Page 4 - 2022 Ranger Medic Handbook

COMMONLY ASKED QUESTIONS
1. TXA may be predrawn into a STERILE 10mL syringe. This should be replaced every 7 days due to bacterial infec-
tion risk.
2. Although the data is not clear at this time it is likely best practice to administer TXA 2g IV/IO flush as the initial dose
and then do not redose. Ranger Medics are approved to pre-draw 2g TXA and give this as an initial dose.
3. Finger Thoracostomy is a CLEAN procedure. Do not cut into a patient’s chest without cleaning the skin or changing
to clean gloves.
4. Chest Tube is a STERILE procedure. Do not place dirty chest tubes that increase our patient’s risk of infection.
5. Backboards are mandated by regulation to carry but have not proven to benefit spinal patients. Backboards should
be used for patient transfer only. No patient should be on a backboard longer than 10 minutes. A rigid litter provides
the same care without the risks of pressure ulcers.
6. Calcium Gluconate is the only approved calcium. Calcium chloride increases risks unnecessarily in the prehospital
environment. No study has proven the benefit of calcium to patients in trauma. The focus should be on blood prod-
uct resuscitation until more information is available. Dose is 1–3g IV/IO after the first unit of blood transfused and
every 4 units after. Dose range is due to the fact that carrying 3g (30mL) is not always tactically feasible.
7. Always reassess your patient and treat based on current or trending vital signs.
8. In hemorrhagic shock the priority and focus of the Ranger Medic should be administering blood products; do not
delegate this important task. TXA, calcium, and other adjuncts should not delay blood products.
9. Levetiracetam dose is 1g IV for seizure prevention and 1 st line antiepileptic after initial benzodiazepine for treatment.
If needed/carried, increase up to 4g IV total for continued seizures. Medics are not expected to carry 4g tactically.
10. Cold stored blood products will be warmed. In extremis, cold blood is better than no blood, but every attempt must
be made to warm blood. A BLOOD WARMER WILL BE CARRIED.
11. Your medical direction only comes from those within Ranger Regiment. While we appreciate the experts that give
advice and learn from them they will never dictate your scope of practice. Do not contradict your Ranger medical
leadership by following outside advice.
12. The 75 th Ranger Regiment does not promote commercial products or companies. No Medic will be mandated to
carry a specific product unless a clear, overwhelming, significant advantage can be proven.
13. Ranitidine has been removed from the US market for prescription and OTC use due to FDA concern over elevated
levels of probable carcinogens. Ranitidine has been removed from the 2022 RMHB.
14. All fluoroquinolones now have a US Black Box Warning due to serious adverse reactions including tendinitis and
tendon rupture, peripheral neuropathy and CNS effects. In some rare cases benefits may outweigh the risks of
fluoroquinolone use. Fluoroquinolone use requires prior approval from unit physician or physician assistant with the
exception of otic or ophthalmic routes. DO NOT PRESCRIBE OR DISPENSE THESE MEDICATIONS WITHOUT
PRIOR APPROVAL!
15. Annual updates will be clarified in this section.