The Guerrilla Assault Medic

 

Guerrilla Assault Medic

Hacking for Austere Medicine

 

By DISRUPTOR 26

Of the SENTINEL SOCIETY

 

“Strike an enemy once and for all. Let him cease to exist as a tribe or he will fly at your throat again.” -Shaka Zulu 

0.0 Abstract

 

     The great Hannibal Barca of Carthage said: “Test yourself with fire and ice, sand and sea, bile and blood, before your enemies do.” And also… “Pain is ever the best teacher. Pain is only weakness leaving the body. Death is only pain leaving the body.” Hannibal had crossed the alps, invaded Italy, and marched on Rome, (circa late 200’s BC). He united the Gauls, Greeks, Sicilians, and other mercenaries. Equipped with War Elephants his tactics have reigned throughout history as one of the greatest Military tacticians of all time. He was both methodical and medical minded. His attention to detail and sustainment practices allowed him to be a formidable force for decades. Hannibal was an expert at guerrilla warfare; subversion, psyops, attrition, and reconnaissance.

0.1 Overview

 

     Types of field medicine can be categorized as: tactical, austere, wilderness, disaster, pre-hospital, improvised, and deployed medicine. In many ways these categories overlap one another. We’ll give it an umbrella term for this article, that’s all encompassing, and title it; “Guerrilla Assault Medicine”. This article is an attempt to blend all of the above categories and shift perception of resourcefulness and give perspective as it pertains to unconventional medicine. 

 

    Medics on a team are in the highest demand. They can perform surgery using tools out of a craftsman tool box or found in nature. They operate in the darkness of night, in a desert that’s sub 30 degrees, in the jungles, in a subterranean setting, or in your mom’s single wide trailer home. They can free a person of their demons like Spawn or Constantine. The guerilla assault medic is the witch doctor, the zulu, the medicine man. The one who can create pure fuckin’ magic by hunting, harming, and healing. It’s where medicine meets; tactical objectives, strategic planning, and logistical prowess. 

 

     It’s important to note that technologies such as artificial intelligence, electronic warfare, and machine learning have the most immediate impact right now in the battlespace. These technologies will improve human understanding, optimize day-to-day human functions, enhance manned & unmanned teaming (MUM-T), and give better warfare analytics. Technology can help close the kill chain faster. ‘The Kill Chain’… meaning: information leads to understanding, which leads to decision making, which leads to action. Or quickly put; ‘See. Think. Act.’ Much cognitive burdens of the kill chain may be pawned off to well-trained machines. Especially in times of unknown diagnosis of a patient or patients. Searching buildings in urban environments for close quarter combat situations. Signal hunting radio frequencies with AI and machine learning drones among other implementations. A deep neural network oriented microcomputer can and will save lives in the near future. So be prepared for having another “medic teammate” in the form of a machine. 

 

     In the near future militaries at every level will have some sort of AI or machine learning loaded platform within its kill chain. We must approach the medical kill chain as if we were JADC2. Joint All-Domain Command & Control; a strategic warfighting concept that connects the data sensors, shooters, and related communications devices of all U.S. military services. We want to put sensors on everything and streamline communications for our battle network in an effort to supplement patient care. It’s no mistake that when you watch tactical sci-fi movies you see a soldier’s vitals displaying on the main screen in some fake pentagon war room or on a spaceship’s command center. Art imitates life, until life imitates it. Keeping that in mind. We want to bring unconventionality to the forefront. That means building unorthodox tools, having irregular skill sets, and creating out of the ordinary machines to onboard situational awareness with your team and the population you serve. This is your ground zero; your foundation for higher learning; in that we put sensors on everything! We think of both humans and machines as sensors. These sensors can provide active intelligence in real time. 

 

     A medic must always have their finger on the pulse of the medical industry, continuously conducting medical reconnaissance and researching. It’s vital for the medic to use any and all tools at their exposure. You should prepare in such a way knowing that the crisis you’re involved in might last a long time or simply forever! The guerrilla assault medic is perfectly fine with setting up a clinic at the team house or in a tent. The medic is also content with throwing darts for IV therapy in teammate’s arms after a long night of drinking. The medic has honed in skills on the battle network itself and is able to identify anomalies. The entire AO is their playground. Reason being: if the team has to stabilize a casualty or patient before extraction the medic knows exactly where to go and where to maneuver to in order to provide effective care. Exfiltration routes and methods of transport can affect medical aid. Whether it be environmental emergencies, terrain, or air transport. Medical approach changes and the medic must adapt to adequate patient care. Knowledge of the ground and the skies is imperative for the medic. It’s almost as important as an extra month’s supply of insulin, grub, or your favorite drugs of choice.

     

     Tactical Combat Casualty Care (TCCC) and Prehospital Trauma Life Support (PHTLS) is the golden standard to keeping your teammates alive. Doesn’t make you a trauma surgeon; but it gives you the skills needed to keep someone alive until you can pass them off to definitive care. 

 

*****In the first part of this work we’ll talk about basic survival, social engineering as a medic, and overview Tactical Combat Casualty Care (TCCC). In the second part we’ll briefly talk about team checks, talk about setting up a clinic, then loadout & equipment considerations, and vector skills. In the third section we’ll highlight a hierarchy of needs for an assault medic, advanced field procedures. The fourth part of this article will delve into manned and unmanned teaming, air to ground integration, AI, special projects, and Machine Learning.

 

You’ll see a bit of redundancy. But that’s because certain topics need to be drilled into skulls like a craniotomy. We’re trying to stay ahead of the curve and stay on top of heads like a bald spot!

