or military assignment to have the opportunity to complete
closed readily spilled supplies across the aircraft. the 770-hour Florida law enforcement academy (5 nights
a week for 10 months), followed by appointments as a
Were any changes implemented after the AAR [after- reserve deputy and then medical director for a sheriff’s
action review] on the incident? department special response team. I made an effort to
A heavy emphasis was placed on developing better surgi- work with different agency elements (e.g., road patrol,
cal packages, such as operating tables that could be rap- aggressive driver enforcement, marine patrol, narcotics
idly employed with a minimum of setup and had supplies interdiction) to broaden my understanding of the chal-
and equipment stored in integrated doors. From a plan- lenges faced by law enforcement officers and completed
ning perspective, there was a renewed focus on looking a SWAT [Special Weapons and Tactics] officer course. I
at ways to integrate far-forward surgical and resuscitative also always tried to apply what I learned in military SOF
teams into the tactical plan. to advocate to law enforcement agencies the utility of
universal training in tactical medicine. For example, I was
What was the significance or impact on the unit, able to [obtain] C-A-T tourniquets [Combat Application
command (JSOC; Joint Special Operations Command) Tourniquet ; Composite Resources Inc., http://combat
®
and task force (Sword) of executing this mission? tourniquet.com/] with holsters for all of my fellow cadets,
This was the first time that the concept of utilizing far- and the academy made it a mandatory part of the uniform.
forward surgical teams aboard evacuation aircraft was Instructors and command staff took notice, the practice
validated under actual combat conditions. While SOF had caught on, and today every deputy in that department car-
practiced this capability for years during joint readiness ries a tourniquet. My goal today is to use my experience in
exercises and other training missions, it was incredibly re- both the military and law enforcement Special Operations
warding to see it save lives during real-world operations. communities to bridge the differences between them, in-
The success of this mission provided compelling evidence crease dialogue, and encourage the exchange of ideas
that employing advanced medical assets as close to the and knowledge.
point of injury as operationally feasible could have signifi-
cant impact on casualty mortality and morbidity. What do you see as the primary difference
between military Special Operations medics and law
What lessons would you like to emphasize to our enforcement (civilian) Special Operations medics?
readers? Important take-homes that may still be Do you view them as equivalent in training, scope
relevant today? of practice, etc.?
From a medical perspective, the operation went very There are a number of differences and similarities be-
well because everyone involved was extremely familiar tween the two. Both perform critical roles in extremely
with unit SOPs [standard operating procedures] and TTPs challenging and dangerous settings. I would say military

Special Talk: An Interview 119