The team of soldiers rushed onto the scene, frantically searching for casualties. They shouted to each other through the smoke and screams for help, first treating serious bleeding, then assembling the injured for evacuation. They worked quickly but made one serious mistake. One victim of the attack, slumped behind a rock and partly hidden by brush, went unnoticed.
Fortunately, the soldiers were not in an actual crisis situation — not yet. The exercise in the IDF’s “multiple casualty event room” was part of their training to become combat medics. It is the last step of their course in the military’s Medical Trauma Simulator, a high-tech training school for the IDF Medical Corps. The facility aims to give soldiers the most realistic experience possible to prepare them for the worst situations they may encounter during their service.
“All units of the IDF send their medical teams to train here on a regular basis,” said Major Aviv Gelbar, commander of the program. “We’re first class in the world for this — I’m not shy to say it.”
The facility is located in the Sharon Military Base (known as “the City of Training Bases” in Hebrew), a sprawling complex being developed south of Beersheba in southern Israel. The course was previously located on another base, and the facility currently being used opened about a year ago, Gelbar said.
Everyone from trained physicians to 18-year-old recruits gets instruction on the premises. The physicians learn how to use their existing skills in a combat situation with multiple casualties, while recruits start with more basic knowledge and skills, said Gelbar, a physician who has been commander of the course for about two years.
Instructors train the new soldiers in three phases. First, they study fundamental medical knowledge, and then learn to perform procedures. Lastly, they practice applying what they know to a crisis situation.
They begin in a classroom, then advance to “single casualty rooms,” which prepare them for small emergency events, such as a single wounded soldier or a traffic accident. These rooms, located in the same building, mimic settings soldiers might encounter in the line of duty, such as the Golan Heights, the hilly Judean Desert, and the scene of a car accident in the Negev. The different scenarios are meant to teach specific lessons. Soldiers can easily lose small equipment in the thick mesh covering the floor of one room; in another, netting hangs across the room, forcing the medics-in-training to work on their hands and knees.
The mannequins in these rooms are the facility’s most sophisticated pieces of equipment, costing about NIS 400,000 ($106,000) each. Instructors use tablets to control the mannequins, which can breathe, blink, and move their limbs. They have blood pressure and a pulse beating in their wrists and necks. Their pupils can dilate to simulate a brain injury and they can make realistic noises to startle and distract the trainees. Options include moaning, screaming, vomiting, and “sob breathing.” The goal is to elicit an emotional response from the soldiers, Gelbar said.
The instructors can monitor the trainees from a separate viewing room and get real-time feedback from the mannequin. The instructors can measure the effectiveness of chest compressions on a mannequin, for example, and they hear everything the soldiers say through a small microphone on the dummy’s chest.
The course’s instructors are also enlisted soldiers. They go through the standard medic’s course, then a month-long instructor course, and another two-month specialized course for instruction in trauma treatment. Despite their youth, they are qualified to train doctors and paramedics, Gelbar said.
“If you take their parallels in the US army or other armies then probably you’d have a 30- or 40-year-old instructor who was deployed to Afghanistan or something. Here we have 18- and 19-year-old medics,” Gelbar said. “After they start talking, you understand that they know what they’re talking about and they’re very professional and you forget about the age difference and status difference.”
Down the hall from the single casualty rooms is a mock house littered with mannequins, also made to feel as realistic as possible. Just outside the front door, a bloodstained pillow sits on a chair below a clothesline. Inside, family photos hang on the walls, an uneaten meal sits on a dining room table and bloody mannequins are strewn on beds and couches. Combat units specializing in urban warfare practice entering the house, doing a sweep and finding and treating casualties.
For most medics, the multiple casualty event room is the culmination of their time in the facility. They have the knowledge and procedural skills to deal with single casualties in a quiet setting, but need to learn how to work as a team in a stressful, disorienting environment. The goal of the exercise is not rehearsing treatment, but practicing decision-making and controlling a chaotic situation.
Before entering the room, the course instructors distribute bandages and quiz the soldiers on the steps they need to go through once they are inside. The trainees, hailing from different infantry brigades and the Border Police, put on latex gloves and get their gear in order.
After the course, they will return to their respective units, where they will be the only medical personnel on their team.
The day’s exercise simulates a mass casualty event on the Lebanese border, but the instructors often run different scenarios in the room. Sometimes the soldiers are required to work in complete silence, for example.
Not today, though. The trainees, now doing the exercise for the second time, rush in in two groups of five. The first is meant to be medics already at the scene of the attack, the second a back-up team of paramedics and doctors. Smoke clouds the dark room, and screams of “hovesh,” or medic, pierce the air. The only light source is a flashing strobe light on one wall.
The first team of soldiers quickly disperses and locates the five bodies on the scene, all blood-spattered and dressed in IDF uniforms. The instructors watch them work and take notes. Trainees sometimes fail to find all of the bodies, for example, or miss a serious injury while treating a casualty, so detailed feedback is crucial. The instructors can monitor the action through tablets, cameras, and an observation room, but prefer to stay in the room to catch all the nuances of the soldiers’ actions.
The medics first need to stop any life-threatening bleeding, then make decisions about what to do next.
“Stop immediate bleeding, that has to happen. All other things, you need to think whether it’s more important or less important for the casualty than being prepared for evacuation,” Gelbar said. “Do you want to start to perform that procedure on the field, or do you want to wait for evacuation and do it later on? Is the casualty going to survive waiting for that procedure?”
The soldiers lay the casualties on stretchers and line them up in the center of the room. After the second team arrives, two trainees attend to each body, shouting to each other over the noise. The team decides which of the wounded needs to be evacuated first, and after a few minutes, the instructors announce that their evacuation has arrived. They hastily carry the bodies out of the room.
After the drill, the instructors debrief the trainees in a classroom. The soldiers do not ask about specific procedures, but about decision-making and coping with the environment. “It wasn’t chaos, but I didn’t know what all the injuries were,” one soldier says. Another asks how they can be sure they found all the casualties, and how to decide whether to take the first option out or wait for a doctor to arrive on scene. The instructors, hands stained with fake blood, address their questions and offer criticism.
The goal is to prepare these mostly 19-year-old soldiers to go back to their units and assume responsibility for the medical care of the rest of their team. In an emergency, they will need to inform their commanders on the nature of any injuries, and make quick decisions on treatment and evacuation.
“A casualty may look okay for a layman, but if you know what’s going on, then you understand that he can deteriorate very quickly so you need to have decisions on evacuation and contact with a physician or paramedic very quickly,” Gelbar said. “A lot of the time, we don’t have a correct answer. We just want to talk about it, so they understand all the things that they need to take into consideration.”
The soldiers finish their debriefing and get ready to go through the exercise again. Outside the classroom, artificial smoke and sounds of screams drift into the hallway as another group of medics-to-be goes through the same drill.