United States Special Operations 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.

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.

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,...

Effectiveness of the Global Surgical and Medical Support Group (GSMSG) activities in Ukraine.

Targeting of healthcare infrastructures in Ukraine has served as a tactical warfare strategy. The goal of the Global Surgical and Medical Support Group (GSMSG) is to provide sustainable, high quality medical and surgical care in war zones. GSMSG deployed United States (US) Special Operations veterans and highly specialized licensed medical experts. Training of Ukrainian civilians was implemented. Over 20,000 Ukrainians trained and over 100 major surgeries performed with assistance of world experts. Specialized medical equipment was also provided. GSMSG lays the groundwork for effective, high quality, and sustainable surgical interventions into a nation in conflict.

Prospective associations of psychedelic treatment for co-occurring alcohol misuse and posttraumatic stress symptoms among United States Special Operations Forces Veterans

ABSTRACT This study evaluated prospective associations of ibogaine and 5-MeO-DMT treatment for risky alcohol use and post-traumatic stress disorder (PTSD) symptoms among United States (US) Special Operations Forces Veterans (SOFV). Data were collected during standard clinical operations at pre-treatment and 1-month (1 m), 3-months (3 m), and 6-months (6 m) post-treatment in an ibogaine and 5-MeO-DMT treatment program in Mexico. Of the 86 SOFV that completed treatment, 45 met criteria for risky alcohol use at pre-treatment (mean age = 44; male = 100%; White = 91%). There was a significant reduction in alcohol use from pre-treatment (M = 7.2, SD = 2.3) to 1 m (M = 3.6; SD = 3.5) post-treatment, which remained reduced through 6 m (M = 4.0; SD = 2.9; p < .001, partial eta squared = .617). At 1 m, 24% were abstinent, 33% were non-risky drinking, and 42% were risky drinkers. At 6 m, 16% were abstinent, 31% were non-risky drinking, and 53% were risky drinkers. There were no differences between responders (abstinent/non-risky drinkers) and non-responders (risky drinkers) in demographics/clinical characteristics. However, there were significant and very large differences between responders and non-responders in PTSD symptom (p < .01, d = −3.26) and cognitive functioning change (p < .01, d = −0.99). Given these findings, future clinical trials should determine whether psychedelic-assisted therapy holds promise for individuals with complex trauma and alcohol misuse who have not been successfully treated with traditional interventions.

Armed Forces in the present United States and Britain military policy. Main Trends

The article presents the United States and United Kingdom Armed Forces evolvement main trends in the warfare below the threshold of war context. The point at issue is United States Special Operations Forces (US SOF), British Army and United Kingdom Special Forces (UKSF). The focus of the research paper on: the US Theater Special Operations Commands - Special Operations Command Africa, Special Operations Command Europe and others; British Army new units - Ranger Regiment, Army Special Operations Brigade, 11th Security Force Assistance Brigade and others. The organizational and establishment of these units, their warfighting and combat training functions, tactical battle employment the spot is on. The article consciously thinks the Future Soldier British Army reform program and its role in the battle units adapting to the new type of conflicts - hybrid warfare below the threshold of war. The special attention is given to the US Military Operation in Syria (Operation Inherent Resolve) and American-British military assistance to Ukraine Armed Forces. The article is also reviewing the CIA Special Activities Center military role in Ukraine and 22nd Special Air Service regiment (UKSF) Syria combat presence.

Optimizing Brain Health of United States Special Operations Forces.

United States Special Operations Forces (SOF) personnel are frequently exposed to explosive blasts in training and combat. However, the effects of repeated blast exposure on the human brain are incompletely understood. Moreover, there is currently no diagnostic test to detect repeated blast brain injury (rBBI). In this "Human Performance Optimization" article, we discuss how the development and implementation of a reliable diagnostic test for rBBI has the potential to promote SOF brain health, combat readiness, and quality of life.

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.

Long-Term Effects of Repeated Blast Exposure in United States Special Operations Forces Personnel: A Pilot Study Protocol.

