How Special Ops medics hone their skills in the streets of Missouri

In the fall of 2018, U.S. Special Operations Combat Medic (SOCM) trainees began to pop up in Springfield, Missouri, riding as medics on civilian ambulances operated by CoxHealth, one of two civilian medical systems based here in Southwest Missouri’s biggest city. This author remembers hearing about the genesis of the program as it was being launched, but then duly forgetting about it until I noticed a SOCM medic on one of our emergency medical calls for the first time. My fire truck was also responding that night, with our three assigned firefighter/EMTs. Immediately when I saw the medic jump from the ambulance, with his distinctive t-shirt depicting the warfare emblems of the various U.S. Special Operations commands served by the SOCM program, combat boots, and tactical-style pants, I knew the program was up and running. 

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The SOCM is often described as the best-trained “austere” medical provider in the world. These are the combat medics who train at the Joint Special Operations Medical Training Center (JSOMTC) at Fort Bragg, NC, and who go on to serve as medics in the U.S. Army Special Forces and Rangers, Navy SEALs, and Marine Special Amphibious Reconnaissance or Force Recon units, among others. The SOCM completes a 36-week training program at Fort Bragg, and part of the curriculum includes approximately 25 days riding along on municipal ambulances in various parts of the country, where the aspiring medics can hone their clinical skills on the streets of America.

A fully-trained SOCM must be able to care for a sick or wounded casualty for up to 72 hours, often in a war zone or other forbidding, remote environment, with just the medical gear that he or she packed on their own back. Part of the process of reaching this level of proficiency is being exposed to as many medical emergencies as possible in the next best thing to a remote battlefield: the city streets of America. Civilian EMTs and paramedics must also address life-threatening emergencies away from well-lit, well-staffed, and well-stocked hospital emergency departments, just like special operations medics. They must often treat patients in the dark, outside, in adverse weather, or through the shattered and broken hulks of wrecked vehicles. They treat victims of shootings, stabbings, various other trauma, overdose patients, and all other life-threatening emergencies on a daily basis.

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In order to give special operations medics some of these same real-world experiences, and to help them face as many challenging scenarios as possible before they deploy to use their skills on the battlefield, the JSOMTC entered into a number of memoranda of understanding (MOU) with various civilian medical systems to give these SOCM trainees “street time.” There have been six such MOUs in operation, of which Cox Health in Springfield, MO, is one of four currently up and running.

It is no coincidence that Cox was one of the locales that ended up hosting some of the SOCM trainees. One of the Emergency Medicine docs at CoxHealth is a former Special Operations medic, having served as an 18D in both the 10th Group and 20th Group of U.S. Army Special Forces. Dr. Matthew Brandt knows well both civilian emergency medicine and special operations combat medicine. He was, in a way, the perfect matchmaker between CoxHealth and the JSOMTC, and pushed to host the SOCM students in Springfield. By his own telling, he was able to steal away the JSOMTC partnership from a site in Chicago due to the dedication and enthusiasm shown by CoxHealth for the program. At one point during the pandemic, for example, Cox accepted 54 SOCM students when the other three training sites had closed their doors due to COVID.

According to Dr. Brandt, “We [at CoxHealth] make the SOCM student better, and [the SOCM students] make Cox and Springfield better.”

Brandt describes CoxHealth as having a culture of dedication to the military, and specifically to Special Operations, as the staff at Cox has a large veteran population, including the former Special Forces medic himself. The SOCM students thus seamlessly integrate into the civilian system at Cox.

Additionally, according to Dr. Brandt: “Cox is unique because we are a level one trauma center, but have very few medical students, residents, or fellows to compete for education time with the attending physicians and staff.” This increases one-on-one time for the SOCM students, and improves the quality of the education they receive.

As far as how the program benefits CoxHealth, Dr. Brandt cites the intangible benefit of civilian medical staff bumping up against military medics, and the creative friction and osmosis that can occur across that membrane. Each medic will glean tricks, practices, techniques, and approaches from the other. It also pushes the civilian staff at Cox to hone their skills and knowledge.

“I’ve got paramedic supervisors who are studying so that they can answer questions posed by the SOCM students,” continues Brandt. “We stand straighter because they are here.”

Brandt points out that other public safety staff in the city (police, fire, and the other local EMS system) also help provide training and guidance to the SOCM students by virtue of those agencies’ near-constant interaction with Cox Health. The SOCM students participated in multi-agency active shooter training at a local university, for example, and were value added, given their extensive knowledge of Tactical Combat Casualty Care (TCCC).

In assessing the overall value of the program for CoxHealth, Dr. Brandt takes a philosophical approach: “Two years of COVID has resulted in a milieu of malaise and emotional exhaustion. Having the SOCMs around helps us extend beyond that to something bigger.  They are like instant coffee and Copenhagen.”

Spoken like a true Green Beret combat medic.

The SOCM’s 25 days of exposure to civilian medicine includes not only EMS ride time on the ambulance, but also time spent in lectures, and in the Intensive Care Unit, the Operating Room, Labor and Delivery, Pediatrics, the Emergency Room, Urgent Care, and the Neonatal ICU. At the completion of the SOCM course, the medic will be credentialed with Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), Advanced Tactical Paramedic, and the National Registry Emergency Medical Technician Paramedic, among other certifications. In other words, the SOCM medic is a highly-trained, multi-disciplined emergency medical technician, and time spent on the streets plays a significant part in that development.

That first night that I saw them out in the field, I remember we were treating a victim of a heroin overdose, and the SOCM medic dove right in to establish an airway, and to begin breathing for the victim with a bag valve mask, as the victim’s breathing had ceased due to the effects of the heroin on his respiratory system. The victim would go on to recover there on scene, as quickly administered naloxone reversed the effects of the opioid. I doubt it was the last overdose that that SOCM student would encounter during his stint on the ambulance. He also no doubt saw his share of trauma victims while responding to emergencies on the streets of Springfield.

CoxHealth, meanwhile, prides itself on the program, as it is helping to train medical providers who will treat not only America’s special operations forces, but citizens of remote locations across the world. Sometimes those SOF medics are the only health care professionals certain people will ever encounter in remote parts of the world. The program’s wide-ranging benefits are a boon for both the providers, their patients, and for the communities here in America serving as the training grounds for these essential medical personnel.

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