FORT RUCKER, Ala. -- Some of the most stressful situations imaginable just come with the job for flight medics, and the staff at the U.S. Army School of Aviation Medicine makes sure its Soldier students are adequately trained to take on any situation.

Thirty-two students from USASAM's Class 18-174 recently took part in a mass casualty exercise as the culminating portion of their training that put the medics' skills to the test in an atmosphere of chaos, according to Sgt. Gaston Garcia, USASAM flight paramedic instructor.

The Soldier-students come from all over to complete the final stage of their training as a flight medic, with the MASCAL exercise testing their knowledge in a real-world scenario, Garcia said.

"These students are coming down here from Joint Base San Antonio (Texas) where they had six months of paramedic training, as well as three months of critical care training, so they come here with a vast knowledge of their medical expertise," said Garcia. "This is the final phase of their pipeline and we kind of operationalize the medicine portion of it -- how to treat patients in a confined area."

The exercise itself exposes the students to a hectic scenario where they must treat three or more patients, as well as exposes them to the stressors of patient triage, in-flight patient care, patient treatment and how to control the scene in a chaotic situation.

During the scenario, the flight medics were called to assist in an event where multiple injuries were reported. From the initial report, they had to board a UH-60 Black Hawk that took them to the point of injury, and during the initial flight were briefed on the event, which would give them some time to figure out how they wanted to approach the situation.

Upon landing, the students had to egress from the aircraft and rush to where the patients were waiting, each of which sustained different injuries the students had to treat.

"We had a patient that was a single-leg amputation, another patient was a gunshot wound to the chest and the third patient was (killed in action)," said Garcia. "(The students') job was to identify who takes priority."

Up until the exercise, the students were trained with classroom and simulation training, and for many of the students, the scenario added a true sense of realism to what they will have to endure in their profession, which included not only having to deal with different aspects of the aircraft, but having to deal with others on the ground and how to interact with them.

"Having the added stressors were very helpful (in the training)," said Spc. Sarah Hanna, a student from Knoxville, Tennessee. "I haven't' yet been deployed in a combat theater, but I have worked in civilian EMS, and even within the civilian practice you may have people on scene who are shouting and distracting you, not necessarily because they are trying to, but because they are upset and don't understand what is happening.

"So, you may have to direct people who are there to do different things to overcome those barriers of stress and noise," she said. "I thought that was a really good facet to include in the training.

For Staff Sgt. Mark Howard, C Co., 187th Medical Battalion, Fort Sam Houston, going from simulation to the actual aircraft training wasn't as big of a transition as he thought, since much of what he encountered was covered in the training leading up to the exercise.

"It didn't seem like a big transition," He said. "When we were in the simulators, I felt like there was a lot more stress put on us -- there were a lot more injuries and a lot more critical thinking had to go on.

"Once we got into the back of the actual helicopter, for me, I barely even noticed that it was moving because I was so focused on patient assessment and treating the patient," he continued. "They put us in that red zone of training so much that when we got to the actual (exercise) and it was time to treat, that's all we were focusing on."

For Howard, the main difference was the realism that the exercise provided, including the extra players at the point of injury, as well as in-flight time to the patients.

"It gave us a lot more time to formulate our plan, figure out how we want to attack things and overall just figure out how we want stuff to run," he said. "Of course, when you get on the ground you have to alter your plan, but it gave us a little more time to get a better base."

Although many of the students said they were well equipped to take on the scenario, the purpose of the exercise was to make sure that each of the flight medics would be able to handle the stresses that they'll endure their real-world environments, said Garcia.

"This is very important for the students because most medical is done in a controlled environment -- a clinic, emergency room," said the flight paramedic instructor. "When we do this type of training in a helicopter, it's not that controlled, so actually exposing them to those stresses of flight is vital, especially when they go downrange."

"I do think this is very helpful training for multiple reasons, but the biggest one for pre-hospital medicine, there are a lot of similarities between civilian and military," added Hanna. "But operating specifically in this airframe and the guidelines given for military is a very specific skill, and this is the only place that I've seen that critical care paramedics hone those specific skills."