Integratio of a small clinic into the Pentagon response: The Bolling Air Force base perspective

Military Medicine, Sep 2002 by Furman, Kenneth A

The September 11 terrorist attack on the Pentagon elicited a large-scale response to assist both active duty personnel and civilian employees. This article discusses the initial response and subsequent integration of a small military Behavioral Health Clinic into the overall helping response. The unique requirements to simultaneously assist with the Pentagon response, while addressing the needs of the Bolling Air Force Base community are highlighted. Recommendations are provided to assist the military in the event of future contingencies.

Introduction

Bolling Air Force Base (AFB), Washington, DC, home of the 11th Wing, provides direct administrative major command support for Headquarters Air Force (within the Pentagon). For the purpose of discussion of this article, organizations at both the Pentagon and Bolling AFB are considered to be part of the "Pentagon Response." The base has a small Behavioral Health Flight within the 11th Medical Operations Squadron, 11th Medical Group. An Air Force Behavioral Health Flight consists of Mental Health, Family Advocacy, and Substance Abuse Elements (clinics). During peacetime, their mission is to provide mental health, family advocacy, substance abuse, and drug testing services to active duty personnel and families assigned to Bolling AFB, as well as other service personnel assigned to the National Capital Region who receive their health care from the 11th Medical Group. They also provide limited mental health consultation and support to the Pentagon Flight Medicine Clinic and the DiLorenzo TRICARE Health Clinic, which are both located within the Pentagon. The clinical staff consist of one active duty clinical psychologist, one active duty social worker, two civilian social workers, and five active duty mental health technicians.

Immediately following the September 11 attack on the Pentagon, all personnel within the Behavioral Health Flight were assembled and emergency supplies were gathered. During the first several hours, staff were not able to leave the clinic at Bolling AFB due to the possibility of other terrorist activities and the increase in the Force Protection Condition. This time was spent in reviewing the principles of disaster response and in gathering equipment and materials likely to be needed in responding to the unfolding contingency. Calls were made to the other agencies of the 11th Wing Integrated Delivery System-a coalition of base helping agencies, to coordinate the potential responses with those of the chaplains, family support center, and other base helping agencies. Various plans were made depending on what type of response would be requested by base and medical group leadership either at Bolling AFB, the Pentagon, or both.

Mission

Early on September 12th, the Behavioral Health Clinic Chief was in coordination with his counterparts at the major military medical facilities in the National Capital Region, including Walter Reed Army Medical Center, U.S. Naval Hospital-Bethesda, and Malcolm Grow Medical Center to discuss the now ongoing activation of the Tri-Service mental health teams. That same morning, members of the Bolling Behavioral Health Flight were tasked by the Bolling Wing Commander to assist the Officer in Charge of the mental health response at the Pentagon to coordinate the multiservice, multidisciplinary response to the attack and rescue and recovery efforts. The majority of staff, augmented by two Air Force volunteers (clinical psychologists), were taken to the Pentagon and were among the first mental health professionals in the building. The psychologists assisted with the initial planning and decision making regarding what type of response was required, how to implement, and how to integrate other mental health personnel arriving over that and the following days. This was a collaborative, Tri-Service process based on a needs assessment. Bolling personnel were assigned to and incorporated into various teams working inside the building with individuals and organizations, as well as outside with the search and recovery crews in a variety of roles to include administrative support and provision of services. These efforts in general are described in greater depth in other articles within this publication.

As a result of the multitasking of the Bolling team (assist with the Joint Service Mental Health Team, consult with and provide treatment for "regular" Pentagon customers, and to coordinate and execute the disaster response at Bolling AFB proper), the decision was made by the Bolling AFB Team Chief to maintain a large degree of independence. While generally working within the framework established by the Officer in Charge, the Bolling AFB Team Chief retained command and control over his personnel. Each day he would decide what Bolling personnel would be dedicated to helping efforts at the Pentagon and Bolling AFB. For those assigned to the Pentagon effort, these Bolling personnel would then be placed into the "pool" of Air Force and Army mental health workers and assigned duties for the day by the Officer in Charge. Several days following the attack and initial emergency response, additional mental health workers were brought in from other military bases and incorporated into the expanding operation. At this time, Bolling Behavioral Health Flight staff were more permanently re-distributed by the Boiling Team Chief to duties at either the Pentagon or Bolling AFB. For Bolling personnel at the Pentagon, the mission evolved as they continued to work closely with other deployed mental health assets within the building, while also beginning to work on unique, complimentary, or parallel missions. These decisions were made to better maximize Bolling personnel's greater knowledge of Pentagon personnel and organizations and the more established relationships they had with these groups before the terrorist attack.