SOCM After Action Review - July 2013

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Bloody_Limey
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SOCM After Action Review - July 2013

Post by Bloody_Limey »

I graduated the Special Operations Combat Medic (SOCM) program in June 2013 as part of my pipeline to become a Ranger Medic. This is a condensed evaluation of the course to give any other Rangers an insight into what to expect. Although the program constantly undergoes changes to make it more effective, the core components have remained fairly consistent throughout the course’s history. The biggest change to date is the recent addition of the 6-week Tactical Combat Casualty Care block after Combat Trauma Management. The addition of this block was intended to be a ‘putting it all together’ block of instruction and the feedback most of the cadre gave me is that it is an improvement on the old course.

Prior to attending SOCM, Rangers will have already completed Basic Combat Training BCT, Advanced Individual Training (AIT) at Fort Sam Houston to obtain their 68-Whiskey Military Occupational Speciality (MOS) and Airborne School at Fort Benning. These blocks of training were not physically demanding or particularly mentally challenging – but I consider them one of the most difficult times of my entire training for those very reasons: the general lack of ‘a sense of purpose’. BCT is a check-box to joining the military. AIT is a dummied down version of being a civilian First Responder. Airborne School is a 3-week school that could have been taught in 3-days. Welcome to Big Army… Lots of waiting around, wasting man hours, killing time doing ‘area beautification’ (picking up dead leaves and cigarette butts), 5 formations a day and the claustrophobic rules of the U.S. Army Training and Doctrine Command (TRADOC). You can’t go anywhere without a ‘battle buddy’ and are generally treated like a grown child. Especially difficult for me, as I was 38-years-old when I enlisted (I’m 40-years-old now) and had walked away from a good civilian career as a Registered Nurse. I make this point because there’s a misconception that Special Operations is going to be hard. It is, but it’s a challenge with a purpose and as such it’s very rewarding. Unlike Regular Army which can be so purpose-less that it’s challenging in a very different way.
Enough said.

After Airborne School you’ll go to RASP. There’s enough posts on ArmyRanger.com to evaluate RASP, so I won’t go into it here. As another Ranger said to me, “It’s nothing a real man can’t do.” and of course, “Never quit”.

Pre-SOCM is a different environment entirely. Up until now your experience in the military will have been almost exclusively physical. Now you have to switch gears and become the academic. It’s important to understand that as a SOCM you are considered a mid-level provider, because of the often austere and remote environments in which you will operate your scope of practice is comparable to a Nurse Practitioner or a Physician’s Assistant. PreSOCM is going to be your first introduction into that steep learning curve that really never ends. Many people can’t make that transition and decide here that being a Ranger Medic isn’t for them. The PreSOCM program itself has undergone many transitions. It used to include a 6-week civilian college course in physiology & anatomy at Columbus State University (CSU), just outside Fort Benning. However, that died when the Army began making budget cuts and cinched the purse strings on their Tuition Assistance. The loss of the program is a real tragedy. The three SOCM classes ahead of mine had an almost 100% pass rate for Rangers and in no small part the CSU course at PreSOCM set those Rangers up for success. The classes behind my graduating class did not have the luxury of the CSU course and it’s more than coincidence that there attrition rate is much higher because of it. Now, instead of the CSU course preSOCM Rangers are sent to obtain their Expert Field Medical Badge (EFMB). The EFMB is definitely going to help you, but what you learn there is not going to be put into practice until towards the end of the SOCM program and unfortunately, as many medical skills are perishable, you may find you’ve ‘brain-dumped’ a lot of what you learnt by the time you get to the end of SOCM.

I arrived at Bragg in June 2012. I’d been in the Army approximately 14-months, about the average amount of time from MEPS to SOCM. I in-processed post very quickly (a few days) and went straight into the first block of training. Be prepared to spend a few weeks in ATOT (Awaiting Training Or Transfer), which is the schoolhouse’s ‘reception’ platoon. Here you can find yourself doing anything from playing a casualty for the SOCM students to mowing the lawn. If you do find yourself in ATOT use the free-time you have to study and to work out. You’ll regret it if you don’t. Once SOCM starts, it’s a wild and furious ride with few respites to catch your breath.

