United States Special Operations Command Research Articles

Impact of Respiratory Muscle Training on Exercise Tolerance in Hypobaric Hypoxia

Hypoxia and certain chronic diseases can intensify the work of breathing, potentially impacting the muscle hyperemic response during exercise and overall exercise performance. Respiratory muscle training (RMT) has been observed to decrease perceived effort under hypoxic conditions; however, it remains unclear if RMT boosts exercise performance in acute hypoxia. We investigated whether 4 weeks of RMT could enhance maximal and submaximal exercise performance in hypoxia (PB=425 mmHg, ~4876 m). Seven adult males underwent a 250 kJ submaximal (RPE 15-17) cycling trial in hypoxia, followed by an incremental test to maximal exertion. After 4 weeks of RMT under normoxic conditions, these tests were repeated in hypoxia. Although six of the participants displayed improvements in submaximal exercise performance, these numerical differences failed to reach statistical significance. However, RMT did raise VO2max peak power (Pre-RMT: 242.62 ± 35, Post-RMT: 251.85 ± 38 W, p=0.04). Moreover, even with an increased HR during the submaximal exercise trial after RMT (Pre-RMT:154.14 ± 16, Post-RMT: 160.86 ± 12, p<0.05), the RPE showed no significant difference during the test (Pre-RMT: 17.43 ± 0.79, Post-RMT: 17.43 ± 0.53, P>0.05). Despite this, no substantial increase in hypoxic submaximal exercise performance was observed, likely due to the small sample size. These findings suggest RMT might increase hypoxic exercise tolerance by reducing perceived exertion for a given HR. This work was supported by funding from the United States Special Operations Command (USSOCOM) and the National Institutes of Health (2L30HL134123-03). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Qualitative investigation of military surgical resuscitation teams: what are the drivers of success of a rapid response team?

ObjectivesThis qualitative study explores the characteristics of a specialised military medical rapid response team (MRRT), the surgical resuscitation team (SRT). Despite mixed evidence of efficacy, civilian MRRTs are widely employed,...

How the Five Principles of High Reliability Organizations Align with the Five Truths of Special Operations.

Special Operations medicine must provide highly reliable healthcare under intense and sometimes dangerous circumstances. In turn, it is important to understand the principles inherent to building a High Reliability Organization (HRO). These principles include (1) sensitivity to operations; (2) preoccupation with failure; (3) reluctance to simplify; (4) resilience; and (5) deference to expertise. Understanding them is crucial to turning good ideas into sound practical benefit in operational medicine. A prime teaching opportunity involves an interesting coincidence that occurred during the emergence of HROs. Specifically, United States Special Operations Command (USSOCOM) adopted five Special Operations Forces (SOF) Truths that contribute to success in Special Operations, including (1) humans are more important than hardware; (2) quality is better than quantity; (3) SOF cannot be mass produced; (4) competent SOF cannot be created after emergencies occur; and (5) most Special Operations require non-SOF support. These five Truths have more in common with the five HRO principles than merely quantity. They describe the same underlying ideas with a key focus on human performance in high-risk activities. As such, when presented alongside the five HRO principles, there is an opportunity to improve the overall health and performance of SOF personnel by integrating these principles across the range of Special Operations medicine from point of injury care to garrison human performance initiatives. The following discussion describes in greater detail the five HRO principles, the five SOF Truths, and how these similar ideas emerged as more than just a useful coincidence in illustrating the key concepts to produce high performance.

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.

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.

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.

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.

Establishing an enduring Military Trauma Mortality Review: Misconceptions and lessons learned.

Under direction from the Defense Health Agency, subject matter experts (SMEs) from the Joint Trauma System, Armed Forces Medical Examiner System, and civilian sector established the Military Trauma Mortality Review process. To establish the most empirically robust process, these SMEs used both qualitative and quantitative methods published in a series of peer-reviewed articles over the last 3 years. Most recently, the Military Mortality Review process was implemented for the first time on all battle-injured service members attached to the United States Special Operations Command from 2001 to 2018. The current Military Mortality Review process builds on the strengths and limitations of important previous work from both the military and civilian sector. To prospectively improve the trauma care system and drive preventable death to the lowest level possible, we present the main misconceptions and lessons learned from our 3-year effort to establish a reliable and sustainable Military Trauma Mortality Review process. These lessons include the following: (1) requirement to use standardized and appropriate lexicon, definitions, and criteria; (2) requirement to use a combination of objective injury scoring systems, forensic information, and thorough SME case review to make injury survivability and death preventability determinations; (3) requirement to use nonmedical information to make reliable death preventability determinations and a comprehensive list of opportunities for improvement to reduce preventable deaths within the trauma care system; and (4) acknowledgment that the military health system still has gaps in current infrastructure that must be addressed to globally and continuously implement the process outlined in the Military Trauma Mortality Review process in the future. LEVEL OF EVIDENCE: Level III.

