"Medics showed up from all different units. They heard what had happened, put on gloves and went to work."
--Margaret Tippy
In response to the 911 alert of the accident at Pope Air Force Base Maj. C. Craig Corey, MC, the emergency medicine department chief at Womack, activated Code Yellow, the mass casualty (MASCAL) plan. Assuming the worst scenario, he called additional emergency room physicians, nurses, and medical technicians into the hospital. At the same time, a member of his staff alerted the hospital chaplains and the anesthesia, surgery, respiratory, radiology, and nursing departments. Each department activated its own MASCAL plan. Corey's staff then cleared the emergency room of patients not warranting immediate attention, made someone responsible for logging in the MASCAL patients, brought stretchers into the emergency room, and retrieved MASCAL carts from storage in the decontamination shower room. Corey was known as an excellent emergency room physician, capable of performing at high levels under stress. By 1425 the magnitude of the accident was apparent as the first group of casualties arrived in a potpourri of tactical and personal vehicles. [1]
The first victims to enter the emergency room were two food vendors with minor burns. Corey steered them to the outpatient clinic. The next patient arrived on a plywood stretcher. He had a leg amputated and a tourniquet held in place by a crowbar. He was conscious and alert, and Corey directed him to the trauma area. Another soldier suffered burns on 100 percent of his body. Emergency room staff cared for him, while hospital administrators arranged for the victim's transfer to a regional burn facility.[2]
Outside the emergency room, vehicles with casualties on board arrived in great numbers. A 2.5-ton truck held as many as ten victims, thrown into the back in a "scoop and run method," one patient on top of another. A 5-ton truck and Humvees had injured soldiers "on backboards across the radio hump." Burns covered 80 to 90 percent of their bodies. Some had head injuries, bone fractures, and shrapnel wounds.[3]
Maj. Patricia D. Horoho, the competent chief nurse of the emergency room, and other hospi- tal staff ran out to meet the casualties. "We tried to reassure . . . [them] and asked them to hold on," recalled Horoho. Because the emergency room could not hold the great numbers of casualties, its staff, now augmented by anesthesia personnel, surgeons, nurses, family medicine physicians, pharmacists, and medics, began triaging in the driveway, a place designated in MASCAL strategy as a triage area. The sunny day and mild weather made it possible to examine the victims outside.
Physicians pronounced dead two who had suffered cardiac arrest and escorted three who were ambulatory to the outpatient clinic. As medical personnel began treating the severely injured, Major Horoho remembered: "Right after about the third scream, this hush just kind of came across the whole area and people just were clicking and doing exactly what they needed to do." An Army requirement for two exercises each year of the MASCAL plan was paying off.[4]
The triage area spilled over into an oval of grass, about 80 feet by 150 feet, situated inside a horseshoe drive that ran up to and away from the emergency room. Within half an hour every inch of lawn was covered with injured soldiers from Pope Air Force Base. Casualties lay on plastic sheets, procured from the hospital, or on temporary litter stands. Sterile covers protected the burned paratroopers, who accounted for most of the victims. Medical staff applied saline solution to burns and gave intravenous (IV) fluids to prevent shock. Volunteer soldiers held sheets tied together to form a perimeter around the oval and protect the patients' privacy from the reporters, who had begun to gather across the street from the hospital.
