USU Nurses Forge Readiness in Extreme Environments: Dive and Mountain Training Pushes Boundaries
From the peaks of Vermont to the depths off Key West, specialized USU Graduate School of Nursing readiness training hones military nurses for any operational challenge.
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Navy Lt. Sharrod Green and Lt. Sean Hutchinson practice "ascending with a downed diver." (Image credit: Sharon Holland) |
May 8, 2025 by Zachary Willis
Forget the sterile halls of a typical hospital. For aspiring advanced practice registered nurses (APRNs) at the Uniformed Services University (USU) Daniel K. Inouye Graduate School of Nursing (GSN), preparation for military service means mastering life-saving skills in some of the world's most challenging environments. USU's GSN doesn't just teach advanced nursing; it forges operational readiness, embedding critical skills for deployed settings directly into its rigorous curriculum. This distinctive approach ensures graduates—whether earning a Doctor of Nursing Practice, Master of Science in Nursing or a Doctor of Philosophy degree—are equipped to provide high-quality care autonomously, wherever their mission takes them.
Beyond foundational operational competencies like Tactical Combat Casualty Care and Military Advanced Trauma Life Support, GSN’s curriculum includes unique electives that push students to their limits, mirroring the unpredictable nature of operational medicine. Two of the most impactful immerse students in environments demanding peak performance under pressure: the Cold Weather/Mountain Medicine sequence and the Maritime/Dive Medicine course.
“At USU we have a unique curriculum because we need to produce a unique type of advanced practice nurse,” says Dr. Carol Romano, dean of the GSN. “Our graduates must be ready to deploy in a Role Two setting shortly after graduation, and the more than 1,800 hours (twice as many as civilian schools) of clinical experience, and specialized courses in austere environments that they get in our curriculum prepare them to do so.”
This unique focus of the program means USU GSN students “are expected to graduate and immediately have the foundational operational skills necessary to care for those in harm's way,” according to Dr. Matthew Welder, special assistant to the Dean for Operational Medicine. Welder emphasizes the difference between USU and traditional programs, stating that “a typical advanced practice university focuses primarily on hospital- or clinic-based medicine. That environment has ample personnel, supplies, equipment, lights, overhead roofing, etc. A military medical provider not only has to be prepared for the aforementioned environment; they have to translate those skills into the austere environment with a skill set to save a life anytime, anywhere and under any condition.”
What does this mean in practice? As Welder explains, it translates to “caring for a casualty at point of injury, in the dark, on their knees, in the cold, on a boat, in the mountains, with only the medical gear that they have carried on their back.”
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Retired Army Lt. Col. Matthew Welder (left) achieved "Triple Crown" recognition by the Wilderness Medical Society, making him the first person in the world to do so. (Photo courtesy of Matthew Welder) |
Conquering the Cold: Mountain Medicine in Icy Extremes
The Cold Weather/Mountain Medicine training isn't for the faint of heart. Structured in two phases, it builds expertise for providing care in freezing temperatures, rugged terrain, and high altitudes. The initial Military Mountain Medicine Course provides essential wilderness medical knowledge fused with vital tactical skills like mountaineering and land navigation. This is followed by an advanced course focused specifically on casualty care and evacuation in extreme cold and avalanche-prone areas, teaching crucial techniques like snowpack assessment and high-angle rescue.
Training unfolds in authentic mountain environments, leveraging specialized military facilities like the U.S. Army Mountain Warfare School in Vermont. Operating in these locations demands specialized gear and meticulous planning, replicating the logistical complexities of real-world deployments. Facing physical exertion and environmental exposure while applying medical knowledge enhances preparedness for the unexpected.
This rigorous training is designed to “stress-inoculate a provider to various extreme conditions so they can do fine motor medical skills in an environment that evokes high stress,” according to Welder.
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The Cold Weather/Mountain Medicine training isn't for the faint of heart. Structured in two phases, it builds expertise for providing care in freezing temperatures, rugged terrain, and high altitudes. (Photo courtesy of USU Operational Medicine) |
Diving Deep: Providing Care Below the Surface
Complementing the vertical challenges of mountain warfare is the horizontal, and often more disorienting, environment of maritime and dive operations. The intensive, 10-day Maritime/Dive Medicine course plunges students into the unique medical emergencies encountered in aquatic settings. Held at the U.S. Army Special Forces Underwater Operations School in Key West, Florida, the program delves into dive physics and physiology, covering critical topics like managing diving injuries such as arterial gas embolism and decompression sickness. Students master vital water rescue techniques, including recovering and transporting casualties in the water using specialized equipment.
