Joint Special Operations University

7701 Tampa Point Boulevard

MacDill AFB, FL 33621

https://jsou.libguides.com/jsoupublications

JOINT SPECIAL OPERATIONS UNIVERSITY

Colonel Warner “Rocky” Farr has made an important contribution to 

the body of SOF knowledge with this well-researched monograph. 

He advances the understanding of the many challenges and accomplishments related to guerrilla warfare medicine—care provided by 

predominantly indigenous medical personnel under austere conditions with limited evacuation capability—by providing a survey 

of the historical record in UW literature. Colonel Farr relates many 

historical experiences in the field, assesses their effectiveness, and 

lays a foundation for further in-depth study of the subject. The Joint 

Special Operations University is pleased to offer this monograph 

as a means of providing those scholars and operators, as well as 

policymakers and military leaders, a greater understanding of the 

complex and complicated field of guerrilla warfare medicine.

ISBN 978-1-941715-28-4

The Death of the Golden Hour and the 

Return of the Future Guerrilla Hospital

Warner D. “Rocky” Farr

JSOU Report 17-10

JSOU Report 17-10 The Death of the Golden Hour and the Return of the Future Guerrilla Hospital Farr 

Members of the 3rd Special Forces Group transport a simulated casualty to a 

medical evacuation zone at Camp Shelby Joint Forces Training Center in Mississippi during training exercise Southern Strike 17 on 27 October 2016. U.S. AIR 

FORCE PHOTO BY SENIOR AIRMAN CLAYTON CUPIT.
Joint Special Operations University

Brian A. Maher, Ed.D., SES, President

Boyd L. Ballard, Director, Center for Strategic Studies

Francis X. Reidy, Deputy Director, Center for Strategic Studies

Robert Nalepa, Lieutenant Colonel, U.S. Air Force, Ret., Editor in Chief

Lisa Sheldon, B.A., Advertising, JSOU Press Editor

Resident Senior Fellows

Peter McCabe, Ph.D., Political Science, Colonel, U.S. Air Force, Ret.

Will Irwin, MMAS, Lieutenant Colonel, U.S. Army, Ret.

Paul Lieber, Ph.D., Mass Communication & Public Affairs

David Ellis, Ph.D., International Relations, Comparative Politics

Editorial Advisory Board

Roby C. Barrett

Ph.D., Middle Eastern & South Asian History 

Public Policy Center Middle East Institute and 

JSOU Senior Fellow

James J.F. Forest 

Ph.D., Higher Education Administration

Associate Professor, School of Criminology and 

Justice Studies, University of Massachusetts 

Lowell and JSOU Senior Fellow

Mario Forestier

Chief Warrant Officer, U.S. Army, Ret.

Director, Joint Special Operations Command 

Center for Counterterrorism Studies

Thomas H. Henriksen

Ph.D., History

Hoover Institution, Stanford University

and JSOU Senior Fellow

Bernd Horn

Colonel, Canadian Dept. of National Defence, Ret.

Ph.D., War Studies

Command Historian, CANSOFCOM Education 

and Research Centre

Russell D. Howard

Brigadier General, U.S. Army, Ret.

John D. Jogerst

Colonel, U.S. Air Force, Ret.

James Kiras

Ph.D., History

School of Advanced Air and Space Studies, 

Air University and JSOU Associate Fellow

William W. Mendel

Colonel, U.S. Army, Ret. 

JSOU Senior Fellow

Alvaro de Souza Pinheiro

Major General, Brazilian Army, Ret.

JSOU Senior Fellow

James F. Powers, Jr.

Colonel, U.S. Army, Ret.

JSOU Senior Fellow 

Bryan C. Price

Lieutenant Colonel, U.S. Army

Ph.D., Political Science

Director, Combating Terrorism Center at 

West Point

Richard H. Shultz, Jr.

Ph.D., Political Science

Director, International Security 

Studies Program, The Fletcher School, 

Tufts University and JSOU Senior Fellow

Robert G. Spulak, Jr.

Ph.D., Physics/Nuclear Engineering

Sandia National Laboratories 

and JSOU Senior Fellow 

Jessica Glicken Turnley

Ph.D., Cultural Anthropology

Galisteo Consulting Group 

and JSOU Senior Fellow 

Rich Yarger

Ph.D., History 

JSOU Senior Fellow

Joint Special Operations University and the 

Center for Strategic Studies

The Joint Special Operations University (JSOU) provides its publications 

to contribute toward expanding the body of knowledge about joint special 

operations. JSOU publications advance the insights and recommendations 

of national security professionals and the Special Operations Forces (SOF) 

students and leaders for consideration by the SOF community and defense 

leadership. 

JSOU is the educational component of the United States Special Operations 

Command (USSOCOM), MacDill Air Force Base, Florida. The JSOU mission 

is to prepare SOF to shape the future strategic environment by providing 

specialized joint professional military education, developing SOF-specific 

undergraduate and graduate level curriculum and by fostering special operations research, analysis and outreach in support of USSOCOM objectives. 

JSOU conducts research through its Center for Strategic Studies (CSS) 

where efforts center upon the USSOCOM mission: 

USSOCOM mission. USSOCOM synchronizes the planning of Special 

Operations and provides Special Operations Forces to support persistent, 

networked, and distributed Geographic Combatant Command operations 

in order to protect and advance our Nation’s interests.

Press publications are available for download from the JSOU Library 

web page located at https://jsou.libguides.com/jsoupublications.
JSOU Report 17-10

The JSOU Press

MacDill Air Force Base, Florida

2017

The Death of the Golden Hour 

and the Return of the Future 

Guerrilla Hospital

Warner D. “Rocky” Farr
Comments about this publication are invited and should be forwarded to 

the Director of the Center for Strategic Studies, Joint Special Operations 

University, 7701 Tampa Point Blvd., MacDill AFB, FL 33621.

*******

The JSOU Center for Strategic Studies (CSS) is currently accepting written works 

relevant to special operations for potential publication. For more information, please 

contact the CSS Director at jsou_research@socom.mil. Thank you for your interest 

in the JSOU Press. 

*******

This work was cleared for public release; distribution is unlimited.

Printed in November 2017.

ISBN 978-1-941715-28-4
The views expressed in this publication are entirely those of the 

author and do not necessarily reflect the views, policy, or position 

of the United States Government, Department of Defense, United 

States Special Operations Command, or the Joint Special Operations 

University.

Authors are granted academic freedom provided their work does not 

disclose classified information, jeopardize operations security, or 

misrepresent official U.S. policy. Such academic freedom empowers 

authors to offer new and sometimes controversial perspectives in the 

interest of furthering debate on key issues.
Recent Publications of the JSOU Press

Property Rights and Social Justice as an Indicator of Stability: The SOF Nexus, 

JSOU Report 17-9, Bill Mandrick 

Transitioning from War to Peace: Post-Deployment Support for Special Operations 

Forces, JSOU Report 17-8, Jennifer M. Hazen 

2017 Special Operations Student Essays, JSOU Report 17-7

Special Operations Theory, JSOU Report 17-6, Volume 3, edited by Peter McCabe and 

Paul Lieber

Special Operations Contracting: 21st Century Approaches for Service and 

Technology Acquisition, JSOU Report 17-5, Benjamin Tkach 

Outside the Box: A New General Theory of Special Operations, JSOU Report 17-4, 

Volume 2, Tom Searle 

On the cover. Army Special Operations Resuscitation Team member, 528th Sustainment Brigade, examine a patient on Crestview Airfield, Florida, on 23 April 2015. 

Emerald Warrior is the Department of Defense’s only irregular warfare exercise, 

allowing joint and combined partners to train together and prepare for real world 

contingency operations. U.S. AIR FORCE PHOTO BY SENIOR AIRMAN CORY 

D. PAYNE/RELEASED. 

Back cover. Members of the 3rd Special Forces Group transport a simulated casualty 

to a medical evacuation zone at Camp Shelby Joint Forces Training Center in Mississippi during training exercise Southern Strike 17 on 27 October 2016. U.S. AIR 

FORCE PHOTO BY SENIOR AIRMAN CLAYTON CUPIT.
v

Contents

From the Director ........................................................................vii

Foreword ......................................................................................ix

About the Author...........................................................................xi

Introduction................................................................................... 1

1. History of Conventional Military Medical Support ..................... 5

2. SOF Unique Medical Support Requirements.............................. 7

3. WWI SOF and Medical Support: Africa and 

the Middle East............................................................................ 11

4. WWII SOF and Medical Support: From OSS to 

the Philippines............................................................................. 15

5. The Cold War and the Korean Partisan Rangers........................ 25

6. The Emerging SF Doctrine: Post WWII ..................................... 33

7. Vietnam, Special Action Forces, and the Green Berets ............. 43

8. The Rise of SOF and the Small Wars of the 

1980s and 1990s......................................................................... 49

9. The Global War on Terrorism and its Golden Hour .................. 53

10. The Platinum Ten Minutes...................................................... 59

11. Back to the Future: Prolonged Field Care............................... 61

12. Technical Challenges, Improving Sustainment, Reducing 

Footprints .................................................................................... 67
vi

13. Conclusion............................................................................ 71

Appendix: Acronym List .............................................................. 73

Endnotes...................................................................................... 75
vii

From the Director 

The Joint Special Operations University presents its first-ever monograph on this topic—an important one. Dr. Farr provides more than 

a succinct, chronicled snapshot of medical support in the realm where special operations forces operate. His discussion has application to today and 

tomorrow—not just for the special operations medical community but for 

those military planners and staff in geographic combatant commands, their 

theater special operations commands, and interagency organizations like 

the Department of State. Insights on modern day military casualty care and 

evacuation procedures likely offer careful consideration by non-governmental organizations as well. We welcome your feedback to this and any other 

of our publications.

Boyd L. Ballard

Director, Center for Strategic Studies
viii
ix

Foreword 

Unconventional warfare (UW) and its guerrilla warfare component have 

long been topics of interest among Special Operations Forces (SOF). 

There has recently been renewed interest in the study of this SOF core activity, as is evident in the many recent UW-related exercises, courses, academic 

papers, magazine and journal articles, and books. However, the study of one 

important aspect of guerrilla warfare—which has been neglected for a long 

time—is the medical care of guerrilla casualties and the establishment of 

hospitals to provide that care. 

Colonel Warner “Rocky” Farr has made an important contribution to the 

body of SOF knowledge with this well-researched monograph. He advances 

the understanding of the many challenges and accomplishments related to 

guerrilla warfare medicine—care provided by predominantly indigenous 

medical personnel under austere conditions with limited evacuation capability—by providing a survey of the historical record in UW literature. Colonel 

Farr relates many historical experiences in the field, assesses their effectiveness, and lays a foundation for further in-depth study of the subject. He also 

provides the reader with an overview of forward medical care shortcomings 

identified in recent exercises. 

Theater Special Operations Commands (TSOCs), in Colonel Farr’s words, 

are documenting a valid and critical requirement for “lean medical support 

by agile forward surgical enablers on missions involving long distances.” 

Coupled with the need to replace outdated doctrine on the topic, he highlights the demand for increased awareness of the problems presented by 

this capability requirement and encourages further study by the military 

and academic communities. Forward surgical care and medical support for 

extended light footprint SOF operations in remote areas, the author points 

out, are more difficult than conventional field medical care because of unique 

challenges such as the availability of adequate facilities and skilled personnel, 

holding capacity, casualty mobility, and survivability. Limited military medical infrastructure in immature theaters and doubtful local air supremacy are 

just two of the many factors that combined, make guerrilla warfare worthy 

of greater attention by scholars and SOF operators, and medical specialists.
x

The Joint Special Operations University is pleased to offer this monograph 

as a means of providing those scholars and operators, as well as policymakers 

and military leaders, a greater understanding of the complex and complicated field of guerrilla warfare medicine.

Will Irwin

Resident Senior Fellow, Center for Strategic Studies 
xi

About the Author

Dr. Warner D. “Rocky” Farr, Colonel, (Ret.), M.D., enlisted in the airborne infantry in l967 and was the distinguished honor graduate of 

his Special Forces 18D-medic class. He served in the 

7th Special Forces Group (Airborne) as an A-Team 

medic. Volunteering for service in Vietnam, he served 

as a recon team member with the 5th SFG(A) in the 

Military Assistance Command Vietnam Studies 

and Observations Group. After graduating from the 

Defense Language Institute, he joined Detachment A, 

Berlin Brigade—an early urban guerrilla warfare special mission unit. While in Europe, he had exchange 

postings with the German Fernspähkompanie 100 and 

the Belgian 1st Paracommandos. 

He served as the special forces instructor at the ROTC Detachment, 

Northeast Louisiana University, while earning his bachelor’s degree in medical technology. He attended the Uniformed Services University of the Health 

Sciences as a second lieutenant in the Medical Service Corps. He graduated with honors from the Army flight surgeons course and became solo 

qualified in the TH-55 helicopter. He earned his doctor of medicine degree 

and completed residencies and board certifications in aerospace medicine, 

and anatomic and clinical pathology. As part of his United States Air Force 

residency in aerospace medicine, he flight trained on the T-37 and T-38 

aircraft. He served as a member of the question writing committee for the 

Aerospace Medicine Board Examination for five years and holds lifetime 

certifications in all his medical specialties, as well as unrestricted medical 

licenses in Alabama.

Farr served as commander, Company F (Airborne), 3rd Battalion, Academy Brigade, Academy of Health Sciences, and course director of the Special 

Operations Medical Sergeants course. He earned his master of public health 

degree from the University of Texas, and holds the Army Skill Identifier 

5X Historian title. He served as chief of the Department of Pathology at 

Blanchfield Army Community Hospital, and flight surgeon of the 50th Medical Company (air ambulance), 101st Airborne Division (air assault), at Fort 
xii

Campbell, Kentucky. He was the division surgeon of the 10th Mountain 

Division at Fort Drum, New York, until becoming deputy commander of 

the U.S. Army Aeromedical Center in Fort Rucker, Alabama. He attended 

Air War College and received a master of strategic studies degree before 

becoming the Deputy Chief of Staff, Surgeon, U.S. Army Special Operations 

Command; Command Surgeon, U.S. Army Special Forces Command; and 

Command Surgeon, U.S. Army Civil Affairs and Psychological Operations 

Command. He became the command surgeon of U.S. Special Operations 

Command in 2006 and command surgeon, Special Operations Command 

Central, in 2009. 

Farr is a subject matter expert for the Department of Defense Tactical 

Combat Casualty Care Committee, which sets standards for battlefield 

combat care. When he retired as a colonel after 46 years of active service, 

he became an associate clinical professor of internal medicine and associate 

clinic professor of anatomic and clinical pathology at Lake Erie College of 

Osteopathic Medicine in Bradenton, Florida. He is also a lecturer at the Joint 

Special Operations University, MacDill Air Force Base in Florida. 

Farr is a fellow at the Aerospace Medicine Association and the College of 

American Pathology. He holds the Army Surgeon General “A” designator in 

aerospace medicine and was a consultant for special operations medicine. 

Farr was the chief editor of The Special Operations Forces Medical Handbook, 

2nd Edition. He authored The Third Temple’s Holy of Holies: Israel’s Nuclear 

Weapons, Counterproliferation Papers #2, Future Warfare Series, and Resting Rebels: A Historical and Medical Study of the San Antonio Confederate 

Cemetery. He served on the editorial board of the journal Aviation, Space 

and Environmental Medicine from 1994-2000, and was the executive editor 

of the Journal of Special Operations Medicine from 2006-2009. In May 2016, 

he became a distinguished member of the Special Forces Regiment. 
1

Farr: The Return of the Future Guerrilla Hospital

Introduction

Medicine is a service responsibility. – Unnamed USSOCOM 

resource manager1

Guerrilla warfare (GW) literature concentrates on the conduct of each 

war and does not often mention the medical aspects of such conflicts. Military medicine began in the early 1800s, with few or no references 

prior to that. Military trauma evacuation and treatment dates back from 

the Napoleonic era. In conventional warfare prior to this time, comrades 

carried wounded soldiers off the battlefield. This caused a significant loss 

of combat power for each wounded soldier.2 During early unconventional 

warfare (UW) campaigns, sympathizers sequestered wounded in civilian 

homes, an example of early guerrilla auxiliaries and undergrounds. The 

purpose of this monograph is not so much to teach, but encourage learning 

about GW medicine by highlighting published resources.

The medics in essentially all UW campaigns are indigenous. They wrote 

of battles and campaigns. Books on guerrilla logistics and medical care are 

rare. Books on guerrilla campaigns are more common and include the countries: Yugoslavia, France, Indochina, Malaysia, and Afghanistan, along with 

less familiar venues such as Northern Ireland, Venezuela, Brazil, Algeria, 

Korea, Tibet, Quebec, and Uruguay. Urban UW comprises a subset of the 

literature. The foremost American urban GW outfit was Detachment A, 

Berlin Brigade—a cold war U.S. Army special forces (SF) stay-behind unit.3 

The SF patch has three lightning bolts representing air, land, and sea. More 

famously, the Navy SEALS represent sea, air, and land teams. Staying behind 

is a method that is often overlooked. 

This monograph will explore the evolution of required medical care support for isolated SOF operations in austere areas. SOF has had 14 years of 

direct action (DA) conflicts on a high-intensity battlefield generously supplied with surgical assets and medevac helicopters. As a result, in the Iraq 

and Afghanistan warzones specifically, the Department of Defense (DOD) 

mandated that the “golden hour” is, by default, a worldwide standard.4

 This 

is neither true, nor militarily supportable. The golden hour requires moving 

the injured from the point of wounding to forward resuscitative surgery 
2

JSOU Report 17-10

within the first hour. Even though the Joint Special Operations Medical 

Training Center (JSOMTC) schoolhouse teaches 

Special Operations Combat Medics (SOCMs) and 

Special Forces Medical Sergeants (18Ds) the skills 

to care for, stabilize, and hold a trauma patient for 

72-96 hours, few have actually done so. The military Services have structured medical sets, kits, 

and outfits to support the golden hour methodology—not extended care in the field. In addition, 

the Army did not design surgical support units to 

support spartanly small, light SOF team operations. 

Operational missions with light footprints are increasingly in geographically challenging areas. They have longer distances to travel and are farther 

from support infrastructure than SOF’ current missions. Already in Africa, 

and soon in the Pacific and South America, teams must hold the wounded 

for a prolonged period of time before evacuation due to challenges with nonstandard land and air transportation with limited availability. This provokes 

significant questions on how to improve evacuation time and outcomes. SOF 

could use close-by host nation surgical resources of our allies or partner 

nations, deploy American conventional military, SOF, or contract forward 

surgical teams. For mission planners, both combat arms and medical, this 

is a new issue for SOF teams. SOF mission planners have generally viewed 

evacuation to surgery and onward as a Service requirement, but in the realm 

of UW operations there will most likely be very limited Service support. 

However, is it a new paradigm? The Office of Strategic Services (OSS) 

and Special Operations Executive (SOE) medics in Yugoslavia and France, 

and the homegrown guerrilla medics in the Philippines, held casualties for 

long periods. In Yugoslavia, the Western allies parachuted in two allied (one 

Canadian Army and one New Zealand Army) forward surgical teams to 

shorten the time to forward resuscitative surgery for Tito’s guerrillas. Empty 

U.S. Army Air Corps C-47 aircrafts transported many wounded Yugoslav 

partisans to American field hospitals in Italy where they utilized local physicians and surgeons. This monograph will research and review these lesserknown historical vignettes for their applicability to the 21st century.

From 1980 to 2000, as SOF numbers grew, conventional forces (CF) supplied surgical support to missions. The capabilities and limitations of these 

teams were evident. The author will review and analyze this development 

The golden hour 

requires moving the 

injured from the 

point of wounding to 

forward resuscitative 

surgery within the 

first hour.
3

Farr: The Return of the Future Guerrilla Hospital

period and show how it led to today’s Special Operations Surgical Teams 

(SOSTs) developed by U.S. Air Force Special Operations Command (AFSOC). 

