USSOCOM Advanced Tactical Practitioner Certification

Ensuring the Right Training and
Techniques for the SOF Medic

by Captain Scott M. Gilpatrick,
Rick Hammesfahr and Bob Hesse

Medics in SOF units are considered the best of the best. The autonomy that they are given requires intense training, certification and strict continuing education requirements. All students of the Joint Special Operations Medical Training Center’s (JSOMTC) Special Operations Combat Medic Course (SOCM) at Fort Bragg, N.C., and the Air Force Pararescue (PJ) School at Kirtland AFB, N.M., take the ATP examination prior to graduation. Students must pass the certification exam to be a deployable combat medic assigned to any USSOCOM unit. Required continuing education and refresher training at the Special Operations Command Medical Skills Sustainment Course (SOCMSSC) is an important component of the CMCP. The SOCMSSC is the only method of recertification for the ATP and is required every two years. The ATP examination and SOCMSSC are critical in creating and maintaining the advanced tactical practitioner (ATP), a true combat multiplier on today’s battlefield.

WHAT IS AN ATP?

The ATP is a unique hybrid medic, whose baseline knowledge starts with meeting the cognitive and psychomotor requirements as a nationally registered EMT-Basic. From there, ATP education and training focus on a myriad of both medical and trauma management problems that are typically well above the scope of practice of many other prehospital care providers. Though trauma plays a large and important role in their training, medical emergencies, military-specific medicine, wilderness medicine and environmental problems are also highlighted. Since the special operations environment extends to virtually any place on the globe, regardless of time, season or weather, the ATP must be multifaceted.

Over the years, medical literature has noted the survival rate of trauma victims depends on the close proximity and timing of getting definitive care at the earliest opportunity. Moving a critically combat-injured patient, particularly in the special operations environment, to this definitive care setting is often impractical or impossible. For these reasons, the knowledge and skills required by an ATP are more extensive than those of a civilian paramedic.

Combined with very limited resources, the ATP must be able to think out of the box and solve complex medical problems while taking into consideration the unique operational environment of SOF. An ATP is not only qualified as a nationally registered emergency medical technician (NREMT) but also maintains certifications in advanced cardiac life support (ACLS), basic life support (BLS), prehospital trauma life support (PHTLS) and pediatric education for prehospital professionals (PEPP). These training pathways are only a small example of the depth and breadth of knowledge and skills required of the ATP. The scope of practice for the ATP is broad, yet controlled. Once certified, an ATP is prepared to treat patients in all environmental extremes, perform preventive medicine, dispense and administer medications, and perform multiple complex procedures—keeping in mind the mission requirements.

EVOLUTION OF THE ATP

In accordance with U.S. Code Title 10, Section 167, USSOCOM’s principle function is to prepare SOF for operations by organizing, training and equipping the force for its unique missions. Responsive medical education and training is fundamental to fulfilling this responsibility. When the medical needs of the modern day SOF were studied, it became clear that no existing certification program provided the advanced medical education, training and certification required. The need for the development of the ATP certification subsequently arose from the recognition that the current national civilian certification process, while working well for the civilian EMS sector, was not answering the requirements of SOF medics.

In the 1990s, SOF recognized the need to certify its combat medics to one standard. In fulfilling this need, the National Registry of Emergency Medical Technicians (NREMT) was utilized as the licensing and oversight agency for medical training of combat medics. With the different levels of certification, it was possible to develop different levels of training, which allowed for different levels of clinical responsibility (emergency medical technician-B, -I or -P). The degree of medical skills that were allowed by the health care provider increased as the level of certification increased. This certification process provided a manageable way to implement a graduated assumption of clinical responsibility and would dictate which clinical techniques could be performed by the different levels of training. In addition, the testing process was developed and managed outside of the military, thus allowing for independent verification that accepted EMS practice being followed by military health care providers.

Unfortunately, as global events developed along with the military actions in Somalia, Bosnia and Desert Storm, the dynamics of warfare and the non-linear battlefield made us relearn the lessons for previous conflicts. SOF medical personnel engaged in the global war on terror consistently provide medical care in situations that fall outside of the standard paramedic training and certification parameters. They are required to perform increasingly sophisticated invasive medical procedures and assume greater responsibility for prolonged patient care. A shift occurred in the training paradigm of civilian street medicine and the close proximity of definitive care as opposed to the current SOF global/austere environment with often limited and prolonged evacuation. This shift necessitated the creation of a unique, SOF medic training and certification program to ensure the best comprehensive combat medical care.

