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Army acts on 'emergency' laigINew documentoutlines goals

The US Army Medical Department, whichbegan America's first ambulance system in1862 and approximately 90 years later not onlyinitiated but in the next ten years perfectedhelicopter medevac techniques, "can't waitany longer?' to upgrade nationwide hospital-based emergency medical services.

Colonel (Dr.) Joseph F. Powers, Chief of theAmbulatory Care Division, Headquarters, USArmy Health Services Command, delivered the"sad but true" message to all commanders ofHSC medical centers and hospitals during arecent Commanders' Conference held in SanAntonio, Tex.

Time to Move Out"The civilian community," he said, "is ahead

of us; so it is time we started moving out." Withthat, he distributed the new Ambulatory Pa-tient Care Program Document containing anumber of emergency service goals, which, hesaid, "may be too ambitious but representnothing new; the goals are based on what thecivilians are doing now."

Generally, the goals encompass fourareas--namely emergency room operations,emergency medical technicians, emergencymedical communications systems and ambu-lances and equipment. "We, at headquarters,"COL Powers said, "need to know both yourpresent and your required capability basedupon the population you serve, primarily sothat we will be in a better position to help you inany one or all four areas."

On the local level, all commanders -- no mat-ter how large or small the hospital -- need toappoint a Chief of Emergency Medical Ser-vices to work, first, as an organizer within thehospital; second, as a liaison man with the postand local community -- both military andcivilian--and, third, as a point of contact forHeadquarters, HSC.

Emergency Room Operations

Upon appointment, the Chief of EmergencyServices, COL Powers said, should inspect theemergency room's design and functions to"determine if it presently meets or, with somemodifications, can conform favorably withguidelines established by the American Col-lege of Surgeons." For example:

"A busy emergency room," he noted, "mayneed several work areas--a separate room forthe treatment of trauma or accident victims;another for severe illnesses -- heart failure,etc.--and a third for minor emergency prob-lems. If at all possible, the treatment of acuteminor illnesses should be removed completely

Patients define 'emergencies'What is an emergency?"If the patient thinks it is an emergency,

then it is an emergency," the CommandingGeneral of William Beaumont Army MedicalCenter answered. In the last year, WilliamBeaumont has begun to take a hard look atemergencies, particularly emergency accidentcases, in its Trauma Unit--the only one of itskind in the Army.

"After all," Brigadier General (Dr.) Robert M.Hardaway continued, "the large majority of pa-tients have not been to medical school." For-tunately, BG Hardaway does not stand alone inhis definition. For instance:

"The patient, not the physician, defines theemergency situation," Dr. Karl G. Mangold, amember of a group of emergency physicians inSan Leando, Calif., said in an address to the103rd annual meeting of the California MedicalAssociation. He then defined an emergency asan unexpected physiological and/orpyschological event.

"Please note that the definition has nothingto do with cardiac arrest, shock, seizures orhemorrhage," he said. Then, as if he were

Valley Forge fades away into historyNot long ago--in the summer months of

1944--the wards bulged with patients -- manyof them double-bunked in Wards 90 through94.

Bob Hope, Eddie Cantor, Xavier Cugat, theDuke and Duchess of Windsor, as well as manydistinguished general officers, came to visitand show the Free World's respect and grati-tude for the wartime sacrifices of the patients.

Today, the wards and hallways in the 130 redbrick cantonment buildings that made up Val-ley Forge General Hospital near Phoenixville,Pa., are silent.

The flag has been lowered, and the Armypeople who once served and were served atValley Forge are gone.

"It (the hospital) will not be placed on

RESPONSEDear Editor:

I am writing to object to an articletitled "RESPONSE" in your 18 April74 paper.

Either your editor did not proof-read the article or did not research itprior to publication. The two items inmind are:

* No advancement. This factordoes not result from lack of goodmanagement and foresight bycommanders and personnel offic-ers. It does show poor managementat the US Army Health ServicesCommand and DA level. These unitscannot promote enlisted personnelinto 91C slots because the indivi-duals are not qualified. They will notgo to school for 40 weeks; hence,they stay an E-4 until the end of theirobligation. Then we have the reor-ganization factor. A good example isthe hospital I am an SAA for. It was aGeneral Hospital, and it was con-verted to an Evacuation Hospital. It2

stand-by," as it was in the years followingWorld War II and the Korean Conflict, Colonel(Dr.) Philip A. Deffer, Commanding Officer,told the workforce on April 17, 1973. "It will(instead) be declared excess for whatever pub-lic ... or private utilization that the borough (ofPhoenixville) or the surrounding townshipssee fit."

