egard to their capabilities. The NSCC will continue tofoster a climate of trust. Safeguarding national concernsis essential to information sharing within NATO.Currently, no standardized definition exists forNATO SOF non-credentialed providers. WhereasNATO has policies for doctors and nurses, it has restrictivepolicies for non-credentialed providers.NATO conventional non-credentialed medicalproviders are based on conventional medical supportsystems within MTFs in direct support of or in proximityto a credentialed providers. The author is gatheringnational input and consensus on the proposeddefinitions for NATO SOF medical professionals. Thiswork will be the foundation for development of initialand sustainment medical training requirements withinNATO SOF. The lack of a certain level of SOF medicalprofessional is not a sign of a nation’s inability tosupport SOF, but rather a planning consideration in theforce generation process.European Union and national policies currentlylimit advanced medical training and sustainmenttraining of non-credentialed providers who lack a recognizedcivilian equivalent medical provider. ManyNATO contributing nations have patriarchal civilianmedical systems, where the “doctor” is the primary decisionmaker and completes most invasive procedures;this is reflected in their concepts and policies relatingto HSS. Medical reforms within NSTI will revolvearound lessons learned and the realities of combat casualties’deaths that may ensue as the result of ColdWar medical polices and doctrine based around robusthost nation infrastructure and response. It is imperativethat a system be developed to enable the NSCC to bea gathering point of best SOF medical practices basedon lessons learned fed by input from SOF on currentand recent operations.Some contributing nations have limited or nopermanent medical staff within their national SOFcommand structures that limits their ability to effectivelyinfluence timely change. There are also nationalmedical structures that do not delegate authority ofSOF medical training requirements and points of instructionto their national SOF commands. This can beovercome by education of SOF specific medical requirements,best practices for joint level staffing/manning,SOF medical lessons learned, and best practicesto positively influence international chiefs of medicaldepartments, and mentor NATO SOF members whoare limited by people, funding, technology, or trainingrestrictions.The author will be engaging NATO’s conventionalmedical planners this spring at the NATO MedicalConference where he will highlight similarities andsignificant differences between NATO conventionaland SOF HSS capabilities and identify current gaps inrequirements. The intent will be to stimulate thought,generate dialogue, and make formal contact betweenthe NSCC and national SOF command level medicalstaff. At the NATO Medical Conference in the fall of2009, the author intends to engage NATO and Partnersfor Peace (PfP), SOF Surgeons, and medical plannersin a NATO SOF Medical Working Group (WG) to refineand further develop NATO SOF medical doctrineand policy. The development of an ongoing NATOSOF Medical WG will be reviewed at that time.This article gave a brief overview of the establishmentand development of the NSCC, and reviewedthe NSTI concept development. It proposedthe establishment of new NATO SOF definitions to defineSOF medical capability using the battle focusedtraining model. Through an understanding of the definitionof “SOF medical professionals,” sharing medicalintelligence resources, and identified best practicesfor medical support to SOF we can foster best practiceswithin NATO SOF. The article discussed the developmentof NATO SOF medical doctrine and policy, andreviewed some barriers to change. Lastly, it set anagenda for change over this coming year to establishrelationships between the NSCC and NATO <strong>Special</strong><strong>Operations</strong> medical staff at strategic and operationallevels. Please contact the author to provide input intothe development of NATO SOF medical doctrine andpolicy. Your contributions are critical to this effort andare essential to corporate understanding, improved interoperabilityand to establish NATO SOF common“capability” or definitions.12Journal of <strong>Special</strong> <strong>Operations</strong> Medicine Volume 9, Edition 3 / <strong>Summer</strong> 09
REFERENCES1. James L. Jones, “A blueprint for change: TransformingNATO <strong>Special</strong> <strong>Operations</strong>,” Joint Forces Quarterly; Issue45, 2nd quarter 2007, page 36.2. George W. Bush, remarks in Riga, Latvia, 28 November 2006.3. NSCC Handbook, 5 April 2009, page 7.4. Military Committee Decision 437/1, <strong>Special</strong> <strong>Operations</strong> Policy,11 Jun 2006.5. Allied Joint Publications 3.5, Allied Joint Doctrine for <strong>Special</strong><strong>Operations</strong>, 27 January 2009.6. AJP 3.5, page 2-1 through 2-4.7. Allied Joint Medical Support Doctrine, 2002, and MilitaryCommittee Decision 326/2, NATO Medical <strong>Operations</strong>, 2006.8. STANAG 2126, Ed 5, First Aid Kits and Emergency MedicalKits. STANAG 2122, Ed 2, Medical training in firstaide, basic hygiene, and emergency care.9. Allied Medical Publication (AMedP) – 17, Training Requirementsfor Health Care Personnel in International Missions,10 March 2009.10. Allied Administrative Publication-6, dated 2008.11. AMedP-17, Annex A2.12. Ibid, Annex B.13. AMedP-17, page v.14. ACO MEDAD Medical Directive, October 2008.15. John B. Holcombe, et all, “Understanding combat casualtycare statistics,” The Journal of Trauma Injury, Infection, andCritical Care; 60:2, 397-401.16. Recommendations based on findings of the Committee onTactical Combat Casualty Care, July 2008.17. John B. Holcombe, et al. (2007). Causes of death in U.S.