Austere Medicine

Austere Medicine

Special Operation Combat Medic School Survival Guide

     We are writing this as a guide to help future students prepare and know what to expect when attending the Joint Special Operations Medical Training Center (JSOMTC) Special Operations Combat Medic School (SOCM). We have instructors that are SOCM/SFMS qualified and wanted to pass the knowledge on.

     I am a fan of "If you find yourself in a fair fight, your tactics suck" and wanted to apply that to this school; I wanted to prepare to get an advantage... but when I googled "SOCM" I came across very little, and most posts were about the old 6 month school and not the newer 36-week / 9 month program. You can google everything from Ranger School to Special Forces "Q-Course" preparation and know what to expect and how to prepare, but not really SOCM.  If you ask buddies that went, they usually don't tell you too much besides "You'll do great" and "It was a fun, but difficult course" which leaves much to the imagination. I also find myself writing the same 5-6+ paragraphs whenever people about to go, ask me "what do I need to know about SOCM?", so this article can be used as a guide to send to your buddies about to go. I like to know what I am getting into, especially pertaining to a course where I was one of only 15 out of 80 that made it straight through without a recycle or completely dropping out. Yes, this course is an animal.

Prior graduates: If you, as a graduate, or Instructor of SOCM feel this article could be more accurate or updated, please comment so I can change it. The same goes for any additional comments that helped you prepare and get through. These views are my own and do not represent the schoolhouse or my employers views in anyway, just meant to give students an idea of what they are getting into and hopefully able to prepare more. Please be cautious in what you are commenting due to the nature of the course.

 

" Remember: You are NOT in this course to merely pass with the minimum or check the block. You are in this course to learn to be a Special Operations Combat Medic, to save a life, save multiple lives. Absorb and master as much as you can, and continue to do so after you graduate. "

Preparation (A few months prior) :

     Before you even attend the school, I would highly recommend taking Anatomy & Physiology(A&P) and trying to get a 90%+ in the course. The first reason being that the second block of SOCM is A&P, which is an accelerated, condensed course that is normally months long, jammed into 20 days from cover to cover to include pin tests on cadavers and models. Normally this course is difficult for college students when spread across months, but in 20 days it's a ton of information. Going in already knowing some A&P may allow you to have better grades, as you will be mostly reviewing over learning. I did not take A&P prior, and the students in class who already did, performed well with far less study time. If you haven't taken A&P yet and are too close to SOCM date to enroll, don't stress out as the course is designed for non-medics to go from 0 to 60, just understand you'll be studying hard, every night and weekends.
The second reason for taking a course such as A&P before SOCM is to learn your study habits. We've all been to most military schools where people "say its hard" but its really a joke and you get through like a breeze. That is NOT SOCM, so taking a course of two before attending allows you to figure out if you like to study at coffee shops, in a separate room where the dogs, kids and spouses can't bother you, or if you'll be checking facebook too often to study. I'd also recommend aiming to get a higher grade (90%+) because it will likely be less info, spread out over a longer time than SOCM so you might as well add stress/difficulty to see where you are at.

Are You a Prior Medic? If not, skip this paragraph:

     If you are a prior Combat Medic/Corpsman like I was, and you show up to this course, you will be told almost daily the following: "Medics have the lowest success rate out of anybody." It's because they show up high and mighty thinking they know everything, argue with instructors and are unteachable. Meanwhile the 11B infantryman just shuts up and learns and goes from not knowing what "Dorsal / Proximal" means on Day 1 to discussing Rhabdomyolysis and ACLS for Hyperkalemia on the same level as the medics by a few months in. There is a saying that "Privates don't have shooters preference" and you may be a 6-10 year seasoned conventional medic but for Special Operations Medicine, you are a private... so stay humble and quiet and brain dump everything you know and learn it how THEY want it, then you can EARN your ability to be your own medic once you've jumped through rigorous hoops and standards.

