Special Operations Forces Research Articles

Ready to bleed when touched – Moral Injury in the Special Operations Forces military population

Abstract The armed forces combine different military populations with specific patterns of psycho-medical challenges and needs. The Special Operations Forces (SOF) exhibit one such pattern because they undergo more rigorous selection procedures, train differently and generally engage in different types of missions than other military populations. The aim of this commentary is to briefly introduce the psycho-medical patterns of SOF while paying particular attention to the growing discussion of Moral Injury (MI) in this military population. The mental health construct of MI refers to the persistent psycho-social harm resulting from exposure to events that clash with an individual’s moral beliefs. So far, research has focused on causes and symptoms of MI, less on prevention strategies and early intervention opportunities. This article advocates making a regular screening for symptoms of MI an element of routine physical check-ups of SOF to identify MI-related problems earlier and destigmatise mental health struggles, thereby countering severe manifestations of MI and alleviating suicidality rates in the SOF military population.

Five-Year Serial Brain MRI Analysis of Military Members Exposed to Chronic Sub-Concussive Overpressures.

The Canadian Special Operations Forces Command conducts explosives operations and training which exposes members to explosive charges at close proximity. This 5-year longitudinal trial was conducted in follow-up to our initial trial which examined military breachers with MRI and EEG pre and post blast exposure. To examine brain MRI findings in military personnel exposed to multiple repeated blast exposures. Five-year longitudinal prospective trial. Ninety-two males aged 23-42 with an average of 9.4 years of blast exposure. 3 T brain MRI/T1-weighted 3D with reconstruction in three planes, T2-weighted, T2-weighted fluid attenuated inversion recovery (FLAIR) 3D with reconstruction in three planes, T2-weighted gradient spin echo (GRE), saturation weighted images, DWI and ADC maps, diffusion tensor imaging. All MRI scans were interpreted by the two neuroradiologists and one neuroradiology Fellow in a blinded fashion using a customized neuroradiology reporting form. Matching parametric statistics represented the number of participants whose brain parameters improved or deteriorated over time. Odds ratio (OR) and 95% confidence intervals (CI) were computed using log regression modeling to determine volume loss, white matter lesions, hemosiderosis, gliosis, cystic changes and enlarged Virchow Robin (VR) spaces. A Kappa (κ) statistic with a 95% CI was calculated to determine rater variability between readers. A significant deterioration was observed in volume loss (OR = 1.083, 95% CI 0.678-1.731, permutation test), white matter changes (OR: 0.754, 95% CI 0.442-1.284, permutation test), and enlargement of VR spaces (OR: 0.775, 95% CI 0.513-1.171). Interrater reliability was low: κ = 0.283, 0.156, and 0.557 for volume loss, white matter changes, and enlargement of VR spaces, respectively. There were significant changes in brain volume, white matter lesions, and enlargement of VR spaces. 2 TECHNICAL EFFICACY: Stage 2.

Strategic resilience in human performance in the context of science and education - perspective.

Special situations that jeopardize the internal and external security for communities are increasing in their frequency and complexity. This creates complicated challenges for individuals, governments and humanity. National and international strategies are being developed that focus on the resilience and coping of all first responders during these extreme stress states. The aim of the article is to present the framework of strategic resilience, its multidimensional measurement and the possibilities for training robust resilience to increase operational effectiveness in special operational situations. Research in the area of special operation situations often focuses on the human performance cluster. The Unit of Applied Research 18_RECESS (18_ Research and Education Center for Extraordinary Tactical Situations and Strategically Resilience) at the Department of Disaster Prevention and Crisis Management at Fresenius University of Applied Sciences in Idstein fits into this field. It pursues the adaptation of existing resilience models to special operation situations in line with the definition of strategic resilience. In addition, the focus is on the possibility of training strategic resilience to increase operational effectiveness. There are currently several research projects being conducted in the civilian and civilian-military sectors, as well as with ground and special operations forces. Strategic Resilience with its 3 axes Psychological, Physiological and Cognitive Resilience covers the core domains of various existing models of resilience. This provides an adequate concept to describe different factors leading to personnel perseverance in special operation situations. There exists the possibility to train several domains of strategic resilience via problem-oriented intervention (POH).

