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modular kits that go inside each bag. Similar to their tactical Disclosures
engagement with bag sets, SOST medics learn to dynamically JB, JW-B, JD, and SLH have no financial relationship to this
maneuver within and across social determinants to optimize study. EAJ served as the Senior Lead Research Scientist on this
practical performance across the deployment cycle. project and was paid through the following contracting com-
panies: Parsons Corporation, ABSS Solutions, Inc./1st Amer-
ican Systems and Services, LLC, and Innovative Employee
Conclusion: The Practical Importance of Our
Operational Model to SOF Medicine Solutions (IES).
Having linked our operational model to both our strategic Funding
framework and to tactical engagement with social determi- This research is sponsored by funding (#FU 20-042) from the
nants, we conclude by briefly exploring the limitations of this Air Force Research Laboratory–United States Air Force School
model within SOF medicine. We believe our ethnographic of Aerospace Medicine (AFRL-USAFSAM) through the Stud-
study will resonate with other SOF medics and leaders because ies and Analysis Program.
our inquiry is grounded in the phenomenon of catastrophic in-
jury exposure, which is central to the practical performance of Disclaimer
all SOF medics in SOF missions. This model reinforces the im- The Public Affairs Office, United States Air Force 60th Med-
portance of cultural adaptation and its relationship with team ical Group at Travis AFB, has approved this publication for
and individual practical performance. However, our ethnog- universal distribution. The Institutional Review Board of the
raphy was focused on the organizational culture of SOST and Air Force Research Laboratory approved the study as an
cannot explain the dynamic effects that exist in the broader exempt protocol (#FWR20200104) in August 2020. The in-
SOF culture. Although our operational model has yet to be formation, content, and/or conclusions do not necessarily rep-
validated across SOF medicine, it still has practical importance resent the official position or policy of the Air Force Research
for developing the best possible training in unconventional re- Laboratory–United States Air Force School of Aerospace Med-
silience. Our operational model also provides a rationale for icine, the Department of Defense, or the U.S. Government.
disruptive diversity for optimal performance of a cohesive eco-
system by introducing the opportunity for transformation. The References
practical skill of evaluating cultural systems based on ambigu- 1. Jeschke EA, Baker JB, Wyma-Bradley J, Dorsch J, Huffman SL. Un-
ity not only validates our operational model of unconventional conventional resilience: a strategic framework. J Spec Oper Med.
resilience but also trains SOF medics to be existentially nimble. 2023; 23(3):58–62.
It thereby promotes the ability to engage and find value in di- 2. US Department of Defense. Joint Publication (JP) 1, Doctrine for
the Armed Forces of the United States, Incorporating Change 1.
verse experiences, such as death, discomfort, rejection, failure, Washington, DC: Chairman of the Joint Chiefs of Staff, 12 July
and discouragement. Thus, being existentially nimble is essen- 2017. US Department of Defense. Joint Publication (JP) 1, Doctrine
tial for change. In the next article in this series, we will discuss for the Armed Forces of the United States, Incorporating Change
the social determinants of bonding patterns. 1. Washington, DC: Chairman of the Joint Chiefs of Staff, 12
July 2017. Accessed November 7, 2022. https://irp.fas.org/doddir
/dod/jp1.pdf
Author Contributions 3. Seligman MEP, Rashid T, Parks AC. Positive psychotherapy. Am
EAJ conceived of this study and wrote the protocol. SLH ob- Psychol. 2006;61(8):774–788.
tained funding and Institutional Review Board approval. JD 4. Slomski A. IOM: Military psychological interventions lack evi-
acted as liaison to the Air Force Special Operations commu- dence. JAMA. 2014;311(15):1487–1488.
nity, specifically the 24th Special Operations Wing and Special 5. Lapum JL, Liu L, Hume S, et al. Pictorial narrative mapping as a
Operations Surgical Teams. JD also orchestrated all approvals qualitative analytic technique. International Journal of Qualitative
Methods. 2015;14:1609406915621408.
for field observations. EAJ recruited participants, collected 6. Sandelowski M. The problem of rigor in qualitative research. ANS
and analyzed interviews and data, and drafted the initial tax- Adv Nurs Sci. 1986;8(3):27–37.
onomy of themes. EAJ and SLH wrote the first draft of this 7. Timmermans S, Tavory I. Theory construction in qualitative re-
paper. SLH contributed substantive changes to a second draft. search: From grounded theory to abductive analysis. Sociological
JD served as Air Force Special Operations Command medical Theory. 2012;30:167–186.
expert during the data analysis process. JB and JW-B provided
substantive feedback to the second draft. JB served as military PMID: 37972384; DOI: 10.55460/UOZ5-J9AH
medical expert in redacting findings. All authors read and ap-
proved the final manuscript.

68 | JSOM Volume 23, Edition 4 / Winter 2023