JOINT BASE LEWIS-MCCHORD, Wash., Oct. 27, 2011 -- Maj. Anne Simpson held Staff Sgt. Mathew Horton's hand while she coaxed him out of an anesthetic sleep.
Horton whispered something in her ear, and she replied, "That's just your heart waking up, sweetie."
Meanwhile, medics and other nurses were looking at Horton's chart and evaluating the numbers on a heart rate monitor. Horton had just undergone hernia surgery.
His operation could have taken place in surgical suites at Madigan Army Medical Center, or MAMC, or any hospital.
Horton's procedure took place on Oct. 19 underneath a giant Army tent in a simulated field environment, where surgery on his and another patient not only resolved their pain but also served as training for the medical professionals of the 250th Forward Surgical Team.
The 250th and its higher headquarters, the 62nd Medical Brigade, team with Madigan every year to perform real, scheduled operations in field settings. They set up their surgical tents near the Medical Support Training Facility next to Madigan.
Only active-duty Soldiers with a minor surgical risk can volunteer, said Maj. (Dr.) Kelly Blair, a Madigan endovascular surgeon and the 250th FST commander.
The forward surgical team has a unique medical mission that can be very demanding if the situation calls. The team must be ready to deploy within 24 hours to anywhere in the world. That includes having tents, surgical instruments, operating room equipment -- even personal tents when hardened sleeping shelters aren't available.
The 20-person team can sustain continuous surgical operations for 72 hours.
While civilian medics, nurses and doctors are trained for their health specialties, military medics assigned to the 250th are routinely cross-trained to know a broader variety of treatments and procedures.
Operating room technicians can substitute for nurses and therapists in the ICU, for example. There's no telling what FST Soldiers on duty might be called upon to do in a combat environment, whatever their job classifications, said Sgt. 1st Class Dominic Smith, the team noncommissioned officer in charge, or NCOIC.
"Everyone has to learn everyone's jobs (in a FST)," Smith said.
The Army doesn't require the 250th enlisted health care Soldiers learn other military occupational specialties; but the nature of working in a small surgical tent while forward deployed with combat troops is the reason they do it.
The work of forward surgical teams have saved so many lives in Afghanistan and Iraq that they've become integral to medical support for the fight. Military medical data shows that the current survival rate for wounded troops is higher than 95 percent, due in large part to having mobile advanced-level treatment centers like the 250th near combat zones.
"The FST takes care of patients who can't get to the higher level of care and we can hold them as long as we need to until an evacuation is ready," said Lt. Col. Don Dendy, ICU chief nurse.
Getting treatment for critically injured service members within the initial hour after the injury occurs is widely known as the "golden hour," and the locations of forward support teams make it much easier to get the wounded the emergency medical treatment they need.
"If they can't make it all the way back to Landstuhl (Regional Medical Center in Germany) or a major medical center, we are here to do life-saving surgery so they can make it back," Smith said. "They'll make it back home because of us."
Practice in performing real procedures in field, albeit training environments, helps keep the 250th patient survivability rate high and increasing. The annual exercise augments their work on MAMC staff to maintain their skills at high levels.
Last week's surgery field exercise gave the team an opportunity to repair Horton's hernia and remove a tumor from Sgt. Joshua Clifford's armpit.
"This is as safe as working in a hospital," the commander said.
Clifford didn't mind volunteering to have the tumor excised in a tent; all that meant was an operation date sooner than available in the hospital. The training benefit to the 250th FST was icing on the cake.
Clifford also had a more intimate experience than normal in hospitals. He had the opportunity to meet the entire staff involved in his surgery.
It's rare for doctors, nurses, anesthesiologists and medical technicians to discuss each of their roles with a patient, Blair said.
"(Clifford and Horton) are doing an amazing service for the Army and nation to allow us to do this type of training," Blair said. "It's better for us to figure all this stuff out here so everyone is safer when we get in theater."
Most of the 250th FST team members are new to the unit and benefit from exercises like these to prepare for future deployments. Next on their training cycle is a rotation to Texas to take the Advanced Trauma Operative Management course. Then they'll work at the Ryder Trauma Center in Miami before heading to the combat zone to put their education and realistic training to practice.
Blair said he loves being with the FST and no other job he's had gives so much to others.
"Not many people get the opportunity in the military to enjoy what they do and 'make a life, not a living,' and get to directly help save a life everyday," he said.