JOINT BASE LEWIS-McCHORD, Wash. (Nov. 13, 2014) -- Through layers of protective gear, Capt. Stacey Good quickly assesses her patient's pain levels, symptoms and recent travel history.

"Garth," an advanced patient simulator, responds through a remote operator that he returned seven days ago after surfing in Liberia, one of the countries currently affected by the Ebola epidemic.

What follows are a series of rapidly-changing medical conditions, requiring intubation, an IV, and suction -- all performed by a care team in tier 3 personal protective equipment, known as PPE.

Madigan Army Medical Center's special care teams started this advanced training on Nov. 6, at the Andersen Simulation Center here. Fifty-two Madigan providers, nurses and support staff will receive this training to prepare for the potential of caring for Ebola patients.

While all of the special care team members have already been trained on the meticulous processes of donning and doffing tier 3 PPE, training with advanced simulated patients gives care teams an added layer of realism.

"It gives you the confidence to be able to say, if you get one of these patients who comes in, 'I've done something similar. That motor memory is there. I know what to do to take care of them,'" said Capt. Stacey Good, an emergency room physician, who led an exercise care team of two nurses and two backup nurses.

Although "Garth's" medical conditions required that the team conducted common medical procedures such as checking his heartbeat and starting an IV, the limitations of wearing full protective hoods and the effects of Ebola on his systems required that they find unique methods to treat him. An ultrasound checked his heart rate and that the intubation was placed correctly, in addition to its usual function of checking for internal bleeding.

A traditional IV didn't work because of the advanced stage of his illness, so a nurse inserted a catheter directly into the tibia. Simply performing these tasks with three layers of gloves and the noise of the motors in their PPE made regular medical procedures more difficult.

But working through these unique challenges is the point of an exercise, as well as the touch of realism of operating in a mock intensive care unit.

"When you have a little bit more adrenaline, a little bit more rush, it makes you get to that real-life situation, and that's the practice that's important to take care of these patients," said Good.

The exercise also demonstrated to the care teams how well their PPE works to protect them. After the patient simulator mock vomited on the team, trainers used a black fluorescent light to show the spray pattern to include what was not visible to the naked eye.

"What the staffers see on their suits, that's easy to see and decontaminate; it's the stuff they can't see that we detect by using a fluorescent technique is really the danger," said Lt. Col. Mohamad Haque, director of the Andersen Simulation Center.

Care teams build their confidence in operating in their PPE through the training, said Kate Simonson, the curriculum development coordinator for the U.S. Army's Central Simulation Committee.

"They practice overcoming some of the barriers of practicing in the PPE, and they build competence in their ability to decontaminate," Simonson explained.

The decon process itself is very thorough and is done by a checklist in order to nearly eliminate the risk of exposure to staff, said Haque. He said the two big lessons learned in the exercise is the need for clear communication while wearing PPE, and the need to use additional technology while caring for Ebola patients.

"As we work the kinks out on this model, we're able to share it and get it out across the (Army)," Haque said.

In addition to training its special care teams in simulated environments, Madigan trained their front-line staff on how to conduct initial Ebola screening for its patients, and experts are continuing to refine their training and Ebola preparedness plans as they work with fellow professionals across other agencies.

All this leads the hospital to being extremely assured of its ability to protect staff, while safely caring for potential Ebola patients.

"I'm very confident that we're prepared to take care of any patients who may come to our doorstep with Ebola symptoms," said Col. Stephen Yoest, Madigan's chief medical officer.