Service members train to hone their skills both on and off the battlefield throughout the year, testing their abilities to perform in different environments with various stressors.Recently, soldiers from the 28th Combat Support Hospital (CSH) participated in a mass casualty training exercise at Fort Bragg, N.C."Boom!"The loud sound of a simulated grenade went off outside of the forward operating base and quickly alarmed medical personnel during the first phase of the exercise. Screams and moans from the "wounded" soldiers could be heard as medics fought through the smoke and woodland debris to assess, treat, and extract casualties from the danger zone back to the Combat Support Hospital.In addition to a simulated explosion, a medical evacuation helicopter landed in an open field outside of the forward operating base FOB to transport casualties to and from the hospital.Medics created a line formation of four personnel per team and, while grasping the shoulder of the soldier in front of them, they made their way to the helicopter to pick up casualties on the four-man litter to transport them to the triage area at the hospital."We’ve had some nominal patients all week long who have been giving us feedback at the end of the day as to how they felt their care was during the training. They’ve been rating the soldiers who have been taking care of them. Every day they’re telling us that they see increased confidence and increased smoothness in what they’re doing," Col. Diane Scherr, chief nurse, 28th CSH, and a native of Milford, Conn., said.Casualties were brought to the triage area of the hospital where more extensive medical attention was provided by doctors and licensed practical nurses.The medical personnel also determined the priority of treatments based on the severity of patients’ condition, and clearly tagged each casualty with a colored tape – red for immediate, yellow for delayed, green for minimal or black for expectant."They’ve done an excellent job getting the casualties through, properly assessing them, providing the proper treatments, and moving them on throughout the process to prepare them to either go back to duty or transport them to another location," Sgt. 1st Class Arthur Ebbert, chief ward master and noncommissioned officer, clinical operations, 28th CSH, and a native of Bassett, Va., said.Soldiers were operating as a team in a field environment inside of an 88-bed combat support hospital, while reacting to various scenarios."You might not find yourself in a trauma center or in the best of situations, so a MASCAL exercise is a great way to help us deal with pressure and learn how to deal with time restraints on many of the tasks," Pvt. Kenji Wong, health care specialist, Company B, 28th CSH, and a native of Houston, said."You don’t know if someone’s going to give out and be another casualty, so in a MASCAL exercise, not only are the patients coming in, but you could create more patients within the hospital if there is too much chaos and you don’t keep your cool," Wong added."We’re learning, but it’s been a great exercise and the soldiers had the opportunity to engage and be challenged with the casualties coming into the CSH in a rapid manner," Ebbert said.Several units provided support to the 28th CSH during the MASCAL training exercise.The Medevac was provided by Company C, 2nd Battalion, 104th Aviation Brigade General Support Aviation Battalion, West Virginia National Guard, and field showers were provided and maintained by the 82nd Sustainment Brigade, mass casualty training exercise.