Page 131 - JSOM Spring 2021

An Ongoing Series

Tactical Medicine Training for SEAL Mission Commanders

Frank K. Butler Jr, MD

he following article was originally published in Military Medicine in July 2001, before
the attacks of 911 focused US military attention sharply on Afghanistan. The paper em-
Tphasizes a number of points that bear revisiting now that US involvement in the Middle
Eastern conflicts have largely been concluded:

1. Although the TCCC Guidelines outline the principles of battlefield trauma care, they
do not address the spectrum of tactical scenarios in which combat casualties may be
encountered.
2. Different tactical scenarios may require significantly different small-unit casualty re-
sponse plans for the same injuries.
3. Medics run the unit's medical care, but combat commanders run the mission. Thus,
small-unit commanders must know not just how to perform lifesaving TCCC measures
such as applying a tourniquet and opening a casualty's airway. They must also be
trained in how to conceptualize the array of casualty scenarios that could occur on
a given mission (What injuries? How many casualties? Impact of the mission environ-
ment? What phase of the mission?) and construct unit response plans for each of the
casualty scenarios judged to be significant for that particular mission.

The “Tactical Medicine for SEAL Mission Commanders” course was implemented at the
Naval Special Warfare Center in April 1998 with the support of then-CAPT Joe Maguire, the
commander of the center at that time. Although that course was developed specifically for
SEAL mission commanders, it has great applicability for leaders in other Special Operations
units.
As the US military looks beyond Afghanistan and Iraq to plan for the next conflicts that
our nation may face, the casualty scenarios that would be likely to occur in those conflicts
should be considered not just by military physicians, physician assistants, corpsmen, medics,
and pararescuemen but also by the combat leaders who will command them. This article pro-
vides some insights about how to approach that planning.

This article was previously published in July 2001, Military Medicine,
International Journal of AMSUS. Permission to reprint this article was granted.
Disclaimer: The opinions and assertions expressed by the author are his alone and do not
necessarily reflect the views of the Departments of the Navy or Defense.

AbstrAct apparent that a customized version of this course suitable for
The Tactical Combat Casualty Care (TCCC) project ini- small-unit mission commanders is a necessary addition to the
tiated by Naval Special Warfare and continued by the US Spe- program. This paper describes the development of a course in
cial Operations Command has developed a new set of combat Tactical Medicine for SEAL Mission Commanders and its tran-
trauma care guidelines that seek to combine good medical care sition into use in the Naval Special Warfare community.
with good small-unit tactics. The principles of care recom-
mended in TCCC have gained increasing acceptance through- IntroductIon
out the Department of Defense in the four years since their In the past, combat trauma training for Special Opera-
publication and increasing numbers of combat medical person- tions corpsmen, medics, and pararescuemen (PJs) was based
nel and military physicians have been trained in this concept. on the principles taught in the Advanced Trauma Life Support
Since casualty scenarios in small-unit operations typically pres- (ATLS) Course. In 1993, the Naval Special Warfare Command
1
ent tactical as well as medical problems, however, it has become established a formal requirement to review the management

127