By How Miller.

Imagine, if you will, how excited I was to be invited to tour the Joint Special Operations Medical Training Center (JSOMTC) on my trip to Fort Bragg. Training has evolved tremendously since I became a 91B4S Special Forces Medical Aidman in 1968. Their mission is to merely produce the finest medics in the world.

Thanks to fellow Chapter 78 member, Dennis DeRosia, having invited two head trainers, Mike Jones and Pat Buckles, to join his 91B vs 18D presentation at SFACON 2021 in Las Vegas, they were happy to return the favor and continue the process of highlighting what is on offer for today’s top candidates. My former teammate at A325 Duc Hue in Vietnam, Lew Chapman, and I were treated like extra special VIPs. We helped return the favor with a presentation of what it was like to be a 91B (medic) and 05B (commo man) on an A team at a fun working lunch in their lecture hall.

Nowadays this is an integrated SOF training, including providing SOCOM Medics to be Ranger Medics, SOAR Flight Medics, Civil Affairs Med SGTs, and other USASOC Medics, while some will continue on to be 18D Special Forces Medical Sergeants, or Naval Special Operations Independent Duty Corpsmen.

All students go first through the 9-month 68W1 course. That begins with National Registry EMT basic and ends with National Registry Paramedic civilian certification. The civilian certifications are a big improvement for transition back to civilian life after the service. As a 91B in those early days our qualifications were considered more of a state secret, resulting in no civilian authority recognizing our training and accomplishments. That caused many disappointments when trying to build on our experiences when “back in the world”. The 68W1 course culminates in testing for civilian certification in (ACLS) Advanced Cardiac Life Support and (ATP) Advanced Tactical Paramedic, which is a good intro to any medical facility. JSOMTC lays claim to the highest pass rate of any school in the country. In order to maintain the 68W1 MOS, every two years they return for refresher and updates and re-certification.

Photo: How Miller (author) tries out a sonogram machine. (Lew Chapman)

There are many facets to the training, including many medical subjects, hands-on training, and what we used to call OJT at several civilian hospitals. Experiences at the hospitals can vary from ambulance runs and Emergency Room duty to delivering babies and open heart surgery, depending on what is available when they are working in their assigned areas. There is a heavy emphasis on Trauma care.

A lot of the training is now done online, allowing for students to study and self-test at their own schedule. 100 percent correct answers are required to pass on to the next section (Each block requires a 75% GPA to pass onto the next iteration with an academic review board if you fall under the passing GPA), with reviews available to fill in any info that was missed or misunderstood. The pace of the material is intense, requiring focused attention and good scheduling skills, but this method actually allows for less travel and more studying. The instructors also make themselves available by cellphone or email for an unbelievable amount of time.

Our tour started in a very busy training area. Endotracheal intubations and starting IVs were being practiced when we visited one of the activity areas. The intubations were practiced on sophisticated manikins that showed exposed lungs and stomachs.

If one missed the trachea, the stomach would start to fill with air and expose the error. This was done in cooperation with one’s partner. Then the assistant became the intubater. When under fire, this is not an option, so cricothyroidotomies are becoming the go-to choice in combat if an airway can’t be cleared and maintained otherwise. I recall carrying a ballpoint pen in one of my pockets in case I needed to use the empty barrel to keep an airway open. I’m sure they have better ways now.

Starting the IVs was done in a different manner. One partner would actually start the IV on the other, under supervision, and then roles would be reversed and the patient would become the medic. You can imagine that method leads to a lot of care being taken not to hurt the partner in the hopes that he or she will also be that careful. I recall we used that method for lots of procedures, including nasal intubation.

Intraosseous fluid replacement is another innovation that saves many lives. Instead of a medic trying different vein locations to start an IV, which could ultimately prove too difficult to accomplish in the field, some injured soldiers can only be saved by injecting fluids or even blood directly into a bone. The device has a series of spikes along the circumference of the roughly quarter-sized circle, which are only for stability, so it will grab and hold on. In the center is a stiff, large-gauge needle through which the product is delivered.

The force needed to penetrate the bone is provided by the spring-loaded injector. There are a few bones that make for the most feasible sites. The two most preferred are the flat tibial surface along the shin and the sternum. If the soldier is in bad enough shape to need this, it most likely will not seem to hurt as much as it will when being removed. Quite often, the best location will be the sternum because it is easy to reach and provides a stable target.

