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# Medical logistics Airmen enable enhancement of lifesaving skills at NATO exercise in Romania

By 1st Lt. Andrew LaytonUSAFE - AFAFRICA Public Affairs

                CINCU, Romania  –              
Approximately 50 Airmen from the 86th Medical Group, Ramstein Air Base, Germany, arrived Wednesday at Cincu Military Base, Romania, to participate in the NATO-led medical exercise Vigorous Warrior 19.During Vigorous Warrior’s week-long battery of realistic medical drills – choreographed to test doctrinal concepts and stress the medical assets of participating NATO partner countries – these Airmen will be operating an expeditionary medical support system (EMEDS), designated by NATO as a “Role 2” field hospital under its four-tiered stratification of medical care.The EMEDS is a compact, modular hospital unit designed to be deployed rapidly, with the capability to receive patients within six hours of arrival within an area of responsibility (AOR).For every minute that the U.S. Air Force medical team trains in the administration of patient care, a team of five highly-professional logisticians spends an equal amount of time fine-tuning the infrastructure and support equipment that enables a high posture of readiness for the EMEDS assemblage.“Our logistics specialists are charged with an enormous amount of responsibility,” said Lt. Col. Cody Hess, commander, 86th Medical Support Squadron. “They ensure all of the support equipment for the EMEDS is functional and in the right spot at the right time, so that when it’s time to perform our mission, our team of providers has exactly what they need to save lives.”For the logistics specialists, this means they are often first to the site at the beginning of a workday – and last to leave.“When we get to the site in the morning, we start with our equipment functionality checks,” said Tech. Sgt. Robert Cavenaugh, biomedical equipment technician, 86 MDSS. “None of the medical specialists can do their job without power, so we check the generators first; then the power boxes, distribution panels, and heating and air conditioning units to make sure everything’s good to go.”From that point on, Cavenaugh says it’s nearly impossible to predict how an equipment technician’s day will play out because of the many troubleshooting and support services they may be called upon to perform in their jack-of-all-trades profession.“Most of the day comes down to walking around, checking to see what people need,” said Cavenaugh. “The EMEDS needs a lot of things to run smoothly, so it’s constant problem solving and making things happen.”During peak operations, the logistics team is even able to augment the EMEDS staff by carrying litters and facilitating patient flow.“We take all of the extra demands in stride,” said Senior Master Sgt. Drew Robinson, logistics flight superintendent, 86 MDSS. “Our motto is ‘whatever it takes,’ and that’s what we live by.”While Robinson’s team is an integral piece of the day-to-day mission at Vigorous Warrior 19, a bulk of their contributions to the exercise will ultimately take place before and after the EMEDS is operational.“One aspect of the EMEDS that’s really hard to fathom is how compact the system is,” Robinson said. “It’s designed to be transportable in ten pallet positions, so that the complete package, including equipment and staff, can be transported on one C-17 cargo aircraft.”The last time the 86 MDG fully exercised its EMEDS capability was three years ago during exercise Immediate Response in Slovenia.Robinson said that a particular challenge in transporting the EMEDS from the 86th’s base in Germany for Vigorous Warrior was that the exercise’s remote location in rural Romania made the option of military airlift impossible. This required the normal transportation pallets to be re-configured for movement on European-style cargo vehicles. Robinson and his team responded to the challenge with a typical “can-do” spirit.“We ended up re-packing everything into sixteen European pallet positions,” Robinson said. “It’s more than forty tons of equipment, not counting the forklift, which is 26,000 lbs by itself. The generators are the heaviest things we have at 6,900 lbs each.”Robinson approximates the total value of the EMEDS package to be $2.3 million.Once established, the EMEDS’s efficient flow of patient care was plainly visible as the field hospital began receiving “patients” Sunday with the exercise’s initial scenario inputs.After undergoing initial triage at the Role 2 site, Romanian soldiers, acting as casualties in realistic mulage, were processed through the EMEDS emergency room where they received an evaluation for surgical needs. Once in the surgery room, a team of experts including internal medicine specialists, an orthopedic surgeon, and an anesthetist stood by to respond depending on the diagnosis.Under NATO’s system of medical care, battlefield patients would be initially treated with basic life-saving care at a Role 1 facility. From there, they would commonly be transported by ambulance to a Role 2 field hospital for the type of emergency room and initial surgical care provided by the EMEDS.In addition to the ER room, surgery room, and patient holding area, the EMEDS has a command and control section, where administration and coordination takes place for follow-on treatment at a Role 3 specialist care center, normally maintained at major bases and installations at the theater level. Under NATO, a Role 4 center would later provide definitive specialized treatment, likely in the patient’s country of origin.“As all of this is being done, tracking and documentation is taking place to document what point each patient is at in the process,” Hess said. “There’s also coordination for evacuation and to always answer the questions, ‘how do we stabilize this patient, and how do we get them to the next level of care?’”Vigorous Warrior 19 provides a dynamic space for providers to rehearse this process, in which every second can make the difference between life and death. Uniting over 2,500 providers from 39 countries, the exercise is so far the largest medical readiness event in NATO’s history.Though representing only a small piece of the exercise’s vast diversity in experience and background, the 86 MDG has invested approximately six months planning for their role in Vigorous Warrior 19.Hess says that while the exercise will be highlighted by cooperation between multinational civilian and military counterparts, with the goal of increasing interoperability across nationalities, he expects the 86 MDG team to take away plenty of practical wisdom about the implementation and setup of the EMEDS, as well.“A number of the Airmen on this trip have not deployed before, so this is their first time operating with the EMEDS package in an expeditionary setting,” Hess said. “This is the perfect opportunity for them to become more familiar with the workflow that the EMEDS provides and how to set it up most effectively, not only for the patient, but also to allow the staff to work with the patients more efficiently.”This year marks the fifth iteration of Vigorous Warrior, which has grown significantly from its beginning in 2011 with five countries. The exercise is organized by the NATO Centre of Excellence for Military Medicine, headquartered in Budapest, Hungary.Planning is already underway for Vigorous Warrior 21.*Editor's note: The original story can be viewed on the U.S. Air Forces in Europe & Air Forces Africa website.*

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MedicalAir Force Medical CorpsUSAFEUSAFE – AFAFRICAUSAFE/SG86th Medical GroupRamstein Air Baseexpeditionary medical support systemEMEDS