Special Operations Command Central (SOCCENT) used SOSTs, along with 

conventional Air Force surgical teams called Mobile Forward Surgical Teams 

(MFSTs) in Middle East operations. The author, a former SOCCENT command surgeon, will explore this recent wartime experience.

Much activity is taking place within SOF concerning this issue. The 

Theater Special Operations Commands (TSOCs) are voicing their need for 

and their present lack of lean medical support by agile forward surgical 

enablers on missions involving long distances. Special forces groups are 

looking back to UW/GW doctrine, mostly unchanged from WWII. U.S. 

Army Special Operations Command (USASOC) began an UW/GW exercise 

series in late July 2015 called Jade Helm, which featured the first guerilla 

hospital in recent training memory. It featured the 528th support brigade’s 

medical team. USASOC partially conducted Jade Helm 2015 exercise on the 

author’s Texas ranch.5

Jade Helm lessons learned show the infrequency of practicing core UW 

skills by today’s special forces. Three broad tenets emerged: 

1. Teams were neglectful in the use of guerrilla auxiliaries and undergrounds to help setup and operate a guerrilla hospital and the nets 

to move casualties.

2. Teams did not bring all portions of 18D medical equipment in early 

with them. The laboratory set came in later by automatic resupply. 

This hindered initial hospital setup.

3. The exercise did not run long enough to explore fully extended field 

care, transport, and evacuation.6 

Grassroots, social media driven, electronic conversations on prolonged 

field care are thriving on the Internet among SOF medics and medical officers.7

 These professionals have determined the need and are filling it outside 

of normal channels by unofficial, Internet-based networking. This issue is 

a leading topic of discussion at the Special Operations Medical Association 

scientific meetings and the prolonged field care working group meeting at 

the 2016 Special Operations Medical Association scientific assembly, which 

strives to incorporate the latest developments in prolonged care methods. 
4

JSOU Report 17-10

Numerous articles are included on this topic in every quarterly issue of The 

Journal of Special Operations Medicine.

For SOF to remain relevant in extended light footprint operations and 

support the joint commander, forward surgical care and forward medical 

support must revert to the tested WWII roots of SF. SF must “go back to the 

future” and create the modern guerilla hospital. 
5

Farr: The Return of the Future Guerrilla Hospital

1. History of Conventional Military 

Medical Support

The ambulance corps alone will be allowed to remove the wounded, 

and all will bear in mind that our first duty to our wounded is to 

win the victory. – Major General J.E.B. Stuart, General Orders, No. 

26 Cavalry Tactics8 

The history of conventional battlefield evacuation of the wounded starts 

with the observations of military surgeons that comrades frequently 

helped wounded men off the battlefield. Consequently, when able-bodied 

soldiers assist the wounded, they lose fighters at the most inopportune time. 

General Stuart’s quote above illustrates that concept; one must take care of 

the wounded, but it must not interfere with winning the battle. It is also 

noteworthy that he published the evacuation rules as a “cavalry tactic.” Internal medical drills, promulgated by medics, signed by unit surgeons, and 

not fully supported by commanders, invariably fail. Modern day military 

casualty evacuation procedures must be “battle drills” published by and fully 

supported by the commander. The best example of this concept is the 75th 

Ranger Regiment within SOF.9

Baron Larrey, Napoleon’s surgeon, devised an ambulance corps of dedicated personnel whose duty was to remove the wounded, thus conserving 

fighting strength. The phrase “to conserve the fighting strength” is the motto 

of the U.S. Army Medical Department (AMEDD).10

As medicine and war grew more and more complex, medical support, 

units, and evacuation resources grew larger and more intricate. Clearly, 

a combat surgical support hospital of several hundred beds may be ideal 

for a conventional infantry division, but not for SOF. CF have forced SOF, 

on numerous occasions, to rely on such wrong-sized footprints.11 Conventional Desert Storm army hospital units had grown too large to compete 

with combat support units for space on the deployment plan. The AMEDD 

made a concerted attempt to downsize units for a quicker evacuation. Theater evacuation policy is the number of days that a combat trauma casualty 

can remain in theater, with the expectation of return to duty, versus quick 

removal for further care. The AMEDD shortened the theater evacuation 
6

JSOU Report 17-10

policy meaning that medical planners could reduce the number of beds in 

theater as wounded would quickly depart theater in most cases. Very few 

remained to return to duty. Quick evacuation requires massive airlift and 

air superiority—a luxury SOF will not have most of the time.

Medical units can be the most complicated portion of a guerrilla force. 

In the words of the commander of the Canadian Army Forward Surgical 

Team, which served with guerrillas in Yugoslavia, Major Colin Dafoe stated, 

“The weakest part of a guerrilla force is its hospital unit.”12

Therefore, what are SOF peculiar requirements for medical support and 

why have they not been met more than 70 years after the OSS in WWII? 

Those questions begin the story. 
7

Farr: The Return of the Future Guerrilla Hospital

2. SOF Unique Medical Support 

Requirements

Two days later I went away eastwards to another hospital. This 

one had moved, on an average, every four nights, carrying all its 

wounded with it. – Captain Lindsay Rogers in Guerilla Surgeon. A 

New Zealand Surgeon’s Wartime Experiences with the Yugoslav 

Partisans

What does special operations need that conventional medical surgical 

forces do not possess? The correct team size, availability, proximity, 

malleability, holding capacity, mobility, and survivability, to name just a few. 

In the early days of the Global War on Terrorism (GWOT), the United 

States Army Special Forces Command (Airborne) conducted a series of seminars on UW with the Association of the United States Army. The purpose 

of these seminars is to return SF to its roots and better prepare them to 

continue to be the most relevant SF in the world. UW has always been the 

primary mission of SF. All other tasks conducted by SF are subsets of this 

overarching, core mission. 

UW is, quite possibly, the most misunderstood form of military operations. UW is not simply GW or some variant thereof; it is much more 

complex. GW, unconventional assisted recovery, information operations, 

subversion, and sabotage all play a role in UW. The DOD Dictionary of Military and Associated Terms defines UW as:

Activities conducted to enable a resistance movement or insurgency 

to coerce, disrupt, or overthrow a government or occupying power 

by operating through or with an underground, auxiliary, and guerrilla force in a denied area. 

In ARSOF 2022, published in 2013, then USASOC commander Lieutenant General (now retired) Charles Cleveland set out a plan “to recover and 

revitalize our force.” He stated, “the most critical gap in ARSOF special 

warfare capability exists in the UW mission set, our ability to conduct UW 

in denied areas for extended periods of time.”13
8

JSOU Report 17-10

Because UW is a long dwell mission, conducted in the most immature of 

theaters, and without aerial superiority, medical support to UW is different 

and difficult. Twenty percent of the enlisted structure on a SF “A” Team are 

medical for a reason. Medicine is not just important, it is essential to successful UW. The DOD heavily staffed SF groups with medical, dental, and veterinary officers in excess of their assigned troop strength 

because SF founders realized that these professionals 

would make a difference in the GW operational area. 

Medical capability is a challenge on UW missions. 

Mentioned in ARSOF 2022 as a requirement for the 

first time, are medical needs. In the section headed 

“soldier systems,” it mentions the need for minimal supply burdens and 

increased aerial-delivery capabilities links with new and emerging technologies such as freeze-dried plasma and the need to “increase organic medical 

capability including the establishment of deployable, scalable surgical teams 

modeled after the Joint Medical Augmentation Unit.”14 This document marks 

the emergence of medicine as a full player within SOF structure as opposed 

to a “service responsibility” provided to SOF from outside.

The now 50 year old mantra of “medicine is a service responsibility” 

has resulted in SOF requests for medical support being haphazardly filled 

depending on what branch of Service received the tasking responsibility 

under the joint staff tasking model. A SOF unit could request a capabilitybased surgical team or perhaps one surgical capability and would not know 

until the team arrived if they were receiving a five-person Air Force surgical 

team or a 25-person Army surgical team. This resulted in forward surgical 

teams without experience or training on how to be a forward. Many times 

this left SOF not properly supported, or more commonly, SOF made modifications on the fly to fit an overly large surgical team into a non-doctrinal, 

small space.15 As early as the 1980s, the SOF community recognized this as 

a serious, life-threatening problem but the force design process ignored it. 

The one place that listened, had sufficient money, and the ability to change 

things internally, produced the Joint Medical Augmentation Unit.16

SF are involved in UW on a daily basis, and SF medics are involved in 

UW medicine daily. UW is a reality today in many countries around the 

world. SF, originally designed for UW in the 1950s, was modeled after the 

WWII Jedburgh teams of the OSS. Medics learned many valuable lessons 

Medicine is not 

just important, 

it is essential to 

successful UW.
9

Farr: The Return of the Future Guerrilla Hospital

from those partisan struggles; follow on chapters in this monograph will 

explore this.

As the world becomes increasingly unsettled and volatile, SF must continue to prepare to conduct UW. By law, United States Special Operations 

Command (USSOCOM) is the only force directed to conduct UW. Of all 

the USSOCOM forces, SF are the most prepared forces to conduct UW in 

its broadest terms, including but not limited to, GW.

UW is undergoing a revitalization in a number of ways. The U.S. Army 

John F. Kennedy Special Warfare Center and School (SWCS) has reinforced 

both the UW training conducted during the SF Qualification Course, and 

language and cultural training. The table of organization and equipment of 

the SF groups (based in great part on the missions of the 1980s [DA, Special 

Reconnaissance (SR), and foreign internal defense (FID)]) must be reevaluated. The USSOCOM surgeon’s office is evaluating all medical equipment and 

sets. Aspects of counterterrorism/combating terrorism, counterproliferation 

of weapons of mass destruction, and information operations that are inherent in UW are being further evaluated to ensure that SF are fully capable of 

conducting their limited share of these missions. UW medicine means an 

emphasis on medicine and nursing, in addition to excellent trauma skills.

SF must evaluate potential contributions of technology to UW and UW 

medicine while remembering that the key ingredient in the conduct of UW 

is the SF soldier. It is from the unique capabilities of highly trained warriors that all other capabilities to conduct UW and UW medicine flow. The 

basis of UW is people, and the diversity of those people makes it a dynamic 

medical discipline. To extract the maximum advantage from an ability to 

conduct UW, SOF must stay focused on unique soldiers who achieve that 

advantage. Solid training in UW will ensure that SF of today will remain 

the most relevant SF in the world and solid UW medical training will keep 

them the most relevant medics.

Soldiers required to conduct UW and UW medicine are unique. They 

must be highly trained, skilled, and mature. They must have excellent problem solving skills and mental agility in the most fluid of situations. Their 

ability to be flexible and adapt to their environment is unparalleled. Language capability, area and cultural expertise, and excellent interpersonal 

skills complement these requirements. SF soldiers must understand the current situation of whom they train or encounter, as well as comprehend the 

social, economic, and political milieu in which they operate. The primary 
10

JSOU Report 17-10

purpose of multiple overseas deployments of SF in peacetime is to ensure 

that the required level of expertise is present when the hour of crisis arrives. 

Many of these skills, needs, and expertise are directly applicable to the medical aspect of the mission. SOF medics need to learn the skills of native health 

care providers and, in turn, train local nationals in order to provide optimal 

health care and combat trauma care to indigenous soldiers at their level of 

medicine.

The cultivation of relationships and identification of key personalities 

(engagement) is a mission that SF conduct on an on-going basis. Through 

thorough study and boots-on-the-ground presence, SF engage in prospective UW areas of operations daily. One of the most challenging aspects of 

UW is that SF units are, in fact, in their UW areas of operations regularly. 

This dynamic nature of UW ensures the relevance of SF. However, UW 

has been in a state of neglect, as has UW medicine. UW doctrine needs 

modernization, and training in UW is limited. Doctrine needs revision 

and an update to reflect current requirements and capabilities. As the flexibility and usefulness of UW become apparent, focus will shift to mission 

guidance and training. Lessons learned are not only in after-action reports 

from training exercises, but rather in the after-action reports of forces that 

conduct UW or have been confronted by UW operations around the world. 

Further, the lessons need to transcend American experiences, and extend 

to Russian operations in Chechnya, Australian operations in East Timor, 

and the plethora of other UW activities that have taken place in the last few 

years. Urban UW experiences need review—an area particularly tough for 

medical care. Good examples are present in SOF history.
11

Farr: The Return of the Future Guerrilla Hospital

3. WWI SOF and Medical Support: Africa 

and the Middle East

With only a few hundred civilians and professional soldiers, and 

with the essential aid of black rebels, Lettow sets out to create and 

lead the first modern guerrilla army.17 – William Stevenson, The 

Ghosts of Africa 

While the Western front of WWI was stagnating into trench warfare, other theaters were much more active. The most well-known 

special operations mission involved T. E. Laurence and the Arab Middle 

East. Although we know little about medical care among Laurence’s forces, 

sympathizers likely housed the wounded or they convalesced in Bedouin 

tents. An interesting side note is that when Laurence ultimately died in a 

motorcycle crash, his attending neurosurgeon, Sir Hugh William Bell Cairns, 

started research that led to the increased use of motorcycle helmets for both 

civilian and military riders.18

 Lesser known but equally as intriguing, is the German “victory” in 

southeastern Africa by General Paul von Lettow-Vorbeck.19 The talented 

German commander and his native troops known as Askari,20 bested the 

British in the German East African colonies, albeit with a drastic toll on 

native African manpower, estimated by some to exceed half a million.21 A 

book on this conflict entitled Guerilla by Edwin P. Hoyt is available in English, and My Remembrances of East Africa by von Lettow-Vorbeck is available 

in both English and German. For those with sufficient German skills, try 

Meine Erinnerungen aus Ostafrika. In reading the general’s medical comments, one finds that he uses native women camp followers who accompanied his native troops to provide medical care.22 This use of auxiliaries 

and undergrounds are common SOF tactics. He believed that the German 

uniforms given to his African soldiers provided more protection against 

malaria than the British uniforms (the British wore shorts) and that his 

soldiers were less susceptible to disease than the opposition British troops. 

He highly praised his surgeons saying, “the confidence even of the enemy 

in the German medical service was fully justified.”23 At the end of the war 

he learned that, although he had won his campaign, Germany had lost the 
12

JSOU Report 17-10

war. General Von Lettow-Vorbeck was the consummate guerrilla leader who 

mastered the art of applying superior unconventional tactics to inflict great 

damage on his enemy while surviving in the field without adequate supply 

and managing a multiracial combat force. One of his surgeons wrote a book, 

still available only in German.24

The classic history of GW book, War in the Shadows, praises him as a 

great GW leader, saying that he sought clear-cut missions for his indigenous 

forces and allowed them to operate within their capabilities. 

Although General von Lettow-Vorbeck had multiple physicians accompanying him, he was always short on medical resources. Having had volunteers 

from the German community in East Africa, he attached a surgeon down to 

company level.25 Many German physicians were in Africa studying African 

sleeping sickness when the war started and provided a ready work force for 

disease management and treatment. As in virtually all guerrilla forces, disease caused more casualties than trauma. His forces saw malaria including 

black water fever and numerous larger parasites.26

He sought to capture quantities of quinine and had his soldiers manufacture bandages—both time-honored guerrilla medical resupply techniques. 

Von Lettow-Vorbeck’s forces made soap, an anti-tick and flea balm, typhoid 

medication, and “Lettow-schnapps,” a quinine drink.27 As both medicine and 

bandages ran short, Askaris located and used native medicinal leaves. The 

rate of wound infections did not increase with the use of native resources.28

In reality, von Lettow-Vorbeck could not deal with the number of casualties and the need to be forcefully mobile. This will be a continuing issue 

for guerrilla forces: how to have a casualty evacuation system to enhance 

morale and conserve manpower while continuing to be quickly able to fade 

away after an engagement. Von Lettow-Vorbeck relates:

Nor was it easy to ensure medical attention. We had too few attendants ... So there was nothing ... but to collect our invalids from 

time to time, turn them into a complete Field Hospital, under a 

single medical officer.29

One in three of the 276 Europeans who began the 1918 phase of the campaign did not finish. The British found some, but 27 were still missing in 

action at the close of the war. In October 1918, known as “Black October,” 

the Spanish influenza hit hard and one of eight that had surrendered to the 
13

Farr: The Return of the Future Guerrilla Hospital

British were dead.30 Von Lettow-Vorbeck’s total forces never exceeded 10,000 

men, while the British used 300,000 men to chase him.31

General Von Lettow-Vorbeck received a hero’s welcome with a victory 

parade in Berlin after the war and later became an anti-Nazi. He returned 

to Africa in the 1960s to see his former troops. Ultimately, the West German 

government granted his African soldiers German military pensions.

All in all this was the classic mobile raider style of UW—lean, light, no 

fixed base, shedding anyone or anything not essential, including wounded 

and physicians—all of which worked in this extremely harsh environment. 

It successfully pinned down a large number of Allied troops for the entire 

war, another classic use of guerrillas. However, at the start of the next world 

war, which would feature large guerrilla operations in Europe and Asia, one 

could find no doctrinal manuals to instruct these new guerrilla leaders on 

the techniques of Laurence or von Lettow-Vorbeck. The experiences of both 

sides in these ‘side campaigns’ of WWI did not materialize into written lessons learned. 

15

Farr: The Return of the Future Guerrilla Hospital

4. WWII SOF and Medical Support: From 

OSS to the Philippines

Care of the wounded in partisan warfare is one of the most difficult 

problems ... wherein the presence of wounded, as distinct from 

the regular army, often has a decisive effect on the planning and 

development of military operations. – Major General Gojko Nikoliš, 

Yugoslav Partisans32

WWII became the doctrinal laboratory on the use of special operations, 

and in particular, SF guerilla support. The European theater in WWII had 

vast, differently organized, guerrilla operations, typified by those in France 

and Yugoslavia. In Yugoslavia, there were two main and competing partisan 

forces: the communists and the royalists. In The Creation and Development 

of the Yugoslav Army, communist leader Josip Broz Tito writes:

Besides this ... our operations were closely linked with our wounded, 

who were always numerous, so that it was not possible to avoid 

encirclements, although the Supreme Headquarters were fully aware 

of the enemy’s intentions.33

Several other leaders in the communist guerrilla forces echo these comments. Major General Gojko Nikoliš, M.D. remarks on the difficulties of 

guerrilla medical care quoted at the beginning of this chapter. 

By far the best book on the medical aspects of these guerrilla forces is 

Sanitetska Služba U Partizanskim U Slovima Ratovanja by Colonel Djorđe 

Dragić, M.D. Published in 1964 and later published in English as Partisan 

Hospitals in Yugoslavia 1941-1945: Selected Chapters from the book. Colonel 

Dragić writes: 

The presence of the sick and wounded notably reduces the mobility 

and maneuvering ability of the units, these being vital conditions of 

partisan warfare.... Under the conditions of Guerrilla Warfare, the 

importance of the human factor is also notably enhanced because 

... partisan units are ... replaced on a voluntary basis. The attention 

to the medical services ... is therefore understandable.34
16

JSOU Report 17-10

It seems to be a universal truth that confidence in an army’s medical soldiers by other soldiers is essential for success, in both the conventional and 

the unconventional fight. Yugoslav Partisan Chief Surgeon Colonel Dragić 

noted that an organized medical service “is an important moral-political 

factor” and is a positive factors among new fighters.35

Of all the resistance movements of WWII, the Yugoslavs were able to construct one of the most sophisticated medical support structures. Hospitals in 

both secure areas and in close proximity to the battle lines were developed. 