If you were lucky enough to be selected to be an 18D (Special Forces Medical Sergeant), or an SOIDC (Special Operations Independent Duty Corpsman), another 3 months of Surgical, Dental, Disease and other subjects are in store for you, and could result in you receiving a BS degree. There is even a pathway to earning Physician Assistant credentials later on.

I’m a little murky on the field experiences of an NSOIDC, but I know that an SF medic on an A-team, now an ODA, is as good as it gets. You’re the closest thing to a doctor that many indigenous people will ever see. You can have a lot of responsibility, but you also have comprehensive training to prepare you. You also get all the free ammo you can carry.

The Surgical section was on a cycle break, but we got to tour the facility and see a couple of the surgical rooms and equipment. The portable sonogram that they use to guide their regional blocks reduces anesthetic use by about 80 percent. There were a few students practicing regional blocks on each other and using the sonogram. When they were done, we got to play with the portable ultrasound as well.

Regional blocks are a recent addition to potentially lifesaving tools. Besides giving a “local” anesthetic further up the nerves for some surgeries, by knowing the right locations and techniques, a whole area can be numbed, eliminating the need for general anesthesia sometimes. On the battlefield, sometimes a wound can be so painful as to incapacitate a soldier. In some cases, a regional block can numb the pain and allow the soldier to help get himself off the battlefield, freeing up others for a more vigorous defense.

Photo: Typical lab equipment for blood analysis, centrifuge not shown. (How Miller)

When we walked into the lab, which was not being used at the time, I said “Where’s the Lab?”

The only familiar things in sight were workbenches, a microscope and a bunch of cabinets. Apparently they still use reagents and centrifuges, but they were packed away, except for those in the ventilation hood. What they use now are a lot of electronic devices that do an incredible amount of analysis of blood samples, for example. They are compact enough to be useful in an ODA lab. These devices are constantly adding capabilities and they are expecting another significant upgrade soon.

In the hallway were numerous display cases showing the supplies that are typically available for use by the SF Medic. There is everything from syringes and swabs to autoclaves, sophisticated splints, and full kits and packs. I was searching for and delighted to find that the A team bible, the Merk Manual of diagnoses was available. The one we used was the eleventh edition, and a lot of that same information is in the current version.

Photo: The Hall of Heroes which honors SOF Medics that have died in combat. (How Miller)

We spent some time looking at the Hall of Heroes, SOF Medics that died in combat. A strong message of how serious the job is. 

Later we met with Mike Jones, trainer Mike Jackson, and a group of trainees at Charlie Mike’s Pub. But that’s another story.

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This story by How Miller entitled “18D Training Today” was first published in the April 2023 issue of the Sentinel. This monthly publication is published by Chapter 78 of the Special Forces Association. You can subscribe to it at this link. Top photo, by How Miller, is of one of the 18D training surgical units.

The 24th Special Operations Wing launched the Special Operations Center for Medical Integration and Development, a program designed in cooperation between the U.S. Air Force and the University of Alabama-Birmingham to develop and provide advanced standardized training to special operations medics. The training used realistic and innovative techniques including virtual reality, field training exercises and clinical hospital rotations to maintain readiness of Special Operations Surgical Team members, pararescuemen and independent duty medical technicians.

Watch the video produced by the 24th Special Operations Wing Public Affairs office and Staff Sgt. Ridge Shan, posted on DVIDS February 5, 2021, 6 minutes.

By Kayla Hocker.

Green Berets from 1st Special Forces Group (Airborne) at Joint Base Lewis-McChord are assisting medical personnel at Madigan Army Medical Center, amid the COVID-19 pandemic April 14, 2020.

For two weeks, Special Forces Medical Sergeants (18D) have been providing rehabilitative and innovative care to patients at Madigan Army Medical Center in an effort to lighten the workload of nurses, paramedics and doctors at the hospital.

On a volunteer basis, five Special Forces medics assisted in protecting the force and JBLM community in both the emergency department and the intensive care unit.

“Currently, the 18D team is primarily assisting our emergency medicine physicians and emergency medicine physician assistants in the acute treatment of our installation’s active duty and family member beneficiaries,” said Lt. Col. Allan Boudreaux, Madigan Emergency Department Clinical Nurse Specialist and Deputy Chief of Evidence Based Practice. “This treatment includes respiratory support, disease management, wound care, minor procedures, and the management of Soldiers with behavior health concerns.”

