RMED Packing List

[deployedarmyPA]

Any current Ranger Medics on the forum?? Looking for a Packing List for your BAS / Trauma Chest / Sick Call Chest. trying to Improve my MES packing list. Any Help would be greatly appreciated

[RTO]

Welcome to the site and thanks for serving our great country.
To answer your question, yes, there are several Ranger medics that are regulars here.
I'm sure they'll be along shortly.

Please follow ArmyRanger.com SOP and grab yourself an avatar and post a proper introduction
here----> viewforum.php?f=26

[DJB]

MTOE and packing lists are somewhat secure and better accessed through military channels not internet chat rooms. I recommend that you PM Fish for the appropriate action to get this kind of information. If you are asking individuals Ranger medics what equipment has served them well and what they wouldn't deploy without, thats a different story. After you post a proper intro I am sure they would be more than happy to let you know.

[Sleepy Doc]

MTOE and packing lists are somewhat secure and better accessed through military channels not internet chat rooms. I recommend that you PM Fish for the appropriate action to get this kind of information. If you are asking individuals Ranger medics what equipment has served them well and what they wouldn't deploy without, thats a different story. After you post a proper intro I am sure they would be more than happy to let you know.

Um, yeah... what he said. Unfortunately, as I'm sure you know. the engineer that drives the train is the level of training and skill of the medical personnel you have working for you. As in the civilian world, there can be a huge difference in training, maturity and overall competence of your medics. Remember, the medical personnel in the Regt. are trained to and operate on a much higher standard than the garden variety "combat medic". It really should be it's own MOS, and not just an identifier. Even the combat life savers could smoke a medic just out of Ft. Sam.. can I get an "AMEN!"

[Silverback]

MTOE and packing lists are somewhat secure and better accessed through military channels not internet chat rooms. I recommend that you PM Fish for the appropriate action to get this kind of information. If you are asking individuals Ranger medics what equipment has served them well and what they wouldn't deploy without, thats a different story. After you post a proper intro I am sure they would be more than happy to let you know.

Um, yeah... what he said. Unfortunately, as I'm sure you know. the engineer that drives the train is the level of training and skill of the medical personnel you have working for you. As in the civilian world, there can be a huge difference in training, maturity and overall competence of your medics. Remember, the medical personnel in the Regt. are trained to and operate on a much higher standard than the garden variety "combat medic". It really should be it's own MOS, and not just an identifier. Even the combat life savers could smoke a medic just out of Ft. Sam.. can I get an "AMEN!"

Actually with the MOS change to 68W, the whole Army has raised the Medical care bar.

[Sleepy Doc]

Indeed, they have 1SG. It's quite impressive the strides that have been made. A lot of the credit goes to a 3rd Batt. senior medic whom I'm sure you remember well.. a very, ahem, "outspoken" individual?.. I'm sure it is one of the reasons there are such low numbers of KIA; The emergency care in theater needs to be what you would get for similar injuries CONUS. That was his mantra.

Talking to medics I work with who have been deployed, it sounds like that is exactly what has happened.

[Silverback]

Indeed, they have 1SG. It's quite impressive the strides that have been made. A lot of the credit goes to a 3rd Batt. senior medic whom I'm sure you remember well.. a very, ahem, "outspoken" individual?.. I'm sure it is one of the reasons there are such low numbers of KIA; The emergency care in theater needs to be what you would get for similar injuries CONUS. That was his mantra.

Talking to medics I work with who have been deployed, it sounds like that is exactly what has happened.

And wouldn't you know it...I almost mentioned his name. I miss that Old drunk Fucker.

[Sleepy Doc]

A lot of cats didn't like him, outright hated him... (he once told an officer to get the fuck out of his office that he was shit outta luck because the they didn't give the proper six week notice to request med coverage for a range.. And the BCO backed him up!..) I guaren-fucking-tee you a lot of motherfuckers are alive today because he would accept nothing less than excellence from his people.

