Medical Skill Set Comparison 18D and AF Course

I am curious to see what specific skill sets are taught at to the members of 18D specialty and PJ's.

Does anyone has a up-to-date detailed list of skills taught?


Staff member
A specific comparison doesn't exist pertinent to medical qualifications other than general nature of the 18D is more IDMT and Physician Assistant clinical medicine oriented in that primary purpose of the 18D is to providing health care capability to the deployed SF group and teams, and the indigenous peoples most immediately connected to the reason for Special Forces being in the region or area. Thus the cross-cultural capability emphasis embedded in all U.S. Army Special Forces MOS qualification requirements. The 18D Special Forces medic is primarily a not connected to the Military Medical Treatment Facility healthcare provider.

Compare the MOS description below to the Pararescue AFSC (MOS) description found elsewhere in these forums. I emphasized text in red for further discussion points.

<div class="ubbcode-block"><div class="ubbcode-header">Quote:</div><div class="ubbcode-body">a. Major duties. Special Forces medical sergeant ensures detachment medical readiness; establishes and supervises temporary, fixed and unconventional warfare medical/dental facilities to support conventional or unconventional operations with emergency, routine, and long term medical care; provides initial medical/dental screening and evaluation of<span style="color: red"> allied and indigenous personnel; manages detachment, allied, or indigenous patients,</span> administration, admission and discharge, care, laboratory and pharmacological requirements and the initiation, maintenance and transfer of records; orders, stores, catalogs, safeguards and distributes medical/dental supplies, equipment and pharmaceuticals; supervises medical care and treatment during split detachment missions; operates combat laboratory and treats emergency and trauma patients in accordance with established surgical principles; diagnoses and treats various medical/veterinary dermatological, pediatric, infectious and obstetric conditions using appropriate medications, intravenous fluid support and physical measures; <span style="color: red">manages and supervise all aspects of deployed preventive medicine;</span> develops and provides medical intelligence as required; in unconventional warfare environment, <span style="color: red">instructs medical personnel, manages guerilla hospital, and field evacuation nets; coordinates the operation, interaction and activities of medical/dental facilities within an area of operation; manages battalion size troop medical/dental clinic and its administrative and logistical support;</span> establishes a base stock of medical supplies and equipment, internal or external procurement, storage, security and distribution of those items; coordinates veterinary training and support for area requiring animal transportation or use; <span style="color: red">provides guidance and training of medical personnel and preventive medicine specialists.</span> Duties for MOS 18D at each level of
skill are: …</div></div>
The 18D medic duties is not oriented to specifically be a combat medic embedded in a small tactical team or to be the primarily rescue responder. Basic Airborne qualification and SERE level C training is the only common to all 18 series MOS nonmedical advanced qualification requirement for award of MOS. Q5--Special Forces Combat Diving, Medical, W7--Special Forces Underwater Operations and W8--Special Forces Military Free Fall Operations are possible Additional skill identifiers. The context being probability of getting such qualification during first enlistment is extremely unlikely and not assured at anytime during career in the MOS.

It must be considered in any comparisons to Pararescue that Special Forces cross-cultural capability and MOS requirements most clearly and concisely originate with the supporting of partisan fighting efforts in the Balkans and in the CBI Theater to a lesser extent during WWII. The utilization of the enlisted medics focused on training partisan medics and provide for lack of a better description wellness and healthcare support to the partisan fighters and their families. Partisan warfare was abandoned when WWII ended, only to reemerge during the Korean War. How and why partisan warfare reemerged coincides with the current irregular and/or unconventional warfare origins of U.S. Army Special Forces Branch as a Psychological Warfare and Civil Affairs capability on 11 June 1952 (First Special force unit activated, 10th Special Forces Group, Ft Bragg).

It should be noted official Army press releases during the 1950s emphasized U.S Army Special Forces being liberation forces designed to fight behind enemy lines and the motto ''DE OPPRESSO LIBER'' (Liberate From Oppression) also certainly emphasizes this. However, throughout the Cold War and conflicts since WWII most of the actual fighting behind enemy lines was done with indigenous forces conducting insurgency or counter insurgency (guerilla/irregular) warfare. The context being much of U.S. Army Special Forces utilization is connected to advising, training, nation building (civil Affairs) than being the mainstay (the bulk, the majority) liberation forces fighting behind enemy lines. The 75th Ranger Regiment was established in 1974 to be the tip of the spear going behind enemy lines to fight the enemy (no war of liberation in its truest intent has been fought since WWII).