According to Margaret Tippy, Womack's public affairs officer, the soldiers "were willing to stand there for hours on end if that's what they needed to do."[5]
Inside the hospital, patients filled the twenty-two emergency room beds. People lay on stretchers on the floor between the beds and on every space available in the waiting room and the hallway outside the emergency room.[6]
To coordinate the medical response, Col. William E. Eggebroten, MC, acting commander of Womack Army Medical Center at the time of the accident, but normally chief of Colonel Eggebroten the surgery department, established an emergency operations center (EOC) in the Emerson Room on the first floor of the hospital and directed activities until Col. Harold L. Timboe, MC, the commander, returned from temporary duty at Fort Sam Houston, San Antonio, Texas, late in the evening of the twenty-third. Colonel Eggebroten was the point of contact for the hospital and arranged help from regional medical facilities. He notified the Cape Fear Valley Medical Center, the Highsmith-Rainey Memorial Hospital, and the Veterans Administration Hospital, all in Fayetteville, of the crash. He also contacted the burn centers at the University of North Carolina in Chapel Hill and at Duke University Medical Center in Durham, as well as the Army burn unit colocated at Brooke Army Medical Center in San Antonio. Col. Jerry Palmer, MC, the commander of the 55th Medical Group, 44th Medical Brigade, worked at Womack with the hospital EOC to coordinate the support of other military medical units. Representatives of the 32d Medical Battalion (Logistical)(Forward) also maintained a communications cell in the same room. Colonel Eggebroten kept in touch with other operations centers established on base for the emergency.[7]
About 1445 Captain Rich walked into the hospital. "The bulk of the critically injured had arrived and flooded the emergency room," he remembered, while "medical personnel were running around everywhere." Considering his injuries to be minor, he helped to prepare IV solutions in anticipation of more casualties. After several medevac I aircraft landed with no injured on I board, he walked to the front of the hospital to have his foot examined. En route to the examining room, Rich telephoned his wife to let her know that he was all right. An X-ray revealed that his foot was not broken but was badly bruised. His boot had absorbed the bulk of the impact.[8]
To care for the injured, Colonel Eggebroten had assigned each treatment team an emergency room physician, one or two nurses, two medical technicians, and sometimes a physician's assistant. According to MASCAL planning, "each team was responsible for resuscitating two patients, performing lifesaving procedures, starting two intravenous lines, inserting Foley [urinary] catheters, giving morphine . . . [and] antibiotics and dressing burns." Often team members had not worked together before or had never worked in an emergency room. But "all had done [the] basics like Foleys and IVs, and they were just told what basics needed to be done," said Major Corey. The timing of the accident, near the change of shift for Womack, meant that the hospital was doublestaffed Extra hands increased team energy, which the emergency room chief called "an incredible come together effort" that he doubted "could be reproduced." Eggebroten's Gulf War experience as commander of a combat support hospital, which cared for fifty to sixty casualties simultaneously, and his calm in the midst of chaos undoubtedly helped him to respond effectively to the Pope Air Force Base tragedy.[9]
Maj. Dawn Light, MC, a family practice physician, was asked to help triage victims on the lawn. She had taught the advanced trauma life support course for the Joint Readiness Training Command, but had never experienced a mass casualty. Light tried to sort the worst cases from the minor. She looked first for facial injuries and then for troubled breathing. She gave trauma casualties cervical collars to provide support and called on anesthesia specialists to manage airways. Because burns cause lung damage and throat injury, intubation became necessary on more than thirty patients. Most of the injured needed some form of burn care. Major Light was grateful that the accident had happened in the midafternoon, when there was plenty of daylight. She also was thankful for the many helpers who "made things easier." Light triaged about sixty patients, staying until all the casualties were stabilized and transported to the next level of care. She then went to the surgical intensive care unit and helped manage the most critical patients through the night.[10]
In response to the emergency "medics showed up from all different units," which greatly enhanced patient care. Margaret Tippy recalled "They heard what had happened, put on gloves and went to work." Fort Bragg's 44th Medical Brigade, commanded by Brig. Gen. James Peake, MC, who was also the XVIII Airborne Corps surgeon, came out in full force, sending the staff of its on-site 28th Combat Support Hospital and 5th Surgical Hospital (Mobile Army) to help. Brigade and battalion surgeons of the 82d Airborne Division volunteered their services, as did the medical personnel of all troop medical clinics, which had closed down for the emergency. Special Forces medics, who were trained to operate independently in smaller operations, assisted treatment teams by starting central lines and intubating patients. Also treating casualties were medics from Fort Bragg's Joint Special Operations Command, located on Pope Air Force Base; those from Pope's surgeon's office; and those from Seymour Johnson Air Force Base hospital. Even Army nursing students took off their student tags and started helping. The teamwork was a testament to General Peake's One AMEDD (Army Medical Department) Team, consisting of field and Womack personnel who trained together, and his resource sharing committee, made up of representatives from all medical units on Fort Bragg and chaired by Col. Stephen L. Jones, MC, Womack's deputy commander for clinical services, which met monthly to discuss Fort Bragg's medical needs and assets. About 300 volunteers made their way to Womack to offer assistance.[11]
"Everybody was doing what they're trained to do in a wartime situation," said Maj or Corey, "which is to be a resuscitative physician basically." The situation was chaotic. But it was controlled chaos. Major Horoho remembered:
People just worked together and everybody saw the seriousness of it. It was probably the most wonderful feeling in the world . . . to know that people responded the way they needed to without ever having been told to. Nobody argued; nobody cared if someone ranked who; nobody cared what your MOS was or whatever. There wasn't a job too small or too little for everybody there.
