chapter eleven preparing for action - united states army · captain jeanne picariello was another...

Preparing for Action 255

Chapter ElevenPreparing for Action

A majorthemedatingfromthe1970sthatgrewsignificantlystrongerinthe1980swastheArmy’sclear-cutdeterminationtobetterprepareforfuture combat.Themajorcomponentsofthismovementinvolvedmaintaining

properphysicalfitnessandimprovingtheoverallreadinessoftheArmy.1 AHealthyandFitForcewasthefirstpillaroftheHealthServiceSupportAir-

LandBattle,thedoctrineforcontemporarycombatservicesupportderivedfromlessonslearnedfromWorldWarIItothecampaigninGrenada.2TheHonorableJohnO.Marsh,secretaryoftheArmy,espousedthebeliefthatreadinessbeganwithphysicalfitnessandencompassedallaspectsoftotalfitness.GeneralE.C.Meyer,thechiefofstaffoftheArmy,insistedthateachindividualwaspersonallyresponsible for developing andmaintaining lifestyles for themselves and theirsoldierstomeettherigorsofmilitaryservice,affirmingthatappropriatephysicaltrainingandpropernutritionalhabitsaffectedprofessionalcompetency.GeneralHazelJohnsonexplainedthatthecomponentsofatotalfitnessroutineforArmynursesincludedeatingasensiblediet,copingwithstress,controllingweight,es-chewingsubstanceabuse,participatinginregularphysicalexercise,andprevent-ingdisease.JohnsoninstructedallArmynursestobeginsuchanall-encompass-ingprogram,andadvisedthemthatfailuretodosowouldadverselyaffecttheirArmycareer.3 OneindicationoftheArmy’sintenttopromoteallsoldiers’fitnesswasitsin-

creased emphasis on successful completion of theArmyPhysical FitnessTestandcompliancewiththeheightandweightstandardstwiceyearly.4Meetingthestandardssignificantlyaffectedselectionsforpromotion,continuationonactiveduty, and schooling opportunities.TheArmy required officers tomeet the fit-nessstandardsbeforeitapprovedtheirattendanceateducationalcourses.Thosewhodidnotmeetstandardshadtheircourseattendancedelayed.GeneralClaraL.Adams-Enderadvisedofficersthatthe“rationaleforthedelayisforthebenefitofyou,theofficer.”Attainingthestandardswaspartofcoursecompletionrequire-

256 A Contemporary History of the U.S. Army Nurse Corps

ments,andsonotmeetingthemcouldprecipitateastudent’sfailureinaspecificcourseorcouldresultinapooracademicefficiencyreport.5Thiscouldadverselyimpactselectionforpromotionsandotheropportunities.TheArmy’semphasisonthefitnessbenchmarksmeantfailuretomeetthemcoulddoomacareer.TheArmyMedicalDepartment (AMEDD) officers occasionally singled out

ArmyNurseCorpsofficersfortheirfailuretomeetthefitnessrequirements.Colo-nelCharlesJ.Reddy,chiefoftheNursingDivisionattheHealthServicesCom-mand(HSC),allowed thatmuchwaswrittenandsaidaboutArmynurseswhodidnotmeetweightstandards,butonly5percent(151of2,999)ofArmyNurseCorpsofficersassignedtotheU.S.ArmyHSCexceededweightstandards.LessknownandpublicizedwerethepoundsthatArmyNurseCorpsofficersshedtoconformtobenchmarks.ThemajorityofArmynurseswerecomplyingwiththeweight standards,passing theArmyPhysicalFitnessTest, livinghealthy lives,andexcellinginathletics.6ArmyNurseCorpsofficersalsoworkedtoimproveoverallArmyfitnesslevels.

Theysucceededbeyondanyone’sexpectations.Manyofthemobtainedgraduatedegreesandexperienceascardiac rehabilitationclinicalnurse specialistsor ascriticalcarenurses.7 InMarch1984,CaptainLeslieBrousseaubecamethehealthfitnessconsultant

toEurope’s7thMedicalCommand.Inthatrole,shewroteamonthlyhealthandfitnesscolumn for thecommandnewspaperand servedasaprojectofficer formanyhealthpromotionactivities,suchastheEuropeanCommand’sGreatAmeri-canSmokeout,atobacco-cessationprogram,andhighbloodpressuremonth.ShealsocoordinatedhealthfairsandhealthfitnessconferencesinEurope.8 CaptainJeannePicariellowasanotherArmynurseinvolvedinimprovingfit-

