Combat mode 

9/1/2010 

First responders 
First responders use a table as a stretcher to transport a wounded soldier to an awaiting ambulance at Fort Hood, Texas, Nov. 5.  Col. Steven E. Braverman, commander of the post’s Darnall Army Medical Center, said medical care of the wounded ‘was never an issue.’

Calling the Nov. 5 tragedy at Fort Hood, Texas, a "mass casualty event that is a sensitive issue because of the on-going investigation," Col. Steven E. Braverman, M.D., commander of the post’s Darnall Army Medical Center, briefed 2,000 Army Medical Command personnel and guests on the key role his people and their civilian counterparts played, as Army Secretary John McHugh said, in preventing a "bad situation from getting worse."

On that day, Maj. Nidal Malik Hasan, a psychiatrist at Darnell allegedly shot and killed 12 soldiers and one Army civilian and wounded 30 others at the post deployment readiness center.

Speaking at the Association of the United States Army Medical Symposium and Exposition in San Antonio, Texas, May 19, Braverman said, although there were problems, "what happened that day saved lives, but that’s not unusual. That’s what we are trained for, prepared for."

Reviewing the time line from the first minutes of the shootings, he said the challenges facing the medical community involved the emergency response, incident management, consequence management, community assessment and care, and communication.

He emphasized, "It’s all about communication. Medical care [of the wounded] was never an issue."

After the 911 call was received, the first responders, to include the police, secured the site and within seven minutes ambulances were on the scene, local community air and ground evacuation assistance was arranged, a hospital emergency operations center was stood up at Darnall and off-post civilian hospitals were on call to accept casualties.

Five minutes after the call, the first casualties were evacuated, some in private vehicles, to the hospital where initial hospital care had been established and was functioning.

During the initial minutes and hours, the challenges became a reality.

Because of the volume of casualties, "the multiple-trained combat lifesavers and medics who arrived on the scene went into a combat mode without planned onsite triage," he said.

"Our reaction saved lives," Braverman said, "but this was not the typical triage that we plan for."

There was also inadequate tracking of patients at the time of evacuation from the scene.

"We needed to do a better job of keeping track of who went where, who went with whom. This was a lesson learned. We need to have an observer and all he does is track casualties."

Adding, "We recognized that we needed external support from outside [Fort Hood], … but there was no ‘off-the-shelf crises response plan for external support."

Hitting again on communication, Braverman said, "The information requirements were so intense, we needed a liaison, using layman’s language, to get the information out."

Internal and external information sharing is the key to successful communication.

This situation was so intense, "that everybody was calling. We lacked the [amount of] radios we needed to communicate and some radios didn’t work in the hospital, so we had to use runners to keep the information flowing," he said.

Adding, "We now have radios that work in the hospital."

As always, in an event of this magnitude, there are early media reporting inaccuracies.

Within hours after the shooting, the III Corps and Fort Hood commanding general, Lt. Gen. Robert W. Cone, convened a briefing with his commanders and key personnel to ensure the correct facts were being disseminated, civilian authorities and off-post medical staffs in the surrounding communities were informed and press conferences were scheduled for the now nationwide media coverage.

"On your initial medical engagement, you must get the correct information out to counter inaccurate information and innuendo," he said.

Because so many casualties needed immediate medical attention and care within the first 12 hours of the event, teams, made up of chaplains, Darnall Medical Center staff members, Resiliency Campus personnel, behavioral health specialists, family life consultants and caregivers were assembled to assist with the wounded and their families – and the families of the deceased.

The Fort Hood Resiliency Campus is an innovate approach that deals with soldier and family stress, focusing on emotional, social, physical, spiritual, and family issues. The campus staff works to build stronger soldiers and families by making them more adaptable, more resilient.

At Darnall, "We had to take care of our hospital staff," Braverman said. Because Hasan, the alleged shooter, was a member of the hospital team, "many of our staff felt they were the victims – they felt betrayed."

Adding, "Caregivers need care too."

Following the second day and beyond, medical personnel concentrated on a variety of ways to improve the operation to include organizing external assets, crisis response teams and traumatic event management.

And, in the area of communication, how to establish a more comprehensive, information sharing communication "unity of effort" that will produce improved updates and assessments in a synchronized manner.

"We must have a unity of effort," Braverman said, "not separate stove pipes. One man is in charge, the commanding general, and all information must go through him and through the command structure."

Fort Hood has developed a Behavioral Health Campaign Plan as a direct result of the tragic shooting spree.

The mission: "III Corps leads the team effort to provide comprehensive, long-term support services to meet the physical, emotional and spiritual needs of the entire Fort Hood community in order to reduce the impact and enhance recovery from the shooting incident, while maintaining mission capability."

As the Army chief of staff, Gen. George W. Casey Jr., said to the Fort Hood soldiers and families the day after the shootings, "We take care of our own. We will stand and grieve as a family. We will stay focused on our missions around the world."