Delaware National Guard - DNG News 2002

By Tech. Sgt. Benjamin J. Matwey, 166th Airlift Wing Public Affairs, with material from July 16th AFPN article by G. W. Pomeroy, Air Force Surgeon General Public Affairs

One of the largest mass casualty exercises ever conducted in a U.S. urban area occurred on July 13, in downtown Baltimore, Maryland. Named "Free State Response 2002," this exercise brought forth a day full of injury and mayhem to simulate a chemical attack -- the release of toxic gas -- and bomb explosion in a parked motor home in a Baltimore Ravens Football Stadium parking lot full of fans prior to a Sunday game. The Air Force Medical Service and the University of Maryland Medical Center spearheaded this exercise, a collaborative effort by more than a dozen federal, state and local agencies. It was a planned learning laboratory, created to test the responses and improve the training of those who would swing into action in the event of a disaster or terrorist attack -- something more plausible to the public after the events of Sept. 11. A rapid response unit from the Delaware Air National Guard, an aircrew from the Maryland ANG, and units from the Maryland Army National Guard were involved. Dozens of exercise observers from a variety of civilian and military agencies were also present to watch, listen, and learn.

A four-person Aeromedical Evacuation Liaison Team from the 142^nd Aeromedical Evacuation Squadron, 166^th Airlift Wing, DE ANG, stepped into this urban crisis shortly after 10:00am. The AELT was the initial eyes and ears for a small portable Expeditionary Mobile Aeromedical Staging Facility (EMSAF) rapid response team from the 142^nd AES that was assembling at the same time at Martin State Airport, just eleven miles northeast of downtown Baltimore. Phase I of the exercise was well underway, as roughly a hundred victims portraying a range of ailments and injuries were diagnosed and treated. At the same time, reality coincided with the exercise as twenty-three members of the public received real medical attention at the center’s emergency room.

1st Lt. Scott Russell, an experienced AELT member, said, "Our job is to help mitigate the incident with the resources we bring to the table. We come to the scene with a ‘What we can do for you’ attitude, all the while adapting to the civilian incident command system for command and control. It’s imperative that we adapt to our user service and not come in with a ‘You’ll do it my way’ attitude. Our motto is ‘there is always a way,’ and our team never utters the words ‘We can’t do that.’ Our initial mission was to find the key players on scene, from the medical center’s key trauma administrator, to the Incident Commander and the Medical Sector Officer, and the Maryland Army National Guard on scene commander."

A few hundred people had assembled to help the victims, from uniformed military members with medical skills to emergency responders, joining the civilian doctors and nurses, all trying to sort through the changing situation and get the injured to proper treatment inside the hospital. Firemen were present with fire trucks, and fire hoses were set up on top of ladders and turned downward to create showers for people to walk through to decontaminate their body from chemicals on their clothes and skin. In this turmoil, frantic family members arrived on scene, wanting to know what happened to their loved ones. Overhead, helicopters began to land on a hospital rooftop to unload the injured and take off again for more. Television, radio and newspaper media with cameras and microphones walk the streets, searching for stories.

Medical personnel made decisions throughout the morning as to which exercise victims needed further treatment at other hospitals that were best reached by fixed wing aircraft. That air evacuation portion of the exercise, Phase II, is where the 142^nd AES played a crucial role. The EMASF handles and treats patients who need intensive care that cannot be handled near the scene of an incident, transporting the injured aboard fixed wing aircraft, treating them while in the air, and then getting them to medical facilities on the ground for further treatment.

Earlier that Saturday morning, the total twenty-four-person emergency response team from the 142 AES scrambled morning some fifty miles away at the New Castle County Airport in northern Delaware. A simulated alert message was received, key people quickly assembled, and following emergency procedures, established communications, checked supplies and equipment, spent muscle power starting stubborn electrical generators, loaded vehicles, and departed their home base in a military convoy minutes after 9:00 am. The AELT left in an Air Force pickup truck. The bulk of the crew were transported in the back of two, two and half-ton trucks, plus one Air Force car.

The four person AELT is composed of 1^st Lt. Russell and Capt. Jim Leydon, both Flight Coordinators and Flight Nurses, plus OIC Maj. Geraldine Wyche and Tech. Sgt. Sherra Brown, Communication Specialist. All four AELT members met the Patient Administrator for the University of Maryland Medical Center, who matched up patients to beds on the 6^th floor Intensive Care Unit soon after the patients arrived in the hospital. When not meeting and talking face-to-face with a variety of other key people, the team worked from the Maryland Emergency Management Agency (MEMA) mobile command post. They remained in touch with the EMASF at Martin State Airport, and created a written manifest of patients who would be transported in the aircraft.