Hospitals close to the battle had the advantage of saving more lives while the 

others, remote to fighting, were more secure. Tito’s medical officers saw the 

difficulty of balancing combat proximity to distant security—still a common 

issue facing medical support to UW.

In the first Afghan war, the Mujahedeen sent casualties by mules to Pakistan with predictably bad results. The Yugoslavs compared guerrilla hospitals 

close to the communication lines to those hidden in safe zones distant from 

the fighting. The Otaševac Central Hospital, located in a forest on an isolated, 

secure mountaintop was well equipped and efficient but had 15 percent mortality. In contrast, the Petrovac Hospital Center, located near communication lines, had a “First Surgical Ward” with 4.2 percent mortality rate.36 As 

in many other things: location, location, and location. This may be the first 

example of documentation of the benefit of a golden hour or golden period.

Another large issue was medical supply and logistics. The more sophisticated the guerrilla health care system and the larger it grows in size, the more 

resupply becomes an issue. A lucrative source 

of medical supplies were those captured from 

the enemy –either by stripping the dead enemy 

or actually staging a raid on German military 

hospitals solely to obtain medical supplies.37

Other sources of medical resupply included 

local civilian resources, actual manufacturing, 

and a repair in underground guerilla workshops. As the movement grew, the allies provided some support. Most equipment flown in or parachuted in was lethal aid, but there was some room for 

medical supplies, such as plasma. In addition, allied aircraft flying in supplies 

went back empty until all realized they could evacuate wounded to allied 

military hospitals in Italy.

The more sophisticated 

the guerrilla health care 

system and the larger it 

grows in size, the more 

resupply becomes an 

issue.
17

Farr: The Return of the Future Guerrilla Hospital

Supply distribution, regardless of sourcing, was in the hands of the resistance auxiliary. Members of the auxiliary—many who were young girls—

could pass German checkpoints more easily while transporting medical 

supplies. As the movement continued to grow, manufacturing centers for 

bandages and other medical supplies were established.38

Allied hospitals in Italy found evacuated partisan patients riddled with 

diseases in addition to their surgical wounds.39 The allied forces also assisted 

guerrilla forces in Greece. At least one British and one American surgeon 

parachuted into Greece to assist the partisans. The Greek guerrilla auxiliary 

joined most of the native doctors and nurses to form surgical teams with the 

allies, dropping supplies by parachute.40

Post-operative surgical patients cared for in surgical wards convalesced 

in underground caves with the entrances covered by wooden doors and 

snow. These structures risked discovery by German foot patrols so they had 

stringent rules for the patients and the ward nurses who cared for them.

One of the most hotly debated issues still in the doctrine of UW is the 

use of surgical teams, especially whether or not to infiltrate outside teams 

to augment the indigenous resources of a native guerrilla movement. Part 

of the issue is what level of medicine to provide, host country or supporting 

country. This has become an even bigger issue with the continuing complexity of modern Western medicine. As the Yugoslav movement matured, two 

allied forces forward surgical teams—one from the Canadian army and one 

from the New Zealand army—along with other solo medical personnel, 

infiltrated the country by parachute or boat to supplement local national 

medical guerrilla forces.

The infiltrated surgical teams tackled the rigors of GW surgery with its 

continual movement of both guerrilla hospitals and postoperative convalescent patients. The Canadian Army surgeon and team leader, Major Dafoe, 

had training and combat experience in the British 8th Army in North Africa 

which he found very useful, but he admitted he had much to learn concerning forward amputations from his German trained Yugoslavian communist 

partisan peers. Evidently, the British Army never even considered amputations that far forward in the evacuation levels.

Major Dafoe was a controversial character who died in the Canadian 

wilderness in 1969 amid rumors of CIA ties and a possible assassination. 

Upon entry to Yugoslavia, he first fashioned an operating room out of 

the parachutes that brought him into the country, hence the name of his 
18

JSOU Report 17-10

biography, The Parachute Ward: A Canadian Surgeon’s Wartime Adventures 

in Yugoslavia. He introduced to his Yugoslav colleagues, and to the guerrilla 

medical effort, blood plasma—which was previously unknown to them. The 

guerrillas considered it a great innovation, as it did not require type and cross 

matching like whole blood. He also brought sulfa drugs—the primitive start 

of today’s antibiotics.

The American school charged with writing American military UW doctrine is the SWCS, founded in the 1950s. Apparently, the school debriefed 

Dafoe for three days sometime in 1968. Although mentioned in his biography, no record of that debriefing is in the school’s libraries and archives.41

The accepted role of such forward surgical teams really did not surface in 

the official doctrinal publications until the 1990s with Army Field Manual 

FM 8-43, Medical Support to ARSOF.

The Yugoslav partisans placed their new forward surgical teams at the 

equivalent of divisional level but occasionally attached them down to brigade level.42 The author’s personal copy of the book on Yugoslav partisan 

hospitals by Yugoslav Colonel Dragić Partisan Hospitals of Yugoslavia has 

this handwritten dedication at the beginning: “To Major Colin Dafoe as 

remembrance on the days spent together in the Staff of 38 division National 

Liberation Army of Yugoslavia with best wishes and kind regards of Dr. 

Dragić ... 10.10.1966.”43

In summary, the Yugoslavs had a large, highly organized, and fully developed guerrilla force with sufficient auxiliary and underground to facilitate 

everything from medical logistics and manufacturing to successful employment of multiple forward surgical teams and air evacuation to allied Italy.44 

The predominately-rural country had little pre-war medical infrastructure, 

which forced the guerrilla movements to create their own. The rural nature 

of the operational area was in the guerrilla’s favor against the Germans. This 

allowed the use of advances to include parachute infiltration of the two allied 

forward surgical teams and the use of allied fixed wing medical evacuation 

aircraft, which evacuated over 10,000 critical patients by air to Italy.

France during WWII, in contrast, was a much more highly developed 

urban country with a sophisticated pre-war medical infrastructure. It was a 

dedicated Ally with short lines of communication, supply, and importantly, 

close air support from the United Kingdom. France was also vital to the war’s 

success, with a common invasion border to Germany, a language spoken by 

many allied operatives, and a strong, if fragmented, government in exile. 
19

Farr: The Return of the Future Guerrilla Hospital

While the SOE had the lead in Yugoslavia, both the American OSS and the 

British SOE were heavily involved in occupied France.

The Army OSS was the SOE equivalent. The OSS based much of the doctrine, operational art, and equipment on the SOE. They had a close working 

relationship, even if the British looked at the Americans as upstarts. In the 

now declassified official history of the OSS, the earliest medical comments 

discussed medical and psychological selection issues.45

In an operations order dated 8 August 1944 called “Operational Brief #3,” 

Captain Fred B. Agee, Medical Corps, U.S. Army, deployed on Operation 

Antagonist. The American OSS Operational Group under Captain Larson 

was working with a Maquis unit of 5,000 in Haute Vienne department in 

occupied France and had sent an urgent call for a doctor. Doctor Agee’s after 

action report shows he supported the Maquis but returned to England by 

September 1944 after sustaining a gunshot wound to the thigh from his own 

pistol with subsequent surgery in a French hospital.46 One first-hand account 

of a medical officer’s service with the SOE is The Black Scalpel.

47 Dr. Geoffrey 

Parker, an SOE major, served as a British trauma surgeon, secret agent in 

Switzerland, and guerrilla leader in occupied France. His autobiography is 

highly recommended. For an account of a dentist OSS agent, see Piercing the 

Reich: The Penetration of Nazi Germany by American Secret Agents during 

World War II.

48

Colonel Aaron Bank, one of the fathers of American SF, served in the 

WWII OSS. His accounts of his time spent on a Jedburgh team in France 

mention some medical aspects: 

[B]ut better medical assistance was required. There was also a morale 

factor. The individual guerrilla would perform his battle duties with 

more ardor and spirit and accept more risks if he knew that there 

was medical support in case he became a casualty. 

Colonel Bank relates realizing that the Maquis initially transported their 

casualties into nearby urban areas to local clinics and hospitals, and then saw 

the Gestapo conduct sweeps and capture the wounded partisans. Colonel 

Bank then attempted to create a medical network of individual safe houses 

and very small clandestine hospitals that he used for evacuation of Maquis’ 

wounded and ill. He reported that, “The leaders and couriers reported 

a definite lift in morale when the word got around.”49 It is an interesting 

sidenote that quite a number of Jedburgh teams had medical codenames: 
20

JSOU Report 17-10

Ammonia, Chloroform, Ephedrine, Novocain, 

and Quinine.50

Members of the OSS’ schools and training 

branch at the end of WWII wrote Assessment 

of Men: Selection of Personnel for Clandestine 

Operations. The foundation of the book consisted of statistical calculations by dozens of 

psychologists and psychiatrists. The techniques 

developed in WWII have stood the test of time 

and are still relevant for assessing candidates, 

both to identify any disqualify defects, and for determining a candidate’s 

unusual talents.51

The Allies, mainly SOE, also sent a “chief allied liaison officer” to the 

Greek resistance movement. He was a commissioned dental corps officer. 

His major functions included training on new Allied supplied equipment 

and drugs, medical supply, and medical intelligence. His after action report 

stated that proper triage for surgery was extremely important, to not waste 

resources on hopeless cases, and that nighttime surgical illumination was 

a major challenge. The hunt for a good, lightweight, long-lasting surgical 

lamp continues today. Resupply was a constant issue. The Greek guerrillas 

purchased some medical material on the civilian market from German and 

Italian stores, and received parachuted-in American and British supplies.52

Completely on the other side of the world and without the organizational 

structures of the OSS and the SOE, was the Pacific war. This theater of war 

had large-scale guerrilla activities, especially the Philippines, but little documentation. In spite of that, of the SF “Trinity” of Colonels Bank, Volkmann, 

and Fertig, two were active in the Philippines while the third (Bank) was 

first in France and then in Indochina.

Guerrilla operations began haphazardly as Allied forces fled the Japanese 

advance throughout Asia by going into the bush. There was no command 

sponsorship or support as General MacArthur, the theater commander, 

gave an order that the OSS was unwelcome in his Pacific theater. Even 

personal intervention by OSS Chief General Donovan was without effect. 

General MacArthur did not allow the OSS command into his theater.53 In 

the Philippines, small groups of highly individualistic American military 

who chose not to surrender decided independently to learn and perform 

GW through on-the-job training. They had no prior training, experience, 

Colonel Bank then 

attempted to create 

a medical network of 

individual safe houses 

and very small clandestine hospitals that 

he used for evacuation 

of Maquis’ wounded 

and ill.
21

Farr: The Return of the Future Guerrilla Hospital

supplies, doctrine, or plan. This resulted in uncoordinated, independently 

run operations by multiple uncoordinated bands without a unified commander’s guidance. These operations mostly began during the disaster and 

defeat of the American encirclement, surrender, and internment in the Philippine Islands and suffered from a lack of communications and long, sparse, 

or nonexistent supply lines. General MacArthur ordered a wait-and-watch 

role for those left behind, not desiring an active combat role for them. There 

are many Filipino accounts of these operations that historians have ignored. 

For an account of the use of local Filipino medicine in an American guerrilla 

band, see Behind Japanese Lines: An American Guerrilla in the Philippines.

54

This story of guerrilla war in the Pacific concerns Ray Hunt, one of the few 

American soldiers on the Bataan Death March to escape. Recently, Theresa 

Kaminski has written a book on the auxiliary and underground elements of 

the Philippine guerillas struggle. The auxiliary and underground, necessary 

parts of any successful guerilla movement, were slow to develop because of 

the amateur nature of the start of fully independent, self-identified, guerilla 

bands throughout the Philippines with no coordination. As the guerrilla 

movement matured, so did their auxiliary and underground. They made 

efforts to contact interned Americans (after the Bataan death march) and 

pass medicine to them. See Angels of the Underground: The American Women 

Who Resisted the Japanese in the Philippines in World War II by Theresa 

Kaminski.55 Kaminski stayed on in the Philippines through the occupation, working in hospitals, moving supplies, and building underground 

networks. As one explores the unique history of insurgencies, it becomes 

evident quickly that guerrilla forces do not succeed alone and are always 

heavily reliant on auxiliaries and undergrounds, both of which have an overrepresentation of women. Women are however, underrepresented in GW/

UW literature.

An example of the self-made Philippine guerrilla is the account by Lieutenant Colonel Edwin P. Ramsey entitled Lieutenant Ramsey’s War: From 

Horse Soldier to Guerrilla Commander. During the fall of the Philippines, 

he managed to lead probably one of the last horse cavalry charges in U.S. 

military history. He did not surrender, but vanished into the jungle, joined 

the resistance, and rose to command more than 40,000 guerrillas. Ramsey 

was wholly self-taught, developed his own rules of war, and generally took 

no prisoners.56
22

JSOU Report 17-10

Ramsey spoke in the year 2000 at a SF qualification course graduation at 

the SWCS. The command retroactively awarded him the SF Tab and a green 

beret in recognition of his wartime service. He discussed the importance 

of medical care as a motivating factor in guerrilla recruitment and morale, 

and the difficulties of caring for the wounded, handling turncoats, including 

families, and the lack of medical supplies.57

Many such impromptu guerrillas were only marginally successful in the 

occupied Philippines. North Luzon has some of the worst terrain in the Philippines. Several Filipino-American guerrilla bands were organized and tried 

to gather intelligence to destroy enemy military installations and supplies. By 

mid-war, most had fallen victim to combat, capture, or disease, highlighting 

the need for a medical infrastructure, which was mostly absent. With very 

few local national healthcare providers to recruit and no support from a 

higher headquarters, disease and injuries steadily took their toll. In addition, 

because of the meagerness of care, no examples of forward surgery exist.58

The official American military medical history of the war discusses the 

Philippines: 

A hospital might mean an abandoned house or a grove of trees; 

treatment, the surreptitious aid of a local doctor or nurse. Some 

physicians made horseback visits after dark to the mountain strongholds of guerrilla units.59

Because of the disparate guerrilla bands and the lack of central coordination or control, many schemes, rivalries, much mistrust, and outright 

betrayals existed between partisan groups. Some concerned the production, 

buying, and selling of counterfeit anti-malarial medications.60 Guerrilla war 

in the Philippines continued into the 1950s with the communist-led Huk 

insurgency.

As the Japanese rushed southward through the various island chains, 

another area with spontaneous anti-Japanese resistance activity was Malaysia—north of quickly conquered Singapore. Known for the railroad that ran 

to the bridge over the river to Kwai’s brutal prisoner camps, some Allied, 

mainly British, soldiers escaped and began self-taught GW. The Jungle is 

Neutral by Colonel F. Spencer Chapman is a particularly good account of 

the difficulties of self-education in partisan warfare. He faced many challenges while he acquired his guerrilla skills including his capture several 

times.61 Malaysia in the 1950s was the scene of a successful, anti-communist, 
23

Farr: The Return of the Future Guerrilla Hospital

counter-guerrilla operation by the British.62 This anti-guerrilla effort was one 

various militaries pointed to as one to learn from when the anti-guerrilla 

effort began in South Vietnam.

Also active in Borneo and the Philippines were stay-behind Australian 

coast watchers, who as the Japanese moved into their areas, fled and became 

guerrillas. Australian Captain Robert Kerr (“Jock”) McLaren earned two 

military crosses and a commendation (mentioned in dispatches) for his guerrilla force efforts in Borneo. Interestingly, he also removed his own appendix. 

McLaren had been a veterinary technician before the war and recognized his 

own case. He attempted to enlist a Filipino medical student who demurred, 

as he was a pre-clinical student and was fearful that he would be both unsuccessful and blamed. Captain McLaren supposedly wrote out his own death 

certificate and signed it to avert any blame. Between McLaren, the medical 

student, and a local midwife, he was successful. McLaren was also thankful 

for his false teeth, which kept him from toothaches—a common ailment 

among guerrilla forces in Asia.63

Therefore, WWII featuring General Donovan’s OSS and various other 

professional and nonprofessional players, made GW much more relevant 

than it had been in WWI. 

25

Farr: The Return of the Future Guerrilla Hospital

5. The Cold War and the Korean Partisan 

Rangers

Their unorthodox procedures, weapons, and tactics ... led to great 

successes and tragic mistakes.64 – Ed Evanhoe, Dark Moon

With the end of WWII and the falling out between the Western Allies 

and the Soviets, the era of the Cold War began. Globally, Soviet 

Union supported numerous insurgency movements—the so-called wars of 

national liberation. At the same time, some of the WWII guerrilla movements, which had been usually both anti-German and anti-Soviet depending 

on the circumstances, continued to exist in Eastern Europe. Soviet forces 

rushing westward to meet the Western allied forces quickly occupied the 

area. These movements, which included partisans in Romania, the Ukraine, 

Hungary, Poland, all of the Baltic States, and some even sharing borders with 

the Soviet Union, attempted to continue UW, but as their support and equipment dwindled, and no reinforcements appeared, they turned to espionage, 

subversion, and sabotage by the mid-1950s.

The United States then had two areas of competing interest. One being 

the emerging wars of national liberation popping up around the world in 

places like Cuba, Malaysia, Angola, Vietnam, and Central America, to just 

name a few. At the same time, the newly created CIA, the successor to part 

of the OSS, looked at the remaining Eastern European anti-Soviet partisan 

groups as possible allies in the new Cold War. It spent considerable time, 

effort, and money to keep in contact with these groups. The Soviets and the 

United States started to build intricate networks of spies and equipment 

stockpiles. The secret American plan, Operation Rollback, was “an audacious 

strategy of espionage, subversion, and sabotage to foment insurrection in 

the Soviet satellite countries”—as the book Operation Rollback: America’s 

Secret War Behind the Iron Curtain highlighted these once secret efforts.65

This time UW was to be an adjunct to support the NATO allies in a future 

WWIII by activity in the rear of the advancing Soviet forces against NATO. 

The breakup of the OSS at the end of WWII resulted in a portion of the OSS 

going to the emerging CIA on the civilian side and the rest going into SF on 

the military side. Thus, American UW abilities were not only degraded, but 
26

JSOU Report 17-10

also split between a military and a civilian organization—answering to two 

different masters. Both organizations were new, eager to establish realms of 

power, and not particularly cooperative with each other.

As both organizations looked at the task list for behind the lines clandestine actions required to support NATO operations in the event of a Soviet 

Western advance, the U.S. Army decided to station the 10th Special Forces 

Group (Airborne), and the1st Special Forces, in southern Germany. The 

group’s first commander was Colonel Aaron Bank who served in France 

and Indochina with the OSS in WWII. The location, chosen partially because 

the American zone of German occupation, made stationing it there easy, 

but more importantly, it was reasonably close to SF’ planned GW operational area consisting of Eastern Europe and the Soviet Union. The Green 

Berets started preparing themselves for an operation codenamed “Falling 

Rain.”66 It required that upon the outbreak of NATO-Warsaw Pact hostilities, 

resulting in rapidly westerly moving Soviet forces, 12-man SF Operational 

Detachment Alphas would parachute into Soviet Army occupied rear areas 

to link up with the partisan groups identified to them by the CIA, and then 

initiate GW behind the Soviet front lines. Falling Rain was a plan for all of 

the Warsaw Pact countries.

Supplementing the Falling Rain operational plan was a separate plan for 

Berlin—the divided capital of defeated Germany—100 miles behind the front 

lines already deep inside communist East Germany. NATO secretly placed 

an entire SF unit in the American sector of Allied occupied West Berlin. 

The unit, Detachment A, Berlin Brigade, with six Operational Detachment 

Alphas, was to execute a stay-behind role as the Soviet Army rolled westward 

over Berlin, and other Warsaw Pact units moved westward from occupied 

East Germany. 

