Page 104 - JSOM Summer 2023

Conventional Resilience and the
Impact of Catastrophic Injury Exposure on
Special Operations Surgical Teams

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Erika “Ann” Jeschke, PhD *; Jay Baker, MD ;
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Jared Wyma-Bradley, MDiv ; John Dorsch, DO ; Sarah L. Huffman, PhD 5
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ABSTRACT
This article presents a justification for using an ethnographic Force. SOST was constructed to exclusively support Special
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approach to research resilience. Our hypothesis is that the Operations Command (SOCOM) by providing immediate
conventional resilience construct is ineffective in achieving its surgical- resuscitative intervention during far-forward combat
stated goal of mitigating diagnosable stress pathologies because operations. Since the specialized medical capability of SOST
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it is grounded in a set of assumptions that overlook human ex- is organized around and executed in support of Special Opera-
perience when examining human performance in combat. To tions Forces (SOF) mission objectives, the authors consider the
achieve this goal, we (1) describe the evolution of the strategic medics who make up a SOST to be SOF medics.
framework within which the conventional resilience construct
is defined; (2) highlight certain limiting assumptions entailed Over the past two decades, the ability to successfully maintain
in this framework; (3) explain how bottom-up ethnographic resilience has become a general topic of interest to military
research relates the medic’s practical performance to military health researchers. 9–11 However, there is a paucity of research
requirements and mission capabilities; and (4) articulate the attempting to identify opportunities to ensure the resiliency of
unique elements of our study that widen the aperture of the operational medical teams. While stress impacts all deployed
conventional resilience construct. We conclude by gesturing to SMs, SOST medics are at high risk given their constant and
initial research findings. repetitive exposure to death, dying, and disfigurement when
tending to catastrophically injured combat casualties. More-
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Keywords: resilience; SOST; special operations surgical team; over, SOST medics bear witness to collective tragedy in the
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SOF special operations; catastrophic; injury; ethnographic; aftermath of catastrophic injury exposure. The logistical and
combat personnel constraints of providing PFC, as well as mass ca-
sualty projections of future austere battlefields, are likely to
make catastrophic injury exposure an occupational hazard af-
fecting performance. 7,8
Introduction
Enhanced forward surgical-resuscitative capabilities in sup- While our project focuses specifically on SOST medics’ expo-
port of contested operations are areas of critical interest to sure to catastrophic injury, it will also likely have resonance
the Department of Defense (DoD). A future state requiring with other SOF medics and operators since these groups are
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increased capability to resuscitate, provide Prolonged Casu- all directly exposed to injury, death, and dying. Furthermore,
alty Care (PCC), and perform prolonged evacuations from the the horrific conditions of large-scale combat operations will
point of injury (POI) in an anti-access and area denial (A2/ multiply these exposures and experiences by several factors,
AD) or similar environment makes readiness and retention of lending vastly broader applicability of the findings of this re-
forward surgical-resuscitative teams an area of critical con- search to all military medics and direct-action combatants. As
cern. As more surgical-resuscitative teams deploy far forward, such, SOST medics will function as a representative research
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preservation of ready medical assets and mission performance sample of future battlefield conditions in both SOF and con-
across the full spectrum of operations could be at risk due ventional forces based on their considerable experience with
to high operations tempo. Research on creative means to austere mass casualty events.
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sustain forward surgical-resuscitative teams is necessary be-
cause these assets are composed of low-supply high-demand This methodological article is the first in a series of nine.
Servicemembers (SM) that include: surgeons, anesthesia pro- While subsequent articles will present empirical findings in
viders, emergency medicine physicians, operating room nurses, detail, this article focuses on theoretical science to present a
critical care nurses, and technicians. Henceforth, we will re- historical and philosophical justification for using ethnogra-
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fer to all disciplines that perform medical roles in the mili- phy to research resilience in SOF medics. The argumentative
tary under the singular collective term of “medic.” The Special style of reasoning will explicitly articulate assumptions that
Operations Surgical Team (SOST) is a representative example support our methodological architecture. We have chosen to
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of this high-value surgical-resuscitative capability in the Air provide a meticulous presentation of our theoretical science
*Correspondence to stlamazonia@gmail.com
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1 Dr Erika “Ann” Jeschke is affiliated with Leidos Corp., Reston, VA. COL Jay Baker is a physician affiliated with the U.S. Army. Jared Wyma-
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Bradley is a chaplain affiliated with the Northern Virginia Mental Health Institute. Col (Ret) John Dorsch is a physician affiliated with University
of North Carolina Southeastern, Lumberton, NC. Lt Col Sarah L. Huffman is affiliated with the 60th Medical Group, Travis Air Force Base,
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Fairfield, CA.
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