'Gunpowder' Prepares Students for Prolonged Field Care, Trauma Challenges

military students listening to an instructor in a helicopter
By Zachary Willis

A reliable team can mean the difference between life and death in a crisis situation. It takes effective leadership under pressure to navigate a team to success, and in austere, resource-constrained environments, only trained health care teams can provide the efficient and accurate care necessary for survival. One way the Uniformed Services University (USU) prepares its students for success in these environments is through the Gunpowder exercise.

The Gunpowder exercise, hosted by USU’s Department of Military and Emergency Medicine (MEM) in collaboration with the Maryland National Guard, is unlike any other training exercise at medical schools across the country. This exercise aims to expose third-year USU medical students to the many different challenges they may experience in future conflicts. Students learn about group dynamics, and how stress will affect their ability to provide care.

Students push a gurny into a transport vehicle
USU Students learn how to properly load a patient into a transport truck to get the patient to care efficiently. (Photo by Tom Balfour)

In a two-day field exercise at Camp Fretterd Military Reservation in Reisterstown, Md. held in late March, small teams of USU students work together to provide different forms of care to volunteer “patients” in surgical cutsuits, which allow the students to make real incisions without injuring the patient, and with greater accuracy.

During the exercise, led by course director Army Lt.Col. (Dr.) Grigory Charny, assistant professor of Military and Emergency Medicine, students practice prolonged field care, which consists of lessons in hemorrhage control, using catheters, and airway management. Other scenarios focus on en-route care, learning how to correctly package patients for transportation.  They also train on forward surgical resuscitation, which allows students to practice surgical resuscitative skills such as limb debridement, pain management, and a limb-saving procedure known as a fasciotomy, used to relieve pressure or tension in order to prevent the loss of circulation to muscle or tissue.

military students carry a loaded gurny through snow
Navigating austere environments, such as snow, is an important part of field care, and often requires teamwork to be successful. (Photo by Tom Balfour)

“Gunpowder was a great exercise,” said Air Force 2nd Lt. Ryan Rhie. “It would compete as the most popular military exercise our class went through during our time at USU. It is a unique view that we, as clinicians, may not able to experience [in the] real world, because we are able to experience what happens from point of injury through all the roles of care ultimately to transport to a Critical Care Air Transport Team (CCATT).”

The Gunpowder exercise, named for the Gunpowder Military Reservation in Baltimore, its original intended location, is offered in between the ACME (Advanced Combat Medical Experience) and Bushmaster field exercises.  It identifies itself by its real-time delivery of lessons relating to the care of those in need.  During  Gunpowder, it does not suffice to simply explain what each student would do; instead, they are required to do hands-on resuscitation, blood collection, surgical interventions or other tasks in real-time, so as to gain a more realistic understanding of medical conditions in a high-stress, austere, resource-constrained environment.

military students look at a patient on a gurny in a shelter
The Gunpowder field exercise allows students to practice surgical resuscitative skills at Camp Fretterd Military Reservation in Reisterstown, Md.  

“Dr. Charny, SFC [David] Macias, and the MEM department have done an amazing job coordinating a collaborative effort from Army Special Forces, Navy Corpsmen, Air Force CCATT members, and tri-service medical providers to give us a firsthand experience of how casualties are taken care of,” said Rhie.

While there are “only a handful of programs that teach prolonged field care,” according to Rhie, the Gunpowder exercise is at the forefront of those programs. Rhie went on to say that Gunpowder is an incredible training platform for not only students, but for enlisted faculty at USU as well. In all, Rhie said, Gunpowder stands as a stunning example of the training exercises that mimic real world experiences as closely as possible.