Page 131 - JSOM Summer 2019

Background they have on hand.” SOF medics are often required to pro-
vide combat casualty care training to host-nation forces. Fre-
SOCMSSC, housed at the Joint Special Operations Medical quently, nations that need this type of assistance from the
Training Center (JSOMTC), is the sole refresher for the Spe- United States lack the means to purchase the same medical
cial Operations Advanced Tactical Paramedic (SO-ATP) certi- equipment. SOF medics must frequently demonstrate impro-
fication. The course, 2 weeks in length, is conducted 22 times visational techniques using raw materials procured from local
per year with an annual attendance capacity of just more than sources to maintain credibility with their partners.
1,300 SOF medics. SOCMSSC serves as a forum for discussion
of techniques, experiences, treatment preferences, and lessons “How many hemostatic dressings, limb tourniquets, and cric
learned. SOCMSSC is where the lessons discussed below were kits could I buy for that much money?” A cursory web search
discovered, refined, and broadcast back to the force. Some of for commercially available junctional tourniquets reveals a
the techniques and examples discussed have been applied in price range between $300 and $700. Ideal circumstances call
combat conditions and have resulted in the cessation of hem- for unlimited budgets when purchasing life-saving equipment
orrhage in casualties for whom no manufactured junctional for battlefield use. The unfortunate truth is that cost is a fac-
tourniquet was available.
tor in the procurement of medical gear, sometimes regardless
of the proposed value to the preservation of life. Post–Global
In this article, we try to expose the readers to the SOF philoso- War on Terror (GWOT) budgetary considerations pose a
phy and approach that supports the use of improvised devices, looming threat to the acquisition of medical equipment. This
and in this case, IJTs. Some of the more commonly reported frugality is increasingly evident in mission sets of a scale much
observations and experiences are described Table 1 and the smaller than seen during the height of the GWOT.
following text.
“I have a junctional tourniquet, but it’s in my truck bag.”
TABLE 1 Commonly Reported Observations and Experiences The use of vehicle bags to tote junctional tourniquets may put
Observation/Principle SOCMSSC Students’ Descriptions distance and time between a dying casualty and the life-sav-
Multipurpose items are “All items in my aidbag must have ing treatment they need. If the medic has instant access to
preferred more than one purpose.” the know-how and more rudimentary tools, that delay may
“I already have 300 lb of lightweight
Lightweight items add up be eliminated as a factor in casualty survival. A recent case
stuff to carry around.” in point came from a medic who received penetrating pelvic
“Host-nation forces do not have access trauma while on patrol inside a structure near their vehicle
Host-nation forces to the same equipment, so we have to
lack devices show them techniques with items they convoy. In less than 30 seconds, the medic’s pant leg was sat-
have on hand.” urated with blood. The only individuals on the ground at the
Cost is a consideration “How many hemostatic dressings, limb time were nonmedic Operators. The injured medic had cross-
and trade-off tourniquets, and cric kits could I buy trained his team on improvised junctional tourniquets before
for that much money?” deployment. One of the cross-trained Soldiers reached for the
“I have a junctional tourniquet, but it’s first object within arm’s reach, which happened to be a stain-
Truck and not ruck bag in my truck bag.” less-steel coffee mug. He held the cup in place over the injury
loadout appropriate “What do I have to give up to make with his body weight while another teammate used a strap to
room for this device?” secure it in place. This improvised junctional tourniquet re-
sulted in a cessation of life-threatening hemorrhage, allowing
“All items in my aidbag must have more than one purpose.” the medic to survive through surgery and make a full recovery
This is a mantra frequently overheard at the JSOMTC and in the United States. No commercially manufactured junc-
applied throughout SOF battlefield medicine. This thought tional tourniquet was on site at the time of injury.
process informs every decision the SOF medic makes when
packing an aidbag and offers more flexibility than a “single “What do I have to give up to make room for this device?”
device per problem” approach. A long history of successful An aidbag is considered hallowed ground to a medic. Obses-
use of improvisational techniques reinforces the multipurpose sive preparation and thought go into set-up and layout of the
mentality. SOF medics are often prized for a sense of rugged SOF medic’s aidbag. All one has to do is reach into a medic’s
individualism and adaptability in less than ideal conditions. aidbag without first seeking permission in order to experience
It is this perception of self that may also persuade medics to first-hand the painful consequences of having done so. Before
make do with less rather than seek out the perfect piece of a medic allows a new piece of gear into an aidbag that is to
equipment for each contingency. remain on the body, careful thought will have been put into
the object’s purpose and deployment in an emergency. Junc-
“I already have 300 lb of lightweight stuff to carry around.” tional tourniquets are not small items relative to the size of
Another quote often overheard at the JSOMTC. No matter the typical aidbag. Their bulk is seen as a detrimental feature.
how lightweight a single use item is, a surrogate item with mul- In most cases, something will have to be removed in order to
tiple purposes will ordinarily appear more desirable to the SOF make room for such a large item, and medics often express an
medic, even if that item weighs slightly more than the single-use unwillingness to do so.
item it is replacing. Terms like “cube and weight” are often
used to describe the carrying capacity of the individual. These The steps and principles of improvised inguinal junctional
are strong considerations when planning and packing for a tourniquets are summarized in Table 2 and the following
mission, especially when anticipating a long movement on foot. descriptions.

“Host-nation forces do not have access to the same equip- 1. Apply manual pressure with a hemostatic first! This will
4
ment we do, so we have to show them techniques with items consist of aggressive wound packing with a hemostatic,
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