Prolonged Field Care published an article originally from the 2019 Special Warfare magazine on Survivability: Medical Support to Resistance which discusses “a whole-of society approach to preparing military and civilian medical resources that will build readiness and resiliency… improve casualty mortality rates and enable both resistance members and allied forces to sustain the fight.”
Hope is a primary driver of resistance movements, and the best way to keep hope alive in a resistance movement is to keep people alive. There are many aspects to enhancing survivability of a resistance movement, and medical support is one critical part. Doctrinal military health service support constructs, such as combat support hospitals or forward surgical teams, will be wholly inadequate to support resistance movements in a peer conflict in Europe for the primary reasons that they are overmanned and under trained. This article will discuss a whole-of society approach to preparing military and civilian medical resources that will build readiness and resiliency of our allies or partners, improve casualty mortality rates and enable both resistance members and allied forces to sustain the fight to regain territorial sovereignty against an illegal occupation. Medical infrastructure is vastly different in peacetime Europe than in more austere areas frequented by U.S. Special Operations Forces. Medical evacuations begin with calling 112, the European 911 equivalent, ambulances arrive to provide pre-hospital care, sometimes with physicians onboard, the patient is transported to a trauma center, and medical care is generally comparable to U.S. standards. If peer conflict occurs again in Europe, medical infrastructure will be severely degraded and significant obstacles to medical support will immediately arise, especially regarding extremely prolonged evacuation times and scarce resource availability. The U.S. military has not faced as severe a challenge to provide medical support since World War II. The SOF medical community has been bracing for the regression of medical support in emerging conflicts since at least November 2017 when U.S Army COL (Ret.) Dr. Warner “Rocky” Farr published The Death of the Golden Hour and the Return of the Future Guerrilla Hospital; yet the existential threat facing Eastern Europe poses the worst case scenario for medical support to resistance. The restricted mobility for friendly forces in territory occupied by a peer adversary will severely limit external medical support to U.S. SOF and our allied partners, including the resistance. The isolation of U.S. and allied forces in a denied environment will by necessity convert the delivery of medical care from a linear progression of medical evacuations from point of injury to higher echelons of care outside the combat zone, to a cyclical progression of evacuation, treatment, convalescence and return to duty, all completely within occupied territory.
A resistance scenario in Europe presents a unique risk to U.S. SOF supporting resistance movements, as organic capabilities will not be able to provide required medical support in this tactical environment. Recent exercises have demonstrated that U.S. SOF surgical teams will be severely restrained and may not be survivable in a denied environment, and conventional medical forces will likewise be absent. U.S. SOF medics are highly capable within their scope of practice, but over-inflation of their ability results in commanders miscalculating risk; a medic’s ability to reduce serious risk is often predicated on access to definitive care. The Maquis in occupied France and Partisans of Yugoslavia faced similar challenges in World War II but were still able to provide medical support despite great odds. The relevance of these historical precedents might be limited, however, by exponential advances in technology over the last 75 years. Providing medical support to U.S. SOF and resistance forces will be immensely challenging, but there is one great advantage over historical precedence: there is time and space now to enable ourselves and our allies and partners to be prepared to provide medical support to resistance prior to conflict, instead of reacting after a violation of a country’s national sovereignty.
BACKGROUND
In early 2018, SOCEUR conducted a multinational SOF exercise focused on irregular warfare and resistance in the Baltic region of Eastern Europe. Key medical lessons learned from the exercise were that medical evacuation in restricted areas during peer conflict is incredibly challenging, and U.S. SOF surgical teams as currently configured and trained will have low, if any, chance of survival in occupied territory. It was evident that planning medical support solely using only a U.S. military doctrinal construct was impractical and ineffective; civilian medical resources were identified as, and will necessarily be, the center of gravity for medical support to resistance. Resistance doctrine was turned to as a possible solution to the way ahead, but existing doctrine was found to be largely inadequate for the range of potential operational environments in future conflicts against a peer adversary in Eastern Europe. The focus of U.S. resistance doctrine on unconventional warfare and resistance movements assumes that conflicts have already begun or are ongoing. Furthermore, reverse engineering resistance constructs prior to conflict is difficult because it is impossible to forecast who and what will survive the initial invasion. The whole-of-society approach advocated by the Resistance Operating Concept was embraced as a potential solution for addressing critical gaps in providing medical support to resistance.
