Page 98 - JSOM Summer 2023

can improve the healing process in multiple ways. Immediate brain injury; however, there is no obvious concussive incident
intervention may reduce the scope of injury, and so apply- to associate with the actual injurious event. The expectation
ing medical care closer to the point-of-injury could improve has been to proceed with treatment as though these incidents
outcomes. Likewise, the recovery process may benefit from were similar to other occurrences of a traumatic brain injury.
different, holistic interventions than what normal medical fa- Reluctance to simplify implies that the medical intervention
cilities might provide, such as integrating human performance can and should continue to explore the nature of these injuries
programs to include physical therapists and nutritionists. SOF to provide better care. Meanwhile, a mass-produced medical
medicine approaches any prescribed recovery period for a facility would not be inclined to dig deeper and explore alter-
training injury as a suggestion that can be improved upon. The native avenues of treatment for emerging threats. They would
preoccupation with failure is an insistence that any shortcom- approach the injury with the most comparable treatment plan
ing represents an opportunity for improvement and that the based on the incident, provide corresponding treatment, and
quality of the care is more important than providing care to a move on to the next patient. Mass production does not in-
large group of individuals. centivize advancing treatment in the face of emerging health
threats. SOF medicine applies both portions of the overarch-
ing concept to these brain injuries. Refusing to accept only
HRO Principle #3 | Reluctance to simplify
the simple solutions encourages SOF medical professionals to
SOF Truth #3 | SOF cannot be mass produced seek the best possible interventions against emerging threats,
The third HRO principle involves a reluctance to simplify, and eschewing mass production creates a system that does not
which imparts an acceptance that simple methods may not accept the simple answer. In practice, the HRO principle and
achieve complicated goals. Embracing the tautology, complex SOF Truth achieve the same actionable outcome through both
work is inherently complex. Simple methods might produce the individual attitude and a system that does not accept the
only quick wins with suboptimal results. This HRO principle easiest implementable solution as the best option—both de-
identifies that successful organizations are reluctant to take mand that “close enough” is not good enough.
the easy way out and will instead opt for more complicated
actions to achieve better outcomes.
HRO Principle #4 | Commitment to resilience
Once more, the SOF Truth reaches the same core idea using SOF Truth #4 | Competent SOF cannot be created after
a different approach—stating that SOF cannot be mass pro- emergencies occur
duced. Simplification will suffice when “close enough” solu- HROs can identify, adapt, and overcome when errors occur.
tions are acceptable outcomes. In Special Operations, years of Commitment to resilience conveys the importance of a force
intense training and effort are required to produce fully capa- prepared to respond no matter what obstacles they might en-
ble units. Hastening the process will unquestionably degrade counter. In practice, this principle requires preparing for the
operational capabilities. Simplification may support mass pro- unlikely. Emergency training becomes as important as stan-
duction, but for HROs and Special Operations, situations of- dard organizational training to ensure that emergencies do not
ten demand fully capable professionals who can excel despite become catastrophes.
complicated circumstances.
Special Operations embrace resilience as much as any other
SOF medicine embraces a hybrid of these two concepts. The HRO. Given its relative importance in human performance,
reluctance to simplify acknowledges that hastening the process many studies and evolved capabilities have been devoted to
will produce suboptimal outcomes, which has implications for enhancing resiliency in SOF personnel. 16–18 Principle becomes
the SOF medical training pipeline. Medics could be produced practice with the fourth SOF Truth that SOF capabilities can-
in a short amount of time with suitable first aid skills to pro- not be created after emergencies occur. The unusual, the ex-
vide acceptable battlefield medicine. However, this abbrevi- traordinary, and the seemingly impossible become rules rather
ated training may not include all the requisite skills to ensure than exceptions when working in Special Operations. In turn,
optimal outcomes or pressured training that helps prepare the readiness must be a living and breathing thing. If your force
individual for combat situations. Conversely, the SOF Truth does not have the resilience to maintain a heightened state of
addresses a reality of Special Operations. Mass production readiness, both through continual performance enhancement
and Special Operations are diametrically opposed concepts. and adherence to emergency training standards, then the force
Special Operations are designed to exploit the weaknesses of will not be ready when emergencies occur—when they are
general purposes forces, and in a similar fashion, mass produc- needed most.
tion cannot adapt to the emerging needs of Special Operations.
Specialized and ongoing training are essential to keep current SOF medicine embraces both concepts as two ways of say-
the skills of SOF medical professionals in the face of emerging ing the same thing. That is, readiness cannot occur after the
threats. A reluctance to simplify acknowledges that additional fact. Medical professionals must be prepared for emergencies
training outside the normal realm will be necessary to main- because emergencies are the standard in SOF medicine. The
tain proficiency, and eschewing mass production further ce- HRO principle espouses this concept as a commitment to re-
ments the concept that the standard approach cannot suitably silience that prepares a force for any emergencies or obsta-
address emerging threats. cles that might arise, such as conducting medical operations
despite a hospital blackout. Resilient systems would have re-
There is a unique situation that adequately depicts these con- dundant power-generation capabilities or personnel capable of
cepts in action. Specifically, there is an emerging threat to war- performing under reduced operating conditions. The more ex-
fighter brain health known as unconventionally acquired brain treme example involves a case in which an Army Ranger had
injury, or an anomalous health incident. These experiences been shot twice in the chest. He received medical care across
15
have produced unusual symptoms that resemble a traumatic several air platforms, including a resuscitative thoracotomy
96 | JSOM Volume 23, Edition 2 / Summer 2023