Physical Preparation:

     For a Special Operations School, SOCM is not known for the most brutal regiment. That being said, poor performance can definitely effect your peer reviews and therefore chance to be recycled. I would recommend going in better shape than I did, and consider a workout program that takes a shorter time (20-40 min) as opposed to those who like 90+ minute workouts. This will help you maintain fitness despite study sessions till 8-9pm weekdays and long sessions on weekends. By a few months in most everybody is not in as good of shape due to living in textbooks and chairs (If you want a higher chance to pass than skating by with 75's+ on every exam.)  Some people were still beasts and made SOCM happen when waking up at 4AM to do a workout before PT, so figure out what works for you. A lot of students either have follow on courses that are very physically demanding, or showing up to a team/unit ready to deploy. During the last block of SOCM you will have a chance to have a more steady workout regiment as you will be working but not studying.

 u.s. army special warfare medical group special operations combat medical skills sustainment course tactical combat casu 20858816

The Special Operations Combat Medic School: Each ~25 day block, 36 weeks total.
Block 1 EMT,
Block 2 Clinical Fundamentals (A&P, Pathology/Pharmacology),
Block 3 Clinical Medicine A & B
Block 4 Trauma 1,
Block 5 Trauma 2,
Block 6 Trauma 3,
Block 7: Rotations & Graduation


EMT:

EMS

Each block is approximately 25 days and the first one takes non-medics and medics from cover to cover of an EMT book and the NREMT exam, with psychomotor (hands on) skills in 25 days. I would recommend not trying to memorize everything like you would a flash card for medicine ( if that works for you do it) but would consider learning the "why." For example, do not memorize Congested Heart Failure(CHF) causes Jugular Venous Distention (JVD), but rather LEARN that when the right side of the heart is congested, the blood is pushed back and up into the neck.  NREMT is a difficult smart exam, and I would recommend a week or two out from taking it to download one of the good phone apps they have to prepare you by getting you exposed to how truly silly the questions can be worded and how they are thinking. It's like they are intentionally trying to trick you. This part isn't too difficult, but still accelerated. Here is where you need to really find your successful study habits for the coming months.

 

 

 

 

 

 


A&P / Physical Exam /
Pathology & Pharmacology:


    anatomy physiology 
The most difficult classroom portion of the course. As said above, please take an A&P course before attending.  I did not take it before and this was a brutal section. Approximately 12-17 of the 80 students will be dropped just on this block alone. You will need to study a lot to pass this block. If you underestimate the first test and get a 50-60% or lower you will need to be scoring 80%+ just to pull yourself out and that doesn't leaving a safety cushion to include the difficult pin tests tanking the grade down. Aim for a 90%+, not just 75%+ so you can be above the margin for a difficult tests to cause you to get 'only an 80%', as opposed to failing. It will also look better to have higher grades later on in case you have to recycle. It will be tough juggling family or free time, keep your goal of being a SOCM on your mind and work your butt off for it. Try to handle distractions in family life, you may be married to your textbook for awhile. Better yet, brief you family on the course before you go in. What is different about SOCM from other courses is other courses keep you out in the field and you are able to perform without distractions because you live AT the school, you have no choice. In SOCM you have to exercise self discipline and time management walk past the T.V., video games, wife, kids, dogs, social media... and lock yourself in a room for awhile. Your career as a SOCM will benefit them in the long run. Keep focused.
       They have decent optional homework handouts you can print out to follow along in the textbook. When you're staring at the same 5-6 paragraphs of information and trying to absorb it, it gets monotonous. Take a break, 5-10 minutes every hour, and use the questions as a way to seek the answer in the information you are reading. It helped me, but not others, its just an option.