He was exactly the kind of pit-bull that was needed to make changes happen.

As often happens, he and others responsible, will never get the credit they deserve.

And he was fun to party with. . (speaking of Rockmeyers... )

[Silverback]

A lot of cats didn't like him, outright hated him... (he once told an officer to get the fuck out of his office that he was shit outta luck because the they didn't give the proper six week notice to request med coverage for a range.. And the BCO backed him up!..) I guaren-fucking-tee you a lot of motherfuckers are alive today because he would accept nothing less than excellence from his people.

He was exactly the kind of pit-bull that was needed to make changes happen.

As often happens, he and others responsible, will never get the credit they deserve.

And he was fun to party with. . (speaking of Rockmeyers... )

That fucking Trench Coat...

[91W]

Indeed, they have 1SG. It's quite impressive the strides that have been made. A lot of the credit goes to a 3rd Batt. senior medic whom I'm sure you remember well.. a very, ahem, "outspoken" individual?.. I'm sure it is one of the reasons there are such low numbers of KIA; The emergency care in theater needs to be what you would get for similar injuries CONUS. That was his mantra.

Talking to medics I work with who have been deployed, it sounds like that is exactly what has happened.

First, Amen, Ranger. The care I witnessed amongst the rank and file medics was a mix. There are, as well as in the civilian side I work in now, shitbags that would be better suited for working sick call than Emergency Medicine. That said I met and worked alongside some of the best medics, docs, and trauma surgeons I have ever been privilaged to work with and learn from. I can say that they give the best possible care and I am proud to have been a part of it.

I attribute the problem to lack of hands on patient care when a medic is CONUS. I was a medic on both the civilian side as well as a medic in the reserves so I had the hands on experience before deploying. However I was the only one in the med section that had the experience. We had an E-6 and several lower enlisted that had not started an IV outside of training in there career. I have been out of the loop so I have no idea what steps if any have been taken to fix the problem. I know as the Bn Medical NCO I could not convince the powers that be that training for my medics was mission essential. Starting an IV on each other is far cry from real world pt care. And that does not even start with the problems with assement, airway control or all the other BLS skills.

Most of the medics I worked with in theater were AD Airforce in the ER at Anaconda. They were awesome at what they did and alot of people owe their lives to the work done there. I work for an EMS provider that is ran by a Regional Trauma Center and the care is as good or better than what we give here at home.

[Silverback]

First, Amen, Ranger. The care I witnessed amongst the rank and file medics was a mix. There are, as well as in the civilian side I work in now, shitbags that would be better suited for working sick call than Emergency Medicine. That said I met and worked alongside some of the best medics, docs, and trauma surgeons I have ever been privilaged to work with and learn from. I can say that they give the best possible care and I am proud to have been a part of it.

I attribute the problem to lack of hands on patient care when a medic is CONUS. I was a medic on both the civilian side as well as a medic in the reserves so I had the hands on experience before deploying. However I was the only one in the med section that had the experience. We had an E-6 and several lower enlisted that had not started an IV outside of training in there career. I have been out of the loop so I have no idea what steps if any have been taken to fix the problem. I know as the Bn Medical NCO I could not convince the powers that be that training for my medics was mission essential. Starting an IV on each other is far cry from real world pt care. And that does not even start with the problems with assement, airway control or all the other BLS skills.

Most of the medics I worked with in theater were AD Airforce in the ER at Anaconda. They were awesome at what they did and alot of people owe their lives to the work done there. I work for an EMS provider that is ran by a Regional Trauma Center and the care is as good or better than what we give here at home.

The Ranger Regiment started the trend of casualty treatment during training. I have been in a number of units and I can say that Regiment was the only unit that focused on CASEVAC as much as the live fire being conducted. Soup to nuts, they nailed it and set the standard for the rest of the Army.

