National Training Center (NTC)

Just 45 miles due South of Death Valley National Park in sunny Southern California is the infamous National Training Center (NTC). This is one of the several large-scale training locations owned and operated by the US Army around the World. This location allows units to simulate battle and perform live arms fire at a realistic scale - the "Box" or live training area is roughly the size of Rhode Island. You spend about a month at NTC during a rotation with only two weeks of that being in the Box. I became the Brigade Surgeon just two months prior to our trip to NTC, however, due to provider staffing issues, I am serving as both the Brigade Surgeon in part and as the Role 2 physician in the BSB. I am starting this entry at the tail end of my time in the Box while the fond memories are fresh. Here is my experience:

Before the Box

My unit went to NTC at just about the worst possible time of the year - July (2024). The temperatures the first week hit mid-110s with Death Valley setting a new temperature record the day before I flew out. I arrived at NTC 9 days prior to shipping out to the Box. There are two locations where you (may) live outside of the Box: Santa Fe and Rotational Units Bivouac Area (RUBA). Prior to COVID, you would spend your preparatory phase at RUBA and your clean-up phase at RUBA. During COVID, they switched to Santa Fe. The big difference here is that RUBA has actual barracks, showers, toilets, and food trucks, while Santa Fe is just a few giant tents (without sides) with some port-a-johns. For Army reasons, they have not transitioned back to using RUBA on both ends. We spent our prep phase in Santa Fe and will clean-up at RUBA. This basically adds an extra 1-2 weeks of misery to the experience. 

Ideally, once everyone is on ground, the individual Battalions should be operating out of their vehicles performing tailgate medicine, basically serving as a Role 1. There is a medical aid station at the NTC rear-D, "White cell," that is somewhat like a Role 2. There is a dedicated provider at the White cell aid station who stays there throughout the entire NTC rotation. There is a small hospital at NTC, Weed Army Community Hospital, that has an ER and sparse specialty services. Being so underpowered, they expect the White cell provider to do low-level ER care themselves in the actual ER. I am not a big fan of this setup and have had several arguments with leadership at NTC about this, but it is what it is. So because of this arrangement, the White cell provider gets stuck at the ER for prolonged periods of time, leaving a gap in coverage at the aid station. Being the Brigade Surgeon, I fill in gaps, so I stepped in to cover the aid station for the majority of the time. It was the usual sick call stuff, people trying/needed to get out of going to the Box, and a good number of Heat-Related Events. I quickly became an expert at all things related to dehydration and heat. 

NTC has their own standards for aeromedical evacuation related to heat that are stricter than medical standards: anyone over 102F or over 100F core temp with CNS changes gets on a bird. This lightened the load and took some stress off of me when it came to making decisions for evacuation. I do not want to give out medical advice on this platform, so if you would like some tips and tricks about heat-related illnesses, reach out to me on the Contact page. 

Your time at NTC is largely managed by Observer Controller/Trainers (OC/Ts or OCs). They are senior medics who will be monitoring your progress throughout the game and making sure you follow the rules.

You'll have a few meetings with the OCs and your Brigade to discuss the medical plan of action, but largely you won't be doing much during this time apart from sick call.

The Box

The big sandpit whose reputation precedes itself - you'll find plenty of people who pride themselves on their number of rotations through the Box just as if it was an actual deployment. I can only speak to the experience of doing this once and during the hottest month of the year - it sucks. Doing anything between 1300 and 1800 is difficult due to the relentless sun. That said, there were some things that made the experience better:

• Ice

  • For both medical and drinking purposes, there was always ice. The Brigade ordered 22,000 lbs of ice per day while we were in the box. 

• Port-a-johns

  • Being in a Role 2, we were usually posted up not far from some toilets. At one or two of the locations, it was a decent hike to get there, but it was better than nothing. There was a two-day period during this entire event where we did not have this resource and used the classic "Wag bag." 

  • My colleagues in the Role 1s frequently did not have this luxury

• Air conditioning

  • Part of the requirement for the Role 2 is to have AC in the patient hold tent. Our AC unit was able to provide air to both patient hold and our treatment tent. This pretty much saved the day both medically and personally.  Trying to treat heat injuries in >100F is almost impossible. Also, being able to hang out in relative cool was awesome. That said, in that 1300-1800 period, it was still over 90F in the treatment tent most of the time. 

