332 EMDG, coalition partners train in Mass Casualty exercise Published Oct. 30, 2019 By Tech. Sgt. Satran 332d Air Expedititionary Wing Public Affairs SOUTHWEST ASIA -- In the golden hour when Airmen have been wounded, medical teams combine forces to make every minute count treating patients and saving lives. The 332d Air Expeditionary Wing coordinated a Mass Casualty (MASCAL) exercise on Oct. 16, 2019. Several key players from the 332d Expeditionary Medical Group and coalition medical team partners from the Royal Jordanian Air Force (RJAF) and German Air Force partnered together with the 332 AEW first responder units. The training exercise was multi-faceted with partner nations and first responder units, however this event focused on three objectives. “The objectives were building regional security cooperation, developing trust and strength through international coalition partnerships and providing effective multi-lateral operations among first responders working alongside coalition partners,” said Col. Garrison, 332d Expeditionary Medical Group commander. To meet those objectives, multi-lateral operations was initiated during the crawl stage of planning the exercise. “We sat down with the RJAF and German medical teams to discuss universal healthcare protocols and terminology so all medical teams were all on the same page,” Garrison said. It took several months to plan the ‘crawl, walk, run’ stages for the exercise to ensure everyone involved understood medical evacuation drills for loading and unloading of patients according to Garrison. “We set up training so we could all discuss litter carries to and from the medevac Super Puma,” said Garrison. “Every effort was made to ensure appropriate medical care was given on internationally accepted medical practices.” A Super Puma, the 24 passenger medium-sized helicopter, was the contingency in the exercise to test the capability of air versus ground transport, however on the ‘run day’ it was unable to arrive due to weather. But, this did not hinder the training. To build regional security cooperation, Garrison and her team coordinated transportation capabilities for medical support both on the ground and in the air. She liaised with the RJAF Air Mobility Wing commander, RJAF Surgeon General and U.S. Embassy, to discuss medical evacuations in the event of a MASCAL. The ‘Walk’ Stage This training stage involved a mini-MASCAL exercise consisting of only 332 EMDG Airmen and coalition partners observing. The training consisted of ten Mass Casualty patients where the 332 EMDG demonstrated population-based care and the management of disaster-related injuries caused by traumatic events. “The two partner nations were interested in how we did our litter training and litter carry techniques,” said Staff Sgt. Ewers, 332 EMDG Field Response Team NCO in charge. “We shared safety information and how to load patients in ambulances and the Super Puma.” After the ‘walk’ stage was completed, Ewers began scripting lessons learned for the ‘run’ day and stated, “I created the Field Response Team annual training to train the FRTs and the litter training for all three nations after this exercise in preparation for the ‘run’ day.” The ‘Run’ Day As the sun was rising, a ‘simulated’ active-shooter roamed through a part of the base, shooting multiple people. A call went out for help and 332d Expeditionary Security Forces patrolmen arrived to neutralize the threat. Once the threat was neutralized and the scene was safe, 332 ESFS patrolmen called for additional first responders. Moments later, first responders to include base fire fighters, the 332 EMDG Field Response Teams, RJAF Flight Surgeons, and German EMTs arrived on scene. The rapid-response was an electrified frenzy of first aid. Each nation’s medical team took care of one patient, triaging simulated gunshot wounds, checking for heartbeats and airways, applying direct pressure to stop the bleeding and prepping the patients on litters to transport to the 332 EMDG clinic, this all-in approach happening simultaneously. “We worked as one, it was incredible,” said Col. (Dr.) Govil, 332 EMDG Field Response Team chief, “We provide support for the airmen if there is a MASCAL. If that happens, we have all the support coming in with three nations working together and we know how to talk with one another to protect whoever is here.” Govil was seen going from team to team, each with a patient, to ensure each team had everything they needed, along with monitoring the ‘golden hour’ survival rate of the patients. “For this issue, if you are shot, you have one hour from when it happens to the point you are brought onto an operating table,” said Govil. “After that hour the chances of survival fall. What we were trying to do is test the time to maintain the golden hour.” To maintain the golden hour, all three nation’s transported the patients to the 332 EMDG clinic and simulated triage. Every medical personnel was participating, either simulating direct pressure to stop bleeding or intubating, giving patient’s oxygen. “I think the FRT performed phenomenally, we worked together as a team and handled the entire scenario quickly, meeting the goal of transporting our patients within fifteen minutes of the golden hour,” said Ewers. “Staff Sgt. Zaro, 332 EMDG FRT member, stepped up and stayed behind to coordinate with the Fire Department to be a medical coordinator to answer any questions they had.” For Staff Sgt. Ramsburg, 332 EMDG field response team member, this training was more than just an exercise. “Anytime you’re working with someone else you don’t normally get to work with, it opens up the idea of possibilities,” said Ramsburg. “When you add synergism between people you have more opportunities to find the best route for healthcare. It keeps growing and developing because you find better options the more times you train together.” In the heart-pounding emergency room, a simulated call was made to get the Super Puma. The trial run was set, an ambulance versus a helicopter from a neighboring city. Even though the helicopter was unable to join in on the rescue transport, the teams loaded up patients onto the ambulances and convoyed to the helipad location. One of the exercise planners, Capt. Bradley Strenn, 332 EMDG executive officer, stated, “This exercise brought genuine excitement and willingness to get done what needed to be done.” “Each nation and everyone involved had a clear understanding to care for a patient. It was awesome to see,” said Strenn. Once the three ambulances reached their destination, they simulated off-loading the patients for transport. The training exercise concluded with warm handshakes and big smiles amongst all the coalition partners. The glowing pride for each individual’s participation and partnership was felt across all of the teams. “It’s all about saving people’s lives,” said Garrison. “To do right by our patients, bringing them back to the clinic for sustainability and transport where they need to go, we want to make sure we get it right the first time.” Garrison also stated that the 332 EMDG’s relationship with all the coalition partners will continue on and more is to come. “Only as a team can we effectively demonstrate the ability to integrate capabilities with our coalition partners and provide an effective collaboration that strengthens trust. This teamwork effort will be captured in operational plans to set the framework for future operations that safeguards regional security cooperation,” Garrison said.