The Green Berets of “Det. A,” as it was usually referred to, became the 

master practitioners of urban GW both because it was their wartime mission 

and because they were located in the perfect city to train for it.67 The term 

“Det. A” was an unclassified cover name, which changed later to “Physical 

Security Support Element-Berlin (PSSE-B)” while the then-classified name, 

39th Special Forces Detachment, became the 410th Special Forces Detachment. Detachment “A” remains the least known, most closely held, secret SF 

unit and operation. It is only rarely in literature. After the initial setup in 

1956 in Berlin, missions increased to include hostage rescue, aircraft takedown, and participation in the Iran embassy hostage rescue mission in1980. 
27

Farr: The Return of the Future Guerrilla Hospital

The first book came out on “Det. A” in 2017, Special Forces Berlin: Clandestine 

Cold War Operations of the U.S. Army’s Elite by James Stejskal.68 

The 39th SF Detachment with its six operational “A” detachments makes 

a mark on the wall as the first “Special Mission Unit.” There is evidence that 

the other Western Allied powers may have had similar units in West Berlin. 

There is one unclassified reference to a British equivalent unit.69 Recently 

a report has surfaced of British SAS in Berlin and East Germany, living as 

deaf residents to avoid the foreign language problem. Members of “Det. 

A” all spoke German.70 It is unknown if there were any planned actions in 

coordination with or because of the Hungarian revolution of 1956. It was in 

October of 1956 and the unit in Berlin stood up in July 1956. After the Hungarian Revolution, the Lodge Act, which allowed anti-communist refugees 

to join the army, helped fill “Det. A” and other European-based American SF 

units. SF commanders quickly latched on to the Lodge Act to find soldiers 

who spoke European languages, had WWII experience, even if much of it 

was on the other side.71

Did NATO have concerns about how to provide medical support or 

evacuation in the rear of an advancing Soviet Front? The answer seems to 

be “not much.” Even though these plans seem sketchy by today’s planning 

standards, in a post-WWII Cold War world, there were still sizable clandestine forces opposed to the Soviets in Eastern Europe. Planners assumed 

they could count on their auxiliaries and undergrounds for medical support. 

The Ukrainian WWII resistance movement, the Ukrainian Insurgent Army 

(UPA), fought on into the 1950s when many survivors finally immigrated 

to Canada. They documented their movement very well in a series of books 

and later online. At the close of WWII, they had sufficient combat power to 

take on large Soviet and Polish security forces into the late 1940s.72 Detailed 

resources are available on their website. In particular, they documented their 

medical services quite well.73 Volume 23 of their first series of books is UPA 

Medical Services. The UPA developed medical services in early WWII, and 

the UPA medical staff resembled the Yugoslav in that it was well established 

and self-sustaining—which would have been attractive to Falling Rain teams. 

It had a highly developed underground that managed depots and hospitals, 

ambulances, medical training schools, medicinal herb collections, and even 

textbook publication centers. Tactics, techniques, and procedures of interest included transporting all wounded partisans blindfolded so that if later 

captured they could not give away hospital locations—removing tracks and 
28

JSOU Report 17-10

snow prints after passing with wounded, and taking as a very important duty 

the notification of the next of kin. 

Another interesting stay-behind operation was by the guerillas in the 

Baltic States. These three countries had achieved independence from Russia 

at the end of WWI only to be recaptured at the end of WWII. They maintained clandestine movement in some form until achieving their independence again in 1990. One of the longer UW engagements on record involved 

the three Baltic States of Lithuania, Latvia, and Estonia. It began against the 

Soviets in 1940, then fought the Nazis, and then shifted back to fighting the 

Soviets in 1944. They continued an armed resistance against Soviet occupation until well into the 1950s. After receiving no expected help from NATO, 

the groups, the “Forest Brothers,” running out of ammunition and supplies, 

transitioned into an underground concentrated on sabotage, subversion, and 

then economic and cultural resistance. The long view actually paid off with 

the eventual emergence of a free Lithuania in 1990.

One book on the Lithuanian guerrillas shows that the Lithuanian Freedom Army obtained most of its arms from abandoned stocks left by the 

retreating Nazis and from Soviet forces—obtained by stripping dead enemies and staging raids on Soviet arms depots. In the 1950s, the scarcity 

of ammunition led to shifting passive resistance. Women conducted ‘liaison work’ such as rapidly moving resistance plans and orders, distributing underground press materials to the public, and transporting munitions 

from unit to unit. One book states, “It was 

noted that the female liaisons were not only 

“devoted, determined, and able” but also 

“inconspicuous in the eyes of the NKVD 

[the Soviet secret police organization].” Most 

were teenagers, some of which the Soviets 

captured and sent to Siberia, while others 

were grandmothers and experts at navigating checkpoints with contraband. On the 

medical side, female auxiliaries provided 

fake stories for hospitalized guerillas so that Lithuanian hospitals would 

not think they were wounded guerrillas. As in every guerrilla movement, the 

LFA needed and developed a robust auxiliary and underground capability. 

Through peaceful cultural, religious, and economic resistance, they lasted 

40 years and saw a free Lithuania.74

Women conducted ‘liaison 

work’ such as rapidly moving resistance plans and 

orders, distributing underground press materials to 

the public, and transporting munitions from unit to 

unit.
29

Farr: The Return of the Future Guerrilla Hospital

When the advancing Soviet forces occupied Eastern Europe, guerrilla 

organizations primarily in Albania, Romania, Ukraine, Hungary, Poland, the 

Baltics, and some even within the Soviet Union, shifted from GW to espionage, subversion, and sabotage. America looked upon these groups as possible natural allies against the Soviets and the CIA spent considerable time, 

effort, people, and money, to keep in contact with these Eastern European 

partisan groups. Both sides in the Cold War secretly mobilized forces against 

each other and built intricate networks of spies and unconventional warriors. GW became a cold war proxy, much preferable to a nuclear exchange. 

The secret American plan dubbed “Rollback,” consisted of conducting or 

supporting espionage, subversion, and sabotage within the Soviet satellite 

countries to encourage insurrection.75 The CIA appeared ready to aid these 

homegrown groups of anti-Communists. 

Western Allies from WWII documented doctrine on special operations 

after the war and held various symposia to discuss and dissect the aspects 

of wartime SOF missions. This included GW medical aspects discussed in 

various conferences and journal articles. Major Dafoe, one of the Allied 

Yugoslavia forward surgical team commanders, spoke at an Allied conference on war medicine about his experiences performing up to 15 surgical 

cases per day.76

However, while the newly emerging CIA and SF were planning for 

WWIII in Eastern Europe, multiple places were aflame with communist 

inspired wars of national liberation. Dr. Che Guevara partially led one of 

the first to get America’s full attention in the late 1950s.77 Earlier in the post 

war era, the Greek government with American aid successfully resisted the 

first post-war communist inspired insurgency. During WWII, the conflict 

among the Nationalist Chinese forces, the Maoist guerrillas, and the Japanese raged. With the Japanese out of the way, the communists won the battle. 

Mao Tse-tung’s book On Guerrilla Warfare became required reading for 

those conducting communist guerrilla movements in the 1950s and 1960s.78 

It became the textbook for waging revolution in the emerging third world. 

The book promoted the use of deception, mobility, surprise for superior 

firepower, and retreat as an offensive move. Surprisingly it contains a large 

amount of medical structures in his charts of military units. A good general 

reference on the communist revolution is Osanka’s Modern Guerrilla Warfare: Fighting Communist Guerrilla Movements, 1941-1961.79
30

JSOU Report 17-10

It is worth looking at the philosophy of the communist inspired movements. There are three fundamental types of hospital organizations, corresponding to stages of development in the guerrilla fight: 

1. The Nomad Phase 

2. Semi-Nomad Phase 

3. The True Hospital Organization

In the Nomad Phase, the doctor/medic traveled constantly as a circuit 

rider and full time combatant. He or she treated without the proper means 

to treat, as it did not always exist in the dispersed immature tactical situation, and a chronic lack of supply was common. Che Guevara stated that 

the medic “brings the men necessary consolation from his poorly equipped 

knapsack.”80 As the guerrilla movement grows into the Semi-Nomad Phase, 

the doctor/medic serves more centrally in the guerrilla camp or in an auxiliary house caring for stay-behind casualties. His or her knapsack matured 

into a full set of surgical equipment, used in camp for less hasty operations 

with recuperation in denied areas. Phase 3 became the true hospital set-up 

in areas that the enemy did not control. 

This detailed system organization with clear echelons of care, public 

health personnel with teaching functions, laboratories, x-ray services, and 

supplies captured from the enemy and/or obtained from the Red Cross, is 

similar to conventional units. Mao’s book contains diagrams of the surgeon’s staff positions, a medical unit organizational structure, and the exact 

number of medical services’ personnel appropriate for all sizes of guerrilla 

military units; closely resembling conventional army force structure doctrinal literature.81

Canadian surgeon Dr. Norman Bethune served in both the Spanish Civil 

War in the 1930s and later in the Chinese revolution. In Spain between 

1936 and 1937, he ran a blood transfusion unit until the Communist Parties of Canada and the United States sent him to China. In China, Bethune 

served as a thoracic surgeon and trainer of Chinese barefoot doctors. He contracted blood poisoning while operating on wounded soldiers, and died on 

12 November 1939 in China. Bethune is looked upon as a hero in China but 

generally unknown elsewhere. He wrote several books on both his Spanish 

and Chinese experiences. His comments on Chinese GW medicine include: 
31

Farr: The Return of the Future Guerrilla Hospital

Mud walls, mud floor, mud bed. Smell of blood and chloroform; filthy 

bandages stuck to the skin with blood-glue. Men with wounds like 

little dry pools, caked with black-brown earth; wounds with torn 

edges frilled with black gangrene. Wounds expanding outward like 

decaying orchids or crushed carnations ... terrible flowers of flesh.82

It is remarkable that Major Dafoe, surgeon and author of The Parachute 

Ward, is a hero in Yugoslavia, and another guerrilla surgeon, Dr. Norman 

Bethune, beloved in his adopted land of China as a key figure in Communist 

literature, were both Canadians.

As the Cold War developed in a divided Europe, a hotter war started 

on the Korean Peninsula. Authors have only recently published books on 

the GW activities in the Korean War. In Dark Moon: Eighth Army Special 

Operations in the Korean War, Ed Evanhoe documents the efforts of the 

Allied GW effort through the innocuously named 8240th Army Unit. Later 

its name changed to the United Nations Partisan Infantry Korea with eleven 

partisan battalions, including a battalion known as the White Tigers. That 

battalion is the subject of another book, White Tigers: My Secret War in 

North Korea. Neither book contains much on medicine, but one operations 

order deserves quoting:

2. SUPPLY: Stress to your guerrilla leaders that if they cannot evacuate enemy supplies and if they cannot be given to the local supporters 

that the supplies are to be destroyed. Medical supplies and signal 

and ordinance [sic] equipment will probably become scarce during 

the summer but sufficient supplies will be available to enable you to 

perform your basic mission. This is a principle of GW to live of the 

land and to resupply from captured arms and equipment. Complete 

logistical support is unnecessary. 

5. MEDICAL SUPPORT: Medical Support will continue as at present 

unless the UN forces become heavily engaged in a major offensive 

with its resultant casualties. Wounded can be evacuated by air to the 

121st Hospital at Yongdongp’o where they will receive the same medical treatment as U.S. wounded. Advanced treatment will normally 

be given at the Italian Red Cross Hospital or the Korean hospital. 

Local medical support is believed to be adequate for our current 
32

JSOU Report 17-10

needs. You will continue to exploit the services of Korean doctors. 

Emergency copter lift is available upon radio request.

In addition, one non-medical item of interest:

11. NORTH KOREAN CURRENCY: Due to the large requirements 

for North Korean currency and the limited sources available, commanders will encourage bank robberies and other suitable means 

of procuring this currency. 

Signed: J.Y.D. Vanderpool, Lt. Col. Artillery, Officer in Command83 

The Korean War was an opportunity for those veteran WWII practitioners of the dark arts to try their skills again. Vanderpool had been General 

MacArthur’s liaison to the Philippine guerrillas and knew both Colonels 

Fertig and Volkmann—two prominent Philippine guerrilla leaders.84 However, while some were practicing GW on the Korean Peninsula, half a world 

away other successful WWII guerrilla leaders were attempting to write it all 

down as U.S. Army Cold War doctrine. 
33

Farr: The Return of the Future Guerrilla Hospital

6. The Emerging SF Doctrine: Post WWII

This chapter will discuss WWII lessons learned as contained in the literature and translated into doctrine. It will focus primarily on Army 

lessons learned and resultant doctrine, as it is the vast portion, but will 

highlight Air Force, Navy, and Marine doctrine when available. It will review 

the first manuals and directives published in the post-WWII, early Cold 

War period. There are two noteworthy but unreferenced apocryphal quotes 

on the American Army concerning its grasp and use of doctrine. The first, 

attributed to the Germans circa 1942 states, “The reason the American Army 

does so well in wartime is that war is chaos and the American Army practices 

chaos on a daily basis.” The second, attributed to the Soviets circa 1960 states, 

“One of the serious problems in planning against American doctrine is that 

the Americans do not read their manuals nor do they feel any obligations 

to follow their doctrine.”

There is much truth in these apocryphal quotes. The American military 

has a reputation for off the cuff, seat-of-the-pants actions in combat which 

seem to suggest doctrine is either unread 

or unheeded. Many authors have offered 

the theory that the American Army’s 

grasp of doctrine and its collection of 

doctrinal writings before and during 

WWII made it much more effective in 

combined arms warfare than the British Army. The mechanism of field manuals and doctrine worked as the Army’s 

method to communicate the need for 

rapid change through its dense bureaucracy to troop leaders. Subsequently, 

American doctrine writing became even more robust.85

Looking at Army doctrine and world war guerrilla medicine experiences outlined in the previous chapter, two systems of guerrilla medical 

support emerge. The Yugoslavs were fortunate enough to be able to establish 

larger, more isolated facilities, discussed by Dragić in Partisan Hospitals in 

Yugoslavia 1941-1945 while the French Maquis system favored smaller, more 

Many authors have offered 

the theory that the American 

Army’s grasp of doctrine and 

its collection of doctrinal writings before and during WWII 

made it much more effective 

in combined arms warfare 

than the British Army.
34

JSOU Report 17-10

decentralized facilities, as they were more clandestine for their environment. 

Urban versus rural dictated medical support structures.

The fully developed medical systems of partisan Europe, both in Yugoslavia and France, glowed in contrast to the medical failures in the Philippines 

where no sizable medical footprint in the disease-infested jungles was developed. Multiple books document the UW medical failings in that theater—an 

area in which the OSS did not control special operations. The official history 

of the Army Medical Department states in the chapter on medical support to 

guerillas that a Philippine field hospital was “just a quiet place to die, because 

there’s almost no medicine, and damned few surgical tools.”86

The American Army after WWII still viewed what the OSS had done as 

a “sideshow” and was not eager to promulgate either the unconventional 

war doctrine or the mission. At best, they looked at it as an adjunct, which 

supported a conventional war effort. In 1947, support came from an outside 

source. The Department of State (DOS) sent a proposal to the Joint Chiefs of 

Staff (JCS) highlighting the fact that America did not have the same capability that the Soviets had in GW expertise. The DOS recommended that the 

military establish a GW school for UW training, and subsequently have 

dedicated forces for this new mission. The proposal was from two veteran 

DOS personnel, Charles Thayer and Franklin Lindsay, both of whom had 

worked in Yugoslavia with the partisans. In the DOS’s endorsement to the 

Secretary of Defense (SECDEF), Ambassador George Kennan, the principal 

DOS architect of American Cold War Soviet policies explained: 

I think we have to face the fact that Russian successes have been 

gained in many areas by irregular and underground methods. I do 

not think the American people would ever approve of policies which 

rely fundamentally on similar methods for their effectiveness. I do 

feel, however, that there are cases where it might be essential to our 

security to fight fire with fire. 

At the newly created DOD, the JCS studied the DOS request and decided 

ultimately to require the U.S. Army to develop the ability to support local 

resistance groups, but that in peacetime the CIA should perform this mission. 

The mission requirement drove the need to have a training base. However, 

rather than standing up a UW school, the DOD decided to utilize existing 

Army schools to train the personnel needed to be “on call for introduction 

into countries to organize, direct and lead native guerrillas.”87 This phrase 
35

Farr: The Return of the Future Guerrilla Hospital

“organize, direct and lead native guerrillas” is very similar to the historical and current day SF mission of “organize, train, and equip indigenous 

forces.”88 This decision would ultimately drive the formation of SF groups 

into Army structure.

Spurred by the JCS decision, the American Army began to publish articles 

and ultimately manuals on GW, auxiliaries, counterinsurgency, and to a very 

limited degree, medical support of these operations.89 The manuals have 

been refined, changed, and updated repeatedly to the present day, both in 

unclassified and classified forms. The manuals have grown to include all SOF 

missions, therefore the amount of GW material fluctuates depending on the 

real world dangers the Army is facing. Its practitioners look at UW as their 

core mission that they use to derive all other missions. The conventional 

Army points out the rarity of UW and questions both the need for training and lengthy doctrine on a seldom-used capability. Only small portions 

of the manuals consider mission support issues such as medical. The main 

medical theme from the published literature on guerrilla movements in 

WWII, from doctrine and manuals, is that a successful guerrilla movement 

must have a medical service. Numerous authors including successful senior 

combat commanders commented on the bond between GW, medical care, 

and casualty evacuation, as in Marshall Tito’s comment, “Our operations 

were closely linked with our wounded, who were always numerous, so that 

it was not possible to avoid encirclement.”90

From Colonel Bank, founder of SF, once a Jedburgh Team OSS officer, 

“the individual guerrilla would perform his battle duties with more ardor 

and spirit and accept more risks if he knew that there was medical support 

in case he became a casualty.”91

The United States Army’s first attempt at SF doctrine was an early 1950’s 

Special Regulation 350-5-1. This first attempt clearly saw DOD using GW as 

an adjunct used by the Western allies against the Soviets with indigenous 

forces—the beginnings of the mantra “through, with, and by.”92 By 1951, 

Army FM 31-21, Organization and Conduct of Guerrilla Warfare, brought 

Colonel Volkmann’s efforts to completion.93 Colonel Volkmann was a former 

Philippine guerrilla leader and had returned to the conventional Army as a 

paratroop general officer in the 82nd Airborne Division. The manual defined 

GW as: 
36

JSOU Report 17-10

[O]perations carried out by small independent forces, generally in 

the rear of the enemy, with the objective of harassing, delaying and 

disrupting military operations of the enemy. The term is sometimes 

limited to the military operations and tactics of small forces whose 

objective is to inflict causalities and damage upon the enemy rather 

than to seize or defend terrain; these operations are characterized 

by the extensive use of surprise and the emphasis on avoidance of 

causalities. The term ... includes current capstone field manual as 

“to advise, train, and assist indigenous military and paramilitary 

forces.94

Several notable figures from American UW campaigns of WWII worked 

on this effort, but Colonel Bank, Colonel Edward Lansdale (an Air Force 

officer previously with the OSS), and especially Volkmann, played the largest 

part in writing these first post-WWII manuals. They related their wartime 

experiences into this early doctrine as the Army attempted to reinvent this 

ancient type of warfare, war that, in the words of U.S. President John F. Kennedy: “is another type of war, new in its intensity, ancient in its origins.”95 

The Army published its first effort, Special Regulation 350-5-1, soon 

after U.S. President Harry Truman disbanded the OSS and created the CIA. 

At that time, the Army did not have dedicated units to perform UW. The 

DOD would not establish SF groups until 1952. The President made the 

decision that the CIA would be the peacetime supplier of guerrilla war, 

when required, and the Army would concentrate on wartime operations. 

