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Training for the front line.

It's pitch black, and an improvised explosive device (IED) just exploded nearby, leaving service members sprawled out all over the field. All they hear are voices in the darkness screaming, "Help me! Awww ... Medic! "They dive into the chaos not knowing what to expect, but they know they have to get the wounded out. Some only have minor cuts and bruises, some are burn victims, others may need amputations. But, this particular scenario is only training for real-life situations.

This mass casualty drill is the climax of an annual four-day field training exercise otherwise known as Operation Bushmaster. The exercise is part of the joint service Uniformed Services University of the Health Sciences' (USUHS) medical school curriculum.

Approximately 25 percent of active-duty physicians go through USUHS and this joint training exercise better prepares them for what they will see once they graduate.

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Bushmaster, a two-week operation at Fort Indiantown Gap, Pa., rotates two groups of fourth-year medical students through actual field training with first-year medical students supporting them and acting as 'patients.'

Behind the scenes are enlisted personnel from all branches of service-including corpsmen-who support the training as moulage or make-up artists, advisors, safety officers and more.

During Bushmaster, which is set in the fictitious country of Pandakar, the students learn more than just field medical care: They learn field leadership. They rotate through positions such as commanding officer (CO), executive officer, surgeon and ambulance team leader (ATL).

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"[Operation Bushmaster] is the climax of the military contingency medicine course that our third-year medical students take here at the university," said Lt. Cmdr. Greg Cook, a leadership evaluator at Bushmaster. "For the past year, they've had many presentations, briefs and classes on how to do contingency medicine. We have about 90 students out here so about a third of those students are Navy medical students who are going to be out in the fleet with us one day."

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There are 27 corpsmen stationed at USUHS, 12 of whom supported Bushmaster. Hospital Corpsman 1st Class (FMF) Ebenezer Atekwana, non-commissioned officer in charge at the Marine Corps Battalion Aid Station (MBAS), said one of their jobs is to act as advisors.

"I've been working with these students for approximately a year before I came out here. I really feel that I have the opportunity to help mold them because Bushmaster is the final exercise that really puts everything together-all the train ups, all the field medicine classes they've had, tactical combat casualty care classes that they've had, all the ATL classes they've had-this actually gives me the opportunity to be able to guide them in practicing those things in a field environment," said Atekwana.

Atekwana has had a lot of field experience himself having deployed with the 22nd Marine Expeditionary Unit in Afghanistan and 1st Battalion, 6th Marines in Fallujah, Iraq.

"At some point in my career, I have been exposed to the real life scenarios that are here [at Bushmaster]" he said. "Although the medical students out here have in-depth medical knowledge and are able to clinically treat patients, they are not very exposed to treating patients in field conditions. So the corpsmen act as advisors to guide those medical officers in treating patients in a field situation.

"Now it's not only treating them as far as providing medical care, but it's also being able to organize the MBAS in such a manner that the patient flow is smooth. It's making sure the MBAS is properly set up to receive casualties, that the vehicles are properly arranged, so that if we receive a call to go [evacuate] some casualties, they can move quickly."

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HM3 Tinsae Tekleab was one of the advisors and safety officers at Bushmaster this year.

"Out here I'm doing my primary job, which is as a corpsman. [I'm] mentoring and showing the doctors what an actual corpsman would be doing out there. It gives them an idea how corpsmen who operate under them would perform their jobs out there," said " I definitely feel that the training is extremely valuable, especially for me in a leadership position, which as a medical student you don't really get to do." Ensign Chai Wu Tekleab. He added that the job isn't easy, but it is worth it to him.

"We're doing 16-hour days throughout the two weeks. It's hard work, and there's a lot that goes into it. But we look to the outcome and these are the doctors who eventually will be helping my family or myself, my battle buddies, Marines, Soldiers or Airman out there in the battle zone," he said. "The motto of the university is 'learning to care for those in harms way,' and if we can show them [what it's like] being out there in the battle zone, they can give better directions as commanding officers or as medical officers to get the wounded treated properly."

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A typical Bushmaster scenario begins with first-year students getting ready to be "patients." This happens at the moulage tent where four moulage professionals create realistic looking injuries.

