The special operations aviation flight medic


running up that hill
Jan 3, 2007
in Wonderland, with my Alice
Medical support in the Army Special Operations Forces is a comprehensive continuum of care that begins at the point of injury and extends through definitive management. Each special operations unit has unique medical needs and, as a result, has developed specially trained medical personnel to fulfill those needs. The 160th Special Operations Aviation Regiment has developed the special operations aviation flight medic to fill this role. The training of these medics involves a systematic, graduated approach with specific milestones to ensure a standardized level of training.

The 160th Special Operations Aviation Regiment (Airborne) [SOAR (A)] is a special operations aviation (SOA) asset that clandestinely penetrates hostile and denied airspace to conduct and support special operations. The unit operates with great precision for extended ranges under adverse weather conditions and during periods of limited visibility. Missions include insertion, resupply, and extraction of U.S. Special Operations Forces (SOF), conducting electronic and visual reconnaissance in support of special operations, performing casualty evacuation, providing close air support as well as a direct action rotary-wing option, and supporting and facilitating command and control of special operations.1 The 160th SOAR (A) primarily conducts operations during the hours of darkness; thus, members of the 160th SOAR (A) are known as the Night Stalkers.

For years, the standard for the SOF medic was the Special Forces 18D. The training of the 18D has evolved over the years and currently consists of a comprehensive training program held at the Joint Special Operations Combat Medic Course, Fort Bragg, North Carolina.2 The training of the 18D is designed to provide a medical specialist who can provide complete medical services to both his detachment and indigenous forces.3 The emphasis of training is on medical care in the austere environment, without ancillary, physician, logistical, or medical evacuation support.

The SOA flight medic arose from the special need for medical skills required by the 160th SOAR (A) and to fill a particular niche in the SOF community. The SOA flight medic is a medical specialist with a unique combination of medical and professional soldiering skills who is extremely well suited for the SOA environment. Examples of other military prehospital care specialists include the Navy independent duty corpsman, the Air Force pararescue medic, and the Ranger medic.

These 91B medics were initially recruited to work in the aviation clinic to support the provision of medical care during sick call and other basic medical tasks. With the expanding role of the 160th SOAR (A), these medics were called on to perform at increasing levels of medical proficiency. This increased level of responsibility mandated a concomitant increase in the level of training required for each medic. This training was somewhat haphazard because there was no set training progression model. This was because the exact role of the SOA flight medic was poorly defined and there was no clear "end product" in mind.

The level of medical proficiency of the average 9 IB graduating from advanced individual training at Fort Sam Houston, Texas, does not meet the level of medical skill needed in the SOF community. It was apparent to the flight surgeons and commanders within the 160th SOAR (A) that specific training standards needed to be set. These medics needed to be able to cover a large spectrum of medical responsibilities that included the following:

1. A thorough understanding of trauma management based on the spectrum of environments in which they would be operating. This included the increasing role that the SOA flight medic played in the evacuation of wounded personnel in the support of SOF.1,4

2. A detailed knowledge of the airframes and mission profiles on which they would be performing their duties as flight medics. The back of a completely darkened or "blacked out" helicopter is an environment like no other in medicine and requires a significant amount of exposure for one to become familiar with it.

3. A detailed knowledge of clinical aviation medicine that encompassed diagnostic and patient management skills commensurate with the busy clinic schedule. This includes the gathering of pertinent medical history information, succinct and thorough presentation skills, use of medications within their scope of practice, record maintenance, and the performance of minor procedures. Because immunizations are routinely given at the aid station, the SOA flight medic needed to have a thorough understanding of Advanced Cardiac Life Support protocols as well as the treatment of anaphylaxis.