Yet, the memory of the Army hospital thatwas once located on more than 180 acres in theChester County hills near historic Valley ForgeState Park may well remain -- in a traditionsimilar to that of a small log cabin in the park.The inscription over the hut's door reads:

"Reproduction of a hospital hut built on theoriginal site occupied in 1777-78 by contractsurgeons serving with George Washington."

No advancement

went from an authorized 17 MSCstrength to 8 MSC authorized--froma total authorized strength of 480 to220. What happens to the personnelretained in the unit on reorganiza-tion? They are frozen in grade. As forchances of advancement during hiscareer--that depends on how highthe grade is for the job he is doing.

* Commissioning. Again thehigher commands are at fault in thisrespect. The overages in MSC are sohigh that the Army states that nopersons will be commissioned in theMSC Branch until further notice.

In my opinion, the publishing ofsuch an article is poor timing. AllUSAR units are on a push to go over100 per cent and working hard toachieve it. Then a "short timer"reads your article.

CMS Charles F. Churchwell (Ret)Staff Administration Assistant

(DAC)

EDITOR'S NOTE: The sub.

echoing BG Hardaway or vice versa, he addedthat the patient may be in error but "the patienthas not been to medical school."

So what does this mean? According to Dr.Mangold, it means that the medical professionmust recognize emergency medicine as ahonorable profession.

Not too many years ago "and even today insome minds," he noted, "the image of theemergency physician was one of an emotional-ly unstable, occasionally alcoholic, transientphysician who couldn't develop his own prac-tice." While this description may have appliedin a few cases in the past, it certainly does notapply today, with more and more physicianslooking at emergency medicine as a career.

In Dr. Mangold's words, the new breed ofemergency physicians are doctors who pos-sess "a combination academic backgroundand training, experience, knowledge, skillsand judgment and who are medically and atti-tudinally capable of handling the broad spec-trum of emergent, urgent and non time-dependent medical problems."

So what does that mean for the militaryemergency physician?

"It means we must stablize him in his posi-tion," says Colonel (Dr.) Joseph F. Powers,Chief of the Ambulatory Patient Care Divisionat Headquarters, US Army Health ServicesCommand.

In other words, the military emergencyphysician must not only have one assign-ment--the emergency room -- but he must berecognized and respected for what he does. Inessence, he is a co-equal with other membersof the hospital's professional medical staff.

And, for the patient who hasn't been to med-ical school, that means another kind ofrecognition -- simply that of a rational humanbeing seeking a professional, sympatheticanswer from one who has been to school.Then, should the problem reoccur, the patientusing the answer from his previous experiencemay well be able to choose between an emer-gency room visit or a clinic appointment.

shows poor managementject "article" was not an arti-cle, but a Letter to the Editorwritten by a Reservist -. Spe.cialist 5 Steven L. Brasher."RESPONSE" is our Letter to

The Editor column. In addi-tion, HSC has no direct man-agement control over the USArmy Reserve and/or the Na-tional Guard.

mercuryThe HSC MERCURY is an unofficial publication ofthe United States Army Health Services Command,Fort Sam Houston, TX 78234, published monthlyby offset and authorized by AR 360-81. Publishingoffice is the Public Affairs Office, tel. 512-221-6211.The views and opinions expressed herein are notnecessarily those of the Department of the Army.

COMMANDING GENERALMG Spurgeon Neel, MC

PUBLIC AFFAIRS OFFICER x

COL William S. Mullins

EDITORClare ThnmasI,> L I . .

I I - ' '

-L 1IPl el

OUTSIDE, I NSI DE --On the "outside", a good Army ambulance at Madigan Army Medical Center, Tacoma,Wash., is painted white and features Omaha orange emergency markings. The "inside" has a curtainbulkhead, accessible cabinets for storing emergency equipment and a curb side door leading to the"outside". --US Army Photos

contained in the DOT Highway Safety Pro-gram, Standard II.

To become a certified EMT under the DOTprogram, each applicant must, first, success-fully complete a minimum, state-approved81-hour didactic and on-the-job trainingcourse and, second, pass a certifying examina-tion. Then, to remain on the National Registryof Emergency Medical Technicians, each EMTmust complete a questionnaire on employ-ment skills and skill maintenance every twoyears.

At the present time, the Academy of HealthSciences, US Army--while it does supervise thetraining of military medical corpsmen and clin-ical specialists in the 91 B and C series -- doesnot offer a course identical to the DOT EMTprogram. "''The Academy is, however, consider-ing incorporation of the 71-hour classroomtraining portion of the DOT program into the91B10 course," COL Powers announced.