"We develop all the injuries, apply them all to the [first-year students] and send them out to the fourth-year medical students," said Patti Taylor, senior research coordinator at USUHS and moulage artist. "There is a matrix that we go off of that has all the injuries explained on it. We then receive cards with details on what to expect for each patient and where the injury is located. With that information we use all the moulage and develop whatever kind of injury we need. The fourth-year [students] have the knowledge already and now they need to physically see what the injuries look like."

Once moulaged, the mock casualties are moved to a location where the scenario is to be played out. For example, on day two, an improvised explosive device detonated while a group of non-combatant personnel was passing by in a vehicle.

The first-year students act out the panic that ensues on the scene. Each fourth-year student in this scenario is responsible for four patients-two with life threatening injuries and two with minor wounds. The senior students have to assess and manage all the patients, obtain the required transportation to get them out of the scene, load the patients and exit the area. One fourth-year student, Ensign Benjamin Nelson, was assigned as the evacuation officer of the MBAS and explained what happens next.

"The patients come in here through the triage area, offloaded from the ambulance. [They] get sorted out-either immediate, delayed or minimal-depending on how quickly they need to be seen. The docs see the life-threatening injury patients first. They are brought into the tents and worked on. Because this is just a level one area of care, as soon as the patients are stabilized, we take them over to the evacuation area and [put out] a radio report to get them evacuated out," Nelson said.

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Sailors, such as Ens. Chai Wu, were operating at other stations besides the MBAS. She was part of the Army Battalion Aid Station for 5th platoon, Squad 2.

"I definitely feel that the training is extremely valuable, especially for me in a leadership position, which as a medical student you don't really get to do. You haven't had experience commanding a unit, expeditionary medical squadron (EMEDS) or BAS. So it's very valuable to go through the scenarios and think about how you're going to defend your position, how you're going to treat your casualties and how you're going to set up your equipment," she said.

"Here you get hands-on training," Wu added. "The situation is completely different than the classroom. The type of care is completely different. You're basically doing medicine in bad places. You're trying to keep the Soldier, Marine, Sailor or Airman alive until you can get them to a higher level of care and that's what we're learning out here."

Wu and most of her counterparts agree that working in a joint service operation will help them when they get to the fleet, especially to do their part in the global war on terrorism.

"I think because we run through Army BAS, MBAS and Air Force EMEDS, we've had a taste of each to go anywhere and we would have a good idea of what's available, what type of support we'd have and what our command structure is," Wu said.

And it's not just the fourth-year students that are learning from Bushmaster. The firstyear students said they are getting a glimpse of what's to come.

"As a first-year student it's been nice to go out and get a clear idea of how the medical operations are set up in a situation like this," said Air Force 2nd Lt. Rebecca Slogic. "And we also get to learn a lot about treatment because we're there and hear the doctors telling the fourth-year students lots of information."

Army 2nd Lt. James Weightman, a firstyear student at the exercise said he likes working in a joint environment because we get to learn about each other's services.

"I don't know anything about ships but my friend went to the Naval Academy so he tells me about what's going on there. In the future I'm guessing we're going to have a lot of operations together so I think it's really important to learn how to work with each other and have the connections later on," Weightman said.

Retired Navy Capt. Charles Rice, president of USUHS said that joint service is one of the principles the university was built on.

"Students from all three of the military services, plus the public health service, learn from the very beginning how each service works," he said. "For example I was a Navy officer. I could never tell the difference between a battalion and a brigade but our students learn that. Another factor I think is very important is that they establish relationships with each other that they carry well out into their careers. We see that in combat operations. Say an Army doc at Baghdad needs some capability that the Navy has in Bahrain. Rather than having to go through the usual laborious process, he just picks up the phone, calls his classmate who happens to be down in Bahrain and says, 'Can you send me this and such?' and magically it happens."

Rice also feels training gets the soon-to-be graduating class more prepared for what they will see when they get out to the field.

"The Navy is playing an increasingly important role, particularly in support of ground operations in both Iraq and Afghanistan not just in support of the Marine Corps but increasingly in support of the Army," said Rice. "When injured troops are brought into a BAS or an EMEDS unit, they don't really care whether the people taking care of them are Army, Navy or Air Force. They just want to be taken care of. And that's what this training serves to do."

Blowers is a photojournalist assigned to Naval Media Center, Washington, D.C

Story and photos by MC2 Rebekah Blowers

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Title Annotation:operation bushmaster
Author:Blowers, Rebekah
Publication:All Hands
Geographic Code:1USA
Date:Dec 1, 2007
Words:1849
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