Emerging evidence suggests that repeated blast exposure (RBE) is associated with brain injury in military personnel. United States (U.S.) Special Operations Forces (SOF) personnel experience high rates of blast exposure during training and combat, but the effects of low-level RBE on brain structure and function in SOF have not been comprehensively characterized. Further, the pathophysiological link between RBE-related brain injuries and cognitive, behavioral, and physical symptoms has not been fully elucidated. We present a protocol for an observational pilot study, Long-Term Effects of Repeated Blast Exposure in U.S. SOF Personnel (ReBlast). In this exploratory study, 30 active-duty SOF personnel with RBE will participate in a comprehensive evaluation of: 1) brain network structure and function using Connectome magnetic resonance imaging (MRI) and 7 Tesla MRI; 2) neuroinflammation and tau deposition using positron emission tomography; 3) blood proteomics and metabolomics; 4) behavioral and physical symptoms using self-report measures; and 5) cognition using a battery of conventional and digitized assessments designed to detect subtle deficits in otherwise high-performing individuals. We will identify clinical, neuroimaging, and blood-based phenotypes that are associated with level of RBE, as measured by the Generalized Blast Exposure Value. Candidate biomarkers of RBE-related brain injury will inform the design of a subsequent study that will test a diagnostic assessment battery for detecting RBE-related brain injury. Ultimately, we anticipate that the ReBlast study will facilitate the development of interventions to optimize the brain health, quality of life, and battle readiness of U.S. SOF personnel.

Psychedelic treatment for co-occurring alcohol misuse and post-traumatic stress symptoms among United States Special Operations Forces Veterans

AbstractBackground&amp;aimsSpecial Operations Forces Veterans (SOFV) have unique treatment needs stemming from multiple repeated forms of combat exposure resulting in a complex sequela of problems including alcohol misuse and post-traumatic stress symptoms. Current approved pharmacologic treatments for alcohol misuse and PTSD are lacking in adherence and efficacy, warranting novel treatment development. The current study examined the correlations between psychedelic treatment and changes in alcohol misuse among trauma exposed United States SOFV.MethodAn anonymous internet-based survey was conducted among SOFV who completed a specific psychedelic clinical program in Mexico. Retrospective questions probed alcohol use and post-traumatic stress symptoms during the 30-days before and 30-days after the psychedelic treatment. A total of 65 SOFV completed treatment and were eligible for contact. Of these, 51 (78%) completed the survey, and 27 (42%) reported alcohol misuse (≥4 on the AUDIT-C) in the 30 days prior to treatment and were included in analyses (Mean Age = 40; male = 96%; Caucasian/White = 96%).ResultsThere were significant and very large reductions in retrospective reports of alcohol use (P&lt; 0.001;d= –2.4) and post-traumatic stress symptoms (P&lt; 0.001;d= –2.8) and a significant and large increase in psychological flexibility (P&lt; 0.001;d= –1.8), from before-to-after the psychedelic treatment. In the 30 days after treatment, 85% reduced their alcohol consumption to non-risky levels (33% abstinent; 52% non-risky drinking). Increases in psychological flexibility were strongly associated with reductions in alcohol use and post-traumatic stress symptoms (rs range 0.38–0.90; ps &lt; 0.05).ConclusionRigorous longitudinal studies should be conducted to determine whether psychedelic-assisted therapy holds promise as an intervention in this population.

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.

Supporting Resistance Movements in Cyberspace

ABSTRACT One of United States Special Operations Forces’ (SOF) core missions is support to unconventional warfare (UW). As SOF continues competing with states below the level of armed conflict, it must adapt to and capitalize on advances in technology to enable support to resistance movements. Other states, namely Russia, have capitalized on digital technologies in their undeclared, hybrid conflicts. The U.S., which will likely find itself on the other side of those conflicts, must rethink and update how it supports resistance movements. We suggest why to make this change now, and in the process offer cyber-based proposals that could be employed in support to resistance

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.

Latent TB Infection in USSOF: A Refresher and Update

Tuberculosis (TB) causes approximately 2 million deaths annually worldwide, with 2 billion persons estimated to be actively infected with TB. While rates of active TB disease in the US military are low, military service in TB-endemic countries remains an uncommon, but important source of infection. United States Special Operations Forces (USSOF) and enablers often operate in TB-endemic countries and, as an inherent risk of their mission sets, are more likely to have high-risk exposure to TB disease. Military medical authorities have provided excellent diagnostic guidance; the Centers for Disease Control and Prevention (CDC) recently updated preferred regimens for the treatment of latent TB infection (LTBI). This review serves as a refresher and update to the management of LTBI in USSOF to optimize medical readiness through targeted testing and short treatment regimens.

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.

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.