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Military Medical Students Learn to Care for Combat Injured

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About 170 medical students from the Uniformed Services University of the Health Sciences recently experienced the demands of caring for patients in a simulated combat environment, complete with mock explosions, operational problems, reality-based missions and numerous casualties.

The fourth-year medical students journeyed here this month to participate in a field training exercise known as “Operation Bushmaster.”

Graduate School of Nursing students also participated, along with international military medical officers from Mexico, the United Kingdom, Israel and Japan, said Navy Cmdr. (Dr.) James Palma, an assistant professor of Military and Emergency Medicine at USU.

Preparing for first operational assignments

The goal is to prepare students for their first operational assignment when they graduate from medical school, Palma explained. They might complete a one-year internship and then immediately deploy, or they might go straight into a residency and not deploy for another three or four years, he said. Either way, he added, “our goal is that they are well prepared for their first operational assignment, and that they’re going to be lifelong leaders in our military health care system.”

Before “Operation Bushmaster,” students go through a two-week military contingency medicine course, during which they are presented operational problems and receive pre-deployment training, just as they would prior to a real deployment, Palma explained. This classroom phase includes lectures and is focused on team building. The students become a cohesive unit as they prepare to deploy to a fictional country facing challenges from rebel forces, he added.

Divided into two groups, the students were sent, sequentially, to spend four days at this large National Guard base nestled in the mountains just north of Hershey, Pennsylvania. They were assigned to one of four platoons – all undergoing identical scenarios, planning and executing missions, while simultaneously caring for a variety of casualties, ranging in severity from fatigue to gunshot wounds. The exercise featured nearly 1,000 encounters with simulated patients, Palma said.

Leadership, communication skills, logistics

While patient care is a large part of their training, leadership, communication skills and logistics are just as important, Palma continued, noting that obtaining the necessary supplies and managing logistics are essential to effectiveness.

Students were assigned various roles during the exercise, such as patient administrator, triage officer, medical logistics, or litter bearers transporting patients. They frequently rotated positions, allowing every student to practice each role, Palma said.

The students also were graded on how well they performed key positions, including platoon leader, ambulance team leader, surgeon, and combat stress control officer. They were graded on a number of factors, such as communication and leadership skills, as they were observed by more than 60 faculty members from USU, as well as from across the country.

Dr. Art Kellermann, dean of the F. Edward Hébert School of Medicine of USU, noted that while the exercise is focused on leadership and enhancing the students’ patient care skills, they also interact with role players representing local host-nation citizens, practicing cultural sensitivity and expanding their problem-solving abilities while handling complex issues of their unit’s wellness.

“All of this is wrapped into an incredibly challenging series of unfolding scenarios,” Kellermann said. “They are constantly being thrown problems. They have to adapt and learn to work with one another in a variety of ways and a variety of combinations.”

Upping the ante

As the exercise progressed, they “upped the ante,” until the fourth and final day, Kellermann said. Their training then culminated with a large mass-casualty exercise. “We try to make it as realistic as we can,” Kellerman said. “We don’t pull punches.”

On the final day, the platoons, with about 24 students each, responded to a simulated mass casualty. They were informed that the fictional country’s rebel force leader was identified and had started a last effort to take over the country’s government, Palma explained. As the students responded, they heard loud, rapid gunfire, screaming and explosions booming from a speaker. Smoke billowed from the woods, where casualties were coming from left and right.

“You think you know what you’re going to walk into, but the sheer magnitude, the sights … it’s a shock to the senses,” said Army 2nd Lt. Rowan Sheldon, a fourth-year medical student in the 2nd Platoon. “You have to take a step back and say, ‘This is my plan, this is what I have to do,’ and execute the plan.”

As he played the role of a surgeon during the mass casualty scenario, Sheldon said, his platoon worked to find balance. Those dedicated to providing immediate care did just that, while others remained focused on setting up the triage and treatment areas. “Within the chaos of the environment, we had to create order,” he said. “It was difficult, and very realistic.”

Challenging, rewarding training

Overall, he said, the students’ experience throughout the training was both challenging and rewarding. “Every single person out there now is better than they were four days ago,” he added. “It was the most realistic training I’ve ever done.”

Navy Ensign Tony Romero agreed, adding that even though it was simulated, it was still very stressful. During the mass casualty scenario, playing the role of a medic in the 2nd Platoon, he said, he walked by people who clearly needed help. Though he wanted to delay his assigned tasks to stop and help, he reminded himself his job was just as vital to meeting the mission -- saving as many lives as possible.

Romero said he appreciated the feedback he received while being graded on his performance. “The [faculty] are there to help you, and helping make you better will help the entire system,” he added.

He also noted everyone looked out for each other’s well-being, ensuring they had taken time to eat and were not overexerting themselves, an important aspect of avoiding combat stress.

Incredibly stressful

“It’s incredibly stressful for them,” said Navy Ensign Meghan Quinn. She was among the many first-year students at the exercise who played the role of casualties.

During the mass casualty scenario, Quinn acted as though she was exposed to a roadside-bomb blast, unable to hear and very confused. She said she tried to make it difficult for the students to treat her by stumbling around. She enjoyed watching how they responded, she said, and to “see them really respond to you as a person and as a patient.”

The training also gave Quinn a firsthand look at the difficult training she will go through in just a few years, when she returns for the exercise as a fourth-year student, she said. She recognized the importance of the training, she added, as it tests students in ways that can’t be accomplished in a classroom. She also said it’s important to train in this environment, because military medical personnel will not always be providing care in a hospital.

After the exercise, the students returned to their clinical rotations across the country.

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