Page 89 - JSOM Fall 2024

fixed and formed practical skills necessary to optimize medical activity. As such, prioritization of administrativia clouds SOST
decision-making in the regulated environment. Consequently, medics’ impromptu and fluid movement with the energies of
when initially presented with catastrophic injury exposure life within military medical decision-making amid catastrophic
amid an austere mass casualty scenario, SOST medics are injury assessment.
distracted by battlefield dynamics instead of being able to in-
terpret and move with real-time battlefield dynamics. Thus, Prioritization of administrative activities clouds performance
problem-solving skills are minimized causing SOST medics to pressure by diffusing the torque necessary to sustain a sound
initially blunder through military medical decision-making in perspective on operational medicine. Placing paperwork above
the SOF missions. medical-martial creativity development blurs SOST medics’
ability to discern life energy and degrades short-term uncon-
Lack of realistic mass casualty training volume increases per- ventional resilience. Long-term unconventional resilience is
formance pressure, creating overwhelming torque that para- degraded when SOST medics question the value of their skill
lyzes the integration of life and death energies. The practical set within the SOF performance space.
result is that creativity stalls out. The infrequent practice of
engaging death energy specific to the SOF performance space Bag Sets as Meaningful Metaphor:
ii
increases ambiguity. In response, SOST medics engage black Medical-Martial Creativity
and white decision-making behaviors that rigidly aim to save
all casualties. his fixed and formed mode of problem-solving Tactical Function of Social Determinant:
degrades short-term unconventional resilience. Long-term un- Medical-Martial Creativity
conventional resilience is degraded by delimiting and reducing The social determinant of medical-martial creativity carries the
appreciation of real-time patterns of death energy in austere weight of the circulation component of bag sets as a meaningful
mass casualty scenarios. When SOST medics perseverate over metaphor. 10–12 Circulation is a central component of bag sets
their interpretations of catastrophic injury patterns—especially because there can be no movement of biological life and death
those that lead to death—it introduces doubt and hesitancy energies without the ability to establish a stable rhythmic pulse.
into military medical decision-making. The SOST’s credibility Catastrophic injury generally compromises circulation by dis-
with the SOF team is reduced through inflexible performance rupting the rhythmic flow of blood volume. Within bag sets,
amid austere mass casualty scenarios, which minimizes SOST’s medical-martial creativity metaphorically relates the process of
value to the SOF mission. re-establishing a stable rhythmic pulse during catastrophic in-
jury. Medical-martial creativity acts like tourniquet application,
The second reduction of medical-martial creativity that de- IV establishment, and infusion of blood products during military
grades unconventional resilience is the prioritization of non- medical decision-making. The tourniquet stops the flooding and
clinical practices (i.e., administrative activities over medical fragmentation of focus amid the task-saturated environment of
training), which is illustrated by the following quote: a mass casualty scenario by narrowing and directing the flow
of attention to the most critical elements of decision-making.
Teams only have a certain amount of bandwidth. All too Intravenous access creates a pathway to engage gestalt interpre-
often, that bandwidth gets taken up by administrative tation of the immediate medical and military context in which
tasks. Of course, compliance is important, but our primary mass casualty occurs. Infusion of blood products re-establishes
mission is to be medically sound. Work that’s not directly connection to the broad rhythms of life and death energies en-
related to our skills as a surgeon, ER doc, nurse, respi- tailed in the SOST medic’s repertoire of medical-martial cre-
ratory or surge tech takes away important clinical time. ativity. As such, medical-martial creativity, like the circulation
Trying to keep up with a multitude of paperwork detracts components, helps establish a strong rhythmic pulse for military
from our performance. If we are focused on administra- medical decision-making in the SOF performance space.
tivia to the detriment of our medical proficiency, then
something is wrong. Unfortunately, we’ve bumped heads When SOST medics stabilize life and death energies during mass
with plenty of commanders and even teammates who dis- casualty events, equipoise manifests in military medical deci-
agree, but sometimes we get lost in the whirlwind of Air sion-making and a palliative partnership with the SOF team is
Force requirements. Not that these things are bad or in- established. The absence of medical-martial creativity acts like
consequential, it’s just that they can all too easily divert the hemorrhagic shock in military medical decision-making caus-
focus away from being the best medical team we can be. ing major disruption to the flow and integration of information
across the SOST and SOF teams relative to catastrophic injury
This quote highlights that bureaucratization directs SOST assessment and interpretation. When this happens, SOST med-
medics’ focus toward fixed and formed protocol adherence ics expend their focus in attempts to concretize and control the
by equating compliance with professionalism and leadership. medical outcome during the triage process.
Prioritization of administrative activities over the development
of medical and martial skills fragments SOST medics’ focus Tactical Process of Forming Social Determinant:
instead of integrating and expanding it. These activities also Medical-Martial Creativity
disorient SOST medics’ repertoire of creative knowledge of Within our metaphor, the organization tactically engages the
life energies by elevating paper shuffling to a mission essential social determinant of medical-martial creativity by providing

ii Since it was not addressed in our original methodology paper, but has been a concern of multiple reviewers, we want to add a brief comment on
the use of metaphor as a qualitative technique to achieve artistic rigor and resonance. The adept writing of qualitative analysis is determined by
the ability to construct meaningful metaphors that build bridges across the original participant community, the broader population of interest
(here SOF medicine) and a lay audience unfamiliar with the cultural world being discussed. For these reasons, we have drawn on one of the most
dominant practical-tactical realities of the SOST medic experience; namely, their fluent and fluid relationship to their bag sets which is illustrated
as the ultimate tactical expression of unconventional resilience.

Unconventional Resilience: Medical-Martial Creativity | 87