Page 93 - JSOM Spring 2024

the phenomenon of catastrophic injury exposure in austere en- other practical skills developed in everyday life—in particular
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vironments. Both the phenomena and context are fundamen- medical skills—on the assumption that combat performance
tal to the SOF medics’ practical performance. Our approach to is singularly driven by fighting skills formed through mar-
tactics may be disruptive because it values the practical skills tial training. Culturally, “tactical” seems not only to subsume
formed in daily life as the most important aspect of change- skills learned from personal experience into martial training
agency by which performance possibilities are transformed in but also functions as a qualifier for acceptance and bonding
real-time. Everyday practical skills are habits formed through in the team. In contrast, our analysis of the tactical level of
daily practice of a particular activity. As such, power to shape unconventional resilience will focus on a broad range of skills
the performance space amidst SOF missions lies with those learned in everyday activities that are not solely focused on
who utilize commonplace pressures to embrace, absorb, and martial training for combat performance.
direct tension into torque. This enables fluid movement to cre-
ate adaptive bonding patterns in support of unconventional The commonplace definition of tactical relates to the devel-
resilience, defined as the ability to facilitate dynamic freedom opment of the techne attendant to a particular craft, through
of maneuver in ambiguity across the individual SOF medic, hands-on practice of associated skills that need not necessarily
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team, and organization. At the tactical level of unconventional be related to the skills of military fighting. In other words,
resilience, commonplace pressures are not always directly mis- both medical and martial skills are tactical because they are:
sion focused, but emerge within SOF culture as an opportunity 1) obtained and sustained by ongoing practice in daily life;
to direct movement toward cohesive connections across the 2) focused on movement; and 3) developed to achieve a prac-
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ecosystem of relationships. tical function. Said differently, tactical skills are practical
skills, which are the constituents of practical performance. For
example, the practical skill of effectively engaging a weapon
Tactical Engagement with Social Determinants
requires repetitive practice just like the practical skill of effec-
In the third paper of this series, we identified five social de- tively applying a tourniquet requires repetitive practice. Both
terminants that structure and support SOF medics’ practical practical skills are essential for SOF practical performance
performance across the deployment cycle. They are as follows: aimed at achieving SOF mission success.
bonding patterns, impression management, medical–martial
creativity, grief processing, and family formations. In this sec- Social determinants emerged in our analysis as saturated
tion, we develop the tactical level of unconventional resilience themes relating to sociocultural influences that either optimize
by explaining the interrelationship of tactical engagement with or degrade unconventional resilience by regulating pressure
social determinants through the metaphor of bag kits. By tac- across the deployment cycle. Tactical engagement with the
tical we mean, the level of unconventional resilience focused social determinants is how the SOF medic, team, and orga-
on the ordered arrangement of commonplace practices across nization interact with each specific social determinant. When
the deployment cycle that, when brought together, can either cultural change is introduced into the cohesive ecosystem of
optimize and/or degrade practical performance during SOF symbols, values, norms, and attitudes, tactical engagement acts
missions. In other words, tactics are where actual engage- as a dynamic process of formation and destruction, the benefit
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ment with unconventional resilience is planned and executed of which is driven largely by the cultural environment.
to achieve performance objectives. While the quotes provided
are dichotomized for simplicity of illustration, we recognize Bonding Patterns:
that there is a spectrum of tactical engagement with the social Definition and Qualitative Exemplars
determinants that expresses a blend of positive and negative
attributes in practical performance. Qualitative analysis of ethnographic data led us to define the
social determinant of bonding patterns as unique attributes
Social determinants are connections formed across the de- found within the social context of SOF medicine that struc-
ployment cycle that positively and/or negatively facilitate or ture SOST relationships such that practical performance is ide-
constrain the SOF medic, team, and organization’s ability to ally expressed as adaptive, real-time diplomacy across diverse
bear the weight of dynamic freedom of maneuver amidst the stakeholders and communities. To illustrate how bonding
ambiguity of SOF missions. The social determinants we pres- patterns either optimize or degrade unconventional resilience,
ent in subsequent papers are not an exhaustive list, but are we present two exemplars of functional and dysfunctional
rather exemplars of the types of cultural influence that can bonding patterns derived from qualitative data. These exem-
optimize or degrade the ability of the cohesive ecosystem to plars cannot be understood as an exhaustive list describing all
support performance pressure in SOF culture and achieve the ways bonding patterns can optimize or degrade uncon-
unconventional resilience. Understanding and analysis of the ventional resilience; however, they capture the most prevalent
cultural influences on unconventional resilience will need to themes in this unique data set.
be constantly assessed and reassessed for immediate as well as
downstream effects on the cohesive ecosystem.
Optimization of Unconventional Resilience
Something we observed in discourse that took place during The first bonding pattern that optimizes unconventional resil-
field observations, interviews, and Special Operations Med- ience is connection fostered through play (i.e., spirited bond-
icine Scientific Assemblies (SOMSA), was conflation of the ing) as illustrated in the following quote:
term tactical with martial in the SOF culture. Empirical anal-
ysis revealed a cultural conflation of terms wherein tactics are The surgeon and the anesthesiologist were taking the pa-
assumed to be singularly related to the formation of fighting tient from the trauma bay into surgery. The patient rolls
skills directed toward engaging the enemy on the battlefield. over to vomit off the side of the litter. We were all in shorts
Consequently, tactical skills are placed in competition with and flip flops because it was f…ing hot—by the way flip

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