JOINT BASE LEWIS-MCCHORD, WASH. -- Many Army doctors may spend a fair amount of their careers practicing medicine in a large MTF (military treatment facility). But, what they must always be ready for is rendering life-saving care in the most austere of environments -- of caring for the Soldier down range. For all the care they give in garrison, the Soldier on the battlefield is their ultimate priority.

"You may be an excellent provider or physician within your MTF, but when you go into operational medicine, that's a whole different area of practice," said Lt. Col. Thomas Bryant, Interservice Physician Assistant Program Phase II coordinator and deputy director of operational medicine at Madigan Army Medical Center.

Over the last eight years, Madigan's Graduate Medical Education and the Andersen Simulation Center (Sim Center) have been staging and expanding a culminating event, known simply as "Capstone", that ends with a field training exercise (FTX). This year's event, which spanned April 23 through 27, provided graduating residents at Madigan a chance to understand what operational medicine performed in a tactical setting is like.

This year's FTX involved units across Joint Base Lewis-McChord to include the 1st Special Forces Group (1SFG), 62nd Medical Brigade (62nd MED BDE), 7th Infantry Division, the 66th Theater Aviation Command (TAC) with the Washington Army National Guard (WAANG), and the U.S. Air Force's 446th Aeromedical Evacuation Squadron.

"The entire experience was extremely humbling and eye-opening. I've been in the Army for nearly 18 years now, and I've never really experienced that specific aspect of it. Trying to do the job the medics do -- it's not an easy job. It just gave me even more appreciation for what the medics do to get that patient to me so I can cut them open and fix them," said Capt. (Dr.) George Black, a surgical resident following a week of professional, simulation and field training that culminated in the FTX.

A substantial development over previous events -- the inclusion of 1SFG -- resulted from feedback from last year's exercise that expressed a need for more weapons familiarity and tactical exposure. The 1SFG also enabled the use of JBLM's premier training site -- Leschi Town.

Prior to the field exercise, residents participated in classroom and simulation training that reviewed the M.A.R.C.H. algorithm -- massive hemorrhaging, airway, respiration, circulation and head injury/hypothermia -- used for assessing a patient in a trauma situation.

Maj. (Dr.) Jeffrey Burket, a family medicine physician at Madigan who was involved as faculty for the FTX, stressed that the residents need to rely on that algorithm because, "Nobody gets smarter in an emergency."

The mission for the residents was complex. In configurations of eight teams of four to five residents and a nurse, they collected and prepared their equipment, received a mission brief and rolled out.

At Leschi Town, the teams worked along one of two lanes that lead them through the continuum of care from point of injury to a combat support hospital or MTF.

With the 1SFG Soldiers, they performed a care under fire tactical field care urban patrol, administering tactical combat casualty care (TCCC) throughout, moving through the different levels and roles they are likely to find in a deployed situation -- a casualty collection point (CCP), battalion aid station (BAS) and forward surgical team (FST). In addition to the care on the ground, they loaded, unloaded and performed medical interventions on casualties with various aircraft to include a UH-60 Blackhawk, a CH-47 Chinook and walking through a C-17 Globemaster III, a critical care air transport craft. They also treated their patients in a Stryker ambulance.

In assessing the exercise once complete, residents and faculty agreed it displayed how vital teamwork and communication are.

Staff Sgt. Virgil, an "18 Delta" or Special Forces medical sergeant with 1SFG, said the exercise showed, "How much you have to rely on people that you go to support."

Maj. (Dr.) Michael Braun, flight surgeon with the WAANG's 66th TAC, explained, "When we're deployed, we're all the same unit."

While a two-day exercise could never prepare a doctor for an operational situation, it did give a realistic view of what a day downrange could be for them. They dealt with equipment breakdown, running out of supplies and a need to improvise.

Speaking to all those points, Braun said, "The training was more realistic than you guys would imagine."

Throughout the week, the field exercise and the eight months it took to plan the event, relationships were established and strengthened. Relationships that will be relied upon for years to come.

"That's how the Army works -- you could call one of us five years from now and we'll say, 'Yeah, what do you need?'", said Braun, the main link to all the units involved.

At JBLM since 2008, Braun has been assigned to 1SFG, Madigan and brought his current unit, the 66th TAC, their Blackhawks, Chinooks and expert aviators to the exercise.

Lt. Col. (Dr.) Christine Vaccaro, Sim Center director, was one of a number of facilitators for the event to point out its training capacity. "This event is very unique, no other (medical center) has this. It's a benefit for our residents and the other units as well. Mutually beneficial is our watchword," she said.

As Braun and Col. (Dr.) Imad Haque, surgeon and deputy director of the Sim Center, both added, all units were accomplishing their own training objectives within this exercise.

Haque offered the example of the 62nd MED BDE's 102nd FST involvement. Their unit stood up and broke down the FST and provided that portion of training each day. This provided a validation of their own readiness for their upcoming deployment in the next month.

From the 1SFG's perspective, the exercise fit right in with their interest in joint training.

"Any opportunity we have to work with conventional forces means that that relationship down the road is one that we can take advantage of later and the relationship is already there," said Virgil.

In addition to the training element, every unit found this opportunity appealing because of the exposure to other units and their personnel's roles. "That entire concept is one of the main reasons this is such a big deal to us as an organization," explained Virgil.

1SFG brought the concept to life, infusing it with more realism than it had in previous iterations.

"We took Col. Haque and Lt. Col. Vaccaro's concept and did the (noncommissioned officer) job of actually putting it down on a piece of paper step-by-step to validate the feasibility of actually doing those concepts," explained Virgil.

Braun would like to see this become a launching pad for future training efforts. "We hope to model it for other states and other MTFs," he said.

As Madigan's graduating residents leave the well-stocked hospital as they are assigned to other locations, some operational and austere, they will have a greater appreciation of all these other assets that play a role in Army Medicine. They will also now have a sense of what downrange medicine will include.

Editor's note: Due to the mission of Special Forces Soldiers, some members of the 1st Special Forces Group (Airborne) do not release their full names.