 

Disclaimer: This article is in no way going to make you a Medical Professional, you’d have to go to school and practice in the field for that. This article is a broad strokes overview in topics of discussion between field medicine practitioners and futurists. This article will make an effort to detail out; concepts, working disciplines, TTP’s, and preparation for worst case scenarios. We’re operating in a space where there’s no clear policy or doctrine to govern your skills or tactics hence prepper, guerilla, zombie apocalypse, and austere terminology. Take the time to build your skills and get the correct certifications. Remember new capabilities will invigorate and force multiply efforts for your team. There’s no affiliation or endorsement for any and all companies mentioned in this article. Nevertheless, Check the Deployed Medicine App and website for up to date information. 

 

1.0 Basic Survivalism Loadout

 

     This is the most very basic survival loadout possible. It all depends on how much you want to suffer. When preparing for outdoor activities or survival situations, it is essential to consider a comprehensive set of factors, including water procurement and purification, shelter, food, medical supplies, clothing, bartering items, financial resources, fire-starting tools, hygiene products, and technology. 

 

     To address the need for safe drinking water, one may opt for portable filtration systems such as the LifeStraw with a pump module adapter or the Sawyer filtration system. Additionally, chemical water treatment options like chlorine dioxide or iodine tablets can be employed. Water sources like natural springs or rivers can serve as a primary water supply, and if necessary, water can be filtered and purified with the use of charcoal and even soil layers. It is advisable to plan travel routes near water bodies to ensure a consistent supply. Carrying various container options, such as Nalgene bottles, 50 oz bladders, or 100 oz blivets, is essential. We must build redundancy here. Pick your three different ways to sanitize water and wounds, start fires, and keep fuel. 

 

     Regarding shelter, a rated bivy sack, a Thermarest pad, tarp, a neon orange tarp for signaling is optional, and bungee cords or paracord for securing shelter components are vital components of a shelter setup. When considering food, packing a sufficient supply for seven days is recommended. Common non-perishable foods for 3-4 months; food items for such situations include rice and beans, hot chocolate, spam packets, and a pouch of snacks. Hot sauce is the best thing going. Additionally, a fishing kit can provide an ongoing food source. Keeping a small refurbished altoids box or pelican box with all the small tools and essentials is a plus. Know your weather, know your plants, know your machines, know your animals.

 

     In terms of medical supplies, items like antibiotics, foot care items (moleskin and body glide), beta blockers, a suture kit, an extra 2-3 months supply of diabetes management setup, and multiple tourniquets (TQ) are crucial for addressing injuries and medical conditions. You can go to a North American Rescue and grab an individual first aid kit (iFAK). Note, with an iFAK it’s important to know all the items in the kit and their application. Anti-diarrhea and cough meds are a must. Layered clothing is important for regulating body temperature, and items like a wool beanie cap, a neck gaiter, three-layered t-shirts, two pairs of pants, a wet weather jacket, a poncho, and smartwool socks should be included. Again, it’s all about how much you’d want to suffer.

 

     For bartering and trade, carrying extra medications, pain meds, and narcotics (narcs) can be valuable. Yea, psychedelics and Mary Jane’s fine ass. It’s also wise to have cash on hand. You never know who you’ll come across and who’s willing to barter. Fire-starting tools, stored in a pelican case, are crucial for warmth and cooking. Build redundancy here. This may include Bic lighters, hurricane matches, tinder, dryer lint, and petroleum jelly for fire starting. Cooking and heating equipment, such as a Jetboil or MSR stove, fuel cells, a ton of fuel storage just because, and a steel pot mess tin, should be part of the kit. Hand warmers have come in clutch. If you’re into vices, a dip of long cut chewing tobacco or mike & ike sours go a long way.

 

     Hygiene and personal care items, including hand sanitizer, medwipes, chapstick, toothpaste, a toothbrush, antibiotic ointment, sunblock, and insect repellent, are essential for maintaining health and comfort. Can’t emphasize enough about medwipes. Finally, technology in the form of a solar charger with 2A or 9V batteries for electronic devices can be invaluable in emergencies. In summary, a well-prepared outdoor survival kit encompasses a range of supplies and equipment to address essential needs and contingencies. Pick out what works for you. Not everything is needed in transport because ounces equals pounds, and pounds equal pain.

    It’s imperative to select your outdoor equipment meticulously. This collection of extra essentials encompasses various tools and resources for wilderness exploration and survival. It includes a Bushcraft Knife, a sharpening stone, the versatile Lansky Puck Dual Grit Multi-Purpose Sharpener, a hatchet, a Leatherman tool, tape for various uses, 2’ of rolled duct tape, and navigational aids such as MGRS/WGS84 coordinates, a Lensatic Compass, and proficiency in orienteering techniques. The Army Land Navigation Field Manual 21-26 serves as a valuable resource. Ranger beads or rocks in your pocket help gauge distances using pace counts, and communication with a ranger station provides crucial intel. A compass integrated into your footwear, binoculars (Binos), N95 masks for respiratory protection, and 550 cord for multiple purposes complete this comprehensive selection of extra essentials for wilderness navigation. 

 

     Intelligence of the AO is important. We wrote briefly about it in Vol. 2 of the LFM publication. But to go a bit further check boxes on your SIGINT and HUMINT. Deep dive on SIPRNet and/or NIPRNet. If you as the medic don’t care for it, you’re wrong. Intelligence drives the fight and a quicker closing of the “Kill Chain”. We’ll talk more about the kill chain later. But… If you had to get the fuck up out of dodge. Have everything in this section at a larger scale in your vehicle with ample amounts of water and gasoline so you don’t have to stop and refuel at a gas station. To build redundancy; keeping survival packs on your Batman battle belt, in your 24-hour hiking backpack, in your 72-hour travel backpack, inside your vehicle, or the largest version in your home makes most sense. You never know when you’ll have to ditch one for the other, leave one behind, or need to upscale your resources. 

