Ragged Edge Solutions

RES was proud to support the second iteration of the Defense Health Agency's Traumatic Brain Injury Field Assessment Program end-user evaluation alongside Geneva Foundation and RTI International.

Real feedback from operational medical providers is what transforms promising technology into capabilities that can make a difference in austere environments.

Proud to play a small part in helping move battlefield medicine forward.

https://www.war.gov/News/News-Stories/Article/Article/4545273/dha-partners-with-marines-to-refine-portable-tbi-assessment-technology-for-aust/

Stay tuned...🇵🇱

We spend a lot of time in medicine talking about sterility. Sterile instruments, sterile fields, sterile technique. We obsess over contamination control during procedures, and for good reason.

But in denied or semi permissive environments, I think there’s another layer to that conversation that doesn’t get talked about enough:

How sterile is the scene itself?

Blood on a floorboard. Hair caught in tape. Skin cells on medical packaging. Fingerprints on IV wrappers. Sheets stained with bio. Medical waste left behind in an improvised treatment site.

In austere and operational medicine, patient care is only part of the equation. Depending on the environment, signature management and minimizing forensic exploitation can become just as important as the intervention itself.

And in urban settings, the footprint extends far beyond the room. CCTV systems, traffic cameras, doorbell cams, hotel surveillance, vehicle telemetry, and passive digital collection create a trail most people never even think about while focused on treatment.

Technology has changed the landscape. Attribution timelines are shorter. Collection capabilities are broader. The scene doesn’t end when the casualty moves.

We spend countless hours training casualty care.
Very little time discussing casualty footprint.

At what point does scene sanitization become part of the broader prolonged care or operational medicine discussion?

Just a conversation I think is becoming harder to ignore.

Most agencies with an operational medical mission never chose their training model. They inherited it.

Civilian EMS. Send people to EMT, get the card, check the block. The certification is real. But that model was built around one assumption: transport is fast and the hospital is close.

Hold that against the mission. Protective details. Enforcement operations. Remote field work. Overseas deployments. Places where the medical support is delayed, denied, or just not coming.

The value of operational medicine is not the card. It is the experience and expanded scope, authorized and supported by medical direction that understands the environment, that trains providers to think outside of the if-this-then-that handbook, manage an advanced airway, control pain with narcotics, and carry blood and damage control resuscitation forward to the patient.

Without those, in an environment where transport is not coming quickly, you are stabilizing what you can and waiting. And if waiting is the plan, you may as well call 911 and stand by.

That is one of the gaps the SO+AMT program is built to close. Nationally recognized credential, documented 98%+ first-attempt National Registry EMT pass rate every cohort since 2023, and the operational scope built on top of it under medical direction that fits the mission instead of the 911 system.

So, does your medical training match your mission? Or just your credential requirement?

The Inovytec Sparrow is an impressive capability, but like any tool, training and judgment will always matter most.

We've been doing this a long time. Hundreds of exercises, all over the world, with serious teams preparing for serious situations. The stakes are real, and the training should be too.

But one thing I've believed since the early PFC days is that good training should intentionally include some fun.

Deliberately build time for the things that make teams stronger. Schedule the extra 30 minutes waiting on the shoreline for the boat at sunset. Plan a mule movement instead of another truck ride. Serve a hot meal on the deck of a ship. Sit around a fire after the lane and solve the world's medical problems. Laugh at the inevitable screw ups and shenanigans. Those moments aren't distractions from the mission. They're part of it.

If you're asking volunteers to give up their weekends, units to dedicate resources, and professionals to invest their time, create experiences they'll remember. The camaraderie built during the downtime often pays bigger dividends than another perfectly scripted scenario.

Some of my favorite memories are the storms, the missed boats, the sh*tty jokes, the pack mules run amok, the bad coffee, and the conversations with good people who became lifelong friends.

Train hard. Be professional. Chase the objectives. But schedule the fun too. Because twenty years from now, nobody is going to remember your PowerPoint. They'll remember the people they trained with and the stories they brought home.

Take the pictures.
Make the memories.
The medicine matters, but so do the people doing it.

The value of experienced cadre is that they've seen enough patients, environments, and bad outcomes to recognize problems before they become emergencies.

Anyone can teach skills. Teaching judgment, prioritization, and decision-making under pressure is much harder, and that's where experience matters.