     #1 Tip for these next few blocks: What helped me the most was printing out the slides (3-6 per page) for each week so I could follow along with the instructors. There is simply too much information to write down EVERY slide, but if you already have the slides you can easily highlight or re-write the most important parts to better facilitate it into memory, or when the instructor really emphasizes something that is not in the slide. Print out the slides and follow along. It's also easier to note that "On slide 37 Instructor emphasized this and spent awhile on it." HOWEVER, just because they skimmed past a slide or two does NOT mean it's not testable info. A good way to look at each slide, especially if in a study group is to go, "How could we make a test question using this slide?" It will help you learn by differentiating between possible distractors. " The difference between inspiration and expiration in the muscle is..."

    Resources Include:

"KhanAcademyMedicine" which are good videos for visual learners to understand more complex issues in A&P and kind of a mental break from textbooks. They tend to be longer, but work progressively.
"Crash Course A&P" is another good youtube resource which are short (10 min) animated, high energy clips that break entire chapters down into really simple concepts. I like simple!

Pathology/Pharm portion:
      After hopefully passing A&P you are handed tons of medications and issues and have only a few days to memorize them all. While learning the last part of the name correlating to its category "-olol = beta blockers" is one method, it would be better to also know more of what they are used for. If a question presented with a scenario, you'd have to choose the medication they would need. This is a transition from lots of complex information, to a metric ton of more simple information. After SOCM most students agree they wish they had more time on Pharm/Path and its a great thing to study more of once you are on rotations, graduate, etc. Keep your notes on this block for review.

     Another good thing to get in the habit is find some (smart) friends in the class ahead of you so you can always know what is coming next and have a leg up. This helped me go into the next block prepared, with more resources.


Clinical Medicine A & B:

ClinMed

     While certainly not quite as difficult as A&P ( for some), its not to be underestimated, it still fails a good 7-10'ish students. If you do not have a strong understanding of "A&P", or what the human body looks like when its correct, then it will be even harder for you to understand what the human body looks like when it goes wrong.
The first "A" block is multiple 100-400+ powerpoint slide classes on topics such as dermatology, cardiology, muscoloskeletal, respiratory, etc. that you will be testing on just days later. One way to learn this information when learning hundreds of different conditions at once, was to look at the differences between them. What is the difference between strains of malaria, mosquitos, skin infections, etc. Look for febrile vs. afebrile, this one is in south america vs africa, spreads from hands to chest, rash does or does not appear on palms. These differences and "Hallmark" signs ( I.E., Kawasakis strawberry tongue) are important and will help you when the exams have a patient scenario, but more importantly later on with real patients when trying to rule out and narrow down differential diagnosis.
Ontop of the study guides that help correlate the information, I would try to quickly skim through not only printed powerpoint slides but look at them online, where it shows Instructors notes. Sometimes  if someone took time out of their day to put in excerpt in slide notes, it's pretty important to learn.

Clin Med B: Pretty easy Preventative Med stuff compared to earlier blocks. The only "too easy" part of SOCM and enough to lull you into a false sense of security of what is to come. Don't get burnt out.

Clinical Rotations:  
      Here you go to sick call a couple times as a medic at an actual clinic seeing real patients, as well as going over case studies that are pretty cool. It's like being on an episode of house, so now is time to work on your clinical assessment and thought process. Try to rule stuff in/out, look for red flags. You'll be using this information on upper respiratory infections and musculoskeletal injuries for sick teammates far more often than trauma when you graduate. Be respectful, ask questions. It's okay not to know the first time, but after that you can learn and know it for every patient you encounter after that.

Trauma 1:

page 6

      Now the fun begins!  You start off with Advanced Cardiac Life Support (ACLS) and Pediatric Education for Prehospital Professionals (PEPP). If you understand how the heart works, it should be an easier point to learn. Again, don't memorize EKG strips but rather what the heart is doing and how it correlates to what you are looking at. Think of the "P waves" as the atrium... Is there one, not one, is there multiple? Try to correlate the electricity as what the physical heart may be doing and it will be easier to understand what you are looking at and what medication/electricity they need. Follow your book.
On the JSOM website they have pretty good EKG simulator that can help you differentiate between the rhythms.

