Command Sgt. Major John Wayne Troxell, senior enlisted advisor to the Chairman of the Joint Chiefs of Staff and the senior non-commissioned officer in the U.S. Armed Forces, observes Army Combat Medic Training trainees conduct an exercise in the Combat Trauma Patient Simulator constructed to resemble a Middle Eastern marketplace in the aftermath of an explosion set off by a suicide bomber. The “casualties,” which are life-like manikins called human patient simulators, appear to have received several traumatic injuries including amputations and gunshot wounds. The combat medic trainees assess the injuries and take actions to treat them while sirens blare, the room fills with smoke, and the lights are dimmed.