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Practice Makes Perfect: Uniformed Services University Students Learn Combat Casualty Care

Medical school students work on a simulated combat victim, while an instructor carefully observes during the Advanced Combat Medical Experience, a four-day field medical practicum held in August at the Uniformed Services University of the Health Sciences. (Photo Credit: Ian Neligh)

By Ian Neligh


The silence, thick with Maryland’s August humidity, breaks suddenly with shouting, simulated gunfire and combat. 

Five military medical school students rush through the trees to render aid. They come across a crisis actor on the ground with an amputation, pretending to squirm in pain. The man is wearing a cut suit. Fake blood is everywhere. 

An instructor looks on, analyzing, offering information, and questioning their decisions. The pressure is on and the teacher evaluates every choice the students make.

The Advanced Combat Medical Experience (ACME), a four-day medical field practicum at the Uniformed Services University of the Health Sciences (USU), is intense — and that’s the point.

The experience allows students the chance to employ what they’ve learned over the preceding year at a series of different stations throughout a stretch of forest near the university. With actors wearing cut suits which simulate human anatomy, students are able to perform realistic medical procedures on the “patient”.

An instructor gives advice on how a team of medical school students should work on their simulated patient during the Advanced Combat Medical Experience. The exercise draws a host of different instructors with service and specialty backgrounds but all with expertise in combat medical care. (Photo Credit: Ian Neligh)
An instructor gives advice on how a team of medical school students should work on their simulated patient during the Advanced Combat Medical Experience.
The exercise draws a host of different instructors with a service and specialty backgrounds but all with expertise in combat medical care. (Photo Courtesy of
Ian Neligh, USU)

ACME is the first of several field practicums medical school students take part in over the four years of their training as they become military medical officers, with each building upon the last. 

Course director Navy Capt. (Dr) Sherri Rudinsky, an associate professor of Military and Emergency Medicine at USU, goes from station to station as students in teams of five, rush to apply tourniquets and other life-saving measures on actors and mannequins with mock injuries. 

“This is a culmination of their combat medical skills course over the preceding 12 months where they put it all together in the framework of ‘Tactical Combat Casualty Care,’” Rudinsky says. 

The concept behind the training is asking what life-threatening injuries a military physician might see on the battlefield and what can be done to save lives.

Rudinsky says the field practicum is also an opportunity for the students to use their knowledge and skills to help build confidence in what they’ve learned and gain experience employing small team communications and leadership skills. 

According to Rudinsky, the instructors and faculty involved in the ACME practicum come from a host of different service and specialty backgrounds but all with expertise in combat medical care. They include visiting military personnel with a wide spectrum of operational experience,  retired military physicians now practicing in the community, as well as active duty faculty assigned to USU and the National Capital Region.

A volunteer, wearing a surgical cut suit used to simulate combat injuries, waits while a team of medical school students assess her needs as an instructor takes notes during the Advanced Combat Medical Experience field practicum. (Photo Credit: Ian Neligh)
A volunteer, wearing a surgical cut suit used to simulate combat injuries, waits while a team of medical school students assess her needs as an instructor takes
notes during the Advanced Combat Medical Experience field practicum. (Photo courtesy of Ian Neligh, USU)

“The students tend to love it because this is the first time they get hands-on experience taking care of patients — even though they’re simulated patients,” Rudinsky says. “They enjoy getting outside and practicing medicine rather than simply reading about it and listening to lectures.”

Second-year medical student Air Force 2nd Lt. Grace Manno walks out of the forest with her team after finishing one of the practicum’s many encounters.

“I didn’t know what to expect going into it and had no idea what the environment was going to feel like,” Manno says. “…It made a lot of sense once we got out there. All the tactical movement that we had practiced, and once we ran up to our patient -- ours was a double amputee -- and we kind of knew immediately, ‘let’s throw some tourniquets on him and get him stabilized.’”

Manno says being able to work in a team and use what they’ve learned in a practical exercise was a great experience. 

“I think that the environment they’re creating … is a little bit more of a stressful setting for us to practice our skills — and just kind of puts it in perspective about why we’re here and why we’re at USU,” Manno says. “A lot of what we do is like any normal medical school, but this is the really cool aspect of being a USU student and being in military medicine.”