The most distinctively clear Special Forces medic origins utilizations of WWII are connected to the medical support provided wasn’t on the direct ground combat battlefield but rather at locations where partisan forces were operating from. They would train partisan medics and provide for lack of a better description wellness and healthcare support to the partisan fighters and their families. This again became a necessity during the Korean War during the period 1951-54 when the United Nations put reliance on utilizing Partisan Warfare to conduct military and intelligence operations within and behind enemy lines. This is why medics are part of the Special Forces advisory, training and civil affairs capability put in to develop and support partisan forces during the Southeast Asia conflicts and other contingency operations occurring since the Korean War.
Thank you Yukon!

Would it fair to say that the 18D scope of practice includes the capabilities of the PJ, however the 18D's skills with respect to the PJ's scope of practice is not quite as well honed?

Or more roughly:
The 18D has wider scope of practice which includes the scope of practice of the PJ.
The PJ is more skilled in his ( the PJ's ) scope of practice than 18D.


Staff member
<div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: thart</div><div class="ubbcode-body"> Would it fair to say…</div></div> No it is not and will not be fair to say. The Scope of medical practice has no usable comparison point as the operational utilization of the military occupations diverges significantly.

<div class="ubbcode-block"><div class="ubbcode-header">Quote:</div><div class="ubbcode-body"> current 18D initial qualification course description, Currently Effective 2014-08-26:

Course Scope:

The course teaches 18D and Navy students the advanced skills and knowledge required <span style="color: red">to perform as supervised providers in CONUS environments, and as independent providers OCONUS.</span> Independent provider means the 18D and Navy SM is supervised indirectly after diagnosis. The course consists of 10 academic modules: Administrative, Laboratory Subjects, Veterinary Medicine, Surgery, Anesthesia (to include Monitored Anesthesia Care (MAC), Total Intravenous Anesthesia (TIVA), and Regional Anesthesia), Perioperative Care, Principals of Radiology and Ultrasound, a 24 day Special Operations Clinical Training rotation, and Special Forces Medic Roles and Responsibilities.

Special Information:

The Commander, AMEDDC&S, has the proponency for Army medical doctrine, training operations, and material development. As an agent to the Commander, the Dean of Joint Special Operations Medical Training Center (JSOMTC) will certify the medical competency of each special operations medic by monitoring the successful completion of mutually agreed-upon medical tasks. <span style="color: red">The CDR USSOCOM has charter to conduct and provide oversight for SOF training. (Army). </span> All courses inherent to the Special Forces Qualification Course must be completed, prior to the 18D MOS being awarded. Personnel already qualified in an MOS of the CMF 18 may attend the SFMS Course, after successful completion of the SOCM Course. Upon successful completion of the SFMS Course the SM will be awarded the 18D MOS. (Navy) Special Amphibious Reconnaissance Independent Duty Corpsman (NEC 8403) is awarded upon successful completion of the Special Operations Independent Duty Corpsman (SOIDC) Course. Currently no further NEC is given to SEAL Medics upon completion of this portion of training. ATRRS Info: Army has 34 and Navy has 6 of the 40 OCS seats.</div></div>I emphasized text in red for further points of discussion.

1. “to perform as supervised providers in CONUS environments” directly connects to Military Assistance to Safety and Traffic (MAST) program (1969) and Public Law 93-154 "EMS Systems Act of 1973”. The PJ is a identified National SAR asset required since 1947 to be available and capable of treating civilians with minimal, if any physician supervision, to civilians off and away from military installations and not necessarily connected to ongoing active military operations. The paramedic certification is requirement for PJs connects to the level of emergency response medical treatments PJs provide to injured civilians AND needed to obtain, for legal liability reasons access to sustain medical procedure and skills procedures at various civilian trauma centers and EMS locations.

2. The actual course connected to EMT-Paramedic certification is not an MOS awarding course. The Army’s course leading to EMT-P certification mirrors the PJ Pararmedic course required to become a PJ.