ness.ShewasamemberoftheU.S.ArmyPentathlonTeamfrom1975to1978,thefirstwomanandArmynursetoparticipate.9PicariellowasprogramdirectoroftheArmyStaffCorporateFitnessProgramin1985and1986.SheworkedwithtwootherArmynurses,ahealthriskappraisalandinterventioncoordinator,andthesurgeongeneral’snursingconsultantonfitnesstogaugethecosteffectivenessofhealthpromotionactivitiesof6,000militaryandcivilianPentagonemployees.Asapartoftheproject,volunteersunderwentapreliminaryphysiologicalassess-mentofcurrentfitness levelsand thenstartedphysicalconditioning.Basedonindividualneeds,volunteerscouldenrollinclassesonsmokingcessation,weightcontrol,andstressmanagement.Withcontrolandexperimentalgroups, the re-searchersmeasured and statistically analyzed the variables ofwork productiv-ity,reductionsinhealthcareexpenses,jobabsenteeism,andturnover/retrainingcosts.10Thestudydemonstratedapositivephysiologicaladvantage fromstruc-turedcardiovascularscreeningandhealtheducationclasses.11Picarielloconclud-edthattheprogramwascosteffectiveandwellaccepted.Usingcivilianstaff,theDepartmentofDefense(DoD)continuedtheprogramforthePentagonworkforceover the succeedingyears.12Picariello later servedascommandantof theU.S.ArmyPhysicalFitnessSchoolatFortBenjaminHarrison,Indiana,from1994to1997,wheresheoversawtheArmy’sstudiesontheArmyPhysicalFitnessTest


PicturedisColonelCharlesReddy,ChiefNurse,HealthServicesCommand,1985.PhotocourtesyofArmyNurseCorpsArchives,OfficeofMedicalHistory,FallsChurch,VA.


CaptainJeannePicarielloassessesaparticipantintheArmyStaffCorporateFitnessPrograminthePentagonin1985.PhotocourtesyofArmyNurseCorpsArchives,OfficeofMedicalHistory,FallsChurch,VA.


standardsthatledtorevisionsintheexistingbenchmarks.13 In1987,LieutenantColonelAntoinetteHagey,ahealthpromotionsnursespe-

cialist,madehercontributiontotheArmyfitnessprogram.Sheoversawthede-velopmentand implementationof thehealth riskassessmentcomponentof theArmyHealthPromotionProgram.HageyconcurrentlyservedontheDoDHealthPromotionCoordinationCommitteeandtestedandselectedmaterialsforeduca-tiononsmokingcessationandhypertension.14 Fitnesswasakeycomponentofreadiness.Withoutsoldiersfittofight,readi-

nesswasadifficultifnotimpossiblestatetoachieveonbothapersonalandunitlevel.AMEDDleadersdefinedreadinessastheabilitytoimmediatelydeployquali-

fiedmilitarymedicalpersonnelinsupportofcombat.15Otherelementsalsode-termined readiness.A multidimensional construct, readiness presupposed unitcohesion or a statewhere soldiersworked efficiently in unison for a commongoal.Achievingthegoalrequiredphysicalagility,mentalpower,psychologicalaptitude,andeffectiveleadership.16AppropriateTableofOrganizationandEquip-ment(TO&E)equipment,adequatelevelsoftraining,andpersonnelstrengthalsoinfluencedreadiness.ForLieutenantGeneralQuinnBecker,thesurgeongeneral,readinessdemandedtheintegrationoffinelyhonedmedicalskillswiththelogisti-calabilitytogettherightequipmentandpeopletotheappropriateplaceatthenecessarytime.17

AstheAMEDDenteredthe1980s,seriousreadinessproblemsexisted.In1982,AssistantSecretaryofDefense(HealthAffairs)(ASD[HA])JohnBearywarnedthatthemilitarymedicalservicescouldprovidesurgeryforonlyonein10wound-edcombatantsintheeventofwar.18Bythemid-1980sofficialsdescribedthelevelofmedicalreadinessasextremelycritical.Speakingin1985,ASD(HA)WilliamE.Mayersharedhisdourassessmentwiththenation’sphysicians:

Iregrettotellyouthatifweenteredamajorconventionalwartoday,thesystemcouldnotrenderanadequatelevelofemergencysurgeryandresuscitationtothewoundedinaction.Morbidityandmortalityratescouldbehigh.19

Oneyear later, in 1986,Mayerwrote of steady improvements, although themilitaryhealthcare systemwasstillnotup topar. In theeventofwar,Mayerwrote,“scarcelythreeoutoftenwounded[would]receivethepromptcarethatcanspellthedifferencebetweenlifeanddeath.”20 Atthesametime,medical readinessbecameahigh-profile issue thatproved

embarrassingwhendetailsbecamepublic.21Bothcivilianandmilitarynewspa-persandmagazineschronicledreadinessdeficienciesfromthelevelofDoDallthewaydowntotheAMEDD.In1985,Reader’s DigestquotedaU.S.AirForcephysicianwhobelievedthatweretheUnitedStatestogotowarpriorto1991,“alotofpeoplearegoingtodieunnecessarily.”22Aroundthesametime,aformerNavyphysicianproclaimedintheWashington Post thattheentiremilitarymedi-cine systemshouldbe abolished,with resultant annual savingsofhundredsofmillionsofdollarsbytheeliminationofmedicaldepartmentsalariesandbythe