However, key medical personnel were difficult to identify, and having them wear color-coded vests or hats to mark their position and specialty during the mass casualty would have helped.[12]
Teamwork notwithstanding, the absence of two-way radios in the triage or emergency room areas made communicating with other parts of the hospital difficult. To offset this handicap, supervisors, including Colonel Eggebroten, Lt. Col. George W. Weightman, MC, the assistant deputy commander for clinical services, and Col. Linda Freeman, the nurs~ng department chief, visited the emergency room often. EOC and pharmacy personnel were stationed in the emergency area as well. Emergency room staff relied on verbal contact to obtain supplies or to let the operating rooms or intensive care units know that patients were on the way to them. Later, an after-action report pointed out that a radio system compatible with air and ground ambulances used at Fort Bragg would have helped.[13]
Despite the lack of radios, supplies for the most part were plentiful and arnved within minutes of the initial request. The pharmacy also stationed teams in intensive care units, operating rooms, and wards. The teams "anticipated the requirements for medications, preparing them in advance so they would be immediately available." After Major Corey told the pharmacy that he needed a few items, morphine came "in a bucketful" and IV equipment and Foley catheters "by the truckload within 15 minutes." S. Sgt. Benjamin R. Waring, in charge of Troop Medical Clinic No. 9 of the 82d Airborne Division, backed his truck up to the "supply room and anything that was burn or trauma-related went into the back of the truck." Volunteers unloaded the trucks. As remembered by Major Corey "Nobody said it is not my job.... Everyone pitched in.... We were just getting equipment left and right for what was going on. It was incredible."[14]
Nevertheless, "searching and finding" occurred for vital supplies, such as thoracotomy trays and debridement sets, which were not easily accessible or properly labeled. The availability of these supplies would have lessened the confusion in the emergency room, according to Maj. William H. H. Chapman III, MC, the highly competent chief of general surgery who oversaw triage in the emergency room. Medical logistics shifted approximately $37,000 worth of medical supplies from the warehouse to the hospital in response to the accident.[15]
The triage and emergency room areas were cleared of patients within two hours, a testament to teamwork in getting casualties admitted to the next level of care. During those two hours the hospital initially treated and admitted forty-five casualties; transported burned and traumatized patients to operating rooms; moved burned but not traumatized soldiers to intensive care units; sent moderately injured persons to Ward 6A, Ward 9A, and the ambulatory surgery unit; and triaged minimally injured patients to orthopedic, surgical, and outpatient clinics for treatment.[16]
Triaging went well considering the numbers, but the large volume of patients slowed down the process of selecting people for air evacuation to burn centers or for retention at Womack for further stabilization. As a result, the departure of severely burned patients to the University of North Carolina's Jaycee Burn Center at Chapel Hill was delayed. This did not delay treatment, however, as each casualty was followed closely by a team of physicians, nurses, and medical technicians.[17]
Nonemergency room providers prepared to receive and treat casualties as well. In organizing the response to the accident, Colonel Eggebroten placed a physician in charge of each critical area--a surgeon became the ward doctor for each intensive care unit, the ward doctor for minor burns, and so forth. When numbers of general surgeons proved insufficient to staff all critical areas, he appointed nonsurgical physicians to assist. These doctors became points of contact for receiving information on the status of patients, bed space, nursing issues, and other concerns, which were normally the responsibility of the nursing department. Colonel Eggebroten assigned Major Chapman the task of selecting patients for surgery and coordinating the procedure with the operating rooms. He and another floating surgeon, the on-call general surgeon, Maj. Kim Marley, MC, oversaw resuscitations, intubations, surgical procedures, and movement of patients to the next level of care. Colonels Eggebroten, Weightman, and Freeman supervised the hospital's response by making rounds through the critical care areas. Colonel Freeman, who had served in Honduras and the Persian Gulf, provided a calming influence.[18]
After learning of the accident, Womack surgeons completed four ongoing operations within fifteen minutes and canceled scheduled operations not yet started. As a result, four operating tables were available by 1430, and all operating rooms were ready by 1500. At the time of the accident the 28th Combat Support Hospital was setting up in the parking lot next to Womack to provide overflow operating room space because Womack's operating rooms were being renovated. Hence, combat support hospital staff, who routinely rotated through Womack and knew the procedures, were available to assist in the operating rooms. Only a few casualties required immediate surgery, and they were quickly and easily handled. To manage all who would need surgery later, Major Chapman opened additional operating rooms on the labor and delivery wards. During the night and into the next morning surgeons performed thirty-eight procedures on sixteen patients in the operating rooms and more surgery on thirteen patients in the wards.[19]
