Overlooking our Forward Operating Base on the Western edge of Ramadi, Iraq, is an abandoned glass factory. The place is huge, with smokestacks and tall buildings that loom over the base like the very scepter of death.
It was January 5, 2006, and I was off duty in my room using the computer to chat with my wife back in Vermont. A few hundred yards to my East, a U.S. Marine named Sgt Adam Leigh Cann was checking out a long line of Iraqi men with his bomb sniffing dog. The Iraqi men had come to the empty glass factory to apply for jobs with the Iraqi Police. This was a very encouraging sign, because getting a police force up and operational would bring us one step closer to going home.
Sgt Cann's dog detected the scent of explosives on a suicide bomber. As soon as he was discovered, the man detonated himself. Sgt Cann was killed instantly, along with scores of others. There were almost 100 men wounded.
The blast was huge, and it rocked our base. We scrambled to get our weapons, body armor and medical gear on. I became the crew chief on one of the first three ambulances to respond. As we raced toward the gate, dozens of vehicles passed us racing in the opposite direction. There were Iraqi civilian cars, Iraqi Police trucks and U.S. military vehicles filled with at least 40 or 50 casualties and racing towards the hospital on our base. None of them had any type of bandages applied and, in passing, most looked like critical trauma patients.
I radioed an alert to our hospital and pressed on through the rush of incoming vehicles out to the objective. The scene was a sea of mangled bodies, some living, some dead, stretching over an area 100 yards long and 30 yards wide. The living were writhing in pain and crying out in agony. The dead were everywhere. With three armored personnel carriers set up as ambulances, we had the capacity for 12 litter patients. There were almost 100.
I got out and thought through the disaster training I had received from numerous sources both military and civilian throughout my 20 years in the business. I thought about what to do first and remembered that in every disaster chaos reigns. In this instance, there were dozens of responders from several U.S. Military branches, a flood of well-meaning Iraqi civilian bystanders, numerous Iraqi Police, a smattering of Iraqi civilian ambulances and a river of blood.
Under the best of circumstances, with all of the responders having the same training, speaking one language and using the same radio frequency, a scene like this would be extremely difficult to manage. In this setting we had no portable radios to speak with one another, no visible means of discerning medical personnel from everyone else (no one wore red crosses--snipers would aim for the medics) and with body armor on, we could not even read names or ranks on most of our people. Once dismounted, the only way to communicate with our medics was to find them in the crowd, run over to them and yell in their ear. There was such a cacophony of noise no one could hear anything.
I quickly surmised that command and control would be impossible and incoming medical assets would have to find their own way through the madness. The best we could hope for was to triage the mass of patients and get to those who needed help the most. In hindsight, the one thing we could have done better was establish control of the entry and exit points for evacuation vehicles, loading each one to the fullest before sending it to the rear.