EXMED platforms that include Expeditionary Medical Facilities, Expeditionary Resuscitative Surgical Systems (ERSS) and En-Route Care Systems (ERCS) undergo comprehensive training at NEMWDC to refine their skills and prepare them to deliver life-saving damage control resuscitation and damage control surgery in the most challenging conditions. These training events replicate the stress and complexity of real-world trauma care in an austere environment that challenges the clinical precision and mental readiness of each EXMED team.

Lt. Joshua Grimes, physician assistant with ERSS 7, said the integration of the hyper-realistic simulation elevated the training during a recent ERSS course. “The simulation with a real person in a cut suit allowed for a dynamic interaction and feedback. That integration was impressive.”

Before the first simulated casualty reaches the triage point, hours of meticulous preparation occur behind the scenes. A trained moulage team crafts realistic injuries using silicone prosthetics, artificial blood, and specialized makeup techniques to simulate gunshot wounds, blast injuries, burns, and amputations, mirroring battlefield trauma patterns.

Role-players are also trained to simulate physiological and behavioral responses—ranging from arterial bleeds and altered breathing to shock and hysteria—forcing corpsmen and medical officers to assess and react under pressure.

“Realistic moulage makes a big difference in medical simulations because it helps trainees react as if the injuries were real,” said Hospital Corpsman 3rd Class Abbigail Dunlap, a member of the moulage team. “It creates a sense of urgency and emotional engagement, which helps them stay focused and make quick decisions under pressure. For military medical personnel, this kind of training is essential—it builds confidence, improves recognition of injury types, and better prepares them for real-life emergencies.”

Through their combined efforts, the moulage team ensures that training environments are immersive, challenging, and capable of preparing EXMED teams for the operational realities they will face in the field.

To enhance real-world simulation, NEMWDC will regularly utilize operational support elements to provide integration with roles of care. For this particular course, Special Operations Independent Duty Corpsmen (SOIDC) acted as Point of Injury and Role 1 providers, delivering rapid trauma care in austere, resource-limited environments. These highly trained corpsmen triage casualties, apply life-saving interventions, and prepare patients for movement to the next echelon of care.

The high-fidelity moulage and battle effects challenge them to maintain situational awareness, prioritize care under extreme conditions, and reinforce the critical skills required for survival in combat scenarios.

Adding to the immersive experience, a battle effects team engineered a 360-degree soundscape featuring directional gunfire, simulated explosions, rotor wash, and casualty screams. These auditory effects were synchronized with critical medical interventions, creating a sensory-rich environment designed to elevate stress levels and force rapid decision-making.

High-fidelity manikins added another critical layer of realism. These advanced training aids blinked, bled, breathed, and exhibited physiological responses to interventions. Corpsmen and medical officers performed chest tubes, needle decompressions, surgical airways, and emergency surgeries on the responsive manikins that provided real-time feedback.

The manikins were programmed to deteriorate or stabilize depending on the care provided, reinforcing the importance of timely, accurate interventions. ERCS teams also practiced patient handoffs and en-route care, tracking vital signs and administering treatments during simulated casualty transport.

Surgical teams utilize Strategic Operations (STOPS) Medical Surgical Cut Suit Vests paired with Advanced Surgical Simulation Packages (ASSPs) to replicate complex internal injuries and blood flow during trauma surgery training.

“The vest can be fitted with chest or abdominal injury packages, each designed to simulate damage to critical organs like the lung, heart, liver, spleen, and bowel,” said Kristen Andrade, a STOPS staff member. “As surgeons operate, simulated blood flows from the damaged organs, allowing real-time organ removal and repair in a highly realistic environment.”

Andrade, noted that these systems are designed to eliminate training gaps by creating a hands-on, repeatable, and fully repairable simulation experience, better preparing providers for real-world trauma surgery.

The training evolutions emphasize a full continuum of care, from initial stabilization to damage control surgery to en-route care and further stabilization. This seamless transition of care tested communication, teamwork, and medical proficiency across all operational layers.

As EXMEDs evolve to meet future operational environments, NEMWDC’s commitment to providing hyper-realistic training ensures that EXMED teams are technically proficient to perform combat casualty care under stress in operational austere conditions.

NEMWDC, located at Camp Pendleton, is a center of excellence for unit-level medical training to ensure readiness for future operations. The center's training programs are critical to preparing medical personnel for the challenges of combat and contingency operations.