Special Operations Command Research Articles

United States Special Operations Command South Training Program’s Effectiveness: A Case Study

United States Special Operations Command South (SOCSOUTH) plans and coordinates Special Operations to find and fix threats and enable the Interagency, Intelligence Community, and Partner Nations to counter threats to US interests, maintain regional stability and compete in a complex environment. Physical readiness, performance optimization, and injury prevention are critical to the individual operator. SOCSOUTH has allocated significant financial resources associated with operational training and human performance programs in order to improve and maintain operators’ tactical and physical readiness. Whether these efforts are pointed to the right direction are under evaluation. PURPOSE: To evaluate the effectiveness of a 3 months’ customized training program on SOCSOUTH operators. METHODS: Retrospective data of ten operators (Age 41.1 ± 6.6) who participated in a customized training program for 3 months were analyzed to evaluate program’s effectiveness. Program was designed to improve operational training and human performance, while reducing the risk of musculoskeletal injuries based on microcycle periodization. Pre/Post testing was performed on selected tests, reflective of important mission qualities, to assess upper body muscular endurance (# chin-ups), lower body muscular endurance (150-yard shuttle test), and agility (30-yard sprint). A repeated-measures design for pre/post examined variables performed using SPSS©. RESULTS: There was a significant effect of post-training compared to pre-training on operators’ number of chin-ups performed (F1,9 = 10.42, p = .01, η2 = .54), 150-yard shuttle time (F1,9 = 38.29, p < .001, η2 = .81), and 30-yard time (F1,9 = 16.29, p = .003, η2 = .64) respectively. CONCLUSIONS: The current SOCSOUTH’s efforts on improving operational performance by applying a customized training program was successful. Operators’ selected mission quality capacities for upper- and lower-body performance and agility were improved. SOCSOUTH needs to continue supporting operators’ training based on these data analytics.

On the Importance of 3D Surface Information for Remote Sensing Classification Tasks

There has been a surge in remote sensing machine learning applications that operate on data from active or passive sensors as well as multi-sensor combinations (Ma et al. (2019)). Despite this surge, however, there has been relatively little study on the comparative value of 3D surface information for machine learning classification tasks. Adding 3D surface information to RGB imagery can provide crucial geometric information for semantic classes such as buildings, and can thus improve out-of-sample predictive performance. In this paper, we examine in-sample and out-of-sample classification performance of Fully Convolutional Neural Networks (FCNNs) and Support Vector Machines (SVMs) trained with and without 3D normalized digital surface model (nDSM) information. We assess classification performance using multispectral imagery from the International Society for Photogrammetry and Remote Sensing (ISPRS) 2D Semantic Labeling contest and the United States Special Operations Command (USSOCOM) Urban 3D Challenge. We find that providing RGB classifiers with additional 3D nDSM information results in little increase in in-sample classification performance, suggesting that spectral information alone may be sufficient for the given classification tasks. However, we observe that providing these RGB classifiers with additional nDSM information leads to significant gains in out-of-sample predictive performance. Specifically, we observe an average improvement in out-of-sample all-class accuracy of 14.4% on the ISPRS dataset and an average improvement in out-of-sample F1 score of 8.6% on the USSOCOM dataset. In addition, the experiments establish that nDSM information is critical in machine learning and classification settings that face training sample scarcity.

Training Strategies Maintain Performance Characteristics in Marines Selected for Marine Forces Special Operations Individualized Training Course.

