Page 149 - JSOM Spring 2020

TABLE 1 Documented Team Resuscitation Interventions (N = 173 assistant than the other way around. Cross training with the
Human Casualties) team and the procedures on the operational table is the key for
Intervention n (%)* utilizing the NSOCM as the first assistant.”
Any IV access 88 (50.9)
6
Central venous access 15 (8.7) Kyle N. Remick, MD, states that 18D and SOCM are mem-
IO access 2 (1.2) bers of the team, especially in Special Operations.
Any airway intervention 51 (29.5)
Endotracheal intubation 50 (28.5) Additionally, according to The Golden Hour Offset Surgical
Treatment Team Operational Concept, the GHOST concept
7
Cricothyrotomy 1 (0.6) was created from FST personnel, using small teams of five to
Thoracostomy tube 16 (9.2) seven providing mobility to jump forward with SOF, security
Splinting 12 (6.9) assets, even with MEDEVAC platforms, and establish triage
Whole blood administration 6 (3.5) and operating areas to support the mission with resuscitative
Mean whole blood units, n 3.3 and surgical care. GHOST have two team loadouts: a light
Packed RBC administration 36 (20.8) and a heavy package for flexibility. The makeup of the teams
Mean packed RBC units, n 5.2 is shown in Table 2.
Thawed plasma administration 19 (11.0)
TABLE 2 Team Composition
Mean thawed plasma units, n 5.6
Fluid- or blood-warming device 10 (5.8) GHOST Light Team GHOST Heavy Team
(5 or 6 members)
(7 members)
Drug administration 1. Two surgeons – 01 surgeon 1. Two surgeons
Fentanyl 32 (18.5) 2. One CRNA 2. Two CRNAs
Versed 19 (11.0)
3. One surgical technician 3. One surgical technician
Ketamine 19 (11.9) 4. One nurse 4. One nurse
Morphine 27 (15.6) 5. One medic (68W) 5. One medic (68W)
Tranexamic acid 4 (2.3)
Antibiotics 46 (26.6)
Other medications (i.e., paralytics, 58 (33.5) Creating a SOST can also serve as a developmental effort for
antiemetics, or NOS) national needs in operational surgical support close to the Spe-
Patient warming interventions (external or 28 (16.2) cial Operations teams. One of the most difficult objectives is
internal) to have a surgical asset ready for operating 20–30 minutes
Abbreviations: IV, intravenous; IO, intraosseous; RBC, red blood cell; from POI, and these proficiencies can provide the expertise to
NOT, not otherwise specified. evolve war surgery employment nationally.
*Blood product use reported in No. of units.
Source: Dubose et al. 5 Using the NSOCMs as a member of a SOST—not only as a
leader but also as a medical assistant—is not a new concept
or emergency treatment plan. There is not a function within a but, as already mentioned, this report is based on the follow-
SOST in which an NSOCM cannot assist at the operating ta- ing statement: What is now possible, what is now impossible,
ble when necessary once properly integrated. He or she is, and what is possible in the future, what is necessary to do for the
can be, the medical force multiplier of the team. best level of care for injured operators in absence of Role 2
MTF for some hours.
Far more important in the success of a SOST is the task of or-
ganizing the roles and functions based on the skills of the team
members, to promote the best efficiency in teamwork. Conclusion
After consideration of existing literature and analyzing the
At this point we will lay out an example and a statement that results from the interviews, the following conclusions were
specifically address the role of an NSOCM as support in pri- reached.
mary planning. There are EU countries that have not yet devel-
oped SOSTs, for which specific medical professionals, such as The primary role of an NSOCM in a SOST is to be the oper-
surgeons, anesthetists, and emergency medicine physicians, are ational team leader. Certain requirements need to be taken in
required. And working in conventional environment, inside the consideration—maturity, ability to work as a team member
safety that a hospital provides, is very different from working in with more advanced medical expertise personnel, prior com-
an abandoned house under fire or on board a moving platform. bat experience in Special Operations, leadership and planning
skills, proficiency in medical skills with potential, and modesty
The tactical environment requires specific skills, and the per- to learn beyond scope of practice for contribution to the team.
sonnel of a SOST need to possess those skills. When the ques- Tactics and treatment can be in conflict; it is critical to have
tion, “Who would you decide to train for a SOST—a nurse or an experienced medic as the tactical leader to understand and
an NSOCM?” was posed to the experts, the responses pro- possess the overall view.
vided the same conclusion: Train the NSOCM to specific skill
sets like instrument handling, surgical first assistant skills, and • The role of the NSOCM as a surgical assistant was the
preoperative and postoperative skills and management. most interesting and challenging consideration to an-
alyze. In this unrecognized territory multiple opinions
As a member of a SOST said: “It is much easier to train an were brought forth. The skill set of the NSOCM is very
NSOCM [in] the necessary skills to perform as an operator good, but if we need to use an NSOCM as a primary

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