There are six blocks in SOCM: EMT-Basic (yep, you have to go through EMT-Basic training again, even though you did it all in AIT); Anatomy & Physiology (A & P); Clinical Medicine; Trauma 1; Trauma 2; and Trauma 3. After which you spend 4-weeks on a clinical rotation at one of the 4 clinical sites (Virginia, two sites in Florida, and Michigan).

Each block of instruction is 6-weeks long and has its own cadre. There’s some pro’s and con’s to this. SOCM is a very close-knit environment. Class sizes are around 70 students or ‘operators’, which, over the course of the 10-month program will diminish to between 30 and 40 students. Each class will have a mixture of Special Forces (Green Beret’s) or ’18-delta’ students (some will be ‘legacy’ students – who have already completed some or all of their SF training; some will be ‘spiral’ students – for whom SOCM is the first part of their training after Selection); Navy SEALs; Civilian Affairs; and the 160th Night Stalkers. SF make up the majority of the students. Their military bearing is different to the Ranger Regiment. Over half your class could well be Non-Commissioned Officers (NCO’s). They’ll slap you on the back and will talk to you as an equal. They’ll tell you not to worry about standing at parade rest when you talk to them and basically have a very different standard of military bearing. And that’s okay. For them. For the Area of Operations (AO) that they will be going to, that’s okay. For Rangers, it’s not okay. You have to strike the delicate medium of blending in with them, without losing track of your military customs and courtesies. Otherwise, you will develop bad habits that will be hard to lose when you get to your destination.

Physical fitness standards will vary among your fellow class mates. Much as I am loathe to admit it, the SEALs are generally in the best shape of anyone. Although Rangers and SEALs have our differences, they’re definitely a good yardstick to measure your own performance by. If you can compete with them in the physical events, you’re probably doing okay. PT itself at SOCM is cadre-led. Sometimes your Ranger Liason will run PT just for Rangers. Sometimes the cadre of the particular block of training you are in will run PT. More often than not, PT will have a mixture of some kind of medical training. Think: buddy-carry’s; litter PT; log PT; laps of the schoolhouse and then starting IV’s on each other or splinting each other; and then more log PT… If you’re in good shape, none of the PT you do will be too challenging. I think I can recall about three smoking sessions during my entire time there where I actually came away thinking: That was hard. Some of the time you will be able to PT by yourself and other times (Trauma 2) you will not have much time to do any PT at all. My advice: make the time. Get up earlier. I had an average of 4-hours sleep per night during the entire SOCM course. I got up on average at about 3:30am and did an hour’s PT on my own and an hour’s studying before the morning accountability formation. Develop good study habits. That doesn’t necessarily mean you have to be a gnarly old sack of leather like myself who hardly sleeps – I would encourage you to get at least 5-hours sleep per night. But you really don’t need a lot more than that. If you’re sleeping for 8-hours you’re just plain lazy.

Block 1: EMT-Basic. Don’t underestimate this block. Almost everyone I know said the tests for this block were some of the hardest tests they’d ever done. It’s set up that way. You may think you know EMT-Basic. I’m sure you will at this point. But the type of questions that are in the tests are not just testing your knowledge of EMT-Basic, they’re testing your ability to think critically. You’ll have multiple choice questions where many of the answers are ambiguous and often at least two of the answers seem to be correct. You can almost always rule out two answers as flat-out wrong, but you may find yourself unsure which of the two remaining questions are correct. Rest assured, if you feel stupid, you won’t be the first – I went into it thinking I’d ace every test. I got an average of 85% GPA throughout this block and one exam I only just passed (76%). Use quizlet to study for these tests. Here’s a link to some of the study sets online:

http://quizlet.com/11111710/emtb-chapte ... ash-cards/

http://quizlet.com/23963634/socm-emt-ch ... ash-cards/

As a general rule-of-thumb, quizlet is one of the best study tools for SOCM. Lots of students have passed through the course and have made quizlet sets to help them. They will have study notes handed down to them from other students in their pipeline and incorporated those notes into their own. Use them. If you are struggling to find a set of quizlet study notes for a particular test, just include the search word ‘SOCM’ and whatever block you are searching for, e.g. search quizlet for: ‘SOCM’ and ‘Anatomy & Physiology’.