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Held in Key West, Florida, the program has students mastering vital water rescue techniques. (Photo courtesy of USU Operational Medicine) |
“The ocean's vastness has always been one of my biggest fears,” says Army Cpt. ReynaLynn Palanca, a participant in the Dive Medicine course. “Trusting both my equipment, my buddy, and instructor were a challenge at first. However, with each dive I felt more confident in myself and the fear slowly melted away. I think this applies to life's challenges as well. With a little bit of support, time, and learning I know I can conquer any endeavor or obstacle.”
Leadership, Collaboration, and Real-World Impact
The strength of GSN's operational medicine program is significantly amplified by its experienced faculty, a blend of civilian academics and seasoned uniformed officers. Leaders like Welder are instrumental in shaping and guiding these specialized courses.
A cornerstone of the USU experience is its unwavering commitment to Interprofessional Education (IPE). “Our courses are not just nurses,” Welder clarifies. “We have docs, PAs, medics, warfighters, faculty, mental health providers, etc. If you wear the uniform and are in the medical field, these courses are for you.” Experienced Special Forces combat medics are also part of the training. This team-based approach is considered vital for readiness, fostering the seamless communication and collaboration necessary for effective healthcare delivery in high-pressure military environments.
Welder emphasizes the importance of this IPE approach. “These programs are a prime example of IPE,” he explains, highlighting that “successful medical care requires a team approach. A team that understands the roles, the requirements, the strengths and weaknesses of every team member.”
According to Welder, USU has been committed to IPE “consistently for a decade now” within these austere training courses. In fact, “the warfighters have seen the success of these standardized readiness courses and have now been working with USU for a few years sending their providers to the USU course.”
“This becomes imperative,” Welder states, “because we have now standardized the curriculum to successful training and prepare our team in these environments.”
The expertise of the instructors further enhances the program's value. “It is important to know that our instructors are not just civilian trained medical providers,” says Welder. “We are all decorated combat veterans with multiple combat deployments in all different environments.” Their firsthand experience brings a unique perspective to the training. “We identified the risk of the Walker Dip a decade ago and dedicated our lives to teach at USU,” Welder explains, “ensuring these lessons are not lost and our students build the skills required for success during the wartime mission.”
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"If you wear the uniform and are in the medical field, these courses are for you,” says Dr. Matthew Welder. (Photo courtesy of USU Operational Medicine) |
Student feedback consistently underscores the profound impact of this hands-on, realistic training. Applying theoretical knowledge under simulated operational stress is repeatedly cited as invaluable for solidifying learning and building critical skills that classroom or hospital settings simply cannot replicate. Challenges encountered during training, from austere conditions and environmental stressors to uncertainty and the need for improvisation, are seen not just as hurdles but as opportunities to build resilience, adaptability, and essential military officer attributes.
"I am certified in most advanced major resuscitative programs offered in the United States and have been in the military for 13 years,” says Navy Lt. Taylor Donelson. “However, from beginning to end, the culminating exercise of the Dive Medicine program was the most comprehensive and realistic medical training I have ever been put through.”
"As a medical officer in the U.S. Armed Services, we must be prepared to deliver care anytime, anywhere. Yet, much of our experience is in the controlled setting of traditional hospitals,” says Lt. Cmdr. Emma Sprott, a participant in the Mountain Medicine course. “I never want to be a liability to the mission; I want to be the one who steps up when it matters most. This training has given me the confidence and capability to do exactly that, it’s made me feel better prepared to meet the demands of care in operational settings.”
The USU GSN operational medicine program is a vital asset, uniquely designed to produce operationally competent, independent APRN leaders prepared to meet the evolving healthcare needs of the nation's uniformed services globally. It ensures that when the call comes, USU nurses are ready to answer, no matter the environment.
“Many military training courses fall short due to various limitations, but this course is a clear exception,” says Sprott. “It pushed me through realistic, high-pressure scenarios that demanded leadership, medical expertise, mountaineering skills, and the humility to follow when needed. I can confidently say that I came out of it a more capable provider and a better officer."
