Emergency medicine physicians participating in BAMC's Emergency Medicine Exercise 2021 learn the importance to a smooth tirage process during a simulated mass casualty event. (U.S. Army photo by John T. Franklin, III)

Students in the Combat Casualty Medical Care Course at Ft Sam Houston experience aiding injured soldiers in the field compared to in a medical facility. Emergency Medicine physicans completing their intership at the hospital particpated in the yearly Emergency Medical Exercise to gain awareness of the challenges of caring for patients in remote locations without an established medical facility. The exercise was coonducted at Ft Sam Houston and Camp Bullis. (U.S. Army photo by John T. Franklin, III)

Physicians completing their Emergency Medicine internship at BAMC experience the challenge of examining a Military Working Dog that may have been injured along with its human handler. "Diesel Dog" is a remotely controlled training manikin that was at the exercise to give the physicians some experience with K-9 patients, not their normal clientel, but also possibly wounded and no veterinarian available in remote areas. The BAMC Emergency Medicine Exercise gives the physicians an awareness of practicing medicine in remote areas of the world. (U.S. Army photo by John T. Franklin, III)

Ambushed at the gate, BAMC Emergency Medicine physicians experience the challenges of providing emergency medical care during the Emergency Medicine Exercise 2021 at Camp Bullis. Combat experienced emergency medicine doctors oversee the care during the simulated attack. (U.S. Army photo by John T. Franklin, III)

JOINT BASE SAN ANTONIO, Texas (Aug. 4, 2021) -- Sixteen Emergency Medicine physicians recently completed their training at Brooke Army Medical Center and are now headed to their new duty assignments at units across the globe.

Although some will be assigned to facilities similar to BAMC, many will be deployed to locations where state-of-the-art care is not available. During their last months of residency the doctors trained in combat-related trauma casualties in BAMC’s Emergency Department, and participated in the Tactical Combat Medical Course taught by the U.S. Army Medical Center of Excellence.

“This course is more tailored to medical personnel who may be about to deploy,” explained Army Maj. Darren Hyams, one of the BAMC Emergency Medicine doctors managing the training.

During the five-day TCMC course, the physicians learned what medics face in providing care on the battlefield. Physician assistants, who have had multiple deployments in combat areas overseas, taught the course. During the training, instructors shared their years of practical experience with the students.

The final week of training, the doctors “deployed” to Camp Bullis for some hands-on experience with emergency medicine in an austere environment. Army MEDCoE and Critical Care Air Transport staff provided support to assist the ER physicians using simulations to ensure the doctors understood the process from a casualty’s point of injury to the movement out of the field and into a well-equipped facility. Many experienced trauma doctors, including retired military doctors, came out to volunteer their help to coach their fellow trauma doctors.

In one scenario, a medic played the role of a seriously wounded Soldier being sent to surgery. As the surgeon and EM doctor discussed what kind of care the casualty could receive at a forward location, the medic role player asked the two doctors what he could do in the same situation. After getting some coaching from the more experienced doctors, the medic resumed his role play as the very seriously injured patient.

In addition to getting training on care for human patients, this year, the doctors learned about how to help Soldiers’ four-legged partners.

“What is the first thing you do for a wounded military working dog?” asked Army Capt. Elizabeth Punger, a doctor with the Army Veterinary Corps. “Make sure the muzzle is on,” she told them.“They really like to bite. The dogs get a strong endorphin release when they score a full mouth bite.”

Punger brought “Diesel Dog” to the training. “Diesel Dog” is a robotic K-9 Military Working Dog simulator that weighs as much as a real MWD.

As part of the exercise, the doctors received training on how to handle a MWD with gunshot wound. During the training, Punger provided the doctors with an added layer of realism with Diesel Dog’s growls, yelps, and whines. The simulated dog, with Punger’s control, also changed its breathing rhythms during treatment to provide a more realistic scenario

Throughout their time at BAMC, the EM Department staff worked to ensure the graduating doctors receive the most comprehensive combat casualty care possible. The overarching goal is to train emergency medicine physicians to provide world-class emergency medical care for deployed military personnel.