Here is a link to my quizlet profile:

http://quizlet.com/mandalorian

On the left, under ‘Sets’ you will see links to over 150 study sets, most of them for the SOCM program. Some of them I just ‘imported’ from sets that other students had written (so I can’t claim credit for them all, but my goal was to try to put as many SOCM quizlet sets in one place as possible). Read them with a critical eye as some of the information may have changed, but the majority of it should be solid.

The schoolhouse will provide you with an online account to the Moodle website, which hosts all of its slides and speaker notes – this will be your primary source of study reference and it is excellent. Many of the lectures are on MP3 format, so for instance, you can listen to a lecture on thermal burns while working out. As I mentioned, SOCM is all about optimizing your study-time.
If you’re daunted by all this studying – you should be. You’ll have formal tests and practical exams on average about twice a week throughout SOCM. Many of the tests are ‘GO / NO GO’. If you fail one block, you go to the Academic Review Board (ARB) where the cadre and Program Director will decide whether to give you a second chance. Many people fail the CTM block. I failed CTM. I was one of the few students to be given a second chance. The ARB will assess you on your GPA and your PT score (make sure it’s as close to 300 as possible, mine was 294 in SOCM, but my Ranger peers were scoring 300’s).

Pass this block and don’t fail anything. Also, be seen to have a good work ethic. The cadre of different blocks all talk to each other and rest assured, if someone sees you doing something good they will probably take note and may mention it to another cadre member. Equally true, if you do something dumb – news travels fast in SOCM and the grapevine is very unforgiving. Keep a low profile. Stay out of trouble. Work hard. Right place, right time, right uniform.

Block 2: A & P and Physical Exams.

This is the block where the 6-week course at CSU would have set you up for success. Many people find this block mentally challenging. Understanding DNA synthesis is not easy. There are many online tools you can use to help though. YouTube can be a great (free) tutor.

The culmination of the A & P block is the Gross Pin Test. You will walk through the cadaver lab and have to name various muscles, organs, nerves, vessels. You will have to state which nerve innervates which muscle. What endocrine gland secretes which hormone. Etc.

For the gross anatomy, I made a YouTube play-list to help me study:

http://www.youtube.com/watch?v=sp84mfLv ... VfxxFwPoFV

Similarly, for the ‘Special Tests’ pertaining to the Physical Exam, I made another play-list:

http://www.youtube.com/watch?v=taVMaab9 ... _ZM77gm-EY

I’m a visual learner, so watching was more helpful to me than reading alone.

Block 3: Clin Med.

Aka: death by powerpoint. Here you’ll have a lot of information imparted to you. Stay awake in these lectures. Don’t be ‘that guy’. I found it useful to skip lunch (so I didn’t end up in food-coma in the afternoon) and go for a 30-minute run instead during my lunch break. There’s a 1.6 mile trail (The Engineer’s Trail) right next to the schoolhouse that weaves through the woods. It’s a nice way to just clear your head and get the blood pumping by doing a couple of laps of the trail before the afternoon classes begin. You may even see some of the cadre out running it during their lunch too.

Clin Med is divided into two smaller blocks (‘A’ & ‘B’). Clin Med A is historically harder than Clin Med B. Basically, this will be your introduction to all the diseases and ailments of all the major systems (cardiovascular, immune system, genitourinary, etc). At some point during Clin Med you will have to do physical exams on each other, to include a digital rectal exam (DRE). Yep. You’re going to get real familiar with your classmates. You’ll also have to do vision tests to include fundoscopic exams. And at some point during the course wherever the dental instruction is now located you’ll have to inject a numbing agent into each other’s mouths to give each other the various nerve blocks.

Don’t get complacent in Clin Med. It’s a very academic block. But Trauma 1, 2 and 3 are just around the corner, lurking…
Here’s some more study material I put together on a play-list for Clin Med:

http://www.youtube.com/watch?v=TDoGrbpJ ... rYW8Y8YGt3

If you get through Clin Med, you’ll be feeling like you’ve got it in the bag. Wrong. Yes, many people will have fallen by the wayside at this point. You may have already lost 10% of your original class. Maybe more. But you’re only just scraping the top of the iceberg. SOCM gets gnarly very quickly.

Block 4: Trauma 1.

