COLLEGE STATION, Texas — Airmen assigned to the 149th Fighter Wing trained alongside Army National Guard members at Disaster City in College Station, demonstrating their ability to provide lifesaving medical care during a complex domestic emergency as part of the 6th CBRN Enhanced Response Force Package. The 149th Medical Group Detachment 1 serves as the medical element for the FEMA Region 6 CERFP, a joint Army and Air National Guard capability designed to support civil authorities following a chemical, biological, radiological or nuclear incident. For Lt. Col. Joanna Nelms, commander of the 149th Medical Group Detachment 1, the evaluation provides an opportunity to demonstrate that her Airmen can meet that responsibility. “This exercise exists to certify us on a national level, demonstrating that our team is ready to respond,” Nelms said. Certification requirements establish the personnel and equipment needed for the mission, but Nelms said readiness ultimately depends on having trained Airmen and serviceable equipment prepared to deploy. “At the end of the day, it comes down to having the right people, with the right training and the right equipment, ready to go out the door,” Nelms said. Lt. Col. Kory Lund, lead exercise director with the Army Interagency Training and Education Center, said the National Guard's role during such an incident is to augment civilian first responders through Defense Support of Civil Authorities. “We’re here to augment,” Lund said. “We’re here to help our first responders.” Disaster City, operated by the Texas A&M Engineering Extension Service, provides a realistic urban environment where CERFP members must determine how to position personnel and equipment, establish casualty flow and operate within the physical constraints of a disaster area. For Chief Master Sgt. Ruben Hernandez, superintendent of the 149th Medical Group Detachment 1, the exercise is not simply a test of whether Airmen can perform their medical specialties. “We’ve seen them consistently perform their jobs at an exceptional level long before they got out here,” Hernandez said. Instead, Hernandez said the exercise tests whether Airmen can maintain that level of performance while dealing with fatigue, extreme heat, protective equipment and the uncertainty of a disaster environment. “I think they’re really getting tested on their stress inoculation,” Hernandez said. “It’s not so much, ‘Can this medic triage somebody? Can this medic start an IV?’ I’m not worried about that at all.” Extreme heat, fatigue and protective equipment can turn otherwise routine medical procedures into significantly more difficult tasks. “Can they do that in three layers of plastic, when they’re losing their dexterity? Can they do that while breathing through protective equipment? And not just once or for 15 or 20 minutes,” Hernandez said. “Our message is consistent: This could be much longer. If it is a hurricane or a real-world dirty bomb, we could be there for an open-ended amount of time.” Within the CERFP, 149th medical Airmen operate throughout the casualty response. Search-and-extraction-trained medics accompany Army teams operating within the disaster zone, while other medical personnel triage casualties before they move through decontamination. Once decontaminated, casualties can be moved to the medical element’s ambulatory and nonambulatory treatment tents for stabilization and emergency care. Hernandez described the treatment capability as a mobile emergency room staffed during a real-world response by emergency physicians, nurses, respiratory therapists and other medical professionals. The team deploys with medical equipment and pharmacy support needed to sustain patient care and is equipped for approximately two weeks of continuous operations. “Once casualties hit the tents, it’s literally entering an ER bay,” Hernandez said. The exercise also requires Army and Air National Guard members who normally train within their respective services to integrate as a single response force. Nelms said training alongside sister service members before an emergency is critical because even closely related military services can operate differently. “We don’t live and breathe and speak Army, and they don’t live and breathe and speak Air Force,” Nelms said. “Even though we’re sister services in one Department of War, it’s amazing how even the smallest, subtle things can change how your entire group operates.” Training together allows the two services to identify those differences and learn how to operate together before a real-world response. “The more we can play together, learn to speak each other’s languages, build relationships and friendships, the better it is,” Nelms said. “You never want to meet your teammates on a bad day. You want to meet them beforehand.” Lund said the 6th CERFP demonstrated during the exercise that its members understood their equipment and capabilities and could operate effectively as a team. “They know how to use their equipment. They know what it can do and its capabilities, and they know how to work as a team,” Lund said. “As a whole, they understand the big picture, how to execute the mission and how to get there. They’re there.” The CERFP mission also represents a side of the 149th Fighter Wing that may be less familiar to the public. While the wing is widely associated with its F-16 pilot training mission, its medical Airmen provide the wing with a significant domestic response capability. “While fighter pilot production is primarily a federal mission, our medical Airmen provide a significant portion of the 149th’s domestic operations capability for Texas and the nation,” Nelms said. Nelms said Texans may commonly associate the National Guard with security missions or distributing food and water following disasters, but the CERFP provides communities with a specialized capability when local first responders and medical systems need additional support. “We can actually come in and augment their communities, help their first responders, their hospitals, to be able to keep them all safe,” Nelms said, “and ensure that their families survive what could be the worst day or week of their lives.”