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complementary, and innovative enterprise in support of the process—evokes disequilibrium. Likewise, degraded family
SOF mission. formations increase the friction of relationship building by
cementing certitude into unevaluated momentum, elevating
Optimized tactical engagement with family formations—like SOF-exclusive relationship connections, while regarding out-
proper distribution of the exposure components of bag sets— side relationship connections as weak. Degraded family for-
composes and coordinates performance pressure by expanding mations diminish the proprioceptive skills of the medic, team,
the performance space, apportioning weight across the organi- and organization, causing them to be perpetually skeptical of
zation, team, and individual. Through a willingness to observe, non-SOF relationship connections and disorienting COG.
examine, discern, and integrate unanticipated momentum that
emerges when assessing interpersonal patterns and processes Conclusion: The Pragmatic Value of
that either strengthen or weaken family formations, the medic, Family Formations in SOF Medicine
team, and organization overcome relational inertia during the
character refinement process. Kinesthetic skills are enhanced The pragmatic value of optimized family formations enables
by leveraging the ambiguity inherent in unanticipated momen- exploration of novel social symbols, values, norms, and at-
tum toward recognition and utilization of new patterns and titudes and equips the individual SOF medic, team and or-
process outside of standard operating procedures. Realizing ganization to be choreographically nimble. This agility trait
that the character refinement process—like the exposure pro- organizes the kinesthetic and proprioceptive elements of ev-
cess—evokes disequilibrium, optimized family formations also eryday experience by fostering political hospitality. Optimal
help modulate the friction of relationship-building. By lever- family formations act like a gyroscope that orients COG,
aging ambiguity inherent in unfamiliar momentum toward buffers disequilibrium, and embraces vulnerability in practi-
the development of new relationship connections, optimized cal performance. By conserving momentum and maintaining
family formations enhance the proprioceptive skills of the SOF orientation in space, family formations effectively utilize time
medic, team, and organization, helping them to continually and energy to moderate change. Movement dynamically aligns
re-orient COG. with immediate performance space and directs toward corre-
sponding functional ends. Choreographic agility is essential to
Within our metaphor, the organization degrades tactical en- change agency because it provides an active structure that sta-
gagement with the social determinant of family formations bilizes real-time coordination of human relationships across
by increasing the weight of exposure components through the deployment-cycle.
unnecessary redundancy, which is expected to be carried by
individual medics without reference to their team. Forcing Author Contributions
each SOF medic to carry a blood warmer and HPMK in their EAJ conceived of this study and wrote the protocol. SLH ob-
personal bags displaces trauma shears and space blankets. In tained funding and IRB. JD acted as liaison to the Air Force
other words, when the organization compels individual SOF Special Operations community in specific the 24 Special Op-
medics to prioritize blood warmers over trauma shears in their erations Wing and Special Operations Surgical Teams. JD also
personal bags, individual wisdom is empowered only when orchestrated all approvals for field observations. EAJ recruited
it conforms to boilerplate SOF culture. Limiting influence of participants, collected and analyzed interview, data, and drafted
individual input elevates blind fidelity to SOF-exclusive rela- the initial taxonomy of themes. JD served as AFSOC medical
tionships and limits outcomes. Similarly, obliging every SOF expert during data analysis process. EAJ and JP wrote the first
medic to carry a hypothermia prevention and management draft of this paper. JWB provided substantive feedback to sec-
kit (HPMK) instead of a space blanket, conflates individual ond draft. JB served as military medical expert in redacting
wisdom with SOF cultural clichés that project only positive findings. All authors read and approved the final manuscript.
outcomes and focus team performance on ideological interpre-
tations of SOF truths and imperatives. When all SOF medics Disclosures
are expected to carry the excess weight of an individual blood Jay Baker, Jennifer Patton, Jared Wyma-Bradley, John Dorsch,
warmer and HPMK during the relationship-building process, and Sarah L. Huffman have no financial relationship to this
performance pressure focuses on the individual’s ability to study. Erika Ann Jeschke served as the Senior Lead Research
portray an image of superiority and reinforces social status Scientist on this project and was paid through the following
hierarchy. Ultimately, organizations that foster elitism contract contracting companies: Parsons Corporation, ABSS Solutions,
the enterprise’s performance space and potential. Inc. / 1st American Systems and Services, LLC, Innovative Em-
ployee Solutions (IES), SURVICE Engineering.
Degraded tactical engagement with family formations—like
displacement of trauma shears and space blankets—com- Disclaimer
poses and coordinates performance pressure by compressing The Public Affairs Office, United States Air Force 60th Med-
the performance space, which reallocates organizational and ical Group at Travis, AFB has approved this publication for
team weight to individuals. By rejecting vulnerability to in- universal distribution. The AFRL’s Institutional Review Board
terpersonal weakness that could diminish superiority and so- approved the study as an exempt protocol (# FWR20200104)
cial hierarchy, the individual medic, team, and organization in August 2020. The information, content and/or conclusions
are trapped in circular momentum when accepting interper- do not necessarily represent the official position or policy of
sonal patterns and processes into family formations. When AFRL-USAFSAM, the Department of Defense, or the U.S.
the medic, team, and organization work within degraded Government.
family formations, kinesthetic skills are hindered by replac-
ing ambiguity with certitude that reflects momentum toward Funding
fixed patterns and process within standard operating proce- This research is sponsored by funding (# FU 20-042) from the
dures. The character refinement process—like the exposure Air Force Research Lab-U.S. Air Force School of Aerospace

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