In the meantime, "we strongly recommendthat you either establish in-house training inline with the DOT program," he said, ''"or, as analternative, send enlisted medical corpsmen tocivilian training programs, should they be av-ailable in nearby communities."

Emergency Medical Communications

Then, in the meantime--while people areundergoing training--the Chief of EmergencyMedical Services needs to begin work onupgrading the hospital's emergency medicalcommunications system. "The main radioconsole," COL Powers stressed, "must be lo-cated in the emergency room, and, if the localsituation warrants, should be capable of com-munications upon civilian frequencies.

"The Federal Communications Com-mission," he explained to the commanders,"allocates certain frequencies for civilian useand certain ones for military use. As you know,many military emergency cases are brought toour hospitals by civilian ambulances; so weneed to be able to communicate with thecivilian EMTs on board as the ambulance ap-proaches our emergency room.

"''By the same token, a military patient may betransported by our ambulances to a civilian

hospital to save time--as you know, time is atpremium, especially when working with acci-dent victims--so our EMTs aboard our ambu-lances must be able to communicate withemergency room physicians in civilian hospi-tals."

Emergency Medical VehiclesAs for the Army's installation ambulance

support--only the new Type 2 van, followingrecent evaluation at selected Army hospitals,"approaches the basic DOT standards foremergency vehicles," COL Powers reported."''At the present time, only a handful are availa-ble at Army installations; so, to get effectiveemergency medical vehicles, we must beginco-ordination with installation commanders."

In coordinating efforts, "we need, first," hesaid, "to identify those vehicles required foremergency medical purposes and then sepa-rate them from those vehicles used to trans-port non-emergent patients." Once that isdone, "we can then proceed to modifyemergency vehicles, especially the large Type1 vans, to meet the DOT standards for all ambu-lances." For example:

* All glossy green Type 1 vans used asemergency medical care ambulances shouldbe repainted white and marked with theappropriate Omaha orange markings. Themarkings, for instance, should include theword "ambulance" spelled backward in large,mirror-image letters on the front of the vehicle.

* A curb side door should be installed withinthe passenger compartment as another meansof entry and exit for the EMTs and also as analternate exit in case of accident.

* A bulkhead separating the driver from therest of the vehicle's interior should be installedto give both the driver and attendants privacyin relaying their separate, but equally impor-tant, messages, and to shield the driver's eyesfrom light used in the patient care area duringnight operations.

* Space must be provided in the interior,first, to allow one attendant to sit at the head ofthe patient for resuscitative purposes and,second, to store emergency equipment ineasily-accessible cabinets.

(Continued from Page 1)

from the treatment area for trauma and severeemergency illnesses."

Also, during the initial evaluation, the Chiefof Emergency Services, he continued, shouldtake a hard look at the emergency room staffwith a view toward "stabilizing duty assign-ments." In other words, a certain number ofphysicians, nurses, clinical specialists andmedical corpsmen should not only haveemergency room duty as a primary assignmentbut also should be recognized and respectedfor their duty.

Along with the Chief of Emergency MedicalServices, commanders of larger hospitals andmedical centers, may want to establish apermanent Emergency Medical ServicesCommittee working either under or in concertwith the Chief, Department of Clinics, tostrengthen the support of all medical special-ities to the emergency room. At much the sametime, a continuing training program should beconducted for all emergency room parapro-fessionals, ambulance drivers and attendants.Then, as a word of caution, COL Powersadded:

"Do not rob the emergency room staff forduty as ambulance attendants. The posi-tions--that of an emergency room parapro-fessional and that of an ambulance atten-dent--involve a different mix of skills and, in myopinion, should be a completely separateassignments." Then, to emphasize his point,he said:

Emergency Medical Technicians

"We, here, at HSC headquarters are cur-rently developing recommendations forupgrading job requirements of both civilianand military ambulance personnel to the skilllevel of emergency medical technicians(EMTs) now working in the civilian com-munity."''

On the military side, the upgrading, he re-ported, may well involve an additional militaryoccupational specialty skill identifier essen-tially based on job requirements developed bythe Department of Transportation (DOT) and

Army uses civilian example in setting goals

h

CRITICAL

MOMENTS:Emerency medicaltechnicians laboragainst death intheir efforts tobring an accidentvictim safelyhome.

