Page 148 - JSOM Spring 2020

and as the medical planning consultants for any SOF opera- patient care so that he or she can have the overall image of the
tion. These attributes alone, with the mix of proximity of sur- operational status and see the red flags in the mission. In this
gical support provides great synergy and efficiency for the first way, he or she creates a climate of safety for the surgeon to per-
hour from the POI. The International Special Training Cen- form interventions without the pressure of tactical awareness.
ter (ISTC) in Pfullendorf, Germany, developed the NSOCM
course in 2015 to provide highly trained medics throughout Mass Casualty Triage
European Union (EU) countries. NSOCMs are cross-trained SOST Saves Hundred During Deployment profiled a US
4
Operators to provide both capacity in operational manpower SOST who was deployed for Operation Inherent Resolve.
and medical knowledge with an advanced scope of practice to This SOST team experienced 19 mass casualty events during a
treat and sustain combat trauma in an austere environment. 2-month period. The report also notes a mass casualty expe-
rience of six casualties with trauma in the chest and abdomen
According to Finland’s Special Operation Surgical Team in and triaging them by using a handheld ultrasound device. A
Action, countries like Finland have already met the necessity mass casualty is a stressful situation in which the team leader
3
of both highly trained medics and surgical teams culminat- is also responsible for keeping the team functioning in organi-
ing with the integration of the first NSOCM from the Nordic zation, logistics, and evacuation.
training course during the first Finnish SOST deployment in
spring 2016 to Operation Inherent Resolve in Iraq. The NSOCM medical skill set can contribute greatly in this
challenge, providing excellent assistance in addition to the
emergency medicine physician if necessary. The medics are ex-
Hypothesis Analysis
tensively trained in many mass casualty scenarios during the
Team Leader NSOCM course and further adapted to use limited amounts of
When we consider the SOST either tactically or medically, material and without access to advanced tools normally found
both dynamics require quality leadership. An NSOCM could in hospitals, especially during prolonged field care. Modern
provide great skill and experience when it comes to tactics, medical technologies like handheld ultrasound devices and
techniques, procedures, and personalities of the operational portable electrocardiograms, are tools in which NSOCMs are
unit. His or her traits in communication, weapons handling, additionally trained to use. 8
safety procedures, medical planning, and leadership are criti-
cal and necessary for any Special Operations team. It is also Medical Assistant
important for the team members to have confidence with their Experience with Prehospital Damage Control Surgery in
team leader and his or her role as the tactical decision maker. Modern Conflict – Results from SRT reports a documented
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team resuscitation interventions table (Table 1) in which there
The prognosis for the “golden hour” theory is poor. The op- are all the initial interventions delivered by the surgical resus-
erating terrain is continuously changing, and the ability to citation team in 173 patients in the past 12 years.
have the perfect level of care on quick response MEDEVAC
platforms is becoming more and more difficult. In an absence According to the NSHQ Medical Standards and Training Di-
of an alternative, the goal is to position a SOST in the right rective 75-001, Annex B, the NSOCM Critical Task List is a
1
place at the right time, optimally providing the patient an op- defined scope of practice of more than 150 capabilities and
erating table 20 minutes from the POI. This is a very difficult interventions. Damage control resuscitation, among others, is
goal to achieve. Therefore, it is essential for a SOST to have one of the capabilities of a Special Operations combat medic.
a team leader to operationally enable the team to achieve that
challenging objective. As both medical planner and liaison In addition to the role of the team leader, an NSOCM is a
between the SOST and the SOF element, the NSOCM is a valuable asset not only for his or her tactical background but
valuable asset to the team’s objective while at the same time for his or her medical knowledge and scope of practice. We
minimizing risk. can make the assumption that the skills exist for an NSOCM
to perform and support damage control resuscitation inside a
A SOST has specific personnel requirements. Minimally, it re- SOST.
quires at least a surgeon, an anesthesiologist, and an opera-
tional nurse. Those clinicians have the medical knowledge to However, there are more tasks than resuscitation that the
support the medical mission of the team, but they lack tactical SOST has to perform. As a SOST member stated, “A SOST
training, awareness, and necessary operational experience. As has to deal with what is happening inside the cage”—surgical
important as it is for an NSOCM to sustain his or her medical interventions that require far greater skill than the scope of
knowledge by cross training with the team inside a trauma practice of an NSOCM.
center, the same priority exists for the medical experts to be
trained and led in tactical procedures, weapons handling, and SOSTs have existed for many years (the first FMST was de-
standard operating procedures, making them comfortable veloped in 1995, and the first Air Force SOST was established
with discomfort. This is where experienced noncommissioned in 2002), but as Michael Hetzler said during his interview,
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officer leadership can fill this important gap. “Having an NSOCM is the most flexible part of the team, and
flexibility is key to keeping the team low in numbers and high
When a surgeon has a patient, he or she stands back, analyzes in mobility.”
the facts, mechanism of injury, vital signs, and further exams
so that he or she can have the overall image of the patient’s sit- As in all the operations, planning is in accordance with the
uation before he or she intervenes. That is the same role of an PACE algorithm, meaning that you need redundancy in plan-
NSOCM as the operational team leader in a SOST. The team ning to cover the worst-case scenarios. An NSOCM can fill the
leader is the member of the team who stands back from the role of medical assistant in any primary, alternate, contingency,

142 | JSOM Volume 20, Edition 1 / Spring 2020