W.Va. National Guard’s Ridge Healer trains U.K. special operations medical teams for irregular warfare, austere medicine

Story by Maj. Holli Nelson

West Virginia National Guard

Nestled in a valley in the Appalachian Mountains of southwestern West Virginia sits an out-of-use mining operations building that had become the temporary, clandestine medical facility for a team of British special operations forces medics and doctors. As the rain poured down, a small team of soldiers maneuvered their casualty into a room, fashioned a makeshift operating table, and began to administer life-saving procedures, working in tandem like a well-oiled machine.

The soldiers, who serve with the United Kingdom’s 3 Ranger Special Operations Resuscitation Team or SORT, were participating in a ten-day, West Virginia National Guard-led Ridge Healer exercise that took place across Boone, Mingo, Raleigh, and Wayne Counties in the Mountain State in late April.

Ridge Healer is a medical exercise which provides the special operations community with irregular warfare medical resiliency and resistance training in austere, complex, contested and denied environments.

Building into scenarios being played out through the Ridge Runner irregular warfare exercise that took place simultaneously in West Virginia, this iteration of Ridge Healer focused on training one of Great Britian’s newest special operations units, 3rd Battalion, the Ranger Regiment. 3 Ranger was created in 2021 as one of four new battalions under the U.K. Army’s Special Operations Brigade, whose focus is centered on unconventional and irregular warfare operations in complex, high-threat environments.

The SORT is comprised of four British Army soldiers who specialize in advanced trauma care, prolonged field care, patient stabilization and critical care evacuation with specialized NATO accreditation for their special operations medics. They operate similarly to U.S. special operations resuscitation teams that ensure the survival and well-being of special operators during high-risk missions.

In addition, the team incorporates a non-medical soldier whose job is to assist with tactical overwatch, driving or other non-medical tasks, explained Maj. Luke (last name withheld for security purposes), a 3 Ranger Battalion doctor.

Hours later, after all stabilization procedures had been completed by the SORT, the team dispatched a surgeon assigned to the 2nd Battalion, 19th Special Forces Group (Airborne), who provided surgical expertise and higher echelon care to the team’s patient. The scenario called for the U.S. special forces surgeon to open the chest and perform repair to the patient’s heart which had been damaged by a gunshot wound. British soldiers from the SORT provided surgical assistance with supplies on hand and were challenged with using non-standard logistics to stabilize the patient in a prolonged field care environment.

“Ridge Healer has been a completely different way of working,” stated Maj. Luke. “It’s been challenging, working through things like communications, logistics, and having to hold a casualty for a lot longer. It’s also been rewarding as the team is already learning, taking things away, and adapting as they go. I have no doubt there will be more lessons [from the exercise] that we can take away for future operations to ensure that the level of healthcare we provide is as good as it can be.”

Ridge Healer was designed utilizing lessons learned from the war in Ukraine and implements strategies relevant to the Army and Air Force’s shift from counterterrorism operations to irregular warfare and resistance operations concepts.

Created by a small group of special operators in the West Virginia National Guard in 2023, with assistance from the United States’ Irregular Warfare Center, it has been drastically changing the face of military medical exercises.

“The goal [of Ridge Healer] is to increase operational capabilities and patient outcomes for U.S., partner and allied forces while driving innovation to medical problems faced by today’s operational forces,” said Lt. Col. Mike Susick, Ridge Runner/Ridge Healer program director. “Without a doubt, the focus on medical resiliency in austere, contested and denied environments, coupled with what we have built through our irregular warfare training, has created one of the most dynamic and relevant medical exercises for special operations forces in the U.S. and abroad.”

As the day progressed into the evening, the SORT continued to monitor the patient’s vitals as they planned their movements for the next phase of their operation. Their challenge was the move the patient in a denied environment without exposing themselves or risking increased danger to the patient.

Taking lessons learned from a 3-day academics program offered at the beginning of the Ridge Runner exercise, the team began to implement procedures to plan for low visibility movement, communications, and how to ensure proper care of the patient without the use of an ambulance or critical care transport vehicle.

“The future of warfare is going to be very different from what we’ve experienced over the last couple of decades with Afghanistan and Iraq,” said Maj. Luke. “If you look at what’s going on in Europe and elsewhere in the world, it’s likely that we are going to have to operate in a more clandestine manner and also adapt our forces to operate in the irregular warfare space and overcome those challenges.”

By the end of the exercise, the SORT had been pushed well beyond their comfort zone having adapted to the environment of the abandoned mine building, the scenario at hand, unpredictable weather, and the demands of providing consistent medical care in a rural and austere location.

Maj. Bart, a 3 Ranger Battalion surgeon who participated in the exercise, said that despite their unit being involved with myriad NATO countries for training, both in and outside the special operations forces community, that Ridge Healer is the only exercise that you do point of injury through to surgery to post surgical care.

“It is extremely beneficial for the team to be stressed and work in this environment that we talk a lot about, but we don’t often practice and experience, which was the most valuable thing for me,” Maj. Bart continued.
They received feedback from the U.S. team of special forces medics and doctors who serve as cadre for the Ridge Healer exercise, notating areas for improvement, best practices, and key takeaways for the leadership of the 3 Ranger.

“We learned quite a bit about how to adapt our SOPs [standard operating procedures] and planning for our response in an irregular warfare environment,” said Maj. Bart.

The SORT will continue to train and adapt as they move toward becoming a fully operational unit, with hopes of doing so by 2026, providing each of the four Ranger Battalions with a small, highly mobile, and tactically independent medical care team.

“I can’t say enough good things about our experience with Ridge Healer,” stated Maj. Luke. “The Ridge Healer cadre have tailored this exercise to our training needs and objectives, and we look forward to future opportunities to engage with our U.S. partners is this exercise.”

The Ridge Runner program hosts four to five exercises each year in West Virginia and continues to grow its audience among the special operations community in the U.S. and with allies and partners around the world.