Dakota First Responder

• Can we create a program that can be fielded at our organizational level and sustained for future operations? The purpose of DFR is to close a criti cal gap between the lifesaving capa bilities of combat medics and combat lifesavers (CLS) using the most up-to-date resources and data available from the Committee on Tactical Combat Ca sualty Care and the Joint Trauma Sys tem. DFR does not change anything taught in those courses, but rather is built on their foundation with a week of training that focuses on sustaining life in an austere environment.

Training

CLS certification is required to be a candidate for DFR. Senior line medics identified top CLS performers from their troops, and this list was then vet ted by the troop command team to identify the strongest candidates for the program. Candidates are split into four-person teams at the beginning of the course, with a focus on evenly mix ing military-occupation specialties so they could each learn from each other. DFR is a five-day program combining didactics and hands-on learning, with testing on the fifth day. Each day is concluded with every candidate per forming DFR battle drills involving a multi-trauma casualty. As the course progresses, the casualty becomes more complex, requiring advanced medical treatment – with the corner stone of the treatment being to Figure 1. Troopers with 2nd Squadron, 13th Cavalry Regiment “Dakota,” 3rd ABCT, 1st Armored Division (Rotational, 2nd Infantry Division/Republic of Korea (RoK)-U.S. Combined Division) react to a chemical environment during the DFR Course conducted at Camp Hovey, RoK, April 21-25, 2019. DFR provides week-long advanced CLS training to increase survivability and readiness. (Adapted from DFR video, videographer SGT Alon Humphrey, 3rd ABCT, 1st Armored Division Public Affairs) 25

Winter 2020 stabilize the casualty for up to 72 hours. This goal is achieved with the inclusion of intravenous access, ad ministration of resuscitation fluids and medication, and the monitoring of ca sualty vital signs. Candidates are also trained on managing multiple casual ties, to include operating as the senior medical person at a casualty collection point or ambulance exchange point with casualties requiring triage for evacuation.

Testing Our squadron has been called the “Swiss army knife” for 210 Field Artil lery Brigade because we provide a multitude of capabilities outside the brigade’s modified table of organiza tion and equipment, in addition to our reconnaissance and security special ties. We have adapted to meet a mul titude of missions and earned the nickname, but we master the role of the cavalry scout. Every step of DFR in corporates the scout mindset of recon and security.

During testing, the DFR teams perform a recon mission to gather and report intelligence on a named area of inter est. The operations order delivered on Day 4 outlines the parameters which include liaising with forward elements and transferring responsibility of casu alties to a trailing security team. By controlling these aspects of the sce nario, we create believable interac tions with other U.S. forces and im prove training. We also prevent delay-of-movement along the testing lane. DFR candidates have said that having scenario-based testing vastly im proved this program in relation to any other training they’ve received. It pro vides clear guidance and allowed them to perform the role of the DFR during an actual mission.

Validation for candidates is measured by completion of a 40-question writ ten exam on Day 4 and practical test ing on Day 5. The written test requires a score of at least 80 percent to pass. The practical test uses a standardized algorithm drawn from Training and Evaluation Outline medical individual-task-performance steps. Proficiency is tested on both day and simulated night (low-visibility) lanes using go/no-go criteria.

Sustaining skills Sustainment training for DFR is de signed to emulate continuing medical education for medics, physician assis tants and doctors. We developed a monthly DFR training schedule aimed at building on skills learned in the course. As a perishable skillset, it is important to maintain the validity of the certification.

We have also identified being absent from sustainment training as cause for losing DFR status. To maintain status, a Soldier must be present for at least nine of 12 sustainment-training oppor tunities in a year. Alibis are available for Soldiers who have these legitimate training absences:

• Ranger School;

• Noncommissioned Officer Education System schooling;

• Temporary-duty tasking; or

• Individual-augmentee deployment. These are just a few reasons a Soldier may miss the nine mandated training events. For an additional alibi, the medical team has developed a hands-on and written refresher test that will allow a Soldier to maintain his or her certification based on performance. Sustainment training has also been identified as the best way to add infor mation that pertains to a changing mission. Our current focus may not be the focus six months from now; we can use the sustainment time to key in on new areas such as wildlife or envi ronmental hazards.

Conclusion

DFR is the innovative scenario-based training that successfully bridges the capability gap between combat Figure 2. Troopers with 2-13 Cavalry learn how to insert an intravenous line during the DFR course conducted at Camp Hovey, RoK, April 21-25, 2019. (Adapted from DFR video, videographer SGT Alon Humphrey, 3rd ABCT, 1st Ar mored Division Public Affairs) Figure 3. Figure 3. Troopers from 2-13 Cavalry learn how to insert a nasogas tric intubation to prevent choking during the DFR course conducted at Camp Hovey April 21-25. (Adapted from DFR video, videographer SGT Alon Hum phrey, 3rd ABCT, 1st Armored Division Public Affairs) 26

Winter 2020 Acronym Quick-Scan medics and CLSs. DFRs maintain le thality by increasing survivability in the harshest and most remote envi ronments where U.S. armed forces wage war. They specialize in interven tions relatable to the unit’s current mission and increase the medical web of support. This program is essential for your unit toolbox and ready to be fielded on predicted near-peer battle fields.

CPT Raymond Oberle is the squadron physician assistant, 2nd Squadron, 13th Cavalry Regiment, 3rd ABCT, 1st Ar mored Division, Fort Bliss, TX. Previous assignments include battalion physi cian assistant, 25th Brigade Support Battalion, 1st Stryker Brigade Combat Team (SBCT), 25th Infantry Division, Fort Wainwright, AK; and battalion physician assistant, 3-21 Infantry Reg iment, 1st SBCT, 25th Infantry Division, Fort Wainwright. CPT Oberle’s military schooling includes Basic Noncommis sioned Officer Course Phase I, Drill Ser geant School, Interservice Physician Assistant Program and Basic Officer Leader’s Course. CPT Oberle holds a bachelor’s of science degree in physi cian-assistant studies from the Univer sity of Nebraska and a master’s of sci ence degree in physician-assistant studies, also from the University of Ne braska. His awards and honors include Armed Forces Reserve Medal with M device and the Military Outstanding Volunteer Service Medal.

ABCT – armored brigade combat team CFTF – counterfire task force CLS – combat lifesaver DFR – Dakota First Responder RoK – Republic of Korea MEDEVAC – medical evacuation SBCT – Stryker brigade combat team