Marines must complete an intensive Assessment and Selection (A&S) course before becoming a U.S. Marine Forces Special Operations Command (MARSOC) Raider. Following selection, marines are given training recommendations designed to maintain performance characteristics deemed relevant to successfully complete a rigorous 9-month Individualized Training Course (ITC). However, training strategies are individually implemented by the marine, and the time between the two courses is highly irregular, ranging between 2months and 24 months based on operational factors related to military occupational specialty (MOS). The purpose of this study was to evaluate changes in performance between the completion of A&S and the start of ITC and to examine if the duration between courses and previous MOS influenced changes in performance. Body fat percentage (BF%), anaerobic power (AP), anaerobic capacity (AC), aerobic capacity (VO2max), knee flexion (KF), knee extension (KE), trunk extension (TE), and trunk flexion (TF) isokinetic strength were collected on 38 marines (age: 25.1 ± 2.7 years, height: 1.77 ± 0.05 m, mass: 83.2 ± 7.7 kg, Post-A&S to ITC start: 204.1 ± 68.4 days) following A&S and directly before ITC. Pre-ITC students had significantly greater mass (P = .002), BF% (P = .000), and AP (P = .039). There were no significant changes in AC (P = .170), VO2max (P = .259), KF (P = .400), KE (P = .320), TE (P = .178), and TF (P = .643). There was no significant relationship between performance outcomes and time between courses and previous MOS. Current training strategies appear effective at addressing performance deficits that occur as a result of A&S, while maintaining high levels of KF, KE, TE, TF, AC, and VO2max. However, pre-ITC students still exhibited AP deficits compared to active marine raiders, so forthcoming programming may benefit from an increased emphasis on AP. Assessment of additional selectees at these timepoints, as well as students before A&S may provide valuable information to MARSOC human performance specialists to develop programing, ultimately leading to a higher ITC graduation rate, increased force readiness, and decreased financial burden forcewide.

Personality Traits That Distinguish Special Operations Female Aircrew.

INTRODUCTION: U.S. Air Force Special Operations Command (AFSOC) female aircrew represent a small group of military personnel in challenging high-risk, high-demand professions. Personality characteristics may play a key role in distinguishing those women who pursue a career as a special operations aircrew member and succeed in this pursuit. Having access to normative personality data can potentially support psychologists in assessing AFSOC female aircrew and subsequently making informed recommendations to leadership.METHODS: A total of 586 AFSOC aircrew trainees58 (9.9%) women and 528 (90.1%) mencompleted a series of computer-based psychological tests to assess cognitive ability and personality traits.RESULTS: Results indicated significant differences between female AFSOC aircrew and female civilians on four of the five NEO Personality Inventory domains: Neuroticism (M 74.9 vs. M 87.1), Extraversion (M 123.7 vs. M 112.8), Openness to Experience (M 122.6 vs. M 111.0), and Conscientiousness (M 136.0 vs. M 120.6), respectively. The comparison between female AFSOC aircrew and male AFSOC aircrew revealed significant differences across three of the five domains: Neuroticism (M 74.9 vs. M 65.1), Openness to Experience (M 122.6 vs. M 115.0), and Agreeableness (M 119.6 vs. M 112.7), respectively.DISCUSSION: Implications for assessment and interpretation of psychological testing are discussed. This paper provides a unique perspective and insight into those who pursue and excel in this career field. Identifying specific personality traits in our AFSOC female aircrew allows for tailored care and support when evaluating readiness in special operations aircrew for optimizing performance.Chappelle W, Shadle AH, Martinez RN, Reardon LE, Goodman T, Spencer H, Thompson W. Personality traits that distinguish special operations female aircrew. Aerosp Med Hum Perform. 2021; 92(4):240247.

Clinical utilization of deployed military surgeons.

Combat casualty care has been shaped by the prolonged conflicts in Southwest Asia, namely Afghanistan, Iraq, and Syria. The utilization of surgeons in austere locations outside of Southwest Asia and its implication on skill retention and value have not been examined. This study hypothesizes that surgeon utilization is low in the African theater. This lack of activity is potentially damaging to surgical skill retention and patient care. Military case logs of surgeons deployed to Africa under command of Special Operations Command Africa between January 1, 2016, and January 1, 2020, were examined. Cases were organized based on population served, general type of procedure, current procedural terminology codes, and location. Twenty deployment caseloads representing 74% of the deployments during the period were analyzed. In 3,294 days, 101 operations were performed, which included 45 on combat/terrorism related injuries and 19 on US personnel. East and West African deployments, combat, and noncombat zones, respectively, were compared. East Africa averaged 4.1 ± 3.8 operations per deployment, and West Africa, 7.3 ± 8.0 (p = 0.2434). In East Africa, 56.1% of total operations were related to combat/terrorism, compared with 29.6% of total operations in West Africa (p = 0.0077). West Africa had a significantly higher proportion of elective (p = 0.0002) and humanitarian cases (p = <0.0001). Surgical cases for military surgeons were uncommon in Africa. The low volumes have implications for skill retention, morale, and sustainability of military surgical end strength. Reduction in deployment lengths, deployment location adjustments, and/or skill retention strategies are required to ensure clinical peak performance and operational readiness. Failure to implement changes to current practices to optimize surgeon experience will likely decrease surgical readiness and could contribute to decreased retention of deployable military surgeons to support global operations. Economic/decision, level III.