Immediately after the declaration of Code Yellow, Womack's inpatient wards prepared to receive casualties as well. Ward staff discharged or transferred patients to make room for the accident victims. A heart patient was moved to the Duke University Medical Center. The surgi- cal intensive care unit increased its bed capacity from four to eleven beds, and the medical intensive care unit prepared to receive eleven patients on ventilators and another ten in its stepdown unit, usually reserved for patients removed from medical intensive care. The ambulatory surgical unit became the recovery room. The staff organized Ward 6A to care for thirty burn patients and Ward 9A to treat another twenty. Maximum staffing (the result of a change in shift forty-five minutes before the accident), volunteer staff from other medical units, and borrowed equipment (monitors, pulse oximeters, and ventilators) Burned hands with Silvadene from the 44th Medical Brigade all made it possible to convert wards into temporary intensive care units.[20]
Intensive care units provided continuous reevaluation and additional care. Approximately forty casualties were intubated and placed on ventilators at some time during their treatment to assist breathing. Because twenty-eight patients needed ventilation simultaneously, the hospital obtained additional ventilators from the 28th Combat Support and 5th Surgical Hospitals. The staff gave all casualties IV flu~ds and medication. Most patients also received initial burn treatment, that is, applications of ice, saline, and Silvadene to burned areas, followed by escharotomy "surgical incisions of circumferential burns required to restore blood flow to the involved limbs." Competent staff, with limited burn training, did an adequate job under difficult circumstances, reported Army burn teams later sent to Womack.[21]
Casualties were being triaged to intensive care units within ten minutes of the accident. Following his examination in the emergency room, Capt. James Mingus of the 2d Battalion, 505th Infantry, was directed to the second floor intensive care unit. To treat his burns, the staff cut away the dead skin and put the initial bandages on [his] hands and face and the back of [his] head." After receiving pain medication, he was assigned to a room on the ninth floor. Mingus remained there for two days before being moved to the sixth floor, where the hosp~tal was consolidating the remaining patients not transferred to other hospitals.
Other patients had similar experiences. Captain Walters remembered being escorted from the emergency room to the second floor ~ntens~ve care unit, where the staff set his burned hands in a washbas~n w~th sal~ne and ice and placed some cold compacts on the back of his burned neck. He received pain medication and was admitted to the ninth floor ward. Later that night-around 2100-he had an escharotomy done on his left hand. He remained at Womack until 30 March, when he was transferred to the Army burn unit in San Antonio.
Private Fletcher, who had been soaked with fuel oil and suffered burns over 35 percent of his body, was able to walk from the Humvee into the recovery room, from where he was sent to the second floor intensive care unit. He immediately received an IV and medication but soon fell unconscious. The staff moved him to Ward 9A, placed him on a ventilator, keated his injuries, and stabilized him for a flight the following day (24 March) to San Antonio.[24]
Sergeant Naeyaert remembered mass confusion at Womack, but fell unconscious immediately after receiving an IV He was transferred to the Cape Fear Valley Medical Center, where his broken ankle was set and his ruptured spleen taken out to help heal internal injuries. Because of his burned hands and back, he was moved to the Jaycee Burn Center at Chapel Hill. He stayed there for five days going in and out of consciousness, before being evacuated to the Army burn unit.[25]
By 2200 Womack Arrny Medical Center had provided initial management to all of the accident victims. The 9 killed at the site and the 2 who died en route to the hospital were taken to the morgue. The hospi-tal treated and released 51 casualties, their follow-up care to be on an outpatient basis, and admitted 55--25 to intensive care units and 30 to inpatient wards. Another 13 casualties were transferred to regional hos-pitals 7 to the Jaycee Burn Center, 5 to Cape Fear Valley Medical Center, and 1 to Highsmith-Rainey Memorial Hospital. The Green Ramp disaster had produced 130 casualties.[26]
Hospital personnel realized that even their best efforts could not save some patients. At Womack one died about thirty minutes after the accident. Another death occurred at the hospital about twelve hours later. By 26 March the Green Ramp disaster had claimed 10 more lives, 5 at Womack and 5 at Jaycee, for a total of 23 dead. This total would increase to 24 ten months later (see Appendix), when the last victim passed away.[27]
Major Chapman, who wanted the best care possible for his patients, believed that the initial management of casualties could have been coordinated better. As in any MASCAL, patient overload caused "general chaos," and each ward chief had his own plan for dealing with casualties, making it initially "difficult to get everyone working from the same sheet of music." After a shaky start, however, patient management by physicians not trained in trauma or burn care "was excellent," declared Chapman. They generally paid attention to detail, performed necessary resuscitations, and changed plans after consultation with more experienced staff. Chapman suggested that for future emergencies a single person be placed in charge from the outset to implement the MASCAL plan with the department chiefs, who then would distribute the scheme to the staff within their wards.[28]
