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Maj. Jason Edwards, internal medicine specialist, 86th Medical Group, Ramstein Air Base, Germany, participates in a multinational medical exercise drill during Vigorous Warrior 19, Cincu Military Base, Romania, April 8, 2019.

Maj. Jason Edwards, internal medicine specialist, 86th Medical Group, Ramstein Air Base, Germany, participates in a multinational medical exercise drill during Vigorous Warrior 19, Cincu Military Base, Romania, April 8, 2019. (Andrew Layton/U.S. Air Force)

Maj. Jason Edwards, internal medicine specialist, 86th Medical Group, Ramstein Air Base, Germany, participates in a multinational medical exercise drill during Vigorous Warrior 19, Cincu Military Base, Romania, April 8, 2019.

Maj. Jason Edwards, internal medicine specialist, 86th Medical Group, Ramstein Air Base, Germany, participates in a multinational medical exercise drill during Vigorous Warrior 19, Cincu Military Base, Romania, April 8, 2019. (Andrew Layton/U.S. Air Force)

Airmen from the 86th Medical Group, Ramstein Air Base, Germany, participate in a multinational medical exercise drill during Vigorous Warrior 19, Cincu Military Base, Romania, April 8, 2019.

Airmen from the 86th Medical Group, Ramstein Air Base, Germany, participate in a multinational medical exercise drill during Vigorous Warrior 19, Cincu Military Base, Romania, April 8, 2019. (Andrew Layton/U.S. Air Force)

Airmen from the 86th Medical Group, Ramstein Air Base, Germany, participate in a multinational medical exercise drill during Vigorous Warrior 19, Cincu Military Base, Romania, April 8, 2019. With more than 2,500 participants from 39 countries, Vigorous Warrior 19 is NATO?s largest-ever military medical exercise.

Airmen from the 86th Medical Group, Ramstein Air Base, Germany, participate in a multinational medical exercise drill during Vigorous Warrior 19, Cincu Military Base, Romania, April 8, 2019. With more than 2,500 participants from 39 countries, Vigorous Warrior 19 is NATO?s largest-ever military medical exercise. (Andrew Layton/U.S. Air Force)

Col. Michael Roberts, commander, 86th Medical Group, Ramstein Air Base, Germany, briefs Col. Laszlo Fazekas, director of the NATO Center of Excellence for Military Medicine, Budapest, Hungary, on capabilities of the expeditionary medical support facility operated by airmen from the 86 MDG at Cincu Military Base, Romania, April 7, 2019.

Col. Michael Roberts, commander, 86th Medical Group, Ramstein Air Base, Germany, briefs Col. Laszlo Fazekas, director of the NATO Center of Excellence for Military Medicine, Budapest, Hungary, on capabilities of the expeditionary medical support facility operated by airmen from the 86 MDG at Cincu Military Base, Romania, April 7, 2019. (Andrew Layton/U.S. Air Force)

Dr. Bogdan Mihalache, general surgeon, Iasi Military Hospital, Romania, and 1st Lt. Roxana Oparlescu, participate in a multinational surgical exchange drill at the U.S. Air Force 86th Medical Group Role 2 field hospital at Cincu Military Base, Romania, on April 11, 2019.

Dr. Bogdan Mihalache, general surgeon, Iasi Military Hospital, Romania, and 1st Lt. Roxana Oparlescu, participate in a multinational surgical exchange drill at the U.S. Air Force 86th Medical Group Role 2 field hospital at Cincu Military Base, Romania, on April 11, 2019. (Andrew Layton/U.S. Air Force)

Airman 1st Class Harry Randazzo, 1st Combat Communications Squadron, Ramstein Air Base, Germany, prepares equipment for expeditionary medical support facilities at Cincu Military Base, Romania, April 4, 2019, during exercise Vigorous Warrior 19.

Airman 1st Class Harry Randazzo, 1st Combat Communications Squadron, Ramstein Air Base, Germany, prepares equipment for expeditionary medical support facilities at Cincu Military Base, Romania, April 4, 2019, during exercise Vigorous Warrior 19. (Andrew Layton/U.S. Air Force)

Cristina Prodan, chief nurse, Military Hospital Timisoara, Romania, participates in a multinational surgical exchange drill at the U.S. Air Force 86th Medical Group Role 2 field hospital during Vigorous Warrior 19, Cincu Military Base, Romania, April 11, 2019.

Cristina Prodan, chief nurse, Military Hospital Timisoara, Romania, participates in a multinational surgical exchange drill at the U.S. Air Force 86th Medical Group Role 2 field hospital during Vigorous Warrior 19, Cincu Military Base, Romania, April 11, 2019. (Andrew Layton/U.S. Air Force)

A Romanian aircrew performs a medical evacuation drill at the Role 2 field hospital maintained by airmen from the 86th Medical Group, Ramstein Air Base, Germany, during Vigorous Warrior 19, Cincu Military Base, Romania, April 8, 2019. Vigorous Warrior 19 is NATO's largest-ever military medical exercise.

