USS Rushmore
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PACIFIC OCEAN (Oct. 27, 2017) General Surgeon Cmdr. Michael Johnston and Emergency Medicine Physician Assistant Lt. Michelle Miller of Role 2 Light Maneuver (R2LM) Navy Adaptive Trauma Team (NATT) ONE, treat a simulated casualty wearing a live cut suit in the medical spaces aboard Whidbey Island-class dock landing ship USS Rushmore (LSD 47) during a surgical drill for Dawn Blitz 2017. Dawn Blitz 2017 is a scenario-driven amphibious exercise designed to train and integrate Navy and Marine Corps units by providing a robust training environment where forces plan and execute an amphibious assault, engage in live-fire events, and establish expeditionary advanced bases in a land and maritime threat environment to improve naval amphibious core competencies. (U.S. Navy photo by Mass Communication Specialist 2nd Class Chelsea Troy Milburn)
The evolution of wartime surgery

The Navy’s first Role 2 Light Maneuver (R2LM) team, Navy Adaptive Trauma Team (NATT) ONE, put their crew to the test in their first exercise with the fleet, integrating with the medical department aboard Whidbey Island-class dock landing ship USS Rushmore (LSD 47) for Dawn Blitz 2017, completing four successful surgical drills, Oct. 23-28.

The seven-member team was assembled from Navy medical centers across the country, coming together to complete the pilot R2LM course as a team at Surface Warfare Medical Institute (SWMI) East at Naval Station Norfolk, July-August 2017.

“I wouldn't think of the NATT as something brand new, but as another step in the evolutionary process of wartime surgery,” said Cmdr. Michael Johnston, the team’s general surgeon and officer in charge. “It’s a new program of record within Navy Medicine, but it’s built on the historical Expeditionary Resuscitative Surgery System (ERSS) and Damage Control Surgery (DCS) teams.”

ERSS and DCS teams have been around for about a decade, operating independently of one another in support of deployed units both afloat and ashore.

Johnston explained how primarily U.S. Army-trained ERSS and DCS teams evolved into the Navy’s NATT R2LM program.

“The NATT can do everything the ERSS can do and more,” said Johnston. “For the past 10 or so years, the Navy has filled missions requiring a shipboard surgical team with an ERSS and missions requiring a shore-based surgical team with a DCS team. An ERSS was not capable of surging ashore or working in a hostile environment, while a DCS wasn’t trained to work on ships. We are.”

Though smaller ships like LSDs have their own medical departments, embarking a surgical team would add significant medical capability to the platform. For Lt. Emily Calhoun, Rushmore’s medical officer, there is no question in the value an R2LM team would bring to the ship on deployment.

“A ship is inherently a dangerous environment,” said Calhoun. “Between steep ladderwells, heavy machinery, shipboard operations, as well as the various missions the Marines could be sent out on, there is an inherent risk for injury.”

Calhoun explained that some illnesses and injuries that could be sustained on mission could be outside the scope of what her department can provide alone.

“We aren’t capable of performing surgeries on board without being augmented by a surgical team,” said Calhoun. “During operations where we could be days away from surgical capabilities, having an R2LM team would allow us to treat patients who need surgery to stabilize their injuries. It would mitigate the risk of not being able to save potentially savable patients.”

Johnston predicts that the successful drills with Rushmore and the Essex Amphibious Ready Group (ARG) will set the stage for future amphibious deployments.

“I believe Rushmore Sailors are seeing the future of amphibious role 2 missions,” he said. “Most LSDs sail forth disaggregated from the ARG for a majority of their deployments, and I believe that an R2LM team will become a mandatory part of that disaggregated portion of LSD deployments in the near future.”

With their success during Dawn Blitz propelling them forward, the team is ready to move forward to their next step toward real world implementation.

Dawn Blitz is a scenario-driven exercise designed to train and integrate Navy and Marine Corps units by providing a robust training environment where forces plan and execute an amphibious assault, engage in live-fire events, and establish expeditionary advanced bases in a land and maritime threat environment to improve naval amphibious core competencies.

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