1.1 Guerrilla

 

     Every team prepared for the rapture or zombie apocalypse should have a medic on the roster. If you’re on a team or building a team, at the very least- you’d “want” an Emergency Medical Technician – Basic (EMT-B). At best you recruit a trauma surgeon, practicing medical doctor, physician’s assistant, or paramedic for your team. Either way, look for people who are capable and competent. Do a self/team assessment; if it turns out that you’re the capable and competent one. Then, get out and train on the skills needed to become the team medic. Be real with yourself and team assessment. Do a SWOT analysis to identify skill deficits. 

 

     Back in the Vietnam war era, Recondos or MACVSOG soldiers often operated without a medic. That shit is absolutely crazy. But also a testament to how hardcore those individuals were. They had an individual first aid kit full of goodies, known as a One-Zero kit. No doubt the use of dextroamphetamines (a primitive adderall) back then was standard to stay awake and vigilant. The use of GI Gin to keep their respiratory infections and coughs suppressed. They had a plethora of bandages and other first aid items. They memorized the placement of these items so they can easily grab them in the darkness of night. Elite operators know where all their tools are at, at all times. Another kicker is that… Most didn’t have or need comms either, they were that good at soldiering and navigation. Glad we still have soldiers out there that can do all of the above in present times when necessary.

 

     Nowadays most “special teams” have a Junior and Senior medic on the roster. In addition to that; the rest of the team is cross-trained to a certain level of proficiency that’s most likely EMT-B or TCCC practices. Medics are known to have the most undesirable position, usually they’re drivers and in the back of the stack when doing a house raid, and first to relay command details to the skipper or team leader in the event of a casualty. So yes undesirable, but most important. In a special team, each member should serve as an assaulter, equipped with expertise cultivated from the diverse skills within the team. It’s cross pollination. Meaning just because you’re a comms guy, doesn’t mean you should focus solely upon the spectrum of communication wizardry, but have the skills of marksmanship or unmanned drone operations as well. Reasoning is, your A-team can go from running a wounded hostage rescue mission to sending a swarm of drones on a bombing raid at an HVT’s compound. 

 

     The Guerrilla Assault Medic’s phrase is “Hunt. Harm. Heal”, coined by a former senior medic at CAG. They have medical loadouts specifically tailored to the Area of Operations (AO) and team they’re supporting. Let’s be honest, if you’re on a team full of stud muffins (male or female), you’d have less to worry about. Everyone is trained to a certain level according to (insert favorite doctrine here); like the ranger handbook, local Fire & LE response standard operating procedures, or Special Operations manual. These doctrine manuals are open source and hopefully you can get your entire team acclimated. Remember you’re looking for capability and competency. In addition, as a medic you still have skills to mitigate anything that’s life-threatening to yourself, your team, the population you’re serving, and the environment you’re in. But you’re an assaulter and survivalist first. Medical ISR is real. Intelligence, reconnaissance, and surveillance all on a network.

 

     GRID Networks represents a strategic initiative aimed at optimizing public health efforts and enhancing medical intelligence capabilities. The acronym GRID stands for Global Resilience and Integration of Diagnostics, in our case Guerrilla Resistance Integration Detachment. Emphasizing a comprehensive and interconnected approach to healthcare in both domestic and foreign contexts. The primary objective is to seamlessly integrate into foreign medical infrastructures, fostering collaboration and leveraging existing healthcare systems for mutual benefit. Building out these networks allows you to stash cache and train up team forces in the event you’d need to bound back to their location, resupply, or stage. So how do we set up these networks? It comes with social engineering.

1.2 Medic Espionage

     So how do we implement social engineering as guerilla assault medics to build the GRID? It’s complex but we’d have to gain the trust of the people first. Verbal judo, Jedi mind tricks, or socially undress ‘em. Speak to your potential patient in the best wholehearted way possible. Through reconnaissance we can find who is terrorizing and provide them with comfort. Every medical provider must start with the art of patient rapport. This is the “human connection”. It can be as simple as “may I help you?” or “I’ve come bearing gifts”. 

 

      It’s the ultimate icebreaker and flex to come into a hostile environment or area as the “healer” or “bringer of gifts”. They don’t need to know you or your team is there to gather intelligence on the local neighborhood villain or high value target (HVT). These gifts may consist of helping toddlers or adults with dentistry issues, handing out vaccinations and personal hygiene items, or aiding with malnutrition diseases, pharmacology, etc. Other stuff you can look at is, passing out med-ready kits and money in trade for information. Whatever it may be, you’d want the locals to see value in your help. You get to practice professional aid on patients and test your skills on those who need help. Creating pure fuckin’ magic and releasing people of their demons in an ungoverned environment. 

 

      Sometimes patient or community rapport is hard and rendered ineffective. Socioeconomic norms or cultural norms may be; not to talk, entertain, or deal with outsiders. Whatever the case is, it’s important to stay mission focused and have your security forces in play at all times. 

 

      Say for instance you know your HVT is hiding in that little town behind enemy lines. You have 24 hours to find him/her, and word is getting out that “there’s strangers here in plain clothes- dressed like us, that could be soldiers- acting like they’re doctors”. That 24 hours has elapsed, and you don’t find the person (HVT). It may be sketchy to make repeat visits into that same town and gather more information that leads to the kill or capture of that individual. But because you’re helping the people you have an extended stay and acting as healers may buy you valuable time to operate. Time is of the essence and these moments call for political and social engineering. Special reconnaissance teams do best when not engaging in direct action or being spotted until it’s absolutely necessary. Tricky set philosophies, but subversion is key. 

