A 9mm Full Metal Jacket ammunition round enters the human body sometimes leaving only an inconspicuous entrance hole the diameter of an ordinary pen. But as it's tremendous velocity rips through tissue, destroys organs and shatters bone, it leaves an exit wound the size of a man's fist tearing the flesh to ribbons on its way out.
This type of wound normally only found in combat is exactly why more than 100 reserve and active-duty doctors, nurses, medics and surgeons attached to the Medical Battalion of the Norwegian Army's 6th Division came to Exercise Strong Resolve in Central Norway.
"The training we receive in this setting is invaluable," said Norwegian Army Lt. Co. Terje Svellet, commander of the battalion, which moved it's entire operation 1,000 kilometres from its home station in Indre Troms', Norway.
The battalion's medical personnel train on the treatment of gunshot and stab wounds and are also able to practice treating other minor procedures in the field as if they were in an actual civilian trauma center. It is through the use of a mobile surgical container and live specimens that this incredibly realistic training is made possible.
The Norwegian Army can deploy what is called a 3-in-1, 20-foot container that encompasses a surgical unit capable of treating two critical patients or four less critical patients at the same time - anywhere.
This large green box can be lifted by helicopter or driven by truck to just about anywhere in the world, and with the flip of a few switches and the pull of a few levers it folds out into a fully operational surgical unit, paralleling the best surgical units in the world, in about 20 minutes - complete with running water, heat and electricity.
"This gives the medical battalion commander more mobility and latitude in their operations," said Norwegian Army Capt. Olav Tveiten, project officer for the surgical container. "This is a strong medical concept, without any weak links that is highly mobile and practical."
The container not only meets the international organizational standards, it is also fully interchangeable with all NATO nations, allowing for tremendous flexibility.
To add to the realism of the surgical training, pigs are used. After being fully anaesthetized, the animal is shot in the leg with a high-powered rifle and then again from close range in the abdomen with a 9mm pistol.
Armed with the power to stop the operation at any time are two veterinarians who over see the entire procedure.
"By pinching the hoof very tightly and feeling and visibly checking for any muscle retraction in the leg, I can be sure the animal is not suffering," said Norwegian Army Veterinarian Capt. Knut Grani. "We control the operations from the beginning of the anaesthesia to the end of the surgery. If during this time we notice the animal is suffering we stop the procedure and step in."
During the exercise eight pigs will be used to train surgeons, medics, nurses and anaesthesiologists on everything from minor suturing to treatment of major gunshot wounds.
"We use pigs because their tissue strongly resembles that of human tissue," said Grani. "They eat primarily the same foods as us, therefore our digestive tracts are very similar."
Instructing the course and watching over the surgeons is Norwegian Army Lt. Col. Pillgram Larson, Chief Surgeon of the Norwegian Armed Forces, who remembers going through this same course many years ago.
"Much as changed since I went through this course and it has gotten much better," he said. "This controlled environment allows surgeons and anaesthesiologists to learn to work together. It's better to learn and make mistakes on a pig than on a 15-year-old boy."
This training though is not only for military personnel, according to Norwegian Army Maj. Svein Torp, Chief of the Medical Department for the Norwegian Army. "For a civilian surgeon to be certified in Norway, they must go through this course - it's mandatory. It is designed to train surgeons prior to them meeting their first patient on the operating table."
Based on the training they receive, the battalion's medical personnel are able to create teams of six to eight people, which includes one doctor, that can go into the field, perform surgery and sustain a patient for two to three days in a combat zone if necessary.
"I'm very pleased with how things are going," said Svellet. "Very pleased."
The NATO exercise demonstrating the capability of the alliance to conduct two simultaneous operations coping with two simultaneous crises runs through March 15 in Central Norway. One crisis setting consists of a NATO Article Five war-fighting scenario in response to an aggressive act against a NATO member. Article Five of the NATO charter states that an attack on any NATO member state will be considered an attack on all NATO member states.
The second setting is a crisis response operations exercise and scheduled in Poland. This setting will focus on peace support operations, specifically a peace enforcement operation.