<div class="ubbcode-block"><div class="ubbcode-header">Quote:</div><div class="ubbcode-body"> SPECIAL OPERATIONS COMBAT MEDICAL COURSE description, effective 2014-08-02:

Course Scope:

Special Operations Combat Medic Course (300-ASIWl); This 36 week (180 training days) course teaches eight 87 student classes per year and is based on an approved critical task list which is reviewed and updated by the Joint Medical Enlisted Advisory Committee(JMEAC) as directed by the USSOCOM Command surgeon lAW USSOCOM Directive 350-29. The course consists of a series of didactic and performance based learning objectives presented in a logical sequence, enabling the students to progress through the training both individually and as a collective group. <span style="color: red">The target audience for SOCM is Army or Navy enlisted service members who hold, or are designated for assignment to a special operations medical position.</span> The course qualifies these enlisted service members as highly trained combat medics with the necessary skills to provide initial medical and trauma care and to sustain a casualty for up to 72 hours if needed before evacuation occurs. The SOCM course is subdivided into individual modules. The SOCM student will be proficient in the following areas/objectives upon completing the course. Basic Life Support (BLS) -certifies students through the American Heart Association (AHA) approved curriculum; Emergency Medical Technician -prepares students to sit for the National Registry for Emergency Medical Technician (NREMT) exam and culminates with NREMT certification; Medical Math -instructs how to prepare, calculate, and administer medications; Anatomy and Physiology -instructs the structures and functions of the 11 organ systems and how to identify the anatomical structures and their functions on cadavers in the laboratory; Physical Examination -instructs patient interaction, history taking, physical examination techniques, clinical decision making, and documentation and introduces students to radiology and laboratory procedures; Clinical Medicine-instructs pathophysiology, pharmacology, preventive medicine and medical management of weapons of mass destruction; Dental -instructs the basic emergency dental care in an austere environment; Advanced Cardiac Life Support (ACLS) - certifies students in ACLS through the AHA approved curriculum; Pediatric Education for Prehospital Professionals (PEPP) -certifies students in PEPP through the approved PEPP curriculum; Military Medicine -instructs medical planning in support of tactical operations, preventive medicine and weapons of mass destruction; Trauma -instructs pathophysiology, assessment, and management of traumatic injuries; Advanced Trauma Practical Skills -instructs intravenous and intraosseous access, endotracheal intubation, needle decompression, tourniquet application, nasogastric intubation, urinary catheterization, and Extended Focused Assessment with Sonography in Trauma (E-FAST) examination; Trauma Patient Assessment-instructs assessment and management of a trauma casualty; Combat Trauma Management - instructs additional life-saving trauma interventions including hemorrhage control, cricothyroidotomy, venous cutdown and tube thoracostomy and further enhances overall trauma management skills; Tactical Combat Casualty Care (TCCC) -instructs TCCC, triage, casualty collection point operations, and multi-purpose canine emergency and trauma care; Advanced Trauma Management -instructs medical leadership and utilization of additional resources in the management of complicated trauma patient scenarios through the use of patient simulators;<span style="color: red"> Advanced Tactica l Paramedic (ATP) Examination - certifies students as Advanced Tactical Paramedics; Field Training Exercise - serves as the culmination exercise for the SOCM course and is a comprehensive assessment of training received throughout tile course; Clinical Rotation Field Internship - a clinical practicum designed to integrate didactic knowledge with practical experience in both prehospital settings with emergency medical services and in clinical settings at various medical centers.</span>

Special Information:

On a space-available basis, personnel already qualified in an MOS of CMF 18 may attend this course prior to attending SFMS/SOIDC to "cross-train" in MOS 18D.</div></div>
Further although the 18D does have clinical duties involving prolonged nursing care of non-trauma patients in the hospital bed, this is a ridiculous military occupation (MOS/AFSC/NEC) comparison point as there are aspects of environmental medicine (Biological warfare, high altitude ailments, dive medicine, poisonous animal and plants) of providing realms of medical treatments that require the SF 18D medic being in certain duty position utilization that are core utilization areas for all PJs. How many 18Ds get dive medicine quals or get involved in doing extreme high elevation (above 10,0000 feet MSL) remote mountain operations which for the PJ generally requires understanding and treating adverse effects of high altitude? How many 18Ds are MFF qualified to include being MFF jumpmaster qualified which for the PJ generally requires understanding and treating adverse effects of high altitude?

The duty description for the 18D also indicates much administrative and logistics involvement in establishing and sustaining a clinic. PJs in the past have had some involvement in these duties, but since the establishment of the STSs and Guardian Angel Rescue squadron these duties are performed by assigned to the units 4N career field (AFSCs) medical support personnel.

Again it is other qualifications the PJ must have to obtain award of AFSC that isn’t required for Award of any Army MOS to include the 18D more so than the scope of medical practice and treatments provided to patients more distinctive demarcations of operational utilization of the military occupation on the operational environment. Particularly since AFSOC 4N AFSC IDMTs are eligible to go through the SPECIAL OPERATIONS COMBAT MEDICAL COURSE.


