JOINT BASE SAN ANTONIO, Texas -- Brooke Army Medical Center participated in two major exercises to test the organization's ability to handle a significant amount of casualties using two different scenarios.On Nov. 4, Brooke Army Medical Center (BAMC) participated in a Forces Command Emergency Deployment Readiness Exercise, testing the staff's ability to receive and provide definitive care to combat wounded as part of its Role IV wartime mission."This exercise demonstrates how we would typically execute our casualty receiving mission in the height of operations during wartime," said BAMC Commanding General Brig. Gen. Wendy Harter.Using an Air Force C-17 Globemaster transport aircraft, three Blackhawk medical evacuation helicopters and hundreds of personnel, the joint exercise included the cross-country transport of simulated critically wounded troops from the point of injury to a combat support hospital in a theater of operations for initial stabilization. The critically wounded troops were then transported across country from the combat support hospital to BAMC for definitive lifesaving care at BAMC's Level 1 trauma center as part of its Role IV wartime mission.During a time of war, medical care is categorized in different roles. For example, Role I represents a battalion aid station staffed by a doctor and medics on the battlefield, Role II typically has a limited surgical capability and is supported by a medical company, Role III is a field hospital with expanded surgical capability, and Role IV is a major medical center, such as BAMC, with the capability to provide definitive care to war wounded, explained Steve Burton, BAMC emergency management specialist."It is very realistic," Harter said. "It's not every day you get to participate in a major strategic readiness exercise alongside Forces Command with a C-17 aircraft and three Blackhawks at your disposal."The day of the exercise, BAMC staff implemented expanded 24-hour operations in support of increased surgical volume generated by the simulated combat casualties. Operations and Readiness staff stood up the National Disaster Medical System Federal Coordinating Center and deployed a Patient Reception Team to the Port San Antonio (Kelly Airfield).Twenty-six simulated patients were transported from Sierra Army Depot in California on a C-17 aircraft to Kelly Airfield. Once they arrived, the Patient Reception Team, along with members from the San Antonio Fire Department, triaged them."The BAMC team coordinated seamlessly with STRAC (Southwest Texas Regional Advisory Council) personnel and resources to rapidly transport role-player patients by helicopter, civilian ground ambulance and an ambulance bus to the BAMC Emergency Department," said Army Col. Michael Wirt, BAMC deputy commanding officer. "This was a great opportunity to hone our wartime readiness skills, while strengthening our community partnerships."At BAMC, the simulated patients were re-triaged by emergency department staff, processed by Patient Administration personnel at the ED and further evaluated for definitive care, concluding the exercise."This type of training helps us prepare for the next conflict, and keeps our skills on-point to provide lifesaving care to our nation's most precious resources -- our men and women in uniform," Harter said. "The exercise clearly demonstrated our ability to expertly communicate and be agile.""We treat over 10,000 trauma cases a year, between BAMC, University Hospital and the STRAC system. This allows us to get the wartime training and readiness value we need by seeing real-world trauma," she added.On Nov. 6, BAMC participated in the San Antonio Mass Casualty Exercise and Evaluation. SAMCEE is an annual exercise designed to assess the surge capabilities of the hospitals in a 26,000 square-mile region.SAMCEE-19 was organized by the Southwest Texas Regional Advisory Council, whose members include hospitals, health systems, and EMS agencies.This year, the exercise specifically tested the region's capabilities to respond to a Pandemic Flu-Novel Virus by assessing the patient reception, procedures, treatment processes, and patient tracking abilities at participating hospitals. In addition, the exercise tested regional communications and logistics, as well as EMS capabilities.Nearly 700 volunteers and role players acted as victims, friends and family members to stress the system. BAMC received and processed 54 simulated patients through the ED during the event."This type of training prepares us for real-world events, so that we know what to do," said Air Force Tech. Sgt. Shenique Deninger, noncommissioned officer in charge of the triage team.The patients were quickly triaged based on their severity of symptoms when they arrived, and Patient Administration personnel processed them as doctors and nursing staff evaluated and treated them.Army Col. Stewart McCarver, chief of the Department of Emergency Medicine, thought the exercise was very successful."This is something that we should be prepared for all the time, not just for an exercise," McCarver said.Janet Pena, emergency department nurse, agrees."These exercises help us to prepare by showing us what is missing in our environment, so we can better take care of the patients," Pena said.