Designing at the Cutting Edge of Battle: The 75th Ranger Regiment’s Project Galahad

ABSTRACT This article addresses the formal introduction of military design into the 75th Ranger Regimental organizational form and function over the last few years by leaders and design facilitators through creative destruction and willingness to experiment in paradoxical and potentially radical ways for emergent Special Operations Forces (SOF) needs. This article presents the core concepts behind Project Galahad, including the need for its formation, the context in which it exercises thought and action, and its structure and form as a disruptive engine of designing for novelty in warfare. This effort demonstrates military design “success” within lofty conceptual goals such as “fostering innovation” or “disrupting legacy systems to provide novel opportunities.” Furthermore, this article shows how a broader design movement is simultaneously appearing in various incarnations and similar applications across the United States Special Operations Command (USSOCOM) and international special operations community.

Tactical Medicine Training for SEAL Mission Commanders.

The Tactical Combat Casualty Care (TCCC) project initiated by Naval Special Warfare and continued by the US Special Operations Command has developed a new set of combat trauma care guidelines that seek to combine good medical care with good small-unit tactics. The principles of care recommended in TCCC have gained increasing acceptance throughout the Department of Defense in the four years since their publication and increasing numbers of combat medical personnel and military physicians have been trained in this concept. Since casualty scenarios in small-unit operations typically present tactical as well as medical problems, however, it has become apparent that a customized version of this course suitable for small-unit mission commanders is a necessary addition to the program. This paper describes the development of a course in Tactical Medicine for SEAL Mission Commanders and its transition into use in the Naval Special Warfare community.

Designing in Complex Security Contexts: Enabling Frame Awareness through Sharks, Dollar Signs, and Police Badges

Over the last decade, the emergence of military design theorists, educators, and practitioners has coagulated into a community of practice internationally and across multiple armed forces. This new group of military academics and professionals demonstrates a keen interest in developing and expanding the notion of “designing for war.” For military design theory, there are unexpected design contributions from postmodern philosophy, non-Western concepts, and other highly subjective and alternative fields and practices that provide insight and novel thought for human opportunities within the dynamic and complex conflict contexts of the 21st century. Many of these novel constructs are not available in mainstream commercial design applications, methods, or theory—they were developed for military design contexts and are largely unknown outside of the community of practice for security contexts. Part of this lack of exposure is inevitable, given the classification requirements of many design efforts. This article presents one of the most popular military design techniques used by the Joint Special Operations University (JSOU), a military education platform in Tampa, Florida. JSOU is part of the US Special Operations Command (USSOCOM) and provides tailored education to Special Operations Forces (SOF) worldwide.

Autopsy-Determined Atherosclerosis in Elite US Military Special Operations Forces.