Staff member
The U.S. Army Flight Medic program also offers a paramedic course.

Course Title: FLIGHT PARAMEDIC, Academic Hours: 1045

Course Scope:

Instruction will be provided and conducted at a local (Fort Sam Houston/San Antonio) college affiliated EMT-Paramedic training facility. Students will receive both didactic and clinical training required for application and testing as an NREMT-Paramedic.

Course Prerequisites:

The Flight Medic Paramedic Course is only available to 68WF3 Flight Medics, <span style="color: red">in the grades of E3 to E6 actively serving in the Air Ambulance community, or on subsequent assignment to an aeromedical evacuation unit.</span> The Flight Medic Critical Care Clinical Skills phase is only available to 68WF3 Flight Medics who have completed the Flight Medic Paramedic Course or who are already NREMT-P certified. Soldiers attending this phase of training must be a previous graduate of the 300-F6, phase 1 and 2 conducted at USASAM, Ft. Rucker, AL. , or have met requirements for award of ASI F3 as a non-school trained flight medic.

Beginning FY15, the Flight Paramedic Course is also available to new 68WF2 applicants selected for flight paramedic duty. New flight paramedics will attend both the 300-F1, Flight Paramedic and 300-F2, Critical Care Paramedic courses at Joint Base San Antonio TX prior to attending 300-F6 Flight Medic Course at Ft. Rucker, AL.

Soldiers who attend this training:

Must have current Army Class 3 flight physical.

Applicants must be able to meet the height and weight requirements outlined in AR 600-9 prior to day one of the programs start date. Applicants will be given a diagnostic Physical Fitness Test (APFT) within 7 days of the start of the program. Soldiers with a Permanent profile (DA 3349) that require them to take an alternate aerobic event will submit a copy of their profile with their application to determine course eligibility for review by the Program Director. Soldiers will be required to take a record APFT 30 days prior to graduation. Soldiers who fail to achieve a passing score on the APFT or who fail to pass the Army's Height/weight requirements will be given a minimum of 7 days before given a retest. Soldier must pass the APFT and height/weight as a graduation requirement. Soldiers who fail to meet these requirements will not be awarded the ASI (F2) and will be assigned needs of the Army.

Must be fully qualified in MOS 68W (NREMT, BLS certified) and have no history of felony conviction.

Active Army Soldiers must be on assignment or pending assignment to an aeromedical evacuation authorization with at least 24 months stabilization remaining on tour of duty at the time of graduation.

The attached history mentions: ..Taking the lead, an inter-service effort between the Department of Defense, Department of Transportation, and the Department of Health and Human Services initiated the Military Assistance to Safety and Traffic (MAST) program to determine whether or not military helicopters could effectively augment existing civilian emergency medical services. The MAST program became operational in 1971, and ...

It completely omits Air Force involvement and ignores the National Registry Cert was typically EMT-A (ambulance). EMT-A and EMT-non Ambulance was subsequently merged during the late 1970s and early 1980s to became EMT-B.

It also infers many Army and Air Force MAST units existed. However by January 1977 the Department of Defense had only authorized 24 Air Force and Army helicopter units to take part in MAST. Further MAST was pilot-tested during 1970 at five military bases: San Antonio, Texas-operations began 15 July 1970; Fort Lewis, Washington-operations began 6 August 1970; Fort Carson, Colorado-operations began 6 August 1970; MT Home AFB, Idaho-operations began 1 September 1970; and Luke AFB, Arizona-operations began 1 September 1970.

General- requirements were that the helicopters would augment or supplement the local EMS system, not replace any existing elements of it; that the operation would not be directed into downtown or metropolitan areas where ground ambulance services in general would be more responsive; and that the Military operations should avoid any competition with operators of air and ground ambulance services.

Further, seventy-two percent of the MAST missions flown at the initial five military base locations (primarily at the Army locations) during the pilot test phase were inter-hospital transfers generally involving a patient who had been initially taken to a local hospital, where it had been determined that they required transfer to receive more definitive medical treatment. (context being MAST wasn't a National SAR plan rescue operation, but an aeromedical evacuation operation).

FYI, I was assigned as a PJ at Mt Home AFB during the period October 1975 to October 1977 accomplishing several MAST and SAR missions to include at least three underwater search and recovery missions. There is a being there utilization difference.

