A patient with a collapsed lung lay on a gurney in the Uniformed Services University of the Health Sciences' (USU) cafeteria while receiving care from a team of medical school students.

Unfortunately, their patient died.

Luckily, their patient was never alive to begin with, so the medical students were able to refocus and redo the procedure properly. The life-like patient was part of a simulation of what could happen in a trauma situation when someone is injured by a blast.

"There were times when things went wrong in the exercise because we weren't communicating as well as we should have," said Army 2nd Lt. Mary Gasser, who was the group's team leader during this procedure.

Nearby, other medical students were treating life-like patients, one with a traumatic brain injury, another was getting a lower-extremity amputation and at the another station set up in the cafeteria, students were supposed to quickly diagnose a blunt abdominal trauma and then send the patient to the operating room.

"I think it's an excellent opportunity to get hands-on practice in a simulated environment where if something goes wrong, no one gets hurt," Gasser said. "I can learn from that, before I do that (procedure) to a real patient."

Navy Lt. Cmdr. Gordon Markham, a doctor visiting from the Naval Medical Center in Portsmouth, Virginia, also emphasized that this hands-on learning can help students work out any mistakes before treating service members on the front lines.

"They'll have a much better appreciation of what will happen and they'll have the confidence to go forward to carry out the mission," he said.

These Advanced Trauma Life Support scenarios were just one stop during the first day of Operation Gunpowder, a two-day course put on by the USU Department of Military and Emergency Medicine for third-year medical students.

The exercise is held at the end of the third year for the 160 medical students and prepares them for Operation Bushmaster, which is a full-scale medical field exercise that takes place in central Pennsylvania each year as part of the fourth-year curriculum.

One of Operation Gunpowder's more popular iterations is the Tactical Combat Casualty Care lane where students are told security has secured a scene on campus after an active shooter has attacked and the shooter turns out to be one of the people that the students are supposed to treat.

"Five minutes in the scenario they realize there's a second shooter that is closing in on them and the security forces engage the shooter and then our medical students have to drag their patients to another room nearby to a safe location," said Navy Cmdr. James Palma, a doctor and USU associate professor. "Then once security has made the scene safe again, they continue with the care of their patients."

Army Staff Sgt. Alexander Menchaca, USU non-commissioned officer in charge of the exercise, said he hoped to impress a sense of urgency upon the students.

"They did what they needed to do to treat the patient, and provide all the necessary medical interventions that needed to get done," he said. "It's just trying to hurry up and get it done a lot quicker is something that we need to practice more."

Practicing their medical skills is only one aspect Palma hopes the students learn about during Operation Gunpowder.

"We're using the trauma scenarios as a mechanism to emphasize the communication and leadership skills that we're trying to teach," Palma said.

Being a leader has been a point driven into all of his previous classes at USU, said Army 2nd Lt. Matthew Smith.

"The unique aspect of [being] a military physician, regardless of their specialty of choice ... you could be a pediatrician and be on that convoy and they could take fire and all the combat medics are looking to you to figure out what's going on even though you [are] a pediatrician," he said. "You can't say, 'I'm not an emergency medical doctor. I don't know what's going on.' Not only are you in charge, they're looking at you as the subject-matter expert."

Army 2nd Lt. Danny Jones, a fourth-year medical student who participated in the exercise as a teaching assistant, said this training reminded him of the importance of good communication, especially as he's about to start his residency.

"It's emphasized to me the power of addressing people by name," he said. "When you ask for something to be done, ask that person by name to do whatever task that is and listening to hear that they understood what you're asking of them and that they're capable of doing it or saying, 'No, I can't do that for whatever reason.'"

USU Professor Neil Grunberg said throughout the student's schooling they emphasize leadership and communication among team members.

"We're looking at four years of the student's development to make sure we prepare them for military medicine or public health service where they understand not only how to do their own job, but how to motivate, support, and enhance the behaviors, thoughts and motivations of others," Grunberg said.

On the second day, the students are thrown with different team members to participate in a five-hour adventure race consisting of 16 stations of various military medical training. At the improvisation lane where one task is putting up a one-rope or two-rope bridge, each group was taught different aspects of that challenge the previous day. So when they're put together in different teams, each team member has a unique set of skills during the race, Grunberg said.

"So if a student was passive and didn't really learn their skills, their team cannot possibly succeed tomorrow in the real challenge," Grunberg said.

Air Force 2nd Lt. Helal Syed, a third-year medical student, said working with new team members brought its own set of challenges.

"At the beginning, you could tell things were, not necessarily rocky, but we're trying to get a feel for who's good at what and how to manage the whole situation, but we managed to make it work," he said. "Our mission kept driving us regardless of any challenges that we faced."

One of the challenges during the race was delivering news about the death of a family member, which was an eye-opening experience for third-year medical student Navy Ensign Elizabeth Maldonado.

"Every physician at some point in their career is going to have to do something like that, so to practice that really helps," she said.

Overall, she said Operation Gunpowder was a great learning experience.

"It was a lot of fun, I think that's what made the learning part really fun and stick because we really enjoyed it," she said. "It was a nice challenge."

For more news from Naval Support Activity Bethesda, visit www.navy.mil/.