Autopsy studies of trauma fatalities have provided evidence for the pervasiveness of atherosclerosis in young and middle-aged adults. The objective of this study was to determine the prevalence of atherosclerosis in elite US military forces. We conducted a retrospective study of all US Special Operations Command (USSOCOM) fatalities from 2001 to 2020 who died from battle injuries. Autopsies were evaluated from Afghanistan- and Iraq-centric combat operations for evidence of coronary and/or aortic atherosclerosis and categorized as minimal (fatty streaking only), moderate (10-49% narrowing of ≥1 vessel), and severe (≥50% narrowing of ≥1 vessel). Prevalence of atherosclerosis was determined for the total population and by subgroup characteristics of age, sex, race/ethnicity, combat operation, service command, occupation, rank, cause of death, manner of death, and body mass index (BMI). From the total of 388 USSOCOM battle injury fatalities, 356 were included in the analysis. The mean age was 31 years (range, 19-57 years), and 98.6% were male. The overall prevalence of coronary and/or aortic atherosclerosis was 17.4%. The prevalence of coronary atherosclerosis alone was 13.8%. Coronary atherosclerosis was categorized as minimal in 1.1%, moderate in 7.6%, and severe in 5.1%. Of those with atherosclerosis, 24.2% were <30 years old, 88.7% were from enlisted ranks, and 95.2% had combatant occupations. When BMI could be calculated, 73.5% of fatalities with atherosclerosis had a BMI =25. Autopsy-determined atherosclerosis is prevalent in elite US military Special Operations Forces despite young age and positive lifestyle benefits of service in an elite military unit.

Asymmetrical Loading Patterns in Military Personnel With a History of Self-Reported Low Back Pain.

Servicemembers are required to operate at high levels despite experiencing common injuries such as chronic low back pain. Continuing high levels of activity while compensating for pain may increase the risk of musculoskeletal injuries. As such, the purpose of this project was to determine if servicemembers with chronic low back pain have reduced lower extremity performance, and if they use alternate strategies to complete a functional performance task as compared to healthy servicemembers. Of a total of 46 male United States Marine Corps Forces Special Operations Command (MARSOC) personnel, 23 individuals who suffered from chronic low back pain (age = 28.6 ± 4.4 years, weight = 84.2 ± 6.8 kg) and 23 healthy controls (age = 27.9 ± 3.8 years, weight = 83.8 ± 7.7 kg) completed a stop jump task. In this task, three-dimensional biomechanics were measured, and lower extremity and trunk strength were assessed. The low back pain group exhibited higher vertical ground reaction force impulse on the dominant limb (0.26% body weight [BW]/s), compared to the nondominant limb (0.25% BW/s, p = .036). The control group demonstrated relationships between jump height and strength in both limbs (dominant: r = 0.436, p = .043; nondominant: r = 0.571, p = .006), whereas the low back pain group demonstrated relationships between jump height and dominant limb knee work (r = 0.470, p = .027) and ankle work (r = 0.447, p = .037). This study demonstrates that active-duty MARSOC personnel with a history of low back pain reach similar levels of jump height during a counter movement jump, as compared to those without a history of low back pain. However, the asymmetries displayed by the low back pain group suggest an alternate strategy to reaching similar jump heights as compared to healthy individuals.

Aligning and Assessing Core Attributes of Spiritual Fitness for Optimizing Human Performance

The United States Special Operations Command (SOCOM)'s Preservation of the Force and Family Program (POTFF) identifies spiritual performance (SP) as a key pillar for holistically caring for and optimizing the performance of all Special Operations Forces (SOF) and their families. Enhancing SP is key to sustaining core spiritual beliefs, values, awareness, relationships and experiences. The SOCOM Spiritual Fitness Scale (SSFS) enables religious support teams in SOF communities and beyond to reliably measure SP according to POTFF's definition of SP and the Chairman of the Joint Chiefs of Staff Instruction (CJCSI) on Spiritual Fitness (SF). The three subscales of the SSFS relate to core attributes of SP/SF, which were identified through factor analysis during iterations of the tool's development. Directly aligning SP/SF programs with the core attributes of SSFS will allow chaplains to support both theists and nontheists and to retain certain traditional chaplain activities which no longer have universal connection to religious ministry in the public discourse. Chaplains are also empowered to immediately begin conducting relevant and spiritual assessments. We will illustrate how a chaplain can align SP initiatives with the three core attributes of SP/SF and leverage the SSFS to assess baseline unit needs, conceive and develop evidence-based initiatives, conduct rolling program assessments, and articulate program efficacy to key leaders and collaborators.

The SOCOM Spiritual Fitness Scale: Measuring "Vertical" and "Horizontal" Spirituality in the Human Performance Domain.