The Teton Dam disaster is one of the SAR incidents I was on the first military helicopter responder to. I was on the only military helicopter in immediate area of the dam when it failed and pulled several people to safety before a raging wall of water hit their location immediately downstream of the dam as it began to fail. Other military helicopters didn't arrive until 30 minutes or more after the dam had completely failed.


I'm in paramedic school in the pipeline right now and I can tell you what my instructors have told us about this topic.
18D's are not certified Paramedics and go through their own course that has combat/dirt medicine and a lot of clinical medicine such as odd diseases commonly found in foreign countries that we don't see much in the US. They will know more about diagnosing and treating such oddities.
PJ's are basically the godsquad when it comes to dirt(unconventional)/combat medicine. Plus paramedic school has a lot of clinical/ medical medicine built into it. PJ's also have extra capabilities that normal paramedics don't. They can do some things that only doctors can such as blood transfusions, different kinds of emergency surgeries.. etc

It makes sense when you think about it, think of an 18D in an afghan village with a line of people waiting to see him for some medical problem as the 18D wins hearts and minds. Then think of a PJ treating one of our boys who's been f!@#ed up, trying to prevent him from dying. This is how the medical portion is custom tailored to each career. Of course each career gets good portions of the other side as well, I'm just saying for the most part this is how it is different.


Staff member
The providing clinic type sick call and medical care to indigenous peoples (resistance groups, partisans, and general population) goes back for the 18D to WWII primarily in the Baltic/Slavic region and CBI (China Burma India).
Not certain about today, but back in 1988 the SF Medic basic course gave enough instruction so the students could take the EMT test. The NCO course provided enough instruction so the students could take the Paramedic test. We sent the precedent for Army Medic training and not long after conventional force medics were afforded the same opportunity.

The original intent of the consolidated training facility at Ft Bragg was to address the needs of all medics in the SOF community - Army, Navy, Air Force. It was one of the biggest things noted in the 1988 International SOF Medical Conference hosted at USAJFKSWCS in 1988.

Administrators and lack of continuity may have screwed things up since then. I was the first healthcare administrator assigned to SF Medic training. I was at USAJFKSWCS Jan 87 - Dec 88.897C0A75-A230-4F1B-9EA7-9C7C43DC8054.jpeg


Staff member
Although not definitive to any sort of skills standardization or operational utilization the enlisted medics in the field encompasses everything from the combat medic to Independent Duty Medical Technician (IDMT) before EMT and Paramedic certifications were developed during the 1970s and emerging emphasis on SOF in the 1980s.

The combat medic on the front lines had skills and knowledge predominantly focusing on treating battlefield trauma whereas the IDMT was bit more rounded for conducting sick call/clinic activities.

Special Operations medical operations necessity has its WWII OSS origins with support of underground resistance groups which remerged during the Korean war to provide medical support to partisen forces and continued on during the Southeast Asia conflicts. Of course the SF medics also were there to provide first response treatment of battlefield injuries (combat medic capacity) until the wounded were casualty evacuated.

The conventional forces enlisted medics were already being pushed towards obtaining EMT and paramedic certifications due to the 1974 amendment of the National Traffic and Motor Safety Act of 1966 and the Military Assistance to Safety and Traffic (MAST) system which utilized military helicopters and military medical personnel to respond to civilian emergencies. MAST was done by both Army and Air Force units. . Also
MAST Report of Test Program, July-December 1970, in reading this report awareness is needed that the Air Force local base recue units were not all the same. Mt Home converted to a CSAR unit when PJs were assigned to the unit in 1972 and the negatives stated about LBR units were remedied whereas the Luke LBR unit continued to have problems. I was assigned to the Huey unit at Mt Home from Oct 1975 thru Oct 1977 and have a bit more awareness of MAST after the linked report was published.

The short effect of the MAST system is predominately Army enlisted medics were found to need additional skills training whereas the USAF Pararescue personnel already had the necessary skills training due to National and International SAR requirements unique at this time to this enlisted military occupation specialty. It was mostly legal liability of treating civilians pushing the need for EMT/Paramedic certifications.

Many histories such as Wikipedia's Air Medical Services omit mention of the Air Force Air Rescue Service (Also Aerospace Rescue and Recovery Service) as its mission was SAR and CSAR and not aeromedical evacuation. Thus the medical training precedents set by USAF pararescue get appropriated by other military services and particularly Army SOF.

