Source: United States Navy (Medical)
Camp Foster, Okinawa, Japan February 13, 2025, staff from the U.S. Naval Hospital Okinawa (USNHO) Emergency Department are training the future EMTs charged with providing lifesaving critical care to those in need en route to the hospital. Okinawa is a small island stretching 70 miles from north to south, up to 7 miles wide at its widest and only 2 miles wide at the narrowest. This geography, along with streets not wide enough for two cars to pass and 95% of the population all in the middle of the island, makes Okinawa one of the most densely populated non-metropolitan areas in the world. This unique environment makes it a daily challenge for the EMT personnel who provide emergency first responder care to 6 branch clinics and the interfacility transfers of patients of USNHO.
The two most northern branch clinics can take as long as two hours to navigate the densely populated narrow streets where the average posted speed limit is 30km/h or 19mph. The gravity of that kicks in when you are potentially the sole provider riding in the back of an ambulance with a patient suffering grievous injuries. CDR Pete Nyilas, the Director for Medical Services at USNHO, explained the importance of the hospital providing EMT training to our corpsmen and the incredible responsibility these, often very young sailors, are shouldering. The Naval Hospital is doubling down and conducting ongoing training to ensure enough EMTs are trained to fill the role. A class is testing out today, February 13, 2025, then there will be a refresher training in March, followed by another training class between April and May. This is the constant battle rhythm needed to keep a continuous roster of EMTs to mitigate burnout, accommodate time off, and manage the permanent change of station (PCS) moves that are constantly happening. The goal is to have at least two EMTs per ambulance rig and enough to cover the 24-hour duty they stand when on call.
The EMT course at the Naval Hospital is “rigorous and tests our corpsmen to the top of their training,” CDR Nyilas said. He pointed out that this course and opportunity are unique to Okinawa because stateside emergency transport is done by civilian ambulances and emergency responders, not by the Medical Treatment Facility (MTF) personnel. Nyilas also pointed out the similarities in real-world trauma that the corpsmen might encounter on a battlefield.
The EMT course is challenging, and after passing, the students must take the Nationally Recognized Emergency Medical Transport (NREMT) test and pass to receive a nationally recognized certification that is good for two years. The previously mentioned refresher course given every third month helps keep the certifications current. Time is the enemy of this program because the students are often first tour young Sailors who come on two-year unaccompanied orders. By the time they make it into a course, pass it, schedule to take the NREMT, and pass to finally make it onto the watch bill, it can be nearly a year, and they are halfway through their tour! The demands of the course and the testing make the success rate around 70%, and some find that they are incompatible with the call of this specialized service.
Senior Chief Rachel Kerner, the Senior Enlisted Leader for the Directorate for Medical Services, explained how very important these newly trained EMTs are and their important role on the island. Kerner said, “The importance of having well-trained, well-prepared EMTs stationed strategically around the island means a couple of minutes, and those can be crucial to a positive outcome for our patients.” Senior Chief Kerner pointed out that the opportunity to serve as an EMT is not just for the Corpsmen assigned to the hospital, that there are currently EMT-trained staff with the Dental BN in the Laboratory and Family Medicine who can help cover shifts to maintain their skills and relieve other EMTs. She also stressed the unique opportunity to serve in this capacity overseas, and when she asks her EMTs before they PSC how they liked being an EMT, they usually say something very similar. “The hours were brutal, and the traumas were tough, but I would not have wanted to do anything else while I was here!”
The training is conducted in the Naval hospital, and one of the instructors is HM3 Nessa Zazi. You might mistake her youthful appearance and braces for a lack of experience and be very mistaken. She commanded her role as instructor and evaluator with the confidence and poise of a well-seasoned veteran of the ambulance rig. She was testing out a student, HM3 Jason Veloz, serving with the 3D Marine Division, conducting a complete mockup scenario of a semi-responsive patient on a scene to which he was called. It wasn’t lost in the moment that these two young Corpsmen were preparing to be the sole provider when those minutes count to evaluate and prep a patient for emergency transport. Zazi provided feedback after the role-playing exercise, during which each of them remained in character and walked through a very plausible patient encounter. HM3 Zazi said, “You need to expedite your evaluation and initial contact with the hospital Emergency Department; short, sweet, and to the point; if you are taking too long, you are holding up traffic!” Zazi also let Veloz know that she liked how he examined the patient even though a neighbor had provided their recollection of how the patient went down. HM3 Zazi’s parting advice, “You just have to complete the reps and sets before you can gain more confidence.”
LCDR Amanda Studer, an emergency medicine physician at USNHO, leads the Emergency Department (ED) in a modernization effort that affects the emergency care of all the beneficiaries of USNHO in Okinawa. While it is easy to navigate Okinawa as a foreigner, some of the simple things we have come to expect in the U.S. are not the same here; the first is 911. We teach kids to dial 911 in an emergency from a very young age. In Okinawa, it is still 911 on base, but off base it is 119. Like any complicated system, many caveats and exceptions can lead to confusion, especially in a stressful medical situation. Dr. Studer has worked tirelessly to make changes and upgrade the dispatch system, including overseeing the EMT training program. When talking about the Sailors who have stepped up to the call, Studer said, “These are our modern-day superheroes who show up for you during some of the worst days of your lives.” She explained how it builds confidence in our community to see the strives and improvements to the system. The upgrades are not just in the programs and phone numbers; Dr. Studer was instrumental in helping acquire additional ambulances from the Army in Korea. This massive undertaking involved the Marines, Airforce, Army, and the Navy to ship the vehicles here to Okinawa. Opening lines of communication with host nation EMS allows both services to learn from each other and share best practices for improving care for every patient on Okinawa. Under her watch, the program procured over $500,000 in critical lifesaving EMS equipment. She helped coordinate long overdue EMS site visits for both Navy/Marine Corps and Army services and has helped build the infrastructure for a modern, readily equipped EMS program.
The collaboration between Marine Corps Installation Pacific Command (MCIPAC), the host nation, sister services, and USNHO has provided the resources to help maintain medical care for the residents here in Okinawa. Our beneficiaries can be confident that a new group of well-trained EMTs will test out next Tuesday, and these modern-day heroes will be on the streets providing emergency medical care to those in need.
The U.S. Navy Medicine Readiness and Training Command Okinawa (USNMRTCO) supports the Defense Health Agency’s U.S. Naval Hospital, Okinawa (USNHO) as the largest OCONUS Navy Medicine medical treatment facility and stands at the ready to respond to contingency operations to support the INDOPACOM region. It is a critical regional asset for direct care delivery, regional referrals, and medical contingency operations. The staff of USNHO understands their vital role as pre-positioned, forward-deployed naval forces within the first island chain, aligned and in support of the joint military commands and operations.
Trey Savitz, Public Affairs Officer
U.S. Naval Hospital Okinawa, Japan
Comm: 011-81-971-7024
DSN: (315) 646-7024
isaac.s.savitz.civ@health.mil