United States Special Operations Command fatality study of subcommands, units, and trends.

Death from injury occurs predominantly in prehospital settings. Injury prevention and prehospital care of military forces is the responsibility of combatant commanders. Medical examiner and trauma systems should routinely study fatalities and inform commanders of mortality trends. Data reported on US Special Operations Command (USSOCOM) fatalities who died while performing duties from September 11, 2001, to September 10, 2018, were reevaluated to compare subcommands, units, and trends. Injury was assessed by mechanism, severity, operational posture, and survivability. Death was assessed by manner, cause, classification, mechanism, and preventability. Of 614 USSOCOM fatalities (median age, 30 years; male, 98.5%), 67.6% occurred in the Army command, of which 49.2% occurred in the Special Forces command. Battle injury accounted for 60.1% of USSOCOM fatalities. Most battle-injured fatalities in each subcommand had nonsurvivable injuries and nonpreventable deaths. For each subcommand except Marine Corps, fatalities with nonsurvivable injuries sustained injuries primarily while mounted. By subcommand, the primary cause of death for fatalities with nonsurvivable injuries was blast for Army (57.6%), multiple/blunt force for Navy (60.0%), gunshot wound for Air Force (55.6%), and split between blast (50.0%) and gunshot wound (50.0%) for Marine Corps. For each subcommand except Air Force, fatalities with potentially survivable-survivable injuries sustained injuries primarily while dismounted, and the mechanism of death was primarily hemorrhage plus other mechanism or hemorrhage alone. Hemorrhage only mechanism of death was surpassed over time by complex multimechanism death. Potential for injury survivability and death preventability was greatest during early and later years of conflict. Organizational differences in mortality characteristics and trends were identified from which commanders can refine efforts to prevent and treat injury and improve survival. Fatality analyses inform operational risk matrices and advance casualty prevention and response efforts. Prevention, assessment, and treatment strategies must evolve to reduce death from hemorrhage plus coexisting mechanisms. Performance Improvement and Epidemiological, level IV.

Ketamine Administration by Special Operations Medical Personnel During Training Mishaps.

Opioids can have adverse effects on casualties in hemorrhagic shock. In 2014, the Committee on Tactical Combat Casualty Care (CoTCCC) recommended the use of ketamine at the point of injury (POI). Despite these recommendations the adherence is moderate at best. Poor use may stem from a lack of access to use ketamine during training. The United States Special Operations Command (USSOCOM) is often in a unique position, they maintain narcotics for use during all training events and operations. The goal of this work is to demonstrate that ketamine is safe and effective in both training and operational environments. This was a retrospective, observational performance improvement project within United States Special Operations Command and Air Combat Command that included the US Army's 75th Ranger Regiment, 160th Special Operations Aviation Regiment, and US Air Force Pararescue. Descriptive statistics were used to calculate the doses per administration to include the interquartile range (IQR), standard deviation (SD) and the range of likely doses using a 95% confidence interval (CI). A Wilcoxon signed-rank test was used to compare the mean pre-ketamine pain scores to the mean post-ketamine on a 0-to-10 pain scale. From July 2010 to October 2017, there was a total of 34 patients; all were male. A total of 22 (64.7%) received intravenous ketamine and 12 (35.3%) received intramuscular ketamine and 8 (23.5%) received intranasal ketamine. The mean number of ketamine doses via all routes administered to patients was 1.88 (SD 1.094) and the mean total dose of all ketamine administration was 90.29mg (95% CI, 70.09-110.49). The mean initial dose of all ketamine administration was 47.35mg (95% CI, 38.52-56.18). The median preketamine pain scale for casualties was noted to be 8.0 (IQR 3) and the median post-ketamine pain scale was 0.0 (IQR 3). Ketamine appears to be safe and effective for use during military training accidents. Military units should consider allowing their medics to carry and use as needed.

Practitioner Driven Action Research…Created by a Practitioner, for Practitioners!

The dissertation culminates in an artifact creation called the Practitioner Driven Action Research (PDAR) framework. It was conceptualized, refined, and field-tested during a yearlong Action Research project at the United States Special Operations Command (USSOCOM). PDAR focuses on immediate problem-solving and driving practitioners towards adopting action-driven outcomes grounded in Action Research. The framework seeks to help practitioners across USSOCOM approach organizational problem-solving more systematically and scientifically along with better integrating academic resources into the process.

A descriptive study of US Special Operations Command fatalities, 2001 to 2018.

