The Most Important Skills for a 75th Ranger Medic

The U.S. Army’s 75th Ranger Regiment is organized and equipped similarly to a standard light infantry brigade, capable of conducting raids, ambushes, and a variety of other missions at squad to regiment level. The Rangers execute joint special operations missions, distinguished from units like the Green Berets, Delta Force, and SEALs by their strong direct assault capability. Their tasks include airborne operations, air assaults, and other direct actions to seize key terrain, destroy strategic facilities, and capture or kill enemy forces. Lessons and best practices from the 75th Ranger Regiment can be readily applied to other ground combat units like the Army and Marine Corps. Furthermore, the related concepts and principles are relevant to any units preparing and conducting combat operations.

The 75th Ranger Regiment, with nearly 4,000 personnel, consists of a headquarters, a Special Troops Battalion, a Military Intelligence Battalion, and three infantry battalions (each infantry battalion with about 580 personnel). The regiment includes six physicians, five physician assistants, and 122 medics, focusing on frontline care rather than surgical treatment. The headquarters has one physician, one physician assistant, and four medics; the Special Troops Battalion has one physician, one physician assistant, and 27 medics; the Military Intelligence Battalion has one physician and one senior medic; each infantry battalion has one physician, one physician assistant, and 30 medics (including 14 company medics at the battalion HQ, and four medics per rifle company, with one senior medic and three platoon medics each). All medical personnel assigned to the 75th Ranger Regiment undergo specialized training, such as 68W and W1 Special Operations Combat Medics, forming the backbone of the regiment's casualty care system.

Ranger medics must master tactical skills and basic battlefield care, including marksmanship, physical fitness, medical skills training, squad tactics, and squad mobility. These rigorous requirements cultivate a force with both strong combat and medical capabilities, reducing preventable deaths while ensuring mission success. The regiment emphasizes collecting and analyzing combat injury data to study casualty trends and characteristics, summarize lessons learned, advance new diagnostic and treatment methods, evaluate and improve tactics, techniques, and procedures (TTPs), and suggest improvements to personal protective equipment.

From 2001 to 2021, the U.S. military’s cumulative combat fatality rate (CFR) in Afghanistan and Iraq was 9.5 (i.e., 9.5 deaths per 100 casualties). The Ranger Regiment's CFR was lower at 7.6. While the difference isn't statistically significant, it indicates that the regiment's efforts saved an additional 15 personnel, preserving their combat experience for future missions.

Several key points have been crucial in advancing the regiment’s combat casualty care system and its success. These practices are not task-specific but are mandatory and applicable in various environments, intensities, and combat scales. They include:

The 75th Ranger Regiment was the first unit to adopt and promote Tactical Combat Casualty Care (TCCC) principles. Unit leaders ensure meticulous planning for TCCC training during each training cycle. Battalion commanders must report the percentage of Rangers trained in TCCC at quarterly briefings, serving as a true measure of the unit's combat medical readiness. Company commanders are responsible for ensuring the actual execution of the training.

Since 2016, the regiment has conducted Advanced Ranger First Responder program training for non-medical personnel, enhancing battlefield care capabilities. TCCC training for all personnel, including non-medical, medical, and healthcare providers, is conducted through combat simulations to mirror real combat conditions, making each Ranger and leader accountable for TCCC and medical skills proficiency.

Every aspect of casualty care and evacuation in combat must function smoothly to eliminate preventable combat deaths and reduce mortality rates. This requires a targeted, well-rehearsed, and thoroughly understood tactical medical plan for each mission.

Tactical medical plans are tailored to specific missions, accounting for their unique nuances and variables, rather than applying a one-size-fits-all approach. Plans should include contingency evacuation plans and provisions for managing casualties at each mission phase. Unit leaders must consider the locations of available medical resources, including blood products, and integrate air, ground, and water transport platforms into non-standard casualty evacuation and standard medical evacuation plans. Proper tactical planning and training ensure a streamlined casualty treatment and evacuation process.