Impact of repeated blast exposure on active-duty United States Special Operations Forces

United States (US) Special Operations Forces (SOF) are frequently exposed to explosive blasts in training and combat, but the effects of repeated blast exposure (RBE) on SOF brain health are incompletely understood. Furthermore, there is no diagnostic test to detect brain injury from RBE. As a result, SOF personnel may experience cognitive, physical, and psychological symptoms for which the cause is never identified, and they may return to training or combat during a period of brain vulnerability. In 30 active-duty US SOF, we assessed the relationship between cumulative blast exposure and cognitive performance, psychological health, physical symptoms, blood proteomics, and neuroimaging measures (Connectome structural and diffusion MRI, 7 Tesla functional MRI, [11C]PBR28 translocator protein [TSPO] positron emission tomography [PET]-MRI, and [18F]MK6240 tau PET-MRI), adjusting for age, combat exposure, and blunt head trauma. Higher blast exposure was associated with increased cortical thickness in the left rostral anterior cingulate cortex (rACC), a finding that remained significant after multiple comparison correction. In uncorrected analyses, higher blast exposure was associated with worse health-related quality of life, decreased functional connectivity in the executive control network, decreased TSPO signal in the right rACC, and increased cortical thickness in the right rACC, right insula, and right medial orbitofrontal cortex-nodes of the executive control, salience, and default mode networks. These observations suggest that the rACC may be susceptible to blast overpressure and that a multimodal, network-based diagnostic approach has the potential to detect brain injury associated with RBE in active-duty SOF.

Information and communication component of the network countermeasure to national security in the military sphere

The article conceptualizes ways of forming strategic guidelines for ensuring national security in the field of countering informational and psychological threats. The elements of the national security strategy, which are potentially significant in view of the development of active forms of information operations on the part of the enemy in the modern conflict, including military ones, are considered. Emphasis is placed on the use of special operations forces units in the field of network countermeasures against threats to national security in the military sphere. Taking this into account requires the development and implementation of the public administration specific mechanisms in the field of the national security ensuring, which are aimed at countering informational and psychological threats. In particular, it is about the need to adequately represent this issue in the national security strategy by defining the specifics of network countermeasures against threats to national security in the military sphere. In particular, it is about the development of the use of new methods of remote influence on the enemy, i.e., the expansion of the space for conducting combat operations and the environments of war, the development of new forms of defense and defensive measures, the growing importance of reconnaissance and sabotage actions in the rear of the enemy, the intellectualization of wars focused on the predominant use of high-precision and robotic weapons. This causes additional tasks to creative use of open source information as well as document analysis from documents like the National Security Strategy, National Military Strategy, taking into account that the main task in the field of military security is the development of deterrence potential, combat-ready armed forces and other components of the defense forces, capable of performing complex tasks in a multidimensional space, development of the components of the defense forces and solving the problems of ensuring the defense of the state. Information measures are an integral part of the state response to threats to national security and one of the main components of the information war aimed at achieving victory in the information space.

Irregular warfare must combine good medicine, with both good tactics and good strategies: Position paper by the French Special Operations Forces Medical Command.

Military operations are no longer limited to the application of counterterrorism and counterinsurgency strategies; they are now characterized by hybrid, irregular, and unconventional features. While some authors have indicated the need for medical support to adapt to these new modes of military operations, they have focused mainly on the tactical level of care on the battlefield. As Sun Tzu states, "Strategy without tactics is the slowest route to victory. Tactics without strategy is the noise before defeat," further proposals are still needed on the application of both medical tactics and medical strategies in irregular warfare. Medical experts from the French Special Operations Forces (SOF) Medical Command have identified specific medical challenges that special operations face in the context of the current transformation of armed confrontations into irregular warfare. This position paper presents original tactical medical proposals for improving medical support in irregular warfare, ranging from the definition of a Primary-Alternate-Contingency-Emergency medical plan to the promotion of telemedical support. Original strategic medical proposals have highlighted the importance of recognizing medical issues in irregular warfare, including the medical actions carried out through and with local partners and the multiple approaches to countering medical threats. The SOF medical community must be closely involved with and facilitate the responses to the shift to irregular warfare. International collaboration and interoperability are more necessary than ever, as they will enable a more effective combination of good medicine with both good tactics and good strategies. These perspectives can also be extended to improve medical care in the conventional armed forces and austere civilian settings. Therapeutic/Care Management; Level V.

