Page 3 - 2025 Ranger Medic Handbook

MEDICAL DIRECTION
Hemorrhage remains the number one cause of preventable death on the battlefield. Evaluate and treat each patient in
accordance with protocols. Ranger Medics must apply thought and cannot blindly follow algorithms. Since hemorrhage
accounts for approximately 90% of potentially survivable battlefield death, always consider and treat for hemorrhagic
shock when in doubt. Although Medics should follow the MARCH algorithm, always ask yourself, “What is killing my
patient now?” Act on that question, regardless of the algorithm if there is a clear cause. Patients may stop breathing
because of hemorrhage.
Treating hemorrhage remains a higher priority than airway control or breathing assistance.
Ranger Medics will always train and master the basics before pursuing more advanced skills, procedures, or techniques.
While these skills are care enhancing, the basics of Tactical Combat Casualty Care (TCCC) will save the most lives on
the battlefield.

UPDATES IN THIS ISSUE
1. Rolling a patient with a pelvic binder in place to assess downside wounds is approved so long as the movements
are minimal, controlled, and do not cause further harm to the patient. Hemorrhage control supersedes not rolling
a patient.
2. Expanded explanation on tension physiology onset time, ventilated vs. spontaneous breathing.
3. Medics are approved to slow-push Calcium in the same access port as blood if no other access is available in ex-
treme situations. Medics should always work toward having a dedicated drug port for trauma patients.
4. In extreme deployed situations, Ranger Medics are approved for slow and controlled re-perfusion of partially
filled donation bags (deliberate slow infusion due to risk of citrate concentration in blood stream causing cardiac
dysrhythmias).
5. Updates to calcium administration and addition of calcium chloride to the medications.
6. Updates to Pain management protocol
7. Updates to Flail chest management protocol
8. Updates to Anaphylactic shock protocol
9. Separation of UTI and STI protocols
10. Updates to Crush protocols
11. Added Pediatrics TCCC protocols
12. Updates to packing lists