IV’s and splints. Incorporated into PT. Maybe a PT test at this point also. You’ll also do your Advanced Cardiovascular Life Support (ACLS) and Pediatric Education for Pre-hospital Providers (PEPP) certifications during this block. PEPP is pretty easy. ACLS is broken into practical and written tests. The practical tests are not to be taken lightly. It’s really worth getting to grips with the study material here as it’s the same in civilian medicine as it is taught in the schoolhouse. A word of wisdom: don’t get bogged down trying to understand the complexities of electrocardiograms. Keep it simple. Is the rate regular? Is it fast or slow? Is there a P-wave before every QRS complex? That should be enough to identify the rhythm. Be a master of the basics. I have some excellent one-page cheat-sheet/study guides for understanding heart rhythms and heart blocks that I would be only too happy to email you if you PM me.

There’s also some really good websites like, six-second ECG which will square you away:

http://www.skillstat.com/tools/ecg-simulator

I still use the six-second ECG website to keep my skills fresh. ECG interpretation, just like IV’s and splinting, is a perishable skill. Use it or lose it. It’s on you to maintain your knowledge once you’ve acquired it. Don’t get complacent. True, you may not be interpreting too many ECG’s as a Ranger Medic, but you’d be surprised. Maybe you’ll come across a civilian contractor who is having a myocardial infarction (MI). It would pay to know if it’s a right-sided inferior MI so you know whether to give nitroglycerine and morphine or not (if you give these drugs to someone having a right-sided inferior MI you can tank their blood pressure).

At this point, it’s worth mentioning that if you enjoy learning you’re already ahead of the curve. If you’re just going through SOCM checking the boxes to get to Regiment, you’re wrong. You need to genuinely want to be the best medic you can be for your buddies. There’s always something to learn. Cultivate an inquisitive mind. It will serve you well in the long-run.

Block 5: Trauma 2.

OPSEC restricts me talking about this block in detail. But if you’re familiar with the pipeline you’ll know what this block entails.
Firstly, Trauma Patient Assessment (TPA) is as one instructor described “a kick in the balls” (pardon my French). It’s a steep learning curve. If you haven’t begun studying the TPA sequence at least 4-weeks prior to getting to this block then you’ll be at a distinct disadvantage. Yes, they teach you it during this block, but really you’re expected to know it already. Many people fail TPA.

Next is the infamous Combat Trauma Management (CTM) which has the highest attrition rate of any other part of the SOCM course. On average, only about 80% of your remaining class will pass this block. It’s very hard. Your time-hacks are tight. You have to be expert at intubating and getting IV’s. You have to know your sequence backwards. Your weekends will be spent practicing. You will have hardly no free-time and you will have little sleep. Suck it up and knock it out.

It’s a nerve-wracking time. You can do it though, if you put in the hours and know your sequence thoroughly. Master intubation. And master IV skills.

By the end of Trauma 2, my original class had diminished from over 70 students to about 40 students... This is about average for most classes. Although some of those that fail will get a ‘recycle’, there’s no guarantees. Things that will help you if you go to the Baord: if you haven’t recycled anything else prior to Trauma 2, if your PT score is good (above 290) and if you have no disciplinary actions (or bad reputation in general). If you do have to go to the ARB, make sure you let your Ranger LNO know as soon as possible. His influence can save you at the Board. Also, if you do recycle CTM, you’ll have a great opportunity to teach the other students. Usually every CTM class has enough recycles to assign one to each small group (in CTM you’re broken down into lanes of 8 students and sub-lanes of 4 students, with two instructors per lane / one instructor per sub-lane).

My tip for CTM: KNOW THE SIX MAJOR BLEEDS!!! Facial (and facial with burns). Ax-pocket. Lat-fem. Med-fem. Mesenteric. And Brachial. The major bleeds never change. Nor do the sequences for each of them. If you understand how to identify and treat each of the six major bleeds in CTM you’ll be set up for success. But remember, if TPA was “a kick in the balls”, then CTM as the same instructor put it, is: “a battle-ax to the balls”… (again, pardon my French…).
It’s excellent training. I can honestly say I’ve never done anything so challenging as CTM. When you understand it and get it right it’s a good feeling.

Block 6: Trauma 3.