Duties of the SOA Flight Medic
Medics in today's Army, both in the SOF community and in conventional forces, play a key role in the delivery of health care to our forces (Fig. 1).5 Operational military medicine is a composite of various clinical services that encompass the entire spectrum of medical care. It is a blend of various services, including primary and emergency care, minor surgery, Advanced Trauma Life Support, office orthopedics/sports medicine, and preventive medicine. The SOF medic should have at least a rudimentary understanding of these disciplines and, in many cases, should be well versed in their application.

The SOA flight medic trains for the "dual mission" that typifies military medicine. That is, garrison-based clinic practice as well as combat trauma resuscitation and stabilization skills.

In the clinic, the medic is fully involved in every aspect of care for the aviators and soldiers of the 160th SOAR (A). He is responsible for taking a thorough history and performing a detailed physical examination. After this, he hones his presentation skills through interaction with the flight surgeons. The SOA flight medic is also required to develop a differential diagnosis based on the presenting symptoms and, if possible, devise a treatment regimen. These skills take a significant amount of time and patient contact to perfect, but the volume of patients seen in the clinic affords the medics this opportunity.

Medics in the 160th SOAR (A) are continually mentored by the flight surgeons, and each case is used as a learning opportunity. The medics are encouraged to think for themselves so that they will gain a thorough understanding of the medicine they are practicing. If a particularly interesting case is presented, it is generally used as an opportunity for all of the other medics present to become involved, thereby sharing the lessons learned with the entire section.

In addition to clinical practice, the SOA flight medic is responsible for the medical administrative function of the unit. Every patient that he has seen is documented, charted, and recorded in the clinic's computer database. Flight physical examinations are conducted 3 days each week, and the SOA medics prepare the aviators and crew members before they are seen by the flight surgeons by screening each record and conducting the necessary tests for each examination (electrocardiography, urine screening, etc.). Immunizations are also given by the medics using a strict protocol developed for the 160th SOAR (A). Each immunization given is recorded in all records and in the clinic's computer database for deployability tracking.

The duties of the SOA flight medic continue while the unit is deployed. The 160th SOAR (A) is often deployed to medically austere locations, and it is imperative that the SOA flight medic be capable of a certain degree of independent thinking based on accepted protocols in which he has been trained. Through the use of these various protocols and algorithms developed by the unit's battalion and regimental flight surgeons, the SOA flight medics are able to provide medical support to aviators, aircrew members, and soldiers in these environments. These protocols ensure that the flight medic is trained to provide a high level of medical care to deployed Night Stalkers even when he cannot communicate with a unit flight surgeon.

SOA Flight Medic Development
Balancing the requirements of the apparent dichotomy between the peacetime, largely clinic-based medical system and the predominantly trauma-related training required for the combat medic is a constant battle we all face in military medicine. The initial challenge for the medical section of the 160th SOAR (A) was to develop a training program that would adequately prepare medics to fulfill these missions in an appropriately apportioned timeline. Additionally, it was imperative that we continued to maintain the medical support necessary for a unit with a robust operational tempo. This meant that the "end product" medic had to be conceived and realistic points of progression had to be set until such a goal was attained. Over time and through numerous iterations, a training standard operating procedure was developed that was based on a graduated level of medical proficiency.

The next challenge was to create a training standard where one had not existed and in a program that would be understood by the aviation command. In aviation, there are standard levels of progression that are denoted by the titles "basic mission qualified," "fully mission qualified," and "flight lead." These same titles were selected in the generation of a standard for the SOA flight medic, albeit they are applied differently. These levels include the basic mission trainee (BMT), basic mission qualified (BMg) medic, the fully mission qualified (FMQ) medic, and the medical lead qualified (MLQ) medic. This made the concept of adopting a standardized progression for the medics of the 160th SOAR (A) agreeable to the command and created a "common ground" by which the command could easily understand the capabilities of each medic based on the level he had attained. With the support of the command, a continuous training program was adopted as a recognized standard operating procedure for the regiment, which ensured its longevity after the departure of the medical officers involved in its implementation. As the medic graduates from one level to the next, he is expected to be able to perform at an increasing level of independent medical proficiency, culminating in the ability to plan, coordinate, and execute aviation medical support for a joint special operations mission.

