AL ASAD AIR BASE, Iraq (Army News Service, June 9, 2010) -- Iraqi army medics participated in a mass-casualty training exercise near here June 3 as a final test following months of training by U.S. Army medics.

Medics from three clinics -- 7th Iraqi Army Division, Field Engineer Regiment and Motor Transportation Regiment -- triaged and evacuated 25 casualties of a simulated vehicle-borne improvised explosive device at the 7th IA Division headquarters dining facility at Camp Mejid, an IA base adjacent to Al Asad Air Base.

The exercise was planned, organized and directed by medics of 1st Advise and Assist Brigade, 82nd Airborne Division, who have been mentoring the Iraqi medics since August 2009.

"As in our Army, their medics will disseminate to the different brigades and divisions, and that training knowledge will go with them and spread throughout the entire Iraqi army," said Capt. Kyle Brown, assistant operations officer and Iraqi Security Forces coordinator for 307th Brigade Support Battalion, 1/82 AAB.

"Having the 307th BSB here is critical for the IA. These 'soft' skills the Iraqi Army needs to sustain themselves are absolutely critical. They lack that expertise in the army, and we're here to show them how to do it for themselves," said Brown.

The training was designed to mimic an actual bombing that occurred on an Iraqi base in 2005 that killed 65 soldiers and wounded more than 250, said staff Brig. Gen. Ismaeel Khalif al-Khalifawi, commander of 7th IA Division.

Al-Qaeda in Iraq had recruited a worker at the base, and following several months of befriending the guards, the worker was able to smuggle in enough TNT to turn a tanker into a bomb and detonate it at the base dining facility, said the general.

"As an army, we should have every means to prevent such an incident from happening on our bases," he said.

Following the blast of several harmless "flash-bang" grenades, a busload of Iraqi soldiers made up with moulage, or mock injury kits and fake blood, moved to the foot of the dining facility and pretended to be injured. Simulated amputees were fitted with devices that appeared to be bleeding stumps that squirted fake blood. One soldier held a stick to his head as if it had penetrated through his eye. Many soldiers yelled in mock pain. It was all designed to stress the medics, said Staff Sgt. Tiari Ventura, senior medical adviser for the 7th IA Division medics and organizer of the event.

The Iraqi medics' response to the blast was entirely professional, she said.

"They went to the people who had massive bleeding first so they wouldn't bleed out," said Ventura. "Then they moved their patients to separate the ones that were more serious. They loaded their most serious patients last so they'd come off the vehicle first when they got to the hospital."

Ventura said the IA medics have made great strides during her unit's time with them. Iraqi medics typically receive about 25 days of training, as compared to a U.S. Army medic's 16 weeks.

While the Iraqis were very good at treating individual trauma cases, they struggled with the concept of triage, or separating and prioritizing casualties based upon severity of injury.

"We go with the DIME concept," said Sgt. Michael Stewart, whose job was to shadow Cpl. Hassan, the Iraqi triage noncommissioned officer in charge.

DIME stands for delayed, immediate, minimal and expectant, and is used to direct traffic and ensure that the patients are getting the proper treatment, he said.

Fellow medic, Spc. Aubrey Stoda, said the American medics started training the Iraqis for the mass-casualty exercise, or MASCAL, by going through the steps of MARCH Aca,!" massive bleeding, airway, respiration, circulation and hypothermia and head wounds.

"They were pretty good on it, just as we thought they would be," said Stoda. "Then we started adding in the triage and evacuation."

Eventually, American medics brought together all three Iraqi clinics on Camp Mejid for five-patient, 10-patient and 15-patient exercises. The culminating event was the 25-patient MASCAL.

"They just had a threat of someone trying to wear one of their uniforms and coming on this base, so we thought that if something actually happened, we should probably get them ready for handling a MASCAL situation," said Stoda.

Army medics should hold MASCAL exercises quarterly, said 1st Lt. Jessica Larson, a physician assistant who joined the Army after working with amputees from the wars in Iraq and Afghanistan at the Brook Army Medical Center.

"It's a skill," said Larson. "You use it or you lose it."

The IA have a large turnover with their medics, so quarterly training would give new medics the opportunity to be trained by old medics, she said.

"This is really a train-the-trainer scenario for us so that when we leave, they're in a more comfortable position to train their new people."

Larson's role during the June 4 MASCAL was to assist the Iraqi officer in charge as he controlled the many moving parts.

"His role was to coordinate between the 7th IA Division and the military police that are outside, in terms of coordinating ground evacuation, or air evacuation if they have that capability, understanding what their casualty rate was, where they needed to go, and being able to relay that information upwards as well as mobilize the military police," said Larson.

Unlike in the U.S. Army, communication in the Iraq army has to be from officer to officer to get anything done, she said.

The American advisors were very pleased with the results.

"It went really well," said Stoda. "The first MASCAL with just five patients, even with all three clinics there ... was just chaos. They left really injured casualties alone, while they were trying to help someone with a little scratch and boo-boo. This time, they did massive bleeding first, they were organized like they were supposed to be, and they got everyone out in 25 minutes. That's a pretty good time."

American advisors will continue advising and assisting Iraqi medics at Camp Mejid, but they will move into teaching preventive medicine, said Brown, whose unit is expected to return to the United States by the end of summer.

"When our replacement unit gets here, we will introduce them to all of our Iraqi counterparts, show them everything we've done for the past year, and make sure they don't repeat any of the things we've already trained them on," he said.

"Our goal is to set them up on a training plan [for the Iraqis] for the first couple months that they're here so they can carry forward and continue on down the road of Iraqi self-sustainability."

(Sgt. Michael J. MacLeod writes for 1/82 AAB, USD-C)