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during his evacuation in a helicopter. A hospital setting would training, equipment, and technology that continually advances
not likely ever require preparing to provide medical care un- the standard of care SOF medical professionals can provide.
der these conditions, yet such extreme occurrences are more These research and development efforts acknowledge both the
probable in Special Operations than in any other area of med- HRO principle and SOF Truth because advanced research and
icine. As such, SOF medical personnel must acknowledge that development partners are likely both experts and non-SOF
training for an emerging situation after the situation occurs personnel. In turn, the principle and Truth say the same thing
represents a self-defeating proposition. Hostage situations, as they both imply deferring the experts who practice outside
theft of nuclear material, and a hundred other SOF-specific the realm of SOF units. These partnerships allow SOF medi-
missions cannot wait for months or years while SOF personnel cal personnel to build upon the professional expertise of the
train to handle the complexities of mission essential tasks. In partner organizations while developing internal capabilities
this case, the HRO principle and SOF Truth convey the same for SOF-specific applications.
meaning in different ways—medical professionals must be
ready for emergencies because SOF medicine exists to support For example, SOF medicine benefits from advanced technology
those rare events demanding Special Operations. that enhances situational awareness. Consider a novel point-
of-care ultrasound device that would enable SOF medics to
Hostage situations best exemplify the principle and Truth in find internal bleeding. SOF medical personnel may have many
action. There will not be ample time to prepare for a hostage specialties but designing such a device would likely be beyond
rescue mission as personnel will have mere hours to assemble their capabilities—let alone supporting the production and
and embark. As such, there is no time for additional train- distribution of any resulting product. Instead, SOF research
ing—personnel are either prepared for the emergency or not. and development can support the creation or adaptation of
The situation may require medical attention to stabilize the such a device specific to SOF needs. These actions require de-
hostage or personnel sustaining injuries during the mission, ferring to non-SOF personnel to support the development of
either of which require a SOF medic to perform their craft in such a device. A thousand similar examples could be given, but
a far-forward operating environment. Resilience here implies in short, SOF research and development allows SOF medicine
that the personnel can adapt to any errors, changes, or oppo- to defer to experts outside of SOF units who can deliver novel
sition that occur while trying to rescue the hostage. SOF med- solutions that will enhance internal operating capabilities.
icine embraces a commitment to resilience by acknowledging
that SOF medical personnel cannot be trained nor prepared Five-A-Side: How HRO Principles and
after the emergency occurs.
SOF Truths Describe the Same Ideas
It may seem a remarkable coincidence that two approaches
HRO Principle #5 | Deference to expertise
should have as much overlap as HRO principles and SOF
SOF Truth #5 | Most Special Operations require Truths. Yet, the happenstance is really a byproduct of different
non-SOF support explanations for the same concept (Figure 1). After all, Special
The fifth HRO principle involves deference to expertise. In- Operations commands are HROs even if they are not explicitly
dividual skill and prior experience become more important referenced as such. Operation Eagle Claw and the formation
than seniority or authority during an emergency. That is, rou- of United States Special Operations Command could likewise
tine decisions may follow the usual hierarchy, but decisions be as valuable to teaching HRO principles as other landmark
made during a crisis are best made by personnel on the front examples, including the Three Mile Island nuclear incident or
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lines with the most subject matter expertise. Moreover, this the Challenger disaster. Still, Special Operations also devel-
principle only truly functions when the organization knows oped an important contribution to HRO development through
its people and their expertise in advance. Waiting until a crisis the five SOF Truths. These ideas overlap with the HRO prin-
to learn who knows what will inevitably exacerbate problems ciples without repeating them in a way that makes exploring
rather than solve them. both approaches a valuable training tool in teaching high reli-
ability principles.
Special Operations build the idea of front-line decision- making
into the training pipeline. Headquarters cannot make all deci- The ideas are presented here as parallels, but the principles
sions during a crisis because communications may be degraded, and Truths are not perfect one-to-one iterations of the same
enemies may be actively conducting signal denial, or equipment concept. Some do indeed overlap to an extraordinary degree
might not be available for direct contact. Furthermore, the fifth that they might as well be identical. The fifth principle and
SOF Truth further echoes the HRO principle by stating that Truth—deference to expertise and that most Special Opera-
most Special Operations require non-SOF support. Achieving tions require non-SOF support—is a prime example of over-
optimal performance requires joint operations with general lap in practical application. Deferring to experts often requires
purpose forces, industry partners, academic researchers, and relying upon non-SOF personnel, because SOF units cannot
many other personnel who ultimately contribute to enhanced be expected to maintain expertise over the many different
capabilities. In this sense, deference to expertise becomes ex- types of activities with SOF implications. Another dyad with
tended beyond the point of decision-making during crises and remarkable overlap involves the commitment to resilience
to a concept that integrates outside expertise where appropri- and the SOF Truth that competent SOF cannot be created af-
ate throughout the entire training process. ter emergencies occur. Both concepts speak to the same un-
derlying principle that personnel must be prepared for any
SOF medicine fully adopts both concepts through practical emergencies prior to their onset, or the SOF medical function
action. Specifically, SOF medicine utilizes research and devel- becomes irrelevant. Other dyads speak to similar ideas, but
opment to remain on the cutting edge. Academic and industry in unique ways. The first dyad, sensitivity to operations and
partners working with science and technology leads to new humans are more important than hardware, has a combined

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