[Sleepy Doc]

Having been in the Penn. Nat. Guard, I feel you pain in convincing the chain of command. Unfortunately, leaders don't sometimes see the big picture. Not to sound cliche, but it's that whole "fighting the last war" mentality. I wish I could have gone back to my old unit to give them a nudge in the right direction. One of he advantages in the Regiment is their relative autonomy. It is in the charter that they should develop new techniques and tactics, to then be disseminated through the rest of the military. It definitely helps to have a good budget and get the best equipment (I remember once the Bn Senior Medic when asked why we needed a particularly expensive piece of equipment. He in turn asked the S-3 "How much is the life of an injured Ranger worth?..". We got the equipment) It wasn't always like this, from what I understand.

It was after Somalia, and some high profile training accidents following, that caused people to sit down and re-evaluate what we were doing on the medical side of the house. By looking at the data, injury profiles, past casualty rates, etc. the powers that be realized that, for the most part, we were going to war with the same shit they were using (and the same attitude..) from the Korean War. Even after Vietnam it was discovered that nearly 70% of the fatalities from that conflict were from uncontrolled bleeding after the first dressing was applied. Think about that; If you have ever been to DC to see the wall it is a chilling thought. Over HALF of those names would not be there if the person who first rendered care took the time to completely stop the bleeding. They also looked at the wound placement. Mapping them on the body, they found that only 2% would have been fatal with modern body armor. William Donovan (former 1st Bn. Pa., Plank Owner, Card carrying member of he BTDT club.. for those who don't know..) used to say "the life of the injured patient lies in the hands of the first person who touches him"

They also realized that it was not "if" casualties are taken, but "when". To this end they started from the bottom. It was re-learned that ANY soldier could be called upon to do CASEVAC, so to have all your Joes trained as first responders is an advantage. At first it was like pulling teeth to get the officers and senior NCO's to come to training, but when Stanley McChrystal said every swinging dick, from his on down would have it by a certain date it was assholes and elbows. It was also realized, partially because of the high profile missions that the Regiment does, that CASEVAC needs to be practiced as much as the everything else; when you are shooting at someone, they tend to shoot back, and people will get hurt. (so I'm told..)

Unfortunately, because the Army is so large it takes a loooonnngggg time to learn the lessons of the past. That and all of the little fiefdoms that people tend to make when they achieve a certain station. It's human nature to resist an outsider coming into your house and telling you that everything you have been doing is bullshit and needs to be updated completely. As far as the training? We used to get around it by becoming masters of hip-pocket training. And it's the basic, basic shit that really will save a life, not what I do. I used to try and impress opon the Joe's that what they did would make a huge difference, and quite possibly all the difference. Shit, If I can loose this 50lbs over the next year, I just might go back in the reserves so I can poison young impressionable minds about how much fun it is to practice CASEVAC in the cold rain, with people shooting at you, shit burning, squatting in an overturned helocopter, with a joe screaming at you while pulling your shirt "DOC, DOC!!... save my buddy! He's the one over there with the thorn in his paw... "

[resqparamedic]

My hat is off to the Army on this one. With the GWOT they have made great progress in training their medics. From my observations, I think some of it may be a little slow in filtering down to the medics themselves. But it is there and rolling.

I have taken several Tactical Medical classes since I started working as a contractor. In every one of those classes, most based off of Tactical Combat Casualty Care a military based trauma course, I have seen huge gains. Unfortunately, now the shoe is on the other foot, because the practical information and real world experience gained working in a war zone is very, very slow in filtering down to the street medics in the US.

Case in point, if you're in the States as a medic and run on a GSW to the arm, with an arterial bleed, and you whip out a tourniquet, they're very liable to freak out in the Emergency Room. It takes 6 - 8 min for brain damage to occur from loss of oxygen to the brain due to some sort of respiratory/airway problem. At the same time it takes just a few minutes, or so, to die from a major bleed, they still advocate treating the airway first.

Now some of that is changing, but it is slow in coming.

As far as what gear do the hooahs carry, I won't answer that in a public forum such as this.