The Special Forces medics reinforce the civilian sector by integrating their unique perspective and the sharpened critical thinking skills they’ve honed throughout years serving as Green Berets. The impact of the Special Forces medics has made a significant difference at JBLM.

“The 18D team has provided invaluable assistance by augmenting the organization’s physician and nursing staff,” said Boudreaux. “This included working directly within the clinical teams providing direct care to the critically ill and injured, in addition to specific treatment of patients suspected of COVID-19, he added.

The staff at Madigan is highly skilled and trained, however in these unprecedented times as the environment continues to change it is beneficial to have additional support to lean on.

“Medics, nurses and doctors each have their own job, but for us there’s a lot that overlaps between the three,” said a senior Special Forces Medical Sergeant assigned to 1st SFG (A). “Whenever somebody is having a tough time or someone is a little overwhelmed, we can step in there and provide some help and make things go a bit smoother.”

The resiliency and inventiveness displayed by Special Forces medics gained by operating in austere environments with limited capability, changes what health care looks like during this time.

The experiences and relentless mindset of Green Berets leads to unique dialogue and open exchange on how to exhibit ever-improving care for patients, said a senior Special Forces Medical Sergeant assigned to 1st SFG (A).

As Green Berets continue to assist in the fight against COVID-19, there is a mutual respect, learning and strategizing between the Special Forces Soldiers and Madigan staff.

“This process has laid the foundation for future Corps-level missions of an emergent nature,” said Boudreaux. “The teamwork demonstrated by all is a clear and true demonstration of Soldiering, and has facilitated processes that will allow for future mission accomplishment.”

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Article: The above article is a repost of a story by Sergeant Kayla Hocker, 1st Special Forces Group, posted on DVIDS on April 22, 2020 entitled 1st SFG (A) Green Beret Medical Sergeants assist Madigan Army Medical Center in fight against COVID-19. Original story can be accessed here.

Photo: A Special Forces Medical Sergeant (18D) assigned to 2nd Battalion, 1st Special Forces Group (Airborne), unwraps a needle to prepare medication from a vial, Joint Base Lewis McChord, Wash., April 14, 2020. The Special Forces Medical Sergeants can integrate their expertise with the civilian sector, stepping in to aid where needed in the fight against COVID-19. The impact of the Green Berets has made a significant difference at JBLM. (Army Photo by Sgt. Kayla Hocker)

Watch a four minute long video about the Special Operations Combat Medic (SOCM) Course conducted by the U.S. Army Special Warfare Center and School. (May 21, 2019).

SOCM Overview 2019

This SARC video explains the job and responsibilities of the Navy Special Amphibious Reconnaissance Corpsman. The SARC has to perform as a medical provider and as a warrior. They deploy with Navy and Marine special operations units. Watch the two-minute long video published on January 24, 2019 by America’s Navy.

https://www.youtube.com/watch?v=5ONl8Z1s-Ac

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Photo: Taken from the video.

ISTC SOF Medic Course – The North Atlantic Treaty Organization (NATO) has a number of special operations related courses that are conducted at a school in Pfullendorf, Germany. One of these courses conducted at the NATO International Special Training Center (ISTC) is the NATO Special Operations Combat Medical Course or NSOCM.

The 24-week long NSOCM prepares students to be able to implement over 160 NATO-recognized critical tasks in the treatment of trauma and non-trauma injuries and illness. Much of the time the SOF medics train to these skills in a tactical environment.

Injuries and wounds suffered by special operations forces personnel will likely happen in austere locations far removed from the ‘golden hour’ of medical evacuation. The SOF medics need to able to render a wide variety of lifesaving techniques to be able to meet the unique medical challenges that they will be faced with during SOF operations.

Clinical skills are a part of the training course. The students study clinical medicine as well as the treatment of battlefield injuries and wounds. Some special operations missions such as unconventional warfare (UW) will take place for prolonged periods of time (months) in denied areas with limited access to medical treatment. Learning tasks such as basic dental care (cleaning or pulling of teeth) can go a long way to ensuring a Solider’s health in an austere environment for long periods of time.

The commander of Special Operations Command Europe (SOCEUR) – Major General Mark Schwartz – made the following comment about the ISTC SOF medic course:

“Saving more lives in combat is the NSOCM foremost intent. As NSOCM equips SOF Medic Soldiers with more advanced abilities; they take away what they learned here at ISTC to build a collective capability from medical and non-medical SOF within their organic unit.”