Studies of fatalities from injury and disease guide prevention and treatment efforts for populations at risk. Findings can inform leadership and direct clinical practice guidelines, research, and personnel, training, and equipment requirements. A retrospective review and descriptive analysis was conducted of United States Special Operations Command (USSOCOM) fatalities who died while performing duties from September 11, 2001, to September 10, 2018. Characteristics analyzed included subcommand, military activity, operational posture, and manner of death. Of 614 USSOCOM fatalities (median age, 30 years; male, 98.5%) the leading cause of death was injury (97.7%); specifically, multiple/blunt force injury (34.5%), blast injury (30.7%), gunshot wound (GSW; 30.3%), and other (4.5%). Most died outside the United States (87.1%), during combat operations (85.3%), in the prehospital environment (91.5%), and the same day of insult (90.4%). Most fatalities were with the US Army Special Operations Command (67.6%), followed by the Naval Special Warfare Command (16.0%), Air Force Special Operations Command (9.3%), and Marine Corps Forces Special Operations Command (7.2%). Of 54.6% who died of injuries incurred during mounted operations, most were on ground vehicles (53.7%), followed by rotary-wing (37.3%) and fixed-wing (9.0%) aircrafts. The manner of death was primarily homicide (66.0%) and accident (30.5%), followed by natural (2.1%), suicide (0.8%), and undetermined (0.7%). Specific homicide causes of death were GSW (43.7%), blast injury (42.2%), multiple/blunt force injury (13.8%), and other (0.2%). Specific accident causes of death were multiple/blunt force injury (80.7%), blast injury (6.4%), GSW (0.5%), and other (12.3%). Of accident fatalities with multiple/blunt force injury, the mechanism was mostly aircraft mishaps (62.9%), particularly rotary wing (68.4%). Most USSOCOM fatalities died abroad from injury in the prehospital setting. To improve survival from military activities worldwide, leaders must continue to optimize prehospital capability and develop strategies that rapidly connect patients to advanced resuscitative and surgical care. Epidemiological, level IV; Therapeutic level IV.

Tactical combat casualty care in special operations.

U.S military medical personnel are currently trained to care for combat casualties using the principles taught in the Advanced Trauma Life Support (ATLS) course. The appropriateness of many of the measures taught in ATLS for the combat setting is unproven. A 2-year study to review this issue has been sponsored by the United States Special Operations Command. This paper presents the results of that study. We will review some of the factors that must be considered in caring for wounded patients on the battlefield with an emphasis on the Special Operations environment. A basic management protocol is proposed that organizes combat casualty care into three phases and suggests appropriate measures for each phase. A scenario-based approach is needed to plan in more detail for casualties on specific Special Operations missions, and several sample scenarios are presented and discussed.

Special Operations Forces in the Gray Zone: An Operational Framework for Using Special Operations Forces in the Space Between War and Peace

In September of 2015, the United States Special Operations Command published a report on the challenges presented by hostile adversarial actions that exist outside of the “traditional peace/war duality.” Yet neither that paper nor subsequent treatments of the subject address the central question of when and how to employ the most innovative, subtle, and adaptable instruments of national power—special operations forces—in these ambiguous threat environments. This article provides an initial inquiry into this question. After discussing the inadequacy of current operational models to address “gray zone” challenges (however loosely defined), the article introduces and uses an alternative model to illuminate the utility of special operations forces power at various points on the escalatory spectrum. The paper closes with additional questions to spur further research and a synopsis that addresses the implications of the model to the United States’ overall approach to gray zone competition.

