Trial by (Simulated) Fire

Students from Bethesda's Uniform Services University of the Health Sciences spend two weeks in a simulated war zone learning how to treat wounded soldiers on the battlefield.Note: contains some graphic images. Video by Ricky Carioti/The Washington Post, Editor: Francine Uenuma/
By Philip Rucker
Washington Post Staff Writer
Friday, August 8, 2008

FORT INDIANTOWN GAP, Pa. -- After four years of medical school and 700 hours of military training, the final two weeks for students at Bethesda's Uniformed Services University of the Health Sciences come down to this:

Smoke fills the dark sky in the woods of Pennsylvania, as piercingly loud bombs and gunfire stir chaos on a mock battlefield. Terrorists, in the make-believe country of Pandakar, drive a hijacked van into a tent inside a U.S. military camp, wounding more than 30 troops in the ensuing explosion.

"Doc, you've got to help me," cries a student acting as a wounded soldier.

"My hands! You're going to make me lose my hands," another shrieks.

"Grab his legs. One, two, three, lift," orders a student acting as a medic, pulling a dying soldier onto a green canvas gurney.

In a two-week simulation, which culminates in a mock evening battle with catastrophic casualties, the medical students learn to treat combat wounds and ailments, from the traumatic (severed limbs and blast wounds) to the mundane (diarrhea, aches and foreign diseases). They also learn to cope with the psychological wounds of war, including watching a fellow student acting as a medic become so depressed he pretends to commit suicide. And through it all, the doctors-in-training play dual roles as military officers, fending off sniper attacks on their medic camps from the fictional enemy.

Lt. Gen. James G. Roudebush, the Air Force's highest-ranking medical officer, flew from the Pentagon to Fort Indiantown Gap, about 25 miles northeast of Harrisburg, to watch the evening simulation last month. The exercise, known as Operation Bushmaster, teaches students to practice good medicine in a demanding environment, he said.

"This helps build skills, it helps build confidence and it helps build awareness of how to work in a very challenging environment," Roudebush said. "In any mass casualty event, there's always going to be the fog and friction of war, the element of the unknown. It could be a jungle, it could be an urban environment, it could be a desert, but these skills persevere."

The students agreed. Ensign Stephen Lewis held an M-16 rifle to his torso as he stood guard along the perimeter of a medic camp.

"You can talk about it in the classroom, but until you get out here and have all the variables in place you just can't simulate it -- the stress level, so many things in your head," said Lewis, 35, a former Navy flier from Blacksburg and a fourth-year medical student.

"Even though we know in the backs of our minds that this is artificial and a mock experiment, it prepares us for the real thing," said his classmate, Army 2nd Lt. Corey Mossop, 25, of Pennsauken, N.J. "It takes out the 'Oh my Gods' of seeing these battle injuries for the first time."

Operation Bushmaster is an elaborate dramatization of war. While fourth-year students work as medics, first-year medical students play patients. Makeup, or "moulage," artists use wax, stage blood and other material to create realistic trauma injuries on uniformed first-years. Those students act as wounded soldiers, some limping, coughing or crawling. Others squeeze bags of fake blood from inside their uniforms to simulate bleeding.

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