 

     Now that we’ve looked at social engineering in an unknown location. Sometimes we have to do the same thing with our own partner forces and mutual aid. We have to look at the vertical supply chain here. The mission is to operate in this AO for however many weeks or months. Duration unknown, but you have zero budget to buy enough drugs, medical aid tools, etc. to sustain operations. Not saying you have to do what Hannibal Barca did by resorting to cannibalism in dire straits or eating your war elephants. But, how can you source drugs, bandages, or tools needed to be “medic”? 

 

     Well just like anything else we can wheel and deal, negotiate and barter. Say your team raided the local lowes or home depot’s garden section once the rapture kicked off. You have a ton of fertilizer and seeds for growing produce and food. You can now exchange that garden supply for meds and drugs needed. Your team engineer, eod dude, or 18Charlie might be mad at this transaction, but who cares. Or say you have something all teams want, like a set of relics taken from the local warlord’s house. Three Kings style kinda, gold plated weapons cache instead of actual gold. Everyone on your team has one and you have hundreds more. Now you can really be specific with partner forces on what you want. Last example could be, there’s a medical unit leaving the battle space. You can reach out to that med unit and heist or grab stuff they don’t want anymore. This is logistical prowess and now that you have a surplus of medical shit. Store it in a 40’ shipping container somewhere around your AO. Hell, dig a hole and hide it like a time capsule. Store it for later. This is social engineering with friendly forces.

 

      So considerations for resources… It’s a multifaceted approach to supply and resupply. Is it covert or overt? We must refer to the local system and what they have to offer. Is there a CVS or Walgreens anywhere in your AO and has it been raided? Can you find out what drugs are being smuggled into the territory? What happens if you throw money at situations for your resupply? Who’s watching you resupply? From your point of view, can you flood the market with med supplies giving you better possibilities to sustain? What’s the delivery system of choice to infil this payload? How often? How big is the payload? Area surveys will give you what you need on the objective. Do I have a guy on the ground that knows about this? Ground truth vs. theoretical is a great point of consideration also. What can they support in the long run? If we leave, what happens? 

 

     Again, “If we leave, what happens?” Say for instance we just provided $400 metformin pills and hooked the local population onto it. No doubt, big pharma can get us into incredible places. But now that miracle dust is gone. What’re sustainable practices once we infiltrate into this austere environment? Do you encourage or partner? Do you create a problem like Bill Gates and then get them hooked on your solution?

 

     Guerrilla medic situations call for different approaches and solutions. On one hand you have the local warlord who employs the local hospital personnel for his troops. On the other hand sometimes there’s no medical infrastructure that needs reconnaissance; that village or town has been in existence without medical aid for centuries. Or even if it’s a small community in the United States who doesn’t rely on medicine or health care. For all situations resource logistics and social engineering can aid your mission. The network is the end goal. 

     By embedding guerilla medical intelligence capabilities within these networks, GRID aims to enhance situational awareness and response effectiveness. This includes leveraging advanced technologies for real-time data analysis, predictive modeling, and early detection of potential health threats. The integration also allows for more efficient deployment of medical resources during emergencies, contributing to faster and more targeted responses to public health crises.

1.3 The Golden Standard

 

      Tactical Combat Casualty Care was spearheaded by a Navy Captain Frank K. Butler MD., a Prehospital Trauma Life Support (PHTLS) consultant, and also a part of the Naval Special Warfare Biomedical Research program. Under his guidance and with the help of SMU Medics, USIS, SEAL Medics, Army Medics, Corpsman, and PJ’s the TCCC doctrine was born. It was composed of evidence based best practices and reflected wisdom from the above stated entities. To put this doctrine together was no easy task. He researched combat medicine and published papers during the Vietnam era. The death statistics were staggering. He curated a system that evolved around those specific stats. For example; bleeding control. The number one leading cause of preventable death in the battlespace is hemorrhaging from extremities. Soldier’s were dying even before they ended up in definitive care or in the hands of a surgeon. So at the foundation of TCCC we have the tourniquet. From there attention to airway management, to respiration rates & breathing, circulation, blunt traumas, burns, thermal emergencies, and so on, and so forth. 

 

     In 1996 they put out the first TCCC best practices, customized for use in the battlespace.  Battlefield Trauma Care was divided into 3 phases. Care Under fire (CUF), Tactical Field Care, and third but not last Casualty evacuation (CASEVAC) or Tactical Evacuation (TACEVAC). These three phases are in place because; doing the right thing medically at the wrong time tactically could be catastrophic for your patient. We want to conceptualize optimal care of the casualty with considerations of each tactical event. 

 

     TCCC had to be presented to high level DOD, Special Operations Command, senior medical advisory committees, wilderness medical society, medical conferences, and the list goes on. Advocated and onboarded. Special Missions Units, Naval Special Warfare, and Ranger regiment gave the first real feedback on TCCC. Fast forward to 1997 and the PJ’s started giving feedback. After evaluation of specific casualty training workshops like: wilderness, underwater, urban warfare, arctic situations. The doctrine was evolving with robust dialogue and optimal care considerations were being made. In 2001 the TCCC was stabilized as a doctrine and had established its own committee within the Navy. Joint Trauma System (JTS) / Committee on Tactical Combat Casualty Care (CoTCCC).  The CoTCCC is the branch of the JTS focused on the standard of care for prehospital battlefield medicine.

 

     TCCC is the bread and butter for Guerrilla Assault medics. Deployed Medicine detailed it best when it comes to Care Under Fire (CUF). Return fire and take cover. Direct or expect casualty to remain engaged as a combatant if appropriate. “Get off the X” Direct the casualty to move to cover and apply self-aid if able or when tactically feasible, move or drag casualty to cover. Try to keep the casualty from sustaining additional wounds. Casualties should be extracted from burning vehicles or buildings and moved to places of relative safety. Do what is necessary to stop the burning process. Stop life-threatening external hemorrhage if tactically feasible. That’s the first of the three phases in TCCC.

