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Multinational medics, civilian first responders ‘save lives’ at exercise Cope North 20

The Rota Fire Department, U.S. Air Force and U.S. Navy medical personnel, as well as Guam Fire and Police Departments, worked together during the Cope North 20 (CN20) Medical Field Training Exercise on Rota and Guam, Feb. 20, 2020. The exercise's focus on humanitarian assistance and disaster relief provides critical training military and civilian personnel who have a direct impact on the military’s ability to support the region, to include the Commonwealth of the Northern Mariana Islands, Palau, and Yap in the Federated States of Micronesia.

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Guam Police escorts an ambulatory bus transporting simulated patients en route at U.S Naval Hospital Guam during Cope North 20 (CN20), Feb. 20, 2020. During the exercises’ trilateral mass casualty scenario, the U.S. Air Force and Navy, Japan Air Self-Defense Force, Royal Australian Air Force, Guam Army National Guard and Guam Police integrated their medical, air and ground operations to save 24 lives on the islands of Rota and Guam. (U.S. Air Force photo by Staff Sgt. Greg Nash)

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U.S. Air Force medics transport a patient onto an ambulance bus for continued care during Cope North 20 (CN20), at Andersen Air Force Base, Guam. During the exercises’ trilateral mass casualty scenario, the U.S. Air Force and Navy, Japan Air Self-Defense Force, Royal Australian Air Force, Guam Army National Guard and Guam Police integrated their medical, air and ground operations to save 24 lives on the islands of Rota and Guam. (U.S. Air Force photo by Staff Sgt. Greg Nash)

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U.S. Air Force medics discuss patient loading procedures underneath a C-130J during Cope North 20 (CN20), at Andersen Air Force Base, Guam. During the exercises’ trilateral mass casualty scenario, the U.S. Air Force and Navy, Japan Air Self-Defense Force, Royal Australian Air Force, Guam Army National Guard and Guam Police integrated their medical, air and ground operations to save 24 lives on the islands of Rota and Guam. (U.S. Air Force photo by Staff Sgt. Greg Nash)

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A U.S. Navy medic transports a simulated patient into U.S. Naval Hospital Guam as part of a mass casualty scenario during Cope North 20 (CN20), Feb. 20, 2020. During the exercises’ trilateral mass casualty scenario, the U.S. Air Force and Navy, Japan Air Self-Defense Force, Royal Australian Air Force, Guam Army National Guard and Guam Police integrated their medical, air and ground operations to save 24 lives on the islands of Rota and Guam. (U.S. Air Force photo by Staff Sgt. Greg Nash)

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U.S. Navy medics transport a simulated patient into U.S. Naval Hospital Guam during a mass casualty scenario as part of Cope North 20 (CN20), Feb. 20, 2020. During the exercises’ trilateral mass casualty scenario, the U.S. Air Force and Navy, Japan Air Self-Defense Force, Royal Australian Air Force, Guam Army National Guard and Guam Police integrated their medical, air and ground operations to save 24 lives on the islands of Rota and Guam. (U.S. Air Force photo by Staff Sgt. Greg Nash)

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U.S. Air Force 1st Lt. Paul DiBenedetto, 43d Aeromedical Evacuation Squadron flight nurse, motions thumbs-up for patient transport from a C-130J onto an ambulance bus during Cope North 20 (CN20), at Andersen Air Force Base, Guam. During the exercises’ trilateral mass casualty scenario, the U.S. Air Force and Navy, Japan Air Self-Defense Force, Royal Australian Air Force, Guam Army National Guard and Guam Police integrated their medical, air and ground operations to save 24 lives on the islands of Rota and Guam. (U.S. Air Force photo by Staff Sgt. Greg Nash)

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U.S. Air Force Staff Sgt. Christine Ebio assigned to the 18th Medical Group, Kadena Air Base, Japan, directs a Humvee for a patient transport during a Cope North 20 (CN20) mass casualty exercise at Rota, U.S. Commonwealth of the Northern Mariana Islands, Feb 20, 2020. Service members from the U.S., Royal Australian Air force, and Koku Jieitai (Japan Air Self-Defense Force) honed their Humanitarian Assistance and Disaster Relief (HADR) skills by providing emergency medical care for simulated patients. Cope North enhances U.S. relations with regional allies and partners by demonstrating resolve to promote security and stability throughout the Indo-Pacific. (U.S. Air Force photo by Staff Sgt. Curt Beach)