• Dropped gear

  • When we first went out to the Box, we were given the OK to remove the armor plates from our IOTVs to reduce heat. After a few days, we were permitted to drop the IOTV entirely. This was literally a lifesaver in this Summer heat.

The Game

The whole point of this operation is to allow the fighting force to conduct a simulated battle plan against an enemy force. NTC has a home unit dedicated to being the bad guys year-round. Your job in medical really isn't too central to the whole point. The Role 1s are judged based on their time to treatment and time for transportation purposes. There aren't any metrics on the Role 2, itself.  The actual "force-on-force" game is to last a total of 10 days.

Another classic feature of the Box is the constant risk of being attacked. You are required to wear your MILES (Multiple Integrated Laser System) gear at all times outside of a tent. This is basically fancy laser tag gear with a speaker that goes off if you get killed. Apart from the enemy, the OCs will kill you if you are caught outside of a tent without all of your gear (helmet, gas mask, full MILES set) or are otherwise doing something you shouldn't. Being a physician, getting killed doesn't really change anything because you still have to treat people. I was killed once for not having my mask on my person while outside, but in my defense, I thought we were in a pause period. 

The Role 2 was attacked once (with gunfire) and we had to hold them off. I didn't do anything productive in this as I am required to be in the Role 2 for patient treatment purposes and am one of the least expendable members of the Brigade. Also, my weapon, the M17 doesn't get MILES gear like the M4s do, so I couldn't fight back anyway. 

Another risk of being in the Box is that of being hit with a chemical weapon attack. You are to have your mask on your person at all times and have easy access to your JSLIST (chemical suit). At the time of writing this, we are 2 days from being done with the game and the Role 2 has yet to be hit with a gas attack. We assume this has both to do with the heat (the JSLIST is basically a firefighter suit you wear on top of your regular uniform) as well as the fact that many of our patients in the hold tent do not have masks. Boy, I sure hope I don't have to update this paragraph in the next 48 hours...

Medical Care

We had a few hundred real-world patients come through the Role 2. Happily, the number of heat-related concerns decreased substantially as the Game went on - likely due to some combination of acclimatization, non-heat-tolerant individuals already being taken out of the Box, and improved heat illness care at the Role 1s. 

We had a few hundred more notional patients. These individuals had simulated battle injuries. Usually, they were actual battalion soldiers who were "killed" and handed a casualty card by an OC that contained their injuries and status. These patients allowed the medics to practice their combat casualty care. There were a few times when we received actors, often Veteran amputees, who put on a much better show and allowed for much better training. 

Live Fire

The force-on-force Game was only supposed to last 10 days with plan for live fire exercises for 4 more days. Because of ... reasons ... our plans changed to 11 days of the Game and 3 days of live fire. Life in the Role 2 didn't change much apart from no longer receiving notional casualties and had no risk of being gassed (which was a nice change of pace).

After the Box

Home sweet RUBA! 

If you were not prior service and had never been camping before, there is something magical about your first shower after 3 weeks sleeping in the desert. I hardly noticed the fact that the shower had only 1 temperature - scalding hot. It was glorious. 

Ok back to reality... As mentioned towards the beginning, you end up at RUBA; there are barracks, showers, hot chow two times a day, food trucks, small restaurants a small PX, a barber shop, and a USO. 

Your job as a physician is similar to what it was before the box: doing sick call medical care. We would have each battalion PA bring a medic or two and run sick call for their individual battalions out of the RUBA aid station. It was a whole lot of sitting around, but I got back into exercise (predominantly running, push-ups and pull-ups off of door frames - we technically were not permitted to use the gym facilities at NTC but...), and it was great not being under constant threat of being attacked or gassed (oh, we actually got away with never being gassed! It was so hot the entire time, they realized that we would have probably all died if we had to wear MOPP gear). 

Once all of the vehicles and equipment are packed up, slowly the flights take people away and you get to keep your fond memories at NTC...