Andy Fisher is currently a second-year medical student at Texas A&M College of Medicine.  He is probably like a lot of other medical students, studying hard and trying to grind his way through a grueling four years of intense academia.  Unlike most other medical students, he served as a former physician assistant (PA) for the 75th Ranger Regiment and logged multiple combat deployments while on active duty.

Max Dodge is an Army Flight Paramedic in the National Guard.  John Lacroix is an active duty 68W (combat medic specialist) in the U.S. Army.  Dominic Thompson is also an active duty 68W and a former Special Operations Combat Medic (SOCM) from 3rd Special Forces Group.  Paul Loos is an 18D (Special Forces Medical Sergeant) in the U.S. Army.  Collin Dye is also a SOCM with Army Civil Affairs, and Eric Soderlund is a police officer who previously served in the U.S. Army as an MP.

Last but not least, as we proceed through our roll call, is retired U.S. Army Master Sergeant Harold R. “Monty” Montgomery.  Monty is pretty much a legend in the combat medical world, having served as an Army Ranger for 22 of his 26 years in U.S. special operations forces (SOF), and 29 years total in the U.S. Army.  He deployed to combat in Operations Desert Storm, Uphold Democracy, Enduring Freedom, and Iraqi Freedom, and has also served as Regimental Senior Medic for the 75th Ranger Regiment.

Monty went on to become the senior enlisted medical advisor at U.S. Special Operations Command (USSOCOM), and in 2010, received the Frank K. Butler Tactical Combat Casualty Care (TCCC) Award for his contributions to TCCC.  He now works for the Joint Trauma System (JTS), which is the lead agency for trauma care in the U.S. military.

These medical professionals have banded together to form Next Generation Combat Medic (NGCM), which bills itself as a resource for providing free online access to medical education (FOAMed) materials for “perpetual learning, discussion and camaraderie for ‘Doc.’”  ‘Doc’ refers to the universal term for a medic in the U.S. military.  The group focuses on combat, pre-hospital, austere, tactical, and field medicine, and decidedly not on their individual resumés.  They will adamantly tell you — as they did this author — that the focus is not on them, but rather on all medics in the field. 

As Monty put it to SOFREP,

definitely put me at the bottom of the list of these other guys.  These young medics and Andy [Fisher] are really leading the charge on this and everything NGCM.  The most I’m doing is giving them some advice along the way.  I’m mostly just tapping into their energy.” 

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That is pretty typical of the self-deprecation you will get from these guys.

This author certainly understands that mindset and thus agreed to not shine too bright a light on the individual resumés within NGCM.  However, this author also knows all about Monty, having grown up in TCCC culture, and is also aware that Fisher helped bring TCCC to the Rangers, along with Monty, Russ Kotwal, and Rob Miller.

Doctor Frank K. Butler, namesake of the TCCC Award, also spoke with SOFREP for this article, and described Fisher and Monty as two of the “medical superstars” of the conflicts in Afghanistan and Iraq.  Those medical superstars are now looking to direct their powers toward establishing a National Stop the Bleed Day on March 31st, 2018, to inspire bystanders to get trained in applying tourniquets and/or hemostatic dressings to uncontrolled bleeds caused by either mass shooting events, accidents at home, car wrecks, or any other scenario where they might be faced with a life-threatening uncontrolled hemorrhage.

The genesis of the larger Stop the Bleed Campaign, according to Butler, was an attempt by national leaders to replicate TCCC’s success at saving lives in the conflicts in Iraq and Afghanistan through the aggressive use of tourniquets and hemostatic dressings to control external bleeding.  This approach supersedes the previous — direct pressure and application of pressure dressings — which have proven not as effective as the use of tourniquets and hemostatic dressings.  Stop the Bleed looks to bring this life-saving approach to everyday civilian life, much in the same way that CPR and use of Automatic External Defibrillators (AEDs) have become widespread throughout the United States.

SOFREP interviewed the medical professionals of NGCM about the National Stop the Bleed Day, their service and transition to civilian medicine, and saving lives when responding to mass shooter events, among other topics.  Here is what they had to say.

SOFREP:  What kind of combat trauma did you face in the war zones, and what were the challenges you saw in effectively delivering combat medical aid?

Max Dodge:  Everything from simple car accidents to complex blast injuries. The biggest obstacle to excellent care was my own lack of knowledge and training. Even though I was hungry for more knowledge, finding a reliable source of information and being able to effectively train was difficult.  As I progressed from a line medic to a flight paramedic I took on the responsibility to teach what I wish I had learned sooner.

