Encompassing Full Medical Mission Preparedness

From Combat & Casualty Care, Fall 2018 Issue

The Defense Medical Readiness Training Institute (DMRTI), Joint Base San Antonio, Ft. Sam Houston, TX, became part of the Defense Health Agency in 2014. Today, the tri-service organization offers resident, nonresident, and distance learning joint medical readiness courses.

By COL Michael W. Greenly, PM, Joint Operational Medicine Information Systems, PEO DHMS

The legacy of organized medical readiness training in a joint environment goes back nearly 40 years. In 1980, the Combat Casualty Care Course (C4) Task Force was stood up to teach a military-unique curriculum for DoD Graduate Medical Education programs. This was followed six years later by the Joint Medical Readiness Training Center, formed to continue operational training. Meanwhile, C4 continued and C4A evolved for senior leaders. This transitioned into the Joint Operations Medical Managers Course (JOMMC).

Ten years later, in 1996, the Defense Medical Readiness Training Institute (DMRTI) was stood up. Initially the Uniformed Services University of the Health Sciences acted as executive agent, followed by the Army. DMRTI featured an expansion over previous efforts, including joint exercise support (combatant command support), reserve component support, distributive learning (online training) and an expansion on operational emphasis.

DMRTI is a tri-service organization staffed by professionals from the U.S. Army, Navy, Air Force, Department of Defense civilians, and contractors that offers resident, nonresident, and distance learning joint medical readiness courses. It provides support to a range of “customers” including the Department of State, the armed services, combatant commands, the Center for Global Health Engagement, and reserve components by working directly with the Services to meet their medical readiness and training requirements. The Institute’s fundamental mission is to improve the coordination of readiness training efforts between military and civilian organizations. DMRTI became part of the Defense Health Agency in 2014, under the Education and Training (J7) Directorate.

A Multi-Scope Training Regimen

DMRTI utilizes several combat and trauma medicine course selections. These include:

Combat Casualty Care Course (C4): Provides an orientation to the first and second echelons of care under simulated combat conditions. This postgraduate course is designed to enhance medical readiness by providing training in leadership, knowledge and skills necessary for direct medical support of tactical units under combat operations.

Emergency War Surgery Course (EWSC): A three-day course for surgeons and non-surgeon physicians deploying to a position where they will be treating battlefield trauma. Training focuses on guides referenced in the Emergency War Surgery Handbook with an emphasis on live tissue and cadaver lab.

Professional Medical Certification Courses:

  • Tactical Combat Casualty Care Course (TC3): A two-day course that provides skills to assess and manage a combat casualty from point of injury to a higher level of care. The target audience is deploying medical personnel assigned to line units.
  • Advanced Trauma Life Support® (ATLS®): In-resident course and mobile training teams; the ATLS course provides essential information and skills doctors may apply to treat life-threatening or potentially life-threatening injuries in extreme conditions.
  • Trauma Nurse Core Course (TNCC): In-resident course and mobile training teams; the course enhances the nurse’s ability to assess patients that have sustained trauma. The target audience is military Nurse Corps officers and U.S. government-employed registered nurses. TNCC is not a stand-alone exportable course; it is conducted in conjunction with the combat casualty care course.
  • Pre-Hospital Trauma Life Support (PHTLS): In-resident course and mobile training teams; PHTLS is a two-and-a-half-day course sponsored by the American College of Surgeons and the National Association of Emergency Medical Technicians. The PHTLS course increases the participant’s pre-hospital trauma management skills. The target audience is DoD medical personnel. PHTLS is not a stand-alone exportable course; it is conducted in conjunction with the combat casualty care course.

In addition, DMRTI instructs the professional medical certification course Advanced Burn Life Support (ABLS), which is a one-day course sponsored by the American Burn Association. It focuses on the assessment and management of burn patients during the first 24 hours post injury. The target audience is military and U.S. government-employed medical personnel.

DMRTI embraces the Joint Concept for Health Services while building on the mandate of the 2017 National Defense Authorization Act. The Joint Trauma System has partnered with DMRTI to implement the Joint Trauma Readiness Training Platform (JTRTP). The pilot course was delivered in 2018 to a multi-disciplinary class of U.S. Army medical professionals. The central goal of JTRTP is to increase standardization of shared capabilities and decrease variance across the services.

Concept-Based Preparation

The Combat Casualty Care Course and associated professional courses utilize a variety of presentation techniques to ensure the material facilitates a learning atmosphere in which students assimilate appropriate knowledge, skills and attitudes. Medical simulation and modeling are key to enabling skills-based assessment and ensuring that the learning is relevancy-oriented to mission accomplishment in austere environments.

The providers, nurses and medics who attend our courses utilize intrinsic knowledge and life experiences to skillfully integrate the new material into their work/field experience, helping the lessons become an active part of their thought process. The courses at DMRTI have to see measurable learning objectives and have a clear system of gauging the attendee’s progress.

Prolonged field care and patient holding are concepts that are emphasized in our Combat Casualty Care Course, as the joint force prepares for more and more austere environments of care while simultaneously preparing for cases in which our forces do not enjoy complete air superiority.

Looking Forward

Over the past two years, DMRTI has been tasked to conduct new medical training as requirements across the joint forces have been refined. DMRTI has partnered with the U.S. Agency for International Development to offer the Joint Humanitarian Operations Course in San Antonio twice a year. Additionally, in direct support of combatant command requirements for joint medical planning and public health emergency management, the Joint Medical Operations Course and Public Health and Medical Services in Defense Support of Civil Authorities Course were implemented.