Page 3 - 2021 Advanced Ranger First Responder Handbook

MEDICAL DIRECTION
Hemorrhage remains the number one cause of preventable death on the battlefield. Evaluate and treat each patient in
accordance with protocols. Advanced Ranger First Responders (ARFRs) must apply thought and cannot blindly follow
algorithms. Since hemorrhage accounts for approximately 90% of preventable battlefield death, always consider and
treat for hemorrhagic shock when in doubt. The MARCH algorithm is never wrong, but always ask yourself, “What is kill-
ing my patient now?” Act on that question and you will save a life. Patients may stop breathing because of hemorrhage.
Treating hemorrhage remains a higher priority than airway control or breathing assistance.
ARFRs are trusted with an advanced skillset of procedures, medications, and training. You will save lives with this
knowledge. While these skills are enhancing the basics of Tactical Combat Casualty Care (TCCC), training your fellow
Rangers, conducting precombat checks (PCCs)/precombat inspections (PCIs), and rehearsals will save the most lives
on the battlefield.

COMMONLY ASKED QUESTIONS
1. Tranexamic acid (TXA) may be predrawn into a STERILE 10mL syringe. This should be replaced every 7 days due to
bacterial infection risk.
2. ARFRs are approved to predraw 2g TXA and to give this as an initial dose.
3. In hemorrhagic shock, the priority and focus of medical care should be administering blood products. Do not delay
blood products. Ensure you are proficient with the execution of the ROLO protocol and know who your ROLO donors
are. PCC/PCI their equipment regularly.
4. Your medical direction only comes from those within Ranger Regiment. While we appreciate the experts that give
advice and learn from them, they will never dictate your scope of practice. Do not contradict your Ranger medical
leadership by following outside advice.
5. The 75 th Ranger Regiment does not promote commercial products or companies.
6. Product-specific protocols have been removed from this handbook. Follow specific product instructions and train
with each product that will be used in combat prior to deployment. This handbook will not instruct on every product
available for use.
7. Annual updates will be clarified in this section.
8. Data is showing that penetrating chest/torso trauma is a significant source of hemorrhagic shock. Treat aggressively
with blood in casualties with this MOI and signs/symptoms of hemorrhagic shock.