Page 27 - JSOM Spring 2021

Rationale and Implementation of a
Novel Special Operations Medical Officer Course

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Preston J. Fedor, MD *; John Dorsch, DO ;
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Chetan Kharod, MD, MPH ; Lorenzo Paladino, MD ; Stephen Rush, MD 5

ABSTRACT
Background: The Air Force Special Warfare Medical Officer course to prepare Air Force Special Operations Forces (SOF)
Course was created to address the lack of operationally fo- medical officers (MOs) – physicians and physician assistants –
cused, job-specific clinical training for medical officers (MOs). for their unique roles in operational medicine and the care and
This course addresses the gap in knowledge, skill, and applica- education of Special Operators. 1,2
tion of operational medicine, as well as the behavioral health,
human performance, education, and medical oversight of Op- Air Force SOFMO positions include performing operational
erators. Methods: The course was designed around the senior medicine, elements of aerospace and dive medicine, instruct-
author’s decade of experience piecing together training for his ing pararescuemen (PJs) and medics, and providing emergency
own role as a pararescue flight surgeon and informed by 5 years medical services (EMS) oversight. The SOFMO also facilitates
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of flight surgeon courses, lessons learned from case studies of the human performance optimization (HPO) program, which
ill-prepared deployed physicians, and input from prehospital includes injury prevention and rehabilitation, performance
medicine subject matter experts. Results: Air Force pararescue training, sports and regenerative medicine, as well as behav-
and special tactics flight surgeons, physician assistants, and an ioral health (e.g., resilience strategies, posttraumatic stress dis-
independent duty medical technician (IDMT) attended. The order [PTSD], depression, family stressors, etc.). 4,5
course consisted of 10 full weekdays of didactics and skills ses-
sions covering theory and application of operational medicine, The senior author (SR) is a radiation oncologist who became
human performance optimization, behavioral health for Oper- a pararescue flight surgeon (PFS) in 2008. After completing
ators, adult education theory, principles of prehospital clinical Officer Training School and the Aerospace Medicine Primary
oversight, and other expeditionary concepts. The course cul- Course at the USAF School of Aerospace Medicine, he assumed
minated with combat casualty care scenario-based exercises, the role of squadron medical director, providing clinical over-
in which the providers performed operational medicine in sight and operational medicine training for his unit. There was
full kit with weapons and simulation rounds. Discussion: For no dedicated course or formal process to prepare him for these
many logistical and practical reasons, civilian medical experi- responsibilities at the time. He devoted several years to attend-
ence, traditional military medical training, existing special op- ing military and trauma meetings, training with other teams,
erations medical courses, and “merit badge” card classes are questioning senior Operators, reaching out to peers in other
not adequate preparation for this specialized role. Focused, services, and consulting subject matter experts to create an ap-
job-specific training should be provided to Special Operations proach to the position, and ultimately, to codify proven meth-
Forces Medical Officers (SOFMO) and, ultimately, to any MO odologies and evidence-informed approaches into a course.
deploying in support of medics or combatants. The goal is to
maximize the success of military medical operations while re- There exists a series of notable missions, described in further
ducing the morbidity and mortality of combat and training detail in the case studies below, in which pararescue or spe-
casualties. Conclusion: This operationally focused MO course cial tactics (ST) general medical officers (GMOs) experienced
can serve as a model for the future training of SOFMO and has clinical and operational situations for which they were never
stimulated discussion for consideration of a joint approach to trained. GMOs are physicians who have completed the mini-
prehospital medical training. mum requirements for licensure (medical school and internship)
before being assigned to an operational unit. These medical per-
Keywords: Special Operations Forces; medical officer; physi- sonnel have not completed a clinical residency, nor have they
cian; prehospital; training; education been afforded specific operational medical training. However,
they are expected to perform as a fully qualified provider. Even
residency-trained physicians in similar positions often lack mili-
tary-specific operational medicine skills and knowledge.
Introduction
Although numerous general and card-bearing courses ex- In the first case study, a GMO physician was providing sup-
ist, there is no operationally focused, comprehensive clinical port to his Air Force ST Team when a PJ sustained a critical
*Correspondence to preston.fedor@us.af.mil
1 Maj Fedor is an emergency medicine and EMS physician and a United States Air Force (USAF) pararescue flight surgeon in the 920th Rescue
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Wing. Col Dorsch is the Wing Surgeon of the 24th Special Operations Wing and the USAF Pararescue Medical Director. Col (Ret) Kharod is
an emergency medicine physician, associate professor in the Department of Military and Emergency Medicine, Uniformed Services University of
the Health Sciences in Bethesda, Maryland, and an advisor for the Committee on Tactical Combat Casualty Care, Joint Trauma System. Maj
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Paladino is an emergency medicine physician, an associate professor of Emergency Medicine at SUNY Downstate Medical Center in Brooklyn,
New York, and a flight surgeon in the New York Air National Guard’s 106th Rescue Wing. Lt Col Rush is the Commander for the 106th Rescue
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Wing Medical Group.
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