Every American warfighter now goes into combat with a personal first aid kit and Combat Lifesaver training to provide both personal and buddy medical care immediately. Only moments away is a Combat Medic, trained beyond the capabilities of previous battlefield medics, whose job is to stabilize the patient pending medical evacuation, often in a matter of minutes, to a field surgical care facility and, usually within 24 hours, back to Europe or the United States for top-level hospitalization.

Except special operators.

The current conflict in Southwest Asia has seen increased demands on the joint Special Operations Command (SOCOM) and its service components – U.S. Army Special Operations Command (USASOC), Air Force Special Operations Command (AFSOC), Naval Special Warfare Command (NAVSPECWARCOM), and Marine Corps Forces Special Operations Command (MARSOC). But just as special operators typically function alone with specialized equipment, so have they evolved their own brand of field medical care.

“We are unique, in that we are dropped into remote, austere locations, often surrounded by the enemy. You have to use whatever you can take with you to reduce the morbidity and mortality of your team, host nation personnel, and even enemy combatants,” noted Col. Jeffrey Kingsbury, dean of the Joint Special Operations Medical Training Center (JSOMTC). “If a special ops unit infiltrates an area where they do not want to be detected, they may have to hold a wounded warfighter for days until they can get him out.

“I have seen situations where evacuation simply cannot get to them and our guys are prepared for that. And that is when the tools and skill sets they have combine with their very good reachback capability [typically satellite communications – voice, data, and video – to specialists anywhere in the world], where they become the eyes and ears of someone who helps them deal with situations for which they were not trained. They also encounter conditions among the host nation population, such as skin problems, they have never seen before and local medicine cannot help.”

JSOMTC, located at Fort Bragg, N.C., is the centerpiece of SOCOM medical training, beginning with a 26-week course that produces a Special Operations Combat Medic (SOCM) – the minimum level of training for SOCOM medics.

“This is beyond the basic training and combat medic training that produces the 68W MOS [military occupational specialty] for Army combat medics,” according to SOCOM Command Surgeon Col. Virgil T. Deal. “Total training time for the 18D or medic assigned to a 12-man Special Forces Operational Detachment-Alpha – or A Team – may be up to over 40 months when language and other requisite training is completed.

“Even non-medical personnel now receive far more extensive training in the initial management of trauma than has ever been taught. In the late 1990s, Dr. Frank Butler, later SOCOM command surgeon, authored a paper that refocused our approach to casualty care in far-forward areas of the battlefield and led to our current training in Trauma Combat Casualty Care.”

A regular Army combat medic or Navy corpsman (who provides field medic services for the Marine Corps) completes a 16-week course that provides field skills at the EMT-Basic level of a civilian emergency medical technician. With a substantially improved medical kit, they can stabilize and hold a wounded warfighter during the “golden hour” before the patient can be medevaced to a higher level of care.

For SOCOM, the term “medevac” – traditionally associated with the use of specialized medical evacuation helicopters – does not exist. Neither do the specialized helicopters. Instead, special ops wounded await “casevac” (casualty evacuation) by whatever means may be available, whenever it may be available. That may be a resupply helicopter that arrives days after the injury – or even a horse, mule, or camel, if that is the only means of transport available.

“Our course for a special ops combat medic, our lowest ranking, is 26 weeks. Our special ops independent duty corpsman – or 18D – is an additional 24 weeks of advanced training, including two one-month rotations: one during the basic course in Virginia or Tampa/St. Petersburg [Fla.] civilian hospitals – that includes two weeks on ambulance runs and two weeks at various assignments, from the ER to maternity to surgery – and one during the second, at one of 40 DoD [Department of Defense] locations around the nation, where they primarily will do more advanced work, such as dermatology, pulmonology, etc.,” Kingsbury said.

“For SOCOM, we teach them to the EMT-P [paramedic] level and how to stabilize patients until they can be casevaced. For the combat provider, trauma is 5 to 10 percent of what you do; the rest is taking care of pneumonia or skin infections. Our special operators work very closely with host nation personnel and will, on occasion, break bread with them, so they could pick up a GI infection of some sort.”

Dropped into remote locations, cut off from traditional support systems, perhaps unable to call for help due to the risk of revealing their location, special operators must take everything they need with them – including medical caregivers who can keep a wounded warfighter alive for several days. Due to the small size of special ops units, those medical personnel are considered warfighters first, medics second.

“Each operator is trained to the level of a Combat Lifesaver [a three-day annual course], who can stop hemorrhage, start an IV, do CPR – there is no real civilian equivalent,” Kingsbury said. “The next level is a Special Ops Combat Medic or Advanced Tactical Practitioner [ATP], which is more than an EMT-P in civilian medicine, sort of an EMT-P medic with additional training in trauma medicine [a graduate of the 26-week course]. This medic has the capability to hold a patient up to 72 hours.

“Above that is the 18D or Special Forces Medical Sergeant or Special Ops Duty Corpsman [Navy/Marines]; that I would describe as a wilderness physician. Like a civilian PA [physician’s assistant], they have the breadth, but not the depth – they have trauma capability and a broad spectrum of knowledge, and may be the only medical care a host nation patient sees, especially for uncomplicated cases. They have the capability to indefinitely hold patients who cannot get into our medical system or a host nation medical facility.

“Each special ops team has 12 members, two of whom are 18Ds. In addition, each company has six ODAs [Operational Detachment-Alpha] and each battalion has a doctor and a PA plus a couple of 18Ds. At the group level we have a doctor, a veterinarian, and a dentist. So a Special Forces Group typically has five doctors, four PAs and 160 18Ds; four-man special affairs teams have one ATP.”