Background: Multiple casualty incidents have become commonplace in areas of conflict. High-fidelity simulation is often used to prepare medical providers for such events. Operation Bushmaster is a simulated field exercise for students at the Uniformed Services University in preparation for a career in military medicine. Current literature has shown that deployed healthcare providers routinely exposed to death are more likely to experience impaired mental health. Studies have also found that novice learners are vulnerable to acute stressors following the unexpected loss of a patient. These are intensified when the patient is a child. The aim of our study is to understand the experience of medical students involved in the care of a simulated pediatric death during a multiple casualty combat exercise. Methods: Five medical and nurse practitioner students, directly involved in the pediatric case, were enrolled in this study. A focus group was used for data collection with the students providing rich descriptions of their perceptions and experiences. Thematic analysis, following Braun and Clarke’s six-phase analytical process, was used to analyze the audio transcripts. Results: Five major themes were identified. These themes were (1) simulation: impactful training; (2) patient volume: forced to move on; (3) debrief: necessary for closure; (4) death: pediatric death is more difficult; (5) underprepared: inadequate medical knowledge. Simulation provided an opportunity for students to take primary responsibility for complex polytrauma patients in a controlled environment. The constant flow of critically injured combat casualties was overwhelming. It forced students to move to the next patient, which delayed emotional processing and impacted future patient care. Students felt a comprehensive debrief was necessary to provide closure after patient death. The pediatric trauma evoked negative emotions, added unanticipated emotional stressors, and revealed significant knowledge gaps in pediatric resuscitation. Students felt they needed a dedicated debrief of the pediatric trauma case due to the unexpected nature of pediatric death in a combat environment. Conclusion: Deaths on the battlefield are high-stress events for all medical providers, especially for trainees. This study demonstrated that this stress was compounded in the setting of pediatric trauma. Specifically, learners described feeling unprepared for multi-traumas, expressed difficulty coping with pediatric demise, and experienced a lack of closure in the setting of inadequate debriefing by faculty. Senior medical providers should be aware of the impacts of unexpected death on trainees and provide a thorough and timely debrief for all patient deaths in addition to resources for coping with patient death. “The opinions and assertions expressed herein are those of the author(s) and do not reflect the official policy or position of the Uniformed Services University of the Health Sciences or the Department of Defense.”