A Romanian aircrew performs a medical evacuation drill at the Role 2 field hospital maintained by airmen from the 86th Medical Group, Ramstein Air Base, Germany, during Vigorous Warrior 19, Cincu Military Base, Romania, April 8, 2019. Vigorous Warrior 19 is NATO's largest-ever military medical exercise. (Andrew Layton/U.S. Air Force)

Maj. Lindsey Marquez, a nurse anesthetist, 86th Medical Group, Ramstein Air Base, Germany, and Maj. Florin Buia, general and vascular surgeon, Cluj-Napoca Emergency Military Hospital in Romania, participate in a multinational surgical exchange drill during Vigorous Warrior 19, Cincu Military Base, Romania, April 11, 2019.

Maj. Lindsey Marquez, a nurse anesthetist, 86th Medical Group, Ramstein Air Base, Germany, and Maj. Florin Buia, general and vascular surgeon, Cluj-Napoca Emergency Military Hospital in Romania, participate in a multinational surgical exchange drill during Vigorous Warrior 19, Cincu Military Base, Romania, April 11, 2019. (Andrew Layton/U.S. Air Force)

KAISERSLAUTERN, Germany — If a war broke out in Europe or the Continent saw another disaster on the scale of the Chernobyl nuclear meltdown, military and civilian medics with NATO and partner nations would likely be called to the front lines, jointly treating the wounded.

They’re already preparing for such scenarios, and this month, 2,500 medical personnel from 39 nations drilled at four different locations in Romania as part of Vigorous Warrior, the largest combined NATO medical exercise ever staged.

U.S. military participants included, for the first time, the 86th Medical Group at Ramstein Air Base, Navy medical specialists and a handful of soldiers from Europe. The Ramstein unit sent about 50 airmen and its mobile field hospital to Cincu Military Base, a mission that involved hauling 16 pallets of equipment in flatbed trucks across much of Europe.

Once set up, the airmen triaged and treated simulated combat injuries in a collective scenario, officials said.

“It was basically large NATO against an adversary,” said Col. Michael Roberts, 86th Medical Group commander. “We were behind the line of conflict,” taking patients from the point of injury on the battlefield to the field hospital for treatment.

“We had patients that coded,” Roberts said, referring to a slang medical term for heart failure. Others turned up with simulated chemical burns or probable radiological exposure.

The NATO Center of Excellence for Military Medicine, the Romanian Armed Forces General Staff and the Romanian Ministry of National Defense Medical Directorate organized the two-week event in the first half of April.

The exercise included NATO drills on the Black Sea and in Bucharest — Romania’s capital and largest city — where civilian and military emergency responders staged the evacuation of 200 people injured in a mock attack on one of the city’s subway stations.

“There’s all these unknowns that we deal with on this globe,” said Col. Bradley Nielsen, U.S. Air Forces in Europe – Air Forces Africa deputy command surgeon. The U.S. military, he said, “can’t do it all ... we have to ask partner nations to assist us.”

Vigorous Warrior exposed nations’ medical strengths and, in some cases, weaknesses — useful information in the event of an international medical emergency. The Czech Republic, for example, stood up a very capable chemical response team, Nielsen said. “You can definitely go back in your little ledger and say, ‘Hey, this country did awesome.’”

In a real combat scenario in Europe, it’s almost certain Ramstein’s medical capabilities would be needed. Its modular field hospital is designed to be deployed and fully operational within six hours of arrival at its destination, Roberts said.

In the Defense Department, “we’re the fastest medical capability into a contingency environment,” he said.

The exercise allowed airmen to practice quickly deploying their field hospital, consisting of five tents, an operating table and a mix of trauma, intensive care and holding beds. But it also gave them much-needed practice using their emergency medical skills in an austere environment.

“When we started the exercise, I asked the team how many of them had deployed in a setting of trauma patients and only seven people raised their hands out of the 49 we have here,” Chief Master Sgt. Amy Riley, 86th Medical Group group superintendent, said in a statement. “I think one of the lessons learned for them is the ability to move outside a clinical setting, which is very controlled, into a very uncontrolled environment ... pushing them outside their comfort zone.”

Romanian military personnel posed as patients, sporting realistic-looking mock wounds from gunshots and broken bones, Nielsen said.

“You can never replicate what you see out on the battlefield or in an emergency room ... but I think they did a fantastic job of creating an environment that was stressful,” he said of the Romanians.

Near the end of the exercise, U.S. and Romanian medical personnel swapped places, with the Romanians working in the U.S. field hospital and the U.S. surgical team training in the Romanian facility.

It took some time “to get the processes squared away, but at the end of the day we could work at saving patients collectively as a team,” Roberts said.

svan.jennifer@stripes.com Twitter: @stripesktown

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Jennifer reports on the U.S. military from Kaiserslautern, Germany, where she writes about the Air Force, Army and DODEA schools. She’s had previous assignments for Stars and Stripes in Japan, reporting from Yokota and Misawa air bases. Before Stripes, she worked for daily newspapers in Wyoming and Colorado. She’s a graduate of the College of William and Mary in Virginia.

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