Page 161 - JSOM Spring 2018

The Death of The Golden Hour and the
Return of the Future Guerrilla Hospital

Farr, Warner D. “Rocky.” The Death of The Golden Hour and the Return of the Future Guerrilla Hospital. MacDill Air Force
Base, FL: Joint Special Operation University (JSOU) Press; 2017. 72 pp. Dr Farr’s monograph is available from JSOU Press
Publications: http://jsou.libguides.com/ld.php?content_id=37706446
Review by Charles A. Neal, PA-C, MPH, MAJ (Ret), US Army

r Farr’s monograph is well referenced and cited, encour- The exercise did not run long enough to develop extended
Daging readers to learn more about medical support in field care, transport, and evacuation.
unconventional warfare (UW), especially medical support to
guerrilla or partisan forces. The 182 citations and numerous Dr Farr’s monograph uses original research and well-refer-
other references to books and other historical field manuals enced military history examples that describe in a historical
mentioned in the monograph offer a treasure of references on context doctrinal and operational strengths and weaknesses of
medical support in UW, which the reader can use to further medical support to different UW conflicts and partisan strug-
explore and expand their knowledge base on the subject. A gles. The introductory chapters define the context and set the
motivation of the author to write the monograph is what he background for the monograph—lack of current operational
identifies as the unsustainable concept of “Golden Hour.” understanding of medical support in UW—and the purposes
After 14-plus years of wars in Iraq and Afghanistan, Speial of the monograph—to educate readers and to spark interest in
Operations Forces (SOF) commanders and Medics have come learning more about UW medical support.
to regularly rely on prompt medical evacu-
ation, with little opportunity to practice The main body of the monograph consists
prolonged medical/surgical care, patient of six separate chapters of well-cited con-
hold, and nursing care. Current US military flicts or struggles that explore the evolution
medical support to SOF centers on doctrine, of doctrinal and operational medical sup-
using medical equipment—sets, kits, and port to UW forces over a period from World
outfits—best designed to support medi- War I to the current Global War on Terror-
cal operations following the Golden Hour ism (GWOT). Dr Farr chose six geographi-
principles of prompt trauma stabilization, cally different examples of medical support
resuscitation, and rapid medical evacuation to UW: (1) reviewing German medical sup-
to a higher echelon of care. However, the port to UW forces in World War I Africa,
problem Dr Farr points out is that current (2) Office of Strategic Services in Europe
global military operations, especially for and guerrilla warfare (GW) in the Philip-
SOF mission sets, increasingly occur in re- pines during World War II, (3) UW medical
mote and austere areas with smaller teams support during the Cold War and Korean
of Service members beyond traditional ro- and Vietnam conflicts, (4) establishment
bust military medical support footprints. of the US Army Green Berets, (5) medical
SOF frequently operates beyond a doctrinal support during small wars of the 1980s and
60- to 90-minute Golden Hour with limited 1990s, and (6) UW medical support during
readily available US standard medical and the current GWOT conflicts. Beyond the di-
surgical support or evacuation times. SOF verse geographic examples cited by Dr Farr,
medical providers and the allied or host nation forces that the his monograph addresses both strengths and weaknesses of
US military partners with must be ready to treat and hold pa- evolving medical support to UW forces, providing examples
tients for extended periods of time and plan for nontraditional of where medical support to UW was sometimes applied suc-
methods of medevac/patient transport. cessfully or of other occasions that were not so successful from
the US military perspective as well as the perspectives of allied
Supporting Dr Farr’s identification of a training and experi- or opposing forces. Dr Farr’s cited examples include histori-
ence gap in current US military medical support to UW forces cal examples of medical support across a broad spectrum of
are after-action reports (AARs) from training exercises and les- irregular warfare operations from counterinsurgency, support
sons learned from other forces supporting or confronted by to insurgencies, and foreign internal defense (FID). The chap-
UW. The medical AAR from a 2015 SOF UW exercise, Jade ters help build the reader’s understanding of recent historical
Helm, highlighted the following issues: limited use of guerrilla medical support in UW conflicts.
auxiliaries and underground to set-up and operate the guer-
rilla hospital and medical evacuation network. Team medical Dr Farr describes historical conventional military medical sup-
equipment, specifically lab sets, arrived later during resupply; port to SOF and educates the reader on how medical support
effectively delaying the establishment of the guerilla hospital. to SOF missions is different. Sometimes, conventional medical

155