This block involves Tactical Combat Casualty Care (TCCC), which is the same as they taught during your 68-Whiskey training back in AIT and the EFMB if you did that at PreSOCM (remember, I said try not to brain-dump all that?). The key word is ‘tactical’. Think: return fire before you do ANYTHING! Stay low. Find cover. Otherwise you’ll end up taking some paintball shots to the face.
Very few people fail TCCC. It’s a chance to catch your breath and recover from CTM.

But don’t let your guard down. Next is Advanced Trauma Management (ATM, not to be confused with ‘ass to mouth’ or ‘automatic teller machine’). ATM will see you manage a patient in a more definitive care environment like a Forward Operating Base (FOB) where you will be managing a team of clinicians including another SOCM medic, a 68-Whiskey, and some first-responders who can do things like bag/ventilate your patient. The emphasis in ATM is on managing the patient care and leading a team. You have to know your algorithms. Electrical burns and Crush syndrome are two of the hardest scenario’s as they incorporate some ACLS scenarios as well as treatment of rhabdomyolysis.

(note, PM me for algorithm’s for these scenarios)

However, it’s an open book test. You can take your Tactical Medical Emergencies Protocols (TMEPs) into the test with you and refer to it (although it is not the easiest book to navigate). You can even annotate the pages with the ACLS drugs and sequences. There’s no reason for you to fail this block, but every class loses 3 or 4 people here. It’s not easy. But students are often so burnt out by this time that they don’t put in the hours required to study. Don’t be that guy.

Once you’ve passed ATM, you’ll do a brief Field Training Exercise (FTX), where you’ll have some fun out in the field for about 5-days taking turns being the lead medic in a 4-man team responding to various real-world tactical scenario’s. This is great training. You’ll be out in the HUMVEE’s and you’ll be working with the canine’s too. Lots of fun. Comparable to Camp Bullis at AIT, but without the TRADOC nonsense. There is a rumor they will start incorporating Blackhawks into the FTX also.

Finally, you’ll finish Trauma 3 and go on your 4-week clinical rotation. At this point you’re pretty much done. No one really fails their clinical rotation unless they do something stupid like get caught fraternizing with the staff or get drunk and get into a fight, etc… If you’re going to get caught doing that then reap the whirlwind brother – you just flushed almost a year of the hardest military medical training down the toilet for nothing. Congrats. If however you want to get the best out of the experience, try to get selected to go to Flint, Michigan. It’s a new clinical rotation venue and much more dynamic that the other locations of Virginia and Florida. That’s not to say you can’t get something out of the other rotation sites, but they won’t compare to Flint.

In May 2013, I had the honor of being the first Ranger Medic to go on clinical rotation to Flint, Michigan. One of the reasons Flint was selected as a clinical site is because it has one of the highest rates of penetrating trauma per capita in the United States. This is a direct reflection of the crime rate. In 2011, the Wall Street Journal voted Flint the ‘Most Violent City in America’. The homicide rate backs this up. In 2012, Forbes rated Flint the sixth ‘Most Violent City for Women’. During my brief 30-day rotation, a woman in her 70’s was raped so violently her acetabulum was fractured, and a woman in her 20’s was shot in the head in a drive-by shooting. She was 18-weeks pregnant.

Yet Flint used to be a thriving city back in the 1940’s, comparable to New York and Los Angeles. Still known as ‘Vehicle City’, Flint was the home of General Motors and as the automotive industry boomed, so did Flint. As one of the Sheriff’s related, “The problem with Flint is it put all its eggs in one basket. When General Motors moved out of Flint, so did the jobs…”. Before the 1973 oil crisis and subsequent collapse of the automotive industry, GM employed over 80,000 people locally. By the year 2000, this number had dropped to just 8,000. As the jobs and people left, the crime rate soared. These facts took on a greater meaning to me when I met some of the inspiring individuals who had stuck with Flint, even when the money left. One Emergency Department (ED) doctor had worked at Hurley Medical Center (the only level 1 trauma center in the region) for over 20-years, and his father had worked as a physician in Flint before him. Many of the Sheriff’s and Deputies had generations of their family who were born and raised in Flint. With their qualifications, they could easily have moved away and found a better place to live. But they didn’t. If you have the fortune of going to Flint on clinical rotation you’ll be impressed by the character of some of these people. The ones that stayed are a tough breed who don’t quit easily. As Rangers and SOF medics – that’s an attribute we have drummed into us day-in day-out.

