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The Glass Factory Disaster: Terrorism Response in Iraq
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.
I jumped in and started triaging patients. I did not stop moving much, just did quick checks of major hemorrhage, airway status and level of consciousness. The one thing that struck me was that there were no critical patients. Except for one man I considered expectant (mortally wounded and soon to die) all of the people I examined were either not that bad or they were already dead. In all, I must have triaged over 40 casualties, but I lacked any type of tag system to attach to the patients after I examined them. The only thing I hoped to do was to turn around and physically direct medics and litter teams to the critical patients, but when I found none, it was apparent that since almost all of the patients had less critical wounds, it really didn’t matter in what order they were evacuated. Apparently the worst trauma patients were already en route to the hospital via the bystanders or were dead.
It was a relief, actually, to realize that the scene was not as bad as it could have been, with more critical patients all vying for the same evacuation and treatment resources. Although it sounds terribly callous, it was also comforting to realize that almost all of the casualties were Iraqis. I didn’t know it at the time, but there were only two U.S. troops killed in action and four wounded. On a conceptual level, I knew that all human life was sacred. In practice, I worked just has hard to save enemy combatants as I did to save our own guys. On an emotional level, however, the loss of Iraqi life was so commonplace in Ramadi that I was numb to it. When innocent people were hurt or killed I was still saddened, but I was indifferent to the loss of enemy combatants. These people who tried to kill me and my buddies were already dead to me. I looked upon them as a way for us to hone our trauma skills with no emotional involvement. After six months in combat, I looked upon enemy combatants as targets.
We loaded up our ambulance and headed back to the base. There were two medics aboard, and I was not needed inside. As the track commander, I was also the gunner, so I climbed atop the track for the trip inside. We were in bandit country, after all, and our defenses were thin.
We dropped off our casualties and headed back out to the glass factory. The scene at the hospital was almost as chaotic as the actual scene of the disaster. The 40 or 50 casualties who had already arrived were everywhere, and the hospital-based medics were overwhelmed. In all, there were over 80 casualties treated at the small field hospital and about thirty treated at our battalion aid station. In the skies above us, medevac helicopters swarmed into Ramadi. They could not land near the scene, so they picked up casualties from a landing pad near the base hospital and dispersed them to any US military facility with surgical capability. Ordinarily, our casualties were stabilized by the surgical team at our base and then flown to a combat support hospital, but not in this case.
As soon as we off-loaded our patients, we raced back to the scene. We helped load up the remaining casualties onto other coalition vehicles and assumed a defensive posture along the perimeter. It became clear that the Iraqis would pick up their own dead. Our medical services were no longer needed, but there were only a handful of vehicles guarding the scene from the hundreds of onlookers, any one of whom could have been an additional bomber or carried a rocket propelled grenade. I spent the rest of the disaster looking down the barrel of a fifty-caliber machine gun at crowds of people. It was here that I thought about how twenty minutes earlier the scene was completely overrun by many of these same civilian bystanders. For better or worse, we had all let our guard down in reaction to the human tragedy before us. Anyone in the crowd could have picked up a discarded weapon and opened fire, but no one did. I thought perhaps there might be hope for these people after all.
Click here to listen to an interview with Thomas Middleton conducted by EMS Magazine Editorial Advisory Board Member Greg Friese. To read a review by Greg of Saber's Edge, see www.everydayemstips.com.
Thomas A. Middleton is the assistant fire marshal and public information officer for the Burlington (VT) Fire Department, and has been a long-time firefighter and EMT. He served as a combat medic in Iraq as part of Task Force Saber from June 2005-June 2006 and is a member of the Vermont Army National Guard.
ADDITIONAL ARTICLES BY THE AUTHOR
