Two enlisted Marines are kneeling on the ground, quickly stuffing gauze into a gaping wound in a pig's belly to stop the bleeding. Another is doing a "blood sweep" to find other wounds.
An officer, just inches from its snout, monitors its breathing and keeps the pig's thick tongue from blocking the airway. At the other end of the 150-pound swine, a Marine corporal has inserted a thermometer into its anus.
"Come on, buddy, stay with us," Capt. Doug Verblaauw whispers to the heavily sedated pig, dubbed Gen. Dude.
Gen. Dude will not survive the day. Nor will the other 19 pigs used in last week's "live-tissue" training for 28 Marines and a dozen Navy doctors. The carcasses were sent to a rendering plant.
But the Marines had the experience of pushing intestines back into living bodies, applying tourniquets and heat packs to gushing wounds, clearing tongues and other obstructions from airways, and working under pressure when time is blood and indecision is death.
Camp Pendleton has used pigs in the training of Navy corpsmen and infantry Marines since 2006. But the training takes on new significance as the U.S. focus shifts from Iraq to Afghanistan.
In Iraq, the U.S. has a highly developed system of transporting casualties from the battlefield to medical stations by vehicles or helicopter. In Afghanistan, the distances are vast, roads are minimal and helicopters are often not readily available.
The waiting time to evacuate a wounded Marine is often much longer than in Iraq. The result is that more frontline troops need to be trained to treat traumatic wounds.
Under a $1-million contract with Deployment Medicine International, based in Gig Harbor, Wash., 1,300 Marines and sailors at Camp Pendleton will receive trauma training this fiscal year, including with pigs.
The company, whose instructors are combat veterans, also trains Army soldiers, Navy SEALs and other U.S. troops. It has annual contracts worth $6.5 million and $10 million, and uses about 2,900 pigs a year. Other companies provide similar training.
The use of the pigs is strongly opposed by animal-rights groups as cruel. Nine members of Congress sent a letter to the Army in June asking that the program be stopped.
But Marine brass said they believe that the pigs provide an invaluable conclusion to a program that also uses classroom lectures, mannequins and computerized simulators.
"You can't quantify it, but we firmly believe that this training saves lives," said Navy Cmdr. Bryan Schumacher, the top doctor for the 1st Marine Division. "You can't replicate living tissue."
Working on a living creature, even a barnyard animal, carries an emotional impact. "You just don't have that visceral feeling when you're dealing with a simulator," Schumacher said.
Marines are told to regard the pigs as wounded comrades. "We are treating these casualties as we would a downed war fighter, a buddy, with respect and consideration," an instructor tells them.
Marines are encouraged to give their pig a name.
"Ours is Pvt. Ryan," said Cpl. J. Crane, "he's definitely worth saving."
The pigs are 2 to 3 months old and range from 140 to 200 pounds. Stretched out, they can reach five feet from snout to hoof. Each costs about $1,000.
Before the training begins, they are sedated. Veterinary technicians monitor the pigs to make sure they remain asleep. Instructors insist the animals feel no pain.
Using scalpels, instructors inflict increasingly serious wounds on the pigs and watch as the Marines scramble to keep their pigs from dying. In the final exercise, the pigs are shot in ways that approximate the injuries that a Marine might suffer, some of the shots severing limbs.
The part of the trauma course using pigs occurs after three days of lectures and simulations at the base. It used to be held at the Escondido police training facility but was moved to avoid controversy.
Now it's held on an avocado ranch in northeastern San Diego County owned by a retired Marine who is also an Escondido police officer.
"I'm not a public entity, I don't care about political pressure," said Dave Bishop, the owner. "They can protest outside my gate all they want."
To view the training exercise, the media had to agree not to photograph the pigs or use the full names of instructors. The lead instructor, known as Kato, has combat experience in Vietnam, Iraq and Afghanistan.
"We've got to move, we've got to move," Kato barks. "We've got to get these guys to the [landing zone]. The helo is coming in and they're not going to wait."
For three days, he drilled the Marines with Kato's Rules, starting with rule No. 1: The main cause of death on the battlefield is massive bleeding, and many of those deaths are preventable with quick response. Another rule: If one tourniquet is good, two are better. And yet another: Constantly reassess your patient, check his breathing, never give up.
"This is kind of the shock-and-awe treatment," said Corpsman Mark Litz, 27, who took the course three years ago and gave mouth-to-mouth resuscitation to his pig, named Chester after legendary Marine Lewis "Chesty" Puller.
"A lot of these guys have never really seen blood and could freeze up the first time they do," Litz said. "What good is a Marine or corpsman who's frozen up in combat?"
With Gen. Dude bleeding profusely, Pfc. Paul Lopez put his hands on the animal's nether region to find the femoral artery and press down firmly.
The femoral artery is a common injury spot from roadside bombs because the blast comes beneath the vehicle and the artery is not protected by the Marine's vest.
"I got it done," said the 20-year-old Lopez. "I did what you have to do."