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As insurgents shot at them, Army 2nd Lt. Jacob Fischer and Navy Ens. Osmund Nogra moved through the streets of a foreign village trying to reach two of their battle buddies, who had been seriously wounded and needed medical attention.

Reaching the casualties, Fischer and Nogra assessed the patients and stabilized them before helping them to a medical evacuation helicopter just a few feet away.

The scenario could have been real, but it was all part of a simulated “train the trainer” exercise July 29 for medical students attending the Uniformed Services University of the Health Sciences (USU) aboard Naval Support Activity Bethesda.

The exercise involved the Wide Area Virtual Environment (WAVE) at Forest Glen Annex’s Val G. Hemming Simpson Simulation Center. The developer of the WAVE, Dr. Alan Liu, describes it as a total immersion large-scale simulator with 24 screens that make up a 1,000 square-foot viewing area. It is different from other simulators in that it allows participants to work together using real equipment, he said.

“It’s a great opportunity to run the students through a virtual environment that’s safe,” Liu explained.

The only WAVE training facility in the world, the simulator gives instructors the opportunity to watch and assess a team’s skills as the simulation unfolds and allows participants to experience the realism of a combat situation. WAVE 3-D Medical Simulation Designer Valerie Henry said the animations are pre-set but can detect the participants’ actions and will change based on their response and movements. Actors wearing surgical cut-suits were also involved in the simulation.

“It’s actually nice to see virtual enemies and debris flying and seeing the situation change,” Fischer said. “You take it more seriously. There’s a person in a cut suit screaming in pain, so there’s a sense of urgency.”

Students involved in the WAVE training were gaining valuable experience to assist with Military Field Practicum 102, the second in a series of four courses all USU medical students must go through that is centered on tactical combat casualty care training, according to Dr. Craig Goolsby, USU Department of Military and Emergency Medicine assistant professor.

“One of the main focuses of our department is to teach pre-hospital trauma life support skills and knowledge,” Goolsby said. “Throughout the course of first-year medical school, students get a series of sessions on a number of basic skills. This course is a synthesis of all of that knowledge. They get to practice it in a very realistic environment.”

Student trainers completed a trial run of the two-day field exercise July 30 to 31 in a wooded area near USU before the actual course took place Aug. 12 to 13. Another course is scheduled for Aug. 18 to 19.

The surgical cut suits are also used in the field exercise and allow the realism of interacting with a human patient while the medical students perform invasive procedures, explained Goolsby, who developed the courses at USU that accompany the cut suit training.

“I saw the cut suits at a conference several years ago and we didn’t have a way to use them at the time,” Goolsby said. “We realized how important tactical combat casualty care training is to our students and it seemed like a very good modality to use.”

Retired Army Lt. Col. James Schwartz, Department of Military and Emergency Medicine deputy and assistant professor, added that proficiency in tactical combat casualty care has been a primary focus coming out of the wars in Iraq in Afghanistan.

“It’s been proven to reduce mortality and be a combat multiplier,” Schwartz said. “As military doctors, these students will be in charge of [personnel] that will have that responsibility. They’ll be in charge of training those medics to be prepared so our feeling is that the medical students have to have a firm understanding of what tactical combat casualty care is all about.”

The non-commissioned officer in charge of the course, Hospital Corpsman 1st Class Juan Vega, stated the exercise helps to emphasize care under fire. It provides an opportunity for the medical students to respond quickly and think “outside the box.”

“As doctors, (the students) will mostly be working in the FOB (Forward Operating Base) areas,” Vega said. “With this training, they get more of an understanding of what medics and corpsman go through in the field with blood pumping and adrenaline rushing.”

Goolsby added that the stressful nature of the training is necessary to make the situation seem more life-threatening, but there needs to be a balance.

“If you have no stress it doesn’t become serious to people and if you have too much stress then you squash the ability to learn,” Goolsby said. “When you have things like the virtual environments and the hybrid simulators you can adjust the amount of stress so it makes (the training) intense enough that it’s realistic, but not making it so crazy that you can’t get education accomplished.”

Schwartz added that USU is the only medical school in the country with a military medicine department, making the training and education USU medical students receive distinctive.

“This is what makes us unique from any other medical school in the country,” he said. “Our students get this opportunity to go through this military training and it makes a difference.”