WHOLE-OF-SOCIETY APPROACH TO MEDICAL SUPPORT FOR RESISTANCE
The SOCEUR Surgeon’s Office has developed a whole-of-society approach to enable medical support to resistance (Figure 01) as a tiered approach to improve trauma care from point of injury through surgical intervention, convalescence and return to duty. Additionally, it aims to increase medical interoperability with Allies and partners in preparation for a resistance scenario in Eastern Europe.
U.S. SOF MEDICINE
The core of this approach begins with increased readiness for U.S. SOF. If peer conflict in Eastern Europe occurs, U.S. SOF medics will be required to treat casualties on extended timelines with limited supplies. Proficiency in Prolonged Field Care improves the SOF medic’s ability to do this, but is dependent on the medic’s ability to transfer casualties to higher echelons of care for definitive treatment or required convalescence. SOF surgical teams may be part of the solution, but will require manning changes and additional training in order to improve survivability in peer-adversary occupied territory.
Previously, the SOCEUR Surgeon’s office developed and conducted a course in UW medicine for surgical teams. This training was conducted as a proof of concept in Fall 2017, and was subsequently turned over to U.S. Army Special Operations Command with a request to further develop UW training for SOF surgical teams. Currently, the SOCEUR Surgeon’s office is continuing to develop Trojan Footprint as an opportunity for U.S. SOF medical units to practice UW medical tactics and techniques in a major exercise. The command is developing training opportunities for U.S. SOF medics and surgical teams to work in partner-nation trauma centers in Eastern Europe. This aims to achieve multiple objectives including enhanced interoperability of U.S. medical personnel and potential partners, information sharing regarding medical materiel and techniques and potentially to raise standards of trauma care as best practices are shared between allies and partners. The strong relationships that would be created by this course of action would be mutually beneficial. These types of training opportunities may be expanded beyond U.S. SOF to other U.S. military medical personnel, further increasing interoperability and alliance building. SOCEUR is also assisting USSOCOM to define the Special Operations Forces Baseline Interoperability Standards for medics and surgical teams. These efforts attempt to link SOF medical requirements to National Defense Strategy priorities in order to develop the force for the future, and not simply to fight the last battle. Finally, current U.S. SOF doctrine on medical support to resistance appears to have gaps in Eastern Europe’s potential operational environment, especially with regard to preparing Allies and partners to conduct resistance prior to conflict. Working with USASOC’s medical teams will help develop future iterations of doctrine in order to prepare U.S. SOF for best success in an extremely challenging environment… (continues)
Constitutional attorney and author John Whitehead has written an article on the need to practice the historic doctrine of nullification against government tyranny. The nullification doctrine says that states, local governments, and individuals have an inherent right to void laws they deem unconstitutional. Many readers may have heard of the specific case of jury nullification but may not remember from their history the nullification crisis of the early 1800s. In recent years, nullification has been surfacing again in the cases of immigration sanctuaries and second amendment sanctuaries.
…Everything the founders of this country feared has come to dominate in modern America. “We the people” have been saddled with a government that is no longer friendly to freedom and is working overtime to trample the Constitution underfoot and render the citizenry powerless in the face of the government’s power grabs, corruption and abusive tactics.
So how do you balance the scales of justice at a time when Americans are being tasered, tear-gassed, pepper-sprayed, hit with batons, shot with rubber bullets and real bullets, blasted with sound cannons, detained in cages and kennels, sicced by police dogs, arrested and jailed for challenging the government’s excesses, abuses and power-grabs?
No matter who sits in the White House, politics won’t fix a system that is broken beyond repair.
For that matter, protests and populist movements also haven’t done much to push back against an authoritarian regime that is deaf to our cries, dumb to our troubles, blind to our needs, and accountable to no one.
So how do you not only push back against the police state’s bureaucracy, corruption and cruelty but also launch a counterrevolution aimed at reclaiming control over the government using nonviolent means?
You start by changing the rules and engaging in some (nonviolent) guerilla tactics.
Take part in grassroots activism, which takes a trickle-up approach to governmental reform by implementing change at the local level (in other words, think nationally, but act locally).
And then, nullify everything the government does that flies in the face of the principles on which this nation was founded.
If there is any means left to us for thwarting the government in its relentless march towards outright dictatorship, it may rest with the power of juries and local governments to invalidate governmental laws, tactics and policies that are illegitimate, egregious or blatantly unconstitutional.
In an age in which government officials accused of wrongdoing—police officers, elected officials, etc.—are treated with general leniency, while the average citizen is prosecuted to the full extent of the law, nullification is a powerful reminder that, as the Constitution tells us, “we the people” are the government.
For too long we’ve allowed our so-called “representatives” to call the shots. Now it’s time to restore the citizenry to their rightful place in the republic: as the masters, not the servants.
