A Test Unlike Any Other

Four uniformed military students carry an "injured" volunteer on a stretcher to a helicopter in a field. The word BUSHMASTER is written on it.
By Christopher Austin

The best way to be prepared for anything is to prepare for everything.

This couldn’t be truer for fourth-year students at the Uniformed Services University of the Health Sciences (USU) as they take part in Operation Bushmaster, a multiple-day continuous medical field practicum. During this Military Contingency Medicine course capstone exercise, soon-to-be military health care providers put their knowledge to the test in a variety of complex scenarios that could occur on a battlefield, preparing them for any challenging environment.

Students respond to mortar attacks, mass casualty exercises, and provide care under fire, while juggling the responsibilities of caring for populated villages, isolated from backup. On top of that, they’re operating with little sleep in often challenging temperatures and conditions. They must handle competing priorities while making decisions and working with a diverse team of colleagues, subordinates and allied leaders.

These might seem like scenarios that only military personnel would find themselves in, but they’re more common for civilian health care providers to encounter than they realize.

“If you were at the Boston Marathon bombing, you’d be in the middle of everything that we teach. If you’ve been to Florida in the last six weeks, Houston, Puerto Rico… We teach more and more what probably every civilian health care worker needs to understand,” said retired Army Lt. Gen. (Dr.) Eric Schoomaker, professor and vice chair for Leadership, Centers and Programs for the Department of Military and Emergency Medicine (MEM) at USU.

Three medical students in fatigues practice veterinary techniques on a mannequin of a German Shepard while four observers stand to the side.
Over the past two decades, training during Operation Bushmaster has become more focused on putting students in scenarios that they’re likely to find while deployed. Here, three fourth-year medical students evaluate and treat injuries sustained by a military working dog using a high tech canine simulator during Operation Bushmaster in 2016. (Image credit: Sharon Holland)

Bushmaster also introduces students to chaotic scenarios that they might encounter responding to medical emergencies.  Health care providers, both civilian and military, might not always have access to the best infrastructure when providing care. According to Schoomaker, the biggest medical challenge to Puerto Rico following Hurricane Maria might be a cholera outbreak as a result of a shortage of clean drinking water. Another anecdote that Schoomaker provided was about a colleague who had served as a medical missionary in Thailand who was stationed in a small mission hospital on the bank of a river. Most of the villagers they were serving lived on the other side of the river, and there was no nearby bridge they could easily cross to get to the hospital. They ultimately worked to better serve their community by splitting their time between caring for the patients they had access to, and building a bridge to reach those they did not.

“That kind of agility and adaptability, where one thinks beyond what they see right in front of them, or what they have preconceived to be their role, is something that we really want our students and graduates to understand. They have to understand to work with other disciplines under circumstances in which conditions and resources change while the strategic goals do not,” Schoomaker said.

Exercises are designed to test student’s versatility, putting them in different roles outside of what they are trained to do to understand the demands of a medical team and learn to follow as well as lead.

“Some of the [students] over the course of the day will be in medical roles as surgeons and physicians, some will be in charge of ambulance teams, some will be platoon leaders, communications officers, or in charge of medications or logistics,” said Dr. Neil Grunberg, professor of MEM. “Clearly our physicians will not be litter bearers, and surgeons will not be radio operators unless they’re shorthanded, but all of 21st century medicine is team medicine, so the experience of acting in different roles, we think is absolutely essential. And based on the feedback that we’ve gotten from students, [Bushmaster] really drives this lesson home.”

A group of students stand in hazmat gear around a simulated patient, also in hazmat gear, lying on a gurney in the field during the day.
Operation Bushmaster has been around for almost as long as the Uniformed Services University of the Health Sciences itself. Initially, students weren’t placed in scenarios in as much as they practiced health care response in a non-hospital setting. In this photo, taken during Operation Bushmaster in 1990 in San Antonio, Texas, students watch a demonstration of how to care for an injured person in a hazardous environment. (Image credit: Jim Coker)

Grunberg stressed that Bushmaster is a major test of participants’ leadership skills, and a major aspect not often highlighted is that being able to follow the leadership of others and actively participate is extremely important to operational success.

“They have to think about how the team’s going to work; ‘what’s my role as the leader of a team?’ What’s my role as an informed follower in a team and organizations that are instrumental in translating the larger view down to the tactical level?” said Schoomaker, “One moment you’re a follower, the next you’re a leader. In fact, sometimes the leader becomes the follower as the situation changes.”

The scenarios students are put through are constant and challenging to everything they’ve learned over the past three years.

“Everyone who starts this begins eager, well-rested, champing at the bit. Then, about 24 to 36 hours afterwards, they all bottom out because they begin to see how difficult the challenges can be,” Schoomaker said. “But, by the end, they get in their groove and start to perform and come out like a professional sports team. They’ve worked with one another now for a couple of days, overcome enormous challenges, had continuous opportunities to self-evaluate and conduct peer-to-peer reviews, shifted roles from leader to follower so many times that, by the end, I don’t think I’ve ever seen a team not come out feeling very confident and proficient, and that’s rewarding to see.”