Page 56 - JSOM Winter 2017

of the PROFIS system include variable personnel quality, defi- professionals. While assaulting a target, a US Special Opera-
cient training, and failure to integrate during deployments. tions Command Operator was critically injured with gunshot
14
The high levels of performance expected of ARSOF surgical wounds to the bilateral chest. Medics on scene temporized the
teams will be unattainable with PROFIS personnel. patient’s condition through multiple interventions and evacu-
ated him to a surgical team on standby near the target. The
Another insidious issue is the barrier to organizational im- surgical team recognized the casualty’s critical condition upon
provement from lessons learned on the battlefield. As provid- arrival and, as he lost a palpable pulse, immediately performed
ers redeploy independently to their parent MTFs, they lose an emergency thoracotomy. Like clockwork, massive pulmo-
collective learning because they neither transfer their knowl- nary vessel bleeding was controlled, open cardiac massage per-
edge gained in battlefield trauma resuscitation to colleagues formed, and blood products infused via central line. Minutes
nor sustain individual skills acquired, because of the lack of later, the patient’s pulse returned and his life was restored. Evac-
trauma care opportunities. To avoid these pitfalls, we recom- uation proceeded and the patient was subsequently discharged
mend formal assignment to USASOC, rather than reliance on in good condition from a hospital in the United States. 18
PROFIS to man these teams.
The high-quality care delivered by the onsite surgical team was
not accidental. A unique asset in SOF medicine led the team:
SOF Truth 5: Most Special Operations Require
Non-SOF Assistance a trauma surgeon who practices full-time trauma surgery at a
civilian Level I trauma center. The surgeon achieved this high
The US military operates a single Level I trauma center at San An- level of performance as a result of daily practice in caring for
tonio Military Medical Center (SAMMC) in Texas. It is a valuable severely injured trauma patients. He was prepared with the
training and sustainment platform but insufficient for training necessary intuitive judgment and reflexive technical skills to re-
ARSOF trauma teams, because of its current use as a busy train- store life to this critically injured Special Operator. Absent the
ing platform for conventional forces. Injecting additional training high-quality care provided by this true trauma professional, the
forces into SAMMC would dilute the current quality of training casualty may not have survived a potentially survivable injury.
for all providers without adding benefit to anyone.
SOF Operators will continue to sustain grievous and life-threat-
Several military and civilian trauma leaders have proposed se- ening injuries as they do battle with our nation’s enemies. They
lectively stationing military physicians at civilian and military deserve the highest-quality medical care available on the battle-
Level I trauma centers, including the General Surgery Consul- field. Embedding ARSOF trauma professionals in the nation’s
tant to the Surgeon General. In 2016, the National Academy best civilian trauma centers will create expert surgical trauma
13
of Sciences called for “integrated, permanent, joint civilian teams with the honed judgment and sharpened skills to live up
and military trauma system training platforms to create and to the SOF Truths. More importantly, expert ARSOF FRSTs
sustain an expert trauma workforce.” The National Defense will save more lives and reduce deaths from potentially surviv-
6
Authorization Act for fiscal year 2017 directed that “trauma able injuries of Special Operators and others on the battlefield.
combat casualty care teams of the Armed Forces led by trau-
matologists of the Armed Forces shall embed within” civilian Disclosures
15
trauma centers, and a separate bill in Congress would award The authors have nothing to disclose.
grants for “military trauma teams to provide . . . trauma
care” at civilian trauma centers on a fulltime basis. Disclaimers
16
The opinions or assertions contained herein are the private
Civilian and military collaboration in trauma care has several views of the authors and are not to be construed as official or
successful precedents. For years, the military has operated suc- reflecting the views of the Department of Defense, the United
cessful trauma-training centers with embedded active-duty States Army Special Operations Command, the Uniformed
medical personnel at civilian trauma centers in Miami, Florida; Services University of the Health Sciences, or any other agency
Los Angeles, California; Baltimore, Maryland; and Cincinnati, of the US Government.
Ohio. Air Force Special Operations Command embeds Spe-
cial Operations surgical teams in Birmingham, Alabama; Las Author Contributions
Vegas, Nevada; and Miami, Florida. A recent Military Medi- All authors approved the final version of the manuscript.
cine article demonstrated the impressive value of the Air Force
model: Embedded surgeons at a civilian Level I trauma center References
performed more than six times the number of surgical cases as 1. Holcomb JB, Stansbury LG, Champion HR, et al. Understanding
their MTF-based counterpart. 17 combat casualty care statistics. J Trauma. 2006;60:397–401.
2. Mabry RL. Challenges to improving combat casualty survivability
Civilian Level I trauma centers in the United States manage on the battlefield. Joint Forces Q. 2015;76:78–84.
many severely injured patients daily, often with injuries similar 3. Eastridge BJ, Mabry RL, Sequin P, et al. Death on the battlefield
(2001-2011): implications for the future of combat casualty care. J
to those encountered on the battlefield. The critical nonmili- Trauma Acute Care Surg. 2012;73:S431–S437.
tary enablers for training ARSOF surgical teams to the level 4. Riesberg J. The Special Operations resuscitation team: robust role
expected by SOF are high-quality, high-volume Level I trauma II medical support for today’s SOF environment. J Spec Oper Med.
centers in the civilian sector. 2009;9(1):27–31.
5. US Army Special Operations Command. SOF truths. http://www
soc.mil/USASOCHQ/SOFTruths.html. Accessed 18 November 2017.
The Way Ahead 6. Committee on Military Trauma Care’s Learning Health System and
Its Translation to the Civilian Sector, National Academies of Sciences,
A recent case report in the Journal of Special Operations Engineering, and Medicine. A national trauma care system: integrat-
Medicine illustrates the real-life value of high-quality trauma ing military and civilian trauma systems to achieve zero preventable

54 | JSOM Volume 17, Edition 4/Winter 2017