Therefore, President Truman handed the mission to the CIA—an organization headed by General Eisenhower’s former chief of staff, General Walter 

Bedell Smith, who made no secret of not liking the OSS and considered it of 

“little military value.”96 This regulation, a manual of Army terms, defined 

partisan warfare as: “Activity carried on against an enemy by people who 

are devoted adherents to a cause, but who are not members of organized and 

recognized military forces. It includes guerrilla action, passive resistance by 

underground groups, espionage, sabotage, and propaganda.”97

This verbiage infers that GW was a type of warfare that enemies did to 

U.S. forces, not something that the DOD expected U.S. forces to do as an 

American mission or a standing American Army capability. The Army’s view 

was that, “Guerrilla warfare is ordinarily carried out by irregular or partisan 
37

Farr: The Return of the Future Guerrilla Hospital

forces; however, regular forces which have been cut off behind enemy lines or 

which have infiltrated into the enemy rear areas may use guerrilla tactics.”98 

Next, in 1951 came the first field manual, FM 31-21. The manual number 

31-21, now assigned to this FM had been used before in 1941 for the Jungle 

Operations field manual—a manual largely based on America’s turn of the 

century Philippine rebellion experience.99 The DOD labeled it classified confidential when issued and it would remain so for 38 years. Its doctrine firmly 

states that GW could be the mission of regular Army forces, as opposed to 

irregular forces, forecasting the development of SF groups the following year. 

The first section of this seminal publication gives a concise and thorough 

history of both the European and the Pacific theaters of war in WWII, the 

extent of UW activities in each, and the role they played in the winning 

war effort. It discussed emerging threats from guerrilla groups, primarily 

communist, since the end of the war, citing multiple examples. It mentions 

the communists in France and Italy who kept the faithful engaged not in an 

actual struggle but by stockpiling arms and using “ex-partisan” associations.

Another example cited was in the Philippines where communist-inspired 

Huks were operating against the American-friendly government. In Greece, 

a successful campaign to overthrow a communist guerrilla enemy was just 

over. Indonesia had used guerrilla tactics to oust the Dutch colonial power. 

Malaya was in an ongoing struggle with the British. In Indochina, the Viet 

Minh were fighting the French, and in Burma, various hill tribes that fought 

against the Japanese during the war (with OSS help) were effectively resisting 

efforts of the Burmese government to bring them under control.100

Under a Medical Service section, this first FM 31-21 states:

The guerilla area commander is responsible for the medical service 

within his command. The plan for medical treatment, evacuation, 

and hospitalization is prepared by the chief surgeon in close coordination with the operations section of the area command staff. 

It further explains that prompt casualty evacuation is important, 

losses greatly affect a guerrilla unit, and that medical plans must 

be decentralized to the lowest level possible.101

Guerrilla forces, being small, need to attend promptly to wounded. 

Rehabilitation of trained fighters is a major source of “new” guerrilla fighters. Unretrieved wounded fighters are also an intelligence 
38

JSOU Report 17-10

risk. This initial doctrinal guidance in the very first SF manual 

draws strongly from World War II experiences of the authors. The 

World War II robust guerrilla medical services, which had enhanced 

morale, conducted treatment and evacuations, received supplies from 

theater sources, and had established clandestine hospitals, should all 

become the doctrinal guidance for the future. Several stories from 

the war highlighted worries concerning casualties as intelligence 

leaks and the ability of the enemy to follow casualties to treatment 

locations. (6) Existence of evacuation means.”102

The term “theater special forces” in the FM refers to a proposed higher 

headquarters organization developed in the manual. It showed in two figures, a SF theater command at an equal level with theater level Army, Navy, 

and Air Force components. It further stated that, “the theater commander 

may organize a theater SF command on the same level as the theater army, 

navy, and air.”103

This need for a ‘seat at the theater table,’ first recognized in 1951, started 

in 1986 with the creation of the TSOCs in the geographic combatant commands, and now reflects as such in today’s joint publications. This debate 

on whether or not SF really need to be co-equal with other theater service 

components continues to this day. Current doctrine calls for SOF to be a 

separate theater command, but geographic combatant commanders do not universally follow at 

present. This continuing disconnect has a large 

effect on medical operations as the senior SF or 

SOF command surgeon may or may not get a 

seat at the ‘theater medical table’ depending on 

whether his commander gets a seat at the theater 

commanders’ table. This theater level access for the 

SOF command surgeon is a critical key to making 

the theater evacuation system flexible enough to meet the unique needs of 

the theater’s far-flung SOF.104

In the FM, use of civilian hospitals and other such medical facilities, 

which Colonel Bank had deemed a problem in France, was discouraged and 

used only when “the loyalty of the civilians within the area, particularly 

those of the medical installation, must be unquestionable.”105

This debate on 

whether or not SF 

really need to be 

co-equal with other 

theater service components continues to 

this day.
39

Farr: The Return of the Future Guerrilla Hospital

This came straight from Colonel Bank’s experiences with Allied OSS/

SOE teams in occupied France who saw Gestapo sweeps of local hospitals 

searching for their resistance fighters. In lieu of using local hospitals close 

to the battle space, the doctrinal guidance was to replicate the clandestine 

systems used in the European theater of war to include establishing covert 

hospital stations, smuggling supplies, and recruiting from the local population. The field manual also strongly encouraged the use of auxiliaries as an 

important part of resistance movements.106

This decentralized care for casualties, with the circuit riding medical 

officer, was most evident in occupied France with the Maquis and the Jedburgh Teams. It requires an organized auxiliary, which takes time. Medical 

supplies were and continue to be a huge issue in all guerrilla movements. In 

WWII, guerrillas, especially with the Russian and Yugoslav partisans, staged 

specific medical raids to obtain pharmaceuticals and medical supplies.107

Several of the more mature, better-organized WWII guerrilla movements had large manufacturing centers for medical supplies, according to 

Yugoslav and the Ukrainian writings.108 An important early glimpse into the 

ever-growing mission of training indigenous medics and the development of 

a medical system by SF medical sergeants (18Ds) is the guidance which provided for prototype organizations and functions of a guerilla medical unit: 

a. When a guerilla force becomes large enough it organizes its own 

medical support. Plans for each guerilla operation should provide for 

one or more men whose duty is to carry medical supplies and provide 

first aid. One aid man is provided for every 50 men ... With a force of 

150 men or more, which requires 3 or 4 aid men, at least one aid man 

should be an experienced technician. 

b. Two or more forces require a medical aid station under the control 

of competent medical personnel. Such an aid station is capable of 

fulfilling ... three or four 200-man units operating in a given area. It 

consists of a doctor and several trained assistants who may be augmented by special personnel when the situation demands. It is similar 

to a standard aid station for a regular infantry battalion. There are, 

however, these differences: 
40

JSOU Report 17-10

1. There may be no need for a litter bearer section. Guerilla actions 

are usually short, and the guerillas are usually able to transport 

their own casualties after first aid has been given. 

2. The aid station must be prepared to conceal and transport casualties from the scene of action, and to continue treatment at some 

covert location until the situation permits evacuation to a more 

distant point. 

3. In guerilla warfare there is no army rear area in which casualties 

may be promptly evacuated. It is important, therefore, that surgical 

aid be given on the spot, probably at the aid station. 

The receiving, care, sorting, and evacuation of casualties is a unit responsibility much the same as it is in a standard infantry regiment. If secure 

guerrilla hospital units exist, hospitalized patients should be moved from 

aid and collecting stations as soon as possible so the stations will be clear 

to receive new casualties. It is necessary, however, that this evacuation 

be made by personnel under the control of the guerrilla area staff, with 

adequate coordination and secrecy. Evacuation must be secure and rigidly 

controlled.109

The previous comments about secure evacuation stem from the immense 

difficulties the Yugoslavs had with their casualties, as Dragic discussed.110

Note the term “aid man.” What is now a SF medical sergeant began as a 

SF medical aid man. The mention of surgical capability “on the spot” may 

relate to the experiences of the Allied forward surgical teams inserted into 

Yugoslavia to support Tito, Canada111 and New Zealand.112

Other comments in the field manual concerning guerrilla surgery: 

In guerilla warfare, much of the emergency surgery, ordinarily 

performed at regular hospitals, is done in the field at aid stations 

and collecting stations.”113

The section on evacuation infers the need for ‘secure guerrilla hospitals.’ 

Discussed in the section on hospitals: 

It is not expected that hospitals will be elaborate equipped or manned 

entirely by highly skilled personnel. Items like X-ray apparatus, 

pressure sterilizes, and refrigerators for blood banks are immobile 
41

Farr: The Return of the Future Guerrilla Hospital

and difficult to obtain. Therefore, hospitals should have a small 

nucleus of highly trained personnel and a large overhead of ordinary 

personnel for handling the average convalescent patient. Equipment 

will consist chiefly of dressing material, essential drugs, and those 

housekeeping items necessary to keep a patient comfortable until 

he can be transferred to a convalescent camp.114

The plan of a system of sophisticated underground (sometimes literally) 

hospitals in the resistance organizations of WWII influenced the senior 

officers writing these doctrinal points. They considered an organized medical service to be a morale booster, force multiplier, and a requirement of a 

successful guerrilla movement, however labor intensive. They recommended 

a large work force expense for this vital service. Clearly, the need for a large 

auxiliary and underground force of willing 

civilians is essential to perform these services. 

This doctrine of a large medical footprint is 

the most controversial and the most changed 

from manual to manual as doctrine progresses 

through the decades. The requirement for success to recruit an auxiliary to support medical services means that the shorter the war, the 

smaller the auxiliary and the smaller the medical support. The medical support was small to nil for the organized guerrilla force fighting in Afghanistan’s recent, very short, American sponsored 

Northern Alliance guerrilla war in 2001.115 

There is a continued orientation in these early pre-SF group days of 

doctrine supporting GW as only a part of a larger, conventional war, or as 

something done by completely indigenous forces with only supply and other 

physical assistance provided by outside forces. No organic army unit had 

GW as an assigned mission at that time. Field Manual 31-20, 1951, Operations 

Against Guerilla Forces, a counterinsurgency manual, described a guerrilla 

medical service as often nonexistent since the requirements are not the same 

as for a regular force.

Therefore, in summary, this first fledgling Army doctrine, before the 

founding of the SF groups, dictated an American Army not equipped to perform a GW mission, having no dedicated forces for that mission. The Army 

was ready to supply and assist an indigenous force as part of a larger war. 

This doctrine of a large 

medical footprint is 

the most controversial 

and the most changed 

from manual to manual 

as doctrine progresses 

through the decades.
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JSOU Report 17-10

Lessons learned from the WWII guerrilla operations by the Allied powers 

and put in the new FM included: 

• Guerrilla organizations should exert the necessary work to produce a 

sophisticated medical service to motivate irregular fighters. 

• Successful guerrilla medical organizations require the support of an 

auxiliary and underground force. 

• Far forward surgical care is required. 

• Guerrillas should avoid treatment at civilian hospitals. 

• Partisan hospital organization and size depends on the tactical 

situation. 

• Medical supplies are always in short supply and may be seized from 

the enemy or manufactured in the guerrilla warfare operational area. 

• Casualties may be an intelligence risk if captured. 

• SOF and the SOF medical authority must have a presence at the theater level decision-making bodies to succeed. 

• Theater level control and support of guerrilla forces is required, especially for medical supply and perhaps for surgical and evacuation 

support. 

These early post-war doctrinal manuals clearly delineated WWII experiences and set the stage for the arrival of the first of the SF groups (Airborne) 

and the writing of a capabilities document for the employment of the Army’s 

new SF units. It shows the involvement of WWII guerrilla ground commanders on doctrine development. In the author’s opinion, these manuals are the 

most extensive ever produced on guerrilla war because as time progressed 

the portions of SF and SOF manuals that dealt on GW became shorter and 

shorter and were crowded out with the doctrine of other SOF missions. Even 

today, SF continues to rely on these earlier manuals.
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Farr: The Return of the Future Guerrilla Hospital

7. Vietnam, Special Action Forces, and 

the Green Berets

People also say that as a result of our support, Ho [Chi Minh] came 

to power. I don’t believe that for a minute. I’m sure Ho tried to use 

the fact that the Americans gave him some equipment. He led many 

Vietnamese to believe that we were allies. But there were lots of 

reasons why Ho came to power, and it wasn’t because we gave a few 

arms for 100 men or less.” – Major Allison Thomas, Commander, 

OSS Team Deer

Vietnam has become synonymous with the Green Berets. President Kennedy recognized the surreptitiously worn Green Beret. “The Ballad 

of the Greens Berets” was written by a SF medic staff sergeant, the actor 

John Wayne starred in the movie The Green Berets, and the Green Berets 

themselves flourished and then suffered with the Vietnam War, the publicity, the post-war anti-SF backlash, and the military draw down at the end 

of that war.116

However, before that, the OSS was in Indochina. Toward the end of 

WWII, the OSS began to work in Burma and Indochina, now the countries 

of Laos, Vietnam, and Cambodia. OSS cooperation with native irregulars 

in Indochina, some communist, was similar to the OSS cooperation with 

French and Yugoslav freedom fighters. Various indigenous resistance groups 

fought the Japanese.

OSS medics had important roles in most WWII OSS missions. Oftentimes, in primitive locations, they were the only providers caring for OSS 

team members and the indigenous personnel that the teams contacted and 

lead. In 1945, the OSS inserted a team into what was then Indochina to work 

with native forces opposing the Japanese in the closing days of the war.117

The OSS had previous contacts with resistance forces in the area, primarily to facilitate rescuing downed Allied Air Force pilots. In May, OSS team 

number 13, codenamed ‘Deer,’ infiltrated Japanese lines of communication, 

worked with guerrillas, and performed target identification for the Army 

Air Corps. Team medic Private First Class Paul Hoagland, a nurse before 
44

JSOU Report 17-10

the war, trained indigenous Vietnamese medics to take care of the guerrilla 

forces that the OSS-Viet Minh collaboratively raised and trained. 

Hoagland was asked to see a sick guerrilla leader—Ho Chi Minh. The 

team medic relates the house call:

In the darkest corner of the room lay a pile of bones covered with 

yellow, dry skin. A pair of glassy eyes stared at us. The man was 

shaking like a leaf and obviously running a high fever. When my 

eyes had become accustomed to the darkness, I noticed the long 

scraggly goatee hanging from a pointed chin.... Hoagland took a 

quick look and said, “This man doesn’t have long for this world.”

His diagnosis was malaria, dengue fever, dysentery, or perhaps a combination of all. PFC Hoagland administered quinine and sulfa. The Team 

Deer Executive Officer said the medic had Ho Chi Minh on his feet in about 

ten days.118

Now switching forward to the early 1960s, life was good in America. The 

beret was out of the closet, President Kennedy was talking about a new kind 

of warfare, and SF began to grow. DOD developed new missions for SF like 

“Greenlight Teams,” with man portable, parachutable nuclear devices.119

As SF planners began to look at the capabilities needed for a regional 

SOF power projection platform, they began to talk of Special Action Forces 

(SAF), where for the first time, organic medical support units appeared. SAF 

were an early combination of SOF units which resembled today’s battlefield 

array of various SOF “tribes” like civil affairs, psychological operations, and 

aviation, combined with SF. FM 31-22, U.S. Army Counterinsurgency Forces, 

1963 defines them as:

a specially trained, area-oriented, partially language-qualified, ready 

force, available to the commander of a unified command for the support of cold, limited and general war operations. SAF organizations 

may vary in size and capabilities according to theater requirements. 

A SAF consists of a SF group and selected detachments, which may 

include civil affairs, psychological warfare, engineer, medical, intelligence, military police, and Army Security Agency detachments.120

The inclusion of medical as one of the possible detachments in a SAF 

marks a milestone in SF thinking. Rather than looking for medical expertise 

in a nearby conventional unit, the SAF brought its own to the fight.
45

Farr: The Return of the Future Guerrilla Hospital

They had a regional focus with dedicated assets in 

a geographical area of the world. The Asia SAF had the 

156th Medical Detachment and the Latin America SAF 

the 255th Medical Detachment.121 With the drawdown 

after the Vietnam War, SAF were short-lived but successfully offered a quick view of the not-yet-thought-of 

TSOCs of the 1990s. The plan encountered significant 

resistance from the conventional army as they were adamantly against assigning conventional army units to SF on a continuing 

basis. The DOD ignored the SF argument that an alignment was necessary 

to assimilate such units into the SF culture. This argument will reappear in 

the 1990s with the TSOCs.

As the Vietnam War increased in size and scope, many such plans like 

the SAF, fell apart and the SF groups’ regional focus and training suffered, 

as they became replacement depots for SF soldiers rotating to Vietnam.122 

Vietnam was a counterinsurgency war, not an insurgency war, but SF used 

many of the same techniques. Medicine quickly came to the forefront as SF 

medics often led the way in local engagements. Villages were accepting of 

healthcare, which appeared not threatening. The local militias formed by SF 

teams, the Civilian Irregular Defense Groups (CIDG) received the care one 

would expect as a recruit soldier, including immunizations, public heath, 

dependent care, and first aid training.

Two arguments emerged for developing the CIDG program. The first was 

that the State Department thought that a paramilitary force, developed from 

ethnic minorities, would “strengthen and broaden” the Vietnam counterinsurgency effort. The second was that these minorities were prime targets 

of the communists due to the South Vietnamese government ignoring such 

minority groups.123

The need for casualty care began as CIDG soldiers trained and initiated combat operations. SF medics at the ‘A-camp’ could provide some care, 

including limited surgical care due to their extensive training at Fort Bragg, 

but there was a limit to their capabilities and resources. Medics also routinely 

performed sick calls on CIDG dependents, as well as in some cases, the entire 

village of CIDG families. The choices facing SF commanders were to: 1) keep 

the combat wounded at the camp, 2) put them into the Vietnamese Army 

evacuation and care system, 3) attempt to convince the American Army to 

evacuate and care for them, or 4) develop their own casualty care system.124

The inclusion of 

medical as one 

of the possible 

detachments in 

a SAF marks a 

milestone in SF 

thinking. 
46

JSOU Report 17-10

These dilemmas led to the creation of the CIDG Hospital concept. Above 

the A-Teams at camps were the B and C teams. The C-team was a battalion 

headquarters and blessed with a battalion surgeon and a medical section with 

senior SF medics. Soon the B and C teams expanded their capabilities and 

resources and started taking more severe CIDG soldier casualties including 

those in need of extensive rehabilitation. Note that the term ‘surgeon’ as in 

‘battalion surgeon’ actually means doctor, and most probably at that time, 

was a general medical officer (GMO) with no specialty training. SF medics 

under the supervision of GMOs accomplished care, including surgery, in 

these CIDG hospitals. SF medics have always had a strong block of surgical 

training in their medical course at Fort Bragg so it was a natural fit. Some 

hospitals established relationships with local medical capabilities varying 

from American surgical units to missionary non-governmental organization 

hospitals for various levels of support. Evacuation was dependent largely on 

SF opportunity air for the A-Camp to CIDG Hospital flight.

A good example of this concept is U.S. Army Captain Eugene Edynak, 

M.D. He graduated from medical school in 1964, completed a surgical residency in 1964-1965, and from 1966 to 1968 deployed as director and chief 

surgeon, III corps, U.S. SF CIDG Hospital, Republic of Vietnam. His web 

biography notes: “designed, supervised construction, equipped, trained the 

staff and managed an eighty-bed surgical Hospital (sic) for Civilian Irregular Defence Group of the III Corps area, Republic of Vietnam.”125 Many 

other young doctors’ training was interrupted by the war and the doctor’s 

draft had similar experiences. Dr. Edynak then finished his surgical training and became board certified in general surgery in 1975.” This capability 

improved medical care and reduced dependence on U.S. or Vietnamese 

medical facilities.

