USU Students Join French Military for Cutting-Edge Combat Medicine Exercise

USU medical students participate in a high-stakes combat medicine exercise in France, collaborating with international peers to sharpen their skills for future deployments.

Military medical students, including those from USU, participate in an intensive field simulation during the

EXOSAN exercise, designed to test their ability to deliver care in challenging, resource-limited environments.

(Courtesy photo)

July 16, 2025 by Sharon Holland

Military medical students from the Uniformed Services University (USU) joined their international peers in Valbonne, France, June 15-20 for the 2025 EXOSAN exercise—an advanced, high-stakes medical field simulation designed to test and sharpen their readiness for real-world deployments.

Held at the French military medical academy (ACASAN) in La Valbonne, EXOSAN is the final evaluation for French military medical and nursing students before their first operational assignments. The 2025 iteration was redesigned to reflect lessons learned from recent conflicts, incorporating new technologies, immersive simulations, and a focus on delivering care in contested, resource-limited environments. The goal: to prepare students to manage high volumes of wounded and sick patients under pressure, with precision and resilience.  

Nearly 170 students—including 11 international participants from Belgium, Germany, the United Kingdom, and the United States, as well as the host French—took part in this year’s exercise. The tri-service team representing USU were Army 2nd Lt. Karine Zeidan, Air Force 2nd Lts. Edgar Villaruel and Grace Roe, and Navy Ensign Kamryn McKenzie, who were accompanied by USU Brigade Commander Army Col. Albert Kinkead and retired Army Lt. Col. James Schwartz, deputy chair of USU’s Department of Military and Emergency Medicine which oversees a similar exercise called Bushmaster, the university’s capstone medical field exercise for fourth-year medical students and USU nursing students.

The USU students spent their first few days in Paris learning about French tactical combat casualty care (TCCC) doctrine through classroom sessions and hands-on workshops. They noted a few differences from what’s done in the U.S., including the French use of hypertonic saline as a primary fluid replacement to reduce volume needs, rapid evacuation with more aggressive pre-flight interventions—such as conducting cricothyrotomies before patient transport, and their use of freeze-dried plasma kits, which allow for simplified blood product reconstitution and delivery in austere conditions.

USU students (center) join their international counterparts for a triage board "game" during the 2025

EXOSAN exercise in France. (Courtesy photo)

Once in the field, the students noted additional differences and experiences.  

“During the EXOSAN experience I learned a lot about the subtle differences in trauma management priorities between different countries. There were certain alternative tools and procedures that we had been taught throughout our USU training exercises to use in case of emergency and low resource situations that the French students were either not exposed to, or were not allowed to do based on their curriculum,” said McKenzie. “The German students seemed to be more similar to the U.S. in the sense that they were willing to branch out of the typical algorithms, procedures and equipment, if needed, in order to save a life in an emergency situation.”

McKenzie also observed that the French program included some emergency procedures taught regularly that the USU students had not seen before, including taking blood out of a patient’s chest after chest trauma and reinfusing it into their blood supply. 

“This was a great time to adapt to these differences in a simulation setting, instead of in a real combat situation in the future when we may be working with our NATO colleagues in future conflict,” she said.

One of the highlights of the experience for the students was how lessons from current conflicts had already been incorporated into the exercise, including Ukraine. 

Villaruel had the opportunity to serve as a leader during a particularly intense scenario involving simulated drone attacks and combat triage in confined trench conditions. “It challenged all phases of TCCC—care under fire, tactical field care, and evacuation under stress. It’s the kind of training I hope more students get to experience,” he shared.

Zeidan also described the trench scenario, noting “It was super hot. There were a lot of us plus the patients. Everyone’s sweating, everyone’s carrying equipment. It was chaotic,” she said. “But that’s probably the best way to prepare for that sort of environment.”

In addition to that one, the exercise incorporated a simulated chemical/biological situation, and other unique patient care scenarios.

“We had a workshop where we were making an old restaurant into an aid station to temporarily take care of patients while waiting for transport,” McKenzie recalled. “We also had an exercise taking care of patients at night, using only our red lights in order to simulate an unsafe area at night.”

A “fun, non-medical, highlight” of the exercise, according to McKenzie, was trying the French field rations. “The menu was filled with French cuisine like pate and fondue cheese,” she said. “Also, the heating mechanism had a real flame, which is much different than what is allowed and provided in our typical MREs during USU exercises.”

USU students (from left) Air Force 2nd Lt. Edgar Villaruel, Army 2nd Lt. Karine Zeidan, Navy Ensign

Kamryn McKenzie, and Air Force 2nd Lt. Grace Roe attend an evening gala as part of the events

surrounding the French EXOSAN field exercise. (Courtesy photo)

The students also reflected on how their prior USU training—especially the Gunpowder exercise—helped them feel prepared, but not overconfident. “I thought I was ready going into it,” said Zeidan, “but even small differences in equipment or protocols force you to stay on your toes.” Roe added, “It was our first time truly living in the field—no electronics, limited resources, and no backup. But it was a great learning experience and I’m now even more excited for Bushmaster.”

Much like Bushmaster, EXOSAN tests not only clinical knowledge but leadership, adaptability, and teamwork under stress. For the USU students, the experience was more than an exercise—it was a unique opportunity to engage in international military medical collaboration and expand their understanding of what it means to deliver care on the modern battlefield.

The experience also emphasized multinational interoperability as the students trained alongside their international peers. Roe, a former British citizen, said the camaraderie and collaboration were highlights of the trip. “Everyone was incredibly kind and welcoming. We shared techniques, swapped patches, and really built friendships. It reminded me of the importance of learning some of the local language beforehand—I relied on Karine’s French a lot more than I expected!”

Another unique component of EXOSAN was its combination of theoretical workshops and practical exercises—an approach Zeidan appreciated. “It was helpful to have that knowledge base before we hit the field. It allowed me to think more clearly through what I was doing.”

Cultural immersion was another memorable part of the trip. The USU students attended a formal gala for French medical graduates, toured historic sites, and were hosted by Zeidan’s family during a weekend in Paris. 

As they look ahead to Bushmaster and beyond, Zeidan and Roe said their time at EXOSAN has shaped how they will support international participants coming to USU’s exercise. “We already signed up to sponsor incoming students,” said Roe. “We want to be as welcoming and helpful as everyone was to us—whether it’s with translating, navigating protocols, or just being a friendly face.”

“This was an incredible experience for our students. They gained real value working alongside our Allies in integrated, multinational teams—learning firsthand how the French, Belgians, Germans, and UK operate. It allowed them to compare and contrast these approaches with what they’ve studied over the past three years," said Kinkead. "Experiences like this benefit the Military Health System as a whole by giving our junior medical officers early exposure to international collaboration. I’m confident the connections they’re making now will pay dividends in the future when they deploy or serve on missions with our Allies.”