BARNES AIR NATIONAL GUARD BASE, Mass. — The 104th Fighter Wing strengthened its ability to respond to battlefield casualties Aug. 18-23 by bringing Airmen from across the region together for its first simultaneous Tier 2 and Tier 3 Tactical Combat Casualty Care (TCCC) training.
Participants included medical personnel from the 104th Fighter Wing, 157th Air Refueling Wing and 158th Fighter Wing, as well as explosive ordnance disposal Airmen from the 104th Fighter Wing.
The Department of War’s standard for battlefield trauma response prepares Airmen to provide lifesaving care in unpredictable environments. Tier 2 focuses on foundational trauma skills, while Tier 3 expands into advanced, scenario-driven care under fire.
“Working with Tier 2 and Tier 3 is really important because your Tier 2 is a deployment requirement,” said U.S. Air Force Tech. Sgt. Cassandra Wachowiak, a Tier 2 instructor from the 157th Air Refueling Wing Medical Group. “Everybody going downrange should have the ability to do basic things like your tourniquets and wound packing while your Tier 3 is a little bit more advanced. [Tier 3 medics] can [perform tasks] such as cranks, intravenous (IVs) and intraosseous (IO) access lines. Being able to utilize the individuals that can do certain skills so [the medics] can focus on major life saving techniques gives the patient a better chance of survival.”
Hosting both tiers concurrently allowed instructors to synchronize curriculum, streamline resources and build a more cohesive medical response force.
“The goal is to make sure that our people are ready to do their job in the worst-case scenario, and that we can bring as many people home alive,” said U.S. Air Force Tech. Sgt. Tim Ramos, TCCC program manager for the 104th Fighter Wing Medical Group. “We don’t deploy just with our unit; we deploy with other units, and we want to bring everyone home. So, military wide, we want to bring our [service members back safely] in through unit readiness”
Throughout the week, students trained in Medical Group classrooms and followed a demanding schedule that included classroom instruction, trauma lanes and physically intensive tasks such as litter carries, mannequin drags and simulated casualty movement.
Airmen said the combined training environment strengthened teamwork and broadened their understanding of the mission as medical personnel, Explosive Ordnance Disposal (EOD) specialists and Airmen from different states worked side by side.
“I rely on my Tier 2s, because it’s a whole new learning environment,” said U.S. Air Force Staff Sgt. Gillian Gosselin, a Tier 3 student from the 157th Air Refueling Wing Medical Group. “I ask myself, ‘What can you do and what can’t you do?’ And they have to kind of pull me back to Earth.”
The training culminated in a high-intensity exercise requiring students to apply their skills in scenarios designed to replicate combat conditions.
“[EOD] has some of this medical training, but going through the training to this extent is super valuable for us,” said U.S. Air Force Tech. Sgt. Randy Burlingame, a Tier 2 student with the 104th Fighter Wing EOD flight. “Some guys are having to do these skills in the real world, so being able to practice and run through all the motions in a simulated environment is going to be very helpful for us.”
Instructors evaluated students on communication, coordination, medical proficiency and their ability to maintain composure under pressure.
“If we can stress them out to where they can fail, when they get downrange or are put in that environment, they will be able to react and know that they can do this,” Ramos said.
For the 104th Fighter Wing, hosting dual-tier training reflects a broader commitment to strengthening medical capability and ensuring Airmen are prepared for the demands of modern operations. It also provided participants with an opportunity to work in a combined environment alongside personnel with varying levels of medical training and different skill sets.
“[Integrating] adds another level of training, but I think it also adds a level of understanding on how we all actually integrate and work together,” said U.S. Air Force Chief Master Sgt. Timothy Mutti, senior enlisted leader for the 104th Fighter Wing Medical Group.
Mutti emphasized the importance of continued collaboration and recurring training opportunities to enhance medical readiness across the region, teach Airmen to operate outside their traditional duties and improve their ability to work together during missions.
“Multi-capable Airmen, or next-level Airmen, are tasked to do things outside of what we would think our scope is,” Mutti said. “At the end of the day, we’re all here to do the job and take care of each other, and this [training] highlights that, allows us to actually see [the results], and then utilize it.”
By hosting Tier 2 and Tier 3 TCCC training concurrently and integrating both tiers into a combined exercise, the 104th Fighter Wing strengthened its medical readiness, expanded regional capability and better prepared Airmen to deliver lifesaving care in any environment.