Editor’s note: Special thanks to Anthony Bunkley (SARC) for his work in compiling the information in this article as well as providing all photos.
It is mid-summer in the green-zone of Afghanistan’s Helmand province where coalition forces have been regularly combating the Taliban in the heart of enemy territory. The enemy fights with the utmost tenacity because the land, the Helmand River, and its bright red poppy fields, yield a major revenue stream for their crusade via opium production and sales.
A Marine Special Operations detachment is conducting village stability operations (VSO) in support of the overarching counter-insurgency mission. While patrolling through a small village, the Marines stop to speak with villagers about an observed lack of a civilian presence, when suddenly they begin taking effective fire instantaneously from several nearby compounds. The detachment immediately begins returning fire and moves into the compound of the local villager that they had just been conversing with. Priorities of work begin and fighting positions are taken on the roof. Just as everyone is peeling into the compound to re-orient and push back the fighters, an RPG hits the front entrance of the compound and an ANA (Afghan National Army) Commando takes fragmentation to the face.
The gunfight intensifies dramatically, and while engaging targets from the roof of the compound, the SARC/SOIDC (Special Amphibious Reconnaissance Corpsman/Special Operations Independent Duty Corpsman) hears a Marine speak over the radio, “Doc we have one Commando casualty who suffered an RPG blast injury. He has major frag to the face and he’s having difficulty breathing. I’ve put him on his side to prevent him from choking on his blood and done a full body sweep, there are no additional visible injuries. We’re currently using a bandage to slow the bleeding.”
The SARC responds with, “Roger. En route. Establish and monitor vitals, and maintain the patient’s airway. Can you send someone up to the roof to relieve me? Tell them to bring extra ammo and a LAAW, if possible.”. “Understand all. Out.” is the reply from the Marine.
For SARCs, these are the moments that separate them from their fellow Marines and Special Operations brothers. They immediately start considering all the information on-hand, working out a plan for treatment while maintaining complete situational awareness (SA). Every SARC will revert back to an algorithm that was taught to them at JSOMTC (Joint Special Operations Medical Training Center), the world’s premier school for Special Operations Medicine. It may be slightly personalized and manipulated due to situational constraints, but the educational principles taught over several intense months will oftentimes be conducted the same way for every patient.
Photo taken in the Helmand province during the 2011 fighting season shows a chest tube that a SARC had to insert on a captured Taliban fighter – the SARC’s first time performing that procedure.
The firefight continues, relief arrives on the rooftop and the SARC gives an ADDRAC (Attention, Direction, Description, Range, Assignment, and Control) to his relief for all potential targets and areas of interest. Once he receives confirmation of understanding from his relief, he begins movement to his patient who is just inside the compound walls. As he maneuvers to his patient from the rooftop position, he sees his Joint Terminal Air Controller (JTAC) and several individuals of the command element (CE) coordinating fires and relaying to higher. As he scans the compound to maintain SA he shouts to the CE that he is moving to his patient and to stand-by for a MIST (Abbreviated Casualty Report) report. As he moves toward the patient, he scans the immediate area and gains a visual of the facial injuries on the ANA Commando. Looking past his distracting injury, he conducts a second head-to-toe sweep while listening to his Marine’s patient debrief and reading of the vital signs that had been Sharpie’d on the patient’s chest.
Between the visual presentations of severe lower maxillofacial injury, compensated respiratory vitals, mechanism of injury (MOI), and inability to maintain an adequate airway via intubation, the SARC makes the decision to perform an emergency cricothyrotomy (cric) to maintain the patient’s airway. Instructions are passed to the Marine to prep the patient for a cric via the surgical airway kit in the med-bag, and the SARC checks for IV patency. The IV established by the Marine earlier is still patent and the SARC starts Ketamine induced anesthesia at a rate of 2mg/kg. Once Ketamine is on-board, the SARC begins a surgical-cric and establishes a patent airway. The Marine is placed at the head of the patient to aid in airway management and maintenance.
Editor’s note: Special thanks to Anthony Bunkley (SARC) for his work in compiling the information in this article as well as providing all photos.