Few spiritual scales are tailored to the work of human performance, few enfranchise non-theists, and few simultaneously capture both vertical and horizontal aspects of spirituality. To address the gap, the Consortium for Health and Military Performance partnered with the US Special Operations Command to develop the SOCOM Spiritual Fitness Scale. The scale is reliable, valid, psychometrically sound, and capable of generating comprehensive group and individual profiles to aid chaplains in program development/assessment and tailored spiritual coaching.

Sources of Stress and Psychological Health Outcomes for Remotely Piloted Aircraft Operators: A Comparison Across Career Fields and Major Commands.

U.S. Air Force remotely piloted aircraft (RPA) operators perform a variety of around-the-clock global intelligence, surveillance, and reconnaissance (ISR) missions that are considered critical to operational effectiveness. The growing need for ISR operations has led to significant increases in operational tempo and workload, resulting in elevated operational stress, burnout, and psychological distress. These negative outcomes are linked to conditions such as long hours, low manning, lack of sleep, and communication issues. Through regular assessments and the implementation of additional resources (i.e., embedded health care providers), Air Force leadership is working to alleviate the stressors and maintain psychological well-being. Thus, the purpose of this study is to compare the levels of stress, and prevalence of burnout and psychological distress across RPA career fields within two major commands. Assessments were completed by 571 RPA operators from 2 major commands: Air Force Special Operations Command (n = 158) and Air Combat Command (n = 413). RPA career fields included pilots (n = 331), sensor operators (n = 137), and intelligence operators (n = 103). Results revealed that high stress levels from an array of sources continue to result in increased risk of burnout and psychological distress for RPA operators. Several significant differences in sources of high stress across career fields and major commands are identified and discussed. Overall, the results of this study highlight specific problem areas unique to certain subsets of the RPA community in need of targeted intervention and clarify several avenues for future research.

Adapting the U.S. Air Force's combat rescue management practices could improve organizational responses to challenges posed by the COVID-19 pandemic

In this article, we argue that U.S. Air Force Special Operations Command (AFSOC) pararescue teams offer a model of best practices that could be adapted by leaders of other organizations during the COVID-19 crisis. AFSOC teams recover and provide medical treatment to personnel in unpredictable and dangerous environments. Our research suggests that the ability of AFSOC teams to operate effectively in situations of uncertainty, complexity, and urgency depends on several critical factors: an operational tempo that includes time for reflection; effective assessment, selection, and training of team members; risk assessment and ongoing revision of the planning process; and fluid leadership with a chief executive who maintains ultimate accountability. These same management practices could be adapted by organizational leaders to help them respond more effectively to the challenges posed by the constantly changing COVID-19 pandemic.

Test–retest reliability of the Vestibular Ocular Motor Screening (VOMS) tool and modified Balance Error Scoring System (mBESS) in US military personnel

The Military Acute Concussion Evaluation 2 (MACE 2), which includes the Vestibular-Ocular Motor Screening (VOMS) tool and the single-leg stance component of the modified Balance Error Scoring System (mBESS), was introduced in 2018 as an assessment of acute mTBI in US military personnel. However, the reliability of the VOMS and mBESS in this population has not been established. ObjectivesThe primary purpose of this study was to examine the reliability of the VOMS across a 6-month period in healthy, uninjured US Army Special Operations Command (USASOC) personnel. DesignActive duty/heathy military personnel (n=108) completed the VOMS and mBESS at baseline and follow-up 6 months later (±1 month). MethodCronbach's alpha was used to examine the internal consistency of the VOMS and mBESS at both time points. Two-way mixed intra-class correlation coefficients (ICC) with consistency agreement were used to evaluate test–retest reliability. ResultsVOMS demonstrated excellent internal consistency (α=0.99), whereas, the mBESS demonstrated poor internal consistency (α=0.29). Test–retest reliability of VOMS items was moderate-to-good with ICCs ranging from 0.60 to 0.81. Test–retest reliability was moderate for mBESS total score (ICC=0.59) and double-leg stance (ICC=0.73), while single-leg (ICC=0.49) and tandem (ICC=0.02) stances were poor. ConclusionsThe findings suggest that VOMS has high internal consistency and moderate-to-good test–retest reliability. mBESS has poor internal consistency and poor-to-moderate test–retest reliability. The results suggest that VOMS is a reliable addition to the MACE-2, whereas, mBESS single-leg stance is less reliable. As such, mBESS double-leg stance may be a more reliable measure of balance in this population.