As the CIDG program matured, it became the focus of the 5th SF group’s 

quarterly reports. The August 1967 report states some lessons learned. A 

portion of the report concerned problems with using the Vietnamese Air 

Force for evacuation flights and a request for authorization to task American 

aircraft first. Higher headquarters denied it, stating that it was a Vietnamese 

mission but U.S. aircraft could participate upon saturation of the Republic 

of Vietnam Armed Forces capability. The other issue was the hospitalization 

of CIDG wounded. It was determined that, “Although CIDG hospitals do 

exist, they cannot fully support all CIDG forces. Care of CIDG personnel 
47

Farr: The Return of the Future Guerrilla Hospital

through Vietnamese channels is inadequate. Insufficient medical support is 

detrimental to the mission of Special Forces in Vietnam.”126

Therefore, the CIDG hospitals, with their medical staff of young doctors, coupled with enlisted SF aide men doing definitive war wound surgery, 

became the first Green Beret health care system. This content remains today 

in the medical courses at Fort Bragg. The schoolhouse teaches definitive 

war wound surgical procedures in the second half of the medical course to 

the remaining SF medics (18Ds) after the Ranger, Special Operations Aviation Regiment, and support medics (SOCM) complete their emergency first 

responder trauma training in the first half of the course and have departed.

As Vietnam wound down, the Army reduced SF in both size and capability, partially as a general downsizing but also as a now unprotected small 

unit of non-mainstream soldiers. The latter part of the 1970s was hard, many 

SF soldiers left the Army, or rejoined “big Army” as careers in SF looked 

dismal. Areas in the 1970s showing staying power were the counterterrorism and DA missions. 

SF had a special mission unit in Berlin since the 1950s. Six A-teams we 

stationed there, wearing civilian clothes and speaking German, ready to 

carry-out a stay-behind GW mission when the Russians and East Germans 

headed west in WWII. In the 1970s Berlin, another threat emerged—German 

domestic terrorists, the Red Army Faction, known in its early stages as the 

Baader-Meinhof Gang. The Red Army Faction staged bombings, assassinations, kidnappings, bank robberies, and shootouts with German police over 

three decades and were responsible for 34 deaths, many secondary targets 

such as chauffeurs and bodyguards, with violence peaking in late 1977.

Berlin was in a unique situation as it still occupied territory from the 

WWII and not fully under the government of West Germany. The western 

part of the city had German police but also British, French, and American 

soldiers to protect it. In addition to the Red Army Faction, concern was 

mounting about threats to Tempelhof Airport, which was both a Berlin 

civilian terminal and an Allied military base. As Berlin was not technically 

part of West Berlin, the allies were responsible. The United States European 

Command devolved plans to use an A-team from Detachment A, Berlin 

Brigade to respond to hostage or hijacking situations at Tempelhof. Teams 

received special counterterrorism training both in Berlin and the United 

States on rapidly moving casualties to American or German hospitals—a 

far cry from the definitive care in CIDG hospitals in Vietnam.127
48

JSOU Report 17-10

Thus, Detachment A became SF’ first counterterrorism unit. The unit 

soon evolved as members participated in the American rescue effort in 

Iran.128 At the same time in Fort Bragg, several counterterrorism mission 

units such as ‘Blue Light’ began to evolve and faced the same medical challenges at the end of the 1970s.129
49

Farr: The Return of the Future Guerrilla Hospital

8. The Rise of SOF and the Small Wars of 

the 1980s and 1990s

The beginnings of SOF revolves around the actions of the failed Operation Eagle Claw in Iran in April 1980. SF barely survived the 1970s by 

concentrating on counterterrorism, hostage rescue, and other DA missions 

rather than the historical core mission of GW. Medicine was to follow this 

lead. Medicine, which had been concerned with definitive treatment of guerrilla forces, was now to switch to quick casualty stabilization and transport 

from short duration missions.

The postmortem of the Iran mission, the Holloway Report, recommended 

the establishment of a standing joint task force to strengthen command and 

control.130 This ultimately led to the larger reforms of the Goldwater–Nichols 

Department of Defense Reorganization Act of 1986 Public Law 99-433 and 

the resulting formation of USSOCOM and the resultant growth in special 

operations in all military services.131

During this resurgence of special operations in the 1980s, the conventional Army focused on the threat of Soviet invasion of Western Europe. 

Therefore, SF continued its large role in DA and SR. These missions assumed 

the need for mainly short-term trauma care. With the demise of the Soviet 

Union and the evaporation of the threat of a WWIII “Fulda Gap” scenario, 

DA and SR decreased in importance as the Army increasingly conducted 

other missions. SF then assumed a larger number of FID missions to advance 

the National Military Strategy by shaping the strategic environment. Medical needs for those missions are vastly different—much more medicine and 

longer-term care, less trauma. FID calls for more sick call and native, indigenous care, and less penetrating trauma and evacuation. Practitioners define 

FID as ‘doing GW in peacetime.’ In both situations, SF are working with 

local, indigenous forces.

As the military refocused in the 1980s, military medicine began to look at 

civilian certifications and training opportunities rather than continuing to 

rely on internal training and certification, the earliest being Advanced Cardiac Life Support. One of the other early programs was Advanced Trauma 

Life Support (ATLS). ATLS grew out of an aircraft accident in a rural area 

and attempted to fix the issues of trauma response in small, rural hospitals. 
50

JSOU Report 17-10

ATLS for physicians soon spread throughout the military and civilian world, 

followed shortly by Pre-Hospital Trauma Life Support (PHTLS) for medics 

and other pre-hospital responders.132 By the late 1980s, SF medics took ATLS 

alongside surgeons and other physicians. This decision essentially took a 

course intended for doctors in rural emergency rooms and placed it in the 

hands of pre-hospital providers—the special operations medics. Although 

a great course, it was intended to be fixed-facility based and highlighted 

such things as two large bore intravenous lines, earliest cervical spine stabilization, oxygen, the need for imaging, and other requirements. None of 

these easily translated to conventional battlefield medicine, nor the special 

operations environment.133

The Cold War conventional Army of the 1980s fought the small, overnight 

wars like Grenada and Panama with ATLS and short evacuation times, and 

entered the 1990s with still a large medical footprint consisting of huge combat support hospitals 

and forward surgical teams with strengths in excess 

of twenty. The need to shrink the medical footprint, 

on what was becoming an expeditionary army, was 

acute. After Operation Desert Storm, where beds 

vastly outnumbered patients, the need for smaller 

deployable medical and surgical units reliant on 

quicker theater evacuation times became dire.

SOF were experiencing a growth spurt but 

whenever they needed medical support it came 

from the Services in the form of whatever unit they 

chose to send. Many times this resulted in serious capability mismatches.

The United States was not the only country grappling with how to support small combat forces medically in smaller power projection wars, other 

countries were also looking at far forward surgery. The Norwegian Afghanistan Committee, a volunteer organization, began in 1985 to cooperate with 

various Afghan guerrilla movements and supply small surgical teams to the 

battlefield of the first Afghan war. These international teams consisted of a 

specialist in general surgery, an anesthetist, and a scrub nurse—all deployed 

for a three-month period. The Norwegian government funded civilians with 

deployment experience to comprise teams disguised as Afghans and traveled 

from village to village with three guards, all mounted on six bicycles. They 

were loaded with equipment and a litter used as a surgical operating table. 

After Operation 

Desert Storm, where 

beds vastly outnumbered patients, the 

need for smaller 

deployable medical 

and surgical units 

reliant on quicker 

theater evacuation 

times became dire.
51

Farr: The Return of the Future Guerrilla Hospital

The bicycle mounted equipment was supplemented from a central storehouse 

every second day. Also part of the team was an equipment-laden donkey, 

which carried the X-ray machine, film, and developing fluid. They sterilized 

equipment by boiling them in a kettle for twenty minutes.

Surgery took place in villagers’ homes at night. One of the more interesting requirements was that homes had to have a wooden roof, as thatched 

roofs dripped debris in the operative field. They wore gloves but no gowns, 

and headlamps for illumination. Part of the daytime activities, in addition to 

strategic movement was to train local paramedics. These paramedics became 

responsible for post-operative care and interface with the families. Anesthesia for adults was predominately either regional or local, and for children 

they used ketamine.

In a discussion of their experiences, they noted several interesting points. 

First, this mission was in an area with enemy complete air superiority and 

the guerrillas had a very long evacuation route to Pakistan. The authors mentioned the “advantages of advanced surgery as close as possible to the fighting zone.” They also unanimously agreed on operating on the litter on the 

floor; kneeling was suboptimal. They felt they had proved that with careful 

planning, advanced surgery was possible in primitive conditions, but noted 

that mobile teams were expensive and several teams were needed to provide 

sufficient coverage, but the fighters’ morale and spirit were improved.134 Many 

lessons were learned from OSS WWII.

In addition to the Norwegian Afghanistan Committee, the International 

Medical Corps set up surgical theatres in resistance held, rural Afghanistan 

in the mid-1980s and published their results. Their list of problems included 

sterilization, anesthesia, and transport. Major issues revolved around the lack 

of power generation, flammable gas anesthesia, and the fluidity of the battle 

lines with no safe rear areas for evacuation and further care.135

The culmination point of SOF versus CF medical mismatch took place in 

Mogadishu. SOF parent command, USSOCOM, has service-like responsibilities, which include research funding. The USSOCOM command surgeon 

started developing a medical research program looking at new equipment, 

new solutions, and training issues. A post-Mogadishu panel evaluated the 

principles of trauma care set forth by ATLS to determine whether they were 

applicable to the SOF combat environment. As an example, ATLS stressed 

that cervical spine stabilization should be with a collar that the medics 

needed to perform, but how common is this on the battlefield? Should the 
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JSOU Report 17-10

ATLS mantra of “A, B, C, airway, breathing, and circulation” be changed to 

“shoot back, drag to cover, stop the bleeding?”136

The culmination of the SOF participants resulted in a seminal paper 

published in 1996. It featured “customized” guidelines for battlefield use and 

highlighted that one must not only treat the casualty but also avoid more 

casualties and finish the mission.137 These ‘combat friendly’ new guidelines 

were just a jumping off point for a relook at equipment such as tourniquets, 

new hemostatic dressings, new fluids, and new doctrine. Tactical Combat 

Casualty Care (TCCC), and its committee (the CoTCCC), remain at the forefront of innovative combat medical research. TCCC has remained a portion 

of PHTLS with the publishing of a military edition of the PHTLS manual.

As the 1990s ended, SOF had trained its medics well for trauma management and the golden hour because of ATLS, PHTLS, and the emerging 

CoTCCC. The golden hour is a medical research term referring to the fact 

that patients receiving quicker definitive care had better outcomes and better 

survival rates. Maintaining airway oxygen perfusion with fluids and rapid 

transport were key. However, even in the earliest literature, the golden hour 

varies from patient to patient and wound to wound.138

The conventional Army closed out the 1990s with the conference, Army 

Medical Support to the Army After Next. The main concerns listed in the 

report’s conclusions were:

1. Military operations would demand a smaller medical footprint even 

though combat operations would be high tempo. Casualties could be 

so high the medical department could not keep up and the only care 

far forward would be buddy aid.

2. Asymmetric threats and weapons of mass destruction could produce 

mass casualties.

3. The Army medical department would require technology it does not 

currently have to keep up and evacuate out of theater quickly.139

That same year Army Medical Strategy: Issues for the Future stated a problem being the “lack of true early-entry medical units, needed at the outset 

of operations in new theaters (e.g., command and control, hospital, area 

support, preventive medicine and logistics units), among others.140 
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Farr: The Return of the Future Guerrilla Hospital

9. The Global War on Terrorism and its 

Golden Hour

The GWOT started with a surprise attack on the United States, and the 

American response harkened back to the Vietnam days of the CIA 

and SF cooperation in the Military Assistance Command, Vietnam Studies and Observations Group.141 SF had been training for a guerrilla war for 

decades, defending its UW training exercise “Robin Sage” in the Special 

Forces Qualification Course (SFQC) when naysayers demanded elimination, 

saying global war was never thought to be a viable military option. Early SF 

teams into Afghanistan quietly said to each other, “Thank God for Robin 

Sage” as their guerrilla chiefs acted out from a script that sounded just like 

guerilla chiefs in Robin Sage.142

The guerrilla phase of the war was so short, from October 2001 to January 

2002, that many of the precepts of UW such as auxiliaries, undergrounds, 

and clandestine hospitals were either ignored or did not have the proper time 

to develop.143 American forces’ casualties during the GW phase were predominantly moved on aircraft diverted from non-medical missions. The joint 

combined UW task force that brilliantly executed the unconventional campaign soon had a forward surgical team at its headquarters.144 In the usual 

guerrilla forces, actual guerrillas are a minority of the total force while the 

majority of the insurgency is the underground and auxiliary. Historically, the 

percentage of actual fighters ranged from 40 percent in the French resistance 

(so more than 50 percent auxiliary and underground) to less than 10 percent 

in the Greek resistance (so 90 percent auxiliary and underground).145 Local 

undergrounds provided not only care for wounded guerillas but also care 

for exposed on the street agents who become unexpectedly ill. Host nation 

or non-governmental hospitals can manage non-wounded, sick members of 

the guerrilla, underground, or auxiliary forces as they will not be traceable 

and do not exhibit a distinct war wound.146

Before long though, the war turned conventional with large formations 

of American troops and a robust support organization. This allowed special operations, consisting primarily of SF and the 75th Ranger regiment, 

to rely on conventional ‘big Army’ combat service support. The emerging 

Afghanistan battlefield had numerous forward surgical teams, combat 
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JSOU Report 17-10

support hospitals, and medevac assets from all three Services. Flight times 

for medevac response by established doctrine should be two hours or less 

(notification to mission completion) for 

urgent casualties.147 The complex terrain and 

high altitude of Afghanistan immediately 

had its effect.

The operations in Afghanistan and Iraq 

became the best-documented conflicts to 

date. Medical data was no exception. Problems still arose in pre-hospital data—what 

the medics call roles 1 and 2. Role 3, however—the combat support hospital 

and higher—was the best it had ever been. This led to a volume of medical 

research unprecedented in the history of military medicine. The 75th Ranger 

Regiment showed no preventable deaths by following TCCC principles and 

its research penetrated even the dense void of pre-hospital data at evacuation 

roles 1 and 2, replacing them with elegant studies.148

As the war and the casualties continued, differences between Iraq and 

Afghanistan emerged. Army medevac and flying in general was harder in 

Afghanistan with longer distances and higher altitude. Thanks to the excellent data coming out of theater trauma systems, medical air evacuation mission completion times approached 60 minutes in Iraq, and 90 minutes in 

Afghanistan. Medical planners, a group often unappreciated, assessed that 

with the harsh flying conditions in Afghanistan, with their assigned assets 

(medevac helicopters and role 2 and 3 surgical units) those times were appropriate. Several other issues heightened the complexity. Some NATO allies had 

different rules and would not fly at night in low illumination or into unsecured landing zones. The U.S. Army medevac helicopters were the only truly 

dedicated aeromedical assets. If they were not available, then non-medevac 

aircraft, which needed permission from their combat commander owner, 

were an option, but that took more time from the golden hour.

Because of the excellent data coming through the theater trauma registry, 

this issue ultimately bubbled up to the SECDEF. The immediate response 

was to direct an effort to move Afghanistan to the golden hour standard. The 

push back from the joint staff, the Services, and as he termed it “the civilian 

and military medical bureaucrats,” surprised the SECDEF.149

The Chairman of the Joint Chiefs of Staff was not supportive, nor the 

joint staff surgeon—a physician that understood and argued that the golden 

The emerging Afghanistan 

battlefield had numerous 

forward surgical teams, 

combat support hospitals, 

and medevac assets from 

all three Services.
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Farr: The Return of the Future Guerrilla Hospital

hour timeframe was flexible. Neither the Air Force nor the Navy pressed for 

change. The Army, however, the ones doing the heavy lifting and taking the 

heat, supported the change. The SECDEF at that time, Robert Gates, was 

not happy. He viewed the golden hour as a key component of troop morale 

and expectations. He directed 10 medevac helicopters and 3 forward surgical hospitals to Afghanistan, and by late spring, he sent 15 more helicopters 

and 3 more hospitals.150

The joint staff eventually saw reason. There is logic in flying 65 minutes to 

a full up (role 3) combat support hospital by overflying at 55 minutes a small 

(role 2), forward surgical team. The surgical assets added by the SECDEF 

improved for SOF also. SOF were usually the farthest away with the longest 

evacuation times, so more was better.

The majority of SOF in theater came under a complicated, obtuse command and control-wiring diagram, which positioned SOCCENT toward the 

top. SOCCENT was usually hands-off but helpful upon request to SOF forces 

in Afghanistan and Iraq. In theater missions, SOCCENT had access to a 

conventional Air Force surgical team—the MFST. Later in the war, roughly 

the same time as the Pentagon struggle on medevacs, it acquired an Air 

Force SOST. These two teams were suited for different missions and SOCCENT’s surgeon,151 through exercises and missions, showed the command 

different capabilities, equipment, and mindset. SOSTs and MFSTs promised 

commanders their own transportable golden hour. As conventional medical 

and surgical forces in theater began to decline, this organic nature would 

become more and more important to SOF.

Attempts began to divide larger surgical teams into smaller ones better 

suited for remote bases, smaller airlift footprints, and special operations. 

One Army ‘split FST’ showed a 14-month split location operation with 761 

treated cases. The study showed an “acceptable DOW [died of wounds] rates 

when compared with other larger surgical units currently operating in the 

GWOT.”152

Confusion arose among SOF on how to meet the golden hour edict. Unit 

staff officers would ask the SOCCENT command surgeon how to meet the 

SECDEF rule if they were sending a SF A-Team to Jordan, Kazakhstan, or 

Lebanon. Explanations by the surgeon’s medical planners and/or the command surgeon personally stressed that the golden hour was a SECDEF rule, 

meaning DOD, and was mandated in the two countries that DOD “owned” 
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JSOU Report 17-10

(Afghanistan and Iraq) versus it being a Secretary of State, DOS rule, which 

would cover the rest of the world. 

Nevertheless, is the golden hour the right thing to focus on? Medically, 

the joint staff surgeon was correct in briefing the SECDEF that there was 

not a time to get the ‘best’ trauma care result. Fifty-nine minutes was not 

golden and sixty-one minutes was not specifically going to result in a bad 

outcome. The same applies to 60 and 90 minutes. Former SECDEF Gates was 

also correct that an inequitable standard between combat theaters was not 

politically, ethically, or morally supportable. Underneath all the posturing, 

what it took to “fix” this dilemma was resources. The plan only allocates a 

certain number of medical forces to deploy. That phased deployment plan 

is always a wrestling match among the deploying command’s staff and their 

higher headquarters. Quite often, the medics lose and get less than they want 

on the time-phased force and deployment list.153 Once the SECDEF directed 

more resources, medevac achieved the new standard quite quickly.

It was proven that the golden hour can be done in combat. But, does the 

golden hour medically need to be done in combat? The PHTLS textbook, 

which also is the TCCC textbook, mentions the golden hour three times. 

The first mention discusses the development of the term and points out that 

in the civilian world transport time consumes much of the golden hour. The 

other two mentions both strive to point out that it is not a golden hour but 

a ‘golden period,’ which varies from patient to patient, based on injuries.154 

Is there data on this?

The medical journal Academic Emergency Medicine describes the golden 

hour as “[a] term [which] yielded little scientific evidence to support it ... 

[and was] widely accepted but are in fact not scientifically supported.”155

After the directive to change the golden period from 90 to 60 minutes, 

researchers looked at the effectiveness of the change. The study showed that 

after the mandate, aerial evacuation times fell from 90 minutes to 43 minutes in Afghanistan, and comparing the mortality and morbidity before 

the change versus after, 16 percent of severely injured troops died versus 9.9 

percent after the mandate. Researchers estimated that the 

change saved 359 lives between early 2009 and March 

2014.156 Quicker is better on the battlefield.

One final point in this combat golden period discussion is to highlight what happens after the golden hour. 