It is mid-summer in the green-zone of Afghanistan’s Helmand province where coalition forces have been regularly combating the Taliban in the heart of enemy territory. The enemy fights with the utmost tenacity because the land, the Helmand River, and its bright red poppy fields, yield a major revenue stream for their crusade via opium production and sales.
A Marine Special Operations detachment is conducting village stability operations (VSO) in support of the overarching counter-insurgency mission. While patrolling through a small village, the Marines stop to speak with villagers about an observed lack of a civilian presence, when suddenly they begin taking effective fire instantaneously from several nearby compounds. The detachment immediately begins returning fire and moves into the compound of the local villager that they had just been conversing with. Priorities of work begin and fighting positions are taken on the roof. Just as everyone is peeling into the compound to re-orient and push back the fighters, an RPG hits the front entrance of the compound and an ANA (Afghan National Army) Commando takes fragmentation to the face.
The gunfight intensifies dramatically, and while engaging targets from the roof of the compound, the SARC/SOIDC (Special Amphibious Reconnaissance Corpsman/Special Operations Independent Duty Corpsman) hears a Marine speak over the radio, “Doc we have one Commando casualty who suffered an RPG blast injury. He has major frag to the face and he’s having difficulty breathing. I’ve put him on his side to prevent him from choking on his blood and done a full body sweep, there are no additional visible injuries. We’re currently using a bandage to slow the bleeding.”
The SARC responds with, “Roger. En route. Establish and monitor vitals, and maintain the patient’s airway. Can you send someone up to the roof to relieve me? Tell them to bring extra ammo and a LAAW, if possible.”. “Understand all. Out.” is the reply from the Marine.
For SARCs, these are the moments that separate them from their fellow Marines and Special Operations brothers. They immediately start considering all the information on-hand, working out a plan for treatment while maintaining complete situational awareness (SA). Every SARC will revert back to an algorithm that was taught to them at JSOMTC (Joint Special Operations Medical Training Center), the world’s premier school for Special Operations Medicine. It may be slightly personalized and manipulated due to situational constraints, but the educational principles taught over several intense months will oftentimes be conducted the same way for every patient.
Photo taken in the Helmand province during the 2011 fighting season shows a chest tube that a SARC had to insert on a captured Taliban fighter – the SARC’s first time performing that procedure.
The firefight continues, relief arrives on the rooftop and the SARC gives an ADDRAC (Attention, Direction, Description, Range, Assignment, and Control) to his relief for all potential targets and areas of interest. Once he receives confirmation of understanding from his relief, he begins movement to his patient who is just inside the compound walls. As he maneuvers to his patient from the rooftop position, he sees his Joint Terminal Air Controller (JTAC) and several individuals of the command element (CE) coordinating fires and relaying to higher. As he scans the compound to maintain SA he shouts to the CE that he is moving to his patient and to stand-by for a MIST (Abbreviated Casualty Report) report. As he moves toward the patient, he scans the immediate area and gains a visual of the facial injuries on the ANA Commando. Looking past his distracting injury, he conducts a second head-to-toe sweep while listening to his Marine’s patient debrief and reading of the vital signs that had been Sharpie’d on the patient’s chest.
Between the visual presentations of severe lower maxillofacial injury, compensated respiratory vitals, mechanism of injury (MOI), and inability to maintain an adequate airway via intubation, the SARC makes the decision to perform an emergency cricothyrotomy (cric) to maintain the patient’s airway. Instructions are passed to the Marine to prep the patient for a cric via the surgical airway kit in the med-bag, and the SARC checks for IV patency. The IV established by the Marine earlier is still patent and the SARC starts Ketamine induced anesthesia at a rate of 2mg/kg. Once Ketamine is on-board, the SARC begins a surgical-cric and establishes a patent airway. The Marine is placed at the head of the patient to aid in airway management and maintenance.