Towards a Regional Strategy Contra ISIS

Abstract: A Regional strategy with three essential elements is needed to defeat ISIS. The first involves rolling it back in Iraq and Syria by attacking its capabilities and strategies. The second is to contain it by helping fortify weaker Arab countries that might be at risk. The third is to influence the relationships between Saudi Arabia, Turkey, Jordan, and Iran, countries whose efforts will be required to defeat ISIS and end the conflicts in Syria and Iraq. ********** On the eve of the 13th anniversary of the horrific 9/11 attacks, President Barack Obama delivered a primetime televised speech in which he identified the Islamic State of Iraq and Levant (ISIL, also widely known as ISIS) as a significant threat to the United States, its allies and the overall stability of the Middle East. He also articulated several pillars of a counterterrorism strategy to degrade, and ultimately destroy ISIL. (1) ISIS represents a threat with three different faces. To the United States and its western allies, it is a terrorist organization. However, for Arab states, ISIS represents an insurgency without political boundaries that threatens the survival of countries [such as Iraq, Syria and Libya] in the midst of civil wars, puts at risk weak states desperately trying to avert civil war, like Lebanon and Jordan; and poses a challenge to the legitimacy of even stronger states like Egypt and Saudi Arabia. When examined from a regional perspective, ISIS represents the spearhead of a broader movement threatening to sunder the Arab political order that has existed since the end of World War I, and potentially threatening non-Arab states such as Iran, Turkey and even Israel. Any strategy to eradicate ISIS must take into account the threat's three essential aspects. To deal with it, the United States will need the capability to fight ISIS using military means, but also to strengthen the military and political capacity of individual Arab states at risk. Moreover, it will need to move beyond country-specific approaches towards a regional effort to manage the relationships between competing powers, such as Iran, Saudi Arabia and Turkey, all of which have contributed to the instability that has allowed ISIS to flourish. The Nature of the Threat In the wake of 9/11, the US Department of Defense greatly increased its capacity for dealing with asymmetric threats such as al-Qaeda. United States Special Operations Command, and under it, Joint Special Operations Command, along with other parts of the military, have enhanced detection, surveillance and response capabilities against non-state opponents. However, ISIS is a hybrid organization. It uses a combination of terrorist and conventional military tactics and, atypical for asymmetric opponents, it holds large swaths of territory (in Syria and Iraq) over which it has imposed sovereignty. Other unique aspects of ISIS could bedevil the United States and its coalition partners. First, US-led military operations against ISIS are taking place against the backdrop of civil wars in Syria and Iraq, with the additional complication that ISIS has conflated these conflicts by essentially erasing many of the border areas separating these countries. Military operations taking place within the context of two civil wars are likely to be fraught with unprecedented degrees of complexity. Unfortunately, military operations cannot be sealed off completely from the civil wars; and unintended consequences from these operations could exacerbate the conflicts and inadvertently strengthen opponents the United States has vowed to undermine. For example, the air battle now raging against ISIS in Syria in support of the Kurds could very well reinforce the Assad regime which President Obama claimed in 2011 must be replaced. (2) Second, the US government may think it is battling only ISIS, but the threat comes from a broader political movement which military means alone cannot defeat. …

Global SOF and Interagency Collaboration

The United States Special Operations Command (USSOCOM) has emphasized the importance of international SOF collaboration, or what USSOCOM refers to as a “global SOF network.” It is difficult to achieve requisite levels of collaboration even among departments and agencies within a single country, much less on an international basis. Yet USSOCOM has been rightly praised for its trailblazing collaboration efforts in counterterrorism operations, so perhaps it can extend successful collaboration to its “global SOF network.” This article argues collaboration lessons from the past decade of counterterrorism operations can be used to facilitate better international SOF collaboration. Even if the lessons are well recognized they will be hard to act upon, especially when USSOCOM is using its indirect approach to SOF missions managed out of U.S. embassies overseas. But the first step in solving any problem is recognizing the nature of the problem and what is required to solve it. The rest is all disciplined, aggressive and intelligent implementation, which Special Operations Forces do well.

Deployed Assessment and Management of mTBI Casualties

The wars in Afghanistan and Iraq have placed a spotlight on screening, evaluation, and treatment of mild traumatic brain injury, otherwise known as concussion. The author presents a mass casualty case in which a Ranger company medical section assessed and managed 30 Servicemembers (SM) diagnosed with concussion. Through the process of treating these Servicemembers, a consolidated checklist was created based on existing Department of Defense, United States Special Operations Command (USSOCOM), and United States Army Special Operations Command (USASOC) guidelines. During this and subsequent clinical encounters, utilization of this checklist resulted in efficient identification of concussed personnel, appropriate treatment, and documentation.

USSOCOM TCCC CASEVAC Set Program A Retrospective and Overview

The United States Special Operations Command (USSOCOM) Tactical Combat Casualty Care (TCCC) Casualty Evacuation (CASEVAC) Set Program was initiated in 2006 as a three-step effort. The initial effort was to develop an improved Individual First Aid Kit (IFAK); this was followed by the development of a Medic bag and culminated with the CASEVAC Set. The intent of the Program is both standardizing the medical load out across SOF components and expanding the skill set of Special Operations Forces (SOF) medical practitioners by providing equipment and training outside the normal parameters of many units. Even though the Set is currently being fielded to a variety of units, there are still personnel unaware of the Set and its capabilities. The goal of this article is to increase awareness of the existence of the program and to promote thought/discussion regarding the expansion of the capabilities of the Advanced Tactical Practitioner (ATP) beyond traditional medical skills. This program is best understood by first looking back to where it originated, and then examining where it is at present.

Fresh Whole Blood Transfusions In The Austere Environment

The use of Fresh Whole Blood (FWB) transfusions can be a powerful tool for the Special Operations Forces (SOF) medic to treat uncontrolled hemorrhage. In fact, it may be the only tool currently available for hemostatic resuscitation, which along with hypotensive resuscitation, forms the basis for Damage Control Resuscitation (DCR). Until now, no comprehensive protocol has existed for conducting FWB transfusions in austere environments. The United States Special Operations Command (USSOCOM) sponsored Curriculum Evaluation Board (CEB), which is responsible for authoring the Tactical Emergency Medical Protocols (TMEPs) has produced a protocol. This article serves as its introduction.