At the time of the accident a burn team from the Army burn unit, the U.S. Army Institute of Surgical Research (USAISR), was in North Carolina preparing to move a marine, injured in a gasoline explosion at Camp Lejeune, from the Jaycee Burn Center to the USAISR burn unit. A UH-60 medevac helicopter from the 57th Medical Company (Air Ambulance) flew up to Chapel Hill and brought back the four-member burn team, arriving at Womack at 1930 on 23 March. The general surgeon on the team joined the Womack surgeons as they evaluated and prepared the Green Ramp casualties for transfer to other facilities. A second USAISR burn team, with additional physicians, nurses, and respiratory therapists, arrived from Fort Sam Houston at 2315. This team brought the cardiac monitors, ventilators, IV infusion pumps, and other equipment needed to transport the casualties to San Antonio. Womack's commander, Colonel Timboe, who was at Fort Sam Houston when he learned of the accident, accompanied the burn team to Fort Bragg.29
Following a briefing by Colonel Timboe, the USAISR burn teams evaluated the fifty-five casualties admitted to Womack for the purpose of selecting the most severely injured for transportation on two separate aircraft to the USAISR burn unit. They eliminated those already transferred to the Jaycee Burn Center and those too unstable to survive aeromedical evacuation to San Antonio. The twenty soldiers selected had burns in the range of 6-88 percent of their total body surface; some had traumatic amputations and others inhalation injuries.[30]
Coordination of efforts could have been better. After arriving at Womack, the USAISR burn teams disregarded the Womack plan for triaging patients to burn centers and devised their own plan. The first burn team removed from evacuation helicopters patients whom the Womack staff had already prepared for transport to the Duke University Medical Center. The second burn team reevaluated and retriaged patients, rather than carry out the evacuation plan already developed. Although those actions resulted in delaying the transport of severely burned patients to burn centers, thus stressing the system at Womack and losing an aircraft to crew rest, the essential care of the casualties was not affected. Minor differences on the initial management of casu- alties included the amount and type of IV fluids administered to casualties; reliance on the Parkland formula, taught at most medical schools, by the Womack staff and the USAISR formula by the burn
teams, the use of diuretics to prevent kidney damage; and the siting and depth of some escharotomies. The Womack staff later recommended that the USAISR burn unit develop a standard plan for the treatment of mass casualties at "facilities that do not take care of burns frequently." The distribution of this plan to military hospitals would provide for more standard management and efficient transfer of burn patients. A second recommendation called for a burn team member to remain behind to assist with the management of those too unstable to be transferred and those triaged to a later flight. The USAISR staff also proposed more standard management of burn patients, recommending that each military resident rotate through the institute "where principles of burn patient management adaptable to mass casualty situations are taught and practiced on a daily basis." Techniques emphasized would include evaluating burn areas and performing escharotomies.[32]
Consistent with mass casualty planning, psychologists, psychiatrists, clinical nurses, and social workers met in the expectant care area and physical therapy clinic to await patients in need of counseling. When no one arrived within one to two hours of the accident, these professionals focused on treating the emotional needs of families, hospital staff, and units involved in the disaster. Mental health personnel joined Army chaplains and family support group members in comforting the victims' families who had begun to gather in Womack's Weaver Conference Room. Psychiatric professionals also rotated through hospital wards supporting physicians, nurses, and other clinicians, many of whom had never seen injuries like those produced by the fireball. The 91C mental health technicians provided emotional support to the morgue personnel who had the difficult job of identifying and processing the remains of the deceased soldiers, many of whom were horribly burned or disfigured. [33]
According to Army practice, mental health personnel form teams in response to any disaster or combat. They are drawn from combat stress control detachments and companies and from the neuropsychiatric wards and consultation services of both active and reserve components. Fort Bragg's mental health professionals organized into teams to handle the mass casualty on Green Ramp. Army psychiatrists later promoted the idea that psychiatric teams be designated in advance.[34]
Lt. Col. John W. Plewes, MC, Womack's psychiatry and neurology department chief and the 44th Medical Brigade's staff psychiatrist, organized the mental health effort. Because soldiers with burns to their heads or faces "inevitably will suffer emotional or psychological trauma," Plewes summoned psychiatric specialists from the 82d Airborne Division, the XVIII Airborne Corps, and Womack itself to plan critical incident stress debriefings for the purpose of minimizing posttraumatic stress syndrome among airborne units, the hospital staff, and the patients. For "anyone involved in this accident, their lives have significantly changed." At a businesslike meeting, which began about 2100 on the night of the accident, division, corps, and Womack personnel divided up the work load and shared resources. The 82d Airborne Division became responsible for debriefing its own units, which suffered most of the casualties; the 528th Medical Detachment (Combat Stress), 44th Medical Brigade, was to take care of corps units involved in the accident; and Womack mental health specialists were to handle patients and staff, many of whom had friends hurt in the accident, and to perform outreach programs for the community. Mental health workers were to form teams and be ready to augment each other's staffs during critical incident stress debriefings. The first debriefings were scheduled for twenty-four hours after the accident.[35]
