Page 137 - Journal of Special Operations Medicine - Spring 2016

blocks until we had a trauma tactician. We were able to cre- Your transition from military to corporate realms?
ate a course for the warfighter that was focused directly on It was almost the same. The level of intensity—except for
decreasing potentially preventable death, which has led to being scared when you go to combat—was the same. We
the Regiment, as far as I know in the data that have been have got to find solutions to these historical problems. I was
published, not having any potentially preventable deaths. resourced by [CEO Bob] Castellani to do what we needed to
And that goes to all the work of Kotwal. And one of the do. It was not a big change for me. It really wasn’t.
things we did, too, was that we kept solid documentation.
The Ranger Casualty Card was the stimulus for the card that’s Voice recording condensed and edited.
out there now. Kotwal was ruthless about if you had a casu-
alty, you documented what was wrong with him.
The opinions or assertions contained herein are the private
Personal development thoughts? views of the author and are not to be construed as official or
For those medics, you must create a climate for lifelong as reflecting the views of the Department of the Army or the
learning. You cannot rest; you’re not in this job to f*&#ing Department of Defense.
rest. You’re in this job to constantly get better. And if you’re
not doing that, you’re going to get out-seated by people to
your right and your left.
The emphasis on training and skill level of the
caregiver always seemed to be palpably high there.
That was because of the commander. Once we turned it
over, the Ranger Medic Assessment and Validation became
a commander’s program, just like shooting your day and
night live-fire [exercises] before you assumed ops cycle. COL
McChrystal made it part of the Big 4. That cemented it. It was
important to him. The stars were aligned. We were serious,
too. If we were to go to combat when 9/11 happened, the
only thing we didn’t have was a suitable tourniquet. So we
had to improvise at that point; all I had was Calkins’s paper.
So we sat down and made our own tourniquet with ratchets.
I still see them out there once in a while. I try to cut them up
Knowledge.
when I see them.
I still have one. It came in on a
Blackwater guy’s forearm; he was screaming. Experience.
That thing’s not fun. It’s all we knew that a mechanical [ratchet
similar to those used on pallets in aircraft] device was best. Excellence.
A 1-inch strap that we had made in Texas. I had to convince
the command to carry this 1-pound piece of kit based on the
injury patterns. And they said, “Absolutely. We’ll do it.” They
believed it.

Was it important to get the right information
to the right person to trigger the right decision?
Pappas was the one who triggered this whole thing. He
started this whole thing. As soon as he dropped that paper
in my lap, I went ballistic. Holy f*&#ing shit. If they could
have caught [authors] Frank [Butler] and [John] Hagmann,
they would probably still be incarcerated because when
that came out, that was like crimes against the Lord Himself.
“Tourniquets as first-line hemorrhage control!? Who speaks
these things?” I can remember them talking about it.

The standard to validate the essential knowledge
and critical thinking of the tactical paramedic
operating in the TEMS environment.

www.bcctpc.org

Interview: Rob Miller on Changing Trauma Care 121