Civil Military Cooperation - Relevant Component of 21st Century Rescue Operations [INTERVIEW]

We have discussed the medical aspects of the SOF missions, and the civil-military cooperation in the medical rescue domain with Mariusz “Maniek” Urbaniak, former JW GROM Unit operator, and with Dr. Małgorzata Rak, MD, emergency medicine specialist.

Mateusz Multarzyński: During the SOFEAST conference, several panels would cover battlefield medicine and tactical emergency medicine. Why is that, that these matters are relevant enough to make their way into a conference covering the SOF domain?

Mariusz Urbaniak: Tactical rescue is an indispensable element of special operations. Each of the operators is acquainted with the TCCC basics. Should a need emerge, he would be able to help a teammate or a third person. What we’ve been witnessing globally, for a few years now, is the overlap of the military and civil medical experience. Operations conducted by SOF elements may also involve the provision of medical aid to persons injured in acts of terror.

D24: The SOF component medics, apart from combat training, also need to possess a significant “dose” of know-how and skills, when it comes to combat medicine. Can they be viewed as the elite, in the elite units?

MU: Let’s imagine a special operation taking place in an inaccessible area, where an injured person who took a shot that went through his chest would need to wait a few hours, to receive medical attention. This is why the medics in the assault squads are qualified to effectively react, should trauma as such emerge. This is why such medics need to have theoretical, and practical knowledge when it comes to combat casualty care. D24: Civil and military specialists can be found among the SOFEAST panelists. How this civil-military medical cooperation looks like, in practice? MU: I have managed to invite numerous foreign, and Polish experts dealing with combat medicine, to take part in the panel organized within the framework of the SOFEAST event. We carry out training jointly, involving both the military experts, as well as civil experts practicing emergency medicine. The events that have taken place in recent months - the injured policeman in Racibórz for instance - have shown that we need to be ready to handle the acts of terror, that are so common on the battlefield, in the civil environment. This forces us to transfer the experience, not only from the military to the civil world but also another way round.

D24: What are the contributions that the SOF operators may bring in this domain, from the point of view of a doctor, an experienced emergency medicine specialist? Is the combat experience of theirs useful in the world of civil emergency medicine, if, quoting you: Emergency Room is a battlefield, and doctors and nurses working there - are the soldiers?

Małgorzata Rak MD: The SOF experiences help us work in a far more coordinated manner. Copying the rules of communications, selecting the leader among a group with theoretically identical educational background, CRM rules inspired by aviation, all make it possible to act more efficiently, with fewer errors. At ER we are like soldiers a bit - we are fighting. In our case, we are fighting for the patient’s life. We also have a mission to complete, similar to the SOF operators. Sometimes, we need to use our determination, to overcome the emerging problems. Using the experience of former SOF operators is more and more often justified, in optimizing and accelerating the processes happening in the stressful and dynamic environment of the ER. They have been working like us - under stress, in a rush, with limited resources.

D24: I understand that we are dealing with a bilateral, mutual exchange of experiences, or new solutions here?

MU:  Naturally. Each of the parties shall share their experiences and implement what’s been proven to work. Here I am referring to tourniquets, that have been used in mass quantities by the military for several years, to become a part of the civil rescue toolkit afterward. We could have witnessed a similar story in the case of hemostatic dressings. Analogously, the military medics also take over certain procedures from the civil emergency medicine - but this is the story that our speakers would tell, during the “Medical response to 21st Century terrorist threat” panel.

D24: The coronavirus pandemic has been a major challenge for all nations suffering from it, as it has put to the test the effectiveness of the operation of the state systems, including the services taking care of the citizen’s safety, healthcare systems in particular. It was also a major challenge for the “army” of doctors, rescuers, nurses - without the sacrifices of whom, it would not be possible to fight the pandemic. This, however, is not the only event that would put the state emergency medical system to the test. Are we ready, in Poland, to properly and effectively react to other “mass events”? Not only does it refer to natural disasters, or mass accidents, but also situations similar to acts of terror in Spain, the UK, France?

MR: The COVID-19 pandemic has shown that some of the procedures are not tailored to handle mass quantities of people needing medical attention at once. This forced the rescuers, and the emergency medics, to pay more attention to the patients, as they had no option to transfer them to the destination hospitals. This has been somewhat reminiscent of prolonged field care principles (PFC). The medical rescue teams waiting in a queue in front of the hospitals, to transfer their patients, had to, similarly to a SOF medic working in field conditions, provide life support to a patient - sometimes, for an unspecified period. To handle mass events, we must conduct regular training and exercises, involving qualified personnel. We are currently preparing training with former SOF operators, covering different aspects of our work: working with the casualty, organization of activities, raising the threat awareness

D24: What role the medics from SOF units may play, bringing their knowledge to the table, in civil emergency medicine?

MU: Within the scope of the so-called “total defence” doctrine, using the know-how and skills of doctors currently engaged in the civil emergency system, would act as a catalyst for the undertaken actions. The personnel in question shall, and must be prepared for activities as such, by the SOF medics, whose experience is huge here.

D24: Can RTF teams be an example of such transfer of know-how?

MU: Of course. In my opinion, this is the best example of the overlap, between civil and military knowledge. Within the framework of training, we conduct with RTF teams, combat medics and SOF operators transfer their know-how to the members of the RTF teams (rescuers, emergency medicine doctors), so that they remain ready to work in the actual circumstances of a terrorist attack. More and more often, information emerges about the acts of terror with major casualties. To help these people rapidly, the civil rescue professional needs to work in realistically hazardous circumstances - for instance in the event of an active shooter situation.

D24: Even though the active shooter scenario has never occurred in Poland, it cannot be ruled out. The recent events - policeman murdered in Racibórz, or the shooting in Żyrardów have shown that situation as such may occur, and that probability is not low. Are the civil emergency medicine experts, rescuers in the rescue teams, ready to handle situations as such - in the context of dressing the gun wounds, rescuing victims of shootings, and within the scope of the knowledge on handling one’s safety, or working with other services, such as the Police’s CT units?

MR: : I have been dealing with gun wounds a couple of times, during my career. The rescuers and doctors who engage in emergency medicine have theoretical knowledge of the specific nature of military injuries. They do not have so significant practical experiences at hand. The SOF medic expects injuries like that to happen. A person working in a civil setting is often surprised by them. Inter-service cooperation at the hospitals is good. More coordination is needed in pre-hospital circumstances, along with communications. This has been shown by the exercise that took part in Działoszyn in recent years, covering the mass events. I was involved in that exercise as well. We are working within that scope, as we do see that there is a necessity to organize more joint exercises. One of them, planned this autumn, would be aimed at enhancing civil-military cooperation in response to an act of terror.

Thank you for the conversation.