Page 51 - JSOM Fall 2024

Self-Described Training Needs of Special Operations Forces Medics
and the Birth of the TACMED Division

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Ivan L. Yue, MD, FAWM *; David S. Allen ; James Chung, DO, MPH ;
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Arthur “Shawn” Ruppert, PA-C ; Wayne N. Papalski ; Noel Sons, BS, BA, DiMM ;
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Gregory Zarow, PhD ; Carsten J. Good ; Lucas E. Devenny ; Harrison J. Cady ;
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Erik M.D. Sonntag ; Ray C. Adams ; Amy L. Hildreth, MD, MHPE 13
ABSTRACT
Training needs of Special Operations Forces (SOF) medics Introduction
were surveyed and new training initiatives have been created
to meet their needs. SOF medics perform an array of medical Special Operations Forces (SOF) medics have a staggeringly
procedures in austere environments with minimal supervision. wide and technically deep scope of practice. SOF medics often
Medical skills decay over time after initial training and the work independently, without direct supervision from a medi-
perceived training needs of active SOF medics were unclear. To cal officer, and typically without the benefit of regular clinical
fill this gap, active SOF medics (n=57) completed a survey that training. So, while SOF medics graduate from a rigorous and
included confidence ratings and indications of whether addi- comprehensive initial training course, refresher/sustainment
tional training would make them more proficient in 70 medi- training is vital.
cal knowledge and procedural skills, assembled into categories
by a panel of experts (airway, trauma, neuro, differential di- Medical skills and knowledge retention degrade with time,
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agnosis, administrative, infection, critical care, environmental, particularly when not clinically practiced on a regular basis.
other). Data were analyzed with analysis of variance (ANO- For example, a study of previously trained Army Ranger Spe-
VA) and nonparametric statistics at P<.05. Confidence was cial Operations Combat Medics (SOCMs) and Special Oper-
highest in the trauma, administrative, and airway categories, ation Medical Sergeants (18Ds) found that simple refresher
and lowest in the infection, differential diagnosis, and neuro training improved procedural cricothyrotomy success rates by
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categories (P<.05 or less). Categories indicating the greatest over 20%.
need for additional training were environmental and critical
care, while those indicating lowest need were the airway and Sustainment training is crucial because it improves confidence,
trauma categories (P≤.05). Additional training was endorsed execution, knowledge, and decision-making for lifesaving in-
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by >75% of participants in each category. SOF medics also terventions. Previous studies on Navy Flight Surgeons, Air
wanted additional training in all areas, preferably hands-on Force flight nurses, Air Force aeromedical evacuation techni-
with live patients in realistic scenarios, taught by experienced cians, Army physicians, and Army physician assistants identi-
medics. Findings highlight the training needs of SOF medics fied common themes of lack of confidence and a demand for
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and demonstrate the value of bottom-up feedback toward op- additional training for military first responders.
timizing sustainment training. Based on present findings, two
TACMED (Tactical Medicine) Divisions at the SOF Echelon Further, a large (n=334) survey of 18Ds revealed their belief
III level were created to meet the sustainment training needs that maintaining medical skills was significantly more im-
of SOF medics. portant than maintaining skills in other areas, yet they spent
less time (an average of 3.7 hours per week) on medical skills
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sustainment training than on training in other skills. Interest-
Keywords: special warfare; special operations; advanced tac-
tical provide; medical sustainment program; medical train- ingly, these 18Ds indicated that they have only slight to mod-
ing; TACMED erate control over their sustainment training and that they
need more training in all areas of medicine. They perceived
that the command focus on meeting minimal credentialing
*Correspondence to Ivan Yue, 34800 Bob Wilson Dr., San Diego, CA 92134 or ivanlyue@gmail.com
1 LT Ivan L. Yue is an Emergency Medicine physician at the Naval Medical Center San Diego and Deputy Director of Combat Trauma Research
Group West, San Diego, CA. SO1 David S. Allen is an Advanced Tactical Provider and Special Operations Tactical Medic with the Naval Spe-
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cial Warfare Group One, Coronado, CA and Combat Trauma Research Group West, San Diego, CA. CDR James Chung is the Senior Medical
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Officer with the Naval Special Warfare Group One, Coronado, CA. LCDR (ret) Arthur “Shawn” Ruppert served as a medical provider with
Naval Special Warfare Group One, Coronado, CA and Combat Trauma Research Group West, San Diego, CA. HMCS Wayne N. Papalski is a
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Search and Rescue Medical Technician, Nationally Registered Paramedic, Certified Flight Paramedic, and Certified Tactical Paramedic with the
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Naval Special Warfare Group Two, Little Creek, VA. SOC (Ret) Noel Sons was a Special Operations Combat Medic, Nationally registered Para-
medic, Certified Flight Paramedic, and Certified Critical Care Paramedic with the Naval Special Warfare Group One, Coronado, CA and with
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the Combat Trauma Research Group, San Diego, CA. Dr. Gregory Zarow is with Combat Trauma Research Group West, San Diego, CA and is
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The Emergency Statistician, Idyllwild, CA. SO1 Carsten J. Good is a Special Operations Tactical Medic with the Naval Special Warfare Group
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One, Coronado, CA. SO1 Lucas E. Devenny is an Advanced Tactical Provider and Special Operations Tactical Medic with the Naval Special
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Warfare Group One, Coronado, CA. SO1 Harrison J. Cady is an Advanced Tactical Provider and Special Operations Tactical Medic with the
Naval Special Warfare Group One, Coronado, CA. SO1 Erik M.D. Sonntag is an Advanced Tactical Provider and Special Operations Tactical
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Medic with the Naval Special Warfare Group One, Coronado, CA. SOC Ray C. Adams is an Advanced Tactical Provider and Special Operations
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Tactical Medic with the Naval Special Warfare Group One, Coronado, CA. Amy L. Hildreth is an assistant professor and clerkship director at
the Uniformed Services University of the Health Sciences, Bethesda, MD and with Combat Trauma Research Group West, San Diego, CA.
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