Many NATO SOF units send their combat medics to the NATO medic course. Rear Admiral Jan Sommerfelt-Petterson, a specialist in public health from the Norwegian Armed Forces, says:

“Being a small country, Norway has used ISTC to train our solders for many years. We gain more from the quality of education ISTC provides. The crux of the matter is ISTC takes modern medicine and educates military operators on skills to bring to combat in areas where normal medical support is unavailable”.

Graduates of the ISTC SOF medic course earn the ISTC’s NATO credentials as well as a diploma and 60 applicable college credit hours.

References:

NATO Special Operations Combat Medic (NSOCM) Course. This web page by the International Special Training Centre provides information on the scope, objectives, course length, program, eligibility, packing list, prestudy material, and additional information on the ISTC SOF medic course.
http://istc-sof.org/nato-special-operations-combat-medic/

“Inaugural NATO Special Operations Combat Medic Course Graduates 23 Students at ISTC”, by Sgt Nelson Robles, SOCEUR PA, Army.mil, March 23, 2017.

Much of the information for this story came from “SOF medics from 10 nations increase life-saving skills at ISTC”, by Sgt. Karen Sampson, U.S Special Operations Command Europe, March 9, 2018.

SOF News Update 20170706 – July 3rd casualty identified, ex-Green Beret on North Korea, SOF Medic Field Guide, IDF Special Forces vet designs rotary UAV with machine gun, Glock not happy with Modular Handgun System competition results, college to honor SSG James Miller (Green Beret & MoH), U.S. Army needs more firepower, field guide for boosting Marines senses in combat, and more.

DoD Identifies U.S. Casualty from July 3. The Department of Defense announced the death of a Soldier who was supporting Operation Freedom Sentinel in Afghanistan. PFC Hansen B. Kirkpatrick, 19, of Wasilla, Arkansas, died on July 3rd, in Helmand province from wounds received during an indirect fire attack. He was assigned to the 1st Battalion, 36th Infantry Regiment, 1st Brigade Combat Team, 1st Armored Division based at Fort Bliss, Texas. Info from “DoD Identifies Army Casualty”, DoD, July 5, 2017.

Israeli Special Forces Vet Developed UAV for Machine Guns. Urban warfare will be going high-tech with the introduction of small multi-rotor drones modified to carry machine guns, grenade launchers, and other small weapons. A 20-year veteran of the Israeli Defense Forces (IDF) and reservist in the Israeli Special Forces has founded a company that has developed and marketed the drone. Read more in “The Israeli Military is Buying Copter Drones With Machine Guns”, Defense One, July 5, 2017.

Glock – Not Happy with MHS Competition Results. The leadership at Glock, Inc. says that the U.S. Army’s decision to go with Sig Sauer for the Modular Handgun System (MHS) was driven by cost savings not the performance of the gun. The Government Accountability Office (GAO) recently decided to deny Glock’s protest of the Army’s MHS decision. Read more in “Glock Says It’s the Best Pick for MHS; Calls on Army for More Tests”, Military.com, July 5, 2017.

College of Dupage Honors SSG Miller of 3rd SFGA. Staff Sergeant Robert James Miller, a member of 3rd Special Forces Group, was killed in Afghanistan and received the Medal of Honor. The College of Dupage in Illinois – home state of SSG Miller – is naming a building on its campus after Miller. Read about the memorial ceremony and about the Medal of Honor award to Miller.

Army Increasing Fire Power Capability for Future Conflict. The most likely adversaries for the United States in a ground war is Russia and North Korea. Many of the Army’s leadership feel that the Army lacks sufficient firepower to counter these armies. However, efforts are now underway to correct that shortfall. See “As Global Tensions Rise, U.S. Army Beefs Up Firepower”, Real Clear Defense, July 6, 2017.

Field Guide for Marines – Enhancing Instincts. The Office of Naval Research has spent a good bit of money finding out unique ways to boost a Marines senses while operating in dangerous situations. A 23-page field manual breaks down training, mental exercises, and methods for enhancing natural instincts. Read more in “The Navy Developed a Field Guide for Marines to Boost Their Senses Downrange”, Task and Purpose, July 5, 2017.

Green Beret on North Korea. Special Forces officer Mike Waltz, a Fox News commentator, provides his thoughts on what comes next with the North Korean missile crisis. He thinks time is running out yet there really are no good military options. Read more in “Ex-Green Beret Commander: Time to Consider NKorea Regime Change”, Newsmax, July 6, 2017.

