Thursday, July 24, 2008

Future military doctors hone field medicine skills

(photos by Air Force Tech. Sgt. Andre Nicholson)
Air Force Staff Sgt. Lacy Johnson, a staff member at the Uniformed Services University of the Health Sciences, applies ‘‘moulage” to simulate a combat wound on Army 2nd Lt. Dan Coughlin, a first-year medical student.
About 360 medical, public health and graduate-level nursing students from the Defense Department’s only medical school are here at this Uniformed Services University, experiencing the rigors of caring for patients in a simulated combat environment.

Operation Bushmaster is exposing fourth-year students to the challenges of delivering medical care in support of warfighting, peacekeeping and humanitarian-assistance operations. Meanwhile, Operation Kerkesner is giving many students who just completed their first year of medical school their first tactical training in a field environment.

Both exercises began earlier this week and continue through July 24. The training will wrap up with a convoy coming under a simulated attack during a nighttime operation, resulting in mass casualties. As they triage, treat and evacuate patients, the students will come to recognize that part of being a military medical officer is the ability ‘‘to make order out of chaos,” said Navy Capt. Trueman Sharp, chairman of the university’s Military and Emergency Medicine Department and exercise director.

Sharp called the annual exercises the capstone of the curriculum.

‘‘The field training aspect is essential for our students because we are more than a civilian medical school or graduate school of nursing,” Sharp explained. ‘‘We produce a physician, but we are also producing a military medical officer. That requires a lot of additional knowledge and skills that you wouldn’t get in a civilian medical school.”

Operations Bushmaster and Kerkesner merge students’ classroom training with nearly 800 hours dedicated to military-unique subjects, in a field setting with realistic scenarios like those they’ll encounter as Army, Navy and Air Force doctors.

This year’s scenarios involve a United Nations force called in to conduct peacekeeping and stabilization operations in the fictitious Middle Eastern country of Pandakar in the throes of unrest. The doctors ‘‘deployed” as part of the force and were tasked to set up battalion aid stations and an expeditionary medical support station with surgical capabilities until a combat support hospital arrives.

Casualties started arriving before they finished setting up their operations. The wounded ‘‘patients” — actually first-year students with realistic-looking simulated war wounds like those being seen in Iraq and Afghanistan — put the students to the test.

Increased emphasis on treating patients as quickly and as far forward as possible presents challenges traditional medical students aren’t likely to encounter, from treating patients while under fire to working with far less equipment than they’d find in fixed medical facilities.

First-year students role playing patients got a glimpse at the type of challenges they’ll face later in their training. But Sharp said they also get to see firsthand what it feels like to be a wounded patient in the hands of a military doctor.

‘‘What’s going on here is pretty amazing,” said Army 2nd Lt. John Francis, a first-year student at his first field exercise. Role-playing a patient with asthma earlier in the day and now with ‘‘shrapnel wounds” on his face, Francis said the exercise reinforced what he’s learned so far at the university. ‘‘This brings it all together,” he said. ‘‘I’m really excited about what we’re getting out of this.”

‘‘This makes it real,” said Navy Ensign Danielle Robins, a former Marine Corps captain now with a year at Uniformed Services University under her belt. ‘‘This training defines the uniqueness of what a military medical school means.”

Across the post, other first-year students were getting a better understanding of that as many got their first experience firing a weapon, navigating an orienteering course, and wearing chemical protective gear after a mock attack. Many also were learning how to live and operate in the field for the first time.

Noncommissioned officers are leading the training, with Sgt. 1st Class Franklin Abram overseeing the training, which he said helps develop warrior skills in medical officers likely to serve on the front lines.

‘‘The bottom line is that we need doctors who can perform in the combat zone as well as the clinic,” he said. ‘‘Don’t think for one minute that because you are a doctor, that [enemy forces] are not going to shoot at you.”

Air Force Maj. Glenn Burns, Operation Kerkesner course director, said the exercise teaches not only basic survival skills, but also leadership principles.

‘‘This is not a test of infantry skills, and we are not trying to develop them as infantry officers,” Burns said. ‘‘But as we teach them the basics, what we expect to challenge them with is leadership.”

Fourth-year students were facing those leadership challenges as they treated patients while rotating through a variety of roles they’ll play as medical officers, from litter bearers to logistics officers to unit commanders.

The exercise reinforces the fact that doctors are just one part of a vast medical care network, Sharp said, while underscoring their broad responsibilities as military medical officers.

‘‘Being a medical officer isn’t just being a doctor,” he said. ‘‘It’s about leadership. It’s about planning and organization. It’s about communication. It’s about situational awareness. It’s about learning to prioritize because you never have enough resources or people, and you never have enough evacuation [capability].”

Navy Ensign Art Ambrosio got a taste of what it means to balance those challenges when casualties started arriving as he was serving as commander, overseeing the assembly of the expeditionary medical support unit.

A fourth-year student, Ambrosio had to resist the urge to drop everything and rush to the patients’ needs rather than allowing his staff to do that.

‘‘As a medical person, when you see someone hurt, you want to run, and you want to play doctor,” he said.

‘‘But as the commander, you need to focus on what those responsibilities are,” he said. ‘‘Your job is to keep the whole machine running: the medical, the transportation, the security, the communications, the logistics. You have to manage people, but do it without micromanaging.”

For some of the students, the exercises offer a return to principles they learned during prior service in the Army, Navy, Air Force and Marine Corps, but with a new focus.

Among them is 2nd Lt. Gabriel Pavey, who spent 12 years in the Marine Corps before enrolling in Uniformed Services University. Pavey was a Marine staff sergeant working in the Pentagon on Sept. 11, 2001, and remembers the frustration of not being much help to the medics scurrying to help the wounded. He said it led to a major life decision.

Now an Army second lieutenant about to enter his second year of medical school, Pavey said he’s ready for the rigors of field medicine in a combat environment.

‘‘It’s my brothers and sisters [in the force] who really do the hard part,” he said. ‘‘We’re here to support them. The folks here all have the same call to duty.”

Army 2nd Lt. Barrett Campbell said the training he’s receiving at the Uniformed Services University is providing a great foundation for what he hopes will be a 20-year career as a military medical officer.

‘‘I want to be a military doctor first and foremost, and this is the place to prepare for that,” he said. ‘‘I chose this school because of the military medical aspect. I wanted to be in a program that trained me for that, and that’s what I’m getting here.”

Robins said the exercise reinforces the connection she feels to her fellow Uniformed Services University students, but especially to the service members she will treat as a Navy doctor.

‘‘We have a like-mindedness,” she said. ‘‘They are taking care of me, and I am taking care of them. They are amazing people, and they deserve great care.”