"Helo five mikes out, carrying two IED blast casualties," calls the radio operator to the anxious team of medical providers.

As an MH-60S Sea Hawk of Helicopter Sea Combat Support Squadron 22 touched down at the cold and rainy landing zone on Joint Expeditionary Base Little Creek-Fort Story May 10, members of the Expeditionary Resuscitative Surgical System (ERSS) team rush to carry their simulated patients' stretchers to their makeshift operating room and officially start their field environment training event.

The event was the first of the team's two capstone scenarios that marked the end of a three-week course that focuses on unit cohesion, general military knowledge and equipment familiarization.

The newly composed team of nine individual augmentees will deploy in support of U.S. Central Command operations. While the team of rotating members has been in place for nearly a decade, this is only the second time the ERSS course has been offered.

"We all come from different backgrounds and have had different experiences so the familiarization training is very beneficial to the group," said Cmdr. Michael McNally, the team's general surgeon.

"The primary objective of this class is team building, because this is a group of personnel who have never worked together in an expeditionary environment," said Cmdr. Michael Spooner, director of the Healthcare Simulation and Bioskills Training Center at Naval Medical Center Portsmouth. "There are, however, a number of secondary objectives such as trauma training, aircraft and ship familiarization, shipboard life familiarization, operational language and setting familiarization and familiarization of their specific equipment."

The team consists of nine positions: a nurse anesthetist, a surgeon, an emergency physician, an independent duty hospital corpsman, two critical care nurses, two surgical technician hospital corpsmen, and a field service medical technician hospital corpsman.

The three-week training process was a collaboration of several commands, including NMCP and the Surface Warfare Medical Institute. The first week of training, held at U.S. Fleet Forces Command, consisted of the team receiving training about Navy ships and aircraft, shipboard life, field environments and equipment.

Week two was hosted by NMCP's Healthcare Simulation Center. The week began with a simulated trauma so the team could be critiqued on their practices. Once they were debriefed with that critique, the rest of the week was spent responding to more simulated trauma patients to practice their skills and define team member roles. They also spent time ensuring that they know what equipment will be needed and what scenarios call for specific gear.

"Once that initial session is debriefed, the sim center staff spent the rest of the time building them up by helping them establish a good structure for positioning their members and equipment so they can succeed," Spooner said. "In general, this is a very adaptable team that has to be nimble so they can get in and out with their gear in very demanding environments and we want to make sure they are ready for that."

As the week went on, the exercises got more demanding and more involved, and the Healthcare Simulation Center staff was there to guide and critique.

"For a nine-person team, two patients may seem like a mass casualty because it would kind of exceed their capability," Spooner said. "So we try to get them up to a two-person casualty situation. We also give them an operational scenario that they plan for and will - worst case scenario - force them to split into two teams. This means that they will have to split up and decide how they will divide their gear and keep it to as little gear as possible."

Throughout the week, the team practiced IV insertions, intubations and placing chest tubes and tourniquets. The week ended with a scenario similar to the capstone at the landing zone: a simulated patient had been injured by an improvised explosive device, and the actor portraying the patient was wheeled into the operating room wearing a cut suit.

A cut suit is the most realistic way to simulate the look, feel and smell effects of severe traumatic events on a live human while allowing first responders and physicians to safely perform real procedures from the point of injury, to treatment en route, and transition of care to surgical intervention.

Once the final scenario was completed in the Healthcare Simulation Center, the team was ready for the capstone events: the field environment and shipboard exercises.

At the helicopter landing zone, they set up an operating room environment in a Conex-style box that contained all their gear. The team then worked to ensure their patients were stable and able to be placed back on the helicopter as if they are being flown to a hospital for further treatment.
For the shipboard portion, the team went aboard USS Nitze (DDG 94) on May 12. During this portion of the training, they responded to a simulated shipboard casualty.

"This training has been beneficial not only on a professional level but also a personal level," McNally said. "We are able to learn each other's strengths and weaknesses and focus on what we need to do to help our patients. There is always a high level of uncertainty regarding what kind of scenarios we will face when deployed, and I feel that this training has drastically improved our odds of success wherever we may go."

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