The Pararescue requirement to attend the SOF course at Ft Bragg was short lived as it was many weeks longer due to all the running a sick call clinic requirements and the money per student and money for instructors the Army was demanding the Air Force to pay to the Army and the inability to align the required training pipeline to this one course. This same situation and circumstances contributed to Air Force establishing its own Combat Diver Qualification Course as other occupation specialties (CCT, SR, and TACP) began putting their personnel through such training.

That’s nice ...

The original intent of the consolidated school at Ft Bragg was to have a course catalogue where different organizations could pick and choose what parts of the curriculum applied to their particular needs - not a one size fits all, take it or leave it.

We knew at the time that the needs of an Army SF medic (who needs to know everything from gunshot wounds, to sick call, to animal husbandry) vs AF Pararescue Medics vs a Navy SEAL Medic, vs a Marine Force Recon Medic were all different. However, the very fact that the USAJFKSWCS Surgeon used the privilege of his position to communicate directly with the Surgeon General of the Army to communicate the need, as well as how to pay for it, put so many knickers in a knot at Ft Sam Houston that they were tripping over themselves trying to sabotage the effort. Not long after we had the conversation with the Surgeon General, all medical personnel at USAJFKSWCS were reassigned vía a variety of excuses.

So I’m not surprised that the outcome was less than wonderful. But I felt it my duty to at least pop my nose in at let you folks know we had you in mind when we started it.

As for any medical personnel receiving the training hours necessary to take either the EMT or Paramedic tests - that too was our initiative to include it in their formal military instruction. I lived through all of this, I was boots on the ground.

Take care out there.
I suppose I need to add that in 1988 USAJFKSWCS Special Forces Medical Branch Training was the only facility in DoD with AAALAC (American Association for the Accreditation of Laboratory Animal Care) accreditation. So we could play with goats legally as long as the facility was run like a well managed farm and the animals never experienced any pain. At the time the Navy and Air Force were doing things that weren’t according to regulation (being AAALAC accredited) and so that gave our training more appeal.

Why goats? The anatomy of a goat upper thigh closely resembles the anatomy of a human thigh. The animals were anesthetized, placed in a cradle in a GSW chamber, and wounded with a 7.62mm bullet fired from a stationary mounted rifle barrel. The student then treated the wound, and cared for the animal through the healing process. A nerve block was used to prevent the animal from experiencing pain.

I went by the new facility a few years ago, they no longer have animal patient models, and may never have had them at the new facility. The old facility was wiped clean, nothing remains.

Again, best wishes.


Staff member
I agree the original curriculums consolidation intentions never had a chance due to politics injected by the main stream conventional Army and Air Force medical services. Perhaps the strongest interference is although Physician are the top dog in medical policy decision making USAJFKSWCS is outside of the Army's military medical service organization and establishment. The same organization alignment of being outside of and actually detached from the Air Force's medical organization and establishment exists for pararescue.

Many reading this thread will not realize the pivotal significance of 1988, particularlily for the 18D Special Forces medical MOS. 1988 is a demarcation of the end results of renewed emphasis on special operations occurring during the 1980s.

In June 1983, the Army authorized a uniform tab for wear on the left shoulder solely by Special Forces troops. The Army established on October 1, 1984, a separate career field for Special Forces (18 series MOSs). The warrant officer career field soon followed and, on April 9, 1987, the Army Chief of Staff established a separate branch of the Army for Special Forces officers. The establishment of a separate branch for Special Forces Officers is accompanied with establishment of jungle green as the branch color, approved by the DCSPER on 22 May 1987. June 1988 also saw implementation of the current Special Forces Selection and Assessment program.

The CMF 18 is subdivided into five accession Military Occupational Specialties (MOS's): 18A, Detachment Commander; 18B, SF Weapons Sergeant; 18C, SF Engineer Sergeant; 18D, SF Medical Sergeant; and 18E, SF Communications Sergeant.

Although medics performing 18D duties, role, and mission have been around since the Army established the first permanent Special Forces units in 1952, the process was to obtain volunteers already holding award of the desired MOS and giving them additional training resulting in the the Special Qualification Identifier added to an MOS (MOS classification) until 1984. Legacy of the qualification requirement being connected to a Special Qualification Identifier added to an MOS is evident in the 18 MOS title being Special Forces Medical Sergeant.

