Page 106 - Journal of Special Operations Medicine - Fall 2016

You were in the [Ranger] Regiment when? portion of my medical gear when a rain storm hit and the
I was in the Ranger Regiment from ’91 to 2005. From ‘91 to old wooden crates that stored my equipment became
2003, I was at 3d Ranger Battalion and I had every position soaked. Many of the items in there were not waterproof
you could have from platoon medic to Battalion Senior or in packaging that could withstand the environment.
Medic. Rob Miller was my Battalion Senior Medic while With the leadership funding for optimized gear, we were
he was there and then I took over after he left Battalion. able to develop our own solutions or start working with
I had the privilege to be part of that historical time right vendors to close this gap.
after [Frank] Butler introduced the concepts of TC3 [Tac-
tical Combat Casualty Care]. We immediately knew that At 3d Ranger Battalion, we started implementing these
TC3 made sense and started adapting it into our training. advancements for ourselves first. Later on, the Regimen-
It rapidly highlighted issues that we needed to address. tal Commander had a conference with all the Battalion
Commanders, and they came down to Fort Benning and
The first issue that we recognized was that the TC3 pro- he showed them what we were doing. After reviewing
gram needed to be tailored to the Operator audience. The the program, the other Battalion Commanders asked
original TC3 course included in-depth medical science. why their medics weren’t doing what 3d Battalion’s med-
This actually became a hindrance because the Operators ics were doing. The conclusion was that the Regimental
just wanted to be hands on. They needed to understand Commander mandated our process and it became a
basic concepts and how medicine was blended into the Regimental Program. It was incorporated by COL [Stan-
different phases of care, but other than that, they just ley] McChrystal, making medical one of the top four pri-
needed to be skilled at applying treatments based on the orities for training. This paradigm shift really changed
signs and symptoms presented by the casualty. things around for us. COL McChrystal escalated medical
to the same level as physical conditioning and firing at the
By modifying the course content, we were able to con- range, granting significant credibility to the program. So
dense the original 5-day course down to a 2-day course. now, not only were Rangers highly lethal they were also
This helped a lot because the 5-day course was difficult to highly survivable!
coordinate due to time, location, travel, and equipment
coordination. When we reduced it to a 2-day course, we To be “survivable” required empowering the Operator
were able to get buy-in from the leadership at 3d Ranger to have the ability to save his own life or his buddy’s life
Battalion so that every Ranger was scheduled to com- without having to wait for the Medic. This was really the
plete a 2-day course annually. turning point for the Ranger Regiment. Many times after
we instituted the program, by the time I got to a wounded
The second gap that we identified was learning to speak Ranger, there was little I needed to do except reassess
the language of the leadership and not just using a medi- the casualty. What that did was free the Ranger Medic
cal vocabulary. Medical plans were an afterthought to to focus more on the advanced procedures: the [crico-
leadership, but once they understood how medical emer- thyroidotomies], the chest tubes, and other procedures
gencies affected the operational tempo, they endorsed [that] we were not training the Operators to do. Addition-
the need to be practiced and capable of efficiently re- ally, that allowed the Ranger [Medic] to grow because he
sponding to casualties. Previously, the leadership hadn’t didn’t have to do just the basics. Now the Medic could be
grasped what we were trying to accomplish, which was a the advanced care provider.
huge limitation, as they control the logistics of moving pa-
tients and aircraft. When leadership wasn’t on board, the The biggest lesson that we learned during this time was
tempo was interrupted at the CASEVAC [casualty evacu- that in order to be successful you have to have the right
ation] phase. training, the right equipment, and command endorse-
ment. I think that is a three-legged stool, but without
We were able to develop a course for the Ranger leader- command endorsement you don’t have the time to train
ship, not so that they could be providers but so that they (or the prioritization for training), and you also don’t get
would understand the TC3 principles and be empowered the financial support and the logistics to get the equip-
to better manage us based on understanding what our ment that you need.
capabilities were. This was another big win for us because
the buy-in from the leadership increased our ability to do Of those changes, what are you most proud of?
proper training. We had their endorsement because they When we went outside of the fence. It was Rob Miller that
understood the intent and expectations. That endorse- started what we called “cross-pollination.” We saw that
ment also provided approval for funding to purchase or other SOF [Special Operations Forces] units like the PJs
develop equipment that was optimized for the opera- [US Air Force Pararescuemen] were doing great things,
tional environment. but we were not using some of the techniques and equip-
ment that these units were employing, and SOF guys
That was the third gap that we identified—the need to tended to be pretty innovative. The Rangers weren’t nec-
have equipment that was ruggedized for use in the field. essarily known for being innovative at the time, so when
Only a few days after I arrived in Somalia, I lost a significant we saw what the PJs and the SF [Special Forces] were

88 Journal of Special Operations Medicine Volume 15, Edition 3/Fall 2016