Many moving parts go into producing and executing an exercise, and U.S. Air Force pararescuemen, or PJs, deployed in support of Combined Joint Task Force - Horn of Africa, or CJTF-HOA, put their skills to the test recently during a mass casualty exercise that began in Djibouti's Grand Bara Desert. Mass Casualty Exercise 12-1, a U.S. and French crisis response exercise held Sept. 25, 2012, allowed CJTF-HOA's PJ team to work alongside the French armed forces, as well as their U.S. sister services. "As rescue specialists, it's our job to be prepared for the worst situations possible," said a PJ assigned to the 82nd Expeditionary Rescue Squadron, or 82nd ERQS. "We use exercises like this to overwhelm the PJs' ability to treat patients, deal with a very chaotic situation, and push them to their limits. It's [also] important to work with our coalition partners and let each other see the tactics, techniques and procedures we each use." The PJs are trained for rescue efforts in many types of terrain, including but not limited to high altitude, open ocean, or over land. They are always postured for a real world alert and exercises are important so all moving parts can train together. The PJs preach "train like you fight," and this exercise was no exception, according to the PJ. At Grand Bara, where two simulated bus accidents occurred, exercise officials and participants had everything postured like it was a real-world situation. "It was a good way to posture a mass casualty exercise," the PJ said. "The objective was to overwhelm the ability to individually treat each patient, forcing them to prioritize who they treat with limited medical equipment and to sequence the order they [the victims] are transported to the next higher level of care." Following normal protocol, when the PJs arrived on scene, the combat rescue officer, or CRO, began to work the air flow and established communication with CJTF-HOA's joint operations center, or JOC, becoming the liaison between the accident site and the JOC. Next the CRO and PJ team leader developed a plan to collect all the patients, render life-saving treatments and work a detailed load plan. The plan designated which of the 40 U.S. and French exercise patients were transported first. Since a patient's medical condition may change, the plan had to be fluid. Due to the various medical conditions, many victims were litter-carried to one of the three helicopters that arrived to transport victims. Time played a major factor in each step of the scenario and each PJ had to react to each injury quickly and efficiently, only treating immediate life threatening injuries before moving on to the next patient, according to the PJ. The PJs and other first responders then transported the exercise victims to a temporary triage site at the French forces' Djibouti base, Djibouti, to be further assessed and to receive additional care. From the triage site the patients were taken to Camp Lemonnier's Expeditionary Medical Facility or the French Bouffard Military Hospital. Communication throughout the exercise was key, according to the PJ. "A lot of it is learning how to work together and learning to mesh capabilities so we don't have wasted time or resources," the PJ said. "Lives are in the balance and every second counts in a mass casualty situation. Communication between the team and anyone else we are working with needs to be clear and concise. This becomes critical when working with sister services, coalition partners like the French, and a command and control node like the JOC ... miscommunications puts lives at risk." The 82nd ERQS, currently deployed to Djibouti, is responsible for operations within eastern Africa, but they are postured to respond anywhere in Africa. Their constant training schedule, with sister services and coalition partners, contributes to their capability of carrying out the CJTF-HOA mission. "We're part of a joint personnel recovery task force at CJTF-HOA that is postured to go anywhere, at any time to live up to the motto â? 'That Others May Live,'" the PJ said. Staff Sergeant R.J. Biermann contributed to this article