USU Nursing Students Visit FBI Academy for Trauma Training Exercise

By Ian Neligh

The Black Hawk helicopter lands in a field behind the FBI Academy, its main rotor sending up a massive plume of dust and grit. 

A handful of Uniformed Services University (USU) Graduate School of Nursing (GSN) Registered Nurse Anesthesia students hunker down over the litter they’re carrying to protect themselves and their “patient” from the helicopter’s powerful downwash.

Given the “all-clear” signal, the team gets up and moves to the Black Hawk, staying low under the awesome power of the blades as they evacuate their casualty. The students, using hand gestures to communicate, then work with Navy Cmdr. Ken Radford, USU’s Nurse Anesthesia program director, to intubate the training mannequin, their simulated patient. The first student is successful; Radford offers them a fist bump, and it’s time for the next student to step up and give it a try. 

These GSN students are taking part in the Trauma Culmex training exercise held in conjunction with the FBI’s elite Hostage Rescue Team in Quantico, Va., just days before their graduation from USU. 

The Trauma Culmex exercise was developed to fulfill the Registered Nurse Anesthesia student Trauma Simulation curriculum requirement in their last
semester of clinical education. (Photo credit: Ian Neligh, USU)

Radford says GSN faculty have provided training for the Hostage Rescue Team medical personnel in the past, which helped to open the door for the nurse anesthesia students to receive their own educational opportunity on the FBI Academy grounds.

“This is the first time that we’ve held this simulated trauma experience so this is an incredible opportunity for them to round out their training,” Radford says.

The event was conceptualized by Dr. Matthew Welder, special assistant to the USU President for operational medicine and Radford, and executed by Army Lt. Col. Janet Sims, director for Simulation and Navy Lt. Cmdr. Lauren Suszan, director of Clinical Education, for the RNA program at USU.

The Trauma Culmex was developed to fulfill the registered nurse anesthesia student trauma simulation curriculum requirement in their last semester of clinical education. Students take part in training and exercises focused on providing care in austere environments for both injured service members and military working dogs.

Radford says providing his students with a chance to close out their training with the event helps to get them in the right mindset for an operational deployment.

“Our mission is to train anesthesia providers that can provide anesthesia care in austere settings and this was a way for us to round out their education as they approached graduation,” Radford says. “It’s really incredible.”

The USU GSN students took part in the Trauma Culmex training exercise held in conjunction with The FBI's elite Hostage Rescue Team on May 17 in
Quantico, Va. Here, students rush their simulated patient onto a Black Hawk helicopter. (Photo credit: Ian Neligh, USU)

Inside one building, its walls still spattered with the bright paint of simulated training ammunition used to mimic live bullets during exercises, USU students work on crisis actors made up to look like they have a host of traumatic wounds. Instructors analyze the decisions of the soon-to-be-graduates as they manage the series of injuries their patients experience. 

Sims checks in on one group, making sure all of the many moving parts of the trauma culmination exercise are running smoothly before heading back outside. There, a team of four load their patient onto a military ambulance, climbing on and providing care as the vehicle drives off. Sims says their mission with the exercise is to prepare independent military anesthesia providers to give care in any operational and austere environment. She adds that partnering with the FBI and the Hostage Rescue Team was a natural choice to help meet this mission. 

“USU students are well-prepared to provide medical care in fixed medical facilities with adequate staff and equipment,” Sims says. “However, operational readiness courses (like this) help prepare them for anesthesia care in the field.”

As students go from one exercise scenario to another, flash-bangs go off, the rattle of gunfire echoes nearby, and FBI teams train only feet away in the next room.

“(The students) are taking care of patients with minimal equipment in a building of opportunity, transporting patients and dealing with all that comes along with that — lack of supplies, lots of noise, flash-bangs going off, gunfire, helicopters taking off and landing,” Sims says. “We also have to take care of the military working dogs as CRNAs (certified registered nurse anesthetists) when we’re deployed because they are one of the team and if they get hit, we take care of them until we can transfer them to a higher level of care.”

At another location students are being introduced to a retired military working dog and a half dozen “wounded” canine mannequins. The real dog waits patiently as the new group files in to learn about working with an injured military canine in the field. 

“The experience has been great,” says Army student Maj. Andre Brown, adding that he and the others didn’t initially know what to expect before arriving for the exercise. “They hadn’t really given us any information before we got here. It was ‘hey, get a hotel at Quantico, meet at this place and these are the times we’re going to start.’ Then we get out there and it’s like ‘here’s your scenario, go — how would you react?’”

Brown says one of the day’s impactful lessons was learning about how to give care to an injured military working dog. 

“I knew enough to get the dogs from point A to point B but here we’re learning more effective care, and a more effective means of how to do things,” Brown says. “… Everybody has been super knowledgeable with helpful tips that I hadn’t even thought about.”

A GSN student works to intubate a training mannequin within the confined space of a Black Hawk helicopter. (Photo credit: Ian Neligh, USU)

Sims says this year’s collaboration with the FBI and the Hostage Rescue Team is essentially a test run for future trauma culmination exercises. She says the university currently has the “Gunpowder” exercise which helps expose USU students to a variety of challenges they may come across in the field, training them on tactical field care, tactical combat casualty care, prolonged casualty care, and forward resuscitative care.

“Unfortunately, the timeframe (for Gunpowder) does not align with most of our nurse anesthesia students as they attend a 21-month clinical rotation at various locations throughout the country” Sims says. “We’ll see how this exercise goes and obtain feedback from the faculty cadre and students and add or remove content to make it most beneficial to train and assess their trauma anesthesia skills.”

Navy student Lt. Cmdr. Joseph Dimarucut says taking part in the Trauma Culmex has been an amazing experience. Particularly, he says working to intubate a patient from within the confined space of a helicopter stands out to him as a valuable lesson that couldn’t be practiced in a hospital.

“It’s a good culmination of everything that we’ve learned put into practice and what we’ll expect to see in the field,” Dimarucut added.

Hurrying past FBI agents rappelling down a wall, the next group of USU graduate nursing students carries a litter holding a simulated patient, an instructor following closely behind. They arrive at an open field and soon the sounds of a helicopter’s rotor chopping through the day’s warm air once again grows louder. The dust hits them, they get up and hurry for its open doors and the training begins all over again.