Former Australian SAS Operator and Physician Discusses Reality-Based Training for Special Operations Combat Medics

A while back, Australian SAS operator and medical doctor Dan Pronk shared his insights and experiences on SOFREP regarding the importance of reality-based training in developing skills and optimizing performance. What follows are his insights: 

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In any profession, the ability to perform tasks and respond effectively to challenging situations is directly linked to the quality of training one receives. Whether in the medical field, law enforcement, or the military, the concept of “train as you’re going to fight” has long been touted as a fundamental principle for preparing individuals to excel under pressure. This approach takes on even greater significance for special operations combat medics, as the ability to save lives in high-stress combat-trauma environments is absolutely critical. The method employed to achieve the highest level of skill acquisition in such scenarios is known as reality-based training (RBT), and it has proven to be an invaluable tool in optimizing performance.

The Power of Repetitive and Realistic Training

The notion that repetitive and realistic training is essential for optimal skill performance is not a new revelation. As far back as the mid-600s B.C.E., the Greek lyrical poet Archilochos emphasized the significance of training in determining one’s level of competence. The oft-repeated proverb, “We don’t rise to the level of our expectations, we fall to the level of our training,” also underscores the importance of rigorous and practical preparation.

In the realm of tactical medical training, particularly among military units, the effectiveness of RBT has been vividly demonstrated. When special operations combat medics find themselves facing real-life trauma situations, the skills they have acquired through RBT come to them instinctively, allowing them to act decisively and effectively, often without having to exert much conscious thought. However, this level of proficiency is not achieved by chance; it is the product of a deliberate and structured training process that ingrains the necessary skills.

Understanding the Phases of Skill Acquisition

To comprehend the efficacy of RBT, one must understand the four levels of integration during skill acquisition, as described by Grinder (Murray, 2006). These levels are:

1. Unconscious incompetence: The individual lacks awareness of what they don’t know.
2. Conscious incompetence: The person realizes their lack of skill and cannot perform the task.
3. Conscious competence: The individual can perform the task but requires focused effort and concentration.
4. Unconscious competence: The person can execute the skill automatically and without conscious thought.

For special operations medics, reaching the level of unconscious competence is paramount for reliable performance in high-stress combat-trauma situations. The ability to perform life-saving medical procedures, such as arterial tourniquet application, instinctively and without conscious effort allows the medic’s higher-order cognitive functions to remain focused on other critical aspects of the tactical environment.

Structured Escalation of Training

Achieving unconscious competence in a combat medic’s skillset requires a well-structured escalation of training. Starting at a level of unconscious incompetence, where the medic is relatively unaware of the full scope of their role, they must progress through conscious incompetence, where they become aware of their inadequacies and are motivated to learn and improve.

The next step involves filling the knowledge gaps through a progressive introduction to skills, initially with theoretical lessons and individual practical skills practice. The medic must master the basic individual skills before transitioning to RBT scenarios, as overwhelming the medic with high-fidelity scenarios too soon can erode confidence rather than build it.

Relevance and Realism in Training

A crucial aspect of effective training is to ensure that scenarios are relevant to the student and mirror real-life situations as closely as possible. Whether medics are operating in a hospital resuscitation bay or a complex tactical environment, the training must be tailored to their actual work setting, using the equipment they use on a daily basis. Tourniquets and medical equipment should be consistently positioned on their kit to develop muscle memory, enabling them to instinctively reach for the right tools, even in low-light or high-stress conditions.

Relevance and realism are critical factors in engaging students during training. It is not always necessary to have access to high-fidelity training scenarios with expensive equipment; engaging the students with relevant scenarios using lower-fidelity models can yield similarly positive outcomes. The focus should be on creating meaningful training environments that resonate with the students and prepare them for real-world challenges.

The Power of Those Who Teach

The importance of skilled instructors cannot be overstated in the context of effective training. Instructors who have real-world experience and have “done” in addition to “teaching” are invaluable in imparting their knowledge and expertise to the next generation of operators. They possess the ability to multiply their impact by passing down their hard-won lessons, ensuring that valuable corporate knowledge is retained within an organization.

To wrap it up, the RBT stands as a cornerstone of skill development and optimal performance, especially in the high-stress environments faced by special operations combat medics. By structuring training to progress through the four levels of skill acquisition and incorporating relevant and realistic scenarios, medics can reach a state of unconscious competence, where life-saving skills become second nature. Instructors who have walked the path and now choose to teach others play a pivotal role in ensuring that valuable knowledge is passed on to future generations, ultimately saving lives and impacting the individuals and organizations they serve.

In a world where excellence is not a luxury but a necessity, RBT stands as a powerful ally in preparing individuals for the challenges that lie ahead. Whether in combat, emergency medical response, or any other high-stakes profession, the significance of RBT cannot be underestimated. By training, as they would fight, individuals can rise to the occasion, delivering optimal performance even under the most intense pressure. And for those who choose to teach, their contribution ensures that the torch of knowledge remains bright, guiding the way for generations to come.