For the same reasons the organizational and mission capability situation and circumstances of Pararescue not being medics within the Air Force's medical service has injected politics into justifying and validating pararescue medical training requirements that made the merger with USAJFKSWCS for medical training and sustaining up to date medical treatments protocols. The lack of direct transition from the SF Medic basic course (EMT) to NCO Course (paramedic) contributed to an already training pipeline of 18-24 months extending out to four years. Entry enlistments were over by the the time a PJ got trained and available for assignment to a line unit.


Staff member
This assertion of "I suppose I need to add that in 1988 USAJFKSWCS Special Forces Medical Branch Training was the only facility in DoD with AAALAC (American Association for the Accreditation of Laboratory Animal Care) accreditation" is inaccurate. The Pararescue School discontinued its animal lab and moved this training to the Live tissue training being provided to AF Physicians at Wilford Hall, Lackland AFB, TX. The issues and problems were more complicated than simply being attributed to accreditation.
This assertion of "I suppose I need to add that in 1988 USAJFKSWCS Special Forces Medical Branch Training was the only facility in DoD with AAALAC (American Association for the Accreditation of Laboratory Animal Care) accreditation" is inaccurate. The Pararescue School discontinued its animal lab and moved this training to the Live tissue training being provided to AF Physicians at Wilford Hall, Lackland AFB, TX. The issues and problems were more complicated than simply being attributed to accreditation.
If you insist ...

We had a 4 star general come and thank us personally for being the only DoD accredited facility a few days after we received it.

In the 1988 conference your guys (an MD in charge of medical training then, and a couple of operators) expressed concern about not following DoD guidance, something about sneaking around the details of which I won’t go into.

But like everything, there is always at least two sides to every story.
The enlisted specialties as well as the officer branch were huge successes for Special Forces. However, the nature of the qualification course changed to being a branch qualification course only, and support pukes were no longer allowed to attend unless they rebranched SF.

My joke is there are two basic types of SF officers - the knuckle draggers, and the cerebral. About the time all of these changes were coming about, the cerebrals were replaced by knuckle draggers compounding the damage from Ft Sam. They truly didn’t understand what they had, or why it was necessary.

Army Medical moved the Med Branch MD & veterinarian, the psychologist who helped create selection and oversaw SERE, and myself all at the same time with no overlap. A few years later while at 5th SFG, the USSOCOM Surgeons Office Operations Officer was the guy at JSOC back in 88. When we saw each other at McDill we laughed about it can’t hurt to try, but we’ll likely be retired or forced out before we can see things through proper execution.

My next assignment was 3 years at the National Training Center helping Division Commanders on down understand how to effectively integrate healthcare into the scheme of things. Afterwards they wanted to send me to Ft Sam. Because I knew they were coming up available I asked for the new school - no; so I asked for the SOF medical company - no. So I retired early because I could and back then it was up or out.

Talking with folks at the new facility, things have been watered down.

Happy you folks found a working solution.

Being medical, but not being medical is tough act to pull off.


Staff member
But like everything, there is always at least two sides to every story. The situation of "They truly didn’t understand what they had, or why it was necessary that has caused many problems within the US Armed Forces since the Korean War and is not limited to the medical skills and qualifications being discussed in this thread.

Two sides is exactly my point and the lack of written historical documented record to capture what happened and why contributes to the problem in many ways. In 1988 the claim of "We had a 4 star general come and thank us personally for being the only DoD accredited facility a few days after we received it" is correct and accurate as the Air Force had decided to not pursue sustaining such accreditation for the Pararescue Medical Training conducted at the PJ School. It was decided it was more cost effective to put the handful of PJs (often less than 10 for the 3-level requirement and less than 20 for the refresher courses) through the physician live tissue trauma training at Wilford Hall. Up until 1988 it was required for each PJ to go through the animal lab refresher course every 4 years after going through the 3-level course. Typically the 5 to 6 3-level courses had less than 10 students and the separate refresher courses numbered about 3 or 4 per year with about 15 to 20 students which at this time included the Canadian Forces PJs and occasionally sister service and NATO member military medics. BTW, the 7-level refresher course I went through in 1988 wasn't the same refresher course curricula as far as live tissue training I encountered in 1993.

I presume the Air Force live tissue training program was accredited, but I lack documentation to review and confirm. However, close proximity of Wilford Hall to Ft Sam Huston had much Army politics complicating Air Force training of its enlisted medics even back then. In fact, I have to look up the year, but about ten years ago Air Force training of its enlisted Medics was consolidated at Ft Sam Huston and integrated under Army medical service.

