Page 40 - JSOM Winter 2022

Casualty Response Training for Ranger Leaders basic principles of TCCC, battle drills, available assets, and
tactics, techniques, and procedures.
CRTRL is a deliberate module or block of instruction that en-
compasses the entirety of the Ranger casualty response system.
The primary objective of CRTRL is for leaders to have a working Summary
knowledge of the Regiment’s solution for managing combat ca- Each year more than 3,000 Rangers are trained in RFR and
sualties. CRTRL is required for platoon sergeants, platoon lead- CRTRL, 160 Rangers are trained in ARFR, and 130 Ranger
ers, and above. CRTRL is also integrated into the RFR course medics undergo RMAV. After action reviews are routinely con-
as the first block of instruction. CRTRL has historically been ducted following training events; however, they are not cur-
integrated into team leader courses and officer and noncommis- rently aggregated for study and analysis. Standards described
sioned officer professional development training events. Import- above provide a minimum expectation for Ranger casualty re-
ant is that tactical decision makers understand their role in the sponse training. However, Ranger medics are expected to train
casualty response system, and how their response and decisions their personnel as frequently as possible. Units are also ex-
to even a single casualty can greatly impact the unit mission.
pected to integrate realistic scenarios and a casualty response
into as many training and live-fire events as possible. Frequent
CRTRL introduces Ranger leaders to casualty response train- training and repetitions help to prepare, condition, and pro-
ing events and capabilities, limitations, and employment vide muscle memory for Rangers so that they may evolve from
considerations of unit medical assets. Leaders obtain an un- competent, to proficient, to mastery of their level of training.
derstanding of how casualty response must be consistently
planned, rehearsed, and understood down to the lowest level The 75th Ranger Regiment’s pursuit and success with eliminat-
for every mission and throughout each phase of the operation ing preventable death on the battlefield is deep-rooted in the
(infiltration, actions on the objective, consolidation, exfiltra- execution of a continuous joint operational readiness train-
tion). Leaders must be prepared to adapt and respond in a ing cycle that includes individual and unit collective medical
contingency situation as a casualty can occur at any moment. training. Foundational to this training is a command-directed
When a casualty occurs, leaders must consider their actions casualty response system which serves as a forcing function to
and how the loss of the casualty’s firepower, and the loss of the ensure proficiency and mastery of the basics. Unit collective
firepower of those who aid the casualty, can impact the tactical medical training merges the training experiences of each in-
plan and mission success.
dividual to produce a communal response and capability that
can efficiently, effectively, and successfully execute a casualty
The CRTRL culmination event can vary from scenario-based response. This communal response is a tactical solution to a
discussions to table-top exercises to integration with field exer- tactical problem that ultimately saves lives.
cises. A basic scenario or vignette will review a mission in which
a casualty was incurred and discuss how the casualty impacted Acknowledgments
the mission or changed the tactical plan and how leaders re- The authors would like to acknowledge CAPT (Ret) Frank K.
acted. The students then discuss what could have been done Butler Jr, MD, for establishing the current battlefield standard
differently or how they might better prepare themselves and the for prehospital trauma care. Dr Butler’s 1996 article entitled
unit for future scenarios. Table-top exercises assign a mission “Tactical Combat Casualty Care in Special Operations” con-
to leaders and have them integrate and allocate support assets tinues to be a landmark reference point and guiding star for
into their tactical plan. Casualties are introduced into the exer- the 75th Ranger Regiment Casualty Response System.
cise at various points prompting leader decisions that can affect
the outcome of the mission, the casualty, or both. Field exer- Conflicts of Interest
cises introduce casualties into unit battle drills as a contingency None
drill in which leaders must react to the situation and adjust as
needed. Critical for all to understand is that the term “casualty Disclaimer
play” is inappropriate. A casualty response is not play; rather, The views, opinions, and findings contained in this article are
it is a required capability and battle drill for every mission that those of the authors and should not be construed as official or
must be trained and expected by all leaders. Leaders must also reflecting views of the Department of Defense unless otherwise
expect the unexpected during a casualty response and be pre- stated. This article was reviewed by Public Affairs, Operational
pared for rapid analysis and decision making. Security, and the Commander at the 75th Ranger Regiment,
and approved for public release on February 11, 2022.
CRTRL training is conducted annually and prior to deployments.
The end-state ensures combat casualties receive optimal care Disclosures
and evacuation without interrupting the flow and momentum None
of the assault force. CRTRL is taught using the most up-to-date
block of instruction by a company senior medic or above. Lead- Author Contributions
ers are required to complete additional hands-on training with SCG and RSK conceived the manuscript concept and design.
their company senior medics on MASCAL scenarios and CCP SCG and RSK contributed to the initial draft of the manu-
operations. This training is conducted in conjunction with RFR script. All authors revised the manuscript for critically import-
training in order to consolidate annual training requirements. ant intellectual content. All authors read and approved the
final version of the manuscript to be published.
CRTRL was initiated in the regiment similarly to how tac-
tical medicine for SEAL mission commanders was integrated References
3
into naval special warfare units. However, such training must 1. Butler FK Jr, Hagmann J, Butler EG. Tactical combat casualty care
be tailored to the unit, culture, and mission while adhering to in special operations. Mil Med. 1996;161(suppl):3–16.

38 | JSOM Volume 22, Edition 4 / Winter 2022