ABSTRACT

Separate evidence-based, best practice guidelines and recommendations exist for the prehospital management of traumatic injuries sustained in combat settings and those encountered during high-threat civilian operational incidents. The Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) Tactical Medic Program is a mature operational medicine asset supporting high-threat federal law enforcement operations. The ATF conducted an audit of its agency-issued tactical medic bags with regards to completeness, as defined by authorized medical protocols, which are aligned with current Tactical Combat Casualty Care and Tactical Emergency Casualty Care guidelines.

Social Determinant of Unconventional Resilience: Tactical Engagement with Impression Management

Jeschke EA, Wyma-Bradley J, Baker JB, Dorsch J, Huffman SL. 24(2). 103 - 108. (Journal Article)

ABSTRACT

Building upon our operational model, we will discuss findings from our ethnographic study titled "The Impact of Catastrophic Injury Exposure on Resilience in Special Operations Surgical Teams" to establish that impression management allows Special Operation Forces (SOF) medics to navigate implicit social status symbols to either degrade or optimize performance. We will use qualitative quotes to explore how Special Operations Surgical Team (SOST) medics engage in impression management to establish individual, team, and/or organizational competency to deal with ambiguity. To achieve our goals, we will: 1) provide a background on impression management and perception of competency; 2) define the social determinant of impression management extrapolated from qualitative data as well as use qualitative data to thematize various types of impression management; and 3) relate tactical engagement with impression to our metaphor of bag sets. We conclude by gesturing to the importance of impression management in orienting SOF medics' proprioception and kinesthesia in the SOF performance space.



ABSTRACT

Background: Medical training and evaluation are important for mission readiness in the pararescue career field. Because evaluation methods are not standardized, evaluation methods must align with training objectives. We propose an alternative evaluation method and discuss relevant factors when designing military medical evaluation metrics. Methods: We compared two evaluation methods, the traditional checklist (TC) method used in the pararescue apprentice course and an alternative weighted checklist (AWC) method like that used at the U.S. Army static line jumpmaster course. The AWC allows up to two minor errors, while critical task errors result in autofailure. We recorded 168 medical scenarios during two Apprentice course classes and retroactively compared the two evaluation methods. Results: Despite the possibility of auto-failure with the AWC, there was no significant difference between the two evaluation methods, and both showed similar overall pass rates (TC=50% pass, AWC=48.8% pass, p=.41). The two evaluation methods yielded the same result for 147 out of 168 scenarios (87.5%). Conclusions: The AWC method strongly emphasizes critical tasks without significantly increasing failures. It may provide additional benefits by being more closely aligned with our training objectives while providing quantifiable data for a longitudinal review of student performance.

Keywords: evaluation metrics; military medicine; training techniques; trauma care; education; pararescue

The JSOM podcast digs deeper into the articles and subjects that matter to our readers. Our podcast hosts, Captains Alex Merkle and Josh Randles, tackle articles from the journal based on merit, interest, and application for operators in the field. The Spring 24 episode is here!

Current Episode

Our JSOM podcast team will be reviewing the following articles for our Spring podcast: 

Development and Implementation of a Standard Operating Procedure for Military Working Dog Blood Collection, Storage, and Transport by Elizabeth L. Evernham, Benjamin T. Fedeles, and Kayla M. Knuf (https://www.jsomonline.org/FeatureArticle/2024128Evernham.pdf)

Derivation of a Procedural Performance Checklist for Bifemoral Veno-Venous Extracorporeal Membrane Oxygenation Cannula Placement in Operational Environments by Elizabeth Powell, Richard Betzold, et al. (https://www.jsomonline.org/FeatureArticle/2024132Powell.pdf)

Emergency Fresh Whole Blood Transfusion Training for Ukrainian Health Professionals in Austere Environments by Zachery L. Brown, Joshua P. Cuestas, Kevin J. Matthews, Jonathan T. Shumaker, Durwood W. Moore, and Rebekah Cole (https://www.jsomonline.org/FeatureArticle/2024138Brown.pdf)

JSOM Guest Editor Captain Cam Strawn reviews Development and Implementation of a Standard Operating Procedure for Military Working Dog Blood Collection, Storage, and Transport. Capt Strawn serves as an Air Force Combat Rescue Officer and combat veteran who teaches leadership as an Assistant Professor of Aerospace Studies at Brigham Young University, where he is also completing a premedical post-baccalaureate program. He is a SOFtoSOM Scholar applying to medical school this year.

JSOM Guest Authors

Emergency Fresh Whole Blood Transfusion Training for Ukrainian Health Professionals in Austere Environments authors SFC Zachery Brown and HM1 Kevin John Matthews are

interviewed by our podcaster team about their article. SFC Zachery Brown enlisted in the Army on 15 September 2009. He has served with the 75th Ranger Regiment for the past 13 years: 7 years in the 1st Ranger Battalion and 6 years in the Regimental Reconnaissance Company (RRC). He served as a Ranger Squad Leader, Regimental Reconnaissance Team (RRT) Medical Sergeant, RRT Assistant Team Sergeant, and RRC Operations NCOIC and has nine combat deployments to Afghanistan, Iraq, and Syria, amounting to over 500 Special Operations Raids. In 2021, the Uniformed Services University of Health Services (USUHS) selected him for one of seven Army slots for the 24-month Cohort 9, Enlisted to Medical Degree Preparatory Program (EMDP2). This program prepares top-performing enlisted Servicemembers to apply to medical school. He is currently enrolled as a graduate student and aims to continue serving our nation and global community as a military physician and medical officer in the United States Army. SFC Brown earned a BS in Biology, Bio-Engineering Concentration, from the University of Arkansas in 2008, an MS in Strategic Leadership from the University of Charleston, and is currently working towards completing an MS in Biology at George Mason University.

Hospital Corpsman First Class, HM1 (FMF/ SW) Kevin John Matthews enlisted in the Navy in 2016. Operationally, HM1 Matthews served as the Senior Line Corpsman, Scout Sniper Platoon, Weapons Company, 1st Battalion, 4th Marines, deploying to Africa and the Middle East aboard the 15th Marine Expeditionary Unit (MEU) in 2021. Upon returning from deployment, the Navy Education and Training Office (NETO) selected HM1 Matthews as a Combat Trauma Management and Valkyrie Emergency Fresh Whole Blood Transfusion training instructor. He oversees the training of all medical personnel attached to Marine Corps expeditionary ground forces at 1st Marine Division, Camp Pendleton, CA. Hand-selected by the Division Surgeon, he was appointed the founding Course Manager for the inaugural Prolonged Casualty Care Course, preparing forward-deployed Corpsmen to sustain casualties beyond the “Golden Hour” in resource-limited environments and austere terrain. In 2021, USUHS selected HM1 Matthews for one of seven Navy slots for the EMDP2. He is currently enrolled as a graduate student and aims to continue to serve our nation and global community as a physician and Medical Officer in the United States Navy. HM1 Matthews earned a BA in History, Middle Eastern Concentration, from the University of California San Diego in 2014 and worked as an EMT-B and Ocean Lifeguard for the San Diego Fire Rescue Department from 2014 to 2016. Additional current and prior professional qualifications include PHTLS, ABLS, TCCC Instructor, Personal Watercraft Operator for High-Surf Rescues, and AHA BLS Instructor. 

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