The SARC listens to the lungs carefully for any over-pressurization injuries due to mechanism of injury (MOI) and associated airway injuries – none are found. All pertinent times, serial vital signs, drugs, etc. are annotated on the patient’s chest and patient packaging for evacuation via helicopter begins. The SARC does one last full-body visual/palpation assessment during packaging and finds no additional injuries and wraps the patient’s body to prevent hypothermia. The information is passed to higher via an abbreviated 10-Line and MIST report; due to a patient with a surgical airway a request for PEDRO (AFSOC Pararescueman) and accompanying escort. CASEVAC request is granted – PEDRO is inbound. The SARC preps a casualty turnover card and passes a purple 40mm smoke round up to the rooftop gunner to mark the HLZ for when the helicopters are on-station.
Overview
The SARC/SOIDC provides medical and operational services for Fleet Marine Force Reconnaissance, Marine Corps Special Operations and other SOCOM units engaged in DA (Direct Action), COIN (Counter Insurgency), CT (Counter Terrorism), U/W (Unconventional Warfare), FID (Foreign Internal Defense), R/S (Reconnaissance and Surveillance) & SR (Special Reconnaissance) operations.
A SARC is the foundation of medicine within a platoon or team of Marines. Oftentimes they begin teaching their Marines basic trauma medicine within days of being assigned a platoon. They learn to hone all the skill-sets instilled in them throughout the pipeline and they adapt the mindset needed to thrive in a high-tempo operational environment with the men they’ll be deploying with all over the world. Learning the personalities of the various men in the team and building relationships with them is what truly gives the team its lethality. As a SARC becomes seasoned and competent in all the other aspects aside from medicine in the teams, he can be elected to attend advanced schools such as Ranger, Freefall, Sniper, Jumpmaster, etc. This is what every SARC aspires to as he grows in the team environment. But two or three years passes quickly, and often it is necessary to move up in the medical aspect of the profession because both NECs (Naval Enlisted Codes) are always undermanned and that ultimately affects mission-readiness for deploying Commanders.
The SOIDC is the next, and final, progression in this career path. SOIDCs are experts in all the SARC skill-sets mentioned above, but they will specialize in long-term care of patients in both the clinical and austere environments. Returning to JSOMTC, SARCs who attend SOIDC attain the knowledge and training needed to perform comparable tasks to that of a Physician Assistant (PA) and/or Medical Doctor (MD). These are the medical professionals that understand every aspect of medical administration and patient care. They ensure that a patient can survive some of the most life-threatening injuries under the most arduous conditions in the world. SOIDCs are highly sought after by SOCOM units because of their diversity and knowledge in the military medical arena.
All SARCs and SOIDCs will perform the operational duties mentioned above, in both their medical and tactical disciplines. They also maintain a high-level proficiency in various SOF Insertion/Extraction methods such as: open and closed circuit SCUBA, and basic/advanced military parachuting in direct support of Fleet Marine Force Reconnaissance units and various Special Operations units within SOCOM.
History
The largest rate, also known as job, in the Navy is the rate of Hospital Corpsman (HM). Within this 26,000+ personnel force there are roughly 8,800 HM’s who serve with the USMC Fleet Marine Force (FMF). And within these 8,800 HM’s there is a very small, highly-selective, elite community of 150-200 Naval Special Operations medical personnel that are always looking for a couple of people who can ‘make the cut’ and serve in this elite small unit environment as ‘tactically proficient medical providers’ alongside servicemembers of Marine Recon, Marine Special Operations Command and various other units of Special Operations Command.
In 1994, the Naval Enlisted Code (NEC) of HM-8427 & HM-8403 was officially approved, recognizing the FMF Reconnaissance Corpsman (Special Amphibious Reconnaissance Corpsman [SARC]), and FMF Reconnaissance Independent Duty Corpsman (Special Operations Independent Duty Corpsman [SOIDC]), respectively. This breaking away from the previously held NEC of HM-8492 and HM-8491, which was shared by Navy SEAL and Navy SWCC medics, allowed for a significant degree of clarity.