When numbers of mass casualties proved too large for Womack to handle, MASCAL strategy called for the transfer of patients to regional hospitals. After Code Yellow was activated, Colonel Eggebroten contacted local medical facilities to determine the number of casualties the local hospitals could take. He then coordinated the transfer of casualties to those hospitals through the 55th Medical Group, 44th Medical Brigade, and the hospital EOC. Medical authorities accomplished the major portion of the transfers to regional hospitals within two hours of the accident.[36]
In the grassy area outside the emergency room, a sheet marked AIREVAC designated the place where patients were being readied for transfer by helicopter to regional hospitals. The 57th Medical Company, which was on a field exercise nearby when the accident occurred' had five helicopters on the pad at Womack and three at nearby Simmons Army Airfield ``ready to go." Major Corey arranged for four UH-60s to take seven soldiers who required immediate burn treatment to the Jaycee Burn Center at Chapel Hill; a physician and a respiratory therapist accompanied each patient. At 2330 a helicopter transferred a soldier with an open spinal wound to the Naval Medical Center Portsmouth, Virginia.[37]
Womack ambulances carried five patients who required surgery to the Cape Fear Valley Medical Center and one to the Highsmith-Rainey Memorial Hospital, because the hospital operating rooms were full. Although a hotline between the emergency rooms of the regional hospitals and Womack would have eased communications problems during the initial response to the crash, the transfers, in general, went smoothly, largely because Womack rehearsed mass casualty planning with the regional hospitals several times a year.[38]
At 0400 on 24 March the Womack staff began the careful process of loading the burned patients on field ambulances of the 261st Medical Battalion (Area Support) for transportation to Pope Air Force Base. The first medevac C-9 Nightingale, with eleven of the twenty on board, departed the air base at 0720 for San Antonio. About 1000 the other nine left Womack for the air base, departing on the second C-9 at 1250. The 23d Medical Squadron from Pope Air Force Base provided many of the personnel used to load the two groups onto the aircraft, and its unit control center coordinated the evacuation with Womack and with Scott Air Force Base, in Belleville, Illinois, which provided the medevac aircraft and crew. With the transfer of three more critically burned patients to the Jaycee Burn Center that afternoon, the Womack staff could concentrate its efforts on the remaining casualties.[39]
On the day of the accident, as families were descending on Fort Bragg, a decision was made to identify the dead soldiers at Womack and not send them to Dover Air Force Base in Delaware, where verification of deceased military personnel often takes place after mass casualty incidents. Members of the Armed Forces Institute of Pathology (AFIP), in Washington, D.C., traveled to Fort Bragg and took charge of the identification process. They worked with personnel from Womack's pathology department and dental activity (DENTAC), as well as from Fort Bragg's Office of the Adjutant General. Again, teamwork helped in the medical response.[40]
The identification process involved a comparison of antemortem dental records with postmortem dental records, techniques that dental residents learned in the AFIP forensic dentistry course, conducted at Fort Bragg once every two years. According to Col. Gary W. Allen, DC, Fort Bragg's dental activity chief, the DENTAC team took radiographs and did a dental charting to discover "identifying features, either morphologic . . . or manmade . . ., such as a filling or some type of treatment or prosthesis." The team did not release a body to the medical examiner until it was sure the X-rays turned out accurately. The civil fans and enlisted soldiers, who assisted the dentists in the mass casualty, had not taken the AFIP course and were unfamiliar with some of the procedures. This lack of knowledge, as well as the limited space in the hospital morgue, lengthened the identification process. The team finished the last body about 1430 on 27 March.[41]
Based on this experience, Colonel Allen hoped that enlisted soldiers would be required to take the AFIP forensic dentistry course in the future. General Peake believed that a "more clearly written SOP [standard operating procedure] to know what has to be done . . . [to] move on it quickly" would have helped execute the tough job of casualty identification.[42]
While terrible misfortune sometimes just happens, a professional response to crisis is no accident. Training, hard work, esprit, and dedication-the everyday routine of soldiers-pay off in emergencies. Such was the case at Fort Bragg, where Womack medical personnel, with the help of volunteers, triaged the Green Ramp casualties, gave them lifesupporting treatment, and advanced them to the next level of care within two hours. The timing of the accident, coming at a change in hospital shifts, allowed for maximum staffing, and the presence of other medical units on post provided additional people and equipment. Womack's Colonel Timboe believed that the experience gained by his medics in Panama, the Persian Gulf, Honduras, and Somalia as well as the training received at Womack's December 1993 mass casualty seminar-when department chiefs discussed responsibilities and preparations for the upcoming Haiti contingency operation enabled the hospital to respond with confidence to the disaster. Colonel Weightman, who agreed with Timboe, also credited the usefulness of the advanced trauma life support and combat casualty care courses, taught at Fort Sam Houston, and recent mass casualty exercises in Honduras and at Fort Bragg. Teamwork was possible because the 44th Medical Brigade ``had bult up the links" that ensured an organized and efficient response. As stated by General Peake, "It's one Army Medical Department not multiple chunks that never talk. [43].
