Page 119 - JSOM Fall 2020

An Ongoing Series

Editorial on the Approach to Prolonged Field Care
for the Special Forces Medical Sergeant

Balancing the Opportunity Cost

James Nicholson, MD, MMAS, MPH, MHA, MBA, FAAFP, FAWM *;
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Justin N. Searor, ATP, NREMT-P ; Andrew D. Lane, ATP 3

INTRODUCTION
America’s adversaries will contest US military superiority in Background
the domains of land, sea, air, space, and cyberspace. Funda-
mentally, these foes seek to disrupt the dominance of Ameri- The definition of PFC remains absent in official doctrine.
can fighting forces through anti-access and area denial (A2AD) Keenan and Riesberg endorsed a description of PFC as being
systems, such as cyber exploitation, electromagnetic jamming, field medical care applied beyond doctrinal planning timelines
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air defense networks, and hypersonic capabilities. According to and utilizing limited resources. Due to the anticipated effects
Training and Doctrine Command (TRADOC) Pamphlet 525- that might be imposed by enemy A2AD systems during a fu-
3-1, these A2AD capabilities create multiple layers of stand-off ture MDO, American forces may encounter PFC scenarios at a
that inhibit the US ability to focus combat power and achieve greatly increased probability. This is in stark contrast to the pre-
strategic objectives in a contested, increasingly lethal, inher- vious “Golden Hour” standard enjoyed for nearly two decades
ently complex, and challenging operational environment. The during the Global War on Terror. However, this is by no means
1
Department of Defense (DoD) plans to mitigate this shift in revolutionary, as these conditions surrounding medical care
enemy strategy through the adoption of multidomain opera- were the norm for the majority of American combat operations
tions (MDO). MDO is defined as operations that converge in history. Thus, PFC is a return to the fundamentals of military
1
capabilities to overcome an adversary’s strengths across vari- medicine that build on the hard-earned lessons of past conflicts.
ous domains by imposing simultaneous dilemmas that achieve
operational and tactical objectives. Within this MDO con- Arguably, the greatest advancement in military medicine of
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struct, medical treatment expectations must shift accordingly the past 40 years is predicated on the epidemiological un-
as the ability to rapidly treat and evacuate patients may be con- derstanding of potentially-survivable battlefield injuries pio-
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strained by enemy action. Thus, the notion of prolonged field neered by Ronald Bellamy. Subsequent research delineated
care (PFC) may be a necessity on the future battlefield. these causes into controllable hemorrhage, tension pneumo-
thorax, and loss of airway. Thanks to this understanding,
3–5
and the appreciation for the relative incidence of each, it be-
As Special Operations Forces (SOF) continue to refine what
PFC entails, it is imperative that an understanding of the inci- comes clear how to optimally prioritize training and equip-
dence and type of diseases that require medical evacuation to ment requirements. This is the essence of opportunity cost; to
higher levels of care be thoughtfully estimated. Armed with an accomplish one action, we must likely compromise on some
understanding of the anticipated epidemiology, effective prior- other action(s). These daily calculations balance risk based on
itization of training requirements and equipment acquisition is the knowledge at hand, particularly when capacity is limited
possible in a manner that is complementary to the overall suc- to leveraging resources against only one option. Acknowl-
cess of the assigned mission. Furthermore, this prior planning edging that no Special Forces medical sergeant (SFMS) can
mitigates risk, as the limitations of money and time impose sufficiently train on every task within the Soldier Training
significant opportunity costs in the short run should the dis- Publication (STP) 31-18D34-SM-TG to a uniform level of
proportionate mix of disease states be pursued, which in turn, proficiency, how should resources be allocated to best prepare
avoids jeopardizing Soldiers’ lives over the long term. for MDO against a dedicated future adversary where PFC is
an increasing probability? This editorial seeks to rationalize
Keywords: prolonged field care; Special Forces medical ser- the prioritization of the 380 tasks within the STP to minimize
geant; evacuation; medical care opportunity cost and maximize success by understanding the
*Correspondence to james.a.nicholson.mil@socom.mil
1 LTC Nicholson is group surgeon, 5th Special Forces Group (Airborne), Fort Campbell, KY; MSG Searor is senior enlisted medical advisor, 5th
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Special Forces Group (Airborne), Fort Campbell, KY; MSG Lane is NCOIC, Prolonged Field Care, 5th Special Forces Group (Airborne), Fort
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Campbell, KY.
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