Actual Trauma 1:
     Here is where you start learning what you are meant to do and be the best at in the world. Learn the medication, the "why." Knowing the why is one of the things that seperates SOCMs from conventional medics is we aren't taught just to do stuff, we are taught the "why", which allows you to master the rules and at times know when to not follow them due to critical thinking. The tests are pretty difficult and worded awkwardly, so just like with other tests really understand the slides more than memorize, including the notes. You also begin the transition from classroom to physical tests:  your hands on tests and assessments.

     Hands on tests: As you learn more psychomotor skills and begin the dreaded "Trauma Patient Assessment" practices, I have one piece of advice that stands out. Do it perfect, every time, the same time, or start over. What gets people is their ego when they mess up, and they say, "Well yeah, I wouldn't have really done that." But you did! So shut up and make your punishment starting the task over from square one to build better muscle memory. The reason SOCMs are so highly respected is because our mastery of the basics, and our ability to perform near perfectly, quickly, under the most difficult conditions.

 

 

 

THE Trauma 2
"Trauma Patient Assessment (TPA)" &
"Clinical Trauma Management (CTM)":

 

SOCM

     When you get to the schoolhouse, Trauma 2 is kind of a legend. It's difficulty is the hands on equivalent of A&P... but harder, as it fails the most people in the course. This is where prior experience of medics is the only benefit *if* they can shut up and do it exactly how the instructors want. Usually it bites them because bad habits.


TPA:

. Think of it as an obstacle, an ultimate test for you to EARN the ability to critically think and be a medic for yourself. You will have very little time, to do a ton of interventions, and do them very well. A tiny piece of your splint was not padded and was pressing into your patients skin? You created a pressure ulcer due to avascular necrosis and caused further harm. No-Go. Just because of one centimeter, despite everything else being perfect.

     When practicing after school (weekdays, weekends) have your team mates critique you HARD. It doesn't pay off to compliment each other like an echochamber, be hard on eachother and expect more. If they mess up, have them start over from the top of that portion (initial, security halt, etc.)

     Equipment preparation is a big deal. When most people pass by 5 seconds under, or fail for 5 seconds under, you don't want your gear kicking your ass! I have seen packaging on ET tubes cost people 30 seconds messing with the wrapping. Pre-tape edges with tabs if that helps you. Stage everything and have it ready. There is no time for "Ummm" or to think, you have to be moving and do it right the first time because there is little to no time to fix mistakes. You have a few minutes to do an I.V., but you better do it in 2 or less if you want enough time leftover. You have a couple minutes for your crics, but you want to do it in 45 seconds to 1:15, always aim for higher than their intervention minimum because you aren't only timed on interventions but your overall assessment.

     For me, I was a really critical thinker, and would sometimes over-analyze, so you have to learn to pick up the pace. Just like running, It's easy to get comfortable going slow but you have to go smooth and steady if you are going to beat the high standards and low time hacks. Our team even prepped the CT-6 Femur Traction device so that as soon as you opened it, it fell and automatically connected together, saving you 10-15 seconds right there.

    Again, do it the same time, every time. I like to look at it like, "Do I have permission?"
When about to log roll, do I have permission? Let me check sternum and pelvis.
When about to put onto a litter I would ask my assistant, "Hold C-spine" and then verbally consider a C-collar to myself to remind myself to put it on or defer it, that way it was always in the same space in my trauma assessment.

CTM:

     So you move to the next section and they teach you even more skills and procedures, then they cut even more time off your standard and you have to do more in less time. My rule for this block was I am going to be the first one in and last one out every day, even on the weekends. Nobody was going to work harder than me. On the arguably hardest test in SOCM I passed pre-test GO.

     You will stay up late packing your bags from the night before, so most of your practice time will be weekends. There also isn't a lot of time for food so get used to packing lunches and eating early and late. Protein Bars and meal replacement bars were money. Keep your goals in mind on these long days, you arrive when the suns down and leave when the suns down.

