On a balmy June day, blue skies above Baumholder Army Airfield, Germany, contrasted with the 519th Hospital Center/512th Field Hospital’s dark green tents. Planted in the pastoral landscape, the complex was a second home to many of the 400 troops who had prepared for months and trained onsite for weeks to execute HOSPEX 21, part of DEFENDER-Europe 21 — a large-scale U.S. Army-led exercise between the U.S., NATO Allies and partner militaries.
From May 30 through June 4, 2021, the 30th Medical Brigade led multi-national troop response to a simulated battle scenario, including a mass casualty event, as a NATO medical evaluation team observed. Hanging in the balance was a NATO Role 2 Enhanced certification, validating the 512th FH as capable of providing advanced medical support in the field and meeting NATO’s medical doctrine of interoperability. Financial, technical and medical specialist shortages across the NATO nations have increased the profile of multinational support options.
“It’s one thing to say that the practice of medicine can be universal across the spectrum,” said Col. Jason Wieman, 30th Medical Brigade Commander. “But it’s another thing to actually understand how to use a piece of equipment in a German hospital as opposed to a Bosnian hospital or a Polish hospital.”
HOSPEX 21 provided a unique opportunity for the U.S. to train with allies and partners, side-by-side, as they would in a real emergency, to sustain the fighting force, increase interoperability, and strengthen partnerships.
Over five days, the 30th Med Brigade, German Bundeswehr, U.S. Air Force, U.S. Army Reserve Command, Landstuhl Regional Medical Center and medical subject matter experts from partner nations treated more than 100 simulated patients at every level of medical military tactical care—from point of injury, through initial stabilization and medical evacuation to a hospital for more definitive care. Personnel from Germany, Poland, Australia, the Netherlands, France, Bosnia and Herzegovina, and Hungary participated.
According to Wieman, HOSPEX 21 represents the highest level of interoperability between the U.S. and its NATO partners. “It brings us all together,” he said. “It’s been a wonderful experience both from a training point of view and relationship point of view to work with so many of our NATO allies and get to where we are now.”
“Somebody help me!”
The June 3 mass casualty scenario outside the 512th Field Hospital began when seemingly bleeding and broken bodies arrived by 557th Medical Company Area Support Army ambulances. As NATO evaluators observed, patients were triaged, treated and comforted. Some were whisked away for emergency care and surgery, while others lay on the ground, moaning and crying for help.
The scenario stressed the hospital’s capacity, requiring some patients to wait for prolonged periods of time. One of those who had to wait was Pfc. Zoey Gillespie, 64th Medical Detachment Veterinary Service. She looked bad, with a fully bandaged head, and a piece of metal sticking out of a bloodied left eye. But the 512th FH providers determined she could wait.
“Even though it looks grotesque, it’s not as bad as some of the other people,” said Gillespie. “My injury wasn’t one that was necessarily life threatening.”
Nevertheless, Gillespie said she was given pain medication right away, and when her pain increased, she moved up in priority. She felt cared for, even while waiting.
“Everyone is really compassionate.” She said. “I’ve noticed that, for sure. Because when you are confused and you are in pain, having somebody that’s treating you in a harsh manner or sticking things into you can be scary. So, being compassionate and caring when you’re providing medical care is important. And everybody here has done that.”
SPC Travis Benton, Jr., 64th Medical Detachment Veterinary Service, agrees. He played a wounded prisoner of war who did not speak English. Even though he acted aggressively and had to be strapped down, he was provided a translator and asked if he needed anything to eat or drink. His experience at HOSPEX was eye-opening.
“It really gives you an idea of how stressful the environment will be,” said Benton. “It gives you a better idea of how you should go about certain things, like determining what situations are more major than others.”
Making those determinations is a skill that can only be honed with with experience.
“The training opportunity that we have here is invaluable, especially working with our allied partners,” said 512th FH Maj. Thomas Kwolek, Clinical Nurse Officer in Charge of Emergency Medical Treatment.
During HOSPEX 21, away from the garrison environment, soldiers were able to focus and work on technical skills, practicing mission essential tasks they have to perform with partners in the European theater.
“That’s invaluable because at the time when we’re needed, we have the opportunity to be at our best,” said Kwolek. “Because we’ve had those conversations. We’ve repped those scenarios for the best outcomes for our patients.
“Participating in an event like this brings a sense of realism to our soldiers that’s invaluable,” Kwolek added. “We have training simulations where we’ve broken down the individual pieces, but when we bring them together in a culminating event, they get to see how each one of the pieces work through the system of health, as we progress through the emergency, EMT section all the way to the in-patient arenas. They have the ability to connect the dots.
“When we were stressed with the number of casualties and the complexity of the casualties, everyone rose to the occasion. We were here for everyone’s worst day, but we were at our best, and that makes the difference.”
According to Wieman, joint service cooperation is another element that makes a difference.
“The Air Force has become very important partners for us from all levels of training,” said Wieman, explaining that the next level of care after hospitalization involves transporting patients to a tertiary healthcare facility — a final point where rehabilitative and definitive care is provided outside the battlefield.
On the day of the mass casualty exercise, Capt. Cathy Chavez, USAF 52nd Medical Group, supervised the “ERPS” or en route patient staging system at Baumholder Army Airfield.
“Our job in this setting is to embed with the Army and provide that piece and take all of the patients out to the flight line and load them on to the aircraft for patient movement,” she said.
“A lot of the Army care in the air is going to be rotary wing, so our Air Force assets help with that fixed wing capability for the longer distances to get to those Role 4 centers,” added Chavez.
Patients often have to travel longer distances, including trans-Atlantic flights back to the U.S., for a higher echelon of care. “So it makes sense to use our C-17s, our C-130s and our KC-135s to move those patients,” said Chavez.
Baumholder Army Airfield is quiet now, having played its role as a HOSPEX 21 staging and training area. Exercise participants have gained experience, insight, skills and stronger connections. All will be put toward providing expeditionary, deployable medical care in an austere environment.
The evaluators from NATO’s Military Medicine Center of Excellence will analyze their observations and a final evaluation report may be issued as soon as August, certifying the 512th FH as a NATO Role 2 Enhanced field hospital.