A recent Wall Street Journal article by Michael Phillips, which asked whether U.S. soldiers were dying of survivable wounds in Iraq and Afghanistan, has caused a minor uproar in the military medicine community with its assertion that the military is moving too slowly to adopt casualty care techniques that could better prevent survivable wounds in war. However, embedded in Phillips’ article is the largely overlooked result of a study in the Archives of Surgery that found that the 75th Ranger Regiment had so effectively adopted battlefield casualty care techniques that it had eliminated virtually all preventable battlefield deaths in the decade of warfare following 9/11.
The 2011 Archives of Surgery article, which presented the results, evaluated battlefield survival in a unit—the 75th Ranger Regiment—with a “command-directed casualty response system” that incorporated the tenants of Tactical Combat Casualty Care (TCCC). The Rangers began training in TCCC in 1997, and in 1998, according to the article, then regimental commander, Colonel Stanley McChrystal, directed the 75th to focus on medical training as one of its four major training priorities. In 2001, the TCCC-based Ranger Medic Handbook was distributed within the Regiment.
In fact, the Ranger Regiment is the only DoD force to have put in place a unit-wide casualty response system that incorporates TCCC training for all members, tactical leader “ownership” of battlefield (pre-hospital) medical care, and a thorough record-keeping system for battlefield casualties. In other words, all personnel in the 75th are trained to care for their buddy on the battlefield, and unit leaders take responsibility for that care (not leaving it solely in the hands of medics), given the casualty’s impact on the overall mission. This is a holistic and mission-centered approach to battlefield medicine, which has served the Regiment well.
The 75th, concluded the article, showed an “unprecedented reduction of killed-in-action deaths, casualties who died of wounds, and preventable combat deaths” during the period of October 1, 2001 to March 31, 2010. The Ranger Regiment and Naval Special Warfare (SEALs) were the first units in the U.S. military to extensively implement TCCC, and this implementation appears to have paid dividends for the Rangers. Similar studies on the SEAL teams, as well as on the Special Missions Units and Air Force Pararescue teams that have incorporated TCCC, have yet to be undertaken, though one can assume (hope) that similar findings would result.
The Ranger Regiment’s embracing these battlefield medicine SOPs has resulted in “historically low” casualties for the military’s premier raid force in the past decade of warfare. Significantly, this includes the near elimination of preventable battlefield deaths, such as exsanguination (bleeding out) from a wounded extremity, tension pneumothorax (when pressure in the chest reaches dangerous levels due to the one-way valve formed by an area of damaged tissue), and airway obstruction. Through its program of extensive combat casualty care training, and putting responsibility for that care in the hands of unit leaders, the 75th Ranger Regiment has truly led the way.
1. Phillips, Michael M. “Are U.S. Soldiers Dying from Survivable Wounds?” Wall Street Journal, September 19, 2014.
2. Kotwal, Russ S., MD, MPH; Montgomery, Harold R., NREMT; Kotwal, Bari M., MS; Champion, Howard R., FRCS; Butler Jr, Frank K., MD; Mabry, Robert L., MD; Cain, Jeffrey S., MD; Blackbourne, Lorne H., MD; Mechler, Kathy K., MS, RN; Holcomb, John B., MD. “Eliminating Preventable Deaths on the Battlefield,” Archives of Surgery, Vol. 146, No. 12, December 2011.