By Sarah Marshall
Walter Reed National Military Medical Center
FORT INDIANTOWN GAP, Pa., Oct. 30, 2014 – 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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