This week, we further explored the medical evacuation logistics problem in our beneficiary interviews and found that, in general, this could help 18D’s save time and improve work focus during the right point in time as compared to the standardized clinic set-up. Having a more accessible database of information- ideally with pictures and filters for higher levels of care, such as availability of safe and vetted blood, or sterile surgical equipment, could mean the difference between a med evac 48 hours away versus 12 hours. This eases the burden of shrinking resources on the medic as well as the time the medic would spend sitting on a patient in prolonged field care. The major challenges to this kind of product, though, stem from the need for a database that can be offloaded due to cost and reliability of cell service, security in geo-based products, and implementation among groups so that this information on such a database (on higher levels of care) is constantly refreshed by medics and does not go stale.

 

Interview 1: CPT Amanda Canada

• Testing of new technology could be an essential part
• Better diagnosis, documentation will be beneficial for med eva and database or guide will help make decisions
• Extra work like availability of higher levels of care and prolonged field care slows medic down

Interview 2: SGT Bill Kelly

• It takes 2-5 minutes sometimes 30 or more to figure out med evac logistics
• Clinic set-up is not really a huge need

Interview 3: SGT John Carlson

• Role of medic: Triage, treat, stabilize, delegate, repeat, document
• Need high level of testing to ensure safety in the field

Interview 4/5: General Stanley McChrystal

• Curious about possibility of disconnect between higher ups (Central Command) and individual operations/missions.
• Risk understanding to force, mission, reputation…can be variable and has high effect in decision making.
• Captains tell Central Command that it was high risk and it’s hard to understand what happens when you don’t know the situation.

Interview 6: General Dempsey

• Get specific on what medical scenarios we want to be able to aid medics in treating on the field
• Even solving a niche problem (such as 1 aspect of the med evac logistics) would provide value
• Advised us to get more anecdotal context from our beneficiaries on what they need/want from this product

Interview 7: SFC Chase

 

• Need strong validation- what we see from info online often doesn’t align with reality, and SF’s own clinics often are better than what these hospitals can provide
• Main issues in solving problems that aren’t covered in training, which is why he sees the clinic set-up as a possibly valuable tool for new medics
• Not always about time saving: Increasing survivability in that you’re providing shared understanding of how it’s supposed to work and where they are

 

Interview 8: SOFACC Trainee Michael

• SOFACC Trainee binder is pretty well organized, in a training setting it’s very helpful to have even if it’s more brief and not fully in depth for what may be necessary
• An app solution could be helpful but needs to be really easy to navigate- and a lot of the binder info should be in our heads already anyway so an app would be looked to as the last resort

Interview 9: 18D Mike

How useful would a database be?

• Usually don’t have internet access in austere environments
• A lot of info about local facilities and resources already exists, it’s just about having to find and organize the evacuation based on all that information
  • 18D’s have someone else doing that logistics work as they perform patient care
  • Database/app could be more helpful stateside but wouldn’t be super operable abroad

Interview 10: Army Nurse Josette Noxon

• Medical Evacuation process, what it looks like:
  • Role 1, Role 2, Role 3, Germany, then US Hospital (either DC or San Antonio – where the burn center is)
  • Existing system: A “JSTAR” system currently exists for home theater medical evacuations where patients are tracked and evacuated based on acuity of injury
    • “Med evac” means critically ill patients
    • “Air evac” means less urgent or serious injuries
• The core of the issue is that Role 1/Role 2 facilities can be 8-10 hours away distance wise

Interview 11: Company Physician Assistant – 44th Medical Brigade – US Army Garrison CPT Bob

• Medics need to decide what method of transportation to use (helicopter, ambulance, etc.)
• Be aware of data security concerns

In our third week, the team travelled to Fort Bragg on Wednesday, January 23rd. There we saw all of the equipment that medics have to take inventory for but really don’t use. In general, the equipment medics do take on missions is left up to them and what they believe the team needs. In addition, we went through a quick 30 minute training session in how medics treat a patient after a casualty occurs using the MARCH acronym. M stands for mass hemorrhaging; A for airway; R for respiratory; C for circulation; and H for hypothermia and head injury. After this crash course, we were quickly put into basic gear (a helmet and chest pad) and told that we were going through a training scenario. We were able to use the knowledge from the quick class and turn it around into a real life scenario. The 18D and 18A must work together to coordinate evacuation scenarios and treatment while also securing the perimeter. It made our team realize how stressful these situations can be for medics and how much they are responsible for. In light of this, we want to take the load off the medics in a way that eases the burden of all they have to do. Our new MVP for next week will focus on relieving some of the stress and burden of multitasking, and possibly looking to pivot towards improving availability of information for medical evacuation decision making.