WIllam BeaLBy Clare Thomas

The desert road promises smooth sailing."So 'rev' up the engine -- let's see how fast

this baby can travel."Terrific--up to 70 mph now--the wind's

stinging my face--what's that--a bump--I'mreally sailing now--up, up and over--where'sthe ground--I can't see. . .

"Here, I am, awake. What's this--ahospital--where's the desert, my cycle. I've gottubes in my arms; electrodes on mychest--what's that--oh, it hurts--a cast on myleg. How did I get here?"

Here is William Beaumont Army MedicalCenter's Trauma Unit--the first and only one ofits kind in the Army. It is housed on thehospital's fourth floor--directly above theground-level, third-floor emergency room anddirectly adjacent both to an operating roomand the hospital's medical and surgical inten-sive care units.

"Trauma is the biggest killer of people underthe age of 37," said Brigadier General (Dr.)

Robert M. Hardaway III, William Beaumont'sCommanding General. "We here at the hospi-tal, see a large number of cases, primarily dueto our location."

Located on the outskirts of El Paso, Tex., the12-story, 611-bed hospital, with its 8-storytower, rises majestically above the flat desertnext to the rugged Franklin Mountains. Its pa-tients come not only from across the street atFort Bliss, but "we also provide regional sup-port to Army and Air Force hospitals and medi-cal units in New Mexico and Arizona," BGHardaway explained.

"On average day, we often admit 17 to 19trauma patients, either from the immediate ElPaso area or medevaced to us from the smallerunits," he continued. Of these, "only the mostserious cases go directly from the emergencyroom into our 4-bed Trauma Unit," LieutenantColonel (Dr.) Jack B. Peacock, Chief, reported.

"And we usually know how serious the caseis before the victim gets here," added Captain(Dr.) Alvin L. Barrier Jr., Chief of EmergencyServices, primarily due to messages trans-mitted by attendants aboard either one of thepost's ground ambulances or one of the six

medevac helicopters operated by the 283rdHelicopter Ambulance Detachment at FortBliss.

With that, CPT Barrier took about 10 stepsinto the emergency room's communicationsarea located directly adjacent to the emer-gency room door. "Not only do we monitor allof El Paso's police and fire calls, but we have a'hot line' to the Military Police Station at FortBliss," he said.

"All emergency calls involving military per-sonnel anywhere in the 21/2-state area," hecontinued, "are put through the MPs. On get-ting the call, we can immediately go to a con-ference communications system--to co-ordi-nate our response with the post ambulanceservice, the helicopter detachment and/orcivilian authorities.

Then, depending upon the circum-stances--location, weather, etc. -- "we caneither deploy one of the ambulances"--severalstand ready at the emergency room door--"orcall on one of the helicopters," CPT Barriersaid. The attendents aboard are all Texas-certi-fied emergency medical technicians (EMTs).

VITAL TALK -- CPT (Dr.) Alvin L. Barrier, left, Chief of Emergency Services at William Beaumont Army MedicalCenter, finds out just how serious the case is during 2-way radio conversations with emergency medical tech-nicians, first, at the scene and then shortly before the medevac helicopter lands, bottom.--US Army Photos

4

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ALL SYSTEMS GO -- SP5 Janet Mock, a clinical specialist, and CPT Carrol Brinsfield,Head Nurse in William Beaumont's Trauma Unit, recheck vital signs left, while Mrs.Thelma Myers, Chief of the Trauma Unit's laboratory, runs a blood test to determine theproper chemical level for his IV.--US Army Photos/Haro

"We have, in the past, conducted the state-approved course every six months, not only forour own people but also for people fromtown--city police and firemen," LTC Peacocksaid. The basic training covers three importantsubjects -- field emergency medical pro-cedures, operation of communications sys-te-ms 'and effective communications betweenthe EMTs and the emergency room physician.

At the present time, "we have instant radiocommunications with the helicopter EMTSanywhere within a 60-mile radius," CPT Barriersaid. "In about six months, we will be able tomonitor a 150-mile radius."

Then, on meeting the victim at the door, "wenot only know what's happened but are readywith our response," he continued. "That's alesson we learned in Vietnam," LTC Peacockadded.

The medical people, he said, must be trainedin the treatment of trauma--the paraprofes-sionals must know what the physician is doingand vice versa. At the same time, all life-savingequipment, CPT Barrier said, must not only besimple to operate but must be readilyaccessible--if at all possible in a specialemergency room trauma area. For example:

"Here, in our trauma area, we have a cartequipped with everything needed to treat aninjured child. Over here, we have, on this cart, acomplete cardiac arrest unit equipped withboth monitoring devices and the appropriatedrugs. Everything on the shelves and in thecabinets are clearly labeled, and we have allour body -tubes out--labeled and stored inracks on the wall."