[1] Memo, Col Stephen L. Jones, Dep Cdr for Clinical Services, WAMC, to U.S. Army Center of Military History, 3 Apr 95, sub: Medical Response to the F-16 Crash at Pope Air Force Base, 23 March 1994 (hereafter cited as Jones Memo); Interv, Lt Col Iris J. West with Maj Patricia D. Horoho, 12 Apr 94 (hereafter cited as Horoho Interv). Horoho was Womack's emergency room chief nurse.
[2] Interv, Lt Col Iris J. West with Maj C. Craig Corey, 12 Apr 94 (hereafter cited as Corey Interv).
[3] Horoho Interv, 12 Apr 94.
[4] Ibid.
[5] As quoted in Shannon Rasmussen and Michele R. Hammonds, "Community Acts Bravely During Crisis at Pope," Paraglide (Fort Bragg, N.C.), 24 Mar 94, p. IA. See also p. 3A.
[6] Corey Interv, 12 Apr 94.
[7] Jones Memo, 3 Apr 95; Interv, Lt Col Iris J. West with Col William E. Eggebroten and Lt Col George W. Weightman, 12 Apr 94 (hereafler cited as Eggebroten and Weightman Interv); Interv, Lt Col Iris J. West with Brig Gen James Peake, 21 Apr 94 (hereafter cited as Peake Interv).
[8] James B. Rich, "Memories," 29 Mar 94, an essay written on his recollections of the accident.
[9] First quotation from Jones Memo, 3 Apr 95, p. 2; remaining quotations from Corey Interv, 12 Apr 94.
[10] Interv, Lt Col Iris J. west with Ma; Dawn Light, 21 Apr 94 (hereafler cited as Light
[11] Quotations as given in Rasmussen and Hammonds, ``Community Acts Gravely," 24 Mar 94, p. 1A. See also Horoho Interv, 12 Apr 94, Interv, Lt Col Iris J. west with Maj Gen William M. Steele, 20 Apr 94; Peake Interv, 21 Apr 94; Afler-Action Review, XVIII Airborne Corps, 12 Apr 94, sub: Pope Air Force Base Crash, p. 16 (hereafter cited as XVIII Abn Corps AAR), which recommended that support from other Fort Blragg medical units be incorporated into MASCAL plans.
[12] First quotation from Corey Interv, 12 Apr 94, second quotation from Horoho Interv, 12 Apr 94. See also After-Action Review, Womack Army Medical Center, 29 Apr 94, p. 22 (hereafter cited as WAMC AAR).
[13] Horoho Interv, 12 Apr 94; Eggebroten and Weightman Interv, 12 Apr 94, XVIII Abn Corps AAR, 12 Apr 94, p. 17.
[14] First quotation from Jones Memo, 3 Apr 95; second' third, and fifth quotahons from Corey Interv, 12 Apr 94; fourth quotation as given in Margaret Tippy, "Sullivan Praises Womack Efforts," Paraglide (Fort Bragg, N.C.), 31 Mar 94, pp. 1A, 3A.
[15]Quotation from Memo, Maj William H. H. Chapman III, Chief, General Surgery Service, WAMC, to Dep Cdr for Clinical Services, WAMC, 4 Apr 94, sub. Pope Mass Casualty After-Action Review (hereafter cited as Chapman Memo). See also WAMC AAR, 29 Apr 94, p. 16; Peake Interv, 21 Apr 94.
[16] Jones Memo, 3 Apr 95.
[17] Chapman Memo, 4 Apr 94.
[18] Ibid.; Eggebroten and Weightman Interv, 12 Apr 94.