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Koku Jieitai (Japan Air Self-Defense Force) Tech. Sgt. Atsushi Oyaizu, assigned to Aero Medical Evacuation Squadron, Komaki Air Base, Japan, prepares for a medical evacuation aboard a C-130J Hercules assigned to the 815th Airlift Squadron, Keesler Air Force Base, Miss., during a Cope North 20 (CN20) mass casualty exercise at Rota, U.S. Commonwealth of the Northern Mariana Islands, Feb 20, 2020. Service members from the U.S., Royal Australian Air force, and JASDF honed their Humanitarian Assistance and Disaster Relief (HADR) skills by providing emergency medical care for simulated patients. Cope North enhances U.S. relations with regional allies and partners by demonstrating resolve to promote security and stability throughout the Indo-Pacific. (U.S. Air Force photo by Staff Sgt. Curt Beach)

ANDERSEN AIR FORCE BASE, Guam --

When lives are on the line, there is no margin for error – and for a group of multinational medics and first responders, their razor-thin life-saving operations were put to the test during a Cope North 20 joint, mass casualty (MASCAL) field training exercise on the islands of Rota and Guam, Feb. 20, 2020.

Together, the United States Air Force and Navy, Japan Air Self-Defense Force (JASDF), and Royal Australian Air Force (RAAF) raced against the clock in a realistic exercise scenario to save 24 patients from a bus rollover. They worked alongside Guam’s Army National Guard and local police and emergency medical personnel during integrated medical, air and ground operations. 

Amidst the sounds of injured patients screaming, helicopters chopping and police sirens blaring, the team persevered past extreme duress to accomplish their goal: keeping every patient alive.

“When providing care for critical patients, minutes can often make the difference between life and death,” said USAF Maj. Brian Johnson, Cope North 20 medical planner. “Due to the (patient transport) distance and time of day, ground patient transfer wouldn’t have resulted in a favorable outcome had it been a real-life scenario. However, thanks to the Guam Police Department and local authorities, the patients who weren’t flown were able to get to U.S. Naval Hospital Guam in an expedited and safe manner.” 

Mass casualty scenario – the bus crash

The synergistic movement kicked off with screeching tires as a bus driver lost control while driving on the island of Rota. Gliding into traffic, a loud, piercing boom erupted as a rollover crash ensued, jarring glass debris and its passengers aboard. 

After surviving the collision, the “battered and bloodied” patients were approached by local first responders and a RAAF physician who provided initial triage until higher echelon care was available. 

Inter-island medical care

Once the patients were stabilized, they were transferred onto a US C-130J and flew to Andersen AFB where patients and medical care teams awaited transport to either a UH-72 helicopter, ambulatory bus or Humvee to the U.S. Naval Hospital Guam. A motorcade of emergency response vehicles, accompanied by the ambience of red and blue lights from the Guam Police Department, transported the “accident victims”.

The U.S. Navy Medicine Readiness and Training Command (NMRTC) Guam, which recently co-located with navy medicine, was the ideal hospital to accept aeromedical evacuated patients as their final stop, said U.S. Navy Commander Elliot Ross, Senior Medical Officer, NMRTC Guam emergency department.

“This exercise was a great opportunity for the naval hospital on many levels,” Ross said. “Drills like these help our team to hone our skills and with an all hands-on deck approach, we can confidently practice and perform our procedures when responding and managing large-scale medical emergencies.”

The hospital’s collective efforts included a critical care transport team (CCTT), which conducted inter-facility patient movement at the hospital. They also boarded the Guam Army National Guard’s UH-72 helicopter and conducted patient movement from Andersen AFB to NMRTC Guam. An all-hands hospital staff recall was directed for exercise support while the hospital’s command center coordinated additional island medical resources, regional military resources and local military operations centers with the NMRTC’s new Emergency Management team.
 
Ross said with the exercises’ large muscle movement and potential support to simultaneous real-world incidents, operational challenges were expected, and the hospital staff efficiently overcame those hurdles. 

“We rapidly filled the exercise’s available bed space and because we were running the hospital in real-time, additional space was limited,” Ross added.  “We have the capability to convert single rooms to double rooms, but it is not exercised frequently and is generally reserved for emergency situations. The lack of additional bed space required our staff to execute this plan and double-up our inpatient beds. This was outstanding because we were in real-time executing our emergency plan despite not initially planning to need this.”

The MASCAL’s design showcased Cope North’s interoperable capabilities not only among international military teams, but with local, civilian first responders. 

“The exercise’s trilateral (construct) was the perfect structure to perform as a unified medical effort in the Marianas region,” Johnson added. “Its design enabled all participants to rely on each other’s strengths and capabilities to handle the scenario effectively, emphasizing a synergistic response capability.”

Whether it’s a real-world emergency or a future training scenario, these agencies will be heavily relied on for their expertise. Their ability to find and refine their best practices during Cope North 20 can assure the Indo-Pacific region that the highest echelon of care is available at a moment’s notice.

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