FORT RUCKER, Ala. – The beat of helicopter rotors pulses overhead as medical teams climb aboard, loaded with critical patients and focused minds. Dust kicks up on a sun-scorched flight line as service members rehearse what few in the civilian world will ever experience—resuscitating and stabilizing casualties mid-flight while coordinating care with ground forces in a hostile, resource-limited environment.

This is the Joint En Route Care Course (JECC), the military’s premier training program for operationalizing advanced clinical care across the battlespace. Hosted at Fort Rucker, Alabama, JECC marks the next step in the Navy Medicine paramedic pipeline—moving from academic instruction to hands-on, joint-environment operational training.

Building on efforts such as the accelerated paramedic course at Fayetteville Technical Community College (FTCC), JECC enables Hospital Corpsmen, nurses, and providers from across the services to bring their hard-earned clinical knowledge into action. It represents a deliberate, coordinated shift toward meeting the challenges of the Navy Surgeon General’s 2027 North Star.

The mission now is to meet the demands of modern conflict, to deliver agile, scalable, trained, and certified medical units to provide enduring support to the Fleet, Fleet Marine Force, and Joint Forces in high-end competition, crisis, and combat.

That mission continues here.

The JECC course integrates Navy Medicine personnel into joint teams of soldiers, airmen and Sailors, emphasizing standardized battlefield medical care and seamless interoperability in flight and on the ground. The goal: preparing medical personnel to deliver critical, life-sustaining treatment during casualty movement in deployed, austere, and contested environments.

Hospital Corpsman 1st Class Axel Narvaez, assigned to Naval Medical Forces Atlantic, knows firsthand how far this training pushes its participants and how much it prepares them for the realities of en route care.

“Bringing the knowledge and experience from the paramedic course in Fayetteville to here, puts everything together,” said Narvaez. “Here we’re not just training with mannequins. We’re learning how to be paramedics in flight and this training environment is incredibly realistic. It prepares us in a way I haven’t seen before.”

JECC is a key evolution of the expeditionary pipeline for paramedic-certified corpsmen who are now being trained for operational roles that are a part of the Navy Medicine system of Expeditionary Medicine (EXMED) platforms two of which include: the En Route Care System (ERCS) and Expeditionary Resuscitative Surgical Suite (ERSS) teams – both of which provide immediate surgical care in a highly contested environment.

“Becoming a paramedic is very significant,” Narvaez added. “We’re gaining tools and skills that weren’t previously available to general corpsmen. We’ll have the capacity to deliver advanced life support, not just sustain basic care but offer prolonged care.” Narvaez stressed. “We can do this on aircraft, at sea—anywhere.”

For Hospital Corpsman 2nd Class Kelly Jurkouich, assigned to Expeditionary Medical Facility (EMF) Mike 150, attached to Navy Medical Readiness Training Command (NMRTC) Jacksonville, the draw toward operational medicine is rooted in autonomy, challenge, and impact.

“If you want to understand medicine better, this is the pipeline,” Jurkouich said. “You gain a bigger understanding of en route care—short-term and long-term—and how to work more independently. You learn to help stabilize someone from battlefield to ship, ship to land, and keep them alive through every stage.”

Just as the original paramedic course reinforced hands-on care, JECC expands clinical acumen to operational movement. Jurkouich emphasized that the training strengthens Navy Medicine’s ability to deliver critical care in dynamic environments—directly aligning with the mission of EMF units and the larger EXMED framework.

“We’re learning alongside Army and Air Force medics. That interoperability is essential. If I’m in a helicopter with an Army medic, we’re speaking the same language. If I receive a casualty they have delivered, I know what to expect,” she said.

This shared knowledge base doesn’t just support wartime scenarios—it enables seamless cooperation across joint operations, engagements, humanitarian response, and mass casualty contingencies. The course reflects a broad Navy Medicine-wide commitment to elevating readiness through integrated training and advancing medical capabilities.

Lt. Cmdr. Meredith Marlowe, assigned to NMRTC Guam, sees the course as essential to the evolving nature of warfighting medicine.

“This course prepares us for not every eventuality—but for every possibility,” said Marlowe. “It increases our ability to save warfighters down the line. I’ll be so much more comfortable in the back of a helicopter, an ambulance or a small craft on the ocean. I’ll be ready to troubleshoot and respond when things go wrong.”

Marlowe, who also works in the emergency department at Naval Hospital Guam, described how JECC reinforces operational readiness at the local level as well. With corpsmen frequently conducting patient transfers across the island, the advanced skills taught in JECC translate directly to mission capability—whether at sea, in transit, or ashore.

“The training here helps us develop confidence, helps us prepare for worst-case scenarios,” she said. “If we can teach this to more corpsmen, nurses, and providers, it would expand our expeditionary capabilities dramatically.”
Like the accelerated program at FTCC, JECC follows a high-intensity model designed to push learners into realistic scenarios, merging advanced clinical interventions with joint tactical coordination. The course incorporates modules on ventilator management, invasive monitoring, packaging and transport procedures, and the physiological impacts of altitude and movement—all designed to enhance survivability between points of injury and definitive care.
For Narvaez, the value extends beyond the Navy.

“Right now, I can volunteer with SWAT teams, with local EMS, and keep my skills sharp,” he said. “If I retire tomorrow, I can still be a paramedic. But more importantly, in a military setting—I’m someone qualified to call a medical evacuation, assess a critical patient, and help save lives in real time.”

That real-time impact—on the battlefield and beyond—is the driving force behind Navy Medicine’s continuing investment in this training pipeline.

From the first intravenous injection to in-flight triage under pressure, from civilian trauma protocols to joint operational coordination, Navy Medicine is building a force of medical professionals trained to deliver advanced care anytime, anywhere. Whether in an ambulance, in a helicopter, or on the battlefield, corpsmen trained through this pipeline are bringing life-saving medicine forward with the fight.

As Navy Medicine continues to support the Surgeon General’s Lines of Effort—delivering expeditionary medical systems, increasing Sailor and Marine deployability, providing quality healthcare and safety across the force, and recruiting and retaining capable shipmates—JECC stands as a crucial milestone in the evolution of operational care.

“It’s better for us to concentrate our efforts on hard skills,” Narvaez said. “Being a paramedic and a corpsman, for me, is more impactful than being a clinic manager as important as they are. Going through this pipeline—being part of ERCS—that’s what really matters in order to prepare for future conflicts”

NMFL, headquartered in Portsmouth, Virginia, delivers operationally focused medical expertise and capabilities to meet Fleet, Marine and Joint Force requirements by providing equipment, sustainment and maintenance of medical forces during combat operations and public health crises. NMFL provides oversight for 22 NMRTCs, logistics, and public health and dental services throughout the U.S. East Coast, U.S. Gulf Coast, Cuba, Europe, and the Middle East.

Navy Medicine – represented by more than 44,000 highly-trained military and civilian healthcare professionals – provides enduring expeditionary medical support to the warfighter on, below, and above the sea, and ashore.