Dominic Thompson:  Numerous blast injuries from Improvised Explosive Devices (IEDs), pediatric extremity [arm and leg] amputations, burns from pediatrics to adults, gunshot wounds, and skull fractures.  The challenges that I saw while deployed for delivering effective combat medical aid were not a lack of supplies or support, it was the ability to get to my patient in a timely manner so that I could do everything in my skill set and attempt to save their life to get them to a higher echelon of care.

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Andy Fisher:  It depends on the unit and the mission.  As a member of the 75th Ranger Regiment, I saw a wide variety of penetrating and blast wounds.  Shrapnel from grenades and similar devices was not uncommon.  There was a mix of extremity and thoracic wounds.  The issues I noticed involved delivering medical care at the point of injury (POI), and delivering adequate care in MASCALs [mass casualty events].  You were limited to what you could carry on your back.  We did not have the luxury of a hard structure where you could store equipment, maintain a large staff, and shield yourself from the environment.  I have an aid bag on my back and people to help, but we also have to maintain security, engage the enemy, and complete the mission.  Casualty care is just a small part of the overall mission.

H.R. Montgomery:  Over the years, I have seen everything from jump injuries to gunshot wounds to massive burns.  They all fell into one of three categories: those who would die no matter what we did, those who would live no matter what we did, and those who were dependent on us doing the right thing at the right time that meant the difference between life and death.  Combat medics, EMTs, and now the civilians we are trying to reach must understand their part in dealing with casualties who depend on them to take the critical action at the right time.

SOFREP:  How can civilians best prepare to save themselves and others if faced with a mass shooting or terror attack?

Dodge:  I think that preparedness has been given a bad name.  Building and maintaining the tools and the mindset to be prepared when disaster strikes has been the top recommendation, whether it was from official sources like FEMA, or from the “old guys” who have been there and done that.

Thompson:  This answer is actually very simple – training.  If an individual trains on a piece of equipment initially and continues to train on it, he or she will become proficient in its use.  As a 68W instructor, we would have hundreds of students every class that had zero pre-hospital trauma training and the majority of them were straight out of high school.  We would explain and teach them why placing a tourniquet in this manner is so important and why it will save a casualty’s life.  After providing them a demonstration and them placing it on themselves and their partners, they knew where and how to place a tourniquet to effectively stop life-threatening hemorrhaging.

Eric Soderlund:  While some types of attacks are unavoidable, the idea is not to get injured in the first place.  Not becoming a casualty and being able to help others when the threat is eliminated or suppressed will lead to more lives saved.  We saw this in Boston and Las Vegas, as uninjured bystanders helped others.  Obtaining active killer training along with medical training is a good first step.

The Texas State University has the Advanced Law Enforcement Rapid Response Training (ALERRT) program which puts on training for law enforcement.  This program goes back to 2002 and is a nationally-recognized standard for active shooter response. 

One of the classes offered is the Civilian Response to Active Shooter Events (CRASE) course, which is designed and built on the Avoid, Deny, Defend (ADD) strategy.  This is a “train the trainer course” and it equips local law enforcement to host active shooter training for schools, businesses, and community members.  This gives direction on what civilians should do if confronted with an active shooter event.

I would encourage everyone to look for an agency who has been through this training and take a CRASE class.  At the very least, look at the Department of Homeland Security (DHS) Active Shooter Preparedness Program webpage for information on how to deal with active shooter events. 

Fisher:  Simple first aid education and training used to be common.  However, I feel with larger urban centers, better technology, and access to emergency departments, there is now a sense of security, so many do not concern themselves with learning the basics of trauma care.  Getting the right training through NAEMT [the National Association of Emergency Medical Technicians] or bleedingcontrol.org is the best way to ensure that you can respond appropriately.  Furthermore, communities should engage their local elected officials about placing Public Access Bleeding Control Kits near every AED.

Montgomery:  Often it is the feeling of helplessness that people in desperate situations have the most problem dealing with during and after the situation.  Hopefully, we are arming them with a skill that can both save a life and provide them purpose when confronted with these problems.  People knowing what to do will both raise awareness and skill at fixing the problem.

SOFREP:   The next article in this series will continue our interview, in which we ask the NGCM team about transitioning to civilian life and more.

Featured image courtesy of Next Generation Combat Medic.