FORT RUCKER, Ala. (Sept. 10, 2015) -- Treating severely wounded patients is a serious challenge under the best of circumstances, but trying to save lives in the back of an aircraft hundreds of feet in the air while getting buffeted by gale force winds in a cramped environment with loud noise all around can greatly complicate matters.

That's what 11 flight medic students of the U.S. Army School of Aviation Medicine, or USASAM, had to endure during their third week of training as they took to the skies to practice their potentially life-saving craft.

During the realistic scenario, students got the chance to get hands-on MedEvac training as they took turns loading into UH-60 Black Hawks to be taken to a simulated mass casualty site, according to Capt. Lani Pineda, USASAM En Route Care Branch director.

"They got a call, and they had to gear up, run out to the aircraft and then fly out to the point of injury, and that's where they had to assess their patients," she said.

There were three patients with varying levels of injuries that the students had to assess and treat as soon as the aircraft touched down. After the assessment and initial treatment, the most critical of the patients were loaded onto the aircraft to be taken to the nearest hospital, but while en route, the students had to maintain treatment.

It was completely up to the student to make the assessment on who to treat and which patient was in most need of care -- the scenario was unknown to them before taking flight, said Pineda.

"They assessed the patients to see which was, for the most part, stable and which needed immediate attention, and we even had one simulated patient who had passed away," she said, adding that when students encounter patients who are dead on arrival, they must understand that there is nothing they can do for the deceased and move on to the next most critical patient.

The training is new to the school and isn't something that has been performed in the past, but Pineda said it's a necessary addition to the school because simulations can only teach so much.

"We really just want to bring in what it feels like to actually be in that setting," she said. "We have the simulators at the training complex, which are great, but there's nothing like being in the back of an aircraft with the rotor wash and everything to put those stressors on (the situation)."

The opportunity for the addition of the exercise came as the course was restructured to a shorter course due to the paramedic program starting at Fort Sam-Houston, Texas, said the branch director.

'We had to kind of revamp our role here. In the past, the flight medic course was strictly here, but now that the students are coming here with that knowledge already, we had to revamp the curriculum," she said. "The amount of time we spend on how to treat patients is down to about half the class period -- the first half of the class is mostly about crew coordination.

"This is the third week of training, and we start to refresh them on a lot of their medical skills and what the difference is on how to apply what they know when they're in the back of an aircraft," she said. "All of these students are new paramedics to the Army, and we all know that they're very smart and know how to do their treatment, but it's a matter of how to (practice) that in the back of the aircraft -- this makes it real for them."

Pineda said that most experienced flight medics agree that one can't truly be tested unless they use their skills in the back of a moving, flying aircraft.

"When I went through the school, it was all simulation, so the first time (I got into an aircraft), I didn't really know (what to expect)," she said. "The first time I was in a helicopter was when I was in Afghanistan (on a mission), and I felt like I hindered the mission more than I helped, even though I felt very confident as a medical practitioner. It's just a whole different experience."

The intent is to be able to have the STX as a regular part of the course, which may not always be a possibility due to the amount of support needed for the flight hours, Pineda said.