Page 97 - JSOM Summer 2023

important than hardware. The SOF explanation explicitly and ultimately the most important contribution of both prin-
states that people have more impact than equipment, and not ciple and Truth herein is that situational awareness of the med-
even the best equipment can compensate for having the wrong ical professional better dictates the quality of care provided
people executing a mission. than the quality of equipment.

Each idea speaks to the same underlying message in slightly HRO Principle #2 | Preoccupation with failure
different ways. The HRO principle identifies that situational
awareness is core to successful operations, whereas the SOF SOF Truth #2 | Quality is better than quantity
Truth makes explicit the unspoken message. That is, situa- Preoccupation with failure is the second HRO principle, which
tional awareness and sensitivity to operations may depend on suggests that failed attempts or near misses are prime oppor-
information provided by equipment and processes, but ulti- tunities to gain insight into systems and improve operations.
mate success is dependent on how the human utilizes this in- However, personnel uninitiated to HRO procedures might
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formation. After all, situational awareness is a state of human confuse being preoccupied with failure as pessimism. This
cognition rather than machine output, and military operations interpretation would directly contradict the purpose of the
regularly embrace human performance as essential to success principle, which should be to focus on opportunity for im-
in human-machine integration. 10,11 Here, the SOF Truth better provement over tacit acceptance of things that could produce
conveys the implicit message of the HRO principle that human future problems. To avoid potentially dwelling on the nega-
behavior and awareness are primary determinants of outcome tive, there is another way to approach this concept through the
quality. SOF interpretation.

SOF medicine embraces both the HRO principle and SOF For Special Operations, the second SOF Truth states that
Truth by acknowledging that situational awareness is key to quality is better than quantity. Delivering a small number of
human performance. Advanced technology may help improve carefully selected, well-trained, and well-led personnel will de-
performance in many different ways, but for all the technolog- liver a better solution than pushing out high volume. Given
ical achievements in artificial intelligence or unmanned drone the often razor-thin margins for error in Special Operations
technology, there is no substitute for a medical professional and expectations of high performance, near misses also rep-
in the field. Tools are merely a way to supplement individual resent some of the largest opportunities for performance im-
situational awareness to achieve better point-of-care interven- provement. The common implication is to maximize outcome
tions. The SOF Truth better espouses this point by emphasizing quality rather than achieve success by volume. Both the HRO
the role of the human Operator over the hardware, although principle and SOF Truth suggest that shortcomings repre-
the HRO principle implicitly conveys that the reason humans sent opportunities to make a good product even better. The
are more important involves their flexibility. Tools cannot eas- phrasings are simply two sides of the same coin: the stated
ily adapt in real-time to emerging situations against a variety HRO principle focuses upon methods, whereas the SOF Truth
of threats. Vital sign monitors or point-of-care ultrasounds emphasizes the end goal. Teaching the SOF Truth alongside
may provide critical information, but they cannot adapt to the HRO principle may improve understanding of the core
the real-time concerns about the best decision to be made in message.
battlefield medicine while bullets are still flying. Instead, SOF
medicine embraces both the HRO principle and SOF Truth by SOF medicine embraces both the principle and Truth equally,
using the best equipment and technology available to enhance although the HRO principle represents the more actionable
the situational awareness of the medical provider. interpretation. Preoccupation with failure suggests that im-
perfect outcomes should be perceived as opportunities for
For example, Tactical Combat Casualty Care (TCCC) is a crit- improvement. For instance, SOF medicine strives for a goal
ical component of SOF medicine. 12,13 Medical professionals of zero preventable deaths. Any death represents a scenario
are embedded within units and sometimes provide care while where SOF medical procedures can be improved. If there are
combat operations continue in the surrounding environment. no deaths, then the goal should be better outcomes in the form
As complicated and stressful as most medical operations might of reduced long-term effects or reduced healing time. Perhaps
be during emergencies, the battlefield nature introduces ad- an amputation could have been avoided or a three-month
ditional challenges not found in standard hospital operating recovery period could be reduced to a one-month recovery.
rooms. The HRO principle suggests that sensitivity to opera- The HRO principle suggests that the best caregivers always
tions will produce enhanced care, and, for TCCC, that sensitiv- strive for a better result. Meanwhile, the SOF Truth provides
ity extends to additional aspects of providing care. Stabilizing more conceptual guidance. Quality over quantity implies that
a patient might also involve doing so without the same sterile fewer, better trained personnel can achieve a better outcome
surroundings of a hospital, or the intervention might need to than mass quantities. This idea invokes the specialized training
acknowledge the distance to the nearest Role 2 medical facil- needed to provide combat medicine for Special Operations.
ity. Situational awareness, contextualized as sensitivity to op- SOF medics require additional training to move and commu-
erations for HRO principles, represents how these contextual nicate alongside Operators. Ostensibly, quality here refers to
factors might influence decision-making during point-of-care the advanced training required for SOF medics to be effective.
actions. The next consideration involves how the SOF Truth
better encapsulates the actionable item. Situational awareness The best example involves application of the HRO principle
can be enhanced by better equipment and technology. Novel rather than the SOF Truth. For instance, training injuries are
training procedures will help prepare personnel for combat, likely in Special Operations given the advanced and dangerous
and novel equipment could provide critical information at the training evolutions that Operators undergo prior to missions.
point-of-contact. Still, no equipment can replace the Operator. Any injury will likely setback an Operator, and so returning
There is no medical drone capable of replacing the SOF medic, the individual to combat-ready status is crucial. SOF medicine

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