6/29/2018 UNCLASSIFIED History of SF/SOF Medics & Medicine Colonel (Ret.) Rocky Farr, M.D., M.P.H., M.S.S. Associate Clinical Professor of Internal Medicine Associate Clinical Professor of Pathology Aerospace Medicine Specialist Lake Erie College of Osteopathic Medicine-Bradenton FL Office: 941 782 5680; Cell: 813 434 8010; [email protected] 1 6/29/2018 UNCONVENTIONAL WARFARE • During Operation Enduring Freedom, the United States worked alongside opposition forces in Afghanistan to bring down the Taliban regime and rid the country of al-Qaeda fighters. U.S. Special Forces teamed up with the Northern Alliance in Afghanistan to topple the Taliban's brutal hold on the country and bring known terrorists to justice. Within a few months of launching the campaign, U.S.-led forces and Afghan opposition forces took control of the Afghan capital of Kabul, along with Kandahar, one of the country's largest cities. 2 6/29/2018 UNCONVENTIONAL WARFARE • SF have long employed the use of UW in enemy territory. Unlike DA missions, which are generally designed to be quick strikes, UW operations can last months, even years. This can help the Army prevent larger conventional attacks. And because of deep roots set up by these missions, other SF tactics, like DA or SR, can be launched quickly and seamlessly. 3 6/29/2018 4 6/29/2018 5 6/29/2018 Colonel Doctor Djorđe Dragić 6 6/29/2018 Yugoslavia “Under the conditions of GW the importance of the human factor is also notably enhanced because … partisan units are … replaced on a voluntary basis. The attention to the medical services … is therefore understandable.” – Dragić, Colonel Doctor Djorđe. Partisan Hospitals of Yugoslavia. Belgrade; 1966. 7 6/29/2018 UNCLASSIFIED Hospital Ward Rules Underground Shelter Behavior 1. Male or Female Orderly Is in Charge 2. Wounded Must Obey All Orders 3. Only Open Entrance After Enemy Withdrawal Notification Given 4. Wounded May Not Open Entrance 5. Wounded Can Not Leave Shelter Without Permission 6. Orderly Entitled to Shoot Wounded on Spot 8 6/29/2018 Colonel Dr. Djorđje Dragić • 1. Care of the sick & wounded is one of the most difficult problems & is often decisive in the development of military operations • Regular armies concentrate the sick & wounded while partisans disperse them to protect them • Most tended to on the move, cared by local population, or in secret hospitals 9 6/29/2018 “Two days later I went away eastwards to another hospital. This one had moved, on an average, every four nights, carrying all its wounded with it.” -Lindsay Rogers in Guerilla Surgeon. A New Zealand surgeon’s wartime experiences with the Yugoslav Partisans. 10 6/29/2018 OSS in Indochina • An OSS team “advised” the Vietnamese resistance to the Japanese • A Vietnamese team leader was saved from death by an OSS “18D” • After the war, COL Aaron Bank picked up the same guy as a hitchhiker in Hanoi & they drove to Saigon together….. • Who was he? UNCLASSIFIED The Special Forces Trinity • Colonel Aaron Bank – France • Colonel Russell Volckmann – Philippines • Colonel Wendell Fertig – Philippines 11 6/29/2018 12 6/29/2018 Auxiliary UW manual DAP 550-104 13 6/29/2018 Medics 1950s 14 6/29/2018 1950s • 77th Special Forces Group(Airborne)-Ft. Bragg • 10th Special Forces Group(Airborne)-Bad Tölz – Anti-Soviet “Cold War” force multiplier – Guerrilla War (“Falling Rain”) – Stay behind missions (Det. A/39th SF Det. in Berlin) • Conventional Army Structure issues – 12 man team, 2 “regular” medics, split team – A battalion gets a doctor – Brigade of Indigenous troops; G hospital Cold War Mission Statement • The mission of Special Forces is to kill as many godless communist bastards as possible with the least expenditure of ammunition and to restore cave dwelling as the accepted means of abode in the former communist region. 