Page 41 - JSOM Fall 2022

the Theatre Movement Lane, trainees provide POI care and call The JMEX also provides the residents a first­hand look into
for a MEDEVAC. They are then transported by rotary wing the capabilities of a SOCM medic. Whether trainees serve in
aircraft to a Role I, performing enroute care. At the Role I, SOF units or not, exposure to these experts provides expo­
trainees perform damage control resuscitation, augmented by sure to the most relevant battlefield medicine practices. Un­
members of a BN Aid Station. Upon stabilization of casualties, derstanding how these medics think and the conditions and
patients are transported via ground MEDEVAC to a Role III. stressors in which these medics operate is invaluable. It is pos­
The Role III, augmented with the US Army Burn Team and sible that trainees will eventually receive casualties treated by a
surgeons from across the DoD, provide damage control sur­ SOCM medic on the battlefield, and an understanding of their
gery and postoperative stabilization. At all echelons of care, scope of practice is essential.
trainees care for simulated patients using a mixture of fresh
cadavers, perfused cadavers, high fidelity human and canine The authors of this paper recognize that most participants in
mannequins, and role players. This allowed trainees to accom­ the JEMX will not become SOF medical providers. However,
plish a large volume of their Individual Critical Task List, fur­ this training is equally as beneficial for service in conventional
ther preparing them for SOF positions through completion of units. As Special Operations require non­SOF assistance, it is
procedures that are at times difficult to obtain during training. 8 crucial that the subject matter experts within the community
use their expertise to train non­SOF providers. With opportu­
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Residents also participate in the Prolonged Casualty Care nities to gain operational experience becoming harder to ob­
(PCC) and Critical Care Air Transport Team (CCATT) lanes tain, it is crucial that the SOF community remain engaged with
during the FMP phase. During the PCC lane, residents are the conventional force.
placed in a safe house with limited resources and care for a
progressively worsening patient. These patients continue to
worsen despite the trainee’s best efforts, eventually leading to The Way Ahead
the need for surgical intervention. As most trainees are not It is no secret that the operational environment is changing,
surgeons, they must utilize telemedicine to perform this pro­ but the need for a ready medical force remains. Operation­
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cedure (a lower extremity fasciotomy for compartment syn­ ally proficient and self­sufficient medical providers reduce
drome). Trainees utilize the Telehealth in a Bag system to call a liability for commanders and will continue to do so as the
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surgeon, who then walks them through the procedure. battlefield changes. Military GME programs produce pro­
viders who can provide high quality medical care to special
During the CCATT lane, trainees provide POI care, create a operations soldiers downrange. However, current GME pro­
casualty collection point (CCP), and provide enroute care via grams lack a cohesive program to provide graduates with the
ground MEDEVAC to a simulated theatre evacuation site. operational acumen SOF units require. The SOF problem set is
They are then met by an Air Force CCATT who walk trainees perpetually evolving, and mission success requires supporting
through patient packaging and optimization prior to theatre clinicians with the operational awareness and competency to
evacuation. Simulated patients are packaged and then evacu­ effectively enable and support medics and other operational
ated via rotary wing CASEVAC platforms. personnel.

As the JEMX continues to grow, it will likely outgrow its cur­
Benefits for Trainees
rent command structure. It is the authors’ hope that DHA and
The level of operational experience among GME graduates others will recognize the value of this program and continue to
varies greatly. Through this exercise, participants will receive invest heavily in its success, while allowing continued signifi­
basic exposure to the full continuum of the operational envi­ cant influence from experienced Special Operations providers.
ronment. This exposure is essential to familiarize them with This exercise relies not only on experienced Special Opera­
multiple positions they could fill in future SOF jobs or deploy­ tions clinicians, but also on significant logistical support from
ments. They also interact with supporting personnel at every conventional units who in turn benefit from additional medi­
echelon of care, gaining a deeper understanding of each lev­ cal training.
el’s intricacies which allows them to become more competent
medical directors. The JEMX provides trainees with the opportunity to improve
their operational knowledge through an immersive training
Most importantly, trainees receive professional development exercise which exposes them to all echelons of deployed med­
from experienced and well­trained NCOs and officers from ical care. It is important to note that the JEMX alone will not
the SOF community. These positive interactions drive home create the type of provider that the SOF community requires.
the importance of NCO­driven instruction through support Each individual unit and individual provider must take own­
and empowerment from an involved medical director. ership of the initial training and sustainment of operational
skills that their specific mission demands. However, it is our
hope that this exercise can provide a framework for military
Benefits for Special Operations Units
GME programs to provide a high­quality product to SOF
If the JEMX model is to be successful, continued support from units, and to enhance the overall operational competency and
SOF units is crucial. Instruction from high­quality NCOs from appreciation of providers supporting conventional units.
these organizations is invaluable, and this training exercise
provides a professional development opportunity for NCOs Author Contributions
who interact with and teach multiple future medical directors. HH, GH, JK, AS, PA, and BD conceived the study concept.
For those NCOs with interest in pursuing further medical ed­ HH, JF, SS, KE, GH, JK, AS, and PA compiled the evidence
ucation, this is an incredibly valuable opportunity for them to and literature review and wrote the manuscript. HH, JF, SS,
develop relationships and further career planning. KE, GH, JK, AS, PA, and BD approved the final manuscript.

Military GME Special Operations Clinicians | 39