NC Scout discusses parallels between the Chechen resistance against the Russian Army to Appalachian folk and the potential future fight against a standing army in the Appalachian region.
NC Scout discusses recent events and covers the foundations of preparedness communications with the license free options, the basics of amateur radio, and the equipment needed to get going.
This is an old post from John Mosby at the MountainGuerrilla blog. In Auxiliary Functions within the Tribal Structure, John lays out some of the important functions that can and should be performed by those members of your close-knit group who are too old, too young, or too infirm to help with more strenuous activities in the context of a resistance movement, should such fate ever befall you.
…By fulfilling those roles that the auxiliary has historically fulfilled in a resistance, that do not require the fitness or physical capabilities of the guerrilla force or underground, members of a tribe can still contribute worthwhile efforts to the security of their tribe, thus “earning their keep.”
An individual’s specific contribution to the efforts has—and will—depend largely on their socio-economic status, roles, and their occupation…a farmer or homesteader may “only” provide assistance by providing extra harvest to feed the guerrilla force or underground, or to sell on the local black or gray market, in order to help finance tribal operations. On the other hand, the farmer may end up providing barn space for a way-station on an evasion corridor, or for use as a guerrilla hospital.
Regardless of the specific role the auxiliary tribesman plays in the effort, it is critical to understand that the success of their efforts depends on their participation in such operations remains clandestine. The secret must not be kept only from rival organizations, but even from apparently friendly or supportive neighbors who do not enjoy the trust of being part of the closed circle—innangard—that is the tribe. Even other members of the tribe, outside the leadership, may not know exactly what the auxiliary offers the tribe. Keeping this information compartmentalized, even within the innangard, can reduce the chances that someone will inadvertently reveal it to someone that does not “need to know.”
Auxiliary Tasks
While there is really no task that the auxiliary might be able to perform, to support the tribe’s efforts, there are a number of roles the auxiliary has traditionally played that still offer a significant role for members of your tribe to contribute to your efforts of autonomy.
Security and Warning
One of the best efforts your auxiliary tribesmen can offer is the same that the elderly and young children, not ready to be warriors yet, have always provided a tribe. They can act as a physical security and warning system for the tribe. From simply standing watch during training exercises and meetings, to organizing and directing sympathizers into networks to observe, record, and report on the activities of other organizations—rival or not—in the area…
…While a civil war, by definition, has not yet started, I do argue that a domestic conflict has already started (my specific thoughts are here, here, and here).
There are plenty of naysayers, and I understand their logic. They advise listeners or readers, “Go to your local Walmart or grocery store. Your local doctor’s office. Your local bank. Walk out your front door and talk to your neighbor.” They ask if Americans are at war with each other in these places, and use these anecdotes to explain that America isn’t locked into a civil war and won’t be.
They’re right in that regard. America isn’t at war.
But the problem with their argument is that it’s not all of America fighting the culture war, nor is it all of America fighting in the ongoing domestic conflict. It’s an ‘irate, tireless minority’. (The brunt of the ‘fighting’ in this conflict isn’t being waged by the average American, as two of my favorite thinkers people in the world — Victor Davis Hanson and Niall Ferguson — have alluded to. You can read my review of Ferguson’s latest book here.)
Another reason why most Americans — the overwhelming majority — aren’t engaged in our domestic conflict is because we’re still really early. Those engaged in establishing the battle lines of today’s culture war were ‘innovators’ in the 1990s. Those engaged in the culture war through the 2008 and 2016 elections were ‘early adopters’. But once the ‘early majority’ joins as soon as 2019-2021, the evidence of an active domestic conflict could be overwhelming. That’s a very distinct possibility.
My estimate is that we have maybe a few percent of the population pushing left or right extremes at the center of the culture war, but there’s an even smaller percentage (a fraction) that actually engages in political violence. There’s probably another 10 percent on either side actively engaged in political, information, and economic warfare. The remaining 75 percent is on the bubble, indifferent, or just plain stuck in the middle — a lot like other intra-state conflicts we’ve experienced.
So can we really have a domestic conflict with just a few thousand combatants?
Well, yeah. But we’re probably still very early.
To understand why we’re still in the beginning phases of our domestic conflict, we can look at three concepts…
…We are so divided it’s like we are speaking two different languages. Hell, on this topic we are on two different planets. And it is usually framed with a sanctimonious left versus right, enlightened being versus racist hillbilly, unfailing arrow of history versus the knuckle dragging past sort of vibe…
Lower Valley Assembly 