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Sharpening the Scalpel: Medical Providers Hone Skills in Operation Firebreak

17 November 2022

From Petty Officer 2nd Class Russell Lindsey

(Nov. 15, 2022) CAMP PENDLETON, Calif. – In combat when a casualty occurs it’s an overload to the system. There often is smoke, gunfire, screaming and the person you’ve often shared years of experiences with is down. To sum it up in a word, chaos. How do you prepare for that chaos in a classroom? How do you deal with the tactile problems after our
(Nov. 15, 2022) CAMP PENDLETON, Calif. – In combat when a casualty occurs it’s an overload to the system. There often is smoke, gunfire, screaming and the person you’ve often shared years of experiences with is down. To sum it up in a word, chaos. How do you prepare for that chaos in a classroom? How do you deal with the tactile problems after our service members are critically injured?

To train for those real-world problems faced by our Navy and Marine Corps medical providers, Navy Expeditionary Medical Training Institute (NEMTI) worked with Marine Corps units and Fleet assets on Camp Pendleton, executing the latest iteration of Operation Firebreak on Nov. 15.
NEMTI, the expeditionary medical training detachment of Navy Medicine Operational Training Command (NMOTC), is the Navy’s preeminent leader in expeditionary medical training and is utilized by Navy Medicine teams, Marine Corps units, and Surface Forces Pacific Surgical Teams. The exercise, staged on Tuesday, marked the third iteration of this operation that has gone on from a mere proof of concept a year ago to a fully-fledged critical training operation, producing visible results for Third Fleet
aligned Navy and Marine Corps leadership one year later.

“This operation not only demonstrates our partnerships, which are the strength of Navy Medicine, but also gives leadership glimpses about what we can do better and how to make those partnerships stronger,” said Navy Capt. Kimberly P. Toone, commanding officer of NMOTC. “NMOTC
makes the best caregivers in the world even better! It’s our specialized detachments, unique trainings environments and operations like Firebreak that allow us to showcase the skill sets that make us so effective. Each time we train we come away with more knowledge and insight that allows us to keep that edge.”

CAMP PENDLETON, Calif. (Nov. 15, 2022) – Marines of 2nd Battalion, 1st Marines simulate combat casualty egress with high fidelity manikins at Naval Expeditionary Medical Institute (NEMTI) during Operation Firebreak,November 15.

Operation Firebreak is an exercise designed to evaluate operational readiness through simulated point of injury treatment and transport of casualties to the next level of care. Navy Medicine Operational Training Command (NMOTC) is comprised of six nationwide detachments that offer specialized medical training in the fields of aviation, aviation survival, surface and undersea warfare, expeditionary and special operations medicine. (U.S. Navy Photo by Mass Communication Specialist 2nd Class Russell Lindsey)
CAMP PENDLETON, Calif. (Nov. 15, 2022) – Marines of 2nd Battalion, 1st Marines simulate combat casualty egress with high fidelity manikins at Naval Expeditionary Medical Institute (NEMTI) during Operation Firebreak,November 15. Operation Firebreak is an exercise designed to evaluate operational readiness through simulated point of injury treatment and transport of casualties to the next level of care. Navy Medicine Operational Training Command (NMOTC) is comprised of six nationwide detachments that offer specialized medical training in the fields of aviation, aviation survival, surface and undersea warfare, expeditionary and special operations medicine. (U.S. Navy Photo by Mass Communication Specialist 2nd Class Russell Lindsey)
CAMP PENDLETON, Calif. (Nov. 15, 2022) – Marines of 2nd Battalion, 1st Marines simulate combat casualty egress with high fidelity manikins at Naval Expeditionary Medical Institute (NEMTI) during Operation Firebreak,November 15.

