From the Streets to the Battlefield: When EMS Meets Combat Medicine

Cooper University Hospital is home to several military training programs for healthcare providers. Located in Camden, N.J., Cooper trains special operations medics from every branch of the military. In 2017 it became one of six hospitals in the nation to launch the Special Operations Combat Medic (SOCM) training program for combat medics assigned to the U.S. military’s Special Operations Command (USSOCOM), an umbrella agency for the Navy, Air Force PJs, U.S. Army Special Forces, Civil Affairs, and others. The hospital also provides specialized training for elite providers from around the globe as well as federal, state, and local government organizations.

What’s unique about this program? In addition to working with emergency department staff, the medics train with Cooper EMS ALS crews in preparation for care in combat. Cooper was selected among the other SOCM sites in the U.S. (sites include Camden and Trenton, N.J., Tampa and St. Petersburg, Fla., Flint, Mich., and Springfield, Mo.) based on the high volume of trauma patients seen in its emergency department. Working at the only Level 1 trauma center in South Jersey, Cooper providers encounter a wide range of trauma, creating ripe opportunities for SOCM students to practice treatment of penetrating injuries like gunshot wounds and stabbings and cervical spine injuries seen in patients coming from the shore. 

“We see serious trauma here,” says Army Maj. Rory Tippit, MD, PA-C, director of military training in the Section of Military, Field, and Diplomatic Affairs at Cooper’s Center for Trauma Services. Tippit says trauma and ED staff invite SOCM students to participate in all kinds of care—open chest thoracotomies, cardiac massages, tracheotomies—and then they teach each other.

“While our instructors go to great lengths to increase the realism of our training, up until now much of the training is notional to some degree,” says one SOCM student (soldiers must remain anonymous to protect their identity). “This is the first time we can put all the didactics, algorithms, and skills to practice in a real, live scenario. That’s the payoff—that’s what excites me about our clinical rotations.”

“It’s a symbiotic relationship we’re seeing here at Cooper between the various military programs and civilian staff,” says Tippit. “Everyone is coming together in order to provide the best medical training possible in order to achieve zero preventable deaths overseas.”

Care Behind Enemy Lines

Units within USSOCOM are charged with a wide array of missions that require small teams to operate behind enemy lines and work with indigenous forces to subvert or overthrow enemy regimes. Due to the dangerous, austere missions with little or no support, team medics must be highly trained and prepared to manage a variety of medical emergencies. 

“Their scope of care involves caring for a multisystem trauma patient for up to 72 hours prior to evacuation,” says SFC Corey Terry, recently retired U.S. Army Special Forces medical sergeant and program manager and preceptor of the SOCM Clinical Medical Proficiency Training Rotation. Unconventional warfare encompasses “enabling a resistance movement or insurgency to coerce, disrupt, or overthrow a government or occupying power by operating through or with an underground, auxiliary, and guerrilla force in a denied area,” says Terry. 

In addition to being proficient in trauma care, these medics are trained in dental care, veterinary care, OB/GYN care, and even minor surgery and limb amputation (they don’t perform surgery on the torso or head). These skills are not only reserved for team members but also to aid the host nation partner and their animals.

Terry says medics are also responsible for medical intelligence, logistics and planning for missions, medical loadout, and cross-training team members in tactical combat casualty care. Providing preventive and routine healthcare for the team also falls on their list of duties, such as tracking immunizations and prescribing medications, including narcotics and antibiotics.       

The Forefront of Progress

SOCM students advance through a 36-week program of clinical training. They earn their National Registry EMT certifications in the first 25 days and work their way through a rigorous curriculum that culminates with clinical rotations at one of the six sites. The 276-hour rotation lasts roughly 29 days, with medics spending 180 hours within the hospital and the remaining 96 in the field with EMS.

“As students we are given pieces of the puzzle along the way,” says a SOCM student. “It’s up to us to connect all those dots. Working with experienced professionals who are committed to teaching helps us connect those dots.”

“Being the only Level 1 trauma center in South Jersey means it’s not always pretty,” says Tippit, “but that also makes it an ideal place for the military to gain lifesaving EMS skills.”

Cooper EMS has a great rapport with SOCM students. Between calls crews provide breakout training to help the medics prepare for their National Registry paramedic test, which they take after earning the USSOCOM certification as Advanced Tactical Paramedic. Terry and Tippit credit Ron Murphy, NRP, clinical manager of Cooper EMS, with getting this partnership off the ground. 

In the beginning New Jersey statutes didn’t allow for out-of-state educational institutions to participate in ride-alongs. Murphy dedicated hours of time examining both the state EMS and USSOCOM curricula to demonstrate that SOCM students’ training met New Jersey standards. A waiver process was formulated, and so began the first military and EMS training partnership in the U.S. 

Another advantage provided to SOCM students is having a permanently assigned Forward Resuscitative Surgical Team (FRST) under the Army Military-Civilian Trauma Team Training (AMCT3) program at Cooper. With access to more advocates in the clinical setting who get them involved in procedures and patient care, SOCM students gain an understanding of how a FRST functions, as they will have to work with these teams on deployments to future wars.

“The future is ever-expanding,” says Tippit. “And we want to stay on the forefront of progress within downrange military medical care.”   

Valerie Amato, NREMT is assistant editor of EMS World. Reach her at vamato@emsworld.com.