Page 25 - Journal of Special Operations Medicine - Summer 2014

of emergency care. This is not the case at Camp Blanding, Case Presentation 2
which is like many other Department of Defense (DoD) On Friday, 13 June 1997, at 0228, Major A.B. was pro-
installations such as Dugway Proving Ground and Pacific nounced dead on arrival at Shands Jacksonville Trauma
Missile Range Facility. In this setting of geographic isola- Center after more than 2 hours of what was described
tion, the TMC or equivalent is the “only game in town” as a “comedy of errors” in the response to his tragic
for many miles. In similar circumstances in the civilian accident. MAJ A.B., a decorated member of the 82nd
4
sector, the “freestanding emergency center” concept has Airborne Division, was grading a major field training
developed and is spreading rapidly. 2
exercise for the Maryland Army National Guard. While
observing an ambush lane on a supposedly closed road,
Camp Blanding, established in 1939, is located in Clay he was run over at 0015 by a 2½-ton truck that was
County, FL, southwest of Jacksonville. With 73,000 driving under blackout conditions. Due to communica-
acres of land and capable of hosting up to a light infan- tion failures with Range Control (the post’s 911 center)
try brigade as well as a battalion-sized opposing force, it and obstacles placed along the roads for the exercise,
is the primary training site for the Florida Army and Air the medics in the first field litter ambulance (FLA) did
National Guard. The TMC, overseen by Winn Army not arrive until 0045. They found him combative with
3
Community Hospital, is the sole general-access medical a fractured pelvis and rigid abdomen but were unable to
facility on post, although several tenant units have small restrain him and provide spinal immobilization as their
aid stations. This facility is equipped with a dispensing FLA had not been stocked with a cervical collar. A sec-
pharmacy, four general examination rooms, one trauma ond ambulance was called in, and the patient was trans-
bay with ambulance bay and dual-aircraft capable ported to the TMC for aeromedical evacuation. Due to
MEDEVAC helipad, and a six-bed inpatient ward (one lack of communications and prolonged timeframe, the
isolation bed) credentialed to hold patients for up to 72 civilian MEDEVAC helicopter called by range control
hours. Figure 1 displays the front entrance of the facil- had been forced to return to base due to fuel concerns.
ity. As is usual in similar facilities, staffing typically con- The PA on duty in the TMC documented only a brief
sists of a primary care physician or physician assistant neurologic exam and MAJ A.B. was loaded at 0138 into
(PA) with two or three healthcare specialists (medics). a waiting nonmedical UH-1 “Huey” aircraft for trans-
EMS consists of a civilian EMS helicopter from Jackson- port to Naval Hospital–Jacksonville accompanied by
ville and a civilian Clay County paramedic ambulance two ground medics. The PA called ahead to the Naval
that is stationed on post but responds to the surround- Hospital and was told to send the aircraft to Shands
ing county area as well. The nearest hospital, 10 miles Jacksonville as there was no surgeon on duty, but it was
away from the main gate (approximately 15 minutes by too late and the aircraft had switched off of Camp Blan-
ground under optimal conditions), is the 25-bed Shands ding’s radio net. They arrived at the Naval Hospital’s
Starke Medical Center, which does offer basic emergency remote helipad at 0150, where they waited 8 minutes
services. The nearest trauma center is 41 miles from the for an ambulance to come from the emergency room for
main gate (approximately 50 minutes by ground under pickup as staff had anticipated the patient had been di-
optimal conditions) at the 620-bed Shands Jacksonville verted. Apparently unprepared and upset, they insisted
Medical Center. Many patients with a need for inpatient MAJ A.B. be sent to the trauma center. The confused
care are transferred the nearest major MTF at the 64-bed and likely overwhelmed medics hurried back to the heli-
Naval Hospital–Jacksonville, 29 miles away (approxi- pad and loaded MAJ A.B.’s litter back into the “Huey,”
mately 44 minutes by ground under optimal conditions).
where he went into cardiac arrest. They performed CPR
Figure 1 U.S. Army TMC at Camp Blanding, FL, on the 3-minute flight to Shands Jacksonville, where he
front entrance. was pronounced dead. Florida National Guard lead-
ers vowed not to let this tragedy happen again and re-
sponded primarily by allowing the local civilian EMS
system to station an ambulance on Post. MAJ A.B. was
buried at Arlington National Cemetery, leaving behind a
wife and then 5-year-old daughter.

Methods
Overview
Student medical officers stationed at University of
South Florida College of Medicine first supported the
Camp Blanding TMC in February 2013. The TMC had
undergone a major renovation in 2009, adding a new

Preparedness for Resuscitation at an Isolated Army Troop Medical Clinic 15