 

     The second phase of TCCC is where we implement a battle plan for Tactical Field Care. This is where we work through our progressions and conversions in establishing a perimeter and triage. Assessing massive hemorrhage, airway management, breathing / respiratory rate, circulation, and hypothermia prevention. We look further at care for specific injuries like eye trauma, analgesia, wound inspection, and checks for additional wounds. Monitoring is of high importance during tactical field care. Knowing your burns, splinting applications, CPR, and antibiotics are pivotal. From there we get our comms up, document care, and prepare for CASEVAC.

 

     For sake of simplicity TACEVAC is considered to be both CASEVAC and MEDEVAC. We look at transition of care by designating evacuation point security. Hopping on comms to relay the patient’s information. Continuously assessing and managing airway and respiration rates. Checking for traumatic brain injury and administering aid upon findings. Communication and transferring of care involves a debrief to the definitive care team. That debrief involved the mechanism of injury or nature of illness (MOI/NOI), injuries sustained, signs/symptoms, and treatment rendered. Additional information if and when needed. 

 

    That’s the gist of TCCC, there’s a ton more intricacies and methods involved with the golden standard of keeping your team alive. The least you can do is research, practice, train, study, or gain continuing education credits. Train as if your life depends on it because it does. Vet some instructors and sign up for a class. You’d be surprised at how much fun classes or TACMED competitions are. Training with live ammo, there’s dyed red dial soap everywhere (blood), moulage, and your hand is wrapped up and duct taped with a tennis ball inside it simulating an injured hand. Now you have to return fire, cric somebody, or drop an IV in their arm, one-handed. These evolutions will help you prepare for real life scenarios and threats. 

 

     To get your critical think tank going… Watch movies, read books, read journal articles, and think of medical tactics, comms considerations, and PACE planning. We need to analyze things about public opinion continuously. We need to study events and capitalize on pre-planning for things that happened in history, because it’s possible they may happen again. Topics in recent history; the 24-day left wing occupation of Capitol Hill in Seattle, WA. Or the 1-day January 6th right wing takeover of the Washington Capitol. Those are two instances our enemies are looking at and studying. Topics of subversion, rioting, death, assault, espionage, the list goes on. How would you have assessed that situation and how would you have rendered aid? Trauma is arts and crafts. Trauma can happen anytime and anywhere.

2.0 Team Checks

 

     Loadouts change. If you’re going to roll someone up it’s aid bags, trauma kits, and body bags. But at the core of being the team medic is team checks. That means having the right meds and gear for your team & AO. Making sure your teammates have their own iFAKs and are trained up on the items within them is vital. Make the effort to teach your team about cool shit whenever there’s downtime. Even though it was stated everyone could or should be a stud, that might not be your reality. Because trauma can happen anywhere you can make sure everyone is trained to a certain level of tactical combat casualty care or EMT-Basics.

 

     Another reality is that all it takes is some bad food, contaminated water consumption, trauma, or medical emergency to sideline a teammate or yourself. Being put out of commission is no fun. Shit happens and sometimes it’s lightning fast. If there are known parasites local to the area, then team infestation is definitely a possibility. So monitoring fluids and hydration is crucial. Of course there’s meds for anti-diarrhea symptoms and respiratory issues. Antibiotics and painkillers should be kept in redundancy, those who know pharma know this importance. Sometimes reactivity, contraindications, and allergies make drug administration complex. Let’s look at antibiotics for instance. Understanding the differences in these antibiotic classes is crucial for prescribing the most appropriate treatment based on the type of bacteria causing the infection and the specific clinical scenario. It’s important to note that antibiotic resistance is a significant concern, and the choice of antibiotics should be guided by susceptibility testing whenever possible to ensure effectiveness. As a medic I’d keep antibiotic redundancy and a ton of: Glycopeptides, Aminoglycosides, Macrolides, Carbapenems, Lincomycin, Tetracycline. I don’t expect you to know any of these pharmaceuticals. If you do, then hell yea. Not to get too into the weeds on that topic, but knowing your team and their allergies is good practice. Fighting wounds internally with meds as well as sanitary upkeep externally is also great practice. 

2.1 The Clinic

 

     Throughout the Vietnam War, the U.S. Army Medical Corps conducted Medical Civic Programs (MEDCAPS), initially designed to support the Vietnamese military and later extended to encompass the well-being of Vietnamese civilians. Now medics set up shop(s) with a few things in mind; size, resources, and breakdown if needed. In addition, we must look at preparedness and adaptability for prolonged field care, canine aid, or even a mass casualty incident. To assess what the local populus is doing it’s good recon practices to meet with the local physician or witch doctor. We must create an irregular warfare medical network. We don’t want to overstep our boundaries with the indigenous people but we want to get back to the GRID’s efficiency like we talked about in the espionage section. We want to support the locals and have them support you. Again we go back to the AO survey. You don’t micromanage, you set up the clinic and step away. Decentralizing treatment and medical tactics for the indigenous people. Even showing them some new skill sets for sustainment reasoning. This is where guerrilla medicine shines. Letting the indigenous people be the face of success while covert operations exist in the shadows. 

