Constantly on high alert, and not knowing when or where an attack might occur, serving in a deployed environment can test even the most experienced airmen. For 16 members of the 446th Aeromedical Staging Squadron, a recent deployment to Afghanistan was anything but routine.

Shortly after arriving at Craig Joint Theater Hospital at Bagram Airfield, Afghanistan, in mid-October 2016, citizen airmen of the 446th ASTS participated in a mass casualty exercise to help prepare them for what they might encounter during their deployment.

"The mass casualty exercises are good because it keeps us familiarized with our equipment and roles," said Senior Airman Paul Whatley, an aerospace medical technician assigned to the 446th ASTS. "It also helps with working with other branches of service in building that trust of working together."

The exercise occurred at the beginning of a new rotation of deployed medics. The purpose of this type of drill is to create a realistic scenario of an incident that may occur during a deployment to prepare each team in handling their roles.

But what they couldn't prepare for was putting those skills to the test less than two weeks later.

"I was heading to a base ‘fun-run' for Veterans Day," said Whatley. "I was running late for the run and when I arrived where the run was supposed to start, all I saw was chaos. As soon as I saw the casualties I ran back to the hospital to get ready to work."

On Nov. 12, 2016, a suicide bomber had penetrated the defenses of Bagram Airfield and blew himself up, killing four people and wounding 17 others.

"You have to be flexible, things always change in a deployed environment," said Capt. Christopher Hamel, a 446th ASTS clinical nurse and serving his fourth deployment. "Most of us in the ASTS are in the medical field outside of the Reserves. We all had to step up and fill in wherever we could."

For some, it was their first deployment and an eye-opening experience.

"It was my first deployment and one of the roles I really wasn't prepared for was providing hospital security," said Staff Sgt. Taleesha Thomas, an aerospace medical technician assigned to the 446th ASTS. "I had my rifle and body armor, but there was a lot of uncertainty. We didn't know what was happening with the attack."

After the casualties were treated, the Rainier Wing ASTS members then had to prepare them for aeromedical evacuations out of Bagram.

"After the patients were stable, a lot of the hospital staff left to go rest," said Hamel. "We had to stay behind and step back into our roles as the ASTS. Most of us ended up working more than thirty hours straight."

While no training can simulate the real thing, it works toward enabling a team to work together.

"Any mass casualty incident is hard to prepare for," said Thomas. "There was a lot of chaos at the hospital during the attack, but we were also well organized."

The 446th ASTS is constantly training at home to provide the best care for patients in a deployed environment, moving them between medical facilities on the ground and aeromedical evacuation flights.

"Our mission is to ensure that every patient that comes through our hands is cared for at the highest level -- medically, physically, professionally and mentally," said Tech Sgt. Tamie Zabroski, an aerospace medical technician assigned to the 446th ASTS. "Then we assist them in getting evacuated through the aeromedical evacuation system to the next higher level of care. We don't treat just the "wounds" but the whole person. We want to ensure that the patient is returned to duty as quickly as possible so that he or she can continue in their mission."