In an upstairs room at her home in New York, while her children and dogs are playing downstairs, Lt. Col. Sarah Davis, clinical nurse assigned to the 158th Medical Group, Vermont Air National Guard, sits down at her computer screen with pieces of training equipment nearby, hoping to avoid being interrupted. It was September 28, the first day of a three-day trauma nurse training, when she logged on to greet participants virtually - a new normal during the ongoing COVID-19 pandemic.

On another continent, time zones away, more than 10 nurses in the Armed Forces of North Macedonia were also at home and logging onto their respective computers. These nurses, much like those in the Vermont National Guard, work in clinical environments and also train for contingency operations, similar to training over a drill weekend.

Also logging in for this exercise was Capt. Michael Kelley, senior nurse for Charlie Company (Med) of the 86th Infantry Brigade Combat Team (Mountain), Vermont Army National Guard, who was asked by his chain of command if he was interested in participating a few weeks prior. Agreeing without initially knowing what his role would be or what topics he would cover, Kelley found himself planning the event agenda and presenting multiple topics over this three-day course.

Throughout the engagement, Vermont Guardsmen instructed on topics to include trauma patient management and the nursing process, preparation and triage, team setup, MASCAL procedures and priorities of personnel, among other lessons.

“I covered an overview of what a trauma system is, how a trauma team is set up and responsibilities of the trauma nurse and team leader. I also discussed mass casualty (MASCAL) situations, how to set up for MASCAL operations, disaster triage, emergency operations plans and discussed opportunities to improve current plans,” said Kelley.

September’s virtual engagement was initiated through Vermont’s State Partnership Program (SPP) with North Macedonia. The SPP links each state’s respective National Guard with the armed forces or equivalent from a foreign partner nation to conduct military-to-military engagements in support of defense security goals, as well as building cooperative, mutually beneficial social and economic relationships. The Vermont National Guard has been partnered with North Macedonia since 1993 and Senegal since 2008.

According to Kelley, it would have been extremely helpful to perform simulation scenarios in-person when discussing these topics of trauma response and MASCAL operations. The virtual environment also appeared to influence participation:

“The most challenging [part of the training] was that it was virtual and you just don’t get the same interaction as you would in a traditional seminar,” shared Kelley. “By the third day, we had an increase in participation and a number of individuals shared their experiences with us as it relates to the pandemic response.”

In addition to being unable to demonstrate skills in person, other challenges were faced to include time zone differences and language barriers.

“They wanted mass casualty, but that's very hard to do remotely. Basically, hands on is much better, because we would kind of throw patients, a lot of them, at them at once and see how they could prioritize treatments. So instead, we did a course with slideshows and just talking,” said Davis. “It was interesting, a lot of them don't speak English well, so they understand us better... Of course, there's also a time change of six hours. We had to start bright and early, and they were at the end of their day.”

The third and final day wrapped up with guest speakers discussing NATO echelon of care and Vermont Guardsmen discussing the Vermont National Guard’s own COVID-19 response.

“They wanted to hear about COVID, and how the U.S. responded, so we talked about what we did with the Joint Task Force,” said Davis. “Being part of the alternative health care facility was probably the highlight of my career so far, because it was doing something that helped the U.S. It was what I was trained to do and I actually could put it to use, and so I was able to share my experience about what we did and having been in it.”

This trauma care training would have occurred in-person, whether in North Macedonia or Vermont, but turned virtual in response to the ongoing COVID-19 pandemic, which Kelley believes makes this the first virtual training, at least for the medical side of the SPP.

“We were supposed to go in person and do some nurse trauma training. But obviously, for COVID reasons, you can't go in person. So, we're trying to do trauma training online; this is our first time at it,” said Davis.

“This type of material is normally an in person, especially with the hands-on portion of the classes where equipment was discussed and demonstrated. COVID-19 limited the event to a virtual engagement which was still very beneficial to the participants and instructors,” explained Senior Master Sgt. Michael Bilharz, facilitator for this SPP training.

Kelley added that the most successful part of the training was the overall delivery of the material and topics, providing a well-rounded presentation for Vermont’s North Macedonia partners and receiving “great feedback and thanks” for hosting this event.

Looking ahead, next steps will include an in-person training event or joint exercise once travel restrictions from COVID-19 are lifted. Until then, future ground military engagements with both state partner countries, North Macedonia and Senegal, are on hold. However, there continues to be contact with students and partners from these countries to assist with any questions or future planning of events.

“In my opinion, our next step is getting to North Macedonia. We need to reinforce the topics we discussed and get our hands dirty. We need to set up triage operations, prepare for trauma casualties and then run scenarios. This would allow the participants to have a hard copy certificate for their knowledge and experience in trauma care,” said Kelley.