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Ranger Medic
Handbook
Handbook
2007
DOMINATUS COMMINUS REMEMDIUM
Ranger Medic
75
th
Ranger Regiment Trauma Management Team (Tactical)
Ranger Medic Handbook
In Memoriam to Our Fallen
Ranger Medic Comrades…
SFC Marcus V. Muralles
KIA – 28 June 2005 – Afghanistan
Operation: Enduring Freedom
Special Operations Flight Medic 2003-2005
HHC, 3/160
th
Special Operations Aviation Regiment
Company Senior Medic and Platoon Medic 1999-2003
B Co, 3
rd
Battalion, 75
th
Ranger Regiment
Company Senior Medic and Platoon Medic 1990-1993
C Co, 3
rd
Battalion, 75
th
Ranger Regiment
PFC James M. Markwell
KIA – 20 December 1989 – Panama
Operation: Just Cause
Platoon Medic 1989
C Co, 1
st
Battalion, 75
th
Ranger Regiment
…and one for the Airborne Ranger in the Sky.
75
th
Ranger Regiment Trauma Management Team (Tactical)
Ranger Medic Handbook
FORWARD
Historically in warfare, the majority of all combat deaths have occurred prior to a
casualty ever receiving advanced trauma management. The execution of the Ranger
mission profile in the Global War on Terrorism and our legacy tasks undoubtedly will
increase the number of lethal wounds.
Ranger leaders can significantly reduce the number of Rangers who die of
wounds sustained in combat by simply targeting optimal medical capability in close
proximity to the point of wounding. Survivability of the traumatized Ranger who sustains
a wound in combat is in the hands of the first responding Ranger who puts a pressure
dressing or tourniquet and controls the bleeding of his fallen comrade. Directing
casualty response management and evacuation is a Ranger leader task; ensuring
technical medical competence is a Ranger Medic task.
A solid foundation has been built for Ranger leaders and medics to be successful
in managing casualties in a combat environment. An integrated team response from
non-medical personnel and medical providers must be in place to care for the wounded
Ranger. The Ranger First Responder, Squad EMT, Ranger Medic Advanced Tactical
Practitioner, and Ranger leaders, in essence all Rangers must unite to provide medical
care collectively, as a team, without sacrificing the flow and violence of the battle at
hand.
An integrated team approach to casualty response and care will directly translate
to the reduction of the died of wounds rate of combat casualties and minimize the
turbulence associated with these events in times of crisis. The true success of the
Ranger Medical Team will be defined by its ability to complete the mission and greatly
reduce preventable combat death. Rangers value honor and reputation more than their
lives, and as such will attempt to lay down their own lives in defense of their comrades.
The Ranger Medic will do no less.
I will never leave a fallen comrade…
Harold R. Montgomery
Russ S. Kotwal, MD
Regimental Senior Medic
Regimental Surgeon
1997-Present
2005-Present
RHHC Senior Medic
3/75 Battalion Surgeon
1995-1997
1999-2003
1/75 Plt, Co, BAS NCOIC
1990-1995
Ranger Medic Handbook 2007 Edition
75
th
Ranger Regiment, US Army Special Operations Command
SG, USA
LTC, C
75
th
Ranger Regiment Trauma Management Team (Tactical)
Ranger Medic Handbook
Table of Contents
Subject
Page
SECTION ONE
RMED Mission Statement -------------------------------------------------------------- 1-1
RMED Charter ----------------------------------------------------------------------------- 1-2
Review Committees ----------------------------------------------------------------------- 1-3
Editorial Consultants & Contributors -------------------------------------------------- 1-4
Key References ---------------------------------------------------------------------------- 1-5
RMED Scope of Practice ---------------------------------------------------------------- 1-6
RMED Standing Orders & Protocol Guidelines ------------------------------------ 1-8
Casualty Assessment & Management ----------------------------------------------- 1-10
Tactical Combat Casualty Care (TCCC) --------------------------------------------- 1-17
SECTION TWO
Tactical Trauma Assessment Protocol------------------------------------------------ 2-1
Medical Patient Assessment Protocol ------------------------------------------------ 2-2
Airway Management Protocol ---------------------------------------------------------- 2-3
Surgical Cricothyroidotomy Procedure -------------------------------------- 2-4
King-LT D Supralaryngeal Airway Insertion Procedure ----------------- 2-5
Orotracheal Intubation Procedure -------------------------------------------- 2-6
Hemorrhage Management Procedure ------------------------------------------------ 2-7
Tourniquet Application Procedure -------------------------------------------- 2-8
Hemostatic Agent Application Protocol -------------------------------------- 2-9
Tourniquet Conversion Procedure -------------------------------------------- 2-10
Thoracic Trauma Management Procedure ------------------------------------------ 2-11
Needle Chest Decompression Procedure ---------------------------------- 2-12
Chest Tube Insertion Procedure ---------------------------------------------- 2-13
Hypovolemic Shock Management Protocol ----------------------------------------- 2-14
Saline Lock & Intravenous Access Procedure ----------------------------- 2-15
External Jugular Intravenous Cannulation Procedure ------------------- 2-16
Sternal Intraosseous Infusion Procedure ----------------------------------- 2-17
Hypothermia Prevention & Management Kit Procedure ---------------- 2-18
