Page 95 - JSOM Summer 2025

1. Thorough diagnosis: Ensure associated injuries are ruled Medic – prehospital: At this stage, the healthcare practitioner
out to prevent oversight. first needs to master the basics. This includes simple acts of
2. Treatment order: Focus on immediate life-threatening con- daily life such as changing socks, drinking enough water, stay-
ditions before burns. ing warm. By doing so, the medic will be capable of being
3. Efficient triage: Rapid and clear triage is essential, espe- comfortable and maintaining work capabilities. At this stage,
cially in mass-casualty events. Combat Casualty Care has to focus on an aggressive hypo-
thermia prevention and on a few essential interventions: hem-
This presentation advocates a standardized yet adaptable ap- orrhage control, airway management, initial use of intranasal
proach to burn care in challenging SOF contexts, where prepa- drugs. Tactical evacuation is a particular concern because of
ration, prioritization, and field-adapted protocols are critical the difficulty to move casualties on the snow. Prolonged field
to effective burn management and patient survival. care is a big challenge and needs to be prepared for; usage of
appropriate tents and telemedicine needs to be anticipated.
Strengthening National Resilience Through Tactical medical team: The challenge of medical treatment
Deployed Medicine in Civilian Austere in extreme cold requires new technics and technologies. SOF
Environment: The Belgian Role 2 medical teams have to support a huge spectrum of military
Forward Experience operations in different terrain types (e.g., mountainous, sub-
Dr. Jean-Charles de Schoutheete (BEL), arctic, and arctic conditions). Some missions last a long time
Dr. Arthur Bun (BEL) in isolated environments with long expected evacuation times.
Low-technology solutions have to be emphasized for these
The war in Ukraine has changed our paradigm for manag- situations, such as using body temperature for drug conser-
ing war casualties. New rules apply to the entire evacuation vation or using sleeping bags and pads to wrap casualties.
chain. Medical teams need to provide a broad spectrum of care On the other hand, some SOF missions allow and need high
in austere conditions with very long resupply and evacuation technology solutions, such as electrical devices to warm the
times. Surgery, therefore, remains pivotal for wounded sol- casualty, allow drugs to be ready to use as fast as possible, and
diers—to save our patients, we need to bring surgery forward. bring whole blood and perform transfusion far forward even
in this extreme environment. Finally, and most importantly,
However, the experience acquired to date by most Western all SOF missions conducted in cold conditions require special
surgical teams does not correspond to the Ukrainian para- training.
digm. Few of these teams have had to manage a high volume
of patients in an austere environment, and most experience Surgical Team: These teams expect to receive more severe ca-
has been gained in a hyper-technological environment where sualties, affected by extreme cold before they can be reached.
resupply was not a problem (Role 3). At the same time, this level of care usually relies on more com-
plicated and vulnerable materials. Considering this, the central
To fill this gap, the Belgian Defence has structured the training question for surgical treatment is to know exactly what adap-
of its surgical teams, signing a bi-national agreement with the tations must be done and which kind of interventions are ac-
Democratic Republic of Congo. Every 2 months since January ceptable and which are not. Post-surgical considerations such
2024, our surgical teams have worked with local staff to treat as casualty transport conditions have to be anticipated and
civilian and military patients in a slum hospital for 2 weeks. will probably lead to limitations of surgery if not acceptable
Austerity, lack of second line, high volume, high morbidity, (e.g., open abdomen cannot be evacuated in snowmobiles or
and high mortality (30% in emergency departments) are the sledges). Heating an operating room is a source of thermal or
leitmotiv. smoke footprint that can be unacceptable in low-profile SOF
missions; therefore, it is an area for research and innovation.
After two weeks, we treat about 40 patients (15% pediat-
rics), most for midline laparotomies and fractures, in phase Conclusion: There are many more questions than answers
with global anesthesia and global surgery. We provide daily about SOF medical support in extreme cold weather. Training
whole blood transfusions and face death regularly (10 to 15% and innovations must be emphasized.
of treated patients), increasing our psychological and spiritual
resilience.
The Future of SOF Medicine:
We plan to deploy in 2025 an independent surgical capability A French Point of View
in Africa to not only sharpen our surgical teams but also opti- Dr. Mathieu David (FRA)
mize our protocols and logistics lines. Know the past: After the Gulf War, the French SOCOM was
created in response to lessons learned. It has been shaped over
Tips & Tricks with the Experts: 30 years as a rapid response force to crises and has grown
How Do I Operate in (Very) Cold Conditions? through the Global War on Terrorism. It is in this context that
the French SOF Med command was created in 2018 as the
Prof. Marcus Larsson (SWE), Dr. Yann Bauvent (FRA), medical component for SOF. Over the years, we have devel-
OR-7 Ruben Ström (SWE)
oped a robust and effective medical support model, based on
Introduction: Cold weather operations are attracting a grow- TCCC, remote damage control resuscitation, blood far for-
ing interest among Western armies. The specifics of these envi- ward programs, and forward damage control surgery.
ronments are not currently covered by medical guidelines. The
aim of this session is to settle the questions that concern three Over the years, we have developed a robust and effective med-
different points of view. ical support model based on the following principles:

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