Medical Field Guide. The College of Remote and Offshore Medicine (CoROM) has updated its CoROM Field Guide. The CoROM Field Guide was designed for the medical practitioner working in remote and austere environments. The guide is being used by the NATO Special Operations Combat Medic Course. http://corom.org/field-guide/

SOF News Update for 20161030 – Ukrainian Special Forces, Journal of Special Operations Medicine, mercenaries, fallen Navy CPO takes final voyage home, Malaysian SOF, new deadlier technologies for MARSOC, and more.

Ukrainian Special Forces. The conflict in the Ukraine continues to grind on. Russia is not the only side of the conflict to employ Little Green Men – its version of unconventional warfare. The Ukrainian Special Forces are busy as well. Read more in “Inside the Covert War in Ukraine”, Vice News, October 4, 2016.

MARSOC Seeks Deadlier Technologies. “The Marine Corps is sending some of its Raiders on a new mission: developing new technologies to make MARSOC even deadlier”. Read more in a news report by Marine Corps Times, October 4, 2016.

Program on Mercenaries. BBC World Service recently (Oct 7, 2016) aired a 50-minute long broadcast entitled Mercenaries: Guns for Hire.
www.bbc.co.uk/programmes/p049gt5h

CPO Returns Home on Final Journey. Chief Petty Officer Jason Finan was recently killed in action in Iraq by an Improvised Explosive Device (IED). He is on his way home for memorial services in the San Diego area. Finan was supporting a U.S. Navy SEAL unit when he was killed. Read “Body of Fallen Coronado-Based Sailor Returns Home”, NBC San Diego, October 28, 2016.

JSOM Info. For those who are working in the special operations medical field there is an online magazine that provides a wealth of knowledge in this area. Visit the website of the Journal of Special Operations Medicine at www.jsomonline.org.

Tech Update – Flying Motorcycles for SOF. So a Special Forces battalion has its Combat Dive Team, HALO Team, and Mountain Teams. Is a “Flying Motorcycle” team in the near future? How many specialized teams will we need to have before the day of the “Rucksack Team” goes away? Read more in “Here’s An Idea: Give Special Forces Some Motorcycles”, Wired.com, October 28, 2016.

USAJFKSWCS Honors 12 SOF Members. Twelve former members of Special Forces, Civil Affairs, and PSYOP were honored by the SWC recently for contributions to the SOF community. Read more in a news report by The Fayetteville Observer, October 28, 2016.

SFA Chapter 2 Throw Blankets. The Special Forces Association on Okinawa is selling limited edition blankets for current and former members of 1st Battalion, 1st Special Forces Group members. (LinkedIn, Sep 29, 2016)

A NATO Special Operations Combat Medical Course – NSOCM -has been established at the NATO International Special Training Center (ISTC) in Pfullendorf, Germany. This 22-week course takes special operations forces troops who have basic combat lifesaver skills and further train them to be combat medics who are able to sustain casualties up to 36 hours.

The new medic course will cover over 170 critical tasks in a variety of medical situations to include trauma, non-trauma, injuries, illnesses, and other conditions that require initial medical treatment and care for a wounded, sick, or injured patient on the battlefield.

The NATO Special Operations Headquarters (NSHQ) provides oversight of the NSOCM to ensure that ISTC is fulfilling the training required for NATO SOF. Many SOF operations preclude the ability of special operators to receive advance care during the first ‘golden hour’ since aerial MEDEVAC capabilities do not always exist in some of the more remote SOF operational areas. SOF deployments usually involve longer medical evacuation times and limited medical resources during deployments.

The International Special Training Center (ISTC) in Germany provides centralized training for the North Atlantic Treaty Organization’s special operations forces. The training institution dates back to 1974 when a site was needed for centralized training for NATO Long Range Reconnaissance Patrol (LRRP) and Special Forces units. Although the school has seen several name changes and training locations the mission has remained essentially the same. The ISTC is co-located in the same barracks – Staufer Kaserne – as the German national Special Operations Centre (SOTC).

Courses offered at the ISTC include “Military Assistance Course”, “SOTG Operations Planning Course”, “Conduct After Capture Course”, various medical courses, combat marksmanship, CQB, and sniper courses.

Read more in “ISTC launches NATO Special Operations Combat Medical Course”, Army.mil, October 5, 2016.