In both Afghanistan and Iraq, robust level-three (role 3) hospitals were able 

Quicker is 

better on the 

battlefield.
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Farr: The Return of the Future Guerrilla Hospital

to deal with these surgical cases and speedily send them on to further care 

and more surgery in Germany and the United States. In the ‘non-DOD, no 

golden hour’ countries where SOF classically operate, not only is there no 

golden hour but also no quick, seamless surgical handoff to a sophisticated 

intensive care unit (ICU) holding capability nor quick aerial evacuation in 

a flying ICU. 

An old saying in war is that only young surgeon’s profit from it. Another 

community, which has profited from the GWOT, is special operations medicine. Its medics profited from the capability to quickly hand off American and Allied casualties within the golden hour while learning the latest, 

innovative U.S. surgical care. The other area was in the care of indigenous 

casualties, care usually without a golden hour. This experience gained by SF 

18D medics and SOCMs is directly relevant to the developing style of warfare 

seen by SOF in the future. This particular phase of the GWOT, which presently lacks documentation, has produced a large training gap. 

The newly made 18D or SOCM leaves the JSOMTC with a meager understanding of GW/UW. Doctrinally, units remediate this deficit through “unit 

training.” SF battalion and group surgeons, in most cases denied the opportunity to attend the SFQC, are expected to teach with very few resources 

and little knowledge in the area. This lack of expertise not only interferes 

with GW/UW medical training for medics, but also leaves the battalion and 

group surgeons ill-equipped to utilize the staff decision-making process to 

fight for surgical teams and other assets useful in a GW/UW environment. 

Key to a successful guerrilla medical structure is proper use of auxiliaries 

and undergrounds—also not taught and a major failing in Jade Helm UW 

exercises. 

Since before this war and in the future, the special operations combat 

medic must not only be the initial responder, the golden hour provider and 

transporter, but also must be the holding, and in some cases the onward 

evacuation, for patients on the hyper-distributed battlefields.

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10. The Platinum Ten Minutes

After the trauma literature popularized the golden hour or golden period 

as the required standard time to surgery, the term “platinum ten minutes” emerged. Used mostly in civilian trauma and emergency response 

literature, it describes the time spent at the scene by emergency medical 

service providers before transporting. Typically, during the golden hour 

spent at the scene, providers center on scene safety and vehicle extrication.157 

Since the JSOMTC trains all SOF medics through the Emergency Medical 

Technician-Paramedic level of certification, they see this terminology during 

their training. There is some crossover to military medicine, especially with 

vehicle extrication issues.

Military medical literature does not mention the platinum ten minutes 

much. The current PHTLS/TCCC manual mentions it twice. It states, “for 

critically injured trauma patients, initiate transport to the closest appropriate 

facility within 10 minutes of arrival on scene.” 

There are two main caveats. First, go to the most appropriate facility, 

not the closest. Second, rule out or quickly manage life-threatening problems.158 When the SECDEF mandated the Operation Iraqi Freedom/Operation Enduring Freedom golden hour, medevac aircrews sometimes violated 

the first caveat. Planners directed medevac helicopters to the closest forward 

surgical teams with lesser capability than a nearby combat support hospital 

because it was marginally closer.

One of the few military references in medical literature is from the French 

Army. In Blesses au combat, dix minutes en platine, une heure en, translated 

Wounded in Action: The Platinum Ten Minutes and the Golden Hour, the 

authors state that:

In the battlefield, the majority of casualties die within ten minutes 

of trauma. Most injuries result from an explosion and hemorrhage 

plays a central role. To improve survival rates, the French Army 

Health Service has developed a chain or survival from the battlefield to France based on prehospital combat casualty care, forward 

medical support during the first hour and damage control surgery.159
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JSOU Report 17-10

Noticeably, under the current committee on tactical combat casualty care 

terminology, the platinum ten minutes could include self-aid, buddy-aid, 

possibly the care-under-fire phase, and perhaps portions of the tactical field 

care, depending on the tactical situation. Using 

the term platinum ten minutes in the military to 

stress the importance of self- and buddy-aid could 

be a technique to drive that importance home to 

line commanders.

Today’s civilian trauma literature opines that 

pre-hospital interventions beyond simple basic 

life support during the platinum ten minutes are 

effective. A PHTLS caveat for rural environments 

or when transport times are prolonged, requiring 

more and longer interventions at the scene and 

transport may be necessary, would extend the platinum ten minutes.160

This stage of the GWOT is defined by shrinking medical resources, a 

smaller battle space footprint, and the need to perform prolonged field care 

for missions in evacuation delayed denied areas. The platinum ten minutes 

becomes just a minor portion of the golden hour, which itself is becoming 

less and less crucial if further evacuation is delayed. Having and living the 

golden hour, and for that matter the platinum ten minutes, is a ‘righteous 

act,’ but soon it will become impossible due to post-GWOT distance and 

resource issues. 

A new paradigm for the future hyper-distributed battlefield and for 

denied area casualty management is needed. Look no further than the early 

days of SF and the WWII OSS to develop a plan for nearby surgery, long 

duration holding, and/or long distance nonstandard evacuation. 

Although this pivot from golden hour care and quick evacuation to prolonged field care will require significantly different equipment and medical 

expertise, what it most requires is a different mindset. The GWOT has raised 

a generation of golden hour warrior medics, both SOCM and 18D, who have 

been doing excellent work. They now need new skills, new equipment, and 

most importantly a new approach for casualty care on a new and completely 

different battlefield.

Using the term platinum ten minutes in 

the military to stress 

the importance of 

self- and buddy-aid 

could be a technique 

to drive that importance home to line 

commanders.
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11. Back to the Future: Prolonged Field 

Care

As the wars in Afghanistan and Iraq morph into advising actions with 

fewer troops, more contractors, less medical capability, bigger medevac 

circles, the golden hour/period increases or vanishes. Special operations 

medics who for a decade handed off complicated trauma cases to sophisticated level three surgical facilities for speedy evacuation out of theater, now 

will need to transition back to their roots.

Trauma cases may still need a speedy trip to the operating room but 

that operating room may have to be a vetted (or not) third-world facility, a 

pre-staged, close by, special operations capable mobile surgical team, or a 

more conventional surgical team that has been selected to support several 

SOF teams or operations in a hub and spoke pattern. All of these options 

will most probably call for extended patient holding either before or after 

the surgical intervention.

The need for a more SOF specific, organic surgical capability has finally 

surfaced in command documents. In “ARSOF 2022,” a special edition of Special Warfare magazine, the USASOC commander states, “Increase organic 

medical capability including the establishment of deployable, scalable surgical teams modeled after the Joint Medical Augmentation unit.”161

This scenario quickly takes us back to the guerrilla forces in WWII with 

their small, close-by surgical teams with guerrilla hospitals for holding and 

rehabilitation. After a decade of speedy handoffs, SOCMs and 18Ds will need 

to start doing what their school trained them to do—hold a trauma case for 

72 hours.162 The two missions, which are good examples of needing these 

medical skills, are GW and FID. Some operators say that FID is just GW in 

peacetime. They both involve small teams of SF with little or no support at 

extreme distances, in denied areas, working with local nationals and practicing medicine, which is largely sick call medicine focusing on disease, veterinary, dental, preventive medicine, until suddenly they have a trauma case. 

As the GWOT has run down and traditional missions have multiplied, 

smart thinkers within SF have begun to approach the problem of extended 

care in the field. Even though the lessons learned from OSS and other guerrilla movements in WWII stand the test of time, what has changed? Many 
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JSOU Report 17-10

historical examples of guerrillas were communist inspired with the resulting 

ideology. Therefore, ideology is different. Clearly, technology has changed 

with modern day satellite communications, global 

positioning, faster transportation, the World Wide 

Web, and internet self-radicalization. Moreover, 

medicine has changed. Medical personnel on the 

battlefield are routinely saving soldiers who would 

have died in previous wars. This alone intensifies the 

plea to hold a seriously injured trauma case longer. 

Commanders are comfortable discussing options 

in a relative risk framework and prolonged field care should be termed that 

way. The further away the supporting surgical team, the longer the casualty 

must be held before evacuation, putting the mission at greater risk. 

Concerns about large deployment distances and lack of close by, or at 

least reachable, surgical support are nothing new. However, SF groups largely 

placed these issues on the back burner as they took their turns in Afghanistan and Iraq, where they contended with the golden hour. As SOF troop 

levels decreased in Iraq and Afghanistan, and the SF groups returned to their 

regionally focused mission sets, concerns arose on how to approach these 

problems. Very similar problems existed in the 1990s but at that time, there 

was not the nagging memory of the golden hour or the need of it. After all 

ATLS was essentially hospital-based.

Groups of 18Ds and unit surgeons began a grassroots, bottom-driven 

discussion on how to proceed in planning and execution for missions over 

large distances, with little or no support, and inadequate local medical infrastructure. Operators do much of this on an independent website, https://

prolongedfieldcare.org/. The discussion focused on the intricacies of operational planning and extensive logistical preparation. The 18Ds divided it 

into four stages: 

1. RUCK: the gear carried to the furthest point on a mission, generally 

carried by medical personnel dismounted.

2. TRUCK: whatever additional equipment will be carried in mission-specific transportation, weather that is trucks, boats, all-terrain vehicles, 

kayaks, and so forth.

Medical personnel 

on the battlefield 

are routinely saving 

soldiers who would 

have died in previous wars.
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3. HOUSE: gear available to the medic, but which is only feasible to be 

maintained at a team house, firebase, or other mission support site. 

It represents the highest level of care the operational element has 

organic to it.

4. PLANE: planning stage included to allow the medical providers to 

consider how they will move patients on aircraft, whether medical 

evacuation (MEDEVAC) aircraft (those designated and equipped to 

move casualties as a primary mission) or casualty evacuation (CASEVAC) (preplanned nonmedical support aircraft, opportunity or ‘slick’) 

aircraft.163

This is a large pivot from the golden hour and the GWOT. SF need new 

capabilities, or more accurately, SOF should revive old WWII capabilities 

and apply new technology. The working group identified “The Ten Prolonged 

Field Care Capabilities:” 

1. Monitor the patient

2. Resuscitate the patient

3. Ventilate/Oxygenate the patient

4. Gain definitive control of the patient’s airway

5. Use sedation and pain control effectively

6. Use physical exam and diagnostic measures to gain awareness of 

potential problems

7. Provide nursing/hygiene/comfort measures

8. Perform advanced medic-level surgical interventions 

9. Perform teleconsultation

10. Prepare the patient for flight164

Beyond the requirement of more extensive medical, operational and logistical preparations, changes will require new skills sets for medical planners 

and unit surgeons. The medical and nursing skill differences from the standard TCCC golden hour are staggering. One prime example is tourniquets, 

which have a six-hour max. In classical GWOT TCCC casualty management, 

medics never removed tourniquets. They deposited patients with tourniquets 
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JSOU Report 17-10

at a surgical facility who removed the tourniquet as part of their surgical 

procedures.165

Moreover, tourniquets are just the tip of the iceberg. The long dwell care 

of the wounded calls for different fluid requirements and types, different 

analgesia and sedation, longer periods of airway management, and much 

more expert extended nursing care. Even though 18Ds and SOCMs leave 

the schoolhouse trained in trauma patient management for 72 hours, very 

few have done it and most have forgotten it over the duration of the GWOT.

After extended field care comes the task of evacuation. Evacuation is 

problematic enough in regular missions with total air superiority but it 

increases in complexity in denied areas. Just as the SOF logisticians will 

have problems supporting SOF in access denied areas, SOF medical planners 

and medical logicians will have similar problems in medical evacuation and 

in pushing Class VIII (medical) supplies forward. Just as AFSOC led the way 

in the 1990s with the development of light mobile SOF surgical teams, they 

are again leaning forward with nonstandard aviation and recently stood 

up the 859th Special Operations Squadron, which “specializes in infiltrating and resupplying special operations forces during clandestine missions 

around the world.”166

Leading the way is the USASOC field exercise Jade Helm. The multistate 

UW exercise included a guerrilla hospital, auxiliary, and undergrounds to 

facilitate medical and surgical care of injured guerilla fighters. The definitive 

surgical skills needed to treat guerrilla fighter wounds are different from the 

trauma skills necessary for the golden hour. Unfortunately, the exercise probably did not run long enough to show the problems in holding and nursing 

skills. It was a great step forward, or backward, into UW.167

The Joint Special Operations University is also affecting change by 

offering the pilot “Non-Standard Logistics Course” which “introduces best 

practices in critical/strategic thinking, innovation, problem solving, risk 

management, negotiations, influence leadership, persuasive communication, 

and trust ISO [in support of] conducting global logistics service/support.”168 

As outlined in this monograph, the SF UW doctrine was once robust, but 

competition for space for other mission doctrine in newer manuals began 

to squeeze out UW. Clearly, SOF needs reinvigorated doctrine and field 

manuals. The U.S. Army John F. Kennedy Special Warfare Center and School 

realized that they cannot reply on current modern day manuals and published in 2009 A Leaders Handbook to Unconventional Warfare discussing 
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Farr: The Return of the Future Guerrilla Hospital

conventional capabilities that may be absent “that may include medical 

evacuation, close air support, and continuous lines of communication.”169

This book goes on to discuss the need for commanders to accept risk by 

decentralization. Medics, medical planners, and medical officers need to 

vastly improve their ability to explain the relative risk of no golden hour, 

extended holding, and nonstandard lengthy evacuations so that commanders 

understand the risk. Commanders can then attempt to mitigate high-risk 

missions with more extensive medic training in surgical skills, closer forward surgery, extended holding nursing skills, local nation or allied support, 

dedicated evacuation, and new technology.

Counter to the continued diminution of GW/UW doctrine in SF publications is Training Circular 18-01, published in 2010. Entitled “Special Forces 

Unconventional Warfare,” it proffers the definition of GW and brings back a 

section on organization of medical support within the area complex, which 

outlines medical requirements, aid stations, guerrilla hospital, and convalescent facility. It specifically gives the clandestine medical facilities mission 

to the guerrilla underground.170

With change always comes the need 

for new equipment, new doctrine, new 

ways of doing things, and prolonged field 

care is no different. It will challenge us to 

develop true SOF medicine on our battlefield. The conventional medical capability 

on the battlefield attempts as much as possible to recapitulate American brick 

and mortar medicine, something SOF cannot do and should not try to do.

In the words of a currently serving operator 18D, Sergeant First Class 

Paul Loos:

SOF medics have always had the mission of providing far-forward 

medical care without surgical support or robust medical supply/

support. This skill set has fallen into disuse. Sustainment of robust 

SOF medical skills has also proven to be problematic.171 SOF medicine needs to refresh and refocus this skill set after 14 years of acute 

trauma-centric care in a mature medical environment that assured 

sub-1 hour evacuation to definitive surgical care. Fortunately, the 

SOF medics have a rich history of solutions to far-forward care in 

the absence of surgical support that dates back to World War II.”172

With change always comes 

the need for new equipment, 

new doctrine, new ways of 

doing things, and prolonged 

field care is no different.

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Farr: The Return of the Future Guerrilla Hospital

12. Technical Challenges, Improving 

Sustainment, Reducing Footprints

If SOF are to exist, work, and succeed in the denied areas of twenty-first 

century extended battlefields, they will need new techniques wedded to 

the proven guerrilla lessons learned by predecessors in WWII. The golden 

hour is but one component of TCCC. If future battlefields dictate the 

demise of the golden hour, those battlefields also demand adherence to the 

other TCCC lessons learned. These vary from hypotensive resuscitation to 

advanced pain control, better or oxygen carrying intravenous fluids, tourniquets, hemostatic dressings, and prehospital antibiotics. Those advances in 

TCCC must be preserved and enhanced. Some may change either from new 

scientific advances or from the challenges of prolonged holding of trauma 

patients on the future battlefield of denied areas, limited resources, and 

extreme distances. The first thing is to continue the great progress gained 

in the GWOT TCCC casualty management.173

In addition, the DOD as an institution from top to bottom must address 

the following several areas of specific medical focus.

1. Unit commanders need to own TCCC mandated casualty care and 

make it a unit commander’s battle drill, not just something done by 

“those medics.” It must be a military wide standard.

2. TCCC should become the only medical basic training for all officers, 

soldiers, sailors, airmen, and marines and it should be the same for 

all Services and done with the same equipment.

3. The Joint Trauma System needs to continue and have access to senior 

leadership, even in peacetime. It should continue to set standards for 

battlefield care through its clinical practice guidelines, foster data collection for analysis, and recommend needed military trauma research.

4. Even though the JTS has access to medical data and the electronic 

medical records are improving, the JTS still needs data on killed in 

action and should continue to include the Office of the Federal Medical Examiner in such identification and tracking.
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5. Establish a Rapid Fielding Initiative for medicine to facilitate quick 

new medical equipment fielding, and up-to-date pre-deployment 

TCCC medical training and equipping packages. Include individual 

first aid kit items for all services in it. 

6. To facilitate new devices and medications, the Food and Drug Administration (FDA) and the CoTCCC/JTS should establish a standing, 

lasting interface at the FDA to streamline the drug and device approval 

processes for combat use. 

7. Medicine is just one of the combat service support arms and is closely 

linked to nonmedical logistics. The new interest in sustainment of SOF 

in denied areas, such as the previously mentioned new nonstandard 

logistics course at JSOU, should be broadened to include medical class 

VIII A and B of supply be dealt with in such distributed operations 

support, as well as evacuation issues. The JSOU course “Joint Special 

Operations Medical Orientation” should be linked to both the logistics 

course and the operational planning course.174 The JSOU monograph 

Improving the Sustainment of SOF Distributed Operations in AccessDenied Environments by Robert Haddick is a great start.175

8. UW education has remained in SF training in some decades better 

than others, but always present. One thing that did change was who 

could go to the SF qualification course. Until the early 1990s, medical 

officers (physicians) could attend, but from the early 1990s to early 

2000s, only officers who were re-branching as an 18A and moving 

into the SF branch could attend. Luckily, this is changing. The SF 

community must ensure that SF battalion and group surgeons, physician assistants, veterinarians, dentists and medical operations officers 

(medical planners) fully understand the differences in battlegrounds.

9. SOF must aggressively look for new technology. Miniature 3-D printers than can “print” surgical instruments are already here.176 Now 

needed are 3-D printer-like portable devices, which can produce a 

varied array of pharmaceuticals on demand at the guerrilla medical 

treatment facility site. It should not only be able to produce drugs, but 

also vaccines, biologicals, vitamins, and intravenous fluids, preferably 

ones that are oxygen carrying.177
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Farr: The Return of the Future Guerrilla Hospital

10. SOF medicine must rethink old accepted ‘normals’ of battlefield 

trauma care. Just as TCCC deemphasized ATLS cervical spine control, 

CoTCCC and SOF need to reexamine blood, oxygen, and antibiotic 

use. A recent study remarks on the “significant opportunity to reduce 

the need for high-flow oxygen delivery to the battle space.”178

11. Last and most importantly, SOF must have an organic surgical capability just like in WWII. New technology should drive the fielding and 

equipping of the SOF forward surgical capability preferably under 

the control of the TSOC or the Combined Joint Special Operations 

Task Force.179

Number 11 in the previous list is not a denigration of conventional forward surgical teams from all Services who have soldiered valiantly on the 

SOF battlefield for many SOF commanders. With the proper guidance and 

specialized, supplemental equipment, these teams can handle some missions. 