Flint was sucker-punched when GM pulled out. But it has a second chance to come up fighting. The three universities in the area – Mott Community College, the University of Michigan, and Kettering University – are slowly reinvigorating local development. The SOCM program undoubtedly plays a role in that redevelopment. Hurley’s connection with the Joint Special Operations Medical Training Center gives it a prestige that few hospitals can claim. This was apparent the day we arrived. We were treated as if we had come to pull Flint from the depths. The hospital staff were briefed not to ask anything about our personal lives, not even our last names. Hospital admin had done an amazing job of boosting our mystique. Our black scrubs helped too… But what really paid off for us was our training.

Before you go to Flint, it’s well worth studying the American Heart Association’s Rapid STEMI Identification course because a large number of the calls you will respond to on the paramedic part of your clinical rotation will be cardiac. Understand what is meant by ‘reciprocal changes’ on an ECG. Refresh yourself on your ACLS drugs and cardiac rhythms. Flint is an amazing opportunity and a perfect end to the grueling 10-month SOCM course.

One of the incidents I remember most clearly from Flint was being called to the scene of a 5-year-old girl with Croup. It was the first time I’d actually heard that ‘seal-like bark’ they refer to when describing the cough of someone with Croup. It’s very distinct. There was already a civilian paramedic at the scene and two other SOCM medics. We made the mistake of trying to meliorate the patient on the scene. A hot bath was run and one of the medic’s sat in the bathroom with the child on his lap so she could inhale some of the moist air (this is one way to treat the symptoms of Croup). Meanwhile the civilian paramedic spent some time trying to find out the correct dose of racemic epinephrine to administer to the child via nebulizer, then gain consent from Med Control to administer it. Really, what this child needed was ‘bright lights and gasoline’. She needed to be transported to higher care urgently, but we stayed on the scene for what seemed like 10-minutes trying to provide some care for her before transporting. That was wrong. And you may find yourself in a similar situation. Learn from your mistakes. The child was fine, but she needlessly underwent 10-minutes of various medics trying to help her at the scene when the best treatment would have been rapid transportation.

I would encourage you to keep a journal during your clinical rotation and indeed throughout SOCM. Your experiences may prove invaluable to other Rangers going through the SOCM pipeline. It’s crucial that we help our brothers out. Keep online notes and keep track of your study material then ensure you pass it on.

The very last hurdle you will have to face is the Advanced Tactical Practitioner (ATP) exam. This is a USOCOM test (not a schoolhouse test) where an external proctor will come in and administer the exam. It’s 100 questions and it’s an open-book exam (you are given a copy of TMEPs, but you are not allowed to bring your own copy in because yours will be packed with your own annotations). You won’t find out if you passed the ATP until towards the end of your clinical rotation, but you can find out earlier if you email ATP@socom.mil and politely request your test results (don’t tell everyone this as they will probably curtail the use of requesting individual results by email if 40 guys all email at once asking for their test scores…).

Your ATP is your license to practice as a SOCM medic. Once you graduate you’ll have your Enlisted Record Brief (ERB) updated to include your Whiskey-1 (W1) Additional Skills Identifier (ASI). You have to renew your ATP every two-years to keep it active. This is done through a short refresher course back at the schoolhouse. You’ll also have to either extend or re-up to meet the required 26-months you need to give Regiment upon graduating SOCM. Usually this will only require you to extend for a few months if you haven’t recylcled more than one block and have transitioned fairly smoothly through all the various schools prior to SOCM.

Note, when you get to Regiment almost all of your tactical protocols will come from the Ranger Medic Handbook. So, be flexible as TMEPs and the schoolhouse teach things slightly differently than Regiment. If you take leave to PCS between Bragg and Regiment, that would be a good opportunity to look over your Ranger Medic Handbook (but mostly, I’d just enjoy your leave, you’ll have earned it).
If I have unintentionally violated any aspects of OPSEC here please contact me by PM and I will edit this post accordingly. Also, if you are a Ranger Medic about to start the SOCM program and have any questions at all about the course please feel free to PM me and I will be only too happy to help.