Headache Management in a Traumatic Brain Injury Rehabilitation Program Targeting Military Special Operation Forces

Headache Management in a Traumatic Brain Injury Rehabilitation Program Targeting Military Special Operation Forces

Amenințări hibride la Marea Neagră – identificarea vulnerabilităților geografice și economice ale spațiului maritim al României

With no clear evidence of its origin, hybrid warfare is a worldwide phenomenon, its effects having worldwide reverberations. Characterised by a very high adaptability and flexibility of the methods and procedures used, as well as the continuous expansion of the target audience or the area of coverage, hybrid warfare is not a new concept in human history. Overshadowed by the much higher degree of destruction and the very large number of human victims – specific to conventional war – unconventional actions – an integral part of hybrid war – often go unnoticed, but their effects are felt in all areas of human society existence. Today, the annexation of Crimea and the invasion of Ukraine by the Russian Federation are classic examples of hybrid warfare, characterised by true intentions concealment along with the fact that special operations forces experience and support allowed ethnic Russian communities to organise paramilitary groups with the aim of creating an ambiguous and insecure environment on Ukraine’s territory. Furthermore, these events forced NATO leaders to identify and implement measures to limit and reduce Russian Federation possibilities to apply a similar strategy against the Black Sea or Baltic Sea member states. Analysing in detail the Russian hybrid actions major impact in the maritime environment, materialised both by the two parties’ state borders modification and the Russian Federation Exclusive Economic Zone expansion to the detriment of Ukraine, this paper aims to identify geographical and economic vulnerabilities in the Black Sea, the exploitation of which can result in the weakening of the south-eastern flank of the North Atlantic Alliance. Moreover, the present study’s results will represent the basis of a further analysis that will highlight the optimal measures for their reduction.

Hybrid Threats in the Black Sea – Identifying Geographic and Economic Vulnerabilities of Romania’s Maritime Area

With no clear evidence of its origin, hybrid warfare is a worldwide phenomenon, its effects having worldwide reverberations. Characterised by a very high adaptability and flexibility of the methods and procedures used, as well as the continuous expansion of the target audience or the area of coverage, hybrid warfare is not a new concept in human history. Overshadowed by the much higher degree of destruction and the very large number of human victims – specific to conventional war – unconventional actions – an integral part of hybrid war – often go unnoticed, but their effects are felt in all areas of human society existence. Today, the annexation of Crimea and the invasion of Ukraine by the Russian Federation are classic examples of hybrid warfare, characterised by true intentions concealment along with the fact that special operations forces experience and support allowed ethnic Russian communities to organise paramilitary groups with the aim of creating an ambiguous and insecure environment on Ukraine’s territory. Furthermore, these events forced NATO leaders to identify and implement measures to limit and reduce Russian Federation possibilities to apply a similar strategy against the Black Sea or Baltic Sea member states. Analysing in detail the Russian hybrid actions major impact in the maritime environment, materialised both by the two parties’ state borders modification and the Russian Federation Exclusive Economic Zone expansion to the detriment of Ukraine, this paper aims to identify geographical and economic vulnerabilities in the Black Sea, the exploitation of which can result in the weakening of the south-eastern flank of the North Atlantic Alliance. Moreover, the present study’s results will represent the basis of a further analysis that will highlight the optimal measures for their reduction.

Comparison of Vestibular/Ocular Motor Screening (VOMS) and Computerized Eye-tracking to Identify Exposure to Repetitive Head Impacts.

