Future operations may demand the capability for sustaining a casualty in a place where little to no medical support beyond the combat medic is available. Army Medicine seeks to close this current capability gap with the Delayed Evacuation Casualty Management (DECM) course. DECM provides the medic with prolonged field care training and critical care techniques that prepare them to stabilize and sustain a casualty in an extended care scenario. Womack Army Medical Center completed their third iteration of this course Feb. 9, with aspirations of spreading the program Army-wide.

DECM was implemented as a result of the findings from a 2012 study released by the U.S. Army Institute of Surgical Research that stated 25 percent of combat-related deaths in Operation Enduing Freedom and Operation Iraqi Freedom were preventable.

The coursework for DECM was established from those findings and the need to fill the current medic capability gap.

Command Sgt. Maj. Uriah Popp, WAMC command sergeant major, equipped with a Special Operations medic background, cultivated a team to develop the training plan with research provided by the Prolonged Field Care Working Group.

"This course directly supports one of the Army's top 10 problems and was designed to mitigate the medic's ability to hold and sustain life in an environment where we either lack air superiority, or the ternary of distance to the next echelon of care necessitate prolonged field care," said Popp. "What we are doing is creating a more capable medic that expands the freedom of maneuver for commanders." This latest iteration of DECM training led by Womack cadre hosted 21 students from the 44th Medical Brigade, 82nd Airborne Division, 4th Ranger Training Battalion and four Womack Soldiers.

Sgt. Brittany Kopera, an instructor for the DECM course and noncommissioned officer in charge practical nurse in the intensive care unit, expressed the importance of the course and what the training means for all Army medics. She said that throughout the week of training students learned what actions are needed to perform prolonged combat casualty care and what effect that will have on a patient long term, if they cannot evacuate promptly.

"They are being tested out on their ability to perform critical skills, critical thinking and managing their casualty in a long-term setting," said Kopera.

She also acknowledged the support from Fort Bragg units during the course.

"We have had a lot of really great support from the surrounding Fort Bragg units, which has enabled for the training to be pretty effective," said Kopera. "One thing we have noticed in medical training is that medical personnel may notionalize. So, this is key in what DECM pushes, to perform the interventions and see what that effects in their casualty. Saying it and doing it are two different things."

The curriculum consists of focusing on mitigating what is known as the lethal triad. Combat casualties often experience three compounding factors that lead to their death. These are hypothermia, acidosis and hypovolemia or dilutional coagulopathy. Simply stated the medic must be able to: Administer Fresh whole blood, not normal saline IV solution; warm the casualty, and control breathing volume and rate to help control the acidosis. Soldiers also learn the importance of hypovolemic fluid resuscitation which prevents blowing out clot formation on non-compressible injuries such as penetrating chest trauma.

Sgt. 1st Class Goeun Crabtree, a DECM student and medic at Clark Health Clinic, participated in the most recent training and said she obtained valuable skills needed for the battlefield.

"I truly do feel that other medics will benefit from this course because of its content, the practice of skills in a clinical setting, and improving skills at the tactical level," said Crabtree. "The course successfully combined advanced medical skills in learning scenarios that Army medics need to experience and learn."

The next Fort Bragg DECM course is scheduled to host units from Fort Campbell, Kentucky; Fort Drum; New York and Fort Benning, Georgia.