The 36th Forward Resuscitative Surgical Detachment (FRSD) conducted an exercise known as Operation Nomad from May 30, 2024 to June 1, 2024. The exercise aimed to synchronize Damage Control Surgery (DCS) and Damage Control Resuscitation (DCR) elements to one FRSD split to two distinct locations. Each split team focused on contested logistics in an austere environment. For the Field Training Exercise (FTX), the detachment used a moulage team, Observer Coach/Trainers (OC/Ts), critical care nurses, and emergency physicians, along with nurses with deployment experience. It was also necessary to use their expertise to challenge standard operating procedures in managing patients while testing the team’s medical logistics. Student Registered Nurse Anesthetists from the United States Army Graduate Program in Anesthesia Nursing were used as the anesthesia providers since those assigned to our detachment were on mission at the time of the FTX. The coordinated efforts of these many professionals came together to make Operation Nomad.

The FTX was designed to prepare the unit to handle the task of providing outstanding healthcare in austere environments with constrained logistics for 72 hours. The training focused on setting up the FRSD into split teams in two separate buildings of opportunity while simulating real-world scenarios that the unit might encounter in a deployed environment. Throughout the exercise, the 36th FRSD tackled many obstacles, such as resupply obstacles, managing critical patients, working the sleep-wake cycles of their personnel for night operations, and testing their communication plan for the duration of the FTX. First Lieutenant Tiarion A. Alverson (Health Services Administration, 70B), the Executive Officer for the 36th FRSD, stated, “We pride ourselves on tough and realistic training in the 36th FRSD.” It was essential to determine where the team deficiencies were in a training environment so that the team would be better prepared when it was on an actual mission.

Patients were treated by the 36th FRSD using scenarios based on actual situations from the Africa Command area of operations. The 36th FRSD used resources from the Joint Trauma System and the subject matter experts (SMEs) who were OC/Ts for this exercise to help run these scenarios. The unit was fully prepared for the medical and logistical complexities that small teams like an FRSD may encounter, thanks to the SMEs who were OC/Ts for this exercise and clinical practice guidelines (CPGs) from the Joint Trauma System. This level of realism played a crucial role in implementing these scenarios throughout the FTX. Operation nomad highlighted the importance of operational medicine and the need for FRSDs to manage constrained logistics and mobility. Major Carlos Gonzalez (Critical Care Nurse, 66S), the commander of the 36th FRSD, at the time during this FTX, stated, “I am extremely proud of how my team performed during this FTX. They overcame operational variables such as contested logistics with blood and class VIII resupply, dealing with different actors on the battlefield, and communicating with higher headquarters, all while taking care of critically ill patients. Training how we fight is key to realistic training and preparing for any mission”. Leadership that trains a team with realistic training gives Soldiers the confidence that they will be able to do their job in a deployed environment.

The guidance of SMEs was critical for Operation Nomad to be successful. The 36th FRSD also used two Emergency Physicians (62A), Lieutenant Colonel Dan Brillhart, and Thomas Frawley. These two SMEs ensured each scenario was completed to standard while increasing the rigor with each incoming casualty during the FTX. The SMEs ensured that any knowledge gaps noted during the exercise were reviewed after each after-action review. As the 36th FRSD prepares for future missions, the knowledge gained from Operation Nomad has prepared the team to take on any challenges. The 36th FRSD successfully developed a unique training platform that no other FRSD in the 9th Hospital Center has ever created. The training will not only help the 36th FRSD, but other FRSDs in the future.