Mountain Medicine Course

Review of the Military MMED Course.

Phase Two: LTA/Field

Phase two began early the next morning with refueling at the cafeteria with a last warm meal before heading back to the squad bays. Breakfast in the cafeteria had become a daily tradition, and the food there was surprisingly delicious with fresh fruit, tolerable coffee and eggs to order. While the food was great, the coolest attribute of the cafeteria was the large wall of windows that offered a panoramic view of the mountainscape surrounding the schoolhouse. The scenery was incredible during the course, and many times I found myself just breathing in the fresh mountain air and mentally absorbing the the beauty.


Outside the squad bays, we lined our packs and to our dismay were instructed to remove everything from the packs for inspection. We spent much of the night before carefully stuffing and arranging each piece of gear in our packs to optimize the weight distribution and knew that it would take a while to rearrange the gear. Shortly after inspection and hastily shoving everything back into our main packs, we assembled in columns and marched off toward the edge of the base.


At the fenceline, the class was unleashed on a five kilometer ruck “at our own pace” toward the Leavitt Training Area where we would spend the next four days mountaineering. The fitness heroes charged off on a blistering pace with the rest of us trailing behind just surviving. At this point, our main packs contained all of our issued gear, our mountaineering gear, food for four days, two Nalgenes and a CamelBak filled with water, and our assault packs lashed on top with the remainder of our necessary gear – all weighing in at about eighty pounds.


Level ground with that load was difficult enough, but the elevation change at altitude was crushing. We started at 6500 feet and climbed to the trail’s high point at 7300 feet where we stopped for a break and instruction and “scree surfing.” After catching our breath, emerging from our pain cave, and admiring the surrounding beauty, our instructors were quick to remind us that we were not even carrying a combat load which would easily add another thirty pounds.


The ruck then devolved into a downhill race until we emerged at training area and finished with a maximum pull-ups competition – it seemed that everything eventually turned into a competition. After stowing our packs, we grabbed our mountaineering gear and assembled at a new rope corral to practice knot tying for the upcoming exam. Following lunch, our first training module at the LTA covered “fixed lanes.” Fixed lanes utilize ropes anchored strategically by an expert lead climber allowing other climbers to ascend a slope or cliff-face safely. After the instructors discussed the utility of fixed lanes in combat and demonstrated appropriate utilization, we spent the rest of the afternoon practicing traversing a up and down a small cliff-face.


Later that night, we assembled at the cliff-faces again in the dark exercising light and sound discipline, then one by one ascended a ravine following a fixed lane established by the instructors earlier that afternoon. It was a harrowing experience traversing the cliff-faces in the nearly pitch black and having no idea what was above or below. But by implementing the skills learned earlier that day, clipping in with both carabiners and establishing a good footing and handhold with each movement, we all climbed the cliff safely. At the top we grouped into small teams and rigged up a SKED with no light and minimal noise simulating combat conditions.


The next morning started at a mountain stream where we learned about “swift water rescue.” Rescuing each other from the frigid waters cemented the training, or at least gave us a healthy respect for the danger of freezing mountain streams. Over the next few days, we learned to rappel and belay, then rappelled the LTA cliffs and alternated belaying each other. Then we climbed the cliffs of varying difficulties with ratings based off the Yosemite Decimal Rating System (YDRS). Next, the instructors provided rubberized M4s and taught the basics of patrolling and reacting to contact before ambushing our formation and expecting us to respond accordingly.


In order to complete the Mountain Medicine Course, there were four separate required milestones to be completed satisfactorily. Initially, upon arrival at the course, each candidate passed the fitness test except for one student who failed, and was sent home. The next two failure points were the knot test and the SKED test at the LTA. Only two students completely “cleaned” both tests initially without any failures. Most of us failed a few knots and passed on the retest the next day. The SKED was all or nothing – if any detail was unsatisfactory, the entire SKED was a failure. Thankfully, everyone passed on the retest except for a few who then remediated and passed on the final day at the LTA.


On the last afternoon at the LTA, we were introduced to what initially seemed like an incredibly complex “raise and lower system” comprised of climbing rope, water tape anchors, cordage, a pulley system, and carabiners. We would utilize this system during the next week to raise and lower casualties in our SKEDs on slopes that would be impassable without the system. While seemingly complex initially, we spent the rest of the evening troubleshooting the system as a class until the mangled mess of rope and carabiners began to make sense. The next morning, a few unlucky souls were deemed casualties, whom we then secured in the SKEDs and lifted up the mountain with accompanying litter teams. Once up top, we assembled the lowering systems and retraced our steps. Little did we know, but we would do this ad nauseam during the field exercise the following week.


On our final day, after repacking our gear, we assembled in tactical files and broke into separate squads for the hike back to the schoolhouse. Before the formation even made it to the trailhead, the instructors ambushed the class and began inflicting casualties. After reacting to contact, returning fire and suppressing the threat, the closest students administered medical care while the rest of us set up a defensive perimeter. Two of our classmates were “injured” significantly. We quickly wrapped them in SKEDs and began our evacuation. After making radio contact with higher (the instructors), we were informed that no MEDEVAC platforms were available at that time. They also informed us that a large enemy force was headed in our immediate direction and would overrun our position soon. And so began the most painful experience of mountain medicine. We morphed from three squads to two squads, with one patient and litter team per squad. The first kilometer was somewhat disorganized, but we soon fell into a rhythm of switching litter teams every 50-100 yards depending on the terrain. We also crossloaded the patients’ gear to distribute the extra weight.


One of my most comical course memories occurred moments after the ambush at the LTA trailhead. I was near the front of the formation providing security, when I briefly turned and saw our squad leader, one of the SEAL medics, running full steam up the trail toward me. As he approached, I realized that he was carrying two rifles, his ruck, and one of the casualty’s rucks balanced on top of his ruck pushing his chin down into his chest. He dumped the extra ruck at my feet and asked me to take a turn. At that moment, I couldn’t decide whether to laugh or cry, but in retrospect, I laugh every time. After strapping the ruck to my chest, and rolling onto my knees, I waddled down the trail with the rest of the squad smiling through the sweat.

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The remainder of each squad provided security, spent a few moments recovering, and then readied to switch out with the litter team. One casualty weighed 220 pounds, and the other weighed 160 pounds, which made for an interesting dynamic. So we began switching the patients between the squads as the heavier squad began to lag. While this experience was physically draining, it was mentally enlightening. Just four days previous, we made this same hike with only our personal gear and thought it was difficult. Now we were carrying significantly heavier and more awkward loads that required teamwork and coordination. It was amazing to see what teamwork could accomplish. Also, by the end of the 5K mountain CASEVAC, our system had morphed into a well oiled machine with each squad transitioning quickly, taking short breaks, and moving relatively swiftly. The entire movement lasted four hours, and most of us were wiped at the end. But more mental barriers were eliminated, which was vital for success in the upcoming Field Exercise. Showers, a mattress, and a warm non-MRE meal that night back at the schoolhouse never felt better.


The next few days we discussed altitude medicine and participated in a training evolution with a local Search and Rescue team. We learned the basics of helo operations and how to safely perform a MEDEVAC with a patient in the SKED. Afterward, a lucky student also was hoisted into the air with a SAR team member and briefly flew over the surrounding mountain ridges. We finally earned another day of liberty, but spent most of it preparing our gear for the final Field Exercise that started the next day.

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