Thoughts

[Ranger Psych]

TC3 was basically adopted and pretty much standard fare pre-GWOT.

Ranger First Responder which while maintaining CLS "standards" heavily focused on and covered the big things of bleeding control including rapid Tourniquet use (with everyone carrying one), decompression for tension hemo/pneumo, airway control, and early installation of IV access plus multiple EMT's per squad was being fired up before I got there. I remember that my first RFR in 98, the medical crew instructing specifically made mention of TCCC.

Then CPT Kotwal (mentioned above, went on to become the 75th Regimental Surgeon, worked the Haditha Dam, jumped into Rhino, etc, aka brilliant billy-badass with a stethoscope and rifle) as well as many others were instrumental in the push Regiment-wide towards a combination of increased knowledge and equipment distribution across the Battalion and Regiment as a whole. Every Ranger got trained to standard with continual recurring training as well as repeated implementation of casualty care in training events outside of dedicated medical training (Do something stupid, or just be the biggest guy in the squad and the OC's would render you a casualty). Recurring training to maintain certifications significantly exceeded the norm as well. BLS/RFR/PHTLS classes we'd hold routinely had combat casualty handling lanes where you'd rotate through as the dedicated "medic" and have to do casualty extraction after obstacle courses to get you warmed up prior to beginning the medical portion of the lane, EMT's would tag along with Medics as a 2nd man for work on the human patient simulator, etc.

Conventional side?

There was one CLS class done prior to when I showed up in Alaska with one per fire team being able to attend, and we did absolutely no recurring training that I can remember. I did everything I could hip-pocket and burnt a ton of supplies that I personally had built up, doing it. Had to teach my platoon medic how the hell to pack his aid bag, ended up giving him a spare aidbag I had since all he had was the baby M-5 when I showed up. We didn't even have casualty care components incorporated into any of our combined training up until we hit JRTC during the final push prior to them deploying. Even then, it was little more than "not killing the guy while putting him on a litter and having some semblance of a perimeter for a simulated extraction". They didn't even have any patient push training, loading in the med strykers, etc.

Maybe it's different elsewhere, but that was 04-06 timeframe.

Fuck, I ended up training/equipping the damn entire platoon with ETD's and tq's out of my own pocket because all they had was single X_SF_Med-Era issue fucking dressings... they were so old that the fabric for binding it to a patient would break 10 out of 10 times when you opened the folds from packing... The Bn PA tried to jump my shit for that, but my CO (former 1/75) ended up shutting him up when he showed the PA that the only credential the Bn senior medic trumped me on wasn't even medical.. ie, I didn't have a rocker. Needless to say, when the CO had a chat with me after hours one night whilst I was CQ and sharing some pizza (since CQ = voluntary day room extra training for my team/squad with pizza and soda provided by me) I was not impressed to hear that new fact. I did offer to do some classes which would get the medics some CME credit, but that didn't go anywhere.

The senior medic apparently didn't like hearing about coming up short in the officer's dick contest, since for some reason my shot records started to go missing every month with clockwork accuracy afterwards... his shenanigans didn't work though, since I kept full updated copies of my entire medical record.

This medical goat rodeo I just laid out was just icing on the triple layered Army Birthday sized shit-cake of operations micromanagement.

There's a reason I only half jokingly say that I didn't get PTSD from deploying repeatedly with 3/75, I got it from the conventional army stateside.

 

[x SF med]

In regard to how far battlefield medicine has advanced since this paper was written... I just spent a week with my Brother who should have been dead according to what was written above. I will not walk through all of the multiple injuries sustained, but amputation of a lower leg, near amputation of the other, partial degloving of one hand and almost uncountable shrapnel wounds/excoriations, pelvic fx, and more.... Here, but not quite kicking at the moment, he can't use his prosthetic for about another month. If he kicked, he would fall down, and I'd have to laugh, then he'd kill me.

Care at the incident site, care in theater, care in Germany and care at WRNMMC saved what would have been a second amputation in the past.

But, I'm biased toward the initial care he received from himself and another 18D upon injury.

 

[Muppet]

In regard to how far battlefield medicine has advanced since this paper was written... I just spent a week with my Brother who should have been dead according to what was written above. I will not walk through all of the multiple injuries sustained, but amputation of a lower leg, near amputation of the other, partial degloving of one hand and almost uncountable shrapnel wounds/excoriations, pelvic fx, and more.... Here, but not quite kicking at the moment, he can't use his prosthetic for about another month. If he kicked, he would fall down, and I'd have to laugh, then he'd kill me.

Care at the incident site, care in theater, care in Germany and care at WRNMMC saved what would have been a second amputation in the past.

But, I'm biased toward the initial care he received from himself and another 18D upon injury.

In all respect, he is a fucking bad ass diesel mutant and I respect that bastard medic. Maybe next time for the link up...

F.M.

