The Reserve component of the U.S. Army, especially reserve medical organizations, continues to play a vital role in national defense. Training reserve medical units is a cornerstone operation in First Army Division West at Fort Hood, Texas. From the time a unit prepares to deploy, First Army Division West is involved in every aspect of their training from administrative, intelligence, operations, logistics/resource management, mission command, communication and, of course, medical. For medical personnel, training on the MC4 system is only one piece of the medical training they will receive.
Lt. Col. Christopher Moon, Division West surgeon with First Army, says that as a physician and trainer, the electronic medical record (EMR) system helps the deployed medical staff with their final mission. As a user in Iraq in 2006 and Afghanistan in 2010, Moon has seen the evolution of the MC4 subsystems and its integration with the other battlefield operating systems.
“We have the highest casualty survival rate since Vietnam and a significant portion is attributable to technology.” Lt. Col. Moon said. “We as providers in the medical community couldn’t have done that without the information linkage provided through MC4.”
Moon has witnessed the development of medical recordkeeping over the past 10 years and is aware of the challenges deployed medical units encounter in theater. His mission is to provide the most realistic and challenging scenarios during training to prepare medical units to deploy into theater. From patient records to medical logistics, MC4 is the system of record for all Army medical units.
What is the purpose of pre-deployment training and what is the value-added in incorporating MC4 into the mix?
The First Army mission statement basically boils down to ensuring that Reserve component Soldiers and units are ready for deployment worldwide. How a medical unit prepares itself with the MC4 system is part of their overall pre-deployment training requirement.
Most of the medical units we train are part of the Army Reserves, but there are some National Guard units. When a unit is notified of a deployment mission, we get involved at Division West by working with the unit to produce a single integrated training plan. In that training plan we detail how the unit will be supported during pre-mobilization and how Division West will support the unit during mobilization.
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"Ultimately, the unit is responsible for becoming familiar with MC4."
Ultimately, the unit is responsible for becoming familiar with MC4. MC4 training can consist of several days of classroom training and live, hands-on practical exercises, such as using the EMR system with mock patients. The unit usually schedules MC4 training during the pre-mobilization phase. Over many training cycles, the MC4 team has found it beneficial to conduct individual training close to the unit’s mobilization phase to allow for personnel changes and to have the training fresh in the users’ minds.
At the mobilization phase, training is focused on unit collective events. For those who request additional training or did not have an opportunity to conduct pre-mobilization MC4 training, the MC4 teams offer reiteration training which is refresher training for some folks and first-time training for others. Then, all users are able to participate in the collective events, which depend on the type of medical unit. For example, a combat support hospital (CSH) will have the MC4 system integrated into their combat post exercise at a mission command level; whereas a forward surgical team will have the MC4 system integrated more into a tactical level. The goal of the culminating training event is to verify that the unit is fully prepared to conduct its medical mission.
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"Last year marked the first time an active component theater medical command was trained by Division West."
What has to be accomplished in order for a unit be validated?
Validation simply means that the unit is ready to conduct its mission. A validation board consisting of several members, chaired by the Division West commanding general or brigade commander, agrees that the unit has the necessary personnel, equipment and training to conduct its mission.
Last year, Division West and its collaborative partners, such as the 75th Training Division, trained 28 medical units, consisting of 1,524 medical personnel. Last year marked the first time an active component theater medical command was trained by Division West. Every medical unit received MC4 training, ranging from the smallest medical detachments to CSHs and medical deployment support commands.
How did the training evolve into what it is today?
The training is really unit driven. The Army saw the need to formally incorporate MC4 training because of feedback from theater. Ten years ago when we first initiated operations in Afghanistan, the first medical units tried to do what they could with MC4 as it existed. The units saw the need for streamlining EMR and procuring medical supplies for better patient care. The Forces Command (FORSCOM) and Medical Command (MEDCOM) agreed, so over the years we’ve incorporated MC4 training for every mobilizing reserve medical unit. With each deployment, we collect valuable lessons learned and inject them back into training for the next deploying unit.
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"We use MC4 to augment situational awareness to develop the medical common operating picture."
Can you elaborate on the scenarios provided to medical units during training?
The exercise scenarios are an integral part of training. They give substance to the training event by replicating the deployed theater environment for our training units. We do this by creating storylines to address areas which theater commanders, MEDCOM, FORSCOM, and unit commanders identify as being operationally important. Each storyline has events governed by the Master Scenario of Events List (MSEL), which target the commander’s training objectives and allow unit personnel to play out their roles. Feedback or lessons learned from currently deployed medical units is incorporated into each training event and is critical for the storylines to be believable and realistic.
We take real world situations from theater and prepare our upcoming units to deploy by using those real world scenarios. For example, a storyline for a CSH exercise may support a commander’s training objective of providing health services. MSEL injects could involve a Soldier who gets bit by a dog in an austere environment and arrives at a medical facility. How does it progress from there? Well, that all depends on the unit. There are multiple ways a unit can react and we script for the most commonly anticipated branches and sequels.
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"We want to provide them with the most realistic and most challenging situations."
MC4 is part of the many battlefield operating systems we use to replicate the deployed theater’s medical system in a closed-loop exercise network system. We use MC4 to augment situational awareness to develop the medical common operating picture. By providing simulated patient records, we’re able to see how well the unit medically regulates casualties. By providing a simulated medical logistical environment, we’re able to see how well the unit orders and replenishes medical supplies. Tie it all together and we’re able to see how the command teams develop an operational plan to fit in with the surrounding war fighters.
Every unit’s training is custom tailored because the theater environment is always changing. We want to provide them with the most realistic and most challenging situations. Immersion training – that’s what we call it.
Lt. Col. Christopher Moon, Division West Surgeon, First Army, Fort Hood, Texas