 

     When it comes to building a clinic for team support we look at the same scenarios detailed above. The construction of your clinic depends on the mission. This is where you’ll be operating. Scenarios can go from setting up in a bombed out building, to the back of a barn, or even a small tent. If it’s super small – It’s best to exercise camouflage tactics as if you were building a sniper’s hide, yet it’s a clinic. You set up your own little hospital according to how much resources you have. Think privacy, sensitive medical attention, and luxuries you may or may not have like bins or shelving for instance. But still making sure you can see all your tools and medical aid equipment labeled legibly. A strong supply of sticks, rags, and bags. What are our blood capabilities and storage? Biohazardous waste and hazardous material precautions are often overlooked, therefore that planning should be a part of the essentials. Not everything you’re doing is going to be sanitary but the least you can do is get rid of unnecessary waste and bodily fluids. Humans are certifiably nasty. Telemedicine capabilities usually are done in first checks; we supplement the “tech side of the clinic” with drones, electronic medical devices, and PACE planned comms. Doing some nature checks like foraging for natural herbaceous medicines or finding splinting materials in nature adds to resourcefulness. These are extra but equally important for redundancy. 

 

     Further considerations are; is there the need for a clinic on the objective, in response or evacuation vehicles? How soon can I collapse my clinic on exfil and what can I leave behind? I’d sabotage all my shit if I had to bail! Swap meds in bottles. Or pour alcohol in my medicine bottles knowing the enemy is not too far behind. Gas it up and burn it down leaving no traces that you may have wounded. And finally what’s the evacuation protocol look like for your wounded? Can we make it outside to a secure location in the event our rescue helicopter comes? In your preplanning, think further, faster, stronger.

 

     To summarize this section. How good can you hide your medical box and clinic? In the past 20 years we’ve dominated so much. We haven’t had to. What about the teams that have to keep moving? What does a clinic look like when the rapture hits and it’s in your own backyard? Are we built to sustain medcaps? We create armies to fight for themselves. We are here to develop supplemental teams that go along with these fighting forces. A key example is when the yugoslav partisan resistance fighters fought the communists in WWII. We went in, helped those freedom fighters, supplied them, came in and supported their efforts. That’s the key of being a guerrilla is to not get called out on it. Put the face of victory on the people who inhabit. Train and organize a fighting force and let them do the work and heal their people.

2.2 Loadout Equipment Considerations

    To be honest it’s so vast with what you can do with equipment considerations. It revolves and evolves around the team and your AO. If we could simplify it and say you wanted to build your own iFAK or Med Bag. The Army Medic, Ranger Medic handbook, and the Navy Corpsman doctrine is a great start. Those are some of the best medics in the military. Nevertheless grabbing a Level A Medical bag with supplemental dentistry, surgical, splinting, and pharmaceuticals should be enough to hold the fort down until it’s time to resupply. All it takes is a google search and you can find an itemized list. Over the course of a few months, when you have the money, build one out!

2.3 Vector Skills

 

     Vector skills can be categorized as but not limited to; Crush Injuries, Burns, Amputations, Pain Control, Anaphylactic Shock, Emergency Airway Procedures, IV Therapy, Small Wound Repair, Infected Wound Care, Decompression and Drainage of the Chest, Nutrition and Emotional Support, and CASEVAC.

 

     Small wound care is scientific and surgical. It involves proper scalpel positioning, clamping, grasping, suture selection with placement, ligature, and closing the wound techniques. With small wounds we need to look at timing of closing the wound and proper asepsis (mechanical cleansing of the wound). Care for infected wounds starts with antibiotic therapy. Types of infections are: Muscle (gas gangrene), Bone (osteomyelitis), Abdomen (peritonitis), Skin (burns, trauma), Whole body (broad range). Each of them receive a correct dosage and drug of choice. Now where it gets cool is when we introduce granulated sugar or honey to enhance wound healing, an age old tactic. Our friends on instagram @The_Paradocx have championed maggot debridement therapy. It’s some real guerrilla assault medic shit. Growing maggots from scratch, MDT is effective for ulcer debridement. It achieves the removal of damaged tissue from foreign objects in the wound in less time than other therapies and can be effective in preventing amputations or reducing the need for systemic antibiotics. Everyone remembers the scene in Gladiator where Juba packed Maximus’ wounds with maggots to eat away bacteria. 

 

     Airway management and procedures. There’s several ways to maintain an airway or give emergency ventilation to a patient whose airway is compromised. Endotracheal intubation is the most effective when it comes to addressing respiratory complications, endotracheal intubation (ETI) alongside the use of medications. It is particularly useful in individuals with a functioning gag reflex, full stomach, or life-threatening conditions requiring immediate airway management.  Other alternatives depending on the status or trauma of the patient can be; laryngoscopic orotracheal intubation, digital intubation, nasotracheal intubation, or cricothyroidotomy.

 

     IV Therapy: It’s important to know your solutions; from D5W, to ringer’s lactate, to normal saline. Your environment gives no fucks and mother nature will merc your ass. So composition of IV fluids is essential to patient survival. Establishing a good IV with proper aseptic techniques is going to help because to be honest, in austere environments; contamination is likely. A medic can flip from mission to mission like bisquick with IV therapy, flow rates, and drawing blood samples. From administering IV’s to infants suffering from nutritional diseases to daily fluid requirements for your A-team because everyone’s hungover from the night before. These are topics in ‘Daily Maintenance Requirements’. IV therapy is so much more. It literally deserves its own book. 

 

     Decompression and drainage of the chest. In the absence of proactive care, the patient’s respiratory and circulatory functions may face compromise. Whether dealing with penetrating or perforating chest wounds, the majority of cases can be effectively managed through a closed-tube thoracostomy. Familiarity with interventions to alleviate tension pneumothorax, hemothorax, and hemopneumothorax is essential for preserving the patient’s life. It’s imperative to be knowledgeable about the precise locations for deploying chest decompression needles, understanding when to perform chest tube insertion, determining when to utilize a drainage bottle, and discerning the appropriate times for wound assessment and dressing. 

