Page 55 - JSOM Winter 2017

Table 1 SOF Truths professionals, just as standard models for training large num-
Truth 1: Humans are more important than hardware. bers of troops are not designed to produce SOF.
People, not equipment, make the critical difference. The right
people, highly trained and working as a team, will accomplish the The Army Medical Department (AMEDD) provides the major-
mission with the equipment available. On the other hand, the best ity of medical providers for combat deployments during times
equipment in the world cannot compensate for a lack of the right of war. It also simultaneously cares for millions of beneficia-
people. ries at military treatment facilities (MTFs) worldwide. Because
Truth 2: Quality is better than quantity. of the enormous requirements of the beneficiary mission,
A few people, carefully selected, well trained, and well led, are nonacute care constitutes the vast majority of medical provid-
preferable to larger numbers of troops, some of whom may not be ers’ experiences in garrison. Trauma does not fall into the top
up to the task. 10 medical conditions at MTFs. The limited opportunity to
Truth 3: SOF cannot be mass produced. practice trauma care regularly “exacts a toll on the combat
It takes years to train operational units to the level of proficiency casualty care readiness mission,” leaving medical providers
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needed to accomplish difficult and specialized SOF missions.
Intense training in SOF schools and units is required to integrate unpracticed in caring for acutely injured patients routinely.
competent individuals into fully capable units. This process cannot
be hastened without degrading ultimate capability. Military surgeons, in particular, are debilitated by the defi-
Truth 4: Competent SOF cannot be created after emergencies occur. ciency of trauma and acute illness in their practice opportuni-
Creation of competent, fully mission-capable units takes time. ties. In 2015, the proportion of surgeries performed by Army
Use of fully capable Special Operations capability on short notice surgeons working at MTFs was 76% less than that performed
requires highly trained and constantly available SOF units in by their counterparts in civilian practice. This included far
peacetime. fewer major abdominal, head and neck, thoracic, and vascu-
Truth 5: Most Special Operations require non-SOF assistance. lar surgeries, which compose the anatomic center of gravity
The operational effectiveness of our deployed forces cannot be, for trauma surgery. Most military trauma surgeons do not
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and never has been, achieved without being enabled by our joint practice trauma care regularly, instead caring for healthy ac-
service partners. The support Air Force, Army, Marine, and Navy
engineers, technicians, intelligence analysts, and the numerous tive-duty Soldiers, dependents, and retirees on an elective and
other professions that contribute to SOF have substantially outpatient basis. Ironically, Army Reserve trauma surgeons
increased our capabilities and effectiveness throughout the world. are often better prepared to care for Combat wounded than
their active-duty counterparts by virtue of being employed at
providers who seldom care for acutely injured patients, is civilian trauma centers when not mobilized.
limited in the Army inventory but critical to support SOF
operations. 6 The AMEDD operates several “just-in-time,” predeployment,
combat-trauma training courses to mitigate the lack of prac-
High-quality outcomes in medical care are the result of high- tice opportunities in trauma care. These include the week-long
volume practice across the spectrum of surgical specialties, Tactical Combat Medical Course, the 3-day Emergency War
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including trauma. Studies have demonstrated the life-sav- Surgery course, and 2-week rotations for deploying forward
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ing value of trauma professionals on the battlefield, as well. surgical teams at the Army Trauma Training Center at Ry-
In Iraq, a busy battalion aid station staffed by emergency der Trauma Center in Miami, Florida. This is appropriate and
medicine-trained personnel reported a 7.5% mortality rate, essential training, but it falls short of the necessary years of
compared with the higher theater mortality rate of 10.5%. experience to develop individuals as true experts in trauma.
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Certified critical care flight paramedics reduced 48-hour mor-
tality in medical flight operations by nearly 50% compared The current model for training Army clinicians to provide
with standard Army medical evacuation units. Poor surgical deployed trauma care is suboptimal for the ARSOF mission.
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skills and judgment were found to be critical factors in 70% of Most Army medical providers, because of the nature of the
preventable deaths at a deployed Combat Support Hospital. Army medical system, cannot be considered trauma profes-
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These study findings clearly suggest that better-trained medical sionals and are not expert in care of civilian or combat trauma
professionals provide higher-quality care and save more lives patients. ARSOF, instead, is prepared to work with Army
both in civilian and combat settings. MEDCOM to create a new model for generating small teams
of true experts in trauma care.
High-quality trauma professionals ought to be the dominant
concern for manning and training ARSOF surgical teams. SOF Truth 4: Competent Special Operations Forces
High-quality trauma care by clinicians is acquired only after Cannot Be Created After Emergencies Occur
working full-time for many “years . . . at a high volume and
best quality Level I trauma center.” 6,12 Competent ARSOF surgical teams, like other SOF units, can-
not be created after the need arises. Just as successful military
operations require upfront investments of time and resources,
SOF Truth 3: Special Operations Forces
Cannot Be Mass Produced so do successful trauma surgical team efforts require similar
upfront investments in manning, equipping, and training be-
Intensive training over many years is fundamental for SOF to ac- fore emergencies occur.
complish dangerous and difficult missions. The same is true for
trauma professionals. Trauma surgeons complete a minimum ARSOF trauma professionals should be recruited deliberately
of 7 years of postgraduate training after medical school; other and hand selected for performance and potential. The AMEDD
trauma professionals have similarly demanding requirements. Professional Filler System (PROFIS) for providing medical per-
The standard training models for mass-producing military med- sonnel to deploying units will be a significant obstacle to devel-
ical providers are simply inadequate to produce ARSOF trauma oping expert trauma teams within ARSOF. Inherent problems

SOF Truths for ARSOF Surgical Teams | 53