Military service members (SMs) are exposed to repetitive head impacts (RHIs) in combat and training that are purported to adversely affect brain health, including cognition, behavior, and function. Researchers have reported that RHI from blast-related exposure may affect both vestibular and ocular function, which in turn may be related to symptomology. As such, an examination of the effects of RHI on exposed military SMs should incorporate these domains. To date, researchers have not compared groups of exposed special operations forces (SOF) operators on combined clinical vestibular/ocular and eye-tracker-based outcomes. Therefore, the primary purpose of this study was to compare participant-reported symptoms and performance on the Vestibular/Ocular Motor Screening (VOMS) tool with performance on the computerized RightEye tracking system between SOF operators exposed to blast-related RHI and healthy controls without blast-related exposure. In addition, the study aimed to compare subgroups of snipers and breachers exposed to RHI to controls on the preceding metrics, as well as identify a subset of individual (demographic) factors, participant-reported symptoms, and performance metrics on VOMS and RightEye that best identify SOF operators exposed to RHI from unexposed controls. The study involved a cross-sectional design including 25 Canadian SOF SMs comprised of breachers (n = 9), snipers (n = 9), and healthy, unexposed controls (n = 7). The former 2 groups were combined into an RHI group (n = 18) and compared to controls (n = 7). Participants provided demographics and completed a self-reported concussion-related symptom report via the Military Acute Concussion Evaluation 2, the VOMS, and RightEye computerized eye-tracking assessments. Independent samples t-tests and ANOVAs were used to compare the groups on the outcomes, with receiver operating characteristic curve and area under the curve (AUC) analyses to identify predictors of blast exposure. This study was approved by the Defence Research Development Canada Human Research Ethics Committee and the Canadian Forces Surgeon General/Special Forces Command. The results from t-tests supported group differences for age (P = .012), participant-reported symptoms (P = .006), and all VOMS items (P range = <.001-.02), with the RHI group being higher than healthy controls on all variables. ANOVA results supported group differences among snipers, breachers, and controls for age (P = .01), RightEye saccades (P = .04), participant-reported total symptom severity (P = .03), and VOMS total scores (P = .003). The results of the receiver operating characteristic curve analyses supported age (AUC = 0.81), Military Acute Concussion Evaluation 2 participant-reported total symptom severity (AUC = 0.87), and VOMS total scores (AUC = 0.92) as significant predictors of prior blast exposure. Participant-reported concussion symptoms, VOMS scores, and age were useful in identifying SOF operators exposed to RHI from controls. RightEye metrics were not useful in differentiating RHI groups from controls. Differences between snipers and breachers warrant further research. Overall, the findings suggest that VOMS may be a useful tool for screening for the effects of exposure to RHI in SOF operators. Future investigations should be conducted on a larger sample of military SMs, consider additional factors (e.g., RHI exposure levels, medical history, and sex), and include additional assessment domains (e.g., balance, cognitive, and psychological).

Features of selection of candidates for units of special operations forces of foreign countries by the criterion of physical preparedness

Features of selection of Military Special Operations Forces personnel of foreign countries by the criterion of physical preparedness are considered. Scientific, methodological literature on the research topic was studied, specialists were interviewed. Selection of candidates for special operations forces is consists of several stages. It has been established that the physical fitness of candidates is checked at all stages of selection. Determining the aerobic and strength endurance of candidates is a mandatory element of testing their physical preparedness. Tests are selected based on the requirements of the future professional activity of the fighters. Also take into account how these tests correlate to injury risk or professional tasks performance. The main tests for determining strength endurance choose exercises with local load distribution. Long-distance running is the main exercise for determining the level of aerobic endurance of military personnel. Swimming exercises is included in the selection programmes for most special operations units. The speed and coordination abilities of servicemen are tested with the help of various variants of the shuttle run. There is no gender or age differentiation when assessing candidates. The selection of candidates is made from several phases and involves complication of standards. The selection program also includes applied physical exercises that are performed in uniform, namely: swimming, marching, overcoming an obstacle course, etc. The system of selection is based on the motivation of servicemen. They tend to score more points than their competitors.

Enhancing operational rations for Special Operations Forces: A qualitative analysis and roadmap for product improvement

AbstractNinety‐eight (n = 98) military personnel from the Brazilian Army Special Operations Forces (SOF) participated in 10 Focus Groups to discuss the suitability of Combat Operational Rations with the service doctrine. The operational rations provided partially meet the operational and doctrinal demands of the SOF. Although the military personnel felt secure with the rations provided, the need to customize kits with locally sourced food items before the start of the mission and complaints about the excessive packaging volume were the categories that showed the highest level of engagement. The insights obtained for improving the rations indicated the need for adjustments in palatability, menu variety, modularization, practicality, and an increase in the nutritional content of macro and micronutrients. Further studies should be conducted in partnership with military technical sectors and strategic defense companies to assess the feasibility of developing rations better aligned with the SOF doctrine.Practical ApplicationsAddressing the challenges identified in the Rations used by the Brazilian Army Special Operations Forces (SOF) is crucial for improving the readiness and performance of elite military units and offers valuable insights for academic research. This benefits the academic community by demonstrating the real‐world relevance of nutrition science, food technology, and logistics in military settings. Furthermore, the collaboration between military technical sectors and strategic defense companies presents an opportunity for industrial innovation. Companies involved in producing and supplying rations can use these findings to develop more suitable, efficient, and cost‐effective products tailored to the unique demands of SOF units.

