Page 134 - Journal of Special Operations Medicine - Spring 2016

An Ongoing Series

“It was a special, pivotal time; the stars were aligned.“
—Rob Miller on Changing Trauma Care

Interviewed by John F. Kragh Jr, 8 December 2014, Tampa, Florida

challenged us to look at ourselves: can we perform as ad-
vertised? Can we do the things that the command thinks we
can do? Which is manage these casualties in the conditions
in which we operate in—high noise, low light, physical fa-
tigue—and can we maximize their survivability?

You would ask guys about the medications they were carry-
ing, the indications, the contraindications, and employment
strategy for the demographic that we work with, which is
Rangers—and thank God that guy [the Ranger] was tremen-
dously resilient—you could do a lot of things to a Ranger
and he’s very resilient. Thank God. We realized that these
Rob Miller then and now
guys couldn’t answer some of these questions and we were
How did you come to Special Operations Forces still doing LTT [live-tissue training], the grandioso end-state.
(SOF) medicine? If you passed, you were good to go. Guys felt good, but the
I volunteered for the service as a medic, and went to Ger- problem was that there weren’t any metrics associated with
many. A Special Operations recruiter came by and said, “Hey, that, so if the casualty was hypoxic, and he had a blast wound
you know what? The Rangers may be to the side of the face where he wasn’t
a great opportunity for you.” The next exchanging gas, with maxillofacial dis-
thing you know I’m in RIP [Ranger In- “Rob loves dogs, rifles, and figurement, but by the time they got
doctrination Program] getting the shit colorful conversation.” the airway, this guy was high-fiving
kicked out of me, not thinking I made others and you took that information
the right decision. I realized that the and matched it against data like in the
camaraderie and people who were there, I liked. I ended up hospital, he would have an anoxic brain injury so bad that
going to 2d Ranger Battalion; it’s where I kind of grew up, he’d be dead or be in the VA hospital eating crushed apples
and from there it just changed my life. It really formed who in a diaper for the rest of his life. So “Don’t be high-fiving
I was because I went straight to a rifle platoon, Alpha Com- your f*#@ing buddy. You should have done this a lot quicker.”
pany, 2/75.
[Cricothyrotomy], endotracheal intubation, needle thoracen-
And how did you stay in it? tesis—what we found out was they really couldn’t do these
Just one opportunity after another. I came back and went procedures correctly—us, me included––in the conditions
to ROP [Ranger Orientation Program] into the regimental in which we operated. “You know what, we are not really as
Headquarters’ RRD [Ranger Reconnaissance Detachment] good as we thought we were.” And that was tough for some
and spent about 4 and a half years. Then made E-7 and went people to swallow, because I got here E-6s and E-7s that are
over to 3d Ranger Battalion, and 3d Ranger Battalion . . . Ranger-qualified, 300F1[-trained], thinking that they are the
where things really changed. [Dr] Chris Pappas exposed me shit. When you really boiled it down, it was we couldn’t really
to an article that was written in 1996 called “Tactical Com- do some of these things as good as we needed to maximize
bat Casualty Care in Special Operations,” and my socks were survivability.
going up and down and my shoes were still on that the uti-
lization of tourniquets was for first-line tool for hemorrhage Drive on.
control; don’t fluid-challenge people—this kills people. We decided to look at what they were doing like live-fire
So, suddenly it just resonated with me that we weren’t do- ranges, and everything was commander driven—warfighter
ing things as good as we could do. And also what it did is it driven—and so we tried to get a medical program together

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