Operation Firebreak is an exercise designed to evaluate operational readiness through simulated point of injury treatment and transport of casualties to the next level of care. Navy Medicine Operational Training Command (NMOTC) is comprised of six nationwide detachments that offer specialized medical training in the fields of aviation, aviation survival, surface and undersea warfare, expeditionary and special operations medicine. (U.S. Navy Photo by Mass Communication Specialist 2nd Class Russell Lindsey)
221115-N-BC658-1206
CAMP PENDLETON, Calif. (Nov. 15, 2022) – Marines of 2nd Battalion, 1st Marines simulate combat casualty egress with high fidelity manikins at Naval Expeditionary Medical Institute (NEMTI) during Operation Firebreak,November 15. Operation Firebreak is an exercise designed to evaluate operational readiness through simulated point of injury treatment and transport of casualties to the next level of care. Navy Medicine Operational Training Command (NMOTC) is comprised of six nationwide detachments that offer specialized medical training in the fields of aviation, aviation survival, surface and undersea warfare, expeditionary and special operations medicine. (U.S. Navy Photo by Mass Communication Specialist 2nd Class Russell Lindsey)
Photo By: Petty Officer 2nd Class Russell
VIRIN: 221115-N-BC658-1206


The origins of Operation Firebreak were conceived in fall of 2021, after identifying critical areas where integrated cooperation among medical teams could make the difference between life and death for our service members. After analyzing these areas centering around the “golden hour” of injury and need to have advanced lifesaving interventions, NEMTI engaged with Marine Corps leadership and laid the foundations for training that would be focused on medical personnel and the interoperability between different roles of care with a focus on point of injury providers, surgical teams and other Role 2
providers aimed at escalating care upward.

“NEMTI has an enduring partnership with the Naval Surface Force Pacific Fleet Surgical Teams (FST) and I Marine Expeditionary Force. With every iteration we want to take it to the next level and improve readiness for every medical provider asked to excel in chaos,” said Lt. Alexandra McGaha, NEMTI academics and training department head.

In this evolution of Operation Firebreak, the ERSS team integrated with 2nd Battalion, 1st Marines and Fleet Surgical Team 5 to provide Role 1 and specifically Role 2 health care providers to train and focus on Point of Injury Care, Valkyrie Whole Blood transfusion, communication, patient
tracking and patient movement within a simulated distributed maritime environment in one realistic training evolution. During the scenario, every attempt at immersive realism was given attention including sound, vehicles, and props all used in a cinema quality training environment. For patient care high-fidelity manikins were used to provide audible and physical feedback to the providers were used to simulate actual casualties so lifesaving interventions such as blood infusions and hyper-realistic surgery was made possible with cut-suit simulators.

“The overall mission of Operation Firebreak is to integrate point of injury TCCC (Tactical Combat Casualty Care), Valkyrie emergency whole-blood transfusions, Role 1 damage control resuscitation, Role 2 damage control surgery, and, when available, Role 3 Expeditionary Medical Facility care in a contested, distributed environment,” said McGaha.

Operation Firebreak also provides Navy Corpsmen a chance to better understand how they can improve point of injury treatments, provides an opportunity to learn the capabilities of other medical teams within the continuum of care, and potentially relieve some moral injury that occurs when an untrained team faces real-world casualties. This is one of the areas that Cdr. Virginia Damin, NEMTI’s officer in charge, wants to bring focus to; mitigating the burden of moral injury by properly training and
equipping medical teams to face the future fight. Damin went on to say studies have shown that the more individuals feel prepared for the problems, realities, and scenarios that they will likely encounter in
combat, the less likely they are to suffer psychological trauma afterward.

“Feeling well prepared for whatever may come your way on the battlefield is one of the best things we can do for our warfighters. Feeling unprepared and helpless when your Soldier, Sailor or Airman is down can be more damaging in the long run impacts our ability to fight,” said Damin. “Operation Firebreak is essential in preparing our men and women to deal with those scenarios and allow them to not only practice those critical skills, but also to allow them to feel prepared and make them more resilient for the future.”

Keeping our medical forces trained and ready while implementing the CNO’s operational readiness mindset of “Get Real, Get Better” is the mission of NEMTI and ultimately NMOTC. Comprised of six main detachments with specialties of aviation, surface, undersea, expeditionary, and special operations medicine as well as aviation survival, NMOTC is the Navy’s leader in operational medical training and is the best weapon in combat casualty care across the Navy’s AOR. Using multiple programs with partnerships across the United States, the Navy’s health care providers are trained to the highest levels and, while the Navy will always keep watch on our seas, its medical forces must be ready at a moment’s notice to render aid anywhere on the planet in some of the most austere environments known to man. NMOTC is focused on preparing those medical forces to deliver that specialized care to
anyone, anytime and anywhere!

For more information about this article visit: https://www.med.navy.mil/Navy-Medicine-Operational-Training-
Command/Naval-Expeditionary-Medical-Training-Institute/
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