 

Interview 1: CPT Holly

• She talked about the importance of team cohesiveness and  how she interacts with medics, particularly during cross training
• She mentioned that there is no baseline for equipment and the importance of including medical assets when going on a mission

 

Interview 2: 18D Chris

• He responded to our checklist app and clinic model idea and said it would be hard to make it personalized because every mission and location is so different but would be beneficial
• He talked about how difficult it is to figure out logistics and arrangements of med evacs including describing a PACE plan

 

Interview 3: CSM Dave

• He talked about the limitations of equipment, space competition, austere environments and how situational dependent each deployment is
• He added suggestions to a potential app, wanted a foolproof way to catalogue care and treatment, and spoke about how important a database could be of medical facilities

 

Interview 4: CPT Joe

• From the captain’s perspective, operational readiness rests on having a clinic setup and wouldn’t be able to start a mission without doing that (leads into overall DoD mission)
• Whatever is developed could be helpful if it could cross language barriers because of working with partner forces

 

Interview 5: 18D Chandler

• What he actually takes on a mission is up to him and he’s used his own Government Purchasing Card to get equipment he believes is useful (not something SF thinks/knows is necessary)
• Point of injury care is something medics are well practiced in which is what training focuses on and often gets used in incidence number

 

Interview 6: Kevin – SOFACC

• He says that reliance on technology can’t happen because SF is trying to have greater levels of strategic success so once SF leaves, they won’t give technologies away
• Really want to focus on lasting solutions and finding a next level of care which may not necessarily be a doctor
• Medical knowledge doesn’t have to be secure and gave us information on where to find unclassified information

 

Interview 7: Eric – SOFACC

• Make their students develop their own solutions so they can teach them how to innovate in environments they’re unfamiliar in
• They believe that the best information and resources for 18Ds are other 18Ds

 

Interview 8: Medical Director of SOFACC David

• PFC is mimicked in SOFACC training by having trainees take patients across North Carolina for a few days and having them think on the fly
• Talked about the importance of developing local relationships on missions

 

Interview 9: Winnie, SOFACC Trainer

• Goal of SOFACC training is to get as much basic knowledge taught as possible to perform care for 5-10 hours
• Getting that EMT certification allows SOFACCs to jump a lot of hurdles in acquiring medication/aid from bureaucratic agencies/local pharmacies

 

Interview 10: Sergeant Jim (SOFACC Trainee)

• Certain materials in SOFACC training won’t be present on the field usually like the backboard litter (meant for spinal injuries)
  • The resources come with evacuation chopper/plane – not helpful in the moment for men on the ground
• Certain SOFACC training modules are more realistic than others in representing battle field operations, important to imitate the pressure/lack of resources in the real environment

 

For the second week, our team interviewed another 10 people serving or served in 18Ds or 18As. From these interviews, we redefined our beneficiaries as 18D (clarified medics’ problems on overwhelming work and low motivation) and 18A (discovered new challenge on information sharing and procedure establishing). Furthermore, we got more insight on the requirement of deliverables including knowledge sharing, easy to use and modifiable by non-technicians.

Sergeant First Class Chandler

• The over comprehensive medical equipment set lead to redundancy of checking tasks
• Med logistics isn’t sufficient to deal with actual need

• Swick could be a path when medics retire or get injured instead of a regular program

Joe

• A checklist of baseline clinic for 18D SF Medic will be very useful
• Missions spending 4-7 days in an area, setting up clinics once a week.
• The challenge for 18D is finding an area where casualties get treated quickly

Sam

• Standard procedures would ease ways of doing things
• Struggle with the evac process and being sure of patient status/communication
• Need of mutual communication about patient status/outcomes between Medics and commanders

Alan S. Colvin

• Need for info. management of medical resources in X country, i.e. a data bank for diff. countries

• Can’t rely on internet because of poor connection in certain operational environments

Justin

• The one medic is in charge so non-medics need more medical knowledge (SOFACC)
• Existing checklist include very narrow things like putting on a drip

John R

• More real Africa-specific training other than some stuff on infectious diseases
• Budget (better to be small and portable) is a limitation of adapting new training

• 24 hour hotline (expert physician who can aid in the field) need to be available online

Colin

• Set the course in the Army geared towards load planning for planes
• Need DoD to be involved/approve
• Video telemedicine is helpful in diagnosis and procedures, especially talking to doctor

Paul Loos

• An app/database could contribute better to the medical evacuation process
• Need standardized logistics training in Ergonomics of a clinic

Kyle

• A digital checklist could be not ideal for those who are used to paper version and most apps serve as the reference of diagnosis and  procedure
• It’s important to stay up to date on new medical advances, and filter out relevance

Thomas Williams, Professor at Duke Law School & Initiative for Science and Society

• Positioning SF by GIS, finding a spot or several to set up a clinic nearby based on those surroundings, then layering the clinic design into that space.

