As Special Operations Forces have shifted focus away from Afghanistan into austere, dispersed areas of the world, military medicine has been forced to adapt to emerging needs of SOF personnel.

Deployed in small teams throughout Africa, 3rd Special Forces Group (Airborne) teams and their Navy, Marine and Coalition partners are far removed from the idyllic “golden hour” of emergency medical care. They often lack the capability to transport a trauma patient to a definitive level of medical care shortly after a patient sustains a severe injury.

While casualty rates have been low compared to those seen in Operations Iraqi Freedom and Enduring Freedom, members of the SOF medical community in 3rd SFG (A) have sought to answer the challenges inherent in providing medical care to operators in austere environments by developing specialized training for their Soldiers.

One version of the training, known as Mountain Path, is an intensive medical course designed to give operators the tools necessary to provide Prolonged Field Care to their teammates.

Through classroom and hands-on exercises, Mountain Path incorporates best practices from Emergency Medical Technician and wilderness first responder skill sets. The training audience includes operators possessing only basic combat lifesaver skills on up to the medical experts assigned to Operational Detachment Alphas, 18D Special Forces medical sergeants.

More than 20 Soldiers assigned to 3rd SFG (A) — including two Naval Special Operations personnel — participated in the most recent iteration, Feb. 13 to 18, which included a 48 to 72-hour practical exercise near Kinston, North Carolina.

Maj. Powell, a surgeon with 3rd SFG (A), said the key to achieving prolonged field care success is for operators to apply their team approach to medical care.

“Anybody who’s seen a movie or a news clip about a patient in a trauma bay knows that there’s not one (doctor) in there, there’s not one nurse in there, you’ve got a team around there (with) everybody doing their part,” said Powell. “We don’t have that for a patient that’s critically injured in the desert, so who do you have?

“You have your teammates,” Powell continued. “And so when that person gets injured the medic obviously takes the lead but everybody else on the team needs to play a role. The weapons guy still needs to be a weapons guy, and your (communications) guy still needs to be a (communications) guy, but they can help with other aspects to help take the load off the 18D or the medic to help stabilize the patient.”

The idea to create Mountain Path stemmed from the value of the training Staff Sgt. Dail observed in Swedish Remedy, a prolonged field care exercise held in Sweden.

Dail, an 18D assigned to 3rd SFG (A), said he took lessons learned during the multiple Swedish Remedy exercises he’s participated in and brought them back to his unit. The initial goal of providing more intensive medical training to members of his unit has since evolved to include training non-medical operators.

“We can train those guys up to a certain standard so we know basically, across the board, anybody that we send downrange is at a standard level of training,” Dail said. “(We) decided we wanted to make this (required) pre-mission training for our guys.”

Powell and Dail said the successes they’ve seen during the Mountain Path iterations are due, in large part, to the expertise of the cadre they bring in to teach the courses. Instructors have come from a variety of disciplines, including wilderness first responder trainers, trauma surgeons, emergency room doctors, an anesthesia critical care doctor, physicians assistants, and the director of the Special Operations Combat Medic course.

Combining such expertise with the opportunity for students to apply their new knowledge in an unfamiliar environment has been a recipe for success, Powell said.

“One of the training aids that we use here is the unknown, because when something like this happens when you’re deployed, you’re going to be in an unknown environment (and) you’re probably going to have unknown resources,” Powell said. “It’s not just medical training, it’s critical thinking.”

Dail said he and Powell will use lessons learned from Mountain Path and incorporate them into future training iterations. They also intend to continue to open the training up to SOF from other branches of the military services, in hopes of sharing such lessons with a broader audience.

“I look forward to coming to work every day,” Dail said. “This is an honor to be able to work with the people that we work with and network with the people that help us put this together; every time we do this it’s basically a big brainstorming session.

“The difference (in the students) that we see from day one to day five is drastic, and I love seeing that myself,” Dail continued. “Hearing the guys say, ‘you know I really never put much emphasis on this before, but now that I’ve gotten into it this deep I want to learn more,’ … is reassuring that we’re on the right path with this.”

Powell echoed Dial’s observations.

“I think the best thing from my perspective is being given the opportunity to make a difference in the medical preparation of guys who are still suiting up every day to go off and engage in conflict on behalf of our country,” Powell said. “That mission has changed a lot from OIF and OEF to what we’re doing now, and what we project to be doing into the future.

“And the medical risk has changed as the missions have changed,” Powell continued. “Being in a position (of) having the support and understanding of the … commanders at the battalion and group level … (and them) giving us the freedom to execute training like this as we see fit is, I think, is the most rewarding part.”