Page 224 - 2022 Ranger Medic Handbook

Casualty Response Planning Overview
In planning and training for combat casualty management, the focus is on the possible, not the impossible. Essentially,
there are three groups of casualties that will be encountered. In the first group, no matter what you do, the wounded will
live. In the second group, no matter what you do, the wounded will die. In the third group, if you do the right thing, at the
right time, your treatment and evacuation will make the difference between life and death, or between greater and lesser
disability. The Casualty Response System is focused on this third group as there is a much greater probability of positively
affecting mission and patient outcomes.
Decisions in tactical casualty management are not made by persons far removed from the event. The casualty response
system will be a flattened organization with decentralized decision-making that empowers first responders, tactical lead-
ers, and medical providers at all levels. As all will have direct ownership of the system, they will invest in realistic casualty
management training in order to become more efficient and effective at and near the point of injury. Ultimately, this will
equate to lives saved.
Medical planning in Ranger units depends heavily on the experience and knowledge of the Ranger medical Team. ALL
Tactical Medics, from the most junior to the most senior, must become skilled planners. Effective medical planning
requires that the planner be well integrated into the unit’s (platoon/company/battalion/regimental) mission planning staffs.
Many medical issues that arise during planning are regulated, decided or solved by other members of the unit staff includ-
ing the S3 (operations), S3 (air), S4 (logistics), commanders, executive officers, first sergeants, and platoon sergeants.
Good working relationships and effective communications must be maintained for successful medical planning. Medical
planners must be fluent in the unit’s planning sequences (compressed or deliberate) and have a good understanding of
the role they play therein. Medical planners must be involved as early as possible in planning sequences for ALL training
exercises and real-world contingencies.
The medical plan will include an overall “casualty response” plan in which every unit member has a role. When a casualty
occurs, it is not just the Medic’s problem; it is a tactical problem that must be planned for and solved by the entire unit.
Units will integrate a casualty response phase into all of their tactical battle drills. Unit members and leadership must
be well versed in the casualty response plan. Medical personnel have a tendency to focus on providing critical patient
care once they begin treating casualties, and as such may not be able to maintain sufficient situational awareness to
execute the plan. The unit must be able to execute the casualty response plan around the Medic while the Medic treats
the wounded. Battlefield distracters, wound distracters, and C2 issues and shortcomings all have an impact on both the
commander’s and Medic’s decision-making during an ongoing mission.
Ranger Casualty Response Planning
The backbone of this section is based on the intricacies of a forced-entry combat operation or the execution of a special
operations contingency. For Ranger and SOF units, the initial entry into combat operations is likely to be in a new theater
SECTION 7 of operations or one of extended distances to casualty care assets. As additional military forces follow-on and develop a
theater, the medical support becomes much simpler to plan as there are more assets available. During combat operations
in which the Ranger unit is deploying to a developed theater (such as Iraq or Afghanistan), the unit can quickly adapt to
existing medical assets and resources to develop the casualty response plan.
The compressed time nature of contingency operations requires the medical planner be well versed in the unit planning
methodology and the high expectations of a developed plan. Using the planning methodology outlined here for any type
of exercise or deployment, the medical planner will gain better understanding and habits to execute such a plan under
any circumstances. However, there is no such thing as a “usual” planning technique. Every mission, regardless of timeline,
assets, or constraints, is unique and must have a developed casualty response plan.

210 SECTION 7 MEDICAL PLANNING & CASUALTY COLLECTION OPERATIONS