A review of Special Forces histories that are available give very little insight into the 18D MOS other than consistently identify it has the highest training attrition rate in the Special Forces branch.

For example a few extracted quotes from various histories although some mention of SF medics during the 1950s and 1960s can be found if one really digs.

Present for duty on that day, 19 June 1952, were seven enlisted men, one warrant officer, and COL Bank. By the end of June the Group had assigned 122 officers and men. Sprinkled among these initial arrivals were former OSS, Ranger, and Airborne soldiers as well as Lodge Bill soldiers
(Lodge Bill soldiers were East European or stateless volunteers in the US Army).

Reference to team structure in 1956--- Each team at that time was comprised of one Master Sergeant and five team members.
Overall Officer in charge of the group was a major, assisted by a Captain.

Early training stressed the individual skills represented in the basic Operational Detachment, Regiment: operations and intelligence, light and heavy weapons, demolitions, radio communications, and medical aid. Each man was thoroughly trained in his particular specialty, then participated in "crosstraining" in order to. learn the rudiments of the other skills represented in the detachment.
If you insist ...

We had a 4 star general come and thank us personally for being the only DoD accredited facility a few days after we received it.

In the 1988 conference your guys (an MD in charge of medical training then, and a couple of operators) expressed concern about not following DoD guidance, something about sneaking around the details of which I won’t go into.

But like everything, there is always at least two sides to every story.
Corrected I type ... it was Max Thurman, only 3 stars at the time. He was so impressed he told his aide to cut us a check for $200,000 to build a new medical waste incinerator. I got for $45,000 and used the leftovers to upgrade the medical laboratory classroom equipment.
“A review of Special Forces histories that are available give very little insight into the 18D MOS other than consistently identify it has the highest training attrition rate in the Special Forces branch.”

In 1987 the attrition rate at Ft Sam alone was 70%, we’d send them 100, and only get back 30. Then at Ft Bragg maybe 12-20 of those would graduate. There were medics in groups that were double tasked just to have one medic on a team (e.g. they were assigned to more than one team). To gain entry to SF back then meant you were an E5 for enlisteds, and O3 for officers, for medics they would take a promotable E4. Ft Sam was a permanent change of station move for one year - so the wife, the cat and dog, all of your household crap went also. Once completed, another move back to Ft Bragg. On the scale of stressors, moving is #3 or 4. With all of the training at Ft Bragg, the moves go away, the stress reduces, and the money saved pays for the consolidated facility in two years, after that it’s money in the bank. Get the other services to use it, even better.

The consolidated facility claims 10-20 percent attrition - 100 start, 80-90 graduate. Teams have medics again, many have 2

About the same time the Army made Physician’s Assistants commissioned officers. Many of the SF medics who previously would have been a shoe in, were disqualified for time in service reasons. I had 30 instructors at any given time, every PA cycle we lost at least 5.

With the establishment of the enlisted career field came the responsibility to have a noncommissioned officer professional development course (entry level E4-6, senior course E6-7). Standing back looking at the big picture is where it was decided to include the training needed to take the EMT basic test in the curriculum of the entry level medics. Then because paramedic requires time working as an EMT, the material needed for paramedic was included in the senior medic course. All of which made the hospital administrators happy because the guys seeking time working in their hospital had credentials which in turn made the hospital credentialing authorities happy. Again, the idea was so brilliantly simple, the Army adopted it for the conventional medics as well. Later still, all conventional force medical personnel start life as a field EMT, then specialize later - lab tech, radiology, scrub tech, etc.
“I presume the Air Force live tissue training program was accredited,”

Again according to your guys in 1988, nothing they did live tissue was accredited.
“I have to look up the year, but about ten years ago Air Force training of its enlisted Medics was consolidated at Ft Sam Huston and integrated under Army medical service.”

There is a little dive bar going out the back gate at Ft Sam, a regular hang out for medics, especially SF medics - “Betty’s Battalion”. I know Betty. I stopped by maybe 10 years ago. It took a while for her to remember me since the last time we saw each other was 1989. So I told the story of the consolidated facility. At first she was a little miffed realizing where her favorite clientele had disappeared to. Then she started laughing. I asked, “What?” She said, “Your stupid idea was so brilliant the entire armed forces comes to Ft Sam now to train - Army, Air Force, Navy. So while on one hand I lost customers, on the other I gained them back at least twofold”.

And it was true, Ft Sam had expanded facility wise to accommodate the extra students and instructors. I barely recognized it.
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