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outcomes, qualitative research will need to query command Disclosures
surgeons and SOCMs. These two groups are vital to future The author has indicated she has no financial relationships
research. Command surgeons are medically accountable to relevant to this article to disclose.
the commanders for any changes in medical training and com-
petency that would affect the tactical reality of the mission. References
SOCMs possess the experiential wisdom that can speak to best 1. Rilke RMR. Rainer Maria Rilke. A-Z Quotes. https://www
practices that have not yet been codified in training doctrine .azquotes.com/quote/1420212. Accessed 25 August 2018.
but are captured through lessons learned in the field. Perform- 2. Gawande A. Being Mortal: Medicine and What Matters in the
ing qualitative studies will offer profound insight into what End. 1st ed. New York, NY: Metropolitan Books, Henry Holt
and Company; 2014.
competencies are necessary to achieve each role as well as how, 3. Kübler-Ross E. On Death and Dying. New York, NY: Scribner;
when, and where training could be effectively implemented to 1969.
form these competencies. 4. Wiard W. M*A*S*H. “Sometimes you hear the bullet.” 20th Cen-
tury Fox Television; 1973. http://www.imdb.com/title/tt0638408
In arguing my position, I evaluated certain objections the /quotes. Accessed 25 August 2018.
reader might have as well as assumptions influencing current 5. Ball JA, Keenan S. Prolonged Field Care Working Group posi-
tion paper: prolonged field care capabilities. J Spec Oper Med.
combat casualty care. I moved forward by showing that ex- 2015;15(3):76.
plicitly acknowledging death allows for a clearer delineation 6. Rasmussen CTE, Baer DDG, Doll BAR, et al. In the ‘Golden
of the SOCM’s expanded roles in PFC and the stresses associ- Hour.’ Combat casualty care research drives innovation to im-
ated with role transition and end-of-life decision-making. Ex- prove survivability and reimagine future combat care. Army ALT
plicitly acknowledging death allows SOF medicine to explore Mag. 2015; January-March:80–85.
how to prepare SOCMs for these new roles and their associ- 7. Lorenzo RAD. Improving combat casualty care and field medi-
cine: focus on the military medic. Mil Med. 1997;162(4):268–272.
ated stresses. 8. Gerhardt RT, De Lorenzo RA, Oliver J, et al. Out-of-hospital
combat casualty care in the current war in Iraq. Ann Emerg Med.
Although not addressed in this article, one of my basic con- 2009;53(2):169–174.
cerns with avoiding the SOCM’s proximity to and intimacy 9. Kalanithi P. When Breath Becomes Air. 1st ed. New York, NY:
with death in combat is that grief is hidden and denied. I hope Random House; 2016.
to return to this topic in subsequent articles. Directly address- 10. Wheaton B. Life transitions, role histories, and mental health.
Am Sociol Rev. 1990:209–223.
ing death as a medical reality allows death care to be part of 11. Ashforth BE, Kreiner GE, Fugate M. All in a day’s work: bound-
a broader medical skill set that is inherent in being a good aries and micro role transitions. Acad Manage Rev. 2000;25(3):
medic. Although this will not make death easy, it might lighten 472–491.
the burden by mitigating the pressure to save everyone. Ac- 12. Greenhaus JH, Beutell NJ. Sources of conflict between work and
knowledging death as a medical reality also allows researchers family roles. Acad Manage Rev. 1985;10(1):76–88.
and policymakers to consider SOCMs’ needs relative to the 13. Ostaseski F. The Five Invitations: Discovering What Death Can
grieving process. When directly addressed and made integral Teach Us about Living Fully. 1st ed. New York, NY: Flatiron
Books; 2017.
to the SOCM’s world view, and when proper grief processing 14. McMahan J. Killing, letting die, and withdrawing aid. Ethics.
occurs, attending death need not be traumatizing. As Osta- 1993;103(2):250–279.
seski said, “Being with patients in these moments certainly had 15. Ulrich CM, Hamric AB, Grady C. Moral distress: a growing prob-
its emotional cost, but it also had its rewards. I don’t think I lem in the health professions? Hastings Cent Rep. 2010;40(1):
ever spent a minute of any day wondering why I did this work, 20–22.
or whether it was worth it. The call to protect life—and not 16. Jameton A. Dilemmas of moral distress: moral responsibility and
merely life but another’s identity, it is perhaps not too much to nursing practice. AWHONNs Clin Issues Perinat Womens Health
Nurs. 1993;4(4):542–551.
say another’s soul—was obvious in its sacredness. 13(p97,98) 17. Elpern EH, Covert B, Kleinpell R. Moral distress of staff nurses in a
medical intensive care unit. Am J Crit Care. 2005;14(6):523–530.
By explicitly addressing the SOCM’s role in attending death, 18. Hamric AB, Blackhall LJ. Nurse-physician perspectives on the
combat casualty researchers can develop best practices for care of dying patients in intensive care units: collaboration, moral
death care. In so doing, they will lead the way to a more hu- distress, and ethical climate. Crit Care Med. 2007;35(2):422–429.
mane and intimate manner of being present to death on the
battlefield. Achieving such medical advancements would not
have left the gift of death unopened and unexplored.
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