Page 153 - Journal of Special Operations Medicine - Winter 2014

“People who say ‘No!’ irritate me; we should say ‘yes‘”

— COL Russ Kotwal of the Joint Trauma System on Improving Prehospital Medicine

Interviewed by John F. Kragh Jr

How did you enter Special Operations? Frank Butler, Bob Mabry, John Kragh, and others, learned
It took me 16 years. In 1983 I went to airborne school, and from that sacrifice, and in the long run the lessons learned
then I had to swap to get an infantry assignment as a Medical in Somalia saved many more lives in current conflicts. God
Service Corps officer. I was able to get to Ranger school, but had a plan.
since the Ranger Regiment had no MSC slots I had to go to
medical school. I eventually got to the Rangers in ‘99. I tend Who in Special Operations affected you the most?
to craft what I do; I am meticulous and planned. I wanted Affected most? Hmmm. Through all the years? I’d say that
to serve in a regimented system where they let people have person who is the theme is probably Bill Donovan. As the
flexibility and use their creativity. I love Rangers and the senior physician assistant and long-time Ranger, Bill had a
Regiment. world of experience. I modeled things like he had done.
Training, leadership, care of individuals, systems-based care.
How was medical school?
Somalia was a sentinel event to What did you learn from being a
me in October 1993. We students “Russ doesn’t like doing staff officer?
had a Halloween party, and Rom- interviews, especially I think it helped me work in a sys-
ney Andersen and Dave Kramer— spontaneous interviews.” tem to create and start changes.
both were infantry officers in the 3d To think in a reductionist way, you
Ranger Battalion—went to Walter “We should create opportunities. can care for individual patients as a
Reed and brought the wounded doctor, and that is person-oriented.
Rangers to the party. Senior people should give. You can also care “wholistically” for
Junior people should take.” populations, which is system ori-
From whom did you learn ented. A system-approach allowed
the most? greater and more global change, and the improvements per-
I learned the most from my mentors who were senior en- sisted even with personnel and personality turnover.
listed. I hung out with my NCO mentors, and they were ex-
tremely important to me as an officer who wanted to learn. How do you improve a system?
For example, as a young lieutenant, I learned from CSM Change its structure. By changing the structure of an orga-
Rocky Howser of the 25th Infantry Division. This was my habit. nization, like adding medical service and medical specialist
officer slots to the Ranger Regiment, you create opportuni-
Your thoughts on prehospital data? ties for people who can take or shift ownership of key tasks.
We thought: how do we validate this point-of-injury care like Gradual structural change focuses on the few key basics, like
the SEALs and Ranger First Responders were doing? So we Ranger Regimental Commander COL Stanley McChrystal’s
objectively gathered information to guide us. We and SOF Big Four, which included a mastery of the basics such as first
remade the Field Medical Card—you remember that old, aid. First aid became owned by all Rangers as casualty re-
outdated tag—into the Ranger card, which was the proto- sponse drills. This was important to eliminating preventable
type of what we have today. We knew what the knowledge death on the battlefield.
was, like Bellamy’s work on causes of deaths in war, so we
made standardized bleeder control kits. Everybody knew What’s new for your part in the Joint Trauma System?
what was in them. They became familiar and systematized. Information processes include care card collection, after ac-
We changed the structure of the organization in order to tion reviews, and the prehospital trauma registry. We had
change the work in order to condition all into the techniques similar things in the Rangers. The feedback leads to changes.
of best care. We aim to keep the pilot light on so that we don’t start in the
next war in a worse place than where we are now.
What do we need to do to optimize structure?
Change thought. Change philosophy. We all can be condi- What’s in your future?
tioned. It’s a bit of a chicken-and-egg situation, but if the I officially retired from the military in October 2014. My family
organization can change its thinking, then it can change its and I are in College Station, Texas.
structure. If it changes its structure, it can improve as culture
and strategy follow structure. The Ranger commanders be- The opinions or assertions contained herein are the private
coming the owners of individual Ranger response to casual- views of the author and are not to be construed as official or
ties taken was the pivot to the increased lives saved. This as reflecting the views of the Department of the Army or the
vision became clear after Somalia. Some of us, to include Department of Defense.

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