Page 155 - JSOM Winter 2018

Adapting to Death

Clarifying the Roles of Special Operations Combat Medics
in Prolonged Field Care

E. Ann Jeschke, PhD

ABSTRACT

I suggest that Special Operations Forces (SOF) medicine As a civilian, I associated combat with death, so when I read
should explicitly acknowledge the Special Operations combat through combat casualty care training manuals, I was in-
medic’s role in attending death. This acknowledgment will al- trigued by the lack of focus on death as a possible medical
low researchers to evaluate and delimit the medic’s needs in outcome for which the SOCM is prepared. I admit that en-
relationship to an expanded set of roles that move beyond gaging the topic of death is not an easy task to accomplish,
life-saving care. This article comprises four sections. First, I because it involves delving into intimate and sacred emotions,
provide background to my argument by exploring some as- experiences, and world views. As the poet Rainer Maria Rilke
sumptions of modern medicine and objections to exploring wrote, “Love and death are the great gifts that are given to
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battlefield death care. Second, I describe how I see the medic’s us; mostly, they are passed on unopened.” Although people
role expanding with the introduction of prolonged field care. may never have a pressing need to explore death as a gift,
Third, I address the implications of the medic’s expanded role neglecting to confront the reality of death in combat casualty
in relationship to role and function stress and strain. Fourth, I care places the SOCM in a compromised position. As obvious
address the moral complexity related to withdrawing or with- as it may seem, failing to address the SOCM’s role in attending
holding care. I conclude by briefly highlighting some of the death precludes the military from developing any means of
implications for future research. In explicitly engaging death preparing her or him for the lived reality of combat. The prac-
as a medical reality for which the medic ought to be prepared, tical result is that an SOCM is forced to face various medical
SOF medicine could set the foundational development for see- realities without formal training and is left to make sense of
ing death as a valuable gift to be explored, not a failure to be his or her reality without support.
avoided or burden to be overcome.
In this article, I suggest that Special Operations Forces (SOF)
Keywords: death; ethics; combat casualty care; prolonged medicine should explicitly acknowledge the SOCM’s role in
field care; Special Operations Medic; death care; unconven- attending death. This acknowledgement will allow researchers
tional medicine to evaluate and furnish the SOCM’s needs in relationship to an
expanded set of roles that move beyond life-saving care. This
article comprises four sections. First, I provide background to
Introduction my argument by exploring some assumptions of modern medi-
cine and objections to exploring battlefield death care. Second,
As armed conflict changes, so too does the reality of providing I describe how I see the SOCM’s role expanding with the in-
medical care on the battlefield. Over the last 15 years, the US troduction of prolonged field care (PFC). Third, I address the
Military has experienced a dramatic decline in combat fatal- implications of the SOCM’s expanded role in relationship to
ities, largely owing to medical evacuations that allowed in- role stress and strain. Fourth, I address the moral complex-
jured warriors to be moved to a fixed medical location within ity related to withdrawing or withholding care. I conclude
60 minutes. Looking to future conflicts, anti-access and area by briefly highlighting some of the implications for future re-
denial may not allow for immediate- or long-distance medi- search. In explicitly engaging death as a medical reality for
cal evacuation. In some instances, Special Operations combat which the SOCM ought to be prepared, SOF medicine could
medics (SOCMs) could be required to provide prolonged care set a foundation for seeing death as a valuable gift to be ex-
in austere settings for days. For this reason, the Combat Ca- plored, not a failure to be avoided or burden to be overcome.
sualty Care Research Program and the Prolonged Field Care
Working Group are defining a comprehensive approach to Background to Argument
prehospital medical care that expands on acute trauma aid at Of importance to this article is the word “explicit.” I am not
the point of injury to treat critical casualties. Although essen- insinuating that death has not always been part of the SOCM’s
tial, this research focuses solely on life-saving measures, and a reality. I suspect that SOCMs have always encountered death
likely result of the changing face of warfare is a greater num- even if their training has not directly addressed or prepared for
ber of battlefield deaths. Consequently, the SOCM will not this reality. As a nonmilitary, nonclinically trained bioethicist,
only be required to provide life-saving medical care but also I have no background to suggest that talking about death or
care for dying warriors. experiencing death among SOCMs never happens. I am solely
Correspondence to E. Ann Jeschke, PhD, 11300 Rockville Pike, Suite 1115, North Bethesda, MD 20852; or stlamazonia@gmail.com
Dr Jeschke a bioethicist specializing in military medicine. She is currently engaged in postdoctoral training under the mentorship of Dr Marjan G.
Holloway, PhD in the Suicide Care, Prevention and Research Initiative at the Uniformed Services University of the Health Sciences.

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