By Patricia Deal, CRDAMC Public Affairs

FORT HOOD (Now designated Fort Cavazos), Texas—The different military forces have varying roles in combat but when it comes to combat casualty care, they share the same goal—saving lives.

The standard for medical teams from all services, Tactical Combat Casualty Care has contributed to a record-level survival rate for wounded troops by emphasizing early treatment at the point of injury and bringing life-saving surgical procedures to the frontline.

To improve their TCCC readiness, Carl R. Darnall Army Medical Center’s Emergency Medicine residents were put through the paces at the MEDCEN’s annual, full mission profile Joint Emergency Medicine Exercise held here May 28-31. This year, the exercise expanded the realism of the training by bringing in Air Force and Navy Emergency Medicine residents to simulate real-world, joint operational medicine.

“What better way to prepare the residents than with a culminating field exercise which simulates real-world deployment medicine giving them practical application and hands-on training. The exercise gives them a complete picture of how TCCC flows from the point of injury, to the Forward Resuscitative Surgical Team, to the Field Hospital, to prolonged field care to final MEDEVAC,” said Maj. Benjamin Donham, associate director of CRDAMC’s Graduate Medical Education’s EM Residency Program. “In general, the individual tasks associated with operational medicine are not difficult. However, the combat environment is very challenging and can make even simple tasks very challenging. Without having experienced that austere environment, our residents have no understanding of how difficult it can be.”

Donham said that adding joint participation to the culminating exercise would bring another level of realism and further improve the residents’ combat readiness.

“Although each service has their own unique challenges in providing TCCC, there are a lot of common problems and challenges we all face. It can be very helpful to see how other people are approaching the same problems and borrow already developed solutions,” he said.

Navy Cdr. Sherri Radensky, EM residency program director for the Naval Medical Center, San Diego also thinks that Joint operational training is crucial to the readiness of Navy medical personnel deployed in theater.

“We have limited resources and capabilities and couldn’t manage an exercise like this so we appreciate the opportunity for our residents to be able to work with their Air Force and Army counterparts. It gives them interaction with colleagues who they will be deployed with and helps them to better understand how the different services operate in theater. We all operate similarly but there are some subtle differences, especially with terminology and specific processes,” she said.

Radensky said the level of realism of the exercise with the various operational resources was especially valuable to the residents.

“There’s only so much that you can do with simulated training. Typically it’s all notional with residents verbalizing how they would do a procedure. But this exercise offered that extra level of realism with the role players with the cut suits and the simulated casualties allowing residents to actually perform procedures such as putting in a chest tube. That experience provides an invaluable level of education they can’t get anywhere else,” Radensky said.

Air Force Maj. Chris Pitotti, associate program director, Air Force sponsored Emergency Medicine Residency Program, University of Nevada, also appreciated the opportunity to participate in the exercise.

“The great thing about this is now smaller residency programs like ours can leverage the assets of larger programs like Fort Hood (Now designated Fort Cavazos)’s. Not only do our residents benefit by participating, everyone else can benefit from the Air Force perspective to TCCC that we bring to the table, Pitotti said. “The last few years we’ve been developing Air Force medical assets such as our austere surgical teams that will forward deploy to augment FRSTs which are traditionally all Army or Navy forward teams. So this exercise gives my residents that vital joint operational experience, a more realistic view of how they would operate in a deployed situation.”

Radensky and Pitotti also said that another critical piece of the training for the residents was going through the entire scenario of combat casualty care starting at the point of injury and progressing through all the echelons of care.

“It’s absolutely necessary that the residents see how all the pieces work together. They may be experts in what they do, but they can’t stay focused on just their role. Having a clear understanding of the entire combat casualty care process, what everyone does from getting the patient from the point of injury all the way back to the states, allows the deployed trauma teams to make informed decisions and provide the best care possible,” Pitotti added.

Navy Lt. Cdr. Michael Hight, EM resident from the Naval Medical Center, felt the very high-quality fidelity training did an excellent job of simulating real life downrange.

“They took extra effort to make it realistic with live role players and simulated casualties. We’re doing actual procedures, not just notional training. It’s not us going from building to building in our hospitals, it’s actual tents, an actual FRST. It’s actual Strykers that are picking up patients at the POI. It’s actually flying in the helicopter. We experience first-hand what we have to work with in an austere environment,” Hight said. “We don’t know what’s coming in. We don’t know how many are coming in or what their injuries are. You have to be able to be available physically and mentally the entire time—just as you would be during deployment.”

In addition to exercising the residents’ readiness training, other participants were able to utilize the training opportunity to validate their unit’s operations.

“Participating in exercises like this benefits us in so many ways,” said Capt. Rebecca Johnson, commander of 756th Surgical Detachment, 11th Field Hospital. “I get to see directly what my Soldiers are capable of and what kind of training I need to focus on moving forward. It helps them to learn muscle memory so the next time they see it, they already know how to work through the process. Being able to train with our other forces gives that extra bit of realism to their training and allows them to iron out kinks for that continuity of care.

“When we first got into it, everyone was kind of shell-shocked. But I’ve seen massive growth in our capabilities and that’s just what these kind of exercises are about. We’re not going to be 100 percent in two days, but it definitely gets us a lot closer to where we need to be to be fully mission capable,” Johnson said.