A patient strapped to a wheeled litter carrier is rolled into an emergency room at Rochester Mayo Clinic’s Mayo Multidisciplinary Simulation Center here. The patient’s blood spurting from a simulated roadside bomb with a catastrophic leg injury. Soldiers begin the task of stopping the bleeding and saving his life.

As if this task performed by U.S. Army Reserve medical Soldiers wasn’t chaotic enough, it became more chaotic because they didn’t know each other.

This was the case for 49 Soldiers from 10 different units, five battalions, and three brigades who participated in the three-day training exercise at the MMSC Nov. 19-21, 2021. The 11,500 square-foot center is simulated as a combat support hospital in an austere environment. The exercise, which has been conducted at MMSC several times a year for more than a decade, challenges the Soldiers to improve their team competencies and communication skills in a variety of scenarios. These include an emergency room, operating room, and an intensive care unit.

The training, the first for Fiscal Year 22 and under COVID-19 restrictions, was led by the Medical Readiness Training Command with assistance from Clinic staff, the Regional Training Sites-Medical of Fort McCoy, Wis., and other supporting U.S. Army Reserve training personnel. The Soldiers also are taught the tools and tactics needed within the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPP) makeup. TeamSTEPP is a factual program with buzzwords like hand-offs and close the loop, aimed at optimizing performance among teams of health care professionals, empowering them to respond quickly and effectively to spontaneous situations.

Col. Elizabeth Anderson, clinical operations, MRTC, said the Soldiers worked together from the first day. “Building a new team is not easy to do, and these Soldiers did not hesitate to do the work required for a successful training event,” said Anderson, who has been involved in this exercise for eight years.

Command Sgt. Maj Patricia Van Drunen, 820th Hospital Center, 807th Medical Command (Deployment Support), who was observing the exercise for the first time, said the Soldiers' communication improved throughout the day. “Everybody’s learning something from this situation which is a good takeaway,” she said. “Everybody sees value in what is happening here.”

TeamSTEPP, which the Army Medical Department ordered implemented across its command in May 2011, has five key principles and is based on team structure and four teachable-learnable skills: communication, leadership, situation monitoring, and mutual support.

Spc. Matthew Nelson, a combat medic or 68W with the 328th Combat Support Hospital, 139th Medical Brigade, 807th MC (DS) based in Salt Lake City, Utah, said one way the Soldiers became a team quickly was discussing their civilian jobs pre-exercise and determining their strengths in regards to the exercise. Nelson is a wound care technician at Intermountain Medical Center, Provo, Utah, and enrolled in the Emergency Medical Technician Certification course at Brigham Young University.

The Soldiers were evaluated by medical Observer Coach/Trainers in nine different areas: emergency medical technician, emergency room, operating room, intensive care unit, patient administration, radiology, pharmacy, laboratory, and the tactical operation center. There were 21 clinical scenarios. The OC/Ts not only observed the Soldiers, but they also could remotely manipulate several of the computer-controlled mannequins, including their blood flow and limb movements. One of the mannequins wore a Human Worn Partial Task Surgical Simulator or otherwise known as the “Cut Suit.” The latter is a “simulated live patient” suit that features breakable bones, interchangeable organs, and variable blood flow. The repairable skin and organs can also be operated on.

The OCT’s capability of controlling the mannequins was not the only means of adding realism to the “patients.” The participants in the ER, OR, and ICU were monitored from a “crow’s nest” above the rooms behind two-way mirrors. A clinic simulation technician and OC/T could team up to control a patient’s vital signs like blood pressure in each of the rooms. All activities in the scenarios also are video recorded. After each iteration, the Soldiers execute an after-action review where this footage is used for emphasis.

The exercise kicked off with “patients” being transferred from wheeled carriers to an ER with a variety of wounds, including roadside bomb injuries. The scenario was that these “patients” were being unloaded from a Medevac helicopter. To make this more realistic, audio of Medevac helicopters landing and departing was broadcast over the clinic’s public address system. The scenarios are based on actual injury reports.

“Over time, the scenarios and our simulation setting have been adjusted to improve the realism for the Soldiers attending the training,” said Matthew Brenden, Mayo Clinic Public Affairs Senior Communications Specialist.

Nelson said this was the first time he was involved in a triage scenario. He said he learned how more important it was to transfer information, including “patients'” vitals and required medications, from the arriving ambulances to the ER staff.

First Lt Matthew Rogers, an Emergency Room Nurse or 66T based at the 1980th Forward Resuscitative Surgical Detachment, 807th MC (DS), Fresno, Calif., was in the ER.

Rogers, a former Marine sergeant and machine gunner with three combat deployments, said the exercise was invaluable. “Everybody can be the best what they do but if you are not communicating and working well as a team, it doesn’t matter,” said Rogers, who is a civilian emergency flight nurse.

Rogers pointed out that he was familiar with blunt trauma injuries from car accidents but not familiar with the large amputations created by “roadside bombs.”

Van Drunen pointed out that these Soldiers come from a variety of civilian medical professions and military medical training, including participating in this exercise before or being deployed downrange. She admitted that the center does not replace a combat support hospital in a combat zone, but the Soldiers are learning how to decide the priority of patient’s injuries and this decision has to be made immediately.