Navy Medicine Conducts First Integrated ERCS and ERSS Training

Story by Petty Officer 1st Class Russell Lindsey

Navy Medicine Operational Training Command

SAN CLEMENTE, Calif. – You’re a Sailor or Marine protecting American interests and the freedoms of our partners and ally nations and you’re out conducting distributed maritime operations (DMO), and you’re miles from the nearest base or operations hub. Suddenly you find yourself wounded along with several of your fellow servicemembers with the sinking feeling of “now what? Thankfully, Navy Medicine has been preparing for this eventuality and is implementing the Navy’s expeditionary medicine system (EXMED) components and integrating them to work together in unison and bring you home safely.
On March 12, over the course of eight days at Naval Expeditionary Medical Training Institute (NEMTI) located on Camp Pendleton, Navy Medicine did just that and completed the first En-route Care System (ERCS) course. This marks the first iteration of the ERCS course and incorporated full integration with Expeditionary Resuscitative Surgical System (ERSS) and Role 1 point of injury (POI) care providers as part of an Operational Readiness Evaluation (ORE) of the EXMED system capabilities.
“In past conflicts the Navy has relied more heavily on the Army and the Air Force for en-route care and austere medical support because they were land-based conflicts and already had the infrastructure in place, the next conflict most likely won’t be,” said Captain Kimberly Toone, commanding officer Navy Medicine Operational Training Command (NMOTC). “Although they will likely have land components the Navy has to strengthen and shore up our EXMED platforms and systems by focusing on the care in-between.”
The ORE is the first validation of integrated ERSS and ERCS teams and is part of a brand-new curriculum and training objectives offered by NEMTI whose main goal is to provide an opportunity to exercise a complete integration of Navy medical personnel simulating real-world operations and the roles of care. This integrated training also marks the first time that the two teams will be utilizing the top-of-the-line Authorized Medical Allowance List (AMAL) for training, exercise, and operational employments. This equipment is key to the success of the units and is an important addition to the training curriculum as teams will now have the opportunity to fine tune and practice the implementation of the equipment and gear prior to being deployed.
“It’s becoming more and more apparent that this is where the fight is leading us to, and its process that will have a lot of questions asked and processes streamlined,” said Hospital Corpsman 3rd Class Elisha Rogers, assigned to ERCS Bravo. “There is going to be a lot more distance between point of injury where our guys are operating out into and the medical support they need and I’m excited to be a part of that solution”.
Piloted back in November of 2023, ERCS, the newest component in the EXMED system, is made up of one Critical Care Nurse and one Search and Rescue Medical Technician. The mission of the team is to provide highly mobile casualty care with an ability to function on a variety of dedicated or atypical transportation assets to support operations afloat or ashore in DMO. While it’s composition is among the smallest of the EXMED systems it is ideal and perfectly suited to the types of platforms it is intended to employ i.e.; helo, aircraft, ATV, and other ground transports. Additionally, they are designed to support other medical capabilities such as the ERSS or Casualty Receiving and Treatment Ships to facilitate patient movement without degrading the medical capabilities of the supported unit. It is for this reason different teams from the Joint Patient Movement System and interoperability with joint ERC processes were brought into this initial course implementation to allow all aspects of the other EXMED systems and Role providers to train and focus on integration.
“MTF’s don’t normally give us the acuity that we need and the chance to integrate on the larger scale that a team like this needs, and this course seems to offer both of those aspects,” said Lt. Rebecca Smith, assigned to ERCS Bravo.
Over the course of the training at NEMTI’s facilities the two teams focused on team building, practical skills and familiarization of the actual gear, much of which they had not been issued prior. The training varied different scenarios, patient presentations, and problems that the teams would be likely to encounter in DMO and allowed them the chance to practice fundamentals that would allow them to operate in austere environments.
“It’s a crucial piece to the system, team building and skills preparation are huge and the more times they do this training they will be able perfect its lead up and also incorporate all the other skills we may not even know we need yet,” said Smith.
While ERCS is new to the EXMED system the ERSS component has been established for far longer and has been successfully implemented throughout the Fleet and various platforms. A typical ERSS team is composed of more personnel than en-route teams and uses specialties such as surgeons, ER doctors, physicians’ assistants, nurse anesthetists, trauma nurses, and corpsman to either operate onboard units in the maritime domain while still being mobile enough to support conventional and special operations forces in the field.
The DMO environment will present challenges that will force ERCS teams to prepare, and function in a resource constrained environment while having to meet the capability of providing care for at least two critically injured patients for eight hours of movement. NEMTI addresses this challenge by providing the teams didactic lectures on operational planning, transportation assets, communications, logistic management, prolonged casualty care and operations in low visibility and austere conditions.
“We ran them through their paces,” said LCDR Benjamin Mattox, NEMTI’s Academics Department Head. “Both teams did really well and we wanted to give them logistical problem-solving opportunities as well as complex medical challenges because in an operational environment that’s what you’re going to face and you have to be prepared for your power is going to go out or how are you going to work together to move patients when the situation becomes too dangerous”.
Additionally, the team immersion with Special Operations Independent Duty Corpsman (SOIDC) or Role 1 providers, ERSS, and even Fleet Surgical Teams (FST) to create an enhanced real-world integrated training environment allows teams to understand the resources at their disposal and that they are part of a larger system to facilitate movement away from the POI. This portion of the training performed over four days and nights of various training missions to test their ability to operate effectively in support of multiple casualty and combat scenarios and build in near “real-time” logistics challenges such as re-supply, travel times, and unit movement.
The EXMED expertise found at NEMTI is unlike anywhere else in Navy Medicine and is pivotal to the success of these teams and the larger system. The uniquely integrated training environment at NEMTI and subject matter experts found across the NMOTC enterprise allowed the creation and near seamless integration of the curriculum to occur. The training at NEMTI will prepare each of them for complex patient care challenges in the future DMO environment . The design, equipment, and mission of the EXMED will continue to evolve as the environments that they are required to operate in evolve as well. As those changes occur, NMOTC and NEMTI will continue to focus on integrated training and adapting to meet those dynamic mission requirements. Each component added…and perfected, in the EXMED system ensures Navy Medicine personnel are trained, equipped, and prepared for current and future fights.
NEMTI, a detachment of the Navy Medical Operational Training Command (NMOTC), is located onboard Camp Pendleton in California and is the Navy’s go-to for expeditionary medical training. NMOTC is the Navy’s leader in operational medicine and trains medical providers and specialists for the fields of Aviation, Surface and Undersea Warfare, Expeditionary, and Special Operations Medicine.
Navy Medicine – represented by more than 44,000 highly-trained military and civilian health care professionals – provides enduring expeditionary medical support to the warfighter on, below, and above the sea, and ashore.

NOTE: CDR Damian Storz, LCDR Claire Smith, HM2 James Comick; NEMTI & CDR Colleen Abuzeid, NMOTC, contributed to this article.