"In addition, " LTC Peacock continued, "wehave incorporated a special X-ray device intoour treatment litter. It allows us to take X-raysright through the litter; so we don't have tomove the patient."

"Trauma," CPT Barrier explained, "isunique--you've got to treat and diagnose at thesame time. Your first treatment procedure, ofcourse, is resuscitation--then stabiliza-tion--and diagnosis in between. Then, aftermoving the patient, we take about 30 minutesto reset."

In the meantime, if anything is removed fromthe trauma area -- "well, that person has me toreckon with," he said. "I just won't allow it."And that isn't the only hard-and-fast rule inWilliam Beaumont's trauma care procedures.

"Not every physician," LTC Peacock noted,

"is qualified to treat the trauma victim. So, ifyou have emergency room duty and if you arenot a general or orthopedic surgeon, you callone."

All of William Beaumont's general surgeryand orthopedic residents, plus the staff physi-cians in both specialities, are on-call both tothe emergency room trauma area and/or theTrauma Unit itself. "At the same time," CPTBarrier continued, "we also have a 5- man car-diac arrest team equipped with beepers; so wecan call any one at any time."

"Of course," LTC Peacock added, "not allaccident victims are treated in the emergencyroom's trauma area. We use this room solely totreat only the most severely injured--those, inwhich any further movement, may prove fatal."Seriously injured victims who can be safelymoved are sent immediately upstairs to theTrauma Unit.

"Again," LTC Peacock reported, "we main-(See Trauma .... p 6)

DEATH DEFEATED -- SP5 Janet Mock, a clinical specialist in William Beaumont's Trauma Unit, adjustselectrodes monitoring vital signs of a recently stabilized trauma victim, left. At much the same time, anotherTrauma Unit patient foregoes his IV for a hearty lunch.--US Army Photos/Haro

5

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Neel, HSC Commanding General,Fort Sam Houston, Tex., and MajorGeneral William Maddox Jr., Com-manding General of the US ArmyAviation Center and School, FortRucker, presided over the cere-monies, which also marked the offi-cial beginning of the Military Assis-

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NEWADDITIONS:

MG Spurgeon Nee/welcomes the USArmy AeromedicalCenter, Fort Rucker,Ala., and the AlabamaMAST program toHSC in a speech to thetroops and, inset, in acake cutting cere-mony. COL JamesHertzog, center, cutsthe cake, while MGNeel, left, and MGWilliam Maddox Jr.,right, watch.

US Army Photos

tance to Safety and Traffic (MAST)Program in the state of Alabama.

The two events, MG Neel said, are"significant milestones in theadministration of the US Army, Armyaviation and Army aviation medi-cine."

Under the command of Colonel(Dr.) James Hertzog, the new aero-medical center essentially repre-sents a merger of all health careactivities -- including Lyster ArmyHospital -- formerly administered byFort Rucker's Medical DepartmentActivity, with the Army AeromedicalActivity, which was formerly manag-ed by the US Army Aviation Centerand School.

The merger, MG Neel said, givesthe new HSC medical center anArmy-wide, world-wide scope andmission in four general areas, name-Iy aviation medical training, re-search, clinical care and specialconsultation services. In Alabama,

the aeromedical center's missionalso includes implementation ofMAST -- a co-operative Departmentof Defense and Health, Educationand Welfare program designed tobring aeromedical evacuationtechniques perfected by the ArmyMedical Department in Vietnam tothe civilian community.

In this respect, the Army's MASTprogram in Alabama is unique -- allother Army MAST programs instates across the nation are operat-ed by combat ready helicopterdetachments assigned directly toArmy installations under the com-mand of either the US Army ForcesCommand or the US Army Trainingand Doctrine Command.

In the years to come, a progressivebuilding program--now in the plan-ning stage -- is expected to trans-form the present US Army Aero-medical Center, Fort Rucker, intothe most modern Army facility foraerospace medicine.

A new Army medical center --namely the US Army AeromedicalCenter -- officially joined the USArmy Heath Services Command dur-ing recent dedication ceremonies atFort Rucker, Ala.

Major General (Dr.) Spurgeon

Brigadier General (Dr.) Jack PCtoday is considered to be one of thperienced administrators in the UStal Corps, went "home" recently"Alumnus of the Year" honors frohis former classmates at Southea;tsiana University.

Now serving as Deputy Commareral of the US Army Health Serviceswith headquarters at Fort Sam HoLBG Pollock received the awardceremonies held at the Alumni Asannual awards and installation bansOrleans.

