Page 28 - JSOM Spring 2021

open head injury. The physician had been supplied with a Methods
generic “med ruck” without the medications or equipment
required to provide critical care. Additionally, he had not re- The target audiences for the inaugural course were USAF
ceived any clinical training in critical care or prolonged field pararescue surgeons, ST flight surgeons, and physician assis-
care (PFC) in austere environments. The second case study in- tants (PAs) who were assigned to operational teams with PJs,
6
volved another GMO who flew in a combat zone to transport or to squadrons conducting training for PJs. One experienced
a mechanically ventilated child via an HH-60 (rotary wing independent duty medical technician (IDMT) also attended.
evacuation), without the benefit of any pediatric critical care
training, rotary wing familiarization, en route care exposure, The course was based on the senior author’s years of observa-
or operational experience to ensure combat effectiveness and tion, experience, and training, during which time he not only
mitigate risk to the patient, force, or mission. The final case defined the role of the PJ MO, but also identified the critical
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study is a GMO whose team was injured from a rocket pro- steps to best prepare someone for the role. As the course was
pelled grenade (RPG) attack and subsequent helicopter crash. being designed for physicians and PAs, the course needed to be
He had to provide emergent care to multiple patients and co- accepted as a legitimate medical course. Continuing medical
ordinate a complex effort to stabilize and support the casual- education credits were granted, an academic affiliation was es-
ties back to the United States. tablished with a distinguished medical center housing state-of-
the-art educational resources, and expert military and civilian
All of these examples reflect the absence of specific train- instructors were recruited.
ing to prepare SOFMOs for the difficulties they will face in
the performance of their job and the potentially devastating The format integrated classroom instruction, hands-on skills,
consequences to the patients, the mission, and the provid- and simulation. The course began with one week of opera-
er’s professional standing and self-image if the unthinkable tional medicine and science lectures interwoven with skills
happens. 8 stations based on the MARCH PAWS format (Table 1). This
portion was taught by academicians at a physician and PA
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From 2014 to 2018, we provided informal 1- to 2-week level. This portion of the course provided a deeper under-
courses to prepare PFSs and ST flight surgeons. This unfunded standing of the “why” and “how” to prepare the MO to teach
effort, which was initially called the Pararescue Medical Direc- the content to Operators. The week ended with 2 days focus-
tor Qualification Course, was supported by the US Air Force ing on human performance optimization (HPO), sports medi-
Air Combat Command’s Office of the Command Surgeon. cine, and behavioral health.
The format of the 1-week course was didactic and round table
discussion. The 2-week course was an operationally focused TABLE 1 MARCH PAWS Format
paramedic recertification course in which the MOs assisted Massive Hemorrhage Pain
with instruction, and 2 of the days were dedicated to flight Airway Antibiotics
surgeon–specific issues. In one course in 2018, only two of the Respiration Wounds
eight MOs had ever performed an intubation or placed a chest Circulation Splinting
tube. It was apparent that MOs needed their own training, not Hypothermia/Head injury
only to feel comfortable teaching the skills to their medics but
also for their own clinical competency. In the second week, the MOs provided simulated care out
of a PJ med ruck, mirroring the scenario-based training they
In 2019, we launched the inaugural formal course dedicated will be expected to provide to their assigned PJs. They also
to training these MOs. The course was open to all services underwent critical skills training in multiple hands-on labora-
but filled with Air Force MOs. It coincided with the cre- tory sessions: cadaver labs taught by surgical and emergency
ation of Air Force Special Warfare (AFSPECWAR) and was medicine specialists, hemorrhage control labs with trauma
thus renamed the Air Force Special Warfare Medical Officer surgeons, and a 6-hour PFC lab. 12,13 The course culminated
(AFSPECWARMO) course. The course was unit-funded and in trauma lanes covering key protocols and common injuries,
received students from multiple commands from across the and a Tactical Combat Casualty Care (TCCC) day with “live
AFSPECWAR enterprise. fire” (long guns and Simunition [https://simunition.com/en/]
®
rounds) to simulate real-world care under fire. This finale em-
The AFSPECWARMO course was designed to address identi- phasized the challenges of delivering high-quality care using
fied gaps in knowledge, skills, and application of unique and trauma protocols, with resources limited to a med ruck and
mission-critical aspects of operational medicine. These gaps wearing full tactical ensemble (“in kit”). This occurred while
are not otherwise addressed or are not emphasized in general executing patient movement for care under fire and tactical
military medical or aerospace medicine training, whose focus field care, as well as preparation for exfiltration with docu-
is necessarily on other areas. 9,10 The goal is for similar training mentation for a formal transfer of care.
to become a standard component of SOFMO or any deployed
MO preparation, whether it is a service-specific effort or a
joint effort across the Department of Defense (DoD). Results
The content of the course is outlined in Table 2.
This report defines the rationale and implementation of the
first-ever comprehensive course specifically designed for Air The inaugural course adhered to the program schedule. The
Force Special Warfare MOs. It may serve as a partial template lectures were designed not only to provide education on patho-
for other SOF teams or may inspire the development of a more physiology and fundamental knowledge of each condition but
generalizable cross-service MO training for operational mili- also to include practical guidance on diagnosis and manage-
tary physicians. ment from specialists and leaders with significant combat and

26 | JSOM Volume 21, Edition 1 / Spring 2021