RLTW

© SPC P K, RN/NREMT-P/ATP
Last edited by centermass on January 13th, 2015, 7:36 am, edited 2 times in total.
Reason: Edited to make sticky
"The truth about the world is that anything is possible. Had you not seen it all from birth and thereby bled it of its strangeness it would appear to you for what it is, a hat trick in a medicine show, a fevered dream..."~CORMAC MCCARTHY
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Jim
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Re: SOCM After Action Review - July 2013

Post by Jim »

That's clearly the platinum-grade SITREP! Very important for all the Ranger Medic Mentees. Never, never quit!
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Re: SOCM After Action Review - July 2013

Post by Dreadnought »

Good information for those wanting to be medics in the 75th.
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Re: SOCM After Action Review - July 2013

Post by Sleepy Doc »

Well, there you have it. We should make this a sticky in the MED section. I don't think there is any question about SOCM that wasn't answered by that.

I was talking to someone about the training we had gotten before the advent of SOCM, and how it really should be a seperate MOS, no just an identifier. If this doesn't prove that out, I have no idea what would. It also shows just how much the course and focus of the Medical section has changed. As far advanced from the "sticks and rags" of old, so this is from what we were doing. This truly shows that the medics that graduate SOCM are the absolute best. Period, end.

Awesome work, Limey! (BTW, good advice about not forgetting one's bearing. I had my ass smoked-up like a Philly blunt after returning from 16 weeks of paramedic school with long civilian hair and affect to match.. not a pleasant memory..)
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Re: SOCM After Action Review - July 2013

Post by ConstantineCS »

Roger, Ranger Bloody_Limey
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Re: SOCM After Action Review - July 2013

Post by ASUlaxman »

I'm currently in Pre SOCM right now and to tack some up to date info on to that awesome post, we are currently enrolled in CSU again. It's not something to take lightly, the biology course is intended to be a semester long course crammed into 6 weeks. If you get lower than an 80% you'll be dropped from the program and sent to worldwide, or lower than a 70% and you'll have to pay the money it cost to attend back to the army. We're learning a great deal about clinical medicine here and we have to test on physical exams weekly. That coupled with the A&P experience we get from CSU, I imagine, is a huge advantage above all others attending SOCM. The EFMB testing was a one time thing. There are some guys I'm here with that we're afforded the opportunity to test a couple months ago before I showed up, but to the best of my knowledge Regiment doesn't test for EFMB very frequently.

ASUlaxman
"It's not who wants it the most... When a man enters the ring he wants to win just as badly as the guy on the other side. The question is does he still want it as bad in the 12th round as he did when he entered the ring" - Tony Sanchez

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ukambobp
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Re: SOCM After Action Review - July 2013

Post by ukambobp »

Bloody Limey,

First off, thank you for taking the time to post such a comprehensive review of the SOCM course in a public forum. As an EMT in the UK ambulance service, I can safely say that my practical education has not begun to scratch the surface of that taught in SOCM.

I understand that you are busy, but I would greatly appreciate any information you could provide. Also, I understand the need to protect your own security and not be "that guy" talking about things he shouldn't be. As such, if I could ask one burning question (at least to start)- what are the sequences for the 6 major bleeds? Or alternatively, where could I find them? I've searched Google with various search terms, searched your Quizlet notes, the Rgr Med Handbook and the SOF Med Handbook, and can't find them.

If you can't tell me, no worries, I wouldn't want to get you in any trouble. Either way, awesome move taking good medicine to bad places.

Kind regards,

Ben.
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Re: SOCM After Action Review - July 2013

Post by Doc_Dino »

Ranger Bloody Limey,

This information is gold. I have recently submitted a RASP 1 Application packet( I am an active duty medic so its a little different from you option 40 guys) and I am waiting to hear back if i have been accepted but I have had so many questions in the mean time. Any former rangers I have talked to were not medics and could not answer any of my questions about the SOCOM course and even the recruiter has very limited information for me about it. your post was extremely detailed on what to expect and I am sure this information will prove very useful if i am given the opportunity to make it there.