Their staff, equipment, and size issues cause problems on some missions 

where organic SOF surgical teams will be necessary. In addition, the DOD 

allocates conventional teams to conventional units with no extras for SOF 

use, sustained use, refresher training, or other downtime.

This list should probably be longer and conclude with comments from 

ARSOF 2022: “The most critical gap in ARSOF special warfare capability 

exists in the UW mission set, our ability to conduct UW in denied areas for 

extended periods of time.”

 Under the heading “Soldier Systems,” the need for minimal supply 

burdens and increased aerial-delivery capabilities is linked with new and 

emerging technologies such as freeze-dried plasma and the need to “increase 

organic medical capability including the establishment of deployable, scalable surgical teams modeled after the Joint Medical Augmentation Unit.”180 

ARSOF 2022 marks the reemergence of medicine and surgery as full 

players within SOF as opposed to just being an afterthought “service responsibility” provided to SOF piecemeal by the respective Services. The scarcity 

of resources on the future battlefield will require that medicine become 

more organic and will give medics an opportunity to make their case more 

effectively for seamless inclusion into SOF planning, manpower, and force 

structure. Medics must lead the way in articulating this emerging need.

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13. Conclusion

To be effective in denied areas and hyper-distributed battlefields, special 

operations, and in particular SF, medicine must blend its WWII OSS 

guerrilla support medical doctrine with modern day CoTCCC doctrine and 

technology. Whether denied areas occur simply from the tyranny of deployment distance in a phase zero, peacetime, FID mission, or from operating 

in a denied area with hostile enemy forces who have air superiority on a 

wartime UW mission, the effect on medicine is the same. 

Some new doctrine for this fight appears in the publication of Joint Publication 3-05, Special Operations, in 2014. It addresses UW medical support 

and states:

Medical elements supporting the resistance forces engaged in UW 

must be mobile, responsive, and effective in preventing disease and 

restoring the sick and wounded to duty. It is unlikely the resistance 

movement will have a safe rear where it can take casualties for treatment. Medical personnel may operate casualty collection points and 

provide further evacuation of casualties.181

Casualties will be a less frequent occurrence than in the GWOT, but 

even one trauma casualty will demand the full attention of the SOCM or 

18D for an extended period of care. The high-risk nature of such denied area 

operations and their difficult medical support will demand expert planning, 

cooperation between unit surgeon and planning staffs, and the realization 

that the high-risk nature of such missions cannot always be ameliorated.

Commanders are intimately familiar with managing risk and proceeding 

on mission, if required, in the face of high risk. Medics need to grow their 

ability to speak the commander’s language to convey medical risk adequately. 

Medical soldiers do not often brief or show mission failure. Since life or 

death is involved, they manage to rig non-doctrinal success, often at a high 

cost. This tendency actually works against them when the command looks 

at money and manpower, as those disciplines that show mission failure are 

the most likely to receive additional support in the form of funding and 

additional personnel. The medics, not having failed, are overlooked.
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The modern battlefield will have a more complicated medical infrastructure than before. As evidenced in the current Syrian civil war, numerous 

non-governmental organizations (NGOs) and private volunteer organizations (PVOs), as well as other medical players are now active in such wars. 

This varied array of medical providers may be able to be used to a guerrilla 

forces’ advantage for treatment and hospitalization of resistance members, 

however, as in the French experience in WWII government security forces 

may apprehend the resistance members. The other changing dynamic of 

warzone hospitals is the frequency of which the enemy now views PVOs/

NGOs and other medical personnel as normal targets of war. In the words 

of Médecins Sans Frontièrs, “the targeting of hospitals and humanitarian 

workers is quickly becoming a new normal.”182

The best foundation for SOF medicine’s success on future missions rests 

with the proper war tested doctrine combined with the very newest techniques in trauma management, extended holding nursing care, perhaps a 

period of local nation care, and creative evacuation. All will be dramatically 

different from the GWOT’s golden hour. Today’s medicine is vastly more 

complex and equipment-dependent than ever before. All must realize that 

the UW environment may require less sophisticated medicine. SOF cannot 

always bring the Mayo Clinic to the battlefield but it can strive to make the 

guerrilla leader happy.
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Farr: The Return of the Future Guerrilla Hospital

Appendix: Acronym List

AFSOC Air Force Special Operations Command 

AMEDD Army Medical Department 

ATLS Advanced Trauma Life Support 

BLS Basic Life Support 

CF conventional forces 

CIDG Civilian Irregular Defense Groups 

CoTCCC Committee on Tactical Combat Casualty Care 

DA direct action 

DOD Department of Defense 

DOS Department of State 

FDA Food and Drug Administration 

FID foreign internal defense 

GMO general medical officer 

GW guerrilla warfare 

GWOT Global War on Terrorism 

ICU Intensive Care Unit 

JCS Joint Chiefs of Staff 

JSOMTC Joint Special Operations Medical Training Center 

MFST Mobile Forward Surgical Team

NATO North Atlantic Treaty Organization 

NGO non-governmental organization 

PVO private volunteer organization 
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OSS Office of Strategic Services 

PHTLS Pre-hospital Trauma Life Support 

SECDEF Secretary of Defense 

SAF Special Action Forces 

SF special forces 

SFQC Special Forces Qualification Course 

SOCCENT Special Operations Command Central 

SOCM Special Operations Combat Medic 

SOE Special Operations Executive 

SOF Special Operation Forces

SOSTs Special Operations Surgical Teams 

SR Special Reconnaissance 

SWCS U.S. Army John F. Kennedy Special Warfare Center 

 and School 

TCCC Tactical Combat Casualty Care 

TSOC Theater Special Operations Command 

USASOC United States Army Special Operations Command 

USSOCOM United States Special Operations Command 

UPA Ukrainian Insurgent Army 

UW unconventional warfare 
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Endnotes

1. Said to the author while he was the USSOCOM Command Surgeon in 2008.

2. Richard A. Gabriel and Karen S. Metz, A History of Military Medicine, Volume 

II: From the Renaissance Through Modern Times (New York, NY: Greenwood 

Press, 1992), 157–163.

3. “Secret American Commandos Hid Out in Cold War Berlin. Special troops 

would have spied on the Soviets.” Accessed 14 August 2016, https://warisboring.com/secret-american-commandos-hid-out-in-berlin-during-the-cold-warb1f79b14ff00#.swsc0jl9q.

4. Robert M. Gates, Duty: Memoirs of a Secretary at War (New York, NY: Random 

House, 2014), 304–305.

5. “Remember Jade Helm 15, the controversial military exercise? It’s over.” Accessed 14 

August 2016, https://www.washingtonpost.com/news/checkpoint/wp/2015/09/14/

remember-jade-helm-15-the-controversial-military-exercise-its-over/.

6. Conversation with SFC (Ret.) Ron Lynch about Jade Helm. SFC Lynch helped 

set up the guerrilla hospital in Texas.

7. Last accessed 5 December 2016, http://prolongedfieldcare.org/.

8. United States War Department, The War of the Rebellion: A Compilation of the 

Official Records of the Union and Confederate Armies (Washington, D.C., Government Printing Office, Series I, Vol. 27, Part III), 1055.

9. Russ S. Kotwal, Harold R. Montgomery, Bari M. Kotwal, Howard R. Champion, 

et al., “Eliminating Preventable Death on the Battlefield,” Archives of Surgery 146 

(2011): 1350–1358.

10. Barry Jason Stein, U.S. Army Heraldic Crests: A Complete History of Authorized 

Distinctive Unit Insignia (South Carolina: The University of South Carolina Press, 

1992), 198, 316.

11. The author’s personal experiences as SOCCENT Command Surgeon, 2009-2013.

12. Colin Scott Dafoe, “Experiences of a British Medical Officer in Yugoslavia,” 

Report of the Inter-Allied Conferences on War Medicine (January 1945), 374.

13. United States Army John F. Kennedy Special Warfare Center and School, “ARSOF 

2022,” Special Warfare 26, no. 2 (April–June 2013), 13. Available at: http://www.

soc.mil/Assorted%20Pages/ARSOF2022_vFINAL.pdf.

14. Ibid.

15. The author’s personal experience at USASOC at the start of the GWOT in 2001.

16. ARSOF 2022, 13. 

17. William Stevenson, The Ghosts of Africa (New York: Harcourt, 1980).

18. “Hugh Cairns (surgeon)” accessed 12 August 2016, https://en.wikipedia.org/

wiki/Hugh_Cairns_(surgeon).
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19. Paul von Lettow-Vorbeck, Meine Erinnerungen aus Ostafrika (Leipzig: Verlag 

von K. F. Koehler, 1921); Paul von Lettow-Vorbeck, My Reminiscences of East 

Africa (Nashville, TN: Battery Classics, 1990).

20. Walther Dobbertin, Die Soldaten Lettow-Vorbecks. Ein Buch von deutschem 

Wehrwillen und deutscher Waffenehre (Wiedenhof-Bucchholz: Harburg, 1932). 

21. Helmuth Stoecker, German Imperialism in Africa: From the Beginnings until the 

Second World War (London: C. Hurst and Company, 1986), 279.

22. Edwin Guerilla Hoyt, Colonel von Lettow-Vorbeck and Germany’s East African 

Empire (New York: Macmillan Publishing Co. Inc., 1981), 93.

23. Ibid., 196.

24. Ludwig Deppe, Mit Lettow-Vorbeck durch Afrika (August Scherl: Berlin, 1919).

25. Paul von Lettow-Vorbeck, My Reminiscences of East Africa, 25.

26. Thomas Crowson, When Elephants Clash: A Critical Analysis of General Paul 

Emil von Lettow-Vorbeck in the Great War (Fort Leavenworth, KS: U.S. Army 

Command and General Staff College, 2003), 66–67.

27. Edward Paice, World War I: The African Front (New York, NY: Pegasus Books, 

2008), 131–132, 304.

28. Hoyt, 174.

29. von Lettow-Vorbeck, My Reminiscences of East Africa, 259.

30. Paice, World War I: The African Front, 372, 395.

31. Kenneth P. Adgie, Askaris, Asymmetry, and Small Wars: Operational Art and the 

German East African Campaign, 1914–1918 (Fort Leavenworth, KS: U.S. Army 

Command and Staff College, 2001), 2.

32. G. Nikolis, “The medical service in the fourth offensive,” Military Medical and 

Pharmaceutical Review (1946), 207.

33. Josip Broz Tito, The Creation and Development of the Yugoslav Army (Belgrade, 

Yugoslavia: Central Political Department of the Yugoslav Army, 1949), 236.

34. Dorde Dragic, Partisan Hospitals in Yugoslavia 1941–1945 (Belgrade, Yugoslavia: 

Military Printing House; 1966), 66–67.

35. Ibid., 81–83.

36. Ibid., 66–67.

37. Ibid., 93–109.

38. Ibid., 81–83.

39. Dafoe, Experiences of a British Medical Officer in Yugoslavia, 373-374; and J. 

W. Hirst, “An account of the Medical Services of the National Liberation Army 

of Yugoslavia and of the R.A.M.C. Assistance Given to It,” Journal of the Royal 

Army Medical Corps 84 (January 1945), 105-114.

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(Washington, D.C.: Special Operations Research Office, The American University, 

1961), 154–5.
77

Farr: The Return of the Future Guerrilla Hospital

41. Brian Jeffrey Street, The Parachute Ward: A Canadian Surgeon’s Wartime Adventure in Yugoslavia (Toronto, Canada: Lester and Orpen Dennys Publishers, 1987), 

88–91.

42. Hirst, “Medical Services of the National Liberation Army of Yugoslavia,” 105–114 

and Condit, Case Study in Guerrilla War: 154–155. 

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Partisan Hospitals of Yugoslavia, October 10, 1966. Author’s private collection.

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Journal of Trauma (January 1988): S170–174.

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83, Folder 1205 (Loc: 190/8/28/7). Author’s private collection. Obtained from 

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1952–82.

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57. Author’s personal recollections of attended talk in 2001.
78

JSOU Report 17-10

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228–229.

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75. Grose, Operation Rollback.

76. Dafoe, “Experiences of a British Medical Officer in Yugoslavia.” 
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80. Ibid., 369–370. 

81. Tse-tung and Griffith, On Guerrilla Warfare, appendix, tables 1–4. 

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83. Ed Evanhoe, Eighth Army Special Operations in the Korean War, 145–150.

84. Ibid., 88.

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the Army Profession (Boston: McGraw-Hill, 2005).

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93. McClintock, Instruments of Statecraft, 32.

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1 August 1999), 1–10.

95. Charles M. Simpson III and Robert B. Rheault, Inside the Green Berets: The First 

Thirty Years, A History Of the U.S. Army Special Forces (Novato, CA: Presidio 

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96. Dan Crosswell, The Chief of Staff: The Military Career of General Walter Bedell 

Smith (New York: Greenwood Press, 1991), 96.

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Printing Office, 5 October 1951), 2, quoted in Gary M. Jones and Christopher 
80

JSOU Report 17-10

Tone, “Unconventional Warfare: Core Purpose of Special Forces,” Special Warfare 

12, no. 3 (Summer 1999), 4.

99. Department of the Army, Field Manual 31-21, Jungle Operations (Washington, 

D.C.: The United States Government Publishing Office, December 1941).

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War Against Japan (Laurence, KS: Kansas University Press, 2006).

101. Department of the Army, Field Manual 31-21, Jungle Operations (Washington, 

D.C.: The United States Government Publishing Office, December 1951), 136–137.

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29. For the Ukranian see, “LITOPYS UPA - Series 1 Volume 23,” InfoUkes - 

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ed., UPA Medical Services (Toronto: LITOPYS UPA, 1992). For the Yugoslavian 

see, Dragic, Partisan Hospitals, 29. 

103. Department of the Army, Field Manual 31-21, (1951), 25.

104. Department of Defense, Joint Publication 3-05, Special Operations (Washington, 

D.C.: Joint Chiefs of Staff, April 1998), V-6; Department of Defense, Joint Publication 4-02, Doctrine for Health Service Support in Joint Operations (Washington, 

D.C.: Joint Chiefs of Staff, July 2001).

105. Bank, From OSS to Green Berets, 51–52.

106. Ibid., 138.

107. Leonid D. Grenkevich, The Soviet Partisan Movement 1941–1944 (London: Frank 

Cass, 1999), 197–198.

108. Papo, “The Organization of Surgical Care;” Ripeckyj, UPA Medical Services, 

271–96; Dragic, Partisan Hospitals, 80–101.

109. Department of the Army, Field Manual 31-21, (1951), 138–140.

110. Dragic, Partisan Hospitals, 65–80.

111. Street, The Parachute Ward, 88–91.

112. Lindsay Rogers, Guerilla Surgeon. A New Zealand Surgeon’s Wartime Experiences 

with the Yugoslav Partisans (London: Collins, 1957), 41.

113. Department of the Army, Field Manual 31-21 (1951), 143.

114. Department of the Army, Field Manual 31-21 (1951), 144–145.

115. Author’s personal experience, Task Force Dagger North, December 2001–January 

2002.

116. Major Allison Thomas was greeted with the banner, “Welcome to Our American 

Friends,” when he parachuted into Vietnamese General Vo Nguyen Giap’s camp in 

1945, quoted in Harry Maurer’s Strange Ground: Americans in Vietnam, 1945–1975, 

an Oral History, 1945–1975 (New York: Henry Holt and Company, 1989), 29. 
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Farr: The Return of the Future Guerrilla Hospital

117. Bartholomew-Feis, The OSS and Ho Chi Minh.

118. Ibid., 32–33.

119. Mark D Boyatt, Special Forces: A Unique National Asset “through, with and by”

(Denver, CO: Outskirts Press, 2016), 263–264.

120. Department of the Army, Field Manual 31-22, U.S. Army Counterinsurgency 

Forces (Washington, D.C.: Department of the Army, August 1963), 15–16.

121. Mark D Boyatt, Special Forces: A Unique National Asset “through, with and by” 

(Denver, CO: Outskirts Press, 2016), 416-425.

122. The author’s personal experience as an A-Team medic, Company E, 7th Special 

Forces Group (Airborne) Fort Bragg, North Carolina, August 1968–October 

1969.

123. Francis J. Kelly, Vietnam Studies: U.S. Army Special Forces 1961–1971 (Washington 

D.C.: Department of the Army, 1973), 19.

124. Kelly, Vietnam Studies, 59–60, 63.

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Quarterly Period Ending 31 July 1967 (1967), 55, http://www.dtic.mil/dtic/tr/

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127. Author’s personal experience, A-Team medic, Det. “A,” Berlin Brigade, 1971–1975.

128. James Stejskal, “Special Forces Berlin: Detachment “A” and Physical Security 

Support Element, 1956-1990,” The Drop (Summer 2016), 128–129.

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132. National Association of Emergency Medical Technicians, PHTLS Prehospital 

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& Bartlett Learning, 2011), xxii-xxiv.

133. The author was both an ATLS and a PHTLS instructor.

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82

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Care in Special Operations,” Military Medicine 161, Supplement 1 (1996). Accessed 

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Medical “Urban Legend?” Academic Emergency Medicine 8:758 (2001).

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Golomb, Army Medical Support to the Army After Next: Issues and Insights from 

the Medical Technology Workshop, 1999 (Santa Monica, CA: RAND, 2001), 69–70.

140. Ibid., 6.

141. John L. Plaster, The Secret Wars of America’s Commandos in Vietnam (New York, 

NY: Simon and Schuster, 1997).

142. Author’s personal experience, Dec. 2001–Jan. 2002.

143. Paul J. Tomkins Jr. and Robert Leonhard, Undergrounds in Insurgent, Revolutionary, and Resistance Warfare, 2nd Edition (Ft. Bragg, NC: USASOC, 2013). 

Note: this is an expansion on the famous work of the same title by AR Molnar 

in 1963.

144. Author’s personal knowledge. December 2001–January 2002.

145. Derek Jones, Understanding the Form, Function, and Logic of Clandestine Insurgent 

and Terrorist Networks: The First Step in Effective Counternetwork Operations

(Tampa, FL: JSOU Press, April 2012), 6.

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of Undergrounds in Insurgencies (Washington, D.C.: The American University, 

1966), 54, 223.

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Preventable Death on the Battlefield,” Archives of Surgery 146 (12) (December 

2011), 1350–1358.

149. The briefing was in January 2009. I had seen the draft brief on a trip to the 

Pentagon in December 2008 and told them that it would not go over well. The 

medics had never been very successful in teaching much medicine to the line 

commanders but all of them firmly grasp the “golden hour” concept.

150. Robert M. Gates, Duty: Memoirs of a Secretary at War (New York: Alfred A. 

Knopf, 2014), 304–305.

151. The author was the SOCCENT surgeon during this period.

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Farr: The Return of the Future Guerrilla Hospital

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153. Department of Defense, Joint Publication 3-35, Deployment and Redeployment 

Operations (Washington, D.C.: Joint Chiefs of Staff, 31 January 2013), I-11. 

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Effect of the Golden Hour Policy on the Morbidity and Mortality of Combat 

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161. ARSOF 2022, 26.

162. Discussion with Colonel Kevin Keenan, former Dean of the Joint Special Operations Training Center, 2016.

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Position Paper: Operational Context for Prolonged Field Care,” Journal of Special 

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167. Personal observations by the author, conversation with SFC (Ret.) Ron Lynch who 

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168. Joint Special Operations University, Joint Special Operations University 2016 Fact 

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170. John F. Kennedy Special Warfare Center and School, “Training Circular 18-01” 

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84

JSOU Report 17-10

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174. Joint Special Operations University, Fact Book, 64, 67, 68.

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179. John W. McGrady, Sustaining Unconventional Warfare (Fort Leavenworth, KS: 

School of Advanced Military Studies, United States Army Command and General 

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180. ARSOF 2022.

181. Department of Defense, Joint Publication 3-05.

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