<strong>Special</strong> <strong>Operations</strong> Forces in the Global War on Terrorism,Annuals of Surgery;245: 6, June.18. NATO Comprehensive Political Guidance, endorsed by NATOHeads of State and Government on 29 November 2006.19. AMedP-17, Annex A2.20. Ibid, Annex B.21. Ibid, Annex A2.22. John B. Holcombe, “Causes of Death in U.S. <strong>Special</strong> <strong>Operations</strong>Forces in the Global War on Terrorism,”23. USSOCOM Surgeons, CIPT for TSOST, 2009.24. Ibid.LTC Gary Rhett Wallace, MD, FAAFP, SFS, DMO is currently the Senior Medical Advisor andChief, NATO <strong>Special</strong> <strong>Operations</strong> Coordination Center Medical Branch. He is Board Certified asa Fellow of the American Academy of Family Physicians. He has had the honor of working inoperational billets and for U.S. Army <strong>Special</strong> <strong>Operations</strong> <strong>Command</strong> for 12 years, serving as aBattalion/Flight Surgeon, Group Surgeon, and at the USASOC/USASFC level before being assignedto NATO. He also has spent three years as a Flight Surgeon for the 1/17 (Air) Cav, andthree years as a Clinic <strong>Command</strong>er in Europe. He has had three combat tours to Afghanistanwhere he served once as a Battalion Surgeon and twice as CJSOTF-A Surgeon.LTC Wallace, can be reached at COM: +32 65 44 8262; DSN: 314 423-8262; or by emailat unclassified: Gary.wallace@nscc.bices.org; NATO Secret: wallagr@nsn.bices.org; U.S. SIPR:gary.rhett.wallace@eur.army.smil.milNATO SOF Transformation and the Development of NATO SOF Medical Doctrine and Policy13
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AUTHORS*75th Ranger Regiment6420 Da
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Casualties presenting in overt shoc
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PSYCHOLOGICAL RESILIENCE AND POSTDE
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spondents without PTSD (M = 4.6, SD
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patients, whereas the mean score of
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29. Whealin JM, Ruzek JI, Southwick
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average, time between return from d
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ing functioning in both PTSD (Zatzi
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Editorial Comment on “Psychologic
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Blackburn’s HeadhuntersPhilip Har
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The Battle of Mogadishu:Firsthand A
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Task Force Ranger encountered enemy
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Peter J. Benson, MDCOL, USACommand
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Numerous military and civilian gove
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Anthony M. Griffay, MDCAPT, USNComm
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This is a great read that speaks di
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and twenty-eight. Rabies immune glo
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Rhett Wallace MD FAAFPLTC MC SFS DM
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LTC Craig A. Myatt, Ph.D., HQ USSOC
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LTC Bill Bosworth, DVM, USSOCOM Vet
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Europe, Mideast, Africa and SWAU.S.
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SOF and SOF Medicine Book ListWe ha
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TITLE AUTHOR ISBNCohesion, the Key
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TITLE AUTHOR ISBNI Acted from Princ
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TITLE AUTHOR ISBNRats, Lice, & Hist
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TITLE AUTHOR ISBNThe Healer’s Roa
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TITLE AUTHOR ISBNGuerilla warfare N
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TITLEAUTHORBlack Eagles(Fiction)Bla
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TITLE(Good section on Merrill’s M
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GENERAL REFERENCESALERTS & THREATSB
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Aviation Medicine Resources: http:/
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LABORATORYClinical Lab Science Reso
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A 11 year old boy whose tibia conti
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Meet Your JSOM StaffEXECUTIVE EDITO
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Special Forces Aidman's PledgeAs a