For the first time, medical representatives from the Defense Health Agency participated in a combatant command movement exercise, the Ultimate Caduceus 2023 held in March. The objective was to test the Department of Defense’s aeromedical evacuation and critical care transport capabilities.

The U.S. Transportation Command conducts the annual patient movement field training exercise designed to simulate transporting injured troops on a mass scale from one point to another. This exercise simulated movement from outside the continental U.S. to medical facilities in the U.S., and was held at several locations across the U.S.

“Ultimate Caduceus 2023 allowed all partners in the global patient movement enterprise to work together. It also allowed us to exercise our collective preparedness for any crisis throughout the spectrum of competition and conflict,” said U.S. Air Force Brig. Gen. Norman West, the DHA director of staff.

More than 400 joint and total force military and civilian personnel participated in the exercise, including representatives from the U.S. Department of Veterans Affairs, the U.S. Department of Health and Human Services, the DHA, and several other local partners.

“The patient movement exercise was a great opportunity for the DHA to demonstrate more of the capability we provide to support our national defense,” said West.

The exercise took place in several locations: Joint Base Lewis-McChord in Washington; Joint Base Elmendorf-Richardson in Alaska; Boise, Idaho; and Portland, Oregon.

“Ultimate Caduceus assessed the capabilities of and provided field training to aeromedical evacuation and critical care air transport teams, medical staging systems, as well as reception and onward movement functions for global patient movement,” said Joseph Weston, medical emergency manager with DHA’s Madigan Army Medical Center at Joint Base Lewis-McChord.

This exercise was important for the DHA because it was the first time it activated their operations center and the patient management coordination cell, according to Weston.

Movement Scenario and the Madigan Response

Weston was the lead planner for the hospital activities and coordinated with local and regional partners to help with the response, such as the Air Force Reserve’s 446th Aeromedical Staging Squadron also based at JBLM.

The scenario was this: An explosion occurred on the island of Guam and service members were injured. The hospital in Guam would triage and work with USTRANSCOM to expedite transporting them stateside.

“There would be a call to USTRANSCOM saying there were 30 service members that need to be evacuated,” said Weston. “At which point, the DHA operations center worked with USTRANSCOM to identify what was required and stood up the coordination cell.”

According to Weston, the DHA then identified which facility they wanted to handle the injured: Madigan was chosen.

“We got the call with the number we were receiving and then had to plan our response,” said Weston. “We were asked what our capacity was and how many we could take. What we couldn’t handle at Madigan, we looked to our local and regional partners to see what their capacity was.”

The scenario demonstrated a key capability of DHA: it’s ability to utilize the networks of care within the Military Health System and partners.

“The DHA market is a hub. It’s also a spoke. We get the call to take in patients, (and) we push them to wherever they need to go,” said Weston.

Madigan received a time frame and had to ensure they had the capabilities and staff ready for when the injured hit the ground. “We had to be ready within three hours once we received the call that they were on the way,” said Weston.

“We had a number of objectives that we felt went well,” Weston said. “The first was to activate the emergency operation center and implement the National Incident Management System principles. This established command and control to maintain situational assessment and awareness and operational communications—this was a big piece.”

According to Weston, “another objective was the coordination between TRICARE and the DHA with local partners, and to evaluate our processes for activating the Veteran Administration contingency plan, if needed, to push to them.”

Receiving and admitting those injured was another a tactical objective, with the goal to admit aeromedical evacuation patients to the appropriate level of care from the region within one hour of the aircraft arriving. “I think we did well overall,” said Weston.

“The exercise gave our team of professionals at Madigan the chance to test their ability to receive an influx of patients from anywhere in the world, while continuing to provide daily health care to our deserving beneficiaries,” West said.

Ultimate Caduceus 2023 exercise didn’t just test the immediate response, but also what would happen or need to occur on day 30 and day 60.

“The questions we had to answer were how we could create immediate capacity for that initial event, and then how do we start developing sustainable capacity,” said Weston.

The exercise emphasizes interoperability in bringing all elements of the global patient movement enterprise together to ensure combatant commands can move sick and injured patients to appropriate levels of medical care, according to Weston.

“These exercises are key to sustaining the force, while agility and scalability are the cornerstone of the Defense Health Agency’s combat support,” said West.