Prima Donnas in Kevlar zones. Challenges to the Unconventional Warfare efforts of the U.S. Special Forces during Operation Enduring Freedom

ABSTRACT When Operation Enduring Freedom (OEF) commenced in October 2001, the U.S. Special Forces (SF) were the first U.S. military unit on the ground in Afghanistan, utilising their Unconventional Warfare (UW) capabilities. Despite their significant role at the initial stage of the military campaign, SF began to encounter numerous challenges from as early as 2002 and throughout OEF. Based on an analysis of forty-five master’s theses authored by SF officers, this paper discusses the structural-organisational and cultural-conceptual challenges. These obstacles led to the marginalisation of SF’s UW efforts. Scholarship on special operations forces (SOF) often regards the period of the so-called global war on terrorism (GWOT) as U.S. SOF’s golden age focusing predominantly on the activities of SOF units linked to the U.S. Joint Special Operations Command rather than on SF. By examining the challenges faced by SF, this article aims to contribute to a more nuanced discussion of SOF efforts during GWOT.

Review of the Air Force Academy No.2 (48)/2023 24 MULTICRITERIA ANALYSIS OF PARACHUTES USED BY SPECIAL OPERATIONS FORCES

Special operations forces are well-known for their expertise in rapid tactical interventions, and the use of parachutes plays a crucial role in their arsenal. These elite units rely heavily on parachutes to conduct swift and clandestine insertions into inaccessible or challenging terrain, allowing them to catch adversaries off guard and execute critical missions with precision and efficiency. To establish a ranking of parachutes utilized by special operations forces using multicriteria analysis, it is imperative to delineate evaluation criteria and assign appropriate weights based on their relative significance. Each parachute undergoes assessment according to these criteria, receiving scores commensurate with its performance. Subsequently, total scores are tabulated for each parachute, predicated on the weights allotted to each criterion. The resultant ranking affords a lucid perspective on the optimal options, aiding special forces in making well-informed and strategic decisions concerning the equipment utilized in their operations.

Mild Traumatic Brain Injury andCareer Stage Associate with Visible Perivascular Spaces in Special Operations Forces Soldiers.

Mild traumatic brain injury (mTBI) and occupational blast exposure in military Service Members may lead to impaired brain waste clearance which increases neurological disease risk. Perivascular spaces (PVS) are a key part of the glymphatic system which supports brain waste clearance, preferentially during sleep. Visible PVS on clinical magnetic resonance imaging have been previously observed in patients with neurodegenerative diseases and animal neurotrauma models. The purpose of this study was to determine associations between PVS morphological characteristics, military career stage, and mTBI history in Special Operations Forces (SOF)Soldiers. Participants underwent T2-weighed neuroimaging to capture three-dimensional whole brain volumes. Segmentation was performed using a previously validated, multi-scale deep convolutional encoder-decoder neural network. Only PVS clusters within the white matter mask were quantified for analyses. Due to non-normal PVS metric distribution, non-parametric Mann-Whitney U tests were used to determine group differences in PVS outcomes. In total, 223 healthy SOF combat Soldiers (age = 33.1 ± 4.3yrs) were included, 217 reported career stage. Soldiers with mTBI history had greater PVS number (z = 2.51, P = 0.013) and PVS volume (z = 2.42, P = 0.016). In-career SOF combat Soldiers had greater PVS number (z = 2.56, P = 0.01) and PVS volume (z = 2.28, P = 0.02) compared to a baseline cohort. Mild TBI history is associated with increased PVS burden in SOF combat Soldiers that are clinically recovered from mTBI. This may indicate ongoing physiological changes that could lead to impaired waste clearance via the glymphatic system. Future studies should determine if PVS number and volume are meaningful neurobiological outcomes for neurodegenerative disease risk and if clinical interventions such as improving sleep can reduce PVS burden.

The Tägerwilen II report: Recommendations from the NATO Prehospital Care Improvement Initiative Task Force.

The Committee of the Chiefs of Military Medical Services (COMEDS) initiated the Prehospital Care Improvement Initiative Task Force (PHCII TF) to advise on how to improve prehospital care within NATO nations. The Task Force consisted of the NATO Military Health Care Working Group and its subordinated expert panels, including the Blood Panel, the Emergency Medicine Panel and the Special Operations Forces Medicine Panel. The PHCII TF identified four key prehospital care themes for exploration: 1) Tactical Casualty Care, 2) Blood Far Forward), 3) Forward Surgical Capabilities), and 4) Prolonged Casualty Care. A consensus experimentation workshop explored the four themes, utilizing a modified Delphi technique and Utstein rotations during syndicate work, resulting in 83 consensus statements. The consensus statements were further evaluated on six criteria: actionable, measurable, urgent, interoperability, low risk/threat and impact. The 83 consensus statements, when weighted against the six criteria, resulted in 15 recommendations, focusing on standardization of training, ensuring provision of evidence-based practices and removing legislative barriers to improve prehospital care. The recommendations on these four themes reflect the most significant priorities in improving prehospital care, and must be incorporated in the on-going revision of NATO doctrine.