Since the inception of NEC HM-8427/03, all of the schools listed below must be completed before the NEC designation is awarded. In the earlier years of the SARC community, it could take a potential Recon Corpsman 2-5 years or more to officially earn this new, highly-coveted, NEC. As the community matured, so did the growth of a dedicated training pipeline, which enabled a young Sailor to earn the title of SARC over a rigorous 1 ½ to 2-year pipeline of mentally, academically, and physically demanding courses spanning the Navy, Marine Corps, and Army training communities. This is the pipeline in place today. If passed, and the NEC is earned, a SARC then has to complete 1 to 2 tours (over two or three years depending on marital status, which dictates tour length) at a Marine Reconnaissance Battalion or Marine Raider Battalion as an HM-8427 in order to move on to the ‘mastery’ level NEC of HM-8403.
SARC next to a makeshift ambulance made from a rental van. This was during an exercise for a low visibility direct action (DA) hit.
The Pipeline
USN/USMC Field Medical Training Battalion (FMTB)
8 weeks – Camp Pendleton, CA or Camp Lejeune, NC.
This is a Naval Hospital Corpsman’s introduction to the Marine Corps ‘way of life’ and true start to the ‘SARC Pipeline’. A joint cadre of FMF Corpsman and Marines train several dozen junior HMs in every aspect of the Marine Corps from organizational processes and procedures to competency in the Marine Corps Martial Arts Program (MCMAP). Additionally, training will include general military subjects, individual and small unit tactics, military drills, physical training/conditioning, and weapons familiarization with the opportunity to qualify on the rifle. The second half of training focuses on the fundamentals of identifying and treating medical conditions resulting from combat wounds or injuries, triaging casualties for treatment or evacuation, evaluating field sanitation, introducing practices for preventive medicine, applying appropriate resources for decontamination of hazardous materials, treating specified dental emergencies, and responding to specified psychological problems. Additionally, a NSW (Naval Special Warfare) physical screening test will be performed on all potential ‘pipeline’ candidates. All candidates must meet the SEAL physical fitness standards to move-on to the next school.
USMC Basic Reconnaissance Course (BRC)
13 weeks – Camp Pendleton, CA.
BRC is the ‘first gut check’ in the pipeline where a potential SARC candidate starts to learn what it really means to have the term Reconnaissance in the title SARC. By day one of BRC, every SARC candidate should have gone through several weeks of the Recon Indoctrination Program (RIP) at BRC, known as Basic Reconnaissance Preparation Course (BRPC) in which they must graduate prior to starting BRC. This is purely a conditioning and selection phase that gives cadre the ability to assess who is deficient in certain areas and whether or not they’re worth fixing. If they make it through this initial phase they will be slotted to class-up and start their 3-phase, 13-week journey to earn the title of Reconnaissance Marine. In BRC, every candidate will learn how to perform and become proficient in advanced radio communication operations, application of land navigational techniques, prepare basic beach and hydrographic surveys, read and use topographic maps, understand basic global positioning systems, perform an array of reconnaissance skills such as field photography and sketching, and apply principles and techniques of nonelectrical explosives, surveying, basic seamanship skills, digital communications systems and small unit tactics. Candidates will also become familiar with specialized insertion and extraction methods via Combat Rubber Raiding Craft (CRRC), Helocasting and Helicopter Rope Suspension Training (HRST).
US Army Basic Airborne School
3 weeks – Ft. Benning, GA.
This is often times the ‘break’ in the pipeline. Basic static-line parachuting and physical training are the key takeaways from this school.
USMC Marine Combatant Dive Detachment (MCD)
7 weeks – NDSTC Panama City, FL.
Marine Combatant Dive (MCD) is the ‘second gut check’ in the pipeline. It is one of the most physically demanding courses in the pipeline and is 1 of 3 SOCOM-qualified combatant dive courses in the military. A candidate will ‘fin’ in excess of 65,000 yards during this course, averaging 2-3.5 km daily. The course is split into two phases – SCUBA and MK-25. These two phases are divided by a specific event known as ‘10K’, it’s an event that every Marine Combatant Diver partakes in and is a very unique rite of passage among the various Combatant Dive Courses. This course introduces a potential SARC to his first real interaction, at a peer-based level, with veteran Recon Marines and Marine Raiders. This allows a SARC candidate to gauge himself and his work ethic among his fellow Marines and, if he completes the pipeline, his teammates. Upon completion a graduate will perform effectively as a Reconnaissance and/or Marine Raider dive team member in open-circuit SCUBA and closed-circuit MK25/Mod-2 Underwater Breathing Apparatus (UBA).
