BEMOWO PISKIE, Poland -- The Battle Group Poland conducted a medical shock of the 212th Combat Support Hospital, Oct. 25, 2017. After the forward surgical team's arrival to the Bemowo Piskie Training Area in Poland, a series of training events were hosted.

The purpose of the training was to codify international standard operating procedures related to mass casualty medical evacuations and further the interoperability between the United States and its allied forces supporting NATO's enhanced Forward Presence initiative.

"[This training] puts faces to names as far as who we are supposed to go to for medical evacuations," said Staff Sgt. Anthony Quitugua, 3rd Squadron, 2d Cavalry Regiment, medical platoon sergeant. "As far as the surgical team, it provides us augmented medical assets that can jump at a moment's notice to help support the role one operations."

Training in this capacity is a unique and educational experience for all parties involved. Participants in the training included soldiers from the 3rd Squadron, 2CR, the Polish 15th Mechanized Brigade, the United Kingdom's Light Dragoons and the Romanian Army's Ground Base Air Defense Black Bats. The language barrier amongst participants required medics to establish an innovative communication plan when applying care to simulated patients.

"We have come up with a rudimentary sign language system so that all of the nations can get the supplies expediently that we need," explained Spc. Richard Chaplin, Cobra Battery, 2CR line medic. "If we point to our nose, we need a nasal pharyngeal airway. If we take one finger and point to our chest, we need a needle chest decompression. If we take a full hand and put it over our chest, we need a chest occlusive dressing."

In addition to the language barrier, the medics on hand quickly recognized the triage identification system used by one nation was not identical to that of the others. The U.S. Army medics are trained to identify triage care based on immediate, delayed, minimal or expectant whereas the Polish and Romanian medics identify their patients' level of care using a color coded system. To improve interoperability and provide care more rapidly, all three languages and the color coordination system will be incorporated on signage for future medical operations and training.

Typically, a forward surgical team is made up of 20 personnel. However, for the sake of this training exercise, the surgical element was compromised of only seven medical personnel: one general surgeon, one certified registered nurse anesthesiologist, one intensive care unit nurse, one operating room nurse, one operating room technician, one operations officer and one generator mechanic. In addition, the team was able to travel with only seven medical chests as opposed to the standard 15 and still provide the same capabilities.

"This was a very open operation," said Lt. Col. George Johnson, 212th CSH, CRNA and team chief. "I was given pretty much freedom to do what I needed to do; what I thought was necessary. All of the things that I have done are really non-doctrinal. It is based on experience working with different special operation forces. I have incorporated that into this because it worked very well."

The 212th CSH provides role three surgical care for 126 countries across all of Europe, Africa and the Middle East. Due to a deficit in medical capabilities at the Battle Group Poland, it was recognized that the 3rd Squadron, 2CR could only move patients to the 108th Polish Military Hospital by air and moving soldiers by ground would cause a potentially detrimental delay in care. By establishing an augmented surgical team that can move quickly, 212th CSH can aid the battle group in medical operations in both a fixed environment and mobile field environment.

"We can provide surgical care far forward, we can move on our own, we don't require other support and we can stop bleeding basically so their soldiers can get to the hospital whereas otherwise they would have bled [out]," explained Johnson.

The surgical team successfully built a mission capable operating room at a field site located near the BPTA. A primary and secondary bed were put in place in addition to the operating table. At the field site, the forward surgical team could conduct five major surgeries and five trauma resuscitations prior to a resupply from the battle group's medical office.

"I think the greatest success was demonstrating that we can be a flexible surgical asset," said Johnson.

After completing the designated training, the surgical team assessed different ways their team could improve in the future in order to provide care in a more efficient manner.

"If we come back quarterly it has a couple of effects," said Johnson. "One, it trains new teams to be able to be flexible, think independently and move very quickly to provide surgical care. Two, it shows the 3rd Squadron, 2CR and our NATO allies that we are here to support them. The third thing is it is only going to make us better by practicing."

Continued training with NATO allies allows the teams to form strong bonds and gives one another an accurate assessment as to the prior training and experience level of the medical personnel on hand. When the FST returns to Rhine Ordnance Barracks in Kaiserslautern, Germany, they will compile a list of equipment used and documentation showing how it was organized in order to show future teams how they consolidated their capabilities.