Special Operations combat medicine is an extremely important capability and has been the difference between life and death for operators. In Naval Special Warfare, hand-picked SEALs and SWCCs are chosen to attend the Special Operations Combat Medic Course or the Special Operations Tactical Paramedic Course.

Prospective Special Operations Combat Medics go through extensive and challenging training with a relatively high attrition rate. They get a crash course in everything from anatomy and physiology, delivering babies, screening for cancer, and of course combat trauma. The sequence for treating battlefield casualties is drilled into their heads until it becomes second nature.

Of course, fine-tuned skills such as these have an expiration date and can become perishable if not continuously practiced.

Therefore, Special Operations medics are required to attend a two-week-long refresher course every two years. This allows medics to stay current on all of their qualifications, knock off the dust, and learn about the newest treatments and techniques that Special Operations medicine has to offer.

With that being said, two years is a long time. Within a two year period, on average, NSW medics will have gone on one deployment. Many deployments for SEAL Teams and Special Boat Teams are non-combat, meaning there’s little chance for medics to be exposed to trauma incidents. Even on combat deployments, the goal is always to prevent casualties. The point is, it’s not unusual for medics to have little to no exposure to high-intensity combat trauma training until they attend the refresher course.

What’s the Solution?

The solution to this problem? In comes Naval Special Warfare Group 1’s Tactical Medical Cell (NSWG-1 TMC), in Coronado, CA. This new cell has created an advanced course in Tactical Combat Casualty Care (TCCC) and Prolonged Field Care (PFC), specially tailored for Special Operations medics and Independent Duty Corpsman (IDCs). Under NSWG-1 are SEAL Teams 1, 3, 5, 7, NSW Unit 1 (Guam), and NSW Unit 3 (Bahrain).

The new TCCC and PFC course is one week-long. It is hosted at Naval Medical Center San Diego BioSkills and Simulation Training Center.

IDCs are highly trained Corpsmen that have undergone extensive clinical and combat trauma training. They are assigned to SEAL Teams and Special Boat Teams to work full time in the medical department, treating operators and support staff. IDCs will sometimes deploy with Platoons and Boat Detachments as well and can be operational depending on the situation.

In an article published by DVIDS, Commader Levi Kitchen, the Training Director of the Tactical Medical Cell, pointed out that, “IDCs and SEAL medics have completely separate training pipelines, rarely do they interact in a training environment which can lead to confusion with roles, responsibilities and capabilities in the operational environment. By focusing this course on a SEAL team’s medics and IDCs, they are able to train together and become a fully integrated medical treatment team.”

Kitchen went on to say, “To my knowledge, there is no training like this within NSW that is organically sourced amongst Department of Defense (DoD) components. There are courses similar to this, but they are generally contracted out with a heavy price tag. Though labor-intensive for the NSWG-1 TMC, we provide advanced training for a fraction of the cost.”

TCCC was instituted in 1996, by Dr. Frank Butler, who was a former Navy SEAL officer. Dr. Butler’s goal was to prevent unnecessary combat trauma deaths. It became standardized in the Special Operations community in 1997. TCCC is still a mainstay in combat medicine; it is now implemented throughout the entire U.S. military. Although it has developed and changed over time, its essence and importance is still very real today.

PFC is the next step after TCCC in the patient treatment process. What makes Special Operations Combat Medics unique is their ability and requirement to be able to treat trauma patients for extended periods of time. There is a major difference between treating a trauma patient that receives a MEDEVAC almost immediately versus a patient that medics have to sit on for days on end while waiting for evacuation. This scenario is not uncommon, based on some of the austere environments in which Special Operations members are expected to operate.

What’s Included in the NSW Medic Course?

Leading Chief Petty Officer of the TMC, Dave Dillehay, explained that NSW medics are not just medics, they may also be assigned the roles of breacher, sniper, or comms guy. In fact, it’s extremely unusual for any NSW operator to only have the role of medic. Often, the medic role comes second after their primary responsibility.

Dillehay went on to say in reference to the course, “This week is protected time specifically focused on combat trauma without the distractions of other roles and responsibilities. The training via NSWG-1 puts the combat medics and IDCs in direct contact with a subject matter expert in combat trauma medicine by utilizing the extensive resources of NMCSD.”

The first three days of the course are filled with presentations presented by trauma subject matter experts. Such experts include trauma surgeons, orthopedic surgeons, emergency medicine doctors, and anesthesia experts, to name a few. In addition, medics spend time working on their TCCC and PFC skills by training with simulators and cadavers.

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The fourth day is the capstone, conducted at Strategic Operations in San Diego. TMC Tactical Medical Lead, Special Operator 1st Class Noel Sons, explained that “The capstone event provides simulated environments in order to fully immerse the students and allow them to use the skills and training received throughout the course. Environments range from naval vessels and a crashed helicopter to a medical trauma center. Realism is added with explosions, sounds of gun fire, and role-players that utilize prosthetics and fake blood to simulate realistic combat injuries.”

The final day of the week-long training block addresses controlled substance inventories, authorized medical allowance refresher, and ultrasound.

This is Merely the Beginning for Corpsmen

Cmdr. Kitchen fully believes in the program and explains that this is only the beginning. In the future, the program will be more comprehensive and will include training blocks in Special Operations dive medicine, blood transfusion, and combat casualty training embedded during different pre-deployment training exercises.

Kitchen said, “At a time when training is being cancelled or becoming untenable due to restriction of movement requirements, we are able to produce an extremely high quality, locally sourced product thereby reducing the risk of COVID-19 and the associated ROM requirements for course attendees.”

Historically, in NSW, medical training had been lacking at the team level. Boat Detachments and Platoons have been so busy participating in other training blocks in preparation for deployment that medical training sometimes went to the wayside. It would only become a priority when a real-world medical event arose, requiring a medic to take action.

This certainly wasn’t always the case: sometimes private Tactical Combat Casualty Care (TCCC) companies were contracted to provide training to SEALs and SWCCs, but that came with a steep price tag. The other source of medical training was for medics at the team level to conduct their own training with the members of their unit. While all training is good training, individual medics don’t have the same resources as well-equipped medical training programs.

Therefore, the news of this new course is exciting. And having been an NSW medic I can tell you that it is also well-deserved. Almost any Special Operations medic you meet has a deep passion and interest in combat medicine. They always want to learn more and keep their skills sharp. A common shortcoming of the NSW community has been the lack of specialized and in-depth medical training. No doubt this program will make for much better NSW medics, and will hopefully set the precedence to allow for even more combat trauma training in the future.