Fort Hood Sentinel
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SATURDAY, OCTOBER 25, 2014  02:38:00 PM

Tragic day remembered; procedures reviewed, improved

Email   Print   Share By Jeri Chappelle, CRDAMC Public Affairs
November 4, 2010 | Living
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The Fort Hood Sentinel produced a special commemorative section, “The Aftermath,” in the wake of the Nov. 5, 2009 shootings on the installation. Thirteen people died and dozens more were wounded in the tragic event. Sentinel graphic
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First responders use a table as a stretcher to transport a wounded Soldier to an awaiting ambulance at Fort Hood Nov. 5. Sentinel file photo
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In this file photo, victims’ photos were displayed during the memorial ceremony Nov. 10, 2009, at Fort Hood. Sentinel file photo
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In this file photo, family members of Spc. Kham S. Xiong, killed in the shooting Nov. 5, are overcome with emotion during the memorial service Nov. 10, 2009, at Fort Hood. Sentinel file photo
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In this file photo, a Soldier reaches out to touch each of the photos of comrades slain in the Nov. 5 shooting here. Thousands attended the memorial ceremony Nov. 10, 2009, at Fort Hood. Sentinel file photo
On a cool, fall afternoon, Nov. 5, 2009, Soldiers and civilians at the Fort Hood Soldier Readiness Processing Center were going through their day as usual.

At the time, the medical portion of the SRPC was separate from the main administrative area. Carl R. Darnall Army Medical Center staffed the medical portion with administrative personnel, medics and counselors that process more than 60,000 deploying and redeploying Soldiers each year.

The normal SRPC procedure is to process 300 to 600 Soldiers from one unit. Nov. 5 was a “make-up” day, with 18 different units going through the process. On that day, 735 deploying Soldiers and SRPC staff were in the building when a lone gunman opened fire.

The Nov. 5 tragedy left 13 dead and 31 wounded. Behavioral health professionals know that traumatic events become a part of one’s life experiences that color the soul forever. For the Soldiers and civilians in the Fort Hood SRPC that day, life changed forever.



Rushing to help

As tragedy unfolded, help came from all directions. Over a thousand people were directly affected by the shooting, and scores more required assistance. Just hours into the incident, Darnall requested additional behavioral health assets to augment the fully engaged staff assigned to the Behavioral Health Department. The resources of the entire armed forces came to Darnall’s assistance.

More than 90 providers and support staff from throughout the Department of Defense quickly arrived.

Professionals came from locations including Brooke Army Medical Center, Eisenhower Army Medical Center, and the Defense Center of Excellence for Psychological Health and Traumatic Brain Injury, as well as many other locations. The TRICARE Network increased provider availability, and the community stepped in to help.

“Many at the scene were trained responders,” Col. Steven E. Braverman, CRDAMC’s commander said, “and although they hadn’t practiced as a team, they were very experienced in emergency medicine in a war zone. This enabled them to assess and treat individual victims quickly and appropriately on scene.

“The first casualties came to the Emergency Department within minutes of the shooting, and ‘Code Gray’ (mass casualty) was called to activate the hospital response and set up the Emergency Operations Center,” Braverman said. “Once we reached our capacity in the ED, we started diverting the injured to two local hospitals.”

After the immediate mission of patient care was stabilized, the next mission was to help identify affected personnel and address emerging behavioral health care needs. Later, a long-term plan was developed for Fort Hood to ensure sufficient resources continued to meet other needs as they were identified.

A panel of national experts convened at Fort Hood Nov. 18 to review, discuss, and provide input to Fort Hood’s behavioral health plan. The panel was comprised of civilian and military professionals with expertise in disaster medicine, traumatic stress, community health, child and family services, leadership and risk communication.

Lori Geckle and Bethney Davidson, two risk communicators from the Army’s Public Health Command at Aberdeen Proving Ground, Md., were integrated into the behavioral health team and developed several methods for III Corps and CRDAMC leaders to communicate to Soldiers, families, employees, staff, commanders and the community.

“Research shows that people judge the quality of information and responses based on trustworthiness. A poor response by even one individual could likely increase a person’s concern or outrage,” Davidson said. Davidson and Geckle spent weeks at Fort Hood providing training to help improve communication skills for those dealing with high stress/low trust situations and to help individuals move toward recovery.

Having experience in previous tragic events, Davidson and Geckle knew the public would want to contribute to the healing process. Various agencies and groups were offering help, but how could an individual contribute?

They developed an online survey asking for individual feelings, fears and expectations to get a true sense of where the community stood.

“Over 2,600 people responded to the survey,” Geckle said. “So many in the community wanted to do something, to donate, to volunteer.”

The survey results were provided to the Fort Hood Command as feedback from the community. Results would support the behavioral health campaign for the weeks and months to come.



Lessons learned

Just minutes after the last patient was transferred out of the Emergency Department on that day, staff began the after action review.

