Weapons in hand, service members quickly enter a building—a confrontation ensues. Moments later, personnel evacuate the injured on stretchers. Inside field hospitals, the mood is tense as medical staff treat the seriously wounded.
The scene is an annual training session of the Chilean Navy to train its medical personnel on providing medical services in a combat environment. Through the Combat Casualty Care Course (C4), students develop the ability to form care teams aboard surface ships and in support of military operations.
“The C4 course aims at providing medical training in combat situations,” said to Diálogo Commander Marcela Vidal Marambio, a naval health officer and chief of the Medical Training and Simulation Division at the Naval Polytechnic Academy of the Chilean Navy. “These concepts are taught in an up-to-date combat context in which students receive theoretical instruction, participate in various training stations, and field exercises in highly realistic clinical simulations.”
During the nine day training, students provide medical treatment under fire, in the field, and evacuate the injured. “They deal mainly with traumatic injuries to the upper and lower extremities, which can result in amputations, as well as firearm injuries, chest injuries, and complex injuries to the airways,” explained Chilean Navy Petty Officer First Class Patricia Pedrero, a course instructor.
This latest version of the C4 course was held at Fort Aguayo Naval Base in Concón, in the province of Valparaíso, October 13th–21st, 2017. The course trained 120 students, 18 of whom were civilians. The course debuted in Chile in 2003, with support from the U.S. Defense Medical Readiness Training Institute, and since then qualified close to 1,800 military and civilian health professionals in Chile and 18 other countries, including students throughout South America.
“When it first began, the course curriculum was quite similar to what existed in the United States,” Cmdr. Vidal said. “But over the years, changes were made to adapt the skills learned to the realities of the Southern Cone, considering how our Armed Forces participate more in peacekeeping missions and disaster situations than in armed conflict.”
In the mid-1990s, the medical community within the U.S. Special Operations Forces sought to optimize treatment for wounded combatants, giving rise to the Tactical Combat Casualty Care (TCCC)—a management plan that takes into account the special challenges of combat medical units. Today, TCCC is the standard in the U.S. Armed Forces and in most partner nations.
The objectives of TCCC are to provide lifesaving care to the injured combatant, limit the risk of further casualties, and help the unit accomplish the mission. “The priority is to secure the hostile location and then provide treatment,” Petty Officer 1st Class Pedrero said.
The C4 course is part of the TCCC curriculum. “All the theoretical learning about military medicine is reinforced,” said Cmdr. Vidal. “In addition, the various training stations to gain specialized skills and the highly realistic mock clinical scenarios help consolidate and solidify the classroom learning.”
Combat and disaster situations
The course seeks to reduce the number of combat casualties and save civilians during natural disasters. “Likewise, the competencies gained are applicable to crises on the home front, such as natural disasters or other situations resulting in mass casualties in unsafe environments,” Cmdr. Vidal explained.
In the 2017 edition, all course instructors were Chilean, and for the first time students faced a mock natural disaster presented by a consultant on emergencies and natural disasters of the Pan American Health Organization (PAHO). “Specifically, a class was taught on international emergency response systems and the capacities that can be deployed upon request by another nation, such as humanitarian aid,” Claudio Canales, a PAHO consultant, said. It was PAHO’s first participation in the C4 course.
“To participate was very important for us because we can address issues of international risk management with those agents who are truly connected with emergency response, providing the foundation needed to comply with international standards and agreements of member states of the UN and the Organization of American States,” Canales concluded. “In this regard, civil-military cooperation becomes vital, because local teams and the country's armed forces are the first to respond to emergencies, well before international aid arrives.”