Military Protein Intake Related to Strength and Fat Mass Independent of Energy Intake.

Kinetic military units operate in austere training environments and deprivation not commonly experienced by competitive athletes. Nutritional strategies to protect against decrements in performance and potential injury risk may differ for these two groups. A cross sectional analysis was conducted to determine energy and macronutrient characteristics associated with performance metrics. 78 male subjects (age: 28.4±6.0years, height: 178.3±6.7cm, mass: 84.3±9.4kg, 8.5±5.8years of service) assigned to Marine Corps Forces Special Operations Command completed a 1-day performance assessment. Body mass, lean body mass, fat mass (FM), aerobic capacity (VO2max), lactate inflection point (LT), anaerobic power, anaerobic capacity, knee flexion strength, knee extension strength, peak knee flexion strength, and peak knee extension strength outcome values were recorded. Dietary intake was collected using automated self-administered 24-hour dietary recall (ASA24). Performance assessment scores were compared with macronutrient intake and controlled for energy intake using analysis of covariance. Differences in knee flexion strength, knee extension strength, peak knee flexion strength, and peak knee extension strength were significant across low (LPRO), medium (MPRO), and high (HPRO) protein intake groups (p<0.05) with LPRO performance metrics significantly lower than both MPRO and HPRO and MPRO significantly lower than HPRO. FM was significantly higher in LPRO than MPRO or HPRO (p<0.05). Low carbohydrate intake (LCHO) was associated with greater body mass and FM compared with high (HCHO) (p<0.05). There was no association between fat intake and any variable. Increases in protein intake may have beneficial performance effects independent of total energy intake, while moderate increases in carbohydrate intake may not be sufficient to enhance physical performance in a special operations population.

Disruptive Innovation through Military Design: A Collaboration between the US Joint Special Operations University and the Polish Army

ABSTRACT This article presents a five-year journey for the Polish Armed Forces and U.S. Special Operations Command’s Joint Special Operations University in establishing military design education, theory, and practice within the Polish military. Military design is presented as a significant development in defense theory that draws from complexity theory, systems theory, scenario planning, postmodern theory as well as social paradigm theory as applied to security contexts and war. Military design is a recent development and in part a reaction to traditional, mechanistic, and linear planning and strategy methodologies becoming insufficient in contemporary security environments. The increasing complexity of modern security challenges coupled with institutional barriers to challenging well-established military doctrine, decision-making methodologies, and belief systems concerning war and warfare have ushered “military design” to the forefront of numerous militaries; designing for war is not without controversy and debate over methodological application and relation to existing warfare methods. JSOU and a small team of Polish Army educators would work in tandem to implement military design theory as currently provided within the SOCOM enterprise to international partner nations such as the Polish Armed Forces and Polish Special Forces. The JSOU andragogic approach to design education emphasizes building design facilitation capacity within the partnered organization, and this article explains the five-year process to stand up Polish-centric design concepts and customized education oriented toward Polish security challenges and attuned to cultural as well as geopolitical considerations.

