Page 136 - Journal of Special Operations Medicine - Spring 2016

the] left side of the aircraft there’s a huge explosion by one cut-downs anymore. We went to sternal intraosseous. We
of the engines and a hole ripped into the skin of the aircraft. tried to prove doing these cut-downs and, in the conditions
Problem: your number one man, your leader, the E-7 you in which we operate, it was fruitless. You couldn’t do it; it was
have in charge, is not unhitched anymore, he’s on both of fallacy. If it was freezing out, wind blowing, how do we pro-
his knees at the tail of the aircraft with a hunk of flesh ripped tect people with hypothermia? We led the way at that point
out from his shoulder and a hunk of flesh ripped out from with hypothermia prevention and management. Russ was
his face. He’s holding what looks like the remainder of his critical to that whole process. And Pappas. But the real thing
face in his hands, screaming at the top of his lungs, shooting came to admit that we were not as good as we thought we
bright red blood through his hands. His primary weapon is on were, and we needed continuous training even though we
the ground. “Sir, I need a decision point from you right now: thought we were at our best. We continuously needed to
what are we going to do with this guy?” Holy shit, the game evaluate ourselves, be objective, and truthful to ourselves.
changed. All of a sudden you would see everybody started And our peers needed to be there and evolve our program
to get engaged at that point because they would get called to meet the operational threats that were ahead.
on, but we brought them in with very real, graphic [descrip-
tions]—this is what it would look like—and you could tell that It seems that 3d Battalion was special place for a
now what they learned they were bringing it into perspective long time.
and they could move on with a small knowledge base until It was. If I look back at all the time that I spent in the ser-
they got to their battalions. vice, the time in the 3d Ranger Battalion with those guys,
with Rich Flores and Jim Gentry, and the things we were able
This occurred in ROP [Ranger Orientation Program]. So we to accomplish, and Mike Nesbitt was there, we would not
sensitized them after they got selected for the Regiment, not have been able to do that, do those things, if we did not
before, because we tried it doing it before and all they are have those people in place and everybody kind of seeing it.
keyed in on is getting accepted. You do it afterwards; they’re It was a special, pivotal time; the stars were aligned. And we
looking for everything that they need to be successful in the made some significant gains in managing our casualties for
Regiment. The second part was when communicating with the Rangers. Because, until then, they used to piss me off be-
them. No longer do we say, “Don’t take our packages off [the cause SF used to think Rangers had, like, calloused knuckles
aircraft]; don’t do this,” but “sir, based off S-2 [intelligence and thrusting mandibles. The next thing you know, we turned
staff officer] analysis, there’s a friction point right here where that whole f*&#ing trauma management game around on
we anticipate that there could be casualties. Sir, do you want them. It was ugly for a while.
to assume or mitigate the risk?” “Well, if I assume the risk,
could there be loss of life?” “Absolutely, without a doubt, or How did they react?
significant morbidity associated with that.” “If I mitigate the They didn’t know how to f*&#ing react. Those changes gen-
risk, Rob, what does that mean?” “Well, that means, we have erated a shipload of money for us organically from the com-
the following things in place. . . .” “Goddamnit, who taught mander. He said, “Get the stuff to do the right thing for these
you how to speak this language and everything?” people.” We had the best equipment. Also, when we started
doing these trauma lanes and the medic needed the ability
Believe it or not, it was a Spec-4 [Specialist, E-4] that brought to defend himself and patients and move on the battlefield,
it when we were in a roundtable [discussion] who did. If there the medic needed to have situational awareness. That led to
was a Spec-4 that was super squared away, I referred to him validation of guns, goggles, optics, lasers, communications,
in the same level of respect that [I] referred to a guy who was and a protocol that went with that on how we interfaced with
an E-8 or E-9. The level of competency came from the indi- the warfighters. The Ranger Medic functions as a defensive
vidual [not the rank]. We had a team of people at that time: shooter. He is not really incorporated into the offensive fight-
Chris Pappas was a part of it, Russ [Kotwal] was part of it and, ing plan. So his function is to manage significant trauma on
of course, our PA, John “the Cricket” Detro. And when we the battlefield. Period.
got [COL Stanley] McChrystal [Regimental Commander] to
take a look at his Big 4, we changed “medical training” to Of those changes, what are you most proud of?
“casualty response”: that means more to the warfighter as it’s Probably Ranger First Responder. Until then, what we had
in his language, his culture. So that’s how we changed things. [was] guys running around on the battlefield with a compass
pouch with two first aid dressings—Vietnam-style bandages.
So you changed the ideas, the words, the policies, Now they have a kit where if they employ it correctly, based
and the practices? on the threat as gunfight—I shoot at you, you shoot at me; I
Absolutely. The 3d Ranger Battalion, if we went to war, we’re throw a hand grenade at you, you throw one at me—based
f*&#ing ready to go to war. I mean, we went through all of our off that, those guys can decrease about 80% of preventable
kits, too, and packed based off of data, based off of historical death by themselves.
Ranger missions, all of our Pelican cases, all of our sick call, all
of how we treated patients, the knowledge level of the group The second thing that I’m most proud of is the medics now—
was through the roof. What we did then was transferred re- and [MSG Harold] Montgomery was instrumental in this—
sponsibility into liability for the commander. He needed to was getting them [qualified] before they got to the battalion.
assume or mitigate what he wanted to do. And I remember . . . We didn’t get someone straight out of AIT [Advanced
people like COL Allen, COL McChrystal, they were like, “This Individual Training], so we didn’t have to completely train
makes sense.” And we executed that shit. We couldn’t do them from scratch. They were qualified and we built on those

120 Journal of Special Operations Medicine Volume 16, Edition 1/Spring 2016