However, I will tell you that when bullets are flying, you can never have enough blood stoppers. All the fancy dressings, Quick Clot, Hemcon, etc.., are great and I carry some of each. But I load up on the basics tournisquets, trauma pads/dressings, kerlix, and pressure/ace wraps.

I have a basic 3 day pack/med ruck. Mine is set up so that no matter what pocket is opened, the first thing someone finds is a tourniquet, and right next to that is zip lock bag with 2 rolls of kerlix, a trauma dressing, and an ace wrap, all opened and out of their original packing, in the zip lock, with the word "BLEED KIT" written across it. I have several of these "Bleed Kits" in my aid bag. They work great. If there are multiple casualties, I can toss them to my team members and they can render the aid I have trained them in our down time to provide. If you can't stop a major bleed with a "Bleed Kit" and/or a tourniquet, you've got huge issues.

I also carry other "kits" in zip lock baggies. The zip lock baggies with the slide opener work the best. The allow you to pre-open everything and still keep it clean. Granted it is not sterile, but when you just got blown up, or shot the wound isn't clean and will need antibiotics anyway. The advantage of the pre-opened supplies is speed and ease.

When your sympathetic nervous system has kicked in, and you lose your fine motor skills, opening a zip lock bag is easy. Also, sometimes during stressful situations opening a roll of kerlix, or a bandage can be difficult when you only have your gross motor skills to rely on. Secondly, it allows you to treat people faster if you do not have to open supplies. Lastly, by putting everything into individual "kits" you are able to either grab, or have someone grab you everything you need for a particular problem in no time at all; as opposed to the more time consuming task of searching for individual items.

Some of the examples of other "kits" I carry are a "chest kit," a "burn kit," an "IV kit," a "splint kit," and an "airway kit." The chest kit has everything I need to use when dealing with a sucking chest wound/pneumo. The splint kit has a sam splint and kerlix, or ace wraps. The IV kit has my bag of fluids and everything all ready pre-opened in the pack, needles, opsite, IV tubing, etc...

I also carry as many Israeli bandages and cravats/triangular dressings as I can. Additionally a space blanket, BP Cuff, stethoscope, and pulse ox.

As for the sick call meds, I carry a generic load of different meds. Typically, stuff for the shits, nausea, upset stomach/indigestion, headache, muscle aches, flues, etc... I try to find the smallest pill form possible and they are opened and packed with in little med baggies. I don’t carry a lot, just enough for a few missions. Also throw in some WHO Salts, or Gatorade packets, especially during the summer when people are going down from the heat.

One of the keys I have found over here is to not leave you medic gear in the vehicles, or environment when it is not necessary. The heat will destroy much of your supplies over time, and also heats the hell out of some IV's so when someone goes down form a heat injury/dehydration your IVs are 150 degrees.

I am sure I left stuff out of all of that. But the thing that matters most is that your medics go through their bags on a regular basis. Unpack and repack everything. That way they are inspecting for damaged/missing supplies, but they are even more so familiarizing themselves with where everything in their bags is. When going through my bag I set up little mental scenarios and dive into my bag getting what I need and mentally going through the scenario from start to finish. In the end, when it is a real deal, it helps you be that much more on your game.

Anyhow, I am not sure if that helped, or not. It's what has proven to work for me. Good luck!

[Sleepy Doc]

Duff, you would not believe some of the, ahem, "animated" arguments I've had with my colleagues about this very shit .

Part of the problem is there are a lot of shitheads working on the street. I don't have to remind you because you've worked your time on a rig too. There is a lot of stuff they won't let us do (Like Rapid Sequence Intubation) because our Med Control doc is playing to the least common denominator.

Also, at least around here, the GSW's we run into tend to be small caliber and through and through. I haven't seen a lot of gaping, nasty exit wounds that you hafta pack.

Another huge discrepancy is that the civilian medics aren't properly trained in triage for Mass Casualty. This I've seen time and time again at crashes.

IMHO, the biggest obstacle in the filtering down of lessons learned is you have a thousand seperate FD's and EMS services to deal with (and EVERY one of 'em wants some input..) rather than one big DOD.