Head Injury Management Protocol ---------------------------------------------------- 2-19
Mild Traumatic Brain Injury (Concussion) Management Protocol ------------- 2-20
Seizure Management Protocol --------------------------------------------------------- 2-21
Spinal Cord Injury Management Protocol -------------------------------------------- 2-22
Orthopedic Trauma Management Protocol ------------------------------------------ 2-23
Burn Management Protocol ------------------------------------------------------------- 2-24
Foley Catheterization Procedure --------------------------------------------- 2-25
Pain Management Protocol ------------------------------------------------------------- 2-26
Anaphylactic Shock Management Protocol ----------------------------------------- 2-27
Ranger Medic Handbook 2007 Edition
75
th
Ranger Regiment, US Army Special Operations Command
 75
th
Ranger Regiment Trauma Management Team (Tactical)
Ranger Medic Handbook
Subject
Page
SECTION TWO Continued
Hyperthermia (Heat) Management Protocol ---------------------------------------- 2-28
Hypothermia Prevention & Management Protocol -------------------------------- 2-29
Behavioral Emergency Management Protocol ------------------------------------- 2-30
Altitude Medical Emergency Management Protocol ------------------------------ 2-31
Acute (Surgical) Abdomen -------------------------------------------------------------- 2-33
Acute Dental Pain ------------------------------------------------------------------------- 2-33
Acute Musculoskeletal Back Pain ----------------------------------------------------- 2-33
Allergic Rhinitis ----------------------------------------------------------------------------- 2-34
Asthma (Reactive Airway Disease) --------------------------------------------------- 2-34
Bronchitis ------------------------------------------------------------------------------------ 2-34
Cellulitis -------------------------------------------------------------------------------------- 2-35
Chest Pain (Cardiac Origin Suspected) ---------------------------------------------- 2-35
Common Cold ------------------------------------------------------------------------------ 2-35
Conjunctivitis -------------------------------------------------------------------------------- 2-36
Constipation --------------------------------------------------------------------------------- 2-36
Contact Dermatitis ------------------------------------------------------------------------- 2-36
Corneal Abrasion & Corneal Ulcer ---------------------------------------------------- 2-37
Cough ----------------------------------------------------------------------------------------- 2-37
Cutaneous Abscess ----------------------------------------------------------------------- 2-37
Deep Venous Thrombosis (DVT) ------------------------------------------------------ 2-38
Diarrhea -------------------------------------------------------------------------------------- 2-38
Epiglottitis ------------------------------------------------------------------------------------ 2-38
Epistaxis -------------------------------------------------------------------------------------- 2-39
Fungal Skin Infection ---------------------------------------------------------------------- 2-39
Gastroenteritis ------------------------------------------------------------------------------ 2-39
Gastroesophageal Reflux Disease (GERD) ----------------------------------------- 2-40
Headache ------------------------------------------------------------------------------------ 2-40
Ingrown Toenail ---------------------------------------------------------------------------- 2-40
Joint Infection ------------------------------------------------------------------------------- 2-41
Laceration ----------------------------------------------------------------------------------- 2-41
Malaria --------------------------------------------------------------------------------------- 2-41
Otitis Externa ------------------------------------------------------------------------------- 2-42
Otitis Media --------------------------------------------------------------------------------- 2-42
Peritonsillar Abscess --------------------------------------------------------------------- 2-42
Pneumonia ---------------------------------------------------------------------------------- 2-43
Pulmonary Embolus (PE) ---------------------------------------------------------------- 2-43
Renal Colic ---------------------------------------------------------------------------------- 2-43
Sepsis / Septic Shock -------------------------------------------------------------------- 2-44
Smoke Inhalation -------------------------------------------------------------------------- 2-44
Sprains & Strains -------------------------------------------------------------------------- 2-44
Subungal Hematoma --------------------------------------------------------------------- 2-45
Syncope -------------------------------------------------------------------------------------- 2-45
Testicular Pain ------------------------------------------------------------------------------ 2-45
Tonsillopharyngitis ------------------------------------------------------------------------- 2-46
Urinary Tract Infection (UTI) -------------------------------------------------------------2-46
Ranger Medic Handbook 2007 Edition
75
th
Ranger Regiment, US Army Special Operations Command
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