 

     Anaphylactic shock is a true emergency and epinephrine drug therapy treats it. It’s the allergic reaction on steroids that may end in a patient’s death due to shock or upper airway obstruction when it swells up shut. Pain Control (PC) is probably the most underrated skill set for a medic. You can combine or solo administer narcotics, local anesthesia, IV regional anesthesia, nerve blockers, or dissociative anesthesia. All of these allow you to operate on your patient better, but also puts them at ease. Amputations have indications and contraindications just like pharmacology medications. Indications could be trauma severity whether mangled, ripped off, blown off, severely crushed, etc. We must also look at the circulatory status of the limb (color, artery condition, smell, temperature). This is where we get into dirty wounds and draining stumps and maybe even bring back the maggots (MDT). When it comes to Burns, remember the law of 9’s, its pathology, depth, severity, and the emergency care that goes along with it. Especially antibiotic therapy. We must always assess for shock and thermal emergencies. Your patient can go south quickly if you don’t pre plan for your environment or complications such as shock. 

 

     Last topic… Snake Doctor. Not just the name of the greatest team leader on television; highly skilled in espionage, and unconventional warfare. The 5 deadly venoms, not just the greatest movie about subversion and martial arts. But… antivenoms like polyserp. A remarkable solution for managing snake envenomations in challenging and remote conditions. These freeze-dried antivenoms are engineered to withstand the rigors of austere environments, making them ideal for situations where refrigeration is unavailable. In fact, these antivenoms can be stored and carried in the field for up to six months, even at temperatures exceeding 100ºF, all while retaining their potency. One of the standout features of Polyserp™ antivenoms is their ability to eliminate the need to identify the specific snake responsible for the envenomation. This is a significant advantage in cases where snake identification might be uncertain or time-consuming. Moreover, these antivenoms provide a comprehensive treatment approach, as they are effective against neurotoxic, hemotoxic, and cytotoxic envenomation syndromes. Again shout out to the @The_Paradocx squad for this gem of intel. 

3.0 Hierarchy of Needs

 

     This article is heavily medicated. But let’s be honest at the top of the food chain is comms and ammo supply. We build redundancies from iFAK to our 16-pound Medical Backpack to our GRID Network Clinic just out of resourcefulness. A good medic keeps a library of voodoo and supporting philosophies in their head. But alas, guns & ammo (4 rounds of full mags for each platform). Long Gun, CQB Shotgun, and Sidearm addressing specific tactical needs. Individual First Aid Kits (iFAK) for each team member. Ensuring immediate medical response for personal safety. Level A medical bag and War chest of medical aid stuff for your clinic. Knowledge of mandates if applicable along with scope of mission dependencies. A kit of unmanned gadgets and medical devices.

4.0 Unmanned Teaming for the Medic

 

     Being able to add aerial or ground drones to your medical efforts is great. Whether you’re voice commanding a racing FPV drone to deliver extra drugs at 80mph to your objective. Think of being in a denied environment where you can deploy drones to your location to drop off surgical supplies at the click of a button that’s located on your wrist or quarterback sleeve. Or request your AI drone to scan for combatants and give you 360 degree situational awareness while you work on your patient preparing for a TACEVAC. Or you’re telling a larger fixed wing drone to travel beyond visual line of sight and long distances to drop off an extra med backpack payload or blood. Or casevac a patient from a beachfront via an unmanned surface/ sea/underwater vehicle. Or have a UGV quadruped packmule REV/REX hybrid to extract your patient in a subterranean setting. The packbot nowadays can be seen as a valid tool; ghost robotics can technically carry a patient with a payload of 200+ lbs. Let’s just hope that the algorithm is enough for stabilization. It’s up to you to implement drones where you see fit. Drones have been in the battlespace since WWII and even have some accounts of way before. 

      

     Some learning under the tutelage of Jim L. Hancock a former Navy SOF operator. Let’s start with your network PACE plan. Primary is a man-packed 5G LTE node. Alternate would be Manet radios with spectrum dominance. Contingency is PTT Comms. Emergency is SATCOM. Unmanned autonomy systems operate in three phases: skills, behavior, and tactics. Skills which are conducted by manual control and operate in waypoint navigation. Behavior which is slightly more complex uses follow or patrol features and can be done in C2 applications, via speech & voice command, or in TAK. Tactics is the most complex and it involves building searches and can be controlled by AI, gestures, or eye tracking. 

 

     We must not mistake Autonomy for Artificial Intelligence. Artificial intelligence is considered to be expert systems, self-educating, a deep neural network, and something that can evolve and act like the human brain. Most importantly it can refine and redefine itself. Autonomy is more for streamlining processes, multitasking, has a level of intelligence, high processing capability, and a set of algorithms that enable it to perceive its environment, analyze data, and execute actions without constant human guidance. Therefore, autonomy for unmanned machines is challenged by a few things. Mission complexity, domain complexity, and human-machine interface. Human-machine interface can be streamlined physically or cognitively.

 

     Physically… We can wear gloves to control drones no doubt. This happened back in 2012 with the first sign of G-speak Gestural Technology developments. Individuals were controlling an 8 drone swarm with this interactive glove controller. Cognitively developing a mental prosthesis where you can control drones and machines with your mind is nothing new. DARPA funds these brain-interface/mind-machine interface gigs all the time. The most promising future work cognitively will involve Elon Musk’s Neuralink project. The next level from that is optogenetics. The original concept stems from the 1984’s sci-fi movie Neuromancer. They actually pulled it off in 2009 where Honda debuted its Asimo robot. Neuralink just started human integration trials this month (Fall 2023).

