Gator Hole

A Subterranean Exercise

By MAJ Orphelia Moraga

Article published on: February 1, 2026 in the 2026 E-Edition of Pulse of Army Medicine

Read Time: < 11 mins

Three soldiers in camouflage uniforms carry a fourth soldier on a military stretcher across a rugged, overgrown field.

History Repeats Itself

Underground warfare is neither a foreign nor a novel concept to military warfare. The United States Military experienced it during WWI with Trench Warfare and again during WWII in the Battle of Iwo Jima and the Battle of Okinawa. The United States forces also experienced underground warfare during the Korean War and Vietnam Wars. Subterranean warfare has remained a prominent and evolving feature in recent conflicts, including those involving the Islamic State of Iraq and Syria (ISIS), Hamas, and the Russo-Ukrainian Conflict.

Mission Objectives for Exercise Gator Hole

The goal of Exercise Gator Hole was to replicate real-world conditions in a LSCO environment by utilizing abandoned sites, subterranean facilities, and drone technology as highlighted in lessons learned from Ukraine.

The key objectives for this training exercise were:

1. Conduct a rehearsal of the deployment and redeployment requirements

2. Command and Control (C2) the deployment and redeployment of the 546 MC(AS)

3. Execute Role 2 Operations in an abandoned hard structured facility/subterranean facility

4. Conduct internal staging activities; Understand and Operate in LSCO environment

5. Perform prolonged care

6. Implement Role 2 TACSOP

7. Utilize Ukraine lessons learned to obtain a better understanding of a LSCO environment, including drone threat

8. Reduce exposure/detection through camouflage, dispersion, hardening, and reduction in electro-magnetic spectrum (EMS) emissions

9. Resupply CLVIII and/or blood products

10. Understand how to identify and report counter-unmanned aircraft systems (C-UAS)

11. Treat C-UAS injuries in Role 2

12. Consolidate After Action Report (AAR) comments

13. Complete the MC(AS) Mission Essential Task List (METL).

While this training was not intended to address every specific LSCO challenge, it provided an initial understanding of emerging complexities and ignited new ways of thinking about future LSCO and MDO-related obstacles. This type of subterranean exercise would be the first to stress the 61st MMB Role 2 capabilities through realistic LSCO conditions. This training validated the 546 MC(AS) Role 2 capability and demonstrated the ability to execute Role 2 operations underground.

MAJ Devin Jagow (62B) testing PFC Cooper Hicks (68W) and PFC Grant Ferguson’s (68W) knowledge and fortitude during the ‘power outage’ scenario! Picture taken by: MAJ Orphelia Moraga.

Mission Execution

Exercise Gator Hole began in an abandoned building. The building served as the first occupation site and was fully mission capable at 90 minutes. While at the abandoned building, a total of 18 patients were treated, and one mass casualty (MASCAL) event occurred. To create a quality realistic training environment, resources from Carl R. Darnall Army Medical Center (CRDAMC) and the Fort Hood Training Support Center (TSC) were utilized. Their medical manikins simulated real-life medical scenarios, which created a versatile learning experience. The manikins enabled realistic training opportunities, allowing participants to perform thorough medical assessments while receiving quality feedback from trained simulation technicians.

Role players were an integral part of the exercise as their presence created a more realistic atmosphere. Patient scenarios spanned the full range of Disease Non-Battle Injuries (DNBI) and trauma cases. Two real-world dental cases were identified and treated successfully during the exercise.

Patients were ground evacuated by the 546th MC(AS) evacuation platoon. The Field Litter Ambulances (FLAs) were positioned at two ambulance exchange points located 25 miles from the abandoned building. Counter-Unmanned Aircraft System assets were utilized throughout the AXPs. The objective was to expose the evacuation platoon to an introductory level of drone technology and understand the importance of reduction of exposure/detection through camouflage, dispersion, hardening, and EMS emissions. The feedback received from the C-UAS team was invaluable and highlighted areas of improvement for future training.

