Page 121 - JSOM Fall 2020

Fundamentally, training must focus on how the organization FIGURE 2 SFMS capabilities organized by risk.
is expected to fight. For any Special Operations unit, the mix
of mission requirements is derived from the unique aspects of
the operational environment where they will likely find them-
selves engaged. While this will vary between organizations,
there are likely to be similarities that will far outweigh the
differences, particularly if we are anticipating a future MDO
against a capable adversary.

US Army Special Forces have nine principal tasks: foreign in-
ternal defense, counterinsurgency, security force assistance,
counterterrorism, special reconnaissance, counterproliferation
of weapons of mass destruction, direct action, preparation of
the environment, and unconventional warfare (UW). It is the
10
authors’ opinion that an UW mission, defined as operations
that enable a resistance movement to coerce, disrupt, or over-
throw a government by operating through or with a guerrilla
force in a denied environment, poses the greatest probability
of a PFC scenario during a MDO. This would be particu- combat; victory is obtained by exerting your will upon your
11
larly true if the SFMS was charged not only with the care of opponent and nothing less. Although we can, and should,
fellow American Soldiers but also with providing healthcare continue to press for ever expanding and increasing skills that
to the fighters, leaders, and families of partner force personnel reduce casualty mortality on the battlefield, this must be bal-
engaged in the UW operation. With recent history as a guide, anced against the opportunity cost of maintaining lethal skills
how can we best prepare SFMSs for UW in an environment within the SFMS and their teammates, whose bravery will ul-
similar to Debaltseve in 2015 or Aleppo in 2016? timately dictate the outcome of future conflicts.
Disclaimer
First, what MOS-specific capabilities must a SFMS apply in or-
der to keep themselves, and their teams, alive? Broadly speak- The authors have no institutional affiliation. The authors solely
ing, we assess this as involving five major areas organized by retrieved and analyzed the information and wrote the entirety of
probability of occurrence against the perceived severity to force this article. The authors have no relevant financial relationships
and mission. Specifically, these areas are operational medical or conflicts of interest to disclose. The views and information
planning (A), providing sick-call, preventive, and travel medi- presented herein are those of the authors and do not represent
cine services (B), performing TCCC (C), conducting PFC (D), the official position of the US Army Special Operations Com-
and treating chemical, biological, radiological, and nuclear mand, the US Army Medical Command, the Department of the
(CBRN) casualties (E) as conceptualized in Figure 2. Army, the Department of Defense, or the US government.
Disclosure
By limiting the training to that which is considered necessary
to provide these capabilities, individual skills from the STP The authors have nothing to disclose.
can be selectively identified that compose the standard crite-
ria that all SFMS will be evaluated on in a trained/practiced/ References
1. Department of the Army. TRADOC Pamphlet 525-3-1, The U.S.
untrained framework for appropriate emphasis. Based on the Army in Multi-Domain Operations 2028. Washington, DC: Gov-
risk assessment completed above, it is also possible to make ernment Printing Office, December 6, 2018.
sound judgments about how to further prioritize within these 2. Keenan S, Riesberg J. Prolonged field care: beyond the ‘golden
high-yield skills as time, funding, and other obligations signifi- hour.’ Wildern Environ Med. 2017;(28):135–139.
cantly restrict training opportunity. Again, accepting the real- 3. Bellamy R. The causes of death in conventional land warfare: im-
plications for combat casualty research. Mil Med. 1984;2(149):
ity of opportunity costs, we need to emphasize that training in 55–62.
PFC should complement the overall SFMS skill requirement, 4. Champion R, Bellamy R, Roberts C, et al. A profile of combat
be balanced in its likelihood of occurrence, and reflect the full injury. J Trauma. 2003;54(5 suppl):S13–S1912768096.
spectrum of pathology that will impose healthcare needs for 5. Butler F, Hagmann J, Butler E. Tactical Combat Casualty Care
our personnel. in Special Operations. Mil Med. 1996;161(suppl):3-168772308.
6. Department of the Army. STP 31-18D34-SM-TG: Soldier’s Man-
ual/Trainer’s Guide MOS 18D Special Forces Medical Sergeant
Summary and Conclusions Skill Levels 3 and 4. Fort Bragg, NC: John F. Kennedy Special
Warfare Center and School; October 2003.
It must be acknowledged that PFC situations on the future 7. Murray C, Reynolds J, Schroeder J, et al. Spectrum of care pro-
battlefield should never be the desired outcome. A PFC sce- vided at an echelon II medical unit during Operation Iraqi Free-
dom. Mil Med. 2055;170(6):516–520.
nario implies that the medic, the patient, and a portion of their 8. United States Army. PMF 5019: Let There be Light. Accessed 11 May
supporting team are effectively immobile, combat ineffective, 2020. https://www.youtube.com/watch?v=IQPoYVKeQEs. 1946.
and no longer seizing the initiative against their foe. Therefore, 9. Belmont P, Goodman G, Zacchilli M, et al. Incidence and epide-
although PFC may represent the pinnacle of tactical medical miology of combat injuries sustained during ‘the surge’ portion of
challenge, and a suitable scenario against which training pro- Operation Iraqi Freedom by a U.S. Army Brigade combat team. J
Trauma. 2010;68(1):204–210.
ficiency can be measured, we must still make every effort to 10. United States Army. FM 3-18: Special Forces Operations. Fort
avoid such a situation despite the fact that the SFMS may be Bragg, NC, May 2014.
fully competent to manage it. The strategic equation remains 11. Joint Staff, Department of Defense. Joint Publication (JP) 3-05,
unchanged despite the shifts in technology surrounding land Special Operations. Washington, DC; 16 July 2014.

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