     Recycles: By this time in the course you have more "recycles", or people who were a class ahead of you, failed, then got put into your class, than you do original students. TPA and CTM recycles are a wealth of knowledge because they already have a week or two of experience and (should) know what they are doing, the tips and tricks of equipment preparation. Really utilize them and have them go through your aid bag or watch an assessment, or watch them. The caveat to this is some recycles barely failed, one tiny little mistake, or just 5 seconds over on time, but there are some that are terrible so try to feel them out before taking advice. I was set up for success by the good recycles in my class and appreciated the tips they gave to the rest of the class.

     Drip rates is a big clinic killer. Be able to put your watch up to the drip chamber and count drops while looking at time. Using your assistant to count out loud is time consuming, inaccurate and unfeasible as in real life you may not have an assistant there just to stare at a watch and count seconds anyway.

     Besides that, there isn't too much I can give out about Trauma 2 and no written things that will help you out. Work hard and ask the successful guys in the class ahead of you how they did it and that is where you get your info. Sometimes the Instructors can seem pretty harsh but you aren't in school to pass the test... you're in school because some day may have to save an Operators life. again. and again. They see you as a medic that can show up to a team and work on their buddies. So aim to be damn good at it.

 

Trauma 3:
Tactical Combat Casualty Care (TCCC),
Prolonged Field Care (PFC),
Field Training Exercise (FTX):

 

PFCIntr

 

      While trauma 2 was the hardest, don't let your guard down because 3 gets plenty of people. I had a watch with a countdown timer I could set to 3 minutes so I could re-check drip rates, it was very helpful, especially for narrow therapeutic index drugs (hypertonic saline, fosphenytoin, fresh whole blood transfusion reaction checks, etc.)

  • TCCC:
    So for the first time in the course you aren't following an algorithm besides just "MARCH", you earned the right to critically think. You are given 2+ patients and you guessed it: even less time on the clock! You are going to have to move really fast and figure out your groove, it's pretty wet and wild. A good assistant also helps so you need to get good at directing him. I always had my assistant to say "Hands free, Doc" to remind me he finished a task. Basically, both of you should be working all the time. You also do some K-9 training and take the "Advanced Tactical Paramedic" course but you are well prepared for those. Consider reading up on special populations before the exam.
  • PFC:
    This is a good time to refresh on ACLS for a few of these. This is an easier one if trust yourself and go in order, as this is one of the only tests where time is not a big issue, it's mainly operator mistakes. Take your time and think.
    * For real life purposes, consider this PFC training an introduction as your unit level training may be 8-24+ grueling hours of sitting on one patient.
  • FTX:
    Not too much to say about this, as each instructor does their own thing. You may have one patient or 11, in a vehicle, or in a swamp on foot, or moving through evasion the whole time, with enemy prisoners of war, possibilities are random and endless. Do what you've learned and do it well. Be able to critically think and convey why you decided to do what you did.

 

Clinical Rotations:

original

     My favorite part of the course. You see how highly Doctors and other medical pro's think of the SOCM program when they see you. Your peers who went before you set good examples and these hospitals expect a lot out of you. Scrubbing into surgery, performing intubations, chest tubes suturing peopls hands and faces back together... I even walked a resident through a chest tube and she asked me what medical school I went through... The civilian doctors like to show off what we can do  and believe in what we can do so make sure to keep that well earned trust. We would do grand rounds and know the answers to questions that residents didn't. It was one of the best times and I grew exponentially as a medical provider. Here are some tips.

