FORT SAM HOUSTON, TEXAS -- Members of the Army Medical Department's 25 person elite Expeditionary Resuscitation Surgical Team (ERST) Training and Support Team received the coveted 2017 Army Medicine Wolf Pack Award during a ceremony held at the Army Medical Department Center and School (AMEDDC&S) Health Readiness Center of Excellence (HRCoE) on Dec.19.

The 2017 Army Medicine Wolf Pack Award was presented to the team by; Lt. Gen. Nadja West, U.S. Army Surgeon General and Commander, U.S. Army Medical Command; Maj. Gen. Brian Lein, Commanding General of the AMEDDC&S HRCoE; and Mr. Gregg Stevens, AMEDD Civilian Corps Chief. Accepting the award on behalf of the team was Col. Peter Cuenca, M.D. Director of the Center for Pre-Hospital Medicine.

The Army Medicine Wolf Pack award is sponsored by the AMEDD Civilian Corps to recognize and celebrate teamwork that drives excellence in outcomes supporting the Army Medicine mission.

The 25 person ERST Training and Support Team were presented the 2017 Wolf Pack Award for their meritorious efforts in training and supporting the U.S. Army and Navy's Expeditionary Resuscitation and Surgical Teams (ERST) for their preparation and deployment overseas. According to the Wolf Pack citation -- The team's determination and combined efforts improved the readiness of Army and Navy partners, and enhances the capabilities of the Joint Force.

"When there are service members in harm's way and need medical support, we must ensure we get the right capabilities to them as quickly as we can," said Lt. Gen. Nadja West, commanding general, U.S. Army Medical Command and the Army Surgeon General.

West added the creation of the ERST was an 18 month journey beginning when she was the Joint Staff Surgeon trying to find a way to support service members who were operating in austere conditions.

"The Expeditionary Resuscitation Surgical Training and Support Team provides much need medical support downrange. The team has proven to be an essential asset, to both our conventional and special operations forces," said West.

Maj. Gen. Brian Lein, commanding general of the Army Medical Department Center and School, Health Readiness Center of Excellence (AMEDDC&S HRCoE) said, "The Air Force and Navy said they are standing up very similar teams to what we did, not because of the mission but because the tenets that are taught are directly tied to individual and collective readiness of our small unit damage control resuscitative requirements on the battlefield today and will be the requirements of the multi-domain battle of the future."

How did the ERST concept come about?

The ESRT Training and Support Team concept was envisioned by the current Army Surgeon General and it provides advanced surgical, resuscitative and critical care to conventional and special operations forces operating in austere locations. The emerging operational environment presents a new challenge to Joint Forces, the Army, and the Army Medical Department. As such, the AMEDD must be prepared to support the Multi-Domain Battle using capabilities in more innovative ways to overcome the challenges that the future fight presents. To this end, the Expeditionary Resuscitation Surgical Team (ERST) has proven to be an essential asset to conventional and to special operations forces elements as they seek to outmaneuver adversaries on a highly lethal battlefield.

According to Capt. Joel Budd, Officer in Charge of the ERST Training and Support Team said, "The ERST concept and capability was derived from the need for specialized surgical capabilities in austere environments that push the one-hour 'Golden Bubble'. The format for the ERST has been around Special Operations communities for many years. The ERST program extends and specializes what they created for other forces to benefit from."

Budd added, "The ERST Training and Support concept started back in January 2016 with the first team deploying in May 2016. As a team, they deploy as an expeditionary, rapidly deployable Resuscitative Surgical Team (RST) to provide immediate forward resuscitative surgery, prolonged field care and en-route critical care in support of full spectrum Special Operations Forces operations including Foreign Internal Defense, Counterterrorism, Direct Action, Security Forces Assistance and Counterinsurgency, in austere environments."

ERST Program Director, Mr. Russell Moore said, "The training for the ERST team is spread between Ft Sam Houston, Texas and Camp Bullis and lasts up to three weeks. The primary focus for the team is to learn how to work together as a team."

"They (ERST) are each excellent practitioners in their field. We teach them how to work with less, in the dark and in the worst environments. Much of their time is spent conducting mock mission planning and surgical exercises and then "hot washing" them to figure out how to do it better, faster and more secure. The subject matter experts are integral in helping their decision making process and priorities work," said Moore.

The ERST training process:

All ERST members undergo an Army Medicine Medical readiness skills (pre-deployment) session, utilizing the Interactive Training Approach (ITA) based on evidence generated in the Squad Overmatch Tactical Combat Casualty Care (TC3) Study. This approach uses realistic scenarios including both simulation and live model training to introduce graduated stress with increased complexity. This process engages the learners by leading them to interact with and be immersed in the training environment for the purpose of accelerating cognitive realism.

The medical team recertifies their skills on the most current TC3 guidelines to include, but not limited to, hemorrhage control, penetrating chest trauma, intravenous and interosseous access, amputations, fracture management, ocular trauma, and prolonged critical care transport in an austere environment. This recertification results in a field training exercise that evaluates the Casualty Evacuation, Emergency Resuscitation, Surgical Resuscitation, and Critical Care Transport Capability of the team.

How are members of the ERST selected and what skills do they have?

"The instructors at the AMEDDC&S Tactical Combat Medical Course, (TCMC) are the lead personnel behind the ERST training mission. Most, if not all, team members are prior Special Operations Physicians Assistants (PA's) with exhaustive experience in this field and with setting up programs like ERST. They headed up the initial response to the request for training from the The Army Surgeon General, said Moore.

Moore added, "Members of the Subject Matter Expert (SME) support team are picked according to their specific skill set that can contribute to the team's mission and success. Each ERST team member is provided a dedicated SME to work with. Only the best SME's are selected from their field."

Expeditionary Resuscitation Surgical Teams (ERST) are typically comprised of the following skill sets:

(Tactical Combat Medical Course (TCMC) Support Personnel)
Department of the Army Civilian Instructor Physician Assistants (PA's)
Army Instructors, Physician Assistants (PA's)
DA Civilian Critical Care Nurse Instructor
DA Civilian Program Manager
Soldier Support Detail

(Veterinarian Support)
Veterinarians
Veterinarian Technicians

(Subject Matter Experts)
General Surgeon
Orthopedic Surgeon
Emergency Medicine Physician
Critical Care physician
Nurse Anesthetist
Critical Care Nurse
Emergency Medicine Trauma Nurse
Operating Room Technician

"To date, the ERST has proven to be an essential asset to our Special Operations Forces (SOF) by significantly reducing access time to damage control surgery effectively mitigating the risk and sought to outmaneuver adversaries on highly lethal battlefields in their area of operation," said Capt. Budd.

"This is a stark reminder of the impact of the development and deployment of these lifesaving surgical teams who directly support SOF and conventional forces in the bid to defeat terrorists wherever they may find safe haven in ungoverned, austere environments across the globe," he added.