Page 107 - Journal of Special Operations Medicine - Fall 2016

doing, we made it a point to learn the best practices that list—a list of what drugs we needed the medics to know.
SOF was utilizing and then we started incorporating them We had TC3 as a guideline, but that didn’t break down
into our training. Bringing in the knowledge from other the details of protocols. We wanted a pocket reference so
experts allowed us to grow by seeing what worked for all the medics knew the standard they needed to execute.
us and leap-frogging ideas to better meet our specific Now people are using the Ranger Medic Handbook inter-
needs. There were all these guys in Special Operations nationally. Raising the standardization to include medica-
doing great things, but they weren’t generally allowing for tions and putting everything down in the Handbook really
synergy by sharing ideas and solutions. Miller broke down took the Ranger Medic from the Stone Age to being a
those barriers and said, “Those guys are doing some leader in trauma. That’s something that gives me great
smart things. Just because they aren’t Rangers doesn’t pride—when I see where the Rangers are at now and how
mean we can’t learn from them. Let’s see if that works for they are continuing to improve best practices. I think it’s
us.” We experimented. hard for a lot of people to truly understand the evolution
that we have gone through, but it’s been a significant
One of the big wakeup calls for us was when we started to journey.
do medical simulation. We trained ourselves. We devel-
oped the Ranger Medic Assessment and Validation Pro- The whole thing is changed.
gram (RMAV) in order to really challenge the medics. We Yeah. You see a lot of the things that the Rangers are
put them in real-world-like conditions and as they were doing and people are still adopting. They look to the
doing all these procedures we exposed training gaps and Rangers as a source because they are validating their de-
equipment gaps. We had guys begin the simulation con- cisions. They’re not just writing protocols and going out
fident that they could do a chest tube, or a [cricothyroid- there without first verifying the success and accuracy of
otomy]. Then they opened their aid bag and we found those protocols in real-world-like conditions.
out they were missing their scalpel or they were missing
their chest tube. We realized that we needed to put vali- How do you look at the challenge of giving best care?
dations in place for our training, and a place to start was There’s a common mistake we make. When I was a young
with validating our packing list. There were a lot of guys medic who had just graduated from the schoolhouse, I
that had this sense that they were good to go, and unless thought I knew everything. I was able to succeed at this
you challenged them by submitting them to a situation course, and then I started to think I was super-smart—I
that required confirmation of their readiness or capability, knew everything. Yet, the more you learn, the more hum-
they didn’t learn whether or not they were truly prepared. ble you become because you realize there’s so much you
don’t know. You still get to see the example set by guys
At the time, the medic didn’t have any requirements for like Dr Holcomb and all my previous Battalion Surgeons
medical sustainment. We recognized that we needed to like Dr Pappas, Dr Kragh, and Dr Kotwal. All of my men-
know how to really confirm if our medics were ready. They tors have this incredible base of knowledge, and they’re
didn’t have any required training or credentials, so we still continuing to learn.
mandated in the Ranger Regiment that all of our med-
ics had to be EMT (Emergency Medical Technician)-basic I think that is one of the strengths for the members of
certified. Later on, we made it a requirement that they this community—many of us have realized that we should
go to the Special Operations Medic Course. That was the always be aware that you can never learn enough. Our
evolution of how we reached the quality of medic that experiences in real-world situations have trained us to be
the Ranger Regiment attained—by developing a success conscious that all you have available in a tight spot is what
path that required going through a pipeline [that] verified you brought with you. How long can you sustain some-
training knowledge and confirmed capabilities. Mandat- body with the equipment and training you have right
ing this pipeline really gave us a standard, basic medi- now? Even in the Ranger Regiment, when we conducted
cal capability that we had previously been projecting but a combat parachute insertion into Afghanistan (Objective
were not able to validate. Finally, we had all these guys Rhino), we were told that we would have to complete that
that were SOF medics in capability, not just SOF medics mission within a single cycle of darkness. If we didn’t, we
in title. Once someone completed the course, they pos- might be there for another day or two. We brought extra
sessed a standardized medical capability that everybody medical equipment to sustain our guys to address the po-
could understand and would be consistent across the tential of prolonged field care. On another mission, we
Regiment. ended up bringing three donkeys for [ammunition], water,
and medical gear. I was thinking, “Here we are with all of
You rewrote the book! this modern gear, vehicles, and high-speed technology,
Yes. We wrote the Ranger Medic Handbook. Again, we but in 2012 we’re resorting to solutions they had in [the
had a great team of Medical NCOs [noncommissioned Second] World War.” You have to always be prepared
officers], medical officers, and junior enlisted that came to go back to the basics. You may have all these lasers
together to focus on improving survivability. We started on your rifles, scopes, and stuff, but you have also got to
realizing that we were expecting the medics to perform, be prepared to use iron sights—iron sights don’t require
but we didn’t have a reference that outlined our drug batteries.

Special Talk: An Interview 89