Page 68 - JSOM Winter 2023

The following quote shows the macro level of the ecosystem out, retrieved more casualties, and returned. When we re-
and how SOST teams support individual medics to prepare turned to the hospital, the kid was extubated and sitting
for the impact of catastrophic injury exposure and maintain up in bed, when by all rights he should’ve been dead.
dynamic freedom of maneuver in ambiguity:
The practical performance of SOST teams illustrates how the
The organization has worked to instill a mindset in teams SOST organization infuses teams with flexibility that contrib-
and individuals that prepares us to function with limited utes to symbiotic treatment decisions and transportation of a
resources. It only takes one event to wipe out all our re- catastrophically injured Operator. Semi-permeable boundaries
sources. When we are training or working, we are all con- within teams allow rapid changes to be constantly recalibrated
stantly communicating about various possible scenarios. and integrated into practical performance. The activated SOST
During deployment we always ask questions and commu- becomes an agent of change under enormous pressure to trans-
nicate with ground force commanders. “What’s your intel, form challenging medical scenarios into vibrant possibilities
what do you know? Can we expect more casualties, or do by leveraging relationships across individual medics, teams,
we think that we might have time to refit and figure out and organizations.
what our shortfalls are and what our capability looks like
after this wave?” If we get to the point where we’ve only The following quote shows the micro level of the ecosystem
got a couple of Band-Aids and maybe a suture or two, we and how SOST medics integrate the impact of catastrophic
look to creative ways to use other available resources. As injury exposure to maintain dynamic freedom of maneuver in
an organization, we are very good at promoting creativity ambiguity across the deployment cycle:
and outside-the-box thinking even in garrison. We don’t
give up because our resources run out or because we’re The person I am now, isn’t the person I was when I first
misallocated when executing SOF missions. We may not joined SOST. I know that exposure to very tough life ex-
always achieve the outcome we had originally imagined, periences—both obviously impactful to me and others
but we try to do everything we can to adapt and achieve more subtle—have structured my life. Exposure to mass
the best outcome possible in the circumstance in which casualties and traumatic events influenced my personal-
we find ourselves. I think you’ll find this organization al- ity. Now, when I am in difficult situations, like when my
lows teams and individuals to introduce personal experi- mom was diagnosed with cancer and passed away two
ence into organizational problem-solving. years ago, and then again with my dad getting sick and
passing away a few weeks ago, I am calmer. I was able
Practical performance of SOST as an organization suggests to confront the death and dying of my parents. I allowed
willingness to engage adversity as an opportunity to maintain myself the space and time to grieve. I’m still grieving. This
dynamic balance. The integration of ambiguity at the organi- also helped me go through big life events that happen
zational level allows teams and individuals to re-direct energy and not get flustered, shut down, or stressed out. I can
toward new solutions to continue to optimize performance. As usually just laugh at it and have a deep awareness that it
such, the SOST organization supports achieving the right task, is going to be fine.
in the right way, with the right people, at the right time.
The practical performance of SOST medics illustrates how the
The following quote shows the mezzo level of the ecosystem individual experience of catastrophic injury exposure in SOF
and how SOST teams integrate dynamic balance under the im- missions is transformed into an opportunity for meaningful
pact of catastrophic injury exposure and maintain dynamic interpretation of adversity and redirection into other adverse
freedom of maneuver in ambiguity when performing medical events in life beyond SOST. The individual skill of navigating
interventions during a SOF mission: adversity not only becomes part of the ecosystem at the team
and organizational level but also fosters homeostasis.
As we rolled into base, the other SOST was getting ready
to roll out. We drew the mission that first night. There were Taken together, these three quotes not only make vivid our
some Operators and another SOF medical team working operational model but also demonstrate the strategic frame-
in the field. A 22-year-old Operator got shot twice in the work of unconventional resilience by facilitating connections
chest, right above his plates. The Operators brought this with self, others, and the world to create a dynamic balance
kid to the other SOF medical team where he crashed in and freedom of maneuver in support of the SOF mission. The
front of them. The anesthesia provider intubated him, and quotes also highlight the role of cohesive ecosystem as a rela-
the surgeon cracked his chest before we got the call say- tionship encompassing multiple aspects of conventional resil-
ing, “They’re coming!” They ran this kid onto the C-130 ience, while avoiding a closed system in optimizing practical
where we were located. He was fileted open; it was ab- performance.
solute horror. I had no idea a plane could take off that
fast or land that hard. The air crew red-lined because we Unconventional Resilience:
said “An eagle is down! We have an American hit!” The Tactical Engagement with Social Determinants
ER doc had his hand on the kid’s heart guiding resuscita-
tion saying, “Heart’s not full, heart’s not full, heart’s not Having validated our operational model of unconventional re-
full.” I had an E-6 squeezing blood into this kid as hard silience with SOST ethnographic data, we now link this model
as possible while I was pumping in medications, and the to the tactical engagement of practical performance across the
surgeon was tying off bleeders. We threw him in an am- deployment cycle. Here, practical performance will focus on
bulance and dropped him into the ER. The role 3 surgeon SOST medics’ bag sets for three reasons. First, this unique el-
emerged with the new medical team. They grabbed him ement of practical performance emerged in interviews, focus
and rolled him straight back into the OR. Then we went groups, and field observations as the most refined expression

66 | JSOM Volume 23, Edition 4 / Winter 2023