 

[amlove21]

Another thing to keep in mind when looked at the data points: it covers the beginning, 2001-2003. I'm not sure when the new tourniquets were fielded but when OEF and OIF started, a lot of us where still getting the cravat/belt/anything you can find-put-in-a-stick-and-twist method of tourniquets. A lot of people starting carrying multiple tourniquets when I arrived in '06 but many did not. This could account for bleeding from multiple amputation sites.

GREAT pick up sir.

Everyone remember here- we knew exactly SHIT in 2003. Most of our SOP's we got from Mogadishu. TC3 was the standard then, but only the precious few got anything other than a powerpoint, meaning SOF and front line guys. Shit, we didn't even have proper TQ's, and the main argument there was still "oh no will you use a limb if you put that on an amputation?" That argument is LAUGHED out of anywhere at this point, even in the civilian world. Anyone been in a trauma bay/ER lately? There are TQ's on the wall now, and @Firemedic , is there an argument going on that you need them on the trucks?

In regard to how far battlefield medicine has advanced since this paper was written... I just spent a week with my Brother who should have been dead according to what was written above. I will not walk through all of the multiple injuries sustained, but amputation of a lower leg, near amputation of the other, partial degloving of one hand and almost uncountable shrapnel wounds/excoriations, pelvic fx, and more.... Here, but not quite kicking at the moment, he can't use his prosthetic for about another month. If he kicked, he would fall down, and I'd have to laugh, then he'd kill me.

Care at the incident site, care in theater, care in Germany and care at WRNMMC saved what would have been a second amputation in the past.

But, I'm biased toward the initial care he received from himself and another 18D upon injury.

I want to address your bolded because I think it encapsulates the whole feeling of this thread very accurately.

We are REALLY good at TC3 now. I taught no less than 50 hours of TC3 to regular AF dudes in Afghanistan this last go around. No kidding, hard ass scenario driven TC3. I even got the commander of regular "dirt boys" and CE construction dudes to purchase tourniquets, chest seals, and darts for his entire squadron. Finally, a SOF program (who TC3 was invented for) has gotten to the lowest level- literally Air Force non-combat types, and it saves lives.

I can tell you from 5 IDF attacks on Bagram Air Field- TC3 is working at the lowest level. I've both received patients from "regular" guys that smoked it and ran scenes where people knew EXACTLY what I was saying, and what I needed.

That's why this article reads "weird" or why some don't get it- the entire force has literally gotten so good at this, it's hard to remember a time where we weren't good. But there was, and people died until we figured it out.

Great thread.

ETA- Bagram is not an AF Base. It's an air field. My B.

 

[Ranger Psych]

Well, I have medical priapsis hearing that. Seriously. Raging Ranger, type one each, etc. It needed to happen and it needs to be maintained as the standard.

 

[amlove21]

A couple other confounders to keep in mind here-

The sheer amount of FOB's and surgical teams carrying blood and other trauma resus capes in theater exploded in 2005-ish, and has just now started to calm down. In OIF/OEF during their respective heyday, you were almost always a stones throw away from some sort of advanced FST/CASH/etc that had crash resus as a cape. As it was the only game in town, it also attracted the best this country (and other countries) had as far as trauma surgeons that wanted to get it on.

We (the medical professionals) got much more proficient and experienced. I had PJ's come back from Bastion with 240 missions- some guys hit 8 missions a day for months at a time. Just think about that for a second- 8 missions on a 12 hour shift in Afghanistan. Now, noted, some of those were your classic "this is a bullshit patient transfer that wouldn't warrant a ride in an ambulance stateside" missions- but the majority were "this dude is in a fucking firefight after sustaining a triple amputation and we are going in to get him" type guys. The proficiency alone was enough to skew numbers favourably, and it did.

 

[8654Maine]

Now, here's the key:

The Services have to do something to entice these folks with all the experience and training to stay in and pass on the battlefield knowledge.

The worst thing is to see a mass exodus of brain power and BTDT's.

The next worst thing is to not keep training. These are perishable skills.

 

[Muppet]

@amlove21. Nope on the argument bro. We actually carry active shooter bags that carry mass amounts of that stuff.

F.M.

 

[amlove21]

@amlove21. Nope on the argument bro. We actually carry active shooter bags that carry mass amounts of that stuff.

F.M.

NICE. Glad to see the progress!

 

[pardus]

For your viewing pleasure...

 

[Stretcher Jockey]

Kinda digging through the archives to find this one, but awesome info on the beginings of TC3, Ranger First Responders and acceptance of TC3 as a whole. I had just heard about RFRs at SOMSA a couple weeks ago and while we all know the Ranger Medics are stellar at their jobs, but the fact that they trained some of their other members to those levels is pretty astounding. Also heard mention of Advanced Ranger First Responders but having a hard time finding too much info about them.

Its also worth noting the Air Force has FINIALLY decided to move away from their ridiculous Self Aid/Buddy Care course and mandate TC3 as the new standard for training. Only a couple decades behind the curve, but better late than never. Great thread from experienced medics. Ill get off the soap box now.