A native of Columbus, Miss., Eattended Tulane University, New Cfore enrolling at Southeastern.graduation with a bachelor's degreEand chemistry, he was acceptedgraduated cum laude from the Lversity School of Dentistry.

much progress," LTC Peacock reported, "pri-marily because we seem to be continually lack-ing enough personnel. We have, however, keptrecords on each and every patient -- his in-juries and the treatment he has received--andare currently in the process of computerizingthe information in order to get a better idea ofthe types of injuries, diagnoses and effectivetreatment procedures."

In its primary function--resuscitation, treat-ment and rehabilitation of trauma victims--thebest measure of the Trauma Unit's successmay lie, but not necessarily so, in its death rate.Of the 235 patients admitted to date, only 10have died after being admitted to the unit.

"But, in using the death rate as a measure,"LTC Peacock noted, "you must remember thatwe don't always know the type of care the vic-tim received in those first, few critical momentsat the scene. As BG Hardaway said, our healthcare region encompasses a large, 21/2-statearea; so our emergency medical technicianswith their advanced skills don't always makethe initial response."

(Continued from p 5)

tain a constant around-the-clock 'all systemsgo' vigil." Once in the Trauma Unit, the patientis immediately met by either an orthopedic orgeneral surgeon, one nurse and one 91C--amilitary clinical specialist with training equi-valent to that of a civilian licensed practicalnurse.

"Altogether, we have a total of five ArmyNurse Corps members and five 91Cs workingportions of around-the-clock shifts in theTrauma Unit,'" reported Captain Carrol Brins-field, theTrauma Unit's Head Nurse. The Unit isalso staffed with three laboratory people who,in addition to their regular 8-hour shifts, areconstantly on call.

"Our two small laboratories," LTC Peacocksaid, "constitute a very important part of theTrauma Unit. We can do on-the-spot tests, withimmediate results. Also, if a test appears un-usual, we can always check it immediately."

Following surgery to set broken bonesand/or stop internal hemorraghing, for exam-ple, the patient is returned to the Trauma Unitfor 24-hour monitoring. "All of our monitoring

equipment," LTC Peacock reported, ''haswheels; so we can move the equipment to thepatient and, if necessary, change the space tomeet each individual patient's needs."

Initially opened a little more than a year ago,William Beaumont's Trauma Unit, in BGHardaway's words, is designed to serve threepurposes:

"First, it is used to resuscitate, treat andrehabilitate the injured patient. Second, it isused to conduct intensive investigations of themechanisms of trauma--the body's responseto injury--and to delineate improved techni-ques in the care of injured patients. Third, it isused to train medical and paramedical per-sonnel in the techniques of management andrehabilitation of trauma patients."

All of William Beaumont's general and or-thopedic residents, LTC Peacock said, care forpatients in the Trauma Unit as a part of thehospital's teaching program. In addition, all ofWilliam Beaumont's 91C students receiveTrauma Unit training.

As for the Unit's second -- its research --function, "we haven't been able to make too

Aeromedical Center , MAST join HSC

Trauma Unit's constant vigil helps to defeat death's angel

The Dental Clinic at Redstone Arsenal, Ala.,has reopened in a different building with newequipment, including six P105 dental fieldunits that have never before been used inroutine patient care.

"Actually, we didn't plan to use the P105 sosoon," reported Colonel (Dr.) Richard L. How-ard, Deputy for Dental Activities at Head-quarters, US Army Health Services Command,Fort Sam Houston, Tex. But the April 3rd torna-do "changed our minds."

In all, 96 buildings, including Redstone'sDental Clinic, were either damaged or de-stroyed by the tornado, which, on its rampagethrough the Army installation near Huntsvillein northern Alabama, also injured 26 soldiersand five dependents. Total property loss hassince been assessed at more than $10 million.

On receiving word of the damage to theclinic, "our first task here at Headquarters,H.'( _' PL Howard said. "became one of

After Redstone's restoration of some dental capability as soondental clinic was as possible.'' In the meantime, all emergencydestroyed by a tor- dental cases were being referred to a singlen a d o , to p, FO R- treatment room in Redstone's Army Hospital.

placements iot- In a d d iti o n t o t h e building, most of the dental

m left. HSC then equipment was damaged; so "the answer to

provided the P105 our problem became simple -- find and install

units, bottom in another building field equipment of the typeright.-US Army used by Army combat units under the com-Photos mand of the US Army Forces Command," COL

Howard said.To find the equipment, Major General Spur-

geon Neel, HSC Commanding General, sentthe following urgent message to the Com-manding General, US Army FORSCOM, FortMcPherson, Ga:

"Operational capability at Redstone Arsenalwas completely obliterated by a tornado 3 Apr74. Request your assistance in the provision offield dental equipment for a period ofapproximately 60 days."

