Page 30 - JSOM Winter 2022

Unit Collective Medical Training
in the 75th Ranger Regiment

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Simon C. Gonzalez, ATP *; SFC Patricio F. Vasquez, ATP ; Harold R. Montgomery, ATP ;
Curt C. Conklin, ATP ; Zachary A. Conaway, ATP ; David M. Pate, ATP ;
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James F. Lopata, MPAS, APA-C ; Russ S. Kotwal, MD, MPH 8

ABSTRACT
The 75th Ranger Regiment’s success with eliminating prevent- In addition to raids and ambushes, unit collective training
able death on the battlefield is innate to the execution of a should include tasks to support the casualty response sys-
continuous operational readiness training cycle that integrates tem. All personnel should be trained on the basics of what
individual and unit collective medical training. This is a tacti- is expected through the tenets of Tactical Combat Casualty
cal solution to a tactical problem that is solved by the entire Care (TCCC). Leaders should also be trained to expect the
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unit, not just by medics. When a casualty occurs, the unit must unexpected, and to conduct planning and modify training to
immediately respond as a team to extract, treat, and evacu- account for operational contingencies. Over the past 25 years,
ate the casualty while simultaneously completing the tactical several publications have informed, refined, or guided individ-
mission. All in the unit must maintain first responder medical ual and unit collective medical training for the 75th Ranger
skills and medics must be highly proficient. Leaders must be Regiment. 1–12 This article focuses on training developed and
prepared to integrate casualty management into any phase of implemented by Rangers.
the mission. Leaders must understand that (1) the first casu-
alty can be anyone; (2) the first responder to a casualty can be Unit Collective Medical Training
anyone; (3) medical personnel manage casualty care; and (4)
leaders have ownership and responsibility for all aspects of The success of the 75th Ranger Regiment in eliminating pre-
the mission. Foundational to training is a command-directed ventable death from trauma on the battlefield is entrenched
casualty response system which serves as a forcing function to in unit collective medical training. Key to this success is a
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ensure proficiency and mastery of the basics. Four programs command-directed casualty response system and mastery of
have been developed to train individual and collective tasks the basics through rehearsals, repetition, and conditioning.
that sustain the Ranger casualty response system: (1) Ranger Just as TCCC was a tactical solution to a tactical problem , so
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First Responder, (2) Advanced Ranger First Responder, (3) was the Ranger casualty response system. 1,5–7,13 Ultimately, this
Ranger Medic Assessment and Validation, and (4) Casualty system contributed to saving lives as evidenced by the 7.6%
Response Training for Ranger Leaders. Unit collective med- Ranger case fatality rate (CFR) versus the 10.3% total US mil-
ical training incorporates tactical leader actions to facilitate itary ground troop CFR in Afghanistan and Iraq, and also as
the principles of casualty care. Tactical leader actions are par- compared to the 23.7% CFR of Rangers in Somalia. 2,6,7 Nota-
amount to execute a casualty response battle drill efficiently ble in achieving the 7.6% Ranger CFR was that 26% of hem-
and effectively. Successful execution of this battle drill relies orrhage control interventions, including 42% of tourniquets,
on a command-directed casualty response system and mastery were applied at point of wounding by nonmedical personnel,
of the basics through rehearsals, repetition, and conditioning. thus reducing exsanguination and death. 6

Keywords: medical training; prehospital medicine; Tactical Com- All Rangers, from rifleman to regimental commander, must
bat Casualty Care; casualty response maintain proficiency in respective skill level medical tasks. Task
proficiency is developed and reinforced through a systematic
training program. Described below are the training responsi-
bilities and requirements for basic and advanced medical skills.
Introduction
Collective training is a foundational element of military unit Commanders are responsible for ensuring compliance and
training. Collective training merges the knowledge, expe- incorporating medical training and casualty response into
riences, and training of individuals to produce a communal force-on-force and live-fire exercises. Medical director re-
response and capability that can efficiently and effectively sponsibilities at the regimental level include providing over-
complete unit mission essential tasks. Collective training fo- sight and quality assurance of medical training programs and
cuses on readiness and task proficiency in accordance with the individual critical task list (CTL) medical capabilities. They
commander’s training plan. also include providing unit medical sections with medical
*Correspondence to simon.c.gonzalez.mil@army.mil
1 MSG Simon C. Gonzalez, SFC Patricio F. Vasquez, SFC Zachary A. Conaway, SSG David M. Pate, and MAJ James F. Lopata are all affiliated
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with the 75th Ranger Regiment, Fort Benning, GA. MSG (Ret) Harold R. Montgomery and COL (Ret) Russ S. Kotwal are affiliated with the
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Joint Trauma System, Defense Health Agency, Joint Base San Antonio-Fort Sam Houston, TX. CSM Curt C. Conklin is affiliated with the 2nd
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Infantry Division/Republic of Korea – United States Combined Division, South Korea.
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