“The military requires AARs,” Col. Joan Vanderlaan, who was the deputy commander for nursing and the medical center’s liaison to III Corps headquarters at the time, said. “It’s a known expectation, so people take notes. Information started coming from all over the hospital; we didn’t care who submitted comments and ideas. If comments make it better for the next situation, they are valid.”

Staff members’ input was consolidated into 60 items that either needed improvement or actions that the medical center wanted to sustain. Vanderlaan organized the AAR comments into the Joint Commission’s six critical categories of emergency management: communications, resources and assets, safety and security, staff responsibilities, utility management, and patients and clinics. The Joint Commission is a civilian agency that accredits hospitals.

During Darnall’s Joint Commission survey in July, the JC recognized Darnall’s efforts on Nov. 5.

“We were set up for success,” Braverman said. “It happened during business hours, hospital leadership was present. The Emergency Department had just completed Grand Rounds (a training exercise), the most experienced Emergency Medical Service director was on duty, and teams were assigned to and stayed with beds. Our staff acted magnificently.”

Nevertheless, everything did not go as well as it had in multiple mass casualty exercises.

Ironically, Darnall was to complete the second part of a community-wide exercise Nov. 6.

Some of the things that did not go well on that day included the tracking of patients, communications inside the hospital and with outlying clinics, access to the post during installation lockdown, and security and crowd control in the ED.

“Patient tracking – location, status, prognosis – was an issue because of media interest and HIPAA – the patient’s right to privacy with regards to medical conditions,” Vanderlaan said. “In the military environment, commanders also have a ‘need to know’ about Soldier health. We were asking civilian hospitals for information they were not used to releasing and a culture gap existed.”

Darnall adapted by sending medical liaisons to civilian hospitals to get information in a way that was compliant with the Health Insurance Portability and Accountability Act of 1996.

“Triage didn’t happen as written in our medical emergency management plan, either,” Braverman said. But that was a good thing. “The reality is, the skills of people on the scene saved lives. Combat lifesavers that were not part of our staff went into combat mode. Secondary triage at the ED front door helped get the injured cared for very quickly.”

As the incident continued, an important concept emerged – one voice, one person in charge. Lt. Gen. Robert Cone, III Corps and Fort Hood commander, was the voice of reason that reassured the community that Fort Hood was a safe place and things would be made right again.

Darnall’s Joint Performance Improvement Committee, made up of deputies, special staff, department chiefs and noncommissioned officers-in-charge, reviewed the AAR on Dec. 1, 2009, and again in February.

In May, Darnall conducted a mass casualty exercise to test whether the areas identified as needing improvement were indeed improved or fixed.

“We used an exercise scenario that challenged the areas we wanted to improve, such as patient tracking and pre-made trauma packets. There was a different level of confidence – the kind you get when everyone is well trained,” Braverman said.



Healing continues

Darnall has settled down to a new normal. Some of the injured continue medical treatment. Some have deployed or left the Army.

Fort Hood will hold an awards ceremony Friday to recognize outstanding efforts during the shooting. This event is by invitation only.

Other events will be held to remember the victims and bring the community together. Friday afternoon at 1 p.m., the installation will hold a Remembrance Ceremony at Cameron Field.

The public is invited to attend this event, which will include a moment of silence one year to the minute after the tragic shootings here.

A Run to Remember is set for Saturday, followed by Rock the Hood. The public is encouraged to attend both of these events. The run starts at 8 a.m., and the Rock the Hood event, featuring live entertainment and carnival games for kids kicks off at noon.



The day after the tragedy on Nov. 5, 2009, Lt. Col. Melissa Givens asked the Emergency Department staff to write down their thoughts. Their comments below tell the ED’s story.



Sometime after lunch, I was charting in the team area when I heard someone yell, “We have gunshot victims in the ambulance bay.” As [we] walked out, we were met immediately by two bleeding Soldiers being carried in by their buddies.



When I saw two rows of medics outside of the ambulance bay ready to receive patients, I knew this was not a drill. When I saw Family Medicine and Internal Medicine staff members with bloody gloves around the ED, I knew this was not a drill. When I saw my attending with bloody scrubs at a patient’s bedside, I knew this was not a drill.



You could feel the urgency in everyone-the docs, the nurses, the medics, the clerks-but everyone performed efficiently and without reserve. There were no doubts, no second-guessing, just professionals doing what they were trained to do.



Amidst the flurry of activity, there was a moment where all things seemed to move in slow motion ... I saw interns witnessing with a slight awe all that was going on around them, 2nd years executing with haste those procedures they had been diligently taught, 3rd years practicing what they had preached, and calm staff managing it all. Each of us was, in that moment, living emergency medicine.



Our docs are trained to do this in war zones so they had everything under control but I don’t think anything could prepare the support staff for this assault in an urban, non-combat zone.



All I can say is we raged against the tragedy not with violence or anger but violent passion, camaraderie, and tenacity to hold the tide of fear and destruction at bay. War has been something we got on an airplane to experience but on this day, we lived it in our backya
 
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