vIntroduction
Twenty years have passed since the forerunner of this book, the last edition of The U.S. Army Special Forces
Medical Handbook, was published. The world has changed dramatically in those twenty years, with new
weapons, threats and diseases emerging. Advancing technology and an explosive proliferation of medical
information on the Internet have revolutionized medical practice. However, the mission of the Special Operations
Forces (SOF) medic has not changed: unaided, the medic provides care with limited resources in austere,
hostile, stressful, and isolated environments, without the capability to evacuate the patient for up to seventy-two
hours. The scope and standards of the SOF medical mission are radically different from those found in a fixed-
facility, fully equipped and staffed hospital in a peaceful setting in the United States. Few in the civilian (or even
military) medical profession ever are challenged with the conditions in which SOF medics practice medicine
daily. The SOF medic still has the ultimate medical mission. Despite the proliferation of medical information,
no single reference source has emerged addressing the varied and complicated needs of the SOF medic. As
a result, conflicting information and even misinformation have created confusion over the most basic medical
questions, possibly endangering the lives of those we are committed to helping. The SOF medical community
had to remedy this dangerous situation by creating a new SOF Medical Handbook, one that provides guidance
to medics in our special environment, answering the hard diagnostic and treatment questions as best as
possible. These answers are based on the best possible knowledge and tailored to the austere mission — in
plain, straightforward language, without excuses, conditions or academic musings.
The Handbook is written for SOF medical personnel performing the mission with the understanding that
medicine is not a sacred subject practiced only by physicians, but rather skills and knowledge that can be
learned and used to save lives. There is advice in this handbook that will be viewed as outrageous in traditional,
conservative, hospital-based medical settings. Only someone struggling with life and death decisions in the
difficult environment of a SOF medic can appreciate the need for this advice. In other contexts it could be
viewed as inappropriate, possibly even bordering on malpractice. Be advised that the Handbook has limited
application outside of the SOF context and is not intended for anything other than use by highly trained
SOF medics.
This Handbook is part of an evolving system, one that takes advantage of new information technology. The
printed version is limited by size constraints, so the system includes a CD that covers topics in more exhaustive
detail. On the CD you will find hotlinks in the text to even more information on the Web. Furthermore, we will
no longer stand for an obsolete text — the Handbook will be revised annually, with improvements in format and
updated information reflecting the rapid advances in medicine and information technology. We knew this project
would be immense and that the first edition would be incomplete. It is wiser to get this system in the hands of
SOF medics and start the dynamic process of evolution now than to wait years until the development process
was completed.
All the authors have experience with SOF and its environment. All were challenged with the same question:
“How would you diagnose and treat this patient if it was your wife, child or parent and you were alone,
with no assistance, evacuation or consultation, in an isolated environment, armed only with the most basic
of medical tools?” These authors struggled answering this difficult question, knowing they had to break with
the conservative paradigms of medicine, possibly facing the censure of their peers in doing so. The SOF
community and I salute your pioneering efforts. This Handbook will be instrumental in saving lives. We will
maintain the course — continually improving and updating the Handbook, helping medics make the right
medical decisions in the field, helping them save lives.
“Unconventional Warfare - Unconventional Medicine!”Colonel Steve Yevich
USSOCOM Surgeon