Progression from one level to the next is controlled through a medical proficiency evaluation program conducted by a 160th SOAR (A) flight surgeons This in-depth evaluation is designed to assess the SOA flight medic's medical knowledge and ability to take on an increased level of responsibility. The SOA flight medic is given a minimum of 30 days advance notice before the evaluation to allow the individual adequate preparation. The SOA flight medic who remains at the same skill level for more than 12 months undergoes an annual proficiency evaluation commensurate with his level of training. This is not considered an evaluation for advancement to the next level.

In addition to implementing this new program, the final challenge was to document the training that each medic received. The medics are required to spend a significant amount of time each week in training, and it is appropriate that they receive credit for it. Therefore, a comprehensive medical training section was developed in which files for each SOA flight medic were generated and maintained. The training conducted within the medical section is approved by the Training Office of the Blanchfield Army Medical Hospital, and the SOA flight medic receives continuing education units commensurate with the amount of time dedicated to medical training. These training files also allowed the platoon sergeant, the commander, and the flight surgeons to track the training and progression of each medic from BMT to FMQ.

The Basic Medical Trainee
The BMT is usually a fresh graduate of the Army 91B Advanced Individual Training Course at Fort Sam Houston, Texas, and newly assigned to the 160th SOAR (A). His first exposure to the 160th SOAR is his attendance at the internal selection and training month at Fort Campbell, also known as Green Platoon. Upon graduation, he is assigned to the medical section of the 160th and begins his tour of duty in the regimental aid station. In this period, he conducts sick-call on a daily basis, and his ability to grasp increasing amounts of medical knowledge is periodically assessed. This is akin to the "on-the-job" training atmosphere experienced by third- and fourth-year medical students. He is also required to attend weekly training and is periodically given no-notice trauma scenario evaluations to assess his medical abilities. The amount of time spent in this capacity varies depending on the individual's capability and learning potential. The average time spent as a BMT is routinely 12 months. If a soldier is unable to progress after 12 months, it is an indication that the medic may not be suited for the 160th, and he is subsequently reassigned to a conventional unit. The BMT is required to maintain medical proficiency as an emergency medical technician-basic, maintain currency in Basic Life Support, and be capable of providing medical support for local aerial gunnery ranges, small arms ranges, and controlled water operations (i.e., pool training).

The Basic Mission Qualified
To attain the level of BMg, the SOA flight medic is required to successfully complete U.S. Army School of Aviation Medicine course 300-F6 (Flight Medic Aidman) and attend the Chemical Casualty Care Course or similar military chemical/radiological casualty care training. Additionally, he undergoes specific aircraft survival training that is required for all aviators, aircrew members, and non-crew members who perform aviation-related functions in the regiment. This includes specialized over-water "dunker" training, which teaches the crew member to egress an aircraft in a water-based crash sequence, and the use of the helicopter emergency egress device. Because all nonmedical personnel in the regiment are required to undergo Combat Life Support training, the BMQ SOA flight medic is a combat lifesaver instructor and teaches this course. The BMQ SOA flight medic is familiar with all of the airframes within the 160th SOAR (A). These include the MH-6/AH-6, the MH-60K/MH-60L, and the MH-47E. However, each medic is assigned a primary aircraft in which he will specialize. He is responsible for understanding every assigned task within that airframe's technical manual and undergoes the training requirements for a readiness level 1 progression based on the aircrew training program designed specifically for the medics of the 160th SOAR (A). Each SOA flight medic is also assigned a secondary aircraft in which his scope of readiness level progression is not as detailed but in which he is required to have a functional knowledge. The BMQ SOA flight medic is capable of providing supervised deployment medicine and is manifested on the unit alert roster for worldwide deployment.

