Special Forces Doctor Tells The Craziest Combat Medical Stories | Unsubscribe Podcast 263
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Quick Read
Summary
Takeaways
- ❖Special Forces medics (18 Delta) are trained in a wide array of medical procedures, including basic radiology, dentistry, veterinary medicine, surgery, and anesthesia.
- ❖The game of Buskashi in Afghanistan involves horse-mounted players fighting over a headless, footless goat carcass.
- ❖9/11 radically shifted the purpose of special forces training from hypothetical missions to active combat.
- ❖The U.S. military's commitment to 'leave no one behind' is a distinguishing factor compared to other militaries.
- ❖The VA claims process is often complex, requiring veterans to overcome cultural norms that discourage documenting injuries.
- ❖AI implementation in the VA system is currently flawed, leading to 'hallucinations' and increased workload for human reviewers.
- ❖Veterans should file an 'intent to file' on va.gov immediately to backdate their claim benefits.
Insights
1Unconventional Military Path
Tier's military career began in 1995, including time in the first cavalry riding horses, and an initial aspiration to attend farrier college before transitioning to Special Forces as an 18 Delta medic. This unconventional start highlights the diverse paths within military service.
31 years of service in the army. I did 1995... 25 of that was in special operations and previous to that I was in the first calav. But uh on paper I I had a Abrams driver's license is a 19 kilo, but I actually rode horses for the army.
2Combat Amputation with Improvised Tools
In early 2004 Afghanistan, Tier performed a leg amputation on an elderly local man whose leg had been broken and turned backwards for six months. Lacking specialized surgical tools, he used a DeWalt sawzall (later replaced by a bone saw with thermobaric grenade rings as handles) and an electric cautery tool, while the patient was under ketamine anesthesia.
I was like, 'You got to go to Pakistan, man. I I can't help you.' And he hadn't the patient, the old man actually hadn't said anything up to this point... And he speaks up and he's talking to this real horse, raspy voice. And I was like, 'What'd he say?' He's like, and the interpreter goes, 'He says, "Can't you just cut it off?"' I was like, 'Yeah, I can do that. Come back next Saturday.' ... They looked at me like, 'You're going to cut his leg off with a sawzaw.' I'm like, 'Yeah, why why wouldn't I?' ... I learned something about medical logistics that day. You can't just order the saw. You have to order the handles with it. ... I grabbed the Marine PL and I told security like, 'Hey, there's going to be a couple big booms. Don't go shooting off into the sky about this. Like we will we will radio. So I grabbed the this marine peel and we went to the edge of the hesco. I said, 'All right, listen. We're gonna throw these over the the wall on three, but we were keeping the rings.'
3Challenges of VA Claims and Cultural Barriers
The military culture of 'pushing through pain' and avoiding aid stations creates significant hurdles for veterans trying to file VA claims, as injuries often go undocumented. This cultural issue, combined with the VA's requirement for service connection, penalizes many deserving veterans.
What they're looking for in that range of motion is not how far you can bend it. It's how far you can bend before you meet any kind of resistance... And you have to you have to have you have to swallow your pride and not push through that or you you and not only you but your family is gonna be penalized for it. ... If it's not on paper, it did not happen. And I promise you that it none of anything none of what you're going to do on this trip is going to disqualify you from further service... You need to get that documented.
Bottom Line
The current VA claims system's vulnerabilities to fraud are exacerbated by the Department of Defense's practice of medically discharging service members for 'failure to adapt' or minor issues, pushing the financial burden onto the VA.
This creates a perception of widespread fraud, potentially undermining public and political support for legitimate veteran benefits, and diverts resources from those with combat-related or severe service-connected injuries.
Advocate for policy changes at the DoD level to address early discharge practices and implement stricter criteria for medical discharges that lead to VA disability claims, ensuring that the VA primarily serves those with demonstrably service-connected conditions.
The integration of AI into the VA claims processing, intended to streamline operations, is currently 'hallucinating' and creating fictitious conditions for veterans, leading to increased human workload and potential inaccuracies.
This highlights the critical need for robust human oversight in AI systems, especially in sensitive areas like veteran healthcare and benefits, to prevent errors and maintain trust.
Develop AI solutions with built-in human-in-the-loop validation processes for VA claims, focusing on AI as an augmentation tool rather than a replacement for human judgment, to improve efficiency without sacrificing accuracy or fairness.
Opportunities
Extera Health - Veteran-Centric VA Claims Support
Extera Health offers medical letters (DBQs) and Nexus letters (connecting service to injury) for a flat fee of $500 per letter, rather than a percentage of the veteran's claim. They prioritize veteran support, not turning anyone away for inability to pay, and aim to streamline the VA claims process by providing necessary medical documentation.
Key Concepts
Fake it till you make it (in high-stakes situations)
Tier describes having a 'massive amount of confidence in myself that I probably shouldn't have had' when performing complex medical procedures in the field, which ultimately led to successful outcomes, highlighting the psychological aspect of operating under extreme pressure.
If it's not on paper, it did not happen
This principle is crucial for VA claims, as undocumented injuries or conditions are difficult to service-connect. It emphasizes the importance of meticulous record-keeping, especially for service members who often adhere to a military culture of 'pushing through pain' rather than reporting issues.
Lessons
- Immediately file an 'intent to file' on va.gov to backdate your VA claim benefits, even if you haven't gathered all documentation.
- Document every injury or medical issue, no matter how minor, with your military medic or aid station, and keep paper copies of records, as undocumented issues are difficult to service-connect for VA claims.
- When undergoing VA Compensation & Pension (C&P) exams, honestly report pain and limitations without 'pushing through' discomfort, as the evaluation focuses on the point of resistance or pain, not maximum range of motion.
Notable Moments
Tier recounts playing Buskashi, a barbaric Afghan game involving horse-mounted players fighting over a headless goat carcass, and winning cash that he then gave to a local.
Illustrates the extreme cultural differences and adaptability required in special operations, and the unexpected ways rapport can be built in foreign environments.
Tier describes the moment he and his fellow medic student realized 9/11 meant they were 'going to war,' fundamentally shifting their military careers from training missions to active combat.
Captures the profound and immediate impact of 9/11 on military personnel and the shift in global geopolitical priorities.
Tier details using thermobaric grenade rings as improvised handles for a bone saw during a field amputation, after realizing the ordered bone saw lacked handles.
Highlights the ingenuity and resourcefulness required for combat medicine in austere environments where standard equipment is unavailable or incomplete.
Tier explains that he audibly declared '5-second rule' after accidentally dropping a skin flap (harvested from the amputated leg) onto the ground during surgery, then washed it off and used it.
A darkly humorous and shocking anecdote that underscores the extreme, unsanitary, and high-pressure conditions of field surgery, and the need for quick, pragmatic decisions.
Quotes
"A special forces team does not revolve around the officer. It's the team sergeant who was notably absent from that movie plotline."
"A decapitated goat is easier to come across in Afghanistan than a soccer ball."
"I was the best doctor within a 4-hour donkey ride around me in in in Nay, Afghanistan."
"I had a massive amount of confidence in myself that I probably shouldn't have had."
"You can't just order the saw. You have to order the handles with it. You think that'd be an implied thing, but it's not. Nothing is implied in the military or the government."
"Sergeant Mater, are you telling me that your left hip never gets worn out after compensating for your right hip?"
Q&A
Recent Questions
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