Treating a wounded comrade while under fire is one of the tougher aspects of war-fighting. Enemy fire and adverse battlefield conditions add to the existing stress of a medical emergency. The wounded’s life is in the balance and there’s no room for error. That is the reason why medics undergo long intellectually, emotionally, and mentally challenging courses. Considering the added complexity of their missions, Special Operations units tend to place added emphasis on their medics’ training.

The Special Operations Combat Medic (SOCM) course is notoriously difficult to complete and has a very high attrition rate. It lasts for approximately 36 weeks and draws its trainees from across the U.S. Special Operations Forces (SOF). Special Forces Medical Sergeants, Rangers from the 75th Ranger Regiment, Navy SEALs, Special Warfare Combatant Crewmen, Marine Raiders, Reconnaissance Marines, Flight Medics from the 160th Special Operations Aviation Regiment, and Civil Affairs and Psychological Operations soldiers all attend SOCM.

But there are other courses that provide additional training and add to the SOF medics’ expertise, like NATO’s Special Operations Medic Course. Offered by the International Special Training Centre (ISTC) in Stetten, Germany, the course provides realistic combat medic training to American and allied SOF medics. The most recent class included operators from America, Greece, Germany, Croatia, Italy, Norway, Switzerland (which isn’t part of NATO), and the Netherlands. The course is distinguished for its realism. Amputee role players are actual amputees. The blood used is real.

A U.S. Special Forces master sergeant who is assigned to the ISTC said in an interview with DVIDS that the course’s “purpose is to make a special operations medic who is capable of being proficient in TCCC (Tactical Casualty Combat Care), then being able to hold onto a patient for 72 hours in a prolonged field care setting. They also learn clinical medical skills such as sick call and history taking, and basic veterinary medical skills.”

The course lasts for 21 weeks and ends with a demanding 36-hour field exercise.

“The training was very real, with the trauma patients having real amputations,” said an Italian commando participating in the course. “It’s very awesome and very impressive how they dress up the patients and conducted the training. It can give you a web of knowledge and a network of people that you can talk to for shared experience while increasing your knowledge after the course.”

TCCC, which teaches life-saving techniques and procedures in a tactical environment, has become the standard in terms of assessing the capabilities of combat medics.

The course’s non-commissioned officer in charge added that the operators “are our partners, our allies — we want them to have the best standard of care possible. Being able to work with them and bounce ideas off them is always a good thing.”