Mental Skills for Orthopaedic Surgery.

Orthopaedic surgery training focuses primarily on the knowledge base and surgical techniques that comprise the fundamental and physical pillars of performance. It also pays much less attention to the mental pillar of performance than does the training of other specialists such as aviators, elite athletes, musicians, and Special Forces operators. However, mental skills optimize the ability to achieve the ideal state during surgery that includes absolute focus with the right amount of confidence and stress. The path to this state begins before surgery with visualization of the surgical steps and potential complications. On the day of surgery, the use of compartmentalization, performance aspirations, performance breathing, and keeping the team focused facilitates achieving and maintaining the proper mental state. Considering the similarities between surgery and other fields of expertise that do emphasize the mental pillar, including this training in orthopaedic residencies, is likely beneficial.

The role of physical training in the selection system of military personnel for the special operations forces of the Indian armed forces

This article describes the training system of special operations forces of the Indian Armed Forces. Selection for the units of special operations forces is carried out from army units, in which psychological and intellectual tests are conducted, as well as a check of physical fitness level. The training takes place in various geographical conditions, including in the desert and mountains. Also, urban tactics are practiced. Units of special operations forces perform combat tasks using force methods in extreme conditions with the use of special tactics in specific conditions, which requires a high level of psychological, ideological, physical and combat training of military personnel. The doctrine of joint training of the Armed Forces of India demonstrates the intention of the country’s leaders to put into practice contemporary technologies for training the Armed Forces personnel, to increase the effectiveness of troops in modern military warfare, which are characterized by the use of hybrid forms of armed struggle. The doctrine reveals the essence and content of challenges and threats to national security. According to the military and political leadership of the state, it is considered the result of the activities of terrorist organizations and the foreign policy courses of China and Pakistan, which are aimed at reducing the role of India in South Asia. The existence of interstate disagreements with the countries of South Asia on territorial issues, the implementation by the leadership of neighboring states of military programs aimed primarily at increasing nuclear potential, is considered by Delhi as the main source of military conflict in the region, in which the armed forces may be involved.

Self-Described Training Needs of Special Operations Forces Medics and the Birth of the TACMED Division.

Training needs of Special Operations Forces (SOF) medics were surveyed and new training initiatives have been created to meet their needs. SOF medics perform an array of medical procedures in austere environments with minimal supervision. Medical skills decay over time after initial training and the perceived training needs of active SOF medics were unclear. To fill this gap, active SOF medics (n=57) completed a survey that included confidence ratings and indications of whether additional training would make them more proficient in 70 medical knowledge and procedural skills, assembled into categories by a panel of experts (airway, trauma, neuro, differential diagnosis, administrative, infection, critical care, environmental, other). Data were analyzed with analysis of variance (ANOVA) and nonparametric statistics at P<.05. Confidence was highest in the trauma, administrative, and airway categories, and lowest in the infection, differential diagnosis, and neuro categories (P<.05 or less). Categories indicating the greatest need for additional training were environmental and critical care, while those indicating lowest need were the airway and trauma categories (P=.05). Additional training was endorsed by >75% of participants in each category. SOF medics also wanted additional training in all areas, preferably hands-on with live patients in realistic scenarios, taught by experienced medics. Findings highlight the training needs of SOF medics and demonstrate the value of bottom-up feedback toward optimizing sustainment training. Based on present findings, two TACMED (Tactical Medicine) Divisions at the SOF Echelon III level were created to meet the sustainment training needs of SOF medics.

Social Determinant of Unconventional Resilience: Tactical Engagement with Impression Management.

Building upon our operational model, we will discuss findings from our ethnographic study titled "The Impact of Catastrophic Injury Exposure on Resilience in Special Operations Surgical Teams" to establish that impression management allows Special Operation Forces (SOF) medics to navigate implicit social status symbols to either degrade or optimize performance. We will use qualitative quotes to explore how Special Operations Surgical Team (SOST) medics engage in impression management to establish individual, team, and/or organizational competency to deal with ambiguity. To achieve our goals, we will: 1) provide a background on impression management and perception of competency; 2) define the social determinant of impression management extrapolated from qualitative data as well as use qualitative data to thematize various types of impression management; and 3) relate tactical engagement with impression to our metaphor of bag sets. We conclude by gesturing to the importance of impression management in orienting SOF medics' proprioception and kinesthesia in the SOF performance space.