Page 40 - JSOM Fall 2022

operational experience all together. This is not a phenomenon from the Army, Navy, and Air Force participating. Each of
unique to operational experience­standardized programs exist these five years required incremental growth – additional
due to natural variation in experience levels among faculty, Army programs were added first, followed by Navy and Air
but this variation must be addressed by each program to en­ Force. Logistically, growth required significant buy in from
sure a consistent product. co­located units which was accomplished by identifying local
units’ individual training goals and incorporating them into
Recognizing this gap, the authors of this paper created the the training calendar. The program was expanded to not only
Joint Emergency Medicine Exercise (JEMX), a capstone event provide training for graduating clinicians but also for a multi­
for graduating emergency medicine (EM) and family medicine tude of different medical personnel across III Corps. In 2021,
physicians with the intent of better preparing graduates for the Fort Hood JEMX was a 4­day exercise completed by 42
service in operational units. While initial operational medi­ graduating residents from the Army, Navy, and Air Force as
cine exposure must still be accomplished earlier in training, well as 1486 nonprovider medical trainees.
through programs such as the Combat Casualty Care Course
(C4), Uniformed Services University’s Bushmaster, and other
program level courses, the JEMX serves as a capstone exercise JEMX Core Competencies and Components
to solidify operational knowledge immediately before trainees The JEMX was born out of the identification of a gap in op­
begin to serve in operational assignments. This event focuses erational knowledge by graduating medical providers. The
on exposure to the full continuum of care in the operational identification of this gap occurred mostly by experienced SOF
environment, from point of injury (POI) care to theatre evac­ medical providers while mentoring young clinicians through
uation. It is our hope that this exercise may serve as a frame­ their training. While some trainees have prior operational ex­
work to provide the graduating clinician with operational and perience, the vast majority of military GME trainees have little
tactical knowledge required to be a successful SOF provider. to no experience or understanding of an operational environ­
ment. While most trainees attend C4, this course is designed to
provide basic medical knowledge to all medical officers regard­
History of the JEMX
less of their specific area of expertise and therefore does not
To the best of the authors’ knowledge, the first JEMX was provide robust exposure to the complexities of medical issues
held in 2003 (then called “EMX”) at Brooke Army Medical on the battlefield. Furthermore, the SOF community is clearly
Center (BAMC). This 1­day event focused on teaching POI unconventional, adding another layer of complexity to the al­
care and general Tactical Combat Casualty Care (TCCC) ready complex military medical decision­making process. As
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principles to graduating US Army and Air Force EM resident such, the JEMX is designed to provide as broad of exposure to
physicians. Resident physicians were familiarized with the the elements of a casualty response system as possible.
concepts of TCCC and were provided an appreciation for the
combat medic in the operational environment. Training cen­ This exercise is designed in the classic crawl­walk­run format.
tered around the medic scope of practice and attempted to On days 1 and 2, trainees receive didactic lectures from sub­
simulate the field conditions in which medics operate. ject matter experts from across the Department of Defense.
Topics covered include TCCC basics, approach to point­of­
In 2013, physician and PA faculty assigned to the BAMC injury (POI) care, damage control resuscitation and surgery,
residency program expanded the curriculum to seven days. prolonged casualty care, and care for the military working dog,
The curriculum was focused on preparing physicians for op­ among others. Trainees then participate in autologous fresh
erational assignments, TCCC principles, cadaveric procedure whole blood lab and TCCC lanes. During the whole blood
labs, casualty evacuation, and movement of patients through lab, participants not only perform autologous transfusions on
the echelons of care. The program was given a major opera­ a partner, but also receive instruction on how to develop and
tional boost through a partnership with both the Tactical Com­ sustain a walking blood bank. While there remains significant
bat Medical Care Course (TCMC) and 19th Special Forces pushback from the nonmedical community regarding the po­
Group (19th SFG(A)). Through these partnerships, trainees tential risks of autologous fresh whole blood training, these
were exposed to the entirety of the operational planning cycle risks have been repeatedly proven to be minimal so long as the
and in turn provided high­fidelity casualty care simulations. In appropriate controls are in place. 7
subsequent years, the US Navy began sending residents from
Balboa Navy Medical Center and Portsmouth Naval Medi­ During the TCCC lanes, trainees receive instruction from
cal Center and the name of the exercise was changed to the Special Operations Combat Medics (SOCM) from the 75th
“Joint” EMX. Ranger Regiment and 160th Special Operations Aviation Reg­
iment (Airborne). This training iteration begins with a class on
In 2017, MAJ Benjamin Donham attended the BAMC JEMX how to pack an aid bag, followed by an example of “what right
as an observer. Donham took the lessons learned from BAMC’s looks like,” in which SOCM medics complete a TCCC lane.
decade­long experiment and developed a JEMX at Fort Hood, Trainees then complete a TCCC lane with a SOCM medic as an
TX, where he served as Associate Program Director for the observer controller (OC), with feedback immediately following
Carl R. Darnall Army Medical Center (CRDAMC) Emergency completion. The impact of having SOCM medics as OCs can­
Medicine Residency Program. The Fort Hood program had not be overstated – multiple trainees from 2021 commented on
the advantage of being co­located with III Corps and was able the profound impact these non­commissioned officers (NCOs)
to utilize the large amount of conventional US Army and Air had on their approach to medical direction moving forward.
Force resources located at Fort Hood.
On days 3 and 4, trainees participate in the Full Mission Profile
Over the course of the next 5 years, faculty at CRDAMC grew (FMP) “run” phase. During this phase, they provide the full
the JEMX into a joint effort, with instructors and students continuum of care in the military casualty response system. In

38 | JSOM Volume 22, Edition 3 / Fall 2022