[19] Jones Memo, 3 Apr 95.
[20] Ibid, Chapman Memo, 4 Apr 94.
[21] Quotation from After-Action Report, U.S. Army Institute of Surgical Research, n.d., sub: Response to Pope AFB Accident, p. 4 (hereafter cited as USAISR AAR). See also Jones Memo, 3 Apr 95.
[22] Interv, Col Mary T. Sarnecky with Capt James Mingus, 8 Apr 94.
[23] Interv, Lt Col Iris J. West with Capt M. Lee Walters and Lt Stephanie Walters, 13 Apr 94.
[25] Interv, Mary Ellen Condon-Rall with Sgt Christopher J. Burson, Sgt Jacob T. Naeyaert, Jr., and Spc Michael P Fletcher, 2 Aug 95.
[26] Interv, Lt Col Iris J. West with Sgt Jacob T. Naeyaert, Jr., 25 May 94.
[26] Jones Memo, 3 Apr 95, WAMC AAR, 29 Apr 94, pp. 2-4.
[27] Eggebroten and Weightman Interv, 12 Apr 94; WAMC AAR, 29 Apr 94, p. 4; Casualty List, 82d Airborne Division, 26 Mar 94. On the last victim, Spc. Martm R. Lumbert, Jr., see Chapter 5 of this volume.
[28] Chapman Memo, 4 Apr 94.
[29] Jones Memo, 3 Apr 95; Memo, Maj Wayne W. Clark to Cdrs, 56th Medical Battalion, 55th Medical Group, 44th Medical Brigade, 28 Mar 94, sub: Evacuation of Soldiers From the Pope AFB Mishap, 23 March 1994; USAISR AAR, pp. 1-2.
[30] USAISR AAR, pp. 2-3; Emergency Operations Center Log, Womack Army Medical Center, 24 Mar 94, entry 30 (hereafter cited as WAMC EOC Log).
[31] Chapman Memo, 4 Apr 94; USAISR AAR, pp. 2 4.
[32] First quotation from Chapman Memo, 4 Apr 94; second quotation from USAISR AAR, p 5.
[33] Jones Memo, 3 Apr 95; Interv, Lt Col Iris J. West with Lt Col John W. Plewes, Maj Steve Knorr, and Maj Michael L. Russell, 13 Apr 94 (hereafter cited as Plewes, Knorr, and Russell Interv). Plewes was Womack's psychiatry and neurology chief; Knorr, a psychiatrist with the 82d Airborne Division; and Russell, Womack's psychological services chief.
[34] Franklin D. Jones, Pinchas Harris, Ronald J. Koshes, end Yeng Hoi Fong, "Military Psychiatry and Disasters," in Russ Zajtchuk, ea., Military Psychiatry: Preparing in Peace for War (Washington, D.C.: Office of the Surgeon General, Department of the Army, 1994), pp. 239-49.
[35] As quoted in Ruth Sheehan, "Many Crash Survivors Suffer Severe, Life-Threatening Burns," News & Observer (Raleigh, N.C.), 25 Mar 94, p. 16A. See also Plewes, Knorr, and Russell Interv, 13 Apr 94.
[36] Jones Memo, 3 Apr 95.
[37] Quotation from Horoho Interv, 12 Apr 94. See also Jones Memo, 3 Apr 95.
[38] Horoho Interv, 12 Apr 94; Eggebroten and Weightman Interv, 12 Apr 94, XVIII Abn Corps AAR, 12 Apr 94, p. 15.
[39] Memo, Col (USAF) Lawrence R. Whitehurst, MC, Cdr, 23d Medical Squadron, to Medical Readiness Committee, 23d Medical Squadron, and Cdr, 23d Wing, 31 Mar 94, sub: Medical After-Action Report for Aircraft Accident, 23 March 1994; WAMC EOC Log, 24 Mar 94, entries 48-56.
[40] Interv, Lt Col Iris J. West with Col Gary W. Allen and Lt Col Esther Childers, 15 Apr 94. Allen was Fort Bragg's dental activity chief and Childers an oral pathologist.
[41] Ibid. Twenty-one out of the twenty-three soldiers killed had DNA collection records, which made idenfification certain. However, it was easy to see how body parts and ambiguous dental detail could cause misidentification or failure to identify. The XVIII Airborne Corps subsequently recommended that commanders stress the DNA collection program. See XVIII Abn Corps AAR, 12 Apr 94, p. 26.
[42] Peake Interv, 21 Apr 94.
[43] Quotations from ibid. See also Interv, Mary Ellen Condon-Rall with Brig Gen Harold L. Timboe, 3 Aug 95.