military training
Role 3 Multinational Medical Unit at Kandahar Airfield. A patient/casualty arrived by helicopter and transported by the medical team on a litter from the flight line to the trauma bay by ambulance (Source: Role 3 photographer, provided by Lisa Nenno, 2009/2010).

Military Combat Skills for Civilian Disaster Response

During their service, military personnel acquire a broad range of lifesaving skills that are critical when on the frontline during wartime. Effective medical triage is one of the skills needed during combat and any major disaster or catastrophic event. When preparing and training for all hazards, the learned experience from military veterans provides a unique perspective to build training exercises in partnership with civilian agencies and organizations.

As a trauma nurse and combat veteran, Lisa Nenno was a part of a multidisciplinary medical team that served in a combat hospital in Kandahar, which served coalition soldiers, local Afghan adults and children, and detainees. Every day, the MedEvac helicopters would land with causalities from forward operating bases and combat: traumatic amputations and gunshot wounds, blast injuries, and traumatic brain injuries. The main task was to provide immediate care and stabilization of patients for transport to Landstuhl, Germany. Skills learned in combat included providing culturally sensitive care, learning to work with limited resources, and being prepared to use only the most basic equipment. Triage and trauma care were performed with a skilled team of physicians and nurses.

A Natural Disaster Scenario Exercise

Expertise in triage and assessment is essential in war zones and natural disaster scenarios. In June 2022, at the request of the National Tribal Emergency Management Council (NTEMC), combat veterans from the U.S. Volunteers Joint Services Command (USV-JSC) participated in a whole community exercise conducted in the Pacific Northwest. The simulated 9.0 earthquake caused widespread impacts, with an aftershock that triggered buildings and homes to collapse. Operation Thunderbird and Whale (signifying an earthquake and tsunami in the Native American culture) was a unique natural disaster training exercise conducted in partnership with national organizations focused on supporting vulnerable populations. USV-JSC’s objectives for the exercise were to better prepare civilian exercise participants for their potential roles in a future disaster by:

  • Teaching the essential elements of medical triage;

  • Defining the various roles in disaster response;

  • Providing expertise from subject matter experts;

  • Sharing information about valuable resources and where to find them; and

  • ¬†Explaining what to do when communications are down.

 Led by Nenno, USV-JSC implemented a triage training protocol based on personal experiences from working in a combat hospital in Afghanistan. Participants received minimal preparation, resources, and training in advance to make the exercise realistic. The medical portion went live with a rapidly orchestrated medical trauma procedure protocol based on an impromptu scenario announced by the emergency operations center (EOC). A three-person team from the USV-JSC arrived as first responders to provide lifesaving services at the Farmer Frog Farm (located in Woodinville, WA), where 12 civilian participants from the farm played disaster victim roles.

FARMER FROG BARN COLLAPSE 

The USV-JSC team arrived on the scene to find a barn collapse at Farmer Frog Farm caused by an aftershock of the 9.0 earthquake. The group performed a combined START triage algorithm based on lessons learned from mass causality triage in combat. The START (Simple Triage And Rapid Treatment) system provides a rapid method for first responders to triage mass casualties based on respiration, perfusion, and mental status.

The scene was safe to enter, so they began evaluating injuries using basic triage methods:

  • Immediate (red)¬†‚Äď casualties requiring immediate lifesaving treatment;
  • Delayed (yellow)¬†‚Äď casualties requiring medical intervention but not with urgency;
  • ¬†Minor (green)¬†‚Äď casualties with minor to no injuries (also called the ‚Äúwalking wounded‚ÄĚ); and
  • Expectant (black)¬†‚Äď casualties that are unlikely to survive based on their injuries.

They found 11 wounded and one fatality. With limited supplies, the team used what they found around the barn and surrounding area to create tourniquets, slings, bandages, litters (rescue stretchers), and immobilizers. Then, using litters made from wood and tarps found on the scene, they loaded the casualties onto a transport vehicle and brought the patients to the flight line for medivac support from the air.

  • Real-life trainings can be vulnerable moments for combat veterans.
  • Having a variety of perspectives, strengths, and backgrounds are influential in achieving the best outcome.
  • Bringing family and friends to the exercise enhances the importance of preparing for a real-life disaster.
  • Military participants gained insight and guidance by partnering with non-military participants.
  • Communication can always be improved for logistics, planning, and supplies.
  • There is a need to educate other community stakeholders on the work of the USV-JSC (military volunteers), NTEMC (tribal emergency management), and Farmer Frog (a unique farm providing multi-state food distribution in a national emergency).

The Global COVID pandemic emphasized the need to be prepared to respond at a moment’s notice. Even though many people do not have military training, volunteers with training can have a significant impact on disaster response. Combining military experience with local and national communities to act and serve together will achieve the best outcome.

Partnering with tribal and other civilian stakeholders, military veterans provided a unique perspective and training experience during this exercise.

The Thunderbird and Whale exercise brought the USV-JSC team together with its civilian partners, who had the capabilities to triage casualties successfully, evacuate the wounded, and transport the severely injured to the flight line for immediate care. This exercise provided a realistic experience and lessons learned for all participants. The USV-JSC plans to continue emergency management planning with powerful entities such as Farmer Frog (food distribution) and the NTEMC (tribal emergency management). The exercise succeeded because all participants worked together using their various strengths and perspectives.

Moving forward, pursuing similar full-scale exercises every two years will help build community partnerships. However, training, learning best practices, and working with a strong team between training exercises are also essential. These types of community efforts will educate potential volunteers and build excitement about emergency preparedness. This is not a fear-based approach but a whole-community effort.

lisa nenno
Lisa Nenno

LCDR Lisa Nenno has worked in various healthcare specialties, including adult general medicine and intensive care unit (board certified critical care nurse), and served in the United States military ‚Äď Navy Critical Care Nurse/trauma for 5 years (deployed to Afghanistan for 8 months supporting Operation Enduring Freedom). After her military service, she cared for children and young adults in a school university health setting in a management role overseeing OBGYN/midwife clinics and corporate health/wellness center performing physicals for the FBI and Secret Service ‚Äď fit for duty annuals. She graduated from Yale University with her nursing degree and from the University of San Diego with a doctorate in nursing. She is a member of United States Volunteers ‚Äď Joint Services Command and VFW Post 3348.

Timothy Miller
Timothy Miller

Timothy James Miller graduated from Washington State University in 1968 and was commissioned a second Lieutenant in the U.S. Army Corps of Engineers. He served in Germany (24th Engineer group) and Vietnam (577th Engineer Battalion, 18th Engineer Brigade). In Vietnam, he commanded HHQ Company and was the S-2 (Security and Intelligence) Battalion staff officer. Although serving in two positions, perimeter security was his primary responsibility. As a captain, he recruited, organized, and equipped a 130-member Chinese (Nung) Security Force. As the security force commander, he was awarded the Army Commendation Medal and the Bronze Star by Battalion Commanders Col Koren and Col Kitts. He left active duty in 1972 but stayed active in the Army Reserve as a company commander (659th Engineer Company, Spokane, WA) while finishing his MBA at Eastern Washington University. After finishing his degree, he left the military as a captain. In 1979, he started his own business forms and systems distributorship, which he sold in 2017. In 2005, he joined the Washington State Guard and, as a commander of the color and honor guard, was in charge of the unit performing military honors at Tahoma National Cemetery. For his achievements as a Military Emergency Management Specialist (Senior Level), Major Miller was awarded the Legion of Merit by the Washington Adjutant General LTG Timothy Loewenberg. He now serves as the commander of the 103rd BCT.

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