Within hours, FORSCOM answered:"We have eleven field units of the type used

in Vietnam, field dental chests and field X-rayunits at the 337th Medical Detachment (DentalServices) at New Orleans."

Then, in addition, FORSCOM, COL Howardsaid, made the appropriate arrangements totransport it and also sent orders to accompanythe equipment and stay to install it to Specialist6 Gerald D. Dowda and Specialist 6 Lawrence0. Norton -- both dental maintenancespecialists with the 32nd Medical Depot, 1stMedical Group, Fort Sam Houston.

By April 29, all eleven field units, plus onesalvaged unit, were in service. "These, how-ever, were still not sufficient to restore the Den-tal Activity to its pre-tornado capability," COLHoward said. Altogether, the Dental Activity,under the command of Colonel (Dr.) Lloyd Wil-liams, serves a military community of morethan 21,000 active-duty and retired personneland their dependents.

"That's when we thought about the newP105,'" COL Howard recalled. "Since onlyprototypes had been fabricated, we had to askthe manufacturer to stop production ofconventional equipment to supply us with six."

By May 7, the units had not only been con-structed but shipped to Redstone and installedby SP6 Dowda and SP6 Norton. Altogether, thetask, COL Howard said, could not have beenaccomplished without "the cooperation ofeveryone" -- the people at Headquarters, HSC;Headquarters, FORSCOM; the US Army Re-serve, Redstone's Dental Activity and last butnotleast, private industry.

Then, when the high winds ac-companying the tornado's initialblast subsided, "CPT Klipple," thecitation continues, "redirectedground ambulance evacuation tothe helicopter landing site and per-sonally directed the priority loadingof all seriously injured (for evacua-tion to Ireland) and simultaneouslyorganized those with minor injuriesinto groups which were dispatchedby civilian vehicles to a small com-munity hospital in Elizabethtown."

Altogether, CPT Klipple "laboreduntil past midnight in Brandenburgsorting, treating and evacuatingover 100 patients," the award cita-tion says, and his efforts, alongsideBrandenburg's two civilian physi-cians, resulted in "saving manyI ives. "

The physicians "worked like Tro-jans," one American Red Cross offi-cial said afterward. "I think the

casualty list would have doubledwithout them."

Three Certificates of Appreciationalso gavesimilar praise to First Lieu-tenant Jan Keller, a member of theArmy Nurse Corps; Specialist 5 Ste-ven Cline and Specialist 5 DanielGarcia. Both 1 LT Keller and SP5Garcia, according to the citations,returned to help in Ireland's emer-gency room after working normal8-hour duty days.

At much the same time, SP5 Cline,in the absence of the emergencyroom's regular noncommissionedofficer-in-charge who had accom-panied CPT Klipple, not only assum-ed leadership but was largely re-sponsible for the quick, effective re-suscitative work performed in theemergency room.

Altogether, 31 people out of apopulation of approximately 2,000died in the worst tornado to hit thetown in 100 years.

at Ireland. Then, at approximately 5p.m., he received an emergency callrequesting medical assistance forBrandenburg from the KentuckyState Police.

Within minutes of the call, CPTKlipple, according to the award cita-tion, "organized all available ambu-lances and a team of medicalcorpsmen with a large quantity ofmedical supplies and equipmentand moved at once to the disastersite, some 16 miles away."

"Upon arrival," the award citationcontinues, "CPT Klipple found thetown of Brandenburg largelydevasted, but he quickly located theonly surviving medical facility . . .where casualties had already begunto arrive. The captain established atriage point on the spot and imme-diately deployed his corpsmen tosort, treat and load the injured intoambulances."

"They had special praise for Dr.Gary Klipple, an Army captainfrom Fort Knox." -- Louisville, Ky.,Courier-Journal, April 10, 1974.

The quoted "they" are Dr. Ronald0. Naser and Dr. Walter A.Cole--Brandenburg's two physi-cians--plus other members of thesmall Kentucky community devast-ed in a tornado April 3.

A few days later, Colonel (Dr.)Daniel W. Pratt, Commanding Offi-cer of Ireland Army Hospital, FortKnox, added the Army's "specialpraise". He presented CPT Klipplewith an Army Commendation Medalfor achievement in recognition ofhis "exceptional devotion to duty,his professional excellence andjudgment and his tireless labor" inthe wake of the tornado.

