Ranger first responder and the evolution of tactical combat casualty care.

Surgeons of the United States, Military Medicine, published a supplement titled “Tactical Combat Casualty Care in Special Operations.” This supplement, written by U.S. Navy CAPT Frank K. Butler Jr., Army LTC John Haymann and Navy ENS E. George Butler, altered the course of pre-hospital combat medicine into what we know today as tactical medicine. The authors brought to the forefront the vast differences between providing pre-hospital trauma care in the civilian setting and providing pre-hospital trauma care at the point-of-injury on the battlefi eld. Using data collected from Vietnam, and more recent confl icts such as the Battle of Mogadishu, the authors presented an alternative solution to providing tactical pre-hospital trauma care at the point-of-injury within the military and the Special Operations community. Military pre-hospital providers were not provided with treatment protocols and interventions that were relevant to the parameters of actual combat or tactical scenarios. What’s best for mission success and what’s best for the treatment of casualties may be in direct confl ict, a quandary completely unique to combat or tactical medicine. The three goals of Tactical Combat Casualty Care (TCCC) are to treat the casualty, prevent additional casualties, and complete the mission. These three goals combined mission tactics and medical care into recommended guidelines and protocols for a standard of care to be provided in the battlefi eld setting. The publication of the TCCC article in 1996, coupled with a 1998 directive from the 75th Ranger Regiment’s commander (then-COL Stanley McChrystal) for all Rangers to focus on four priorities, provided the necessary spark needed to refi ne the Combat Lifesaver (CLS) program and develop it into the Ranger First Responder (RFR) program of instruction in 1999. The Ranger First Responder program continues to be updated regularly to refl ect lessons learned during the confl icts over the past decade as well as recommendations from the Committee on Tactical Combat Casualty Care and the U.S. Army Institute for Surgical Research. The “Big Four” are the most important areas of command emphasis for all Rangers and comprise marksmanship, physical training, medical training, and small unit tactics. In 2006, the “Big Four” became the “Big Five,” when mobility was added to this list of priorities. The emphasis on medical training incorporated in the “Big Four” afforded the opportunity for medical personnel from the 75th Ranger Regiment to use the new TCCC guidelines and apply them to the CLS program, the Army standard at the time for non-medic “fi rst-aid” care. TCCC guidelines and protocols focus on the care of casualties in a combat or tactical environment at the point-of-injury. RFR is a program of instruction that incorporates TCCC and better prepares non-medic Rangers to provide self-aid or buddy-aid in the absence of a medical provider. The RFR course SFC CESAR VELIZ, MSG HAROLD MONTGOMERY AND DR. (LTC) RUSS KOTWAL RANGER FIRST RESPONDER AND THE EVOLUTION OF TACTICAL COMBAT CASUALTY CARE