For the medical staff of Naval Medical Center Portsmouth (NMCP) who participated in Exercise Bold Alligator Aug. 22 - 24 on board USS Bataan, communication and high-tech medical simulation were vital to preparing for treating mass casualties during a potential deployment.

Bold Alligator is a large-scale exercise that involves service members from more than 30 U.S. commands and 14 countries. The exercise allows Navy and Marine amphibious forces to test and improve their interoperability. A portion of the exercise focused on medical teams responding to simulated mass casualties.

The exercise is critical to maintaining readiness for the more than 70 doctors, nurses and hospital corpsmen from NMCP who would be called upon to augment the ship's medical staff and the assigned fleet surgical team if Bataan were deployed to a war zone with extensive casualties.

"We provided a full-scale mass casualty simulation to assess and utilize the casualty receiving treatment ship (CRTS) crew, which is the crew that NMCP augments to Bataan in case of a large-scale combat situation," said Cmdr. Michael Spooner, director of the Healthcare Simulation and Bio Skills Training Center at NMCP.
Spooner acted as "movie director" for the scenario, ensuring the actors portraying the injured and the simulation equipment were staged correctly and in the correct order.

"To date, this was the biggest exercise in terms of simulation equipment that we have done," Spooner said of his team of 16 simulation technicians, 11 of whom were on Bataan. "We had three cut suits, three different simulation mannequins and a MAT trainer, which simulates leg trauma for tourniquet application. Each wave had four or five walking wounded that we moulaged in different fashions to simulate different injuries."

Spooner said this was one of the first times in many years that the CRTS augmentation team participated in such an extensive exercise.

"After two days of ship orientation, we brought the (simulated) causalities and actually had the medical team function in their role and work through the scenario," Spooner said. "This takes it to a higher level since they will have to put together the ship orientation with having to treat the casualties."

"There is a huge portion of our team that had not been on a ship," said Cmdr. William Wiegmann, a critical care nurse assigned to the CRTS. "For them, orientation to the ship was critical, as well as to determine which medical supplies are on board since they vary between a ship and a land-based hospital. The ship's medical staff and the fleet surgical team know the ship, the equipment and the capabilities. They helped us find the supplies and determine who would be the best person for certain aspects of care."

The mass casualty exercise began on the flight deck, where in a real-world situation, patients would arrive via helicopter. The simulated patients were triaged to be classified as immediate, delayed or walking wounded and then placed in staging areas by the elevators.

"The first patient is going to be the first person who we want to go into the operating room, and then the second, and we stage them that way," said Wiegmann, who coordinated staffing and matched each nurse's skillset with the simulated injuries. "Then we can take the patients into the operating room or to main medical in the order of severity of their injuries."

While the simulated patients passed through primary and secondary triage or were waiting for transportation, the team continued to perform life-saving care along the way. This included needle decompressions and inserting chest tubes. The CRTS team also continued to assess who should be the next to go to one of the four operating rooms on the ship.

"What evolved the most was the communication," Wiegmann said. "What makes the drill successful isn't necessarily the medical equipment or the resources, but the level of communication. As information traveled throughout the team, it made a huge impact, and so did the simulation.

"It's the realistic ability of patients to get better and worse as they are moved along... when you are doing triage on a plastic mannequin, it's hard not to treat it as a plastic mannequin," Wiegmann said. "But when there's blood spurting out of a rubberized mannequin, and there are audible moans and groans to match, it's much closer to real life. And when someone is wearing the cut suit, and a real person gives real-time feedback, it's very helpful."

A cut suit is worn by an actor, and it allows the surgical team to perform real surgical techniques during a drill.

"The simulation changes the dynamic of the drill," Spooner said. "The medical people involved have to suspend disbelief in order to believe they are actually in that role. When we can provide them the ability to enter into that idea in that moment that this might be real, it's rewarding. By giving the surgeon the equipment to 'operate' on, the entire surgical team has to be there to support the surgeon, so everyone falls into the role as if it's real. The value that we add is that we allow the team to come together and function."

Spooner has deemed this exercise to be the best executed drill that his team has performed, which is a tribute to the team's hard work. From setting up the equipment early in the morning, to resetting the equipment for the second drill during lunch, Spooner said his team puts in a long day that ends with the reward of knowing the impact they are having.

"We want to make sure they are ready, or at least are able to conceptualize that readiness, which is the real reason why we wear the uniform," Spooner added. "We wear the uniform so we are ready when called upon for that mission."


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