Eliminating preventable combat deaths is an organizational issue requiring a collective effort beyond just medical personnel. When casualties occur, the unit must react immediately as a team, managing and evacuating the wounded while completing the mission. All personnel must maintain first aid skills, and medical personnel must be highly proficient. Commanders must integrate casualty management into every mission phase. Commanders must understand:

• The first casualty could be anyone.
• The first responder to a casualty should be anyone.
• Medics focus on casualty care, not just first aid.
• Commanders have the authority and responsibility for all aspects of the mission.

The Rangers’ training cycle integrates individual and collective medical training, with casualty response combat drills being crucial. Rangers train commanders (platoon leaders and platoon sergeants) specifically on casualty management. Successful execution of these drills depends on a commander-led casualty response system and extensive training. This ensures that the Ranger Regiment has an effective casualty response system, allowing everyone to maximize their training and expertise.

Hemorrhage remains the most common cause of potentially survivable battlefield deaths. Survival hinges on rapid hemorrhage control and blood replacement. Medical literature continues to validate the benefits of early blood product resuscitation and the harm of crystalloid resuscitation for trauma patients. Rangers carry blood products, including freeze-dried plasma since 2011 and refrigerated whole blood since 2014, for combat missions. These life-saving products also include packed red blood cells and liquid plasma.

The ability to resuscitate casualties with whole blood and other blood products within minutes of injury significantly impacts the regiment’s casualty care and mortality rates. Early use of whole blood and blood products for resuscitation is crucial for eliminating preventable combat deaths and reducing morbidity.

In the summer of 2019, a Ranger was severely wounded in Afghanistan, losing his right side to an explosion. Immediate and extensive blood transfusions on site saved his life. This case will be detailed in a future post.

Data collection and analysis inform decision-making. A continuous performance improvement effort, including capturing and analyzing data and regularly reporting casualty statistics and trends, is vital for advancing new diagnostics and treatments, evaluating and improving TTPs, personal protective equipment, and casualty response and care systems. Objective data and subsequent evidence-based recommendations effectively secure resources, enhance personnel, training, and equipment planning, and guide force modernization and research.

The 75th Ranger Regiment has a comprehensive system for collecting combat injury data, regularly analyzing it to study casualty trends and characteristics, summarizing lessons learned, advancing new diagnostic and treatment methods, evaluating and improving TTPs, and suggesting improvements to personal protective equipment. The U.S. Department of Defense Trauma Registry, recognizing a lack of prehospital or tactical combat casualty care literature, developed a prehospital casualty data collection system in 2006 based on a template from the Ranger Regiment.

The Rangers' lessons and best practices in casualty care are applicable not only to other combat units but also to non-combat units. Mastering TCCC principles and training, blood product resuscitation, commander-led casualty response systems, and tactical medical planning are relevant in all combat environments, including large-scale combat operations. Although large-scale operations may require longer prehospital care than shorter-duration conflicts like those in Afghanistan and Iraq, effective TCCC implementation forms the foundation of prolonged casualty care.

Previous posts have highlighted the Rangers' frontline care (e.g., SOP for casualty collection points, tactical medical planning by senior medics, and reviews of Ranger combat casualties). These sources show that the 75th Ranger Regiment's methods are valuable for our forces to study and emulate.

1. The 75th Ranger Regiment is a U.S. light infantry unit with both conventional combat and special operations capabilities, comparable to several ground combat units in our forces.
2. The regiment was the first to integrate TCCC principles into its daily operations and remains the best U.S. unit in applying TCCC.
3. The Rangers focus on key aspects of tactical medical support, which includes capability building, pre-mission planning, in-combat command and control, and post-combat review. Tactical medical support emphasizes immediate command adjustments during combat, more so than operational or strategic levels.
4. The Rangers' TCCC training for all personnel, specialized medical training, and commander training, along with detailed and actionable pre-mission medical planning, ensure the integration of "combat" and "care" during operations, embodying TCCC principles.