BAGRAM AIRFIELD, Afghanistan (March 28, 2013) -- Medics rush between multiple patients, evaluating, treating, and preparing them for evacuation.

"Shrapnel to the lower extremity. Vital signs are stable right now. I put on a tourniquet and dressed up the wound," a medic reports.

"Is she breathing?" asks another.

"Rapid breathing, but she was screaming at me in pain."

For these medics from Headquarters and Headquarters Company (HHC), 555th Engineer Brigade, Joint Task Force Triple Nickel, it was an intense, fast-paced, chaotic day in eastern Afghanistan.

But it was also just a training exercise -- fake blood, fake wounds, fake screams.

The scenario: a simulated mass casualty incident (MASCAL) just outside the brigade's headquarters, which is the command element for the U.S. Theater Engineer Brigade.

Medics and other soldiers of HHC, 555th Eng. Bde., from Joint Base Lewis-McChord, Wash., conducted the MASCAL exercise here at Bagram Airfield, March 24, to better prepare the unit in case of a real emergency on base.

Company and brigade leaders observed as the team carried out critical lifesaving procedures in response to an incident involving seven simulated casualties with various levels of injury.

These first responders had their work cut out for them.

With a life-and-death sense of urgency, they had to retrieve and prepare medical equipment, receive and assess the wounded personnel, begin essential life-saving care, categorize and position the patients by order of urgency (immediate, urgent, delayed, and expectant), continually track and report casualty status, then prepare them for evacuation to higher-level care, starting with the most critical yet treatable wounds.

"It felt overwhelming," said Spc. Joshua Adams, company medic and triage officer responsible for leading the medical response on the ground. "There's so much going on at once, you've got to slow down and process everything that's happening," he added.

That's no small task in a situation that demands an immediate, decisive, and correct response to various medical emergencies unfolding all at once in real time, especially while enemy threats may still linger close by.

This was the first time Adams, a Louisville, Ky., native, has served as the triage officer, responsible for casualty tracking, overseeing treatment, preparing the patients for evacuation to higher-level care, and maintaining overall command and control of the team of medics and combat lifesavers.

"It was good to work with all the medics and see how they react to the stresses of being in a MASCAL," Adams noted.

A Soldier with sights set on promotion to Sergeant, Spc. Adams also considered this a valuable opportunity to develop his leadership skills in a challenging yet important way.

For all the soldiers involved, the value and realism of the training were apparent.

Added stresses were mixed into the scenario, pushing the medics and Soldiers beyond their comfort zone.

Staying "in character," Spc. English Mclemore played a delirious and belligerent casualty, lying on the ground with a bloodstained uniform, arms flailing and resisting help as she yelled nonsensical things like "Barbeque DFAC!"

Meanwhile, some of the first-responders became casualties themselves -- a deliberate but previously unannounced part of the commander's training plan -- in order to maximize learning and develop an adaptive, resilient mindset within the unit.

"It's important in this instance that we did it in a way so the soldiers weren't ready for it," said Capt. Matthew Pride, HHC commander, from Staten Island, New York, "including having some of the casualties being the combat life savers that we identified to respond to the event. So that was a big surprise and is something that rings true to real life."

Overseeing the exercise was Maj. Khalid Jaboori of Ft. Wayne, Ind., JTF Triple Nickel's brigade surgeon. He helped ensure the training was realistic, unpredictable, and all-around effective.

"Obviously there's that initial shock when you see a patient for the first time," Jaboori explained. "Once we get settled in and the training kicks in, it goes into automatic mode."

For Pvt. 1st Class Alicia Baum, a company medic from Fresno, Calif., this was her first MASCAL training exercise while deployed.

"It was a good chance to see how things were organized and really get a chance to see how it's going to go down in a real situation," Baum said.

Leaders were quick to note, however, these exercises will be ongoing, as the company continues to hone its training and readiness for real emergencies.

"It's important for all our soldiers to rehearse their battle drills and stay proficient in all their tasks," said Pride. "Because you're in a combat zone, training doesn't cease. You always rehearse-rehearse-rehearse, and that's a critical function of being battle ready."

The medics are already looking at how they can improve and continue to build on the training.

"I think this gives us a real good standpoint for where we're at in training … and what we need to focus on," said Staff Sgt. Maria Morales of Turlock, Calif., senior medic and medical section non-commissioned officer-in-charge for JTF Triple Nickel.

"We always can work on better communication," said Baum -- in an assessment shared by Adams.

"The biggest thing that could help is communication," Adams said. "I could talk more with the medics and have them closer to me, so I can better control how they're treating patients and keep better accountability of casualties."

Maj. Jaboori looks forward to applying these lessons learned, continuing the training, and ensuring his team is fully ready whenever called upon.

"I know there's a lot of things to work on still," said Jaboori, "but this is why we do training, so we can train, see what our deficiencies are, and correct those, before there's a real event in which they need to use their skills."

"Hopefully this is a good learning tool for these medics and the company," he added, "and eventually we'll correct these deficiencies so we'll be 100 percent ready to go if we ever need to."

JTF Triple Nickel, headquartered by the 555th Eng. Bde., serves as the U.S. Theater Engineer Brigade in Afghanistan, with about 5,000 engineer soldiers, sailors and airmen operating across the country. For more information, visit