This week, we spent much of our time in interviews getting a baseline understanding of the roles of medics in the military (both “regular” medics as well as SF medics), and the challenges they face. What we tended to hear from many of the people we spoke to focused on training and on defining the role of a medic. With training, it is challenging to define what is necessary across Special Forces because situations vary across deployments; however there exists a need to balance breadth and depth so that medics can be effective in providing baseline lifesaving treatment. There is currently a gap between realistic approximation of an austere environment and the challenges medics face when deployed- especially with changes in the operating environment and greater need for prolonged field care as missions take teams farther away from access to higher levels of care. These challenges in the field increase with reduced medic retention, leading to, increasingly, only having 1 medic per team to handle all medical responsibilities (because Special Forces do not deploy as medical units). Current understanding of the situation has been limited because of less focus on medics’ perspectives (so there continues to be an emphasis on tactical training and actions- even in determining necessary equipment).

 

1. Estban Barkneft: Army Nurse for 22 years

• Work of SF Medics is to move care up the chain of command as quickly as possible, “make our problem someone else’s problem”
• Explained that resources are organized by the “Ruck, Truck, and House” method and that requires a lot of adaptability on the part of medics
• Getting supplies locally on-the-go and the required re-certifications year-to-year hinder efficiency and effective care provision (bureaucratic hurdles are immense)
• Email – Efbarf13@gmail.com
• Phone Number – 910-574-4118

 

2. Captain Joey Gamba is a critical care nurse with 8.5 years of experience including 1 deployment with hospital capabilities.

• Often those in medical roles within the military have to serve in multiple roles so that their ability to perform their best medical care may be compromised, especially when their training must be kept relevant and up-to-date and when hey must do their best to document actions before moving to higher levels of care.
• Email – josettegamba@gmail.com
• Phone Number – 352-397-9998

 

3. Sergeant Joe Castle has been deployed in austere environments on 5-6 man teams and served as a medic in areas without much medical equipment (such as X-rays, monitoring equipment) where PFC was a necessity.

• Training is not always realistic in depicting the challenges medics in austere environments face, especially when tactical training is emphasized over medical training; he also discussed the constant need for on0the-job innovation when supplies are either unavailable or available but not made to “fit together”.

 

4. Darrell Owens has served for 17 years, and joined following 9/11 and went to Iraq as a part of the initial invasion; he deployed as a medic and served for 10 years in that role after which he became a PA. He sees the limitations of being a medic after he became a PA and became responsible for managing teams of medics, especially when real world experience is such a determinant of success as a medic (which becomes more challenging considering issues with medic retention and those who might follow Darrell’s path to become a PA).

Email – darell.owens@socom.mil

Phone Number – 910-978-3426

 

5. Dan Taylor is a civilian EMT who has taught with SFC Eric Palomar on the SOFAC (Special operational Forces Austere Care) course that trains Green berets who are not 18D’s. The course begins with basic EMT certification to cover elementary training and progresses through pharmacology in PFC and training exercises designed to mimic real operating environments. However, in giving training there are so many limitations that cannot begin to approximate the real environments, especially because of the diversity of students in the course which creates challenges in breadth versus depth.

Email – dan@frozenmedical.com

Phone Number – 315-484-8087

 

6. Paul Tate is a former army medic with 2 deployments, one of which was with SF in Africa; he is now a physician with residency in family medicine. In his perspective, much of the challenges SF medics face can be traced to the changes in missions, especially those in Africa that limit the availability of transport to higher levels of care for patients and strain the resources medics have available to them- even with advances in telemedicine. On the receiving end of such advisory calls, he has to make decisions on patients sometimes based on just texts and no access to vitals information that could really help him and the medic in the field make a stronger patient decision.

Email – paul.tate.@socom.mil

Phone Number – 931-237-5789

 

7. Eric is a sergeant First Class and 18D in the Office of Special Welfare with 15 years of experience in the military, and numerous deployments primarily in Afghanistan. He now teaches the Special Forces Austere Care Course. In the care course, he emphasizes clinical care because that can often be more of an issue than injury treatment; those who are in non-medical roles in active duty groups also go through this training. He also emphasized the changes in the operational environment that have led to challenges in PFC, including determination of necessary equipment and training simply because medicine is never a problem or priority until it is needed.

 

8. Chase joined the Special Forces following 9/11 (when he was in college) and trained to be a special operations medic; he has 15 years of experience with 12 deployments in the SF of which 11 he served in the role as a medic. Chase explained many of the challenges medics face, from understanding of the role from leadership and the rest of an SF team, to medic retention, to changes in operations that have led to the necessity of prolonged field care- and the lack of alignment on what this means that shows gaps in current SF medic training.
9. Jason Myers is a Chief Warrant Officer and works as a Doctrine Developer and Analyst, particularly within Special Forces Doctrine. He is a former medic and has been going over potential SOP and medical treatment overseas. He spoke about the need to address the proper authorities, such as the DOD, and funding in regard to training and supporting indigenous medical elements and find out what could enable this training. He also spoke on immunization programs and the trouble with cold chain management. In the case of technology, he believes that there are some instances that would be beneficial to have technology and some where it would be more important to focus on the training side. He spoke to his medic experience when talking about his experience and how non-medics can be helpful when there are multiple patients such as in the case of a mass casualty.

Email – myersja@socom.mil

Phone Number – 910-432-5759

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