Page 30 - JSOM Spring 2021

and be the medical advisor to the commander. Additionally, Additional examples include (1) the Special Operations Civil
the MO may provide real-world emergent care for injuries or Medical Affairs Medical Sergeant’s (SOCAMS) Course, an
mishaps in training and operational environments, often in re- 8-week course teaching medical topics essential for personnel
mote settings far from a hospital. supporting civil affairs missions overseas, including tropical
medicine, sanitation, public health, and diplomacy; (2) the
Well outside the realm of traditional internship or residency Naval Special Operations Medical Institute (NSOMI), in-
training, the USAF Special Warfare MO must have a func- tensive medical courses for Navy Special Operations Medics
tional understanding of tactical trauma care, management of and Independent Duty Corpsmen, but these do not include
nonbattle injuries and illness, effective use of trauma systems, the education of MOs; and (3) the Joint Special Operations
critical care, field surgical procedures, aeromedical evacua- Medical Orientation Course, a 5-day online primer for any-
tion, behavioral health, orthopedic and musculoskeletal inju- one involved in SOF medical operations, which is primarily
ries, nutrition, human performance, environmental stresses, focused on organizational and administrative issues. 22–24
risk management, knowledge of adult education theory, and
the ability to teach effectively in a variety of settings. On the civilian side, standard courses such as Advanced Car-
diac Life Support (ACLS), Prehospital Trauma Life Support
The Aerospace Medicine courses required of all flight surgeons (PHTLS), and Advanced Trauma Life Support (ATLS) offer
provide a specialty overview and introduction to aerospace good introductory training and allow a common language to
physiology, but such traditional courses are geared toward be spoken, but they have significant limitations in the opera-
MOs supporting aviation units and aircrew in the clinic set- tional environment and lag behind the “Tactics, Techniques,
ting. Without additional clinical and operational content, the and Protocols” (TTPs) taught to PJs and other combat para-
traditional courses lack the specificity necessary for an MO medics. EMS is a new subspecialty for emergency medicine
to be effective in an AFSPECWAR unit stateside, let alone re- physicians, which requires a minimum of a 1-year fellowship
spond to an attack with multiple critically injured patients in after residency, including one that the DoD offers to all ser-
a deployed location. vices. The DoD’s current military EMS fellowship was origi-
nally an Army graduate medical program until Air Force and
Experience gained in clean, brightly lit, and well-resourced Navy EMS fellows completed the training within the past 5
clinical settings does not translate into field and operational years. These training programs cover some key elements that
clinical environments; even seasoned board-certified physi- would be beneficial to the SOFMOs – medic education, pro-
cians may find themselves inadequately prepared without tocol development, performance improvement, field documen-
focused training and realistic preparation. The expeditionary tation, field trauma management, triage, operating in atypical
and austere environments are unlike anything civilian or hos- environments, and more – however, the EMS fellowship is not
pital-based military physicians will have encountered. Medical intended to produce SOFMOs and lacks the granularity to
care and planning must be interwoven into a larger operational do so. The DoD program has a limited number of graduates
picture. Care environments can be difficult, whether managing each year, and there is no pathway by which they would be
a patient lying on the ground at night, in a dimly lit tent, in assigned to SOF afterward. In fact, EMS is a sufficiently new
the back of a helicopter or plane, on a zodiac or ship, or in a specialty that the services do not have specific billets for EMS
moving vehicle. Prolonged field care, in which a patient must specialists; even if they do, there are no specific duties or spe-
be managed for many hours or days with limited resources, cial experience identifiers by which a service would identify
occurs regularly in modern military medicine. the prehospitalists in their inventory. It is further interesting to
note that four EMS fellowship–trained physicians participated
Even in a unit where the role is less direct patient care and as students in the inaugural AFSPECWARMO course.
more clinical supervision and oversight, the MO must have a
working understanding of operational capabilities of the team, The development and performance of the AFSPECWARMO
such that operational medicine can be applied within the con- course, coupled with the review of the numerous disparate
textual limitations. courses above, reveal the lack of a unified approach to the ini-
tial and sustainment training of the MO across the military in
Within the US military, a number of courses pertinent to Spe- general, and in Special Operations in particular. At their core,
cial Operations medicine currently exist that can partially ad- SOFMOs have similar education and training needs, as well as
dress some of the knowledge and experience gaps noted in foundational knowledge and skill sets required to succeed in
this manuscript. Some of these are highly position specific the unique Special Operations environment. There is no com-
and are not available to every MO but may serve as mod- mon baseline of training for all SOFMOs, which results in an
els for components of future courses. These include (1) the absence of medical interoperability at a time when more joint
Combat Casualty Care Course (C4), a 3-day training aimed operations are happening than ever before. Although each ser-
at triservice MOs providing health care in austere and com- vice and each MO role require some degree of position- and
bat environments, with a focus on TCCC; (2) the Tactical unit-specific training, a unified initial training course would
Combat Medical Care (TCMC) Course, a 5-day course for not only save money, it would produce a cohort of MOs that
deploying MOs and senior noncommissioned officers (NCOs) can function synergistically in a joint environment and mutu-
covering trauma assessment and management in the forward ally support one another in theater.
environment; and (3) the Special Operations Aviation Medical
Indoctrination Course (SOAMIC), a 2-week course specific to To our knowledge, despite the significant challenges and gaps
casualty evacuation on the 160th Special Operations Aviation discussed here, there has never previously been a course to of-
Regiment (SOAR) aircraft, which, although only available fer this degree of comprehensive operational medical and ed-
to SOAR medical personnel, is a highly regarded job-spe- ucation training for MO of the SOF community. This unique
cific course that operational medical units can emulate. 2,20,21 course was successful for the following reasons:

28 | JSOM Volume 21, Edition 1 / Spring 2021