FORT INDIANTOWN GAP, Pa. — Complete with helicopter evacuations, mock explosions, reality-based missions – even canine casualties – medical students from the Uniformed Services University of the Health Sciences (USU) recently experienced the challenges of caring for patients in a simulated combat environment.

The fourth-year medical students participated in a field exercise, known as Operation Bushmaster, or Medical Field Practicum 202, which took place Oct. 10-21 at Fort Indiantown Gap, an Army National Guard post nestled in the mountains just north of Harrisburg, Pennsylvania.  The exercise aims to teach future military medical officers the skills they need to perform their duties in operational assignments after medical school, while preparing them to become leaders in the military health care system, explained Army Col. Francis O’Connor, Professor and Chair of Military and Emergency Medicine (MEM) at USU. 

During a field exercise, Operation Bushmaster, fourth-year medical students from the Uniformed Services University of the Health Sciences were constantly faced with unfolding scenarios. While triaging the wounded, they prepared for their evacuation and care in flight. (DoD photo by Sharon Holland)

Bushmaster is the capstone event of the students’ military medical education, challenging their knowledge of military medical practice, tactical combat casualty care (TCCC), and leadership.  The exercise involves nearly 500 personnel and puts in to patient casualty play more than 2,000 patient scenarios.

Before heading up to Bushmaster, the students went through a two-week intensive military contingency medicine course, during which they were presented operational problems, and were given pre-deployment training, just as they would have prior to a real deployment, O’Connor said. This classroom phase included lectures, small group sessions, tactical combat casualty care training, and practical exercises, focusing on needed skillsets and team building.  As they became a cohesive unit, they prepared to deploy to the notional country of Pandakar facing challenges from rebel forces, he said.

The students were then sent sequentially, in two groups, to spend five days on the Army post. Once there, they were assigned to one of four platoons – each undergoing the same scenarios, planning and executing missions, while simultaneously caring for casualties.  The students were constantly faced with unfolding conditions, round-the-clock, with scenarios involving improvised explosive devices, wide-spread disease outbreaks, simulated injured working dogs, and triaging the wounded while arranging for their evacuation and caring for them in flight.

“While patient care is a large part of their training, communication skills and logistics are just as important – it’s essential to obtain the necessary supplies and manage logistics,” O’Connor said.  However, according to O’Connor, the exercise is first and foremost a test of leadership.

Throughout the exercise, the students were assigned various roles, such as triage officer, medical logistics, litter bearers transporting patients, or patient administrators. They frequently rotated positions, allowing each student to practice different roles.  A Pandakar “day” was four hours in duration real-time; with each day change came a new job and responsibility.

Meanwhile, the students were observed by faculty and graded on how well they performed key positions, including platoon leader, ambulance team leader, combat stress control officer, preventive medicine officer, or ambulance team leader. Grades were based on a number of factors, including communication and leadership skills.

On the final day, the platoons – with about 25 students each – responded to a mock mass casualty with more than 30 wounded. Simulated gunfire and explosions resonated through the air as smoke billowed through the woods, and casualties rapidly came from left and right.

“They might have thought they knew what they were going to walk into, but when they see the sheer magnitude and the sights – it’s a shock to the senses,” O’Connor said. “They have to take a step back, reach back from lessons learned over the prior four days, and within the chaos of the environment, come up with a plan, and attempt  to create order and balance, and most importantly, move the casualties. It’s very difficult, and very realistic.”

Overall, though, the students’ experience was both challenging and rewarding, he said.  As they were constantly being thrown problems, they had to adapt in that environment and work as a team. Everyone looked out for one another, making sure they all stayed hydrated, had adequate rest, and did not overexert themselves – an important aspect of combat stress.

“It’s an extremely important exercise, and it definitely tests the students in ways that cannot be accomplished in a classroom,” he said. O’Connor credits the leadership of Air Force Maj. (Dr.) Kevin Semelrath, the exercise director, and his non-commissioned officer-in-charge, Army Sgt. 1st Class Alex Menchaca, as well as all supporting members in MEM, for Bushmaster’s success.

A number of volunteer faculty members supported the exercise, along with colleagues within the Military Health System, including Walter Reed National Military Medical Center, Fort Belvoir Community Hospital  and the Walter Reed Army Institute of Research.  Active duty and reserve units throughout the mid-Atlantic also assisted, including Marine Corps Base Camp Lejeune.

Graduate School of Nursing students participated, as well as international military medical officers from Israel, the United Kingdom, Mexico, France and Canada.  First-year medical students had a role, too. Donning “cut suits” or moulage, they put on their best potential Academy Award-winning performances to portray casualties, ranging from cardiac arrest to gunshot wounds.