Page 87 - JSOM Fall 2024

exposure in austere environments. Our approach to tactical Considering SOF medics’ exposure to catastrophic injury, their
engagement may be disruptive because it evaluates the social practical performance is dependent on the ability to fluidly
context in which an SOF medic’s practical skills are formed as move between life and death energies. As such, creative cour-
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an important aspect of change-agency in which performance age that harmonizes life and death energies in the medical
possibilities are transformed in real-time. As such, pragmatic and martial professions provides an avenue to explore medi-
power to change the performance space amid SOF missions cal-martial creativity in SOF medicine.
lies with those who utilize everyday pressures within available
social structures to embrace, absorb, and direct opposition into Qualitative Exemplars
equipoise (balance of forces), creating fluid medical- martial To illustrate how medical-martial creativity either optimizes or
creativity that supports unconventional resilience. degrades unconventional resilience, we present two exemplars
of how medical-martial creativity enhances and reduces un-
conventional resilience. The subsequent exegesis provides an
Medical-Martial Creativity: Definition and
Significance of Integrating Medical and Martial Skills interpretive analysis of qualitative themes, which supports our
comprehensive theory of human performance in which uncon-
Social determinants are cultural connections that positively ventional resilience is embedded.
and/or negatively pattern the SOF medic, team, and organi-
zation’s ability to facilitate dynamic freedom of maneuver Optimization of Unconventional Resilience
amid the ambiguity of SOF missions. Qualitative analysis of
ethnographic data led us to define the social determinant of The first enhancement of medical-martial creativity that op-
medical-martial creativity as unique attitudes found within timizes unconventional resilience is support for hybrid medi-
the social context of SOF medicine. These attitudes shape cal-martial training (i.e., primary focus on high volume, high
the SOF medic’s imagination such that resilient performance acuity trauma care supported by martial experiences), which is
is expressed as adaptive, real-time military medical decision- illustrated in the following quote:
making that fluidly modulates performance pressure amid the
violence of SOF missions. By “martial” we mean the devel- Clinical currency and proficiency are the primary ways to
opment, management, and application of fighting skills asso- show that we are competent as medics, but we also need
ciated with direct-action SOF missions. In this performance to know the environment into which we are going. To es-
space, medical-martial creativity supports the SOF medic’s tablish our clinical currency and proficiency, we created a
ability to interpret the SOF mission and find their purpose plan to integrate SOST into civilian Trauma One Medical
within it. The optimization or degradation of medical-martial Centers as our main duty assignment. We argued that
creativity is dependent upon SOF cultural attitudes that ac- being constantly exposed to civilian trauma should be
knowledge and/or deny the visceral reality of SOF medicine central to SOST’s mission because it would not only sus-
and the attendant training needs that foster combat readiness. tain, but more importantly increase clinical currency and
proficiency. Integrating into Trauma One Centers opened
Creativity, which gives rise to new possibilities, serves to inte- up infinite opportunities to practice our trauma skills.
grate oppositional energies. In his book The Courage to Cre- Still, out in the field medical resources are limited, and
ate, Rollo May discusses creativity as a willing and intentional the war isn’t going to stop for us to take care of casual-
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engagement with the energies of life and death. These creative ties. That means martial training is not just fun, it’s neces-
energies are not defined simply as physiological life or death, sary. Learning to shoot, move, and communicate helped
nor are they understood as being in competition with each us understand the environment in which we applied our
other. Both energies are challenging, formative, and valuable trauma skills. Martial training develops a broader abil-
aspects of the human condition. Creative energy is born when ity to critically think and problem solve amidst a chaotic
a person is willing to move between both life and death ener- and stressful environment which translated to our ability
gies integrating lessons learned from all experiences in daily to fluently perform life-saving medical maneuvers in the
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life. While such movement precipitates enormous tension, field. Martial training also informed our trauma technique
when its force is intentionally directed toward change-agency, because it helped us understand what types of wound
creativity blossoms. i,3 patterns could potentially occur, which allowed us to fo-
cus on developing skills required to attend those wounds.
Situating SOF medical-martial creativity around life and death Martial training also made clear through experience, not
energies is important because the SOF medic’s practical perfor- just didactics, that the medical team would not be com-
mance relative to catastrophic injury dwells in both energies. pletely in charge of medical decision-making downrange
Unfortunately, the Western culture has put the medical and mil- because the military commander is always in charge. The
itary professions at odds with each other. Consequently, the military mission is always first. So even if a procedure is
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practical skills of caring associated with medical professional medically indicated and we have the capability to perform
virtue, are often seen as oppositional to the fighting skills asso- that procedure, we are not going to do the procedure if
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ciated with martial professional virtue. The former reality can the military commander says it will compromise the mis-
be seen in conventional military culture, wherein medical and sion. One time, a young girl was injured, but the opera-
martial training are often viewed as distinct realities that do tional requirements were too high risk to perform surgery.
not complement one another. The challenge of these deep cul- As a team, we had to be ok with the decision to quickly
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tural assumptions is that they create a serious impasse when relocate, which meant we had to find a way to move our
attempting to develop medical-martial creativity. gear without being a risk to the mission and leave the

i One might generally think of relating to life and death energies as a dancer attempting to engage various moods of music to create and sustain a
connection to self, other dancers, and an audience.

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