When it comes to medical care under fire it’s hard to find a better remedy than Special Operations combat medics.

Last year, two Ranger combat medics proved that fact by saving the lives of six of their brothers during an operation that went south in Afghanistan. And they did so by implementing medical procedures that had never before been used in combat.

Staff Sergeant Charles Bowen and Sergeant Ty Able, two Ranger combat medics assigned to Bravo Company, 1st Battalion, 75th Ranger Regiment, were part of a  Ranger assault force that was conducting a routine High-Value-Target (HVT) operation in Wardak province. The assault force was inserted by helicopters some distance away from the target building. While clearing the objective, the assault force came under heavy enemy fire. Soon people started to go down.

“The first casualty yelled out ‘I’m hit, I’m hit,’ recalled Staff Sgt. Bowen. “I looked at his leg and did not see any blood so I told him to go outside of the building and have someone evaluate his wounds. At the same time, the second casualty yelled out ‘Doc, I’m really messed up! I asked the second casualty if he could hear me and he responded with ‘Yeah, it really hurts, Doc.’”

The second casualty lied down in the open while a hellacious firefight was taking place all around him. Bowen ran to his side and pulled him behind rudimentary cover. Judging his condition critical — a sucking chest wound —  Bowen started life-saving procedures.

“I went to my aid belt and pulled out a needle chest decompression, an intravenous kit and one gram of pre-drawn Tranexamic Acid (TXA), a medication for trauma patients that reduces death due to bleeding,” said Bowen.

Bowen and Sgt. Able then moved the casualties, three critical by this point, to the Casualty Collection Point (CCP). The CCP, however, was exposed and under enemy fire. As they frantically tried to stabilize their comrades, more wounded Rangers started to come in. One, a canine handler, was shot through the neck. Blood pouring out, the Ranger stumbled to the CCP. Bowen and Able, while under fire, performed a surgical cricothyroidotomy, opening the Ranger’s neck so he wouldn’t drown in his own blood.

A surgical Cricothyroidotomy.

Meanwhile, one of the other casualties was bleeding at such a high rate that he would expire unless Bowen and Able did something. They decided to perform the Ranger O-Low Titre (ROLO) protocol. Essentially, ROLO is a blood transfusion on the battlefield.