Thank you
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Re: SOCM After Action Review - July 2013

Post by Bloody_Limey »

Had a lot of great feedback from this post, which I really appreciate. I've been at 2nd BN for 18-months now. Upon arrival I found out that both of my predecessors had been RFS'ed. Oh great, I thought, it's just a matter of time before I go the same route I'm sure. So I broke it down into "Things I have to do before getting RFS'ed" (you may laugh, but some of you will know how I felt). Top of the list was "Deploy". Which I did. Big deal, right? But it kinda was for me.

As a Ranger there's two big training events that stand out in the training cycle: MLATS and TFTs. As a Medic, you can add CTM to that. CTM which is Regiment-based (not schoolhouse). It's annual and it usually runs between a week (all 7-days) and ten days.
Once you get a training cycle done (MLATS, TFTs, and CTM) you get to understand your role a lot better and you get accepted into the organization as someone who is no longer a complete rookie. By that I mean, your boss will expect you to square away the new medics who arrive after you. So you're no longer the bottom of the pecking order, and that's a good feeling. Then of course, once you've got your tab you're golden. But unless you plan on extending or re-enlisting, not every medic will get a chance to get their tab. That will irk a little when you see new Privates arrive and then come back with their tab and get their E-5 in the same amount of time it took you to go through half of SOCM...

However, the best advice I was given when I arrived here was: Don't get broken.

I proceeded to disregard that advice completely.

My first MLATS I tore my pectoralis major completely off the bone. Got it caught on a static line (and no, I wasn't chicken-winging it as I exited the bird - it wasn't my static line). Got that fixed by the Ortho PA, who himself was a Ranger Medic. They sewed the tendon stump back on to the bone.

My second TFTs, I dislocated my elbow (same arm as my pec injury) and tore the lateral and medial ligaments completely off the bone as well as the common flexor tendon and part of the common extensor tendon. Although neither of those injuries stopped me deploying.

The biggest things you learn as a medic when you get to Battalion, trauma-wise, are how to manage more than one casualty in a variety of situations, all of which will be at night, wearing NVGs.

The best advice I can give you once you get to Batt: Don't complain about how hard it is to see with NVGs. It's the same for everyone. You're not special. Carry a little piece of cloth for cleaning lenses and have it in an easily accessible pocket. Clean your NVG lenses often. Take the time to make a decent counterweight and put it in the back of your OPSCORP, so your helmet doesn't slide forward with the weight of your NVGs. I've seen dudes make counterweights out of strips of metal taped together. Batteries are too bulky.

People say, "don't horde supplies". I would say, "horde supplies", just the way the fiscal year and the budget works means that there will come a time when you're just short of something essential, like a needle D, toradol, constricting bands, lip balm, sudogest, whatever... and there will come a time when someone will need one of those things and it won't be in the Aid Station. You can say, "Don't worry, I got you covered" and go get one from your locker.

Never miss a chance to square someone away, medically, even if you're tired.

After a big training exercise, don't wait for guys to come to you with their troubles. Go around and ask how everyone is doing. Be pro-active.

Teach RFR often. 'Pocket-book RFR' is the way it's done. Short and sweet and on the run. And don't teach them how to do IVs until they've mastered the basics. Every 11-Bravo wants you to teach them to do an IV, because it looks cool. But if they can't put a tourniquet on blindfolded in under 20-seconds then there's really no point teaching them to do an IV. And when you DO teach them to do IV's, after they've done it once, grab a set of NVG's and then teach them to do it in the dark. Or at the very least with a red lens.

Make sure you teach RFR's to do thorough blood sweeps. You can't reinforce that enough. My boss would say, "The wound you miss is the wound that kills them", and he's right.

Then, as a new medic, get really comfortable with setting up and running a Casualty Collection Point (CCP) and with Mission Planning. And don't wait for someone to teach you - go pester them to show you.

Get comfortable with talking on the radio. Don't overthink it.

Be confident. Be a rockstar. At this point, you probably are anyway, so you don't even have to fake it.

:)
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Re: SOCM After Action Review - July 2013

Post by Disinfertention »

Elbow looks fine. What's the big deal. 8)
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Re: SOCM After Action Review - July 2013

Post by Bloody_Limey »

Very Humerus.
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Re: SOCM After Action Review - July 2013

Post by rangerjd »

Bloody_Limey wrote:Very Humerus.
That's why they call it the 'funny bone' right?
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