The AELT frequently talked with Lt. Col. (Dr.) William Beninati, from the Air Force Medical Service, who coordinated Phase II of the exercise. He is the Commander of the Coalition for Sustainment of Trauma and Readiness Skills at the University of Maryland’s Shock Trauma Center, and is among roughly fourteen military physicians, nurses and medical support staff assigned to C-STARS, a program in which AFMS people receive refresher training in shock trauma techniques. "When disaster strikes, natural or man-made, the best chance we have to save lives and reduce suffering is to have fine-tuned response systems,’ said Beninati. AFMS’s comprehensive presence included providing scores of medical staff from surgical to support, co-authoring the scenario and providing a small portable expeditionary aeromedical rapid response team (the 142^nd AES from the DE ANG). The mobile SPEARR teams provide medical support for a wide spectrum of aerospace -- and homeland defense -- contingency missions. A SPEARR team can provide health care for up to 500 people for five to seven days.

1^st Lt. Russell explained, "We’re here to educate our contacts on what Aerovac (short for Aeromedical Evacuation) does, show them we can get the patients onto an aircraft. I wanted to explain to them what our role was, so they did not have to worry about how we did our part, just that we were responsible for a certain role in the exercise."

Before patients could be airlifted, they had to be transported from downtown Baltimore to the airport. The MD Army National Guard loaded these 33 victims on stretchers inside eight Field Land Ambulances, FLA’s for short. These specially configured Humvees, which hold up to four patients per vehicle, were driven in a convoy to Martin State Airport. Maj. Leonard Rosicki, MD Army National Guard, heads up the 229^th Main Support Battalion. He brought eight crew from Medical Company C, and eight crew from the 729^th Forward Support Battalion, for this duty calling for speed and precision. The AELT accompanied this convoy in their pickup truck.

Before the FLA’s left the hospital, the AES team had already set up their EMASF at the airport. When the FLA’s arrived, AES members, along with Army Guard and civilian EMT personnel, took their cue, performing their interrelated and cooperative roles

Thirty-three manikins that simulated victims of the morning biochemical explosion were removed on their stretchers from the eight Humvees. Maj. Holly Huber from the 142nd AES checked their condition, and within seconds used hand signals and verbal commands to indicate the severity of the injury to AE and civilian personnel.

Four carriers lifted each patient by stretcher (also called a litter) from the Humvee into the EMASF tent. OIC Capt. David Ward coordinated the movement of patients in the tent, and their placement on the ground. Their condition was continuously monitored as patients in need were treated, and emergency medical procedures applied.

There were thirteen AES members in the EMASF. In addition to Huber and Ward, the others were NCOIC Tech. Sgt. Mark Metzelaar, 1^st Lt. James Mackey, 1^st Lt. Mary Ellen Millman, Tech. Sgt. Hugo McGillian, Senior Airman Kandis Samuels, Master Sgt. Matthew Smith, Senior Airman Amber Williams, Staff Sgt. Lucy Brent, Master Sgt. Aloysius Muscella, Senior Airman India Colon, and Maj. Charles Gebhart.

In another hour, a C-130J model aircraft from the 175^th Airlift Wing, Maryland ANG, flown by their aircrew, landed. In about 15 minutes, the AES team began an urgent but controlled and methodical carrying of victims on their stretchers into the aircraft, which kept its engine running. This Engine Running Onload (ERO) procedure is something the 142 AES has done many times, both in simulations and in missions as recent as those supporting Operation Enduring Freedom in Afghanistan.

Maj. Chuck Gebhart, performing the role of a ‘spotter,’ stood on the flight line, near the open back door of the aircraft, coordinating safety and security, talking to both the flight crew of the aircraft, and giving hand signals to the 142 AES members and other military personnel, telling them when to move the patients toward and onto the aircraft. The litter carriers walked into hot and strong engine exhaust blast from the four C-130J turbine propellers. At 3:40pm, all patients were on board. At 3:48pm the aircraft was in motion on the runway, at 3:52 the engines went full throttle. In thirty seconds the aircraft was in flight.

Five 142 AES aircrew, led by the Medical Crew Director, Capt. Debra Overton, plus Capt. Sheila Carter, Master Sgt. Thomas Hatcher, Staff Sgt. Dinah Lewis, and Senior Airman Lyette Brown monitored and treated patients when loaded in the aircraft and while in-flight.

At 4:50pm the aircraft landed. A one-hour flying mission was complete. Within minutes, all patients were taken off the aircraft in an orderly fashion, simulating that part of the mission where AE would prepare patients for quick and careful handoff to a civilian medical team for transport to a local hospital.

Throughout the exercise Lt. Col. Virginia Schneider, Commander of the 142 AES, and 2^nd Lt. Mike Blair, Communications Officer, worked closely with the exercise Command Post established at Martin State Airfield to ensure smooth mission execution. Lt. Col. Schneider said, "One of the main purposes of the exercise was to improve multi-agency interoperability. Multiple civilian and military organizations had the opportunity to learn about each other’s roles and responsibilities. The 142 AES came to execute our part well, and to demonstrate teamwork both within our unit and with all the other organizations involved in the exercise. The conditions were designed to simulate some of the confusion we might experience in a real disaster at home. We added expertise gained from our training and real-world missions abroad. From our perspective it was a successful exercise. We proved that we can respond to local emergencies within a relatively short period of time and we can successfully integrate with other agencies to provide rapid care, treatment and evacuation if necessary, to injured individuals."