15 6/29/2018 1960s 1960s • Conventional army medical course (91A/B) – Nurse run, nursing skills heavy, in Texas • SF med course (“Med Lab”) @ Ft. Bragg – Trauma surgery – Definitive surgery – Tropical medicine – Care of indigenous forces – 91B4SGMW9 16 6/29/2018 1970s 1970s • Vietnam experienced SF medics – Been “doctors” in Vietnam – The hunt for civilian licensure – Civilian PA school development • SF Downsizing • Growth of Direct Action mission set • Course still split, Texas (91/68) & Ft. Bragg (18) 17 6/29/2018 1980s 1980s • Rise of civilian EMT-Ps • Rise of ATLS, military adoption of “cards” • Regrowth of SOF/SF after Iran mission – Direct Action focus – CMF 18, 18D combatant – Trauma medicine focus – SOF and SF medics • 68-Rangers, Civil Affairs, SEALs, SOF Aviation • 18-Special Forces • Other services 18 6/29/2018 1990s The image part with relationship ID rId2 was not found in the file. 1990s • Civilian credentials rise continues • Trauma focus/training grows (school moves) 24 weeks TX & 24 @ Bragg → 48 @ Bragg • Medicine focus decreases greatly • EMT-P certification became required • The PHTLS driven Golden Hour arrives • Direct Action continues – Post Somalia AAR CoTCCC formation – ATLS critiqued, FSTs came into conventional doctrine as MASH hospitals died 19 6/29/2018 2000s 2000s • 1999-2000, school refocuses – Definitive surgery & post-op after care, medicine • GW starts the GWOT, but DA continues it • DA has a robust medical infrastructure • Joint Trauma Sys. founded through CoTCCC • EMT-P re-certification becomes a problem • Theater and medicine matures – “12 years of one hour evacuations” – SECDEF Directive on Golden Hour • SOF AFSOC SOSTs (MFSTs) grow 20 6/29/2018 The Golden Hour • A recently published study by Russ Kotwal and colleagues confirmed the value of Secretary Gates’s “golden hour” mandate. They found that following Gates’s order, casualty evacuation time in Afghanistan fell from an average of 90 minutes to 43 minutes. The killed-in-action rate declined by 6 percent, and the risk of death among all injured decreased from 13 percent to 7 percent. Based on these findings, Kotwal’s team estimates that Secretary Gates’s mandate probably saved the lives of 359 service members. 2010s 21 6/29/2018 2010s • Missions beyond just OEF/OIF’s rings – 12 man teams, 2 medics, 0 docs (or less!) – Less robust U.S. presence in a country – Long way to anywhere and everywhere – Long evacuation times • “Where’s my golden hour?!?!?” – More medicine, MVAs, less battle trauma – 72+ hour holding skills? – Third world, local medical support – Prolonged Field Care 2020s………… 22 6/29/2018 2020s …… • Back to our roots – 12 man teams, 2 medics, 0 docs – Only U.S. presence in a country – Long way to surgery (local care vs. FSTs?) – Long evacuation times – More medicine, less trauma – 72+ hour holding skills • www.prolongedfieldcare.org – Guerrilla Hospitals The way ahead: (1) • TCCC Medical Battle Drill must be owned by Commander • All School Houses should teach TCCC to All • Formulize JTS for Peacetime • JTS Needs all Data Sources • RFI for quick, joint new medicine fielding • FDA cooperation w/JTS & CoTCCC • Nonstandard (“sterile”) med log for SOF • Reinvigoration of UW training in SOF 23 6/29/2018 The way ahead: (2) • Aggressive hunt for new technologies for SOF Medicine • Question the old medical normals (O2?) • SOF must have an organic surgical capability/team just like it did in World War II. • SOF medicine & surgery in third world countries may need to look more third world. – Non-U.S. equipment & procedures – Guerrilla auxiliary convalescence An isolated SF/SOF team in UW or FID w/a trauma casualty may: • Do prolonged field care first • Do surgery themselves • Do conventional evacuation • Do unconventioanl evacation • Rely on local pre-arranged care • Rely on U.S./Allied FST attached or nearby • Treat U.S. personnel different than indigenous • Combine all of the above • Something else 24 6/29/2018 “We need to stop looking for "high noons" in a hundred-years war." –Brian Michael Jenkins "Unconquerable Nation" 2006 Right Place, Right Time, Right Adversary “SOF can not always bring the Mayo Clinic to the battlefield but it can strive to make the Guerrilla Leader happy.” ─Farr WD. 25 6/29/2018 26.