AT SEA -- Marines with Combat Logistics Battalion 15, 15th Marine Expeditionary Unit, run out of an MV-22B Osprey tiltrotor aircraft and set up a perimeter around a simulated blast. Behind them they hear fellow Marines role-playing casualties yelling and screaming for help as the mass casualty team begins identifying patients who need immediate evacuation.
As quickly as they can, they separate the patients into different categories depending on the severity of their injuries. The Marines in critical condition are put on litters and brought to the Osprey to get further help. The corpsmen work between three to four patients, intervening when necessary.
The corpsmen gather the rest of the simulated patients in a stable condition and the mass casualty drill ends. Sailors and Marines routinely conduct drills like this to stay quick on their feet should something like this occur to be able to save as many people as possible.
“A mass casualty drill gets us ready to encounter any type of civilian or military mass casualty,” said U.S. Navy Chief Petty Officer Oswaldo Hernandez, the leading CPO of CLB 15’s medical team. “It allows us to see where we’re at and how efficient we are at expediting the patients’ care.”
The corpsmen do their best to simulate an actual mass casualty and implement different types of distractions to imitate the “fog of war” that comes with it.
“Our goal, as soon as we get to the scene, is to get the first bird back up with the immediate or delayed patients to get them back to the ship,” said Hernandez. “I try to raise my voice and give them orders, then give them different orders that contradict and see which ones they react to. I also have other corpsmen yell back and forth so they’re able to pick and choose who that conversation is going to and who’s directing that order. You can’t simulate that fog of war but you can definitely increase that confusion by having external people involved.”
The security element and the four corpsmen on the initial response team are the first to arrive at the scene. The security element provides security around the site while the corpsmen section off the mass casualty and take care of all the patients.
“The job for the mass casualty team, especially for the initial response team, is to get the people who can walk out of the way first, so we can start triaging; finding the most critical patient that needs to be brought up so we can start stabilizing them,” said Hernandez.
They triage the patients and begin assessing what category they need to be in; such as immediate, those who are in critical condition, or minimal, the “walking wounded” patients.
During the drills, the patients have simulated injuries that the corpsmen are expected to identify and treat as needed. They use makeup and fake blood to simulate these injuries and make the corpsmen familiar with working with a wet environment.
“It’s difficult to simulate some of these injuries, because a lot of them can be internal, which allows vital signs to decompensate or give us different readings,” said Hernandez. “We try to simulate as much as possible and try to hide several injuries because our corpsmen are trained to do secondary assessments to discover them. Usually the first injury you see is not the most critical; there’s usually something internal that can take a person’s life away faster than a broken femur, or whatever the case may be.”
The corpsmen with CLB-15 try to do these drills often to keep improving their skills.
“Practices can change within a month, depending on after-actions and deciding what does and doesn’t work well,” said Hernandez. “We try to implement those changes and see what works out best.”
These drills are essential for the mass casualty team to stay current in their skills and be able to automatically react to any situation at hand.
“With anything, you have to rehearse consistently to have the muscle memory; that quick, initial reaction,” said Hernandez. “I think under stressful situations, it’s human nature to kind of get that narrow, [tunnel vision]. Even with that, your muscle memory and consistent training automatically kicks in and you start doing things, amazingly without even thinking about it because you’ve been training. [These drills] allow these guys to kind of see where their skills are lacking or where they could have done something different.”
Besides the mass casualty drills, the corpsmen train to fine-tune their skills and find the best strategies to deal with patients.
“We do a lot of our own kind of [tactical combat casualty care],” said Hernandez. “One of us will volunteer to be a patient and we will give [the corpsman] the injury, like, ‘this person just got a gunshot wound, he was involved in a fire-fight, start your treatment.’ They have to open up their med bags, we give them training supplies, but they have to point at what they would use.”
The corpsmen are evaluated by their ER nurse and doctor and are asked to verbalize what they are doing, step-by-step.
Along with these drills they have classes on combat and wound management and then implement that into their training. This training keeps the corpsmen prepared for any type of situation that arises.
“The end-state is to be ready to go and be able to react to any situation,” said Hernandez. “Especially during a mass casualty, people are going to be yelling there will be blood and a lot of confusion. I try to teach these guys to just zone out the confusion and do their job and if they can’t, let their muscle memory take over.”