Cold and Ice Test Military Medical Professionals Adaptability

Photo By Derik Crotts | Students prepare to transition the victim off the cliff during the high angle rescue portion of their Cold Weather Mountain Medicine Course.  

UNITED STATES

02.20.2019

Story by Derik Crotts 

Defense Health Agency

As students nervously attached their crampons they can see their instructors cautiously ascending the icing path to setup the response scenario. In this case, a victim who had been injured and exposed to the cold for nearly 12 hours. “Remember, the provider should be waiting on the patient. The patient should not have to wait on the provider,” blared the instructor.

The Uniformed Services University of the Health Sciences (USU), and its School of Medicine and Graduate School of Nursing, is renowned for producing some the world’s medical leaders for the Military Health System. Recently, several military medical professionals gathered at the US Army Mountain Warfare School (USAMWS) to gain new skills designed to increase their readiness and understanding of the challenges faced in the operational environment. In this case, the cold, ice, and snow.

The Cold Weather Mountain Medicine and Avalanche 1 course takes place in Jericho, Vermont and is a Military Operational Medicine elective course for USU students. This nine-day course covers advanced mountain medicine in the cold and austere environment, as well as an introduction into avalanche response basics. The course is taught by instructors from USU, USAMWS and the Austere and Wilderness Medicine Fellowship (AWMF), Madigan Army Medical Center.

“By the time they get to this course, they have already completed nearly 50 hours of wilderness medicine training,” said Dr. Matthew Welder, Assistant Professor, Operational Readiness, USU and Co-Director of the course. “Completing the course not only counts toward a Diploma in Mountain Medicine (DiMM) rating (USU is one of only three programs in the United States that can award a DiMM certificate) but significantly improves the readiness of our medical force.”

Welder knows first-hand the need to have medical providers trained in a variety of response situations. Just a little more than a week after graduating from USU, Welder found himself in the operational environment when he was deployed to Fallujah, Iraq.

“I quickly learned that while I had been trained very well as a hospital provider, I wasn’t necessarily ready to apply my skills effectively in the operational environment,” said Welder. “The Military Operational Medicine elective was designed to help decrease the readiness delta and help students understand how to function in austere settings.”

While the Military Operational Medicine electives may vary, the three main courses include Military Mountain Medicine, offered four times a year; Cold Weather Mountain Medicine and Avalanche 1, currently offered twice a year and moving to three times annually starting in 2020; and Dive Medicine and Rescue, conducted twice annually.

“In many cases these medical students have just learned how to function in a hospital environment, and now they are placed in a totally different setting with limited resources and in unfamiliar terrain, but must learn how to apply their knowledge in a manner that does no harm – to both themselves and the patient,” said Dr. Ian Wedmore, COL (MC) and Co-Director of the Course.

The mission of the Military Health System is to enable the National Defense Strategy by ensuring a medically ready force, a ready medical force, and improved health of all those entrusted to its care. According to Welder, this training is perfectly aligned with that mission.

“We have four readiness goals for the training – Emotional, Physical, Clinical and Operational,” said Welder. “We assess the student’s ability to react and perform their medical skills in an austere environment when placed in uniquely stressful situations (emotional). At the same time, we’re able to observe their performance after exertion and using the gear required for their and the patients movement in, around, and through the environment (physical). We help them to understand how to take the didactic skills (clinical) used in the Military Treatment Facility (MTF) and transform them to the environment. Finally, the confidence and skills gained help them develop the ability to interact with and become an asset to the line (operational) units.”

These readiness goals and environmental challenges are exactly what the students expect to achieve and overcome during the training.

“I’m interested in the emotional readiness aspect of the course and how the environment impacts the response,” said 1LT (P) Hannah Martinez, a Clinical Psychologist and USU student. “I’m here to show what psychologists can bring to the table in this environment, and how they can and should be integrated into the operational setting.”

This is precisely the type of adaptation the directors of the training are seeking to accomplish.

“Readiness is more than volume acuity and diversity in a hospital,” added Welder. “While that prepares you clinically, and is extremely important, it doesn’t always transfer well to the operational environment. Our goal is to expose the medical and nursing students to the environmental diversity and help them learn how to apply their skills in a variety of environmental settings.”

According to Wedmore, success in the training and the environment comes down to physical and mental flexibility.

“Everyone we train in the military medicine are among the best at what they do, but they don’t necessarily know how to adapt their skills outside of the hospital setting,” said Wedmore. “The people who excel are the ones in reasonably good physical condition and have the mental flexibility to know you don’t always need to treat a patient in a certain manner or always use a certain piece of equipment.”

For many of the students this is the first time they have been placed in an austere environment, and the challenges of working in that environment can be daunting. Learning how to overcome these challenges are critical to mission success.

“If you don’t know how to apply a skill or a piece of equipment in the environment where you’re operating, then you’re battling the environment and not the enemy,’ said LTC Matt Brown, Commander, USAMWS. “They learn this in first few days of the training.”

“I’ve never been ice climbing and have a fear of falling to my death and functioning in the cold that I must overcome,” said Dr. Genevieve Hillis, a course student and a US Army Captain and acting Emergency Room (ER) Chief at Fort Carson, Colorado.

Hillis also pointed to the fact that communication is important in any setting but especially in one where unfamiliarity exists. While very skilled at what they do, the students found the training helped them identify communication gaps.

“There are challenges in the course created by all the levels of skill people involved bring to the training,” said Hillis. “Because of this, the communications dynamics can be interesting. While I know how an ER works, and know my staff well, so in that environment the communication flows easily and effectively. However, put me in this cold weather setting, with new people and unfamiliar equipment and communication and effectiveness is tested.”

Pushing the students outside of their specialty area and their comfort zones is what the training was designed to accomplish. Ultimately, the course helps to bridge the awareness gap between the medical personal in the ER and the medic in field.

“They learn many new skills and gain confidence in a different environment and, in the process, it builds resiliency,” said SFC Jeremy Neskey, Senior Medic Instructor, Army Mountain Warfare School. “It grows their knowledge base and moves them out of the technical aspects of medical support and more into the practical.”

“It helps them to look at things differently,” added Neskey. “Things in the woods or on the side of cliff are a lot different than they are in the ER.”

“When we fight it’s never in ideal settings or circumstances and rarely do you have everything you need or expect,” added Brown. “This training helps the medical professional learn how to adapt.”

While the training helps enhance the readiness and adaptation of medical and nursing students for the operational environment, the partnerships between USU, USAMWS and AWMF has proved mutually beneficial.

“Until we started supporting this training I knew nothing about USU or AWMF and the training provided to military medical professionals,” said ISG Thomas Kontos, USAMWS. “This partnership has been tremendous and allows us to train service members in skill sets that are needed in the field, and should be the norm for all military medical personnel, not the exception.”

“It’s been a great partnership,” added Brown. “USU, and the students going through the training, bring in a skill set and medical expertise that helps build the skills of our trainers. While at the same time, our training helps to enhance the capabilities of military medical support. It’s a win-win.”

• Date Taken: 02.20.2019
• Date Posted: 02.20.2019 10:11
• Story ID: 311231
• Location: US