  •  Be nice to the Nurses. They run the show, they can make or break you. Yes, we have a higher scope of practice because we are in austere medicine but they are the pro's at what they do. Be nice, be humble and they can really help you out. Messing with them can ruin your time and the SOCMs that come after you.
  • Do as much as you can. While starting dozens of I.V.'s a day for weeks seems menial after awhile, especially compared to chest tubes, NCD's and intubations, do it anyway. We are used to sticking piped out fit military guys, so some of the pediatrics, bariatrics, and geriatrics can be really difficult sticks and make good experience to prepare you for shock patients. Some Paramedics and ER Nurses are I.V. access gods and can show you a thing or two. If your unit may have ultrasound, learn how to use those for I.V.'s here.
  • Be assertive... borderline aggressive: You aren't the only one trying to get procedures, so put yourself out there. If a patient is coming in know which scope and blade size you want for intubation and get it prepped. Hesitating can mean a resident or other SOCM getting in and scooping it up. I would walk around with sterile gloves on me and keep gowns stashed nearby so I could be first in a procedure or room and wouldn't miss an opportunity.
  • Operating Room: Use the schedule on the board as your guide to which surgeries are coming up and have the initiative to be in there early, to politely and professionally introduce yourself to CRNA/ anesthesiologist. Ask if you can do the intubation or supraglottic. Additionally have them teach you how to do a good face mask seal and ventilations which is one of the most important basic tasks a medic can do. During intubation,  If you can or cannot visualize landmarks let them know and they can take over and help so patient does not desat. They may use capnography or check placement with stethoscope themselves but its good if you do it yourself afterwards anyway for learning points. They are pretty awesome about questions and sometimes surgeons will let you scrub in for the surgery itself afterward, if you'd like. It's very cool to help out with surgeries but personally not as applicable to our job. I would try to get in as much airway stuff as possible first. Thank the CRNA/anesthesiologist as you will likely see them later and want them to be nice towards SOCMs in the future.
  • Pediatrics: Useful for I.V. and airway experience, as well as clinical experience. Pediatrics is not my forte so this was a good experience, and applicable since you can do a lot of good abroad by taking care of the locals children. Peds can seem like aliens compared to adults, not just little people.
  • EMS: Get there early, brush up on ACLS (They are way better at it) and save the printouts from cardiac cases to look at later. More I.V. practice, and working on other diseases. It is not their job to be worried about diagnosis, so you'll have to do your own or check with nurses at drop off, or next time you make a trip to that hospital to see what it was. For instance I had a respiratory distress that was sarcoidosis and had the charge nurse let me know, was pretty interesting, but the paramedic just wanted to drop off the patient. For those who were not prior medics, this is also a good chance to get used to talking to patients and gathering history. You also may have CPR codes here or at the hospital and its a good chance to get real codes under your belt and be aware of the meds and changes. If you rock it, they may put you in charge to run the whole room. Thats how much they trust SOCMs.
  • ICU: I feel I could have utilized my time so much more wisely, I had all my questions afterward. Now is a good chance to ask Prolonged Field Care questions, study the medications being used (such as Norepinephrine and other pressors, don't get a lot of SOCM exposure on that) and ask them "why." The littlest things hurt patients in the ICU, and wound dressing changings, trachestomy cleaning, pressure padding and patient rotating seem so miniscule but can maim and kill patients. It's not as sexy as gunshot wounds and tourniquets but ICU is the hospital "PFC", so its good to know how much of a pain it is and how to juggle everything.
  • Bring a notebook and pen. If I didn't know something I didn't expect doctors to spoon feed it to or for them to catch me not knowing twice. I would go home and study what I wrote down, such as "using dexamethasone for nausea", or the like to reference later and possibly add to my end of course critique. It also sets you up for success because for the rest of your medical career you can always be in the mindset to stay humble, say "I don't know", then find out and be continually learning. Medicine changes every few years and what you learned now WILL be outdated one day. Graduation is the beginning, not peak of your learning if you do it right.
  • Physical Fitness: After 9 months of mostly studying, this last month is a good chance to start preparing for follow on courses and gates.  Get a process together so all the students can bring workout clothes in bags to work and change and head to straight to the gym right after work instead of going all the way back to living quarters.

     I hope this light guide finds potential SOCM students well and allows them to go in with an advantage. Looking forward to comments from graduates and Instructors so I can attempt to keep this post updated as best as it can. I know it's already changed a little since I graduated.


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