The CMCP and ATP programs are managed by the USSOCOM Surgeon’s Office at MacDill AFB, Fla. In 2001, USSOCOM moved from the NREMT-P certification to the SOF-P as its interoperable certification of competency. This was managed by the USSOCOM Surgeon’s Office as a state-like agency for certification and reciprocity purposes. The ATP program (in its current form) was established in 2003, and for the first few years SOF medics received automatic certification upon graduation from the JSOMTC or PJ course. ATP testing began in 2006 at both of the schools, mandated by USSOCOM Dir. 40-2 (soon to be USSOCOM Dir. 350-29—in the final staffing process). The ATP certification is a DoD-federal certification with the USSOCOM command surgeon as the medical director.

In 2003, a multidisciplinary board— composed of military and civilian physicians, allied health personnel and SOF medics—was established to develop the ATP certification examination for SOF medics. This board, termed the USSOCOM Curriculum and Examination Board (CEB), studied the needs on the battlefield as identified and analyzed by the requirements board (RB). The CEB established the current ATP test bank of questions and certification exam structure. The RB’s mission is to take the real-time frontline lessons learned and input from the field to develop a critical task list (CTL) for the SOF medic. The SOF combat medic CTL is annually reviewed and updated as necessary and serves as the basis for curriculum development.

In the past five years, the CEB and RB have evolved into extremely efficient and valid functioning bodies. Each board meets three to four times a year to carry out its duties as outlined within its charters. Identifying and analyzing the requirements and current accepted medical practice as well as subsequent curriculum development are all components of the ATP certification and recertification program. The program has shown tremendous success as evidenced by the high quality of battlefield care in Iraq, Afghanistan and other regions where special operations forces are deployed.

THE ATP NOW AND IN THE FUTURE

Currently, the ATP certification exam is open only to combat medics from the JSOMTC and PJ school. With an increasing focus on working in the interagency environment, possibilities are being explored to allow federal law enforcement involvement in the ATP process. Additionally, broader civilian agency recognition of the ATP certification is being explored. Approval was recently received from the Board of Critical Care Transport Paramedic Certification (BCCTP) for ATPs to be accepted as a paramedic level certification, therefore making them eligible to sit for the Flight Paramedic Certification (FP-C) examination. USSOCOM is also exploring with some state level EMS boards to offer the ATP and the JSOMTC/ PJ training programs reciprocity for their respective state paramedic certifications.

Recently, the CEB, with psychometrician input and lessons learned data, restructured the operating and exam process to match those of similar medical certifying agencies. Data from each test item are scrutinized and analyzed after each exam is graded. Questions are vetted through the CEB and are beta tested before they are utilized as a graded test item. This is a continually evolving process that makes for a better and more valid test each time it is given. The CEB established and annually updates a set of comprehensive tactical medical emergency protocols and a recommended drug list for SOF medics, both approved by the USSOCOM surgeon and component surgeons. These products lend to the ability of the ATP to operate independently in the austere environment and—more often than not—without professional medical advice. These are both distributed electronically and as a training supplement to the Journal of Special Operations Medicine.

There are many new and exciting prospects on the horizon for the CMCP, the ATP and those who will take tests in the future. Video scenario questions and computer-based testing are two natural progressions for the program. The CEB is also looking to establish the ATP test and process as the standard for tactical medicine in the prehospital environment. Also, there is an increasing discussion in the EMS community of the possibility of a civilian certification for an advanced level prehospital provider, a model that is very similar to the 18D, Special Forces medic. This is a problem the SOF community has already solved and established a standard for. The Special Forces medics and the advanced skill set they possess are a natural fit for this need in the medical community.

CONCLUSION

The ATP certification is the benchmark to ensure that every SOF medic is trained to the stringent standards of USSOCOM and possesses the same skills and knowledge throughout the command. In the expanding joint SOF environment, this becomes increasingly important. When a Navy SEAL medic works with an Army Special Forces or Ranger medic, everyone on the target can be sure they are ATP-qualified and capable of delivering the same high standard of care. When the MARSOC corpsman hands a patient off to a SOAR medic on a Chinook, he knows the patient is going into capable hands. The ATP certification meets the needs of assuring that the best and most competent combat medics in the world today are capable of the high interoperable standard set by USSOCOM for today’s and tomorrow’s SOF fight.

If you have questions about the USSOCOM ATP program or SOF medicine, you can e-mail the USSOCOM Department of Medical Education and Training at atp@ socom.mil or This e-mail address is being protected from spambots. You need JavaScript enabled to view it . ♦