ARC, also known as DMMP (Diving Medicine for Medical Personnel), is a type of academic primer for SOCM. This course is academically challenging and it expands on the ideas and concepts of basic diving physics and medicine that is touched-on in MCD. Advanced diving physics and medicine are the foundational concepts needed to move in to the hyperbaric treatment of diving causalities and all the associated variables considered in the management of these causalities. These are the primary tenets of this course and upon completion of ARC a graduate will be able to effectively identify diving casualties and perform medical functions as a recompression chamber inside tender. This course is also attended by several agencies and organizations within the Uniformed Services, BORTAC, FBI and other organizations in the tactical diving arena.
Special Operations Combat Medic Course (SOCM)
36 weeks – Ft. Bragg, NC.
For a SARC candidate, SOCM is oftentimes a culminating event within the pipeline. It is the last, and longest, leg of this arduous journey. This course introduces SARC candidates to the Joint Special Operations training environment. This introduction fuels the inter-service competition, and camaraderie, that yields the best Special Operations medical practitioners in the world. Every graduate, and in this case a SARC, will specialize in paramedicine, anatomy and physiology, clinical medicine, basic life support, minor surgical procedures, tactical combat casualty care, mass casualty, CASEVAC procedures, and other routine and emergency medical health care procedures as required. At the completion of the course they receive the Advanced Tactical Paramedic Certification (ATP) that enables these individuals to be medics among the ranks of SOCOM, as well as ACLS/PEPP/PALS/TCCC. They will confidently instruct and advise operational personnel, as well as foreign military, in the disciplines of TCCC and prevention of illness and treatment of injuries associated with operating in extremely austere environments, open and closed circuit SCUBA diving, military free fall and amphibious operations.
Special Operations Independent Duty Course (SOIDC)
13 weeks – Ft. Bragg, NC.
SOIDC, or SFMS (Special Forces Medical Sergeant) as referred to by Army SOF, is a follow-on course for SARCs after graduating the pipeline and completing, at the very least, a 3-year tour in the Fleet. SOIDCs are the culmination of several years of experience and education in the SOF Medical arena. The NEC HM-8403 is a mastery-level skill-set within the enlisted program of Navy/Marine Corps medicine. An SOIDC will be an expert in all the skill-sets previously mentioned, but they will focus their specialization in the long-term care of patients in austere environments. Additional specializations are in mass casualty, military triage system, and medical mission planning. Every SOIDC is trained and knowledgeable in several aspects of clinical/austere based medicine to include: veterinary, dental, clinical laboratory, initial and long-term wound care, unconventional warfare hospitals, surgery, administering total/regional anesthesia, nursing care, patient records and reports, and radiology. Upon graduating, an SOIDC will be a senior provider in his respective clinic and he will be responsible for not only seeing patients but ensuring that the pedagogical nuances of SOF medicine are passed down to the younger generation of SARCs.
CASEVAC of an Afghan local at a FOB in northern Helmand province, circa 2012.
Summary
SARC/SOIDCs within teams have opportunities to attend a majority of the same schools that are offered to the Marines they serve with; this is because within these small teams one may take on additional responsibilities within said team. However, this will never deter the SARC from their primary duty as the medical provider for their team. Learning for a SARC is continuous, in all aspects of his various duties and disciplines. SARCs will return to JSOMTC every 2 years to not only re-qualify, but learn from past after-action reports of events that transpired downrange as well as learn current cutting-edge medical protocols developed among the various SOCOM medical communities. This medical refresher keeps the SARCs skill-set sharp and is ever evolving to keep up with the forever turning tide of warfare.
The SARC community is a select group of highly capable SOF medical practitioners. This is a highly-skilled and extremely vital micro community within the Navy and Marine Corps Special Operations inventory. This community arguably builds the best ‘all around’, tactically and technically proficient, medical practitioners in the US Military. We the willing…
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