Page 54 - JSOM Winter 2017

The SOF Truths for
Army Special Operations Forces Surgical Teams

3
1
Jay B. Baker, MD *; Robert E. Modlin ; Ricardo C. Ong, MD ; Kyle N. Remick, MD 4
2

ABSTRACT
The US Army Special Operations Command and Army Medi- The US Army Special Operations Command (USASOC) cur-
cal Command are at a critical junction in Army medical train- rently possesses three Special Operations Resuscitation Teams
ing. Army Special Operations Forces (ARSOF) will receive (SORTs), a deployable unit of action consisting of a flight sur-
Forward Resuscitative Surgical Teams (FRSTs) in the near fu- geon, a critical care nurse, three Special Operations Combat
ture and must establish a training model to enable successful medics, and enlisted personnel trained in laboratory services,
support for ARSOF operations. The military has been directed radiology, and patient administration. The SORT has capa-
4
by Congress through the 2017 National Defense Authoriza- bilities to perform some life-saving interventions far forward
tion Act to embed trauma combat casualty care teams in civil- on the battlefield but cannot perform damage control surgery
ian trauma centers. ARSOF FRSTs should be embedded in the for NCTH. USASOC will receive two Forward Resuscitative
nation’s leading civilian trauma centers to build and sustain Surgical Teams (FRSTs) that will address this potentially lethal
true expertise in delivering trauma care on the battlefield. The shortfall when the SORTs are replaced in a forthcoming force
SOF Truths provide valuable insights into the required condi- design update.
tions for success of this new training paradigm.
The future Army SOF (ARSOF) FRSTs should be considered
Keywords: forward resuscitative surgical team; trauma Special Operations assets and held to the same high stan-
dards as other SOF units. This paper discusses key insights for
manning and training ARSOF FRSTs to high SOF standards
through the lens of the “SOF Truths” (Table 1). We show the
5
Introduction
key to success for ARSOF FRSTs is to assign its professionals
The quiet professionals of our nation’s Special Operations to high-volume, high-quality trauma centers. Only this critical
Forces (SOF) are frequently required to accomplish critical action will develop, sustain, and ensure true expertise for high-
missions in austere and dangerous environments with minimal quality trauma care on the battlefield.
logistical support. They train for many years to achieve the
highest levels of performance and, as a result, enjoy renowned SOF Truth 1: Humans Are More Important
success. The trauma professionals who support Special Opera- Than Hardware
tors downrange when they are injured are likewise expected
to perform at the highest levels of aptitude and skill. They SOF are highly trained masters of the military craft and, as
perform decisive procedures and difficult surgeries in austere, such, are difficult to replace if lost in combat. On the other
challenging conditions to save the lives of the most severely hand, equipment and supplies are expendable and can be more
traumatized casualties. In short, they must be true experts in easily replaced. High-performing medical professionals, as
trauma care to succeed. masters of the medical craft, have similar worth. Many years
of residency and fellowship in busy trauma centers are the only
Despite improvements in combat casualty care over the last path to attain the training and experience to be true trauma
1,2
two decades, a review of combat deaths from 2001 to 2011 3 professionals. Although recent advances in medical technol-
found that almost 1,000 Servicemembers died of potentially ogy have increased battlefield survival, skilled people are still
survivable injuries. Hemorrhage was a factor in greater than required to exercise judgment and perform interventions to
90% of potentially survivable injuries, with 19.2% involving realize technology’s potential to save lives. Expert trauma pro-
junctional hemorrhage and 67.3% involving truncal hemor- fessionals, such as trauma surgeons and other trauma-trained
rhage. These are referred to collectively as noncompressible clinicians, are the indispensable elements for the success of fu-
3
torso hemorrhage (NCTH). Although extremity hemorrhage ture ARSOF surgical teams.
can be effectively temporized by rapidly placing a tourniquet,
casualties with NCTH require time-sensitive surgical interven- SOF Truth 2: Quality Is Better Than Quantity
tion to improve survival. Placing mobile surgical teams far for-
ward on the battlefield is sometimes the only way to achieve Trauma professionals develop excellence only after years of
this in the restrictive operating environments that are the do- training and practice in treating life-threatening injuries. This
main of SOF. high-quality talent pool, compared with most Army medical
*Address correspondence to jay.b.baker@gmail.com
1 LTC Baker, MC, FS, is 528th Sustainment Brigade surgeon, 1st Special Forces Command, Fort Bragg, NC. CPT Modlin is 528th Sustainment
2
Brigade medical planner, 1st Special Forces Command, Fort Bragg, NC. COL Ong is 1st Special Forces Command surgeon and SOF medicine
3
consultant to the Surgeon General. COL Remick is associate professor of surgery, Trauma and Surgical Critical Care, The Department of Surgery
4
at the Uniformed Services University and Walter Reed National Military Medical Center, Bethesda, MD.
52