When a real-world medical evacuation is reported, medics at the aid station kick into gear. They gather their supplies and prep their stations in anticipation of multiple casualties. Every situation is planned for and every type of injury considered. All that is left is to save some lives. This methodical approach is the result of intense, realistic training.

Medics with the 2nd Battalion, 198th Armored Regiment, 155th Armored Brigade Combat Team, and Mississippi National Guard conducted a mass casualty exercise, or MASCAL, April 16 at Fort Bliss, Texas.

The Battalion aid station received six simulated casualties, each with a different set of "injuries" meant to stress the team of medics.

"We were evaluated for our mass casualty exercise," said Sgt. Tyler Knox, a Brandon, Mississippi native, and the station's treatment noncommissioned officer in charge. "Essentially they bring us enough casualties from the line units to overwhelm the forward aid station and battalion aid station assets."

Senior leaders with the 177th Brigade Combat Team acted as Observer/Coach Trainers, or OC/T's, to watch and evaluate the medics in the high-stress environment.

"I'm a medical OC/T," Staff Sgt. Carl Adams, a Picayune, Mississippi native and medical operations noncommissioned officer with the 2nd Battalion, 351st Infantry Battalion, 177th BCT. "I'm here to evaluate their ability not only to handle a MASCAL but to effectively give health care to all of the Soldiers in their unit, whether that is preventative or active medical care."
Adams planned the MASCAL exercise. He constructed the situations, used realistic makeup for the simulated injuries and then followed the medics throughout their aid station as they tried to address various problems at a time.

The exercise started with medics on the ground calling in a medical evacuation after applying tactical combat casualty care by stopping any bleeding, dressing wounds and applying tourniquets.
As the MEDEVAC picked up the injured and delivered them to the aid station, Knox and his team of medics were standing by with latex gloves on their hands and stethoscopes around their necks.

As the treatment beds were quickly filled, communication became critical.

"The most important thing is always communication," said Knox. "These events tend to get a little chaotic. There are a lot of moving pieces and a lot of people doing a lot of different things at one time."

Knox started out by yelling out his patient's injuries and asks for any assistance he needed. The other medics did the same in regards to their own patients.

"We check for major hemorrhaging, making sure their airway is open, make sure they are breathing adequately and make sure they don't need fluid or resuscitation," said Knox.
Some beds cleared up quicker than others determined by the extent of the injuries. Knox's patient had extensive simulated injuries causing them to place the Soldier in the "expecting" category.
Knox said that having a casualty with fake blood, aesthetics and the pressure of being evaluated is much better than just talking about how to address certain injuries.

After the patients' injuries were treated and the appropriate care had been rendered, they arranged for an evacuation to a higher level of care, concluding the exercise.

"As an OC/T, I can drive by and you can see them performing normal day functions that are at a controlled pace and its calm," said Adams. "But the MASCAL puts stress on them. You see them in a stressful environment, how they can handle that stress and how they communicate and work together. Do they do the right things when things go wrong?"
Adams provided an after action review for the medics telling them what he noticed as they operated.

"I'm here to see overall how they do, what the quality of healthcare is, is it sustainable and is it the right way to do it," said Adams. "And if it is not the right way, we coach the platoon sergeant in the right way to do it. This is one of the best exercises you can give to a medical platoon."