The Fully Mission Qualified
No later than 18 months after progression to BMg, the SOA flight medic is required to advance to the level of FMQ. The FMQ is the end product medic for which this progression was developed. He is well versed in all aspects of medical operations within the 160th SOAR (A) and aviation medicine support to joint special operations missions.

The FMQ SOA flight medic is a graduate of the Joint Special Operations Combat Medic Course conducted at the Joint Special Operations Training Center, Fort Bragg, North Carolina. This 6-month course was initially created for the 18D but has expanded to include members of other select special operations units for the trauma portion of the training. After graduation from the Joint Special Operations Combat Medic Course, the flight medic is a nationally registered emergency medical technician-paramedic. While required to maintain skills as an emergency medical technician-paramedic, he is also required to maintain the standards of training for SOF medics in the Special Operations Forces Medical Skills Sustainment Program.' This is a biannual recertification course that provides ongoing medical education for all medics in the U.S. Army Special Operations Command. Additionally, the FMQ SOA flight medic will have successfully completed the U.S. Army John F. Kennedy School of Special Warfare Survival, Evasion, Resistance, and Escape Course, Level C, and be qualified as a U.S. Army basic parachutist.

The FMQ SOA flight medic will be fully qualified with unit forward area rearm and refuel point operations. These operations are potentially the most dangerous environment in which a SOA flight medic operates. This airborne mission inserts the medic into a location far forward of the main force that is in a hostile and austere environment. The medic is the only person on the team capable of performing medical care while aircraft are being resupplied with ammunition and fuel. This level of unsupervised medicine under austere circumstances requires that the medic be capable of safely managing any number of possible disaster scenarios. Because of this, the flight medic completes one of any number of courses in which hands-on management of acute trauma is emphasized. This includes the Operational and Emergency Skills Course at the Uniformed Services University of the Health Sciences and the U.S. Navy Battlefield Trauma Care Course.

The FMQ SOA flight medic is expected to have a thorough understanding of 160th SOAR (A) operations in a variety of different environments, including urban, maritime, desert, and mountain during both day and night conditions and in all types of weather. The FMQ SOA flight medic is capable of providing independent deployment medicine with limited supervision. There is no requirement for further medical proficiency progression to MLQ.

The Medical Lead Qualified
The MLQ is the highest level that the SOA flight medic can attain within the 160th SOAR (A). The MLQ is a senior medical noncommissioned officer who, in addition to a demonstrated capability with respect to all FMQ-level tasks, has completed additional training designed to prepare him to plan aviation medical missions in support of the Joint Special Operations Task Force. He is required to have completed courses such as the Armed Forces Medical Intelligence Center Medical Intelligence Course and an appropriate medical planning course, such as the Joint Medical Planning Course. The planning expected from the MLQ involves the spectrum of SOA operations. This includes (1) internal mission flights, (2) medical coordination for over-water and ship-board flights; and (3) joint-level SOA deployments.

In addition to these requirements, the MLQ SOA flight medic is the standardization instructor for the medical section. There is no requirement for medics to attain this level of training and, accordingly, there is no set timeline required for progression.

The expanded role of the medical mission within the 160th SOAR (A) involves a spectrum of tasks that includes both tactical and nontactical aspects of military medicine. With this wide array of possible medical environments in which the SOA flight medic is expected to perform, it is imperative that a high level of proficiency be maintained at all times. Traditionally in SOF, this level of medical support was expected only from the Special Forces 18D. With the standardization of medical training within the 160th SOAR (A) and a concomitant emphasis on the training of Ranger medics within the 75th Ranger Regiment, there is a new breed of SOF medic within the community. These medics are 9lBs who are specifically suited and trained for the SOF environment. The SOA flight medic is specially trained to fill this unique mission of aviation medicine support in SOF. The training is difficult, but each SOA flight medic goes through this rigorous regimen with a constant adherence to the motto of the 160th SOAR (A): "Night Stalkers don't quit."