I only wish I could have used my training the way I was taught and done some good care under fire. It just wasn't in the cards. I am, however, 110% certain the training I got while working for Bill Fults & others has kept me on my A-game.

And you are right on the money about the bleeder packs. My service dosen't give us kerlex or ace wraps, just some half assed 1952 style roller gauze and cravats. I gotta pinch my own from the local ER and keep a few on hand. (did I say "pinch"?.. I meant "procure".. )

[resqparamedic]

Duff, you would not believe some of the, ahem, "animated" arguments I've had with my colleagues about this very shit .

Part of the problem is there are a lot of shitheads working on the street. I don't have to remind you because you've worked your time on a rig too. There is a lot of stuff they won't let us do (Like Rapid Sequence Intubation) because our Med Control doc is playing to the least common denominator.

Also, at least around here, the GSW's we run into tend to be small caliber and through and through. I haven't seen a lot of gaping, nasty exit wounds that you hafta pack.

Another huge discrepancy is that the civilian medics aren't properly trained in triage for Mass Casualty. This I've seen time and time again at crashes.

IMHO, the biggest obstacle in the filtering down of lessons learned is you have a thousand seperate FD's and EMS services to deal with (and EVERY one of 'em wants some input..) rather than one big DOD.

I only wish I could have used my training the way I was taught and done some good care under fire. It just wasn't in the cards. I am, however, 110% certain the training I got while working for Bill Fults & others has kept me on my A-game.

And you are right on the money about the bleeder packs. My service dosen't give us kerlex or ace wraps, just some half assed 1952 style roller gauze and cravats. I gotta pinch my own from the local ER and keep a few on hand. (did I say "pinch"?.. I meant "procure".. )

Yeah I spent years working in major EMS systems. And you're right; every agency wants input and mucks up the water. I think the biggest problem is the need for medics out there and the lack of pay unless you work in a major metropolitan area. Now people go to school for close to 2 years for school and they get out to expect $10 an hour for working on an ambulance. So since so few people are going to school to be medics standards may not be enforced as well and shit bags are sliding through the system.

In turn I think this has turned many people qualified and experienced people away from EMS. So what you have left is quite often a sub par medic, or a medic who starts off good, put is so hemmed up by some quack medical director that they lose their skills since they are cookie cutter medics doing everything by route memory and not thinking usually.

Many metro FD's have dictated they have a dual role firefighter/medic person. While it saves them money, it does not provide as good a paramedic as possible. The problem being that fire departments run 90% -95% of their calls as EMS calls, and the rest being fire calls; yet, most of the time the training is all fire related. In the 80's and 90's when many departments forced the medics to become firefighters, the training budgets for EMS was sacked and rolled into the fire training budget, with EMS taking the back seat, despite the majority of calls being EMS related.

That is compounded by the fact that medics usually run more calls then their counterparts on the fire engine. So after a while the FF/medics get tired of running calls and promote, or transfer off the ambulance. So to replace them some fire fighter is tapped to go to medic school. Unfortunately the fire fighter has no desire to work on cry baby patients, when he can be fighting fire. So they make shitty students and never really learn their job. So in order to fill the ranks they are pushed through the system and end up on the streets as fucked up, don’t give a shit, medics.

Where am I going with this? Well having shitty medics on the street has caused medical directors (doctors), who have for the most part, never trusted medics, to be even more skeptical. This in turn causes them to put the clamps on the medics, and take thought out of their process. If you want to work in a thinking EMS agency, head off to Atlanta and work for Grady EMS. It's an awesome place to work and pays well.

It is these same Docs who believe that what they learned when they went to school is the gold standard and won’t ever open their minds too new and better ways. EMS is slow in coming around. Hopefully some of the prices being paid on the battlefield today will not be lost before having benefit back home on the streets.

Oh, and Bill Fultz! Dude I remember him from Bco. We played together on the same high school football team in Los Angeles.