For CPT Klipple, the day beganroutinely with emergency room duty

Field units reopen dental clinic

MissionAccomplished

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Brandenburg physicians laud Army captain's aid

Today, a little more than a yearlater, the Army has officially movedout of the 1- and 2-story brickcantonment buildings housing Val-ley Forge General Hospital.

Built in the last eight months of1942, Valley Forge officially openedits doors in January of 1943-withColonel (Dr.) Henry Beeuwkes ascommanding officer--and wasnamed in honor of its historicsurroundings during dedicationceremonies held on Feb. 22, 1943 -the 211th anniversary of GeorgeWashington's birth.

Approximately three weeks later,Valley Forge received its firstpatients--a convoy of 250 sick andwounded soldiers from World WarlI's overseas battlefields. FollowingD-Day, the patient load in the

1,500-bed hospital soared to 3,000with some of the overflow occupy-ing double bunks in Wards 90through 94. After V-J Day in 1945,Valley Forge counted 2,700 patientsand another thousand on convales-cent leave.

Despite the huge patient load, Val-ley Forge's medical staff developednew techniques in plastic and eyesurgery and, in concert with dentistsassigned to the hospital, perfectedthe arcylic (artificial) eye as an aid inthe successful rehabilitation of theblind. At much the same time, itsNuero-Psychiatric Service madesignificant progress in the treatmentof combat-related psychiatrictrauma.

By 1948, most of Valley Forge'swartime casualties had been re-

"Valley Forge General Hos-pital, over the past 31 years, hasfaced many challenges of greatcomplexity, and it has met eachhead on, has succeeded and haswalked away proud that it accom-plished such a mission. It's nowmy duty to officially inform you ofthe next challenge facing us.

"At this hour in Washington, theSecretary of Defense is having apublic news conference, at whichhe is announcing the entire baserealignment package . . . ValleyForge will be closed."--Colonel(Dr.) Philip A. Deffer, Com-mander, Valley Forge GeneralHospital, in an address to the mili-tary and civilian workforce, Tues-day, April 17, 1973.

placed by a new type of patient -- thepeace-time soldier and his depen-dents. Then, a year later, ValleyForge was selected to test the Hoov-er Commission's recommendationsto install new management tech-niques in Army hospitals. For ValleyForge, the test proved so successfulthat on Feb. 2, 1950, the Departmentof the Army decided to close thehospital by June 30.

In the months following, patientswere re-assigned, and the militaryand civilian workforce dispersed. Bymid-May, the hospital lay desertedexcept for a skeleton crew asked byHollywood to stay the summer tohelp in the on-site filming of "BrightVictory"--the love story of a war-blinded World War 11 soldier.

That same summer, another eventoccurred--the North Korean Armysurged across the 38th Parallel. Tostem the aggression, the United Na-tions sent in troops, including manyAmericans--so many that by August15 Valley Forge's "Close" orderchanged to "Stand By". Then, inOctober, the "Stand By" order be-came "Reopen".

During the course of the war, thehospital with its specialities -- treat-ments of psychiatric patients, para-plegics, pulmonary diseases andhand surgery-- received, for the firsttime, many of its sick and woundedby airlift. The patients came from thePacific to Philadelphia's Inter-national Airport via Travis Air ForceBase, Calif.

Then, with the July 27, 1953,Korean War Armistice, Valley Forgebecame a major receiving center forrepatriated prisoners-of-war--a taskit was to repeat almost 20 years laterwith the return of 16 Vietnam PWreturnees, the largest number forany Army hospital in the nation.

Altogether, more than 200,000soldiers received care at ValleyForge General Hospital.I

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8 * U.S. GOVERNMENT PRINTING OFFICE: 1974-778-203/9

DesertedLandmark:The Army deserted some180 acres in the rollinghills of Chester County,Pa., when it moved fromValley Forge GeneralHospital adjacent to thesite of George Wash-ington's 1777-78 win-ter encampment.

US Army Photo

Army moves after 32 years at V/alley Forthe

END OF AN ERA -- Almost immediately aftera a A Pr&11 I A a a FM& =a M th e las t Vie t na m PW returnee left Valley Forge,HEADQU ARKTER left, workers, bottom, began to ease "ole

\O~k OA I I f F& *V& s^ 4<^ y ^^ George" from his wall in the main hospitalVALLEY KORGF tFNFR Al UiODIT AI corricdor.--US Army Photos

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