 The field training exercise, or FTX, of the Medical Management of Chemical and Biological Casualties course is designed for military physicians, nurses, physicians assistants, and other professional-level healthcare providers, as well as for their civilian counterparts. In addition, although medical non-commissioned officers in the military may find elements of the field training exercise familiar from previous common task training, the field exercise is also designed with them in mind. The field exercise is designed to acquaint participants with the capabilities, use, and limitations of chemical personal protective equipment, detectors, and decontamination assets. Now, the FTX itself is organized around two modules in the field, and a separate module held as an after-action report, either in the field or elsewhere, for example, in a classroom. The first module in the field is a mask and mop donning drill, in which participants will have nine seconds to don the chemical protective mask, and an additional eight minutes to put on the rest of the chemical protective ensemble or clothing up to a mission-oriented protective posture or mop level of four. That's the first module. The main module in the field is a group of six rotation stations, and every participant has the opportunity to pass through each of the rotation stations. These stations include a casually triage circle, an emergency medical treatment station on the dirty side of the hotline, a litter decontamination station, a medical task station, and an NBC task station. An additional rotation can be added as circumstances require for rest or for additional tasks. Now, the timing of each of these rotations is determined by the length of time that it takes for a given group to see all of the patients in the triage circle. So if 10 casualties are in the triage circle, and the group is given two minutes to look at each casualty, then each rotation would, per force, be 20 minutes long. If there are 12 casualties, there would be 24 minutes per station. Following the two in-field blocks, that is, the mask and mop donning block, and the six rotations, there is a separate module that can be conducted either in the field or in a classroom setting. This module is an after-action discussion of the patients encountered in the triage circle. Now that we've introduced the three main components of the FTX, that is, the mask and mop donning station, the series of six rotations, and the after-action patient discussion, let's focus on the first module. At the beginning of the field training exercise, the class will need to be divided into five or 16s. However, once this has been accomplished, the students are to open ranks and come together again as one group for the first major module of the FTX, the mask and mop donning drill. This module gives students the opportunity to demonstrate to themselves that they can don the chemical protective mask in nine seconds and don the rest of the chemical protective ensemble in eight minutes. For the main module of the field exercise, the students will split back up into their preassigned groups, and each team will proceed to one of the stations in this module. Furthermore, at the triage station, the team assigned to the station will further subdivide into smaller groups, and each group will proceed to one of the patients in the triage circle. In real life, a casualty triage officer would have only a few seconds to evaluate a given casualty and assign him or her a triage category to prioritize that patient for medical treatment. In the training scenario of the FTX, each team will have two minutes to look at a patient and assess that patient, assigning him or her a triage category immediately, and getting enough information to provide the basis for the after-action discussion of patient casualties to be conducted after the main module of the FTX. There are three ways for a student to acquire pertinent information about a casualty in this circle. The first is simply by taking a history, by asking the patient what happened to him or her. The second way is to examine the field medical card, which may have some pertinent findings concerning the patient's history, and may also have pertinent findings concerning objective signs that the patient may be exhibiting. Thirdly, although moulage in this circle is not designed to be fully realistic, a student at this station can look at the moulage associated with a casualty to form an impression of what is actually going on medically. This is the emergency medical treatment station on the dirty side of the hotline. Now, what patients would come here? Where would they come from? From the triage station, which would be probably just a few meters away. And the purpose of this station in the FTX is for the most trained physician or nurse facilitator at the site to lead a clinical discussion of what would go on at this station. This is the station where patients with immediate life-threatening injuries or conditions would be brought, including chemical intoxications. And the purpose of this station is to instill in the students an appreciation of the fact that saving a patient's life is more than just putting A or B or C or D on a paper in on a test in a classroom. It's how to integrate what they already know about the clinical features of disease and injury and pre-existing medical conditions with what they have just learned about chemical agent intoxications. So at this station, the facilitator would take a simulated patient and go through a scenario and ask the students to treat this patient. And he would proceed from one clinical scenario to another. He'd change the rules. The patient would get better for a while or maybe deteriorate. And at each change in the status of the patient, something else would happen. You'd get input from each of these students surrounding him at this station. And in the 20 minutes or so that it would take to lead a discussion at this station, hopefully in that time, the students will have gained again this appreciation of the importance of treating the patient as a whole rather than just a chemical agent casualty. One of the most important differences between managing a casualty with a medical illness or a conventional wound and caring for a chemically contaminated casualty is the need to remove liquid chemical agent that may have come in contact with the patient, his or her clothing, or his or her equipment. At the litter decontamination station, students will be shown the correct procedures for removing the casualty's clothing and for decontaminating the casualty's skin, hair, and wounds. The next two stations, the medical task station and the NBC task station could be combined if necessary. Their purpose is one in the same, to demonstrate to students that they in fact can perform certain essential manual tasks while at full Mach 4. At the medical task station, students will have the opportunity to perform a variety of medical tasks such as starting an IV, making a blood pressure, administering antidotes, even intubating a mannequin, and they'll learn that despite the fact that they have a mask and that they have gloves and they have chemical protective equipment, they can in fact do these tasks. Similarly, at the NBC task station, students will have the opportunity to work with a variety of chemical detectors such as M8 paper, M9 paper, the chemical agent monitor to show themselves that in fact they can use these in a contaminated environment. Now that we've seen the various components of the FTX, let's put all of what we've seen together again. The FTX is designed for military medical health care providers and their civilian counterparts. It's designed to acquaint participants with the capabilities, use, and limitations of chemical protective equipment and procedures. The FTX itself is composed of three major modules. The first being a mask and mop donning station. The second being a series of six rotations. And the third being an after-action patient discussion of casualties encountered in the triage circle. This after-action discussion may be held in the field or it may be held in a classroom. The six stations in the main module of the field exercise were the casually triage circle, the emergency medical treatment facility or station on the dirty side of the hotline, a litter decontamination station, a medical tasks station, and an NBC tasks station with the provision for an additional rotation as circumstances dictate. The field training exercise is a crucial component of the total learning experience for participants in the medical management of chemical and biological casualty scores. We hope that you're having seen how the various elements of the FTX come together will help you to contribute as much as possible to the total learning experience for as many students as possible.