Page 29 - JSOM Spring 2021

TABLE 2 Content of the AFSPECWARMO Course and included guidance on performing a behavioral health his-
Introductory Material tory, when to call for help, and where to turn for additional
Operational medicine and SOF structure; The Joint Trauma System; resources. The process and challenges of next of kin notifica-
overview of combat trauma; PJ medical and trauma protocols review tion were also covered, including real-world experiences and
JTS Clinical Practice Guidelines and Background Science the emotional toll it takes on the physician. An orthopedic sur-
Massive hemorrhage; airway management; respiratory failure, ven- geon (who is a PFS in the Air Guard) reviewed the most com-
tilators, capnography; thoracic trauma; burns and burn care; eye mon injuries from training mishaps and combat, instructed
injury; crush syndrome; wound care; blast injury; TBI; pain manage- the students on a focused musculoskeletal exam, taught when
ment; orthopedic trauma/splinting; spinal injuries/C-spine clearance various imaging modalities are indicated, and identified when
Pararescue Flight Surgeon Topics referral to a surgeon is necessary.
Medicine on the “X” – physician’s perspective and experience; death
notifications, and other FS issues; pilot ejection & parachute inju- The table-top skills stations during the first week included
ries; aerospace medical issues; medical leadership; training mishaps checklist-based performance of the established pararescue med-
and mission case presentations; neuroscience of adult learning and
how to teach Operators; quality assurance and medical direction/ ical and trauma protocols (MTPs) on intubating mannequin
training of PJs heads, vascular access models, and assorted other commercial
Human Performance and improvised training aids. Dosages of appropriate training
Rationale for human performance programs in SOF; principles of medications had to be calculated, drawn up, and administered.
training and physiological adaptation; function and pathology con- Proficiency with other TCCC skills were also trained, such as
tinuum; ORM for physical training; pain education; The human placing pelvic binders and tourniquets, and packaging patients
performance model; Integrating as a FS into the performance team; in a Skedco (https://skedco.com/) litter. The goal was to use a
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performance nutrition; injury reduction and injury prevention controlled, non–time-constrained environment to develop the
Behavioral Health skills needed to work out of a ruck, prior to putting on the full
PTSD, depression, and anxiety; how to perform a behavioral health tactical kit and getting on the ground.
exam; behavioral health red flags and brief counseling; notifica-
tions of death, managing tragedy, dealing with grief; performance
psychology issues, stress inoculation, resilience training; role of the This was the first time many of these MOs had worked out of
operational psychologist rucks and in kit, and it enhanced their appreciation of kit man-
Orthopedic Trauma & Sports Medicine agement and efficiency in the field. By participating in realistic
Combat orthopedic trauma – extremity and spine; injuries to Op- Operator training, the MOs develop the basic competence and
erators and initial management; performing focused musculoskele- skills to work in time- and resource-limited austere circum-
tal exams; when to refer for imaging and orthopedic consultation; stances, and ultimately gain the confidence and credibility to
radiologic imaging of injuries teach their medics and Operators.
Prolonged field care (PFC) and integrating critical care
Ventilator management; monitor review; prolonged field care didactic In addition to the emphasis on conducting medical care in
Practical Lab Sessions forward settings, the briefings and debriefings stressed andra-
PJ medical and trauma protocols skills intro as a tabletop exercise/ gogy – the neuroscience of adult learning – and strategies to
working out of a ruck; TCCC skills practice – medical and patient optimize instruction and training of operational medicine for
packaging; PJ MTPs practice; field blood typing and transfusion; PJs. This included the importance of incremental introduction
prolonged field care; blood transfusion labs, hands-on vents and of stressors to a scenario as well as the advantages of repetition,
monitors deliberate practice, and self-guided experiential learning. 15–19
Lab: Trauma Lanes
sTBI; thoracic trauma; acute abdomen; amputations/shock; burn; The course also highlighted the minutiae of moulage, training
polytrauma; ACLS; pediatric/Broslow tape; mass casualty triage and
CCP; hemorrhage control; tension pneumothorax props for each specific scenario, limitations of role players,
Cadaver lab and human analog training and how to achieve the desired learning objectives (DLOs) of
Lateral canthotomy; intubation; surgical airway; open and tube tho- a training session. The course participants were provided with
racostomy; thoracic escharotomy; subclavian packing; escharotomy detailed scripts for many of the scenarios to not only assist
full body; wound care; fasciotomy – lower leg only; field amputa- new MOs in future instruction but also encourage standard-
tion; IOs; hemorrhage control techniques ization in training methodology across the enterprise. Last, we
Prolonged Field Care Lab discussed how to address the difficult task of making PJs pro-
Didactic lecture on PFC, review of vents and monitors, review of ficient in advanced clinical skills when the MOs themselves
script for lab. 4-hour lab with shift change every 30 minutes incor- often lacked significant clinical or procedural experience.
porating review of patient, work rest cycles, telemed consultation,
perform a key intervention, hand off to next team, end with package
for exfil; debrief Discussion
Exercise: TCCC in a tactical village with long guns and sim rounds MOs assigned to Air Force Special Warfare units must master
Patient movement and packaging; care under fire drills; tactical field a complex leadership role and a dynamic knowledge base. The
care drills; field scenarios; CQB scenarios; performance of complete
trauma protocols during tactical field care, package for exfil, move MO must not only provide traditional medical care and clear-
patient, hand off to medical treatment facility with verbal report and ance for flight status for Operators but also perform duties
legible patient treatment card; debrief including the following: create and lead medical and surgical
skills training, help integrate medicine into tactics and rescue,
clinical experience in the USAF. Advanced lectures from O–6 act as an EMS medical director (develop protocols, perform
(colonel)-level military trauma specialists, civilian experts in quality assurance, provide online medical control), oversee a
traumatic brain injury (TBI) and human performance, and an comprehensive HPO program, provide basic behavioral health
Air Force psychiatrist were provided. The behavioral health care, provide support to the unit for deployments, provide
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lectures focused on PTSD, depression, and family stressors medical threat assessments for operational mission planning,
Novel Special Operations Medical Officer Course | 27