Eleven non-medical scenarios were executed to test further MC(AS) capabilities. The non-medical scenarios included vehicle maintenance, medical maintenance, supply request, and blood resupply. To meet the objective of CLVIII and blood product resupply by drone, the 546th MC(AS) initially requested a drone that could carry small-medium cargo; however, the specific type requested was unavailable. The 546th MC(AS) then resorted to blood resupply by ground using the 932nd Blood Detachment. The CL VIII resupply training involved pushing orders to Battalion and practicing the action of creating and placing subsequent orders. The tactical jump was conducted on the third day of the FTX, during which 546th MC(AS) jumped from the abandoned building to their second occupation site. The second site is a facility consisting of 1.2 miles of tunneling with 29 rooms of various sizes. While at the second training site, a total of 39 patients were treated, and two MASCALs occurred. The second site became fully mission capable at 90 minutes, and the difference in environment was evident.

C-UAS feedback regarding evacuation platoon. Picture taken by: Mr. Travis Baxter.

Lessons Learned

The success of the FTX was not without its challenges. The first challenge noted was one of communications. The 61st MMB Headquarters and Headquarters command served as the tactical command post, which put underground communication capabilities to the test between higher headquarters and 546 MC(AS). As expected, much of the communication equipment taken to the field was inoperable underground. Therefore, the Company Command Post (CP) was set up outside in an abandoned garage. The relocation improved signal; however, overall communication with the TOC kit was subpar throughout the exercise. Therefore, the Primary Alternate Contingency Emergency (PACE) plan played an integral role throughout the exercise. Command and control (C2) inside the tunnel was another friction point. Since communications inside the tunnel were inoperable, runners were implemented to enable accurate communication. The runners were essential in supporting communication between the tunnel site and the CP.

In addition, electrical outlets were scarce. Therefore, packing extra extension cords improved power distribution and electrical access throughout the area. Another shortfall was the number of available role players. An additional 10 role players would have granted access to more patients to receive full assessment of prolonged care. Patient flow was satisfactory, but there were challenges. The distance from the tunnel entrance to the triage area was an estimated quarter mile walk; therefore, the employment of industrial carts were key in patient transport to the ambulance from the triage area within the tunnel. The carts were highly effective, but more were needed, especially during MASCALs. Patient triage was initially planned to occur inside the abandoned garage; however, due to spatial limitations, most triage was done next to the ambulances. All triage was completed within two to five minutes, depending on the patient scenario. In future exercises, the initial triage should be conducted at the entrance of the tunnel to maintain proper cover and concealment.

Regarding the reduction of EMS objectives, the Intelligence, Surveillance, and Reconnaissance (ISR) drone, requested to assess EMS conditions across the occupied sites, was unavailable. As a result, the unit was required to rely on strict EMS discipline throughout the exercise. Because the training site is located in a “No Fly Zone,” the drone technology objectives were only tested at Training areas site 1 and 2. The exercise did not include a “react to contact” scenario outside the CP nor at the AXPs; however, more emphasis placed on battle drills would have strengthened overall readiness. The primary focus of the exercise was Role 2 operations in a LSCO environment; however incorporating battle drills future exercises would be beneficial. Although the exercise was conducted at a pre-established underground tunneling site, such facilities are not likely to be available in an actual LSCO scenario. Tunnels or underground facilities will have to be rapidly constructed during LSCO. Exercise Gator Hole introduced our unit to subterranean Role 2 operations, creating a foundation for future training exercises to build upon the lessons learned.

MAJ Torrance Nevels (65D) teaching PFC Cooper Hicks (68W), SPC Marshall Tucker (68W), and SPC William Beisel (68W-36th ENG) valuable assessment techniques under pressure! Picture taken by: MAJ Orphelia Moraga.

Shaping Future Exercises

At the conclusion of the exercise, 546th MC(AS) successfully completed their first LSCO-based FTX, leading to an overall increase in Mission Essential Tasks (METs) proficiency conducted in a simulated LSCO environment. The commander’s intent was met through the execution of expeditionary deployment operations with successful movement of troops and equipment. Fifty-two Soldiers were trained through 57 patient scenarios, and 22 medical skills were performed/practiced. Exercise Gator Hole created a foundation for future LSCO-based training by enabling a unique training event that fostered a productive learning environment and helped to broaden knowledge across other medical formations. The 546th MC(AS) was honored to be at the forefront of this innovative training that will help shape future exercises and Army medicine.