Peranan Tentara Nasional Indonesia dalam Penindakan Terorisme Berbasis Agama

The purpose of this research is to find out and to analyze problem and the role of the TNI Special Operations Command (Koopssus TNI), as well as obstacles faced by the TNI Special Operations Command in the prosecution of terrorism in Indonesia. This research is discussed and motivated by the increasing complexity of terrorist acts which use the latest technology, international networks and close links with other transnational crimes, as well as endangering national and international security. The research method is conducted using normative law, while the source of legal material used is through secondary legal material which is material obtained through library studies by examining various references relating to the object of this thesis study such as books, legislation, scientific journals, print and electronic media. The statutory regulations in this study are the Law of the Republic of Indonesia Number 5 of 2018 concerning Eradication of Terrorism Crimes, Law Number 34 of 2004 concerning the Indonesian National Army and Presidential Regulation Number 66 of 2019 concerning the Composition of the Organization of the Indonesian Armed Forces. Based on the results of this study it can be seen that terrorism is not only a criminal offense, but also is broader than that. Terrorism is anything that wants to change Ideology, including those based on religion. The Special Operations Command of the TNI handles Terrorism Crimes which is highly escalated and its deployment under direct order from the President. The TNI Special Operations Command is a new structure within the TNI, and addresses urgent issues. The role of the TNI Special Operations Command is not optimal because it is a relatively new organization. Its existence is as expected because it accommodates the interests of the TNI, related to being able to handle strategic matters at the national level so as to accelerate its deployment under direct command from the TNI Commander.Keywords:TNI Special Operations Command (Koopssus TNI), Role, Obstacles, Terrorism

Development of a mental skills training intervention for the Canadian Special Operations Forces Command: An intervention mapping approach

Mental skills training (MST) has been well documented in the sport and exercise literature, and there is increasing interest in MST interventions for military populations. Although the considerable research on MST interventions in sport contexts provides a valuable framework from which to develop programming for other high performance contexts, the military, and in particular the Special Operations Force (SOF), represents a unique population for which there is less available evidence for the design and implementation of effective mental performance programming. In this manuscript, we describe the use of Intervention Mapping (IM: Bartholomew Eldridge et al., 2016) in the development and implementation of a customized MST package for the Canadian Special Operations Command. The six stages of the IM protocol were systematically applied to develop the program: 1) needs assessment, including a literature review and focus group consultation; 2) identification of program outcomes and objectives; 3) program design, including the selection of theory-driven and evidence-based methods and practical strategies; 4) program production including pilot testing; 5) planning for adoption, implementation and sustainability, and 6) program evaluation. Although time-consuming, IM is a valuable framework for the development of customized MST for military personnel. This approach offers a logical, methodical approach to integrate relevant theory into program development. Additionally, this process enables ongoing consultation with the end-user, facilitating effective implementation and user acceptance. Finally, because IM involves a highly transparent approach to program development, it enables effective replication of intervention development.

Mortality review of US Special Operations Command battle-injured fatalities.

Comprehensive analyses of battle-injured fatalities, incorporating a multidisciplinary process with a standardized lexicon, is necessary to elucidate opportunities for improvement (OFIs) to increase survivability. A mortality review was conducted on United States Special Operations Command battle-injured fatalities who died from September 11, 2001, to September 10, 2018. Fatalities were analyzed by demographics, operational posture, mechanism of injury, cause of death, mechanism of death (MOD), classification of death, and injury severity. Injury survivability was determined by a subject matter expert panel and compared with injury patterns among Department of Defense Trauma Registry survivors. Death preventability and OFI were determined for fatalities with potentially survivable or survivable (PS-S) injuries using tactical data and documented medical interventions. Of 369 United States Special Operations Command battle-injured fatalities (median age, 29 years; male, 98.6%), most were killed in action (89.4%) and more than half died from injuries sustained during mounted operations (52.3%). The cause of death was blast injury (45.0%), gunshot wound (39.8%), and multiple/blunt force injury (15.2%). The leading MOD was catastrophic tissue destruction (73.7%). Most fatalities sustained nonsurvivable injuries (74.3%). For fatalities with PS-S injuries, most had hemorrhage as a component of MOD (88.4%); however, the MOD was multifactorial in the majority of these fatalities (58.9%). Only 5.4% of all fatalities and 21.1% of fatalities with PS-S injuries had comparable injury patterns among survivors. Accounting for tactical situation, a minority of deaths were potentially preventable (5.7%) and a few preventable (1.1%). Time to surgery (93.7%) and prehospital blood transfusion (89.5%) were the leading OFI for PS-S fatalities. Most fatalities with PS-S injuries requiring blood (83.5%) also had an additional prehospital OFI. Comprehensive mortality reviews of battlefield fatalities can identify OFI in combat casualty care and prevention. Standardized lexicon is essential for translation to civilian trauma systems. Epidemiological, level IV.