 

     Something even crazier is what medics can use to fuel their drones and clinic. We’re not thinking about solar power or batteries. We’re thinking of biohazard waste. The Chew Chew drone from the UK ran off of eating slugs, but what about maggots for MDT? The EATR drone scavenges by consuming organic materials and body parts. It’s fuckin’ grim that machines can do such things. The University of Texas had the Vampire Bot. It wasn’t necessarily a drone, yet. But biofuel cells implanted into live bodies that can use glucose and oxygen to generate electricity. In the future it may be powering devices such as drones or your clinic. Who knows when or where we can implement such things, but knowledge of such projects or tactics is a tool within itself. 

 

     Last thought. Think large drone airship the size of a Harley motorcycle with wings, there’s 20 smaller AI drones on board. These drones deploy from the unmanned airship and serve out tactics, behaviors, cyber, medical, electronic warfare, swarm, kinetic payload missions. We’re already there. But it’s all about what works for you. How creative can you get with manned and unmanned teaming? In order for it to be streamlined and/or commercialized, it needs a program of record. Like the TCCC doctrine during its inception phase. Furthermore, robots don’t bleed. But like your medical clinic, robots need a repair shop too. 

      

     Communications Sergeants are in charge of maintaining anything on the spectrum and its hardware radios UHF, VHF, HF, SATCOM, SDR, and its planning implementation. They’re your best friend as a medic. In the fire/ems service there’s a Radio Man and Patient Man. On unmanned teams there’s Remote Pilot in Charge and the Visual Observer. This is redundancy at its finest. Saying all that to say; teaming up with another tech geek would be great for future projects. 

 

     In the future wars we’d have minesweeping cyber payloaded robot dogs patrolling outside the wire just because we can and robots don’t bleed. Or do they? Hopefully you have a set of Unmanned operators on your team and they can man the robot locker or robot clinic. If not, the medic is nerdy enough and has ample mechanical aptitude to make simple fixes for your unmanned unit’s repair. Again we want to emphasize redundancy. If there are designated team members who operate drones and unmanned machines they should teach the rest of the team how to utilize said unmanned platforms. The same goes for cyber, explosives, communications, weapons, etc.. 

 

4.1 AI and Machine Learning Medics

 

     Let’s say you’re in an austere environment and you need to transmit health data or consult also known as “Telemedicine”. It’s been in play for years, 30+ years. But only up until 2017 did we really adopt and adapt telemedicine to the killchain. We need rapid insights, intel, and integration. The way a medic should operate in the future with AI and Machine learning is to have a network that has the following genetic make-up. Data sources consisting of clinical audio, digital pathology, Omics data, etc… Secondary to that is Storage of analyzed databases. From there we have Data Collaborations and Data Access. The action part of providing and optimizing patient outcomes is Machine Learning for Analytical reasons and generative AI for clinical applications (for Doctors & Patients). 

 

     AI’s capability to customize treatment plans based on individual patient data, including medical history and genetics, enhances the effectiveness of medical interventions. Wearable devices equipped with AI can continuously monitor soldiers’ health, alerting medics to deviations from baseline values, preventing emergencies. Moreover, AI-driven language translation facilitates communication, resource management, image analysis, emergency planning, and drone-based medical deliveries. Machine learning and AI can analyze historical combat casualty data to improve combat casualty care protocols, and biometric data analysis aids in identifying early signs of health concerns among special forces personnel. These applications collectively enhance the effectiveness and responsiveness of medical care in challenging and high-stress environments.

 

4.2 Special Projects For Guerrilla Medicine

 

     If we don’t have a $100 burner android A12 phone and our preloaded SD cards, termux, and some AI chatbot. We have the alternative powerful micro computers such as the Jetson Orin, the Asus tinker R board, and the famous new Raspberry pi 5. Great dev boards for incredible projects. You can slap a sensor and whatever glue logic or code needed to create your “medic teammate”. We can create thermal camera surveillance projects, create a phone, webcam, jam airwaves, attach an AI chatbot for diversion, setting up your GRID network point-to-point, the list goes on. We can protect our clinics with laser trip wires or rigging up motion detection sensors tethered to the dev board of our choice. There’s open source scripts for that. 

 

     If I wanted to exploit the local drug lords in reconnaissance. I’d send up a drone with the dev board and monitor their possible wi-fi traffic. Get all my packet captures, map out their network with Nmap. Use Wireshark to analyze those packet dumps. Figure out who’s selling what on the dark market. Get with my comms guy and implement some SDR action and see if there’s anything we can listen to or decipher on movement for supply mission runs of any kind. From there we run the rest of our ISR. My end goal is to get supplies for my team as the medic and knowing what the smugglers are doing is where I’ll get to shine. 

 

     But to stick to the Guerrilla Assault Medic theory and practices. We can use technology like sensors and dev boards for creating; let’s say an ultrasound tool. Ultrasound tools are extremely important in medicine. As a special project you can connect the ultrasound transducer to the Raspberry Pi. The HC-SR04, for example, typically has four pins: VCC, GND, Trig (Trigger), and Echo. Connect these to the GPIO pins of the Raspberry Pi. We’ll write a Python script to control the ultrasound sensor. If we don’t know how, we use chatgpt or other AI chatbots. Use RPi.GPIO to send a trigger signal and measure the time it takes for the echo signal to return. You can calculate the distance to objects based on the time elapsed. Display the distance measurements on the connected display, updating them in real-time. This will provide you with a simple, real-time “ultrasound-like” display of distances. If you want to create an image-like representation of the distances, you can use OpenCV to display the distances as grayscale images. This won’t be a true ultrasound image but a visual representation of the distances. And for the medics who hang out in apocalypses that’s good enough for us!

 

@Sentinel_Society  

@Disruptor26 

#RipVAN