Students experience their first mass casualty

A medical students work on a 'wounded' volunteer wearing a cut suit while an instructor looks on as part of a simulated active shooter exercise.
By Christopher Austin

The Service members quickly enter the dark room and assess the situation – four wounded are on the ground with gunshot wounds and in various states of consciousness. Seeing that there is no immediate danger in the area, they get to work treating the victims. As they are working, shots ring out and explosions light up the room. With no other option, they transport the injured to a more secure area, where they are able to provide more sufficient care and call for an evacuation. All of this happens within 20 minutes.

The victims then wash themselves up and break for lunch before returning for the afternoon sessions.

This isn’t an overseas battlefield, it’s an active shooter training exercise for School of Medicine (SOM) students at the Uniformed Services University of the Health Sciences (USU). One of many such simulations that occur as part of the third-year medical student field exercise series, Gunpowder.

This active shooter simulation took place in USU’s anatomy lab, where volunteers dressed as victims in cut suits – prosthetics that made them appear wounded. The prosthetics allowed students to practice care procedures, such as needle stick and tourniquet application without harming the volunteers.

An added bit of realism is that the suits are able to bleed fake blood. They can be hooked up to remote-controlled pumps, which instructors can activate to cause wounds to suddenly become more threatening and require the students’ attention. The purpose of the exercise is to test the students’ ability to respond to a high-stress situation and the pressures that come with it. If the students aren’t able to respond fast enough, the volunteer can be considered “dead.”

Third-year medical students provide care for a volunteer acting as wounded during a simulated active shooter exercise
Third-year medical students provide care for a volunteer acting as wounded during a simulated active shooter exercise. (Image Credit: Christopher Austin)

“I think it went really well. [The students all] have similar levels of training. Everyone knows what they’re supposed to do and handle the patients on their own, and call for help if necessary,” said Air Force 2nd Lt. Matthew Van Uitert, one of the students that took part in the exercise. “We have worked with cut suits in other exercises, I think they provide an extra level of realism.”

The exercise’s purpose is to create a normal scenario that the students would respond to in a civilian center, like this active shooter event, said Navy Petty Officer 2nd Class Randal Finney, a tactical instructor at USU who ran the exercise. Over the course of the exercise, students run through the different phases of combat casualty care, otherwise known as TCCC or TC3.

The phases of TC3 begin with care under fire; the students enter into the area, ensure there is no immediate danger, give the patient initial treatment and then move them to a safer area to move on to the next phase. With the second phase, tactical field care, the students use their safer surroundings to protect themselves while they provide more care for their patients, addressing any immediate life-threatening injuries and stabilizing them for the third step; preparing the casualties for evacuation.

Volunteers in cut suits take a break while third-year medical students review the completed exercise with their instructors. (Image Credit: Christopher Austin)

"The more I screamed, the more flustered [the students] would get,” said Army Sgt. Clayton Gerrian, a veterinary technician in Laboratory Animal Medicine at USU, who played a victim wearing a cut suit during the exercise. “It’s messing with them, but it gets them ready for real-life scenarios. They’re flustered and trying to figure things out, but it’s really helping them in the end.”

Students had a briefing of what to expect beforehand, but were not told specific details; like the number of casualties they would encounter, or to what degree they would be injured.
The students commended the cut suit volunteers for their work in not breaking character, and committing to portraying an appropriate amount of pain for the situation, which helps create a realistic scenario for the students.

“I hope students take from this learning experience a knowledge of their strengths and weaknesses, and try to improve both. It’s good to understand what you’re weak at so you can build it up,” said Finney. “I have been to Afghanistan twice now and when you’re out there and have real life situations, it’s usually someone you’ve been spending the last nine months to a year with in preparation for deployment. You’ll be over there on patrol and all of a sudden you’ve got a patient with a gunshot wound or were hit with an [improvised explosive device] and at that point in time the training is over and these are real-life patients.”