saleofmilitarymedicalfacilities,locatedonprimerealestatearoundWashington,D.C.,California,andHawaii.23In1986,U.S. News & World Report characterized readinessof themilitarymedical services as substandard, recounting thatonly30percentofinfantrymenwoundedinbattlecouldrelyonpromptmedicalcarebecauseofpersonnelandlogisticaldeficits.24 ArmymagazineacknowledgedthatArmymedicinewastheobjectofintensecontroversybecauseofitslackofreadi-nessforcombat.25TheDepartment of Army Historical Summaryaddeditsvoicetothecalamity,recordingthatthe“abilitytoprovidewartimemedicalsupporthasbeenseverelylimitedbyashortageof themedicalequipmentandprofessionalmedicalpersonnel.”26Everyonerealizedshortcomingshadtobecorrected.Fortu-nately,plansforimprovingandupgradingmedicalcombatsupportwerealreadyintheworks.In 1982, the actingASD(HA), Beary, instructed the threemilitary services’

medicaldepartmentstouseonlyfieldhealthfacilitysystemsdevelopedbyaquad-servicetaskforce,theMilitaryFieldMedicalSystemsStandardizationSteeringGroup, and approved byBeary’s office.His aimwas to improve the services’medicalsupportlevelsandlogisticalcapability.27Becker,theArmysurgeongen-eral,opposedBeary’sdictum,questioningthewisdomofajoint,strictlyhomoge-neousapproach.BeckersawthemandateasanattempttotakecontrolawayfromtheArmyandallowDoDtodictatethesizeandconfigurationofthemedicalde-partmentsoftheservices.WithoutthedestinyoftheentireAMEDDinhishands,Beckersawonlytroubleahead.28Nonetheless, theDeployableMedicalSystem(DEPMEDS), as it came to be known,moved forward.By 1984, theMilitaryFieldMedicalSystemsStandardizationSteeringGrouphadagreedontheuseoftheTEMPER,as thestandardizedfabricwall (exteriorsideof the tent) for thechosensingle-systemDEPMEDS.Thefabricdesignincorporatedalayerofairthatservedasinsulationtocounterextremesofhotorcoldweather.Allthemili-taryservicestestedthenewequipmentatFortHood,Texas,inNovember1984anddeterminedthattheDEPMEDSwasabletocarryoutthemission,aslongasimprovementsweremadetomakeitmoreeasilytransportable.29 During the next fewyears,Congress funded 30 sets ofDEPMEDSs for the

AMEDD,andtheArmyerectedacompleteprototypehospitalatCampBullis,Texas,inAugust1987.30TheDEPMEDS’costfora60-bedmobilearmysurgi-calhospital(MASH)in1987was$8.2millionand$16.6millionfora1,000-bedgeneralhospital.31 InFebruary1988,the8thEvacuationHospitalatFortOrd,California,became

thefirstTO&EunittofieldDEPMEDSs.ItdeployedtoFortHunterLiggett,Cali-fornia,andsetupa400-bedDEPMEDShospital,staffingitwith85ProfessionalOfficerFillerSystempersonnel.32TheassignedstaffimplementedaDepartmentoftheArmy–directedassessmentandvalidationoftheequipmentandforwardedtheirfindingstotheTestandExperimentationCommand.Fieldtestingdidvali-date theutilityofDEPMEDSequipment. In January1989, the8thEvacuationHospital deployed toHonduraswith itsDEPMEDS facility to supportFuertesCaminos 89.33 The detachment inHonduras treated the first surgical case and


deliveredthefirstbabyinaDEPMEDS.ActiveArmy,ArmyNationalGuard,andArmy,Navy,andAirForceReserveunitstookpartinthedeployment.34By1990,theArmyhadfielded46DEPMEDShospitalsetsandexpectedtoequipatotalof129hospitalsinthenearfuture.35 DEPMEDSusedmodulesthatofferedalmostunlimitedpotentialforconfigu-

ration.36Thehard-walled containers, referred to as ISOcontainers, housed theoperating room, radiology, laboratory, pharmacy, and central supply elements.TheTEMPER,soft-sidedtents,containedthetriagearea,intensivecareunits,andinpatientwards.37

TheDEPMEDSmodelhadbothadvantagesanddisadvantages.Itsmanyad-vantageswereitsfuelefficiencycomparedtotheMobileUnit,Surgical,Trans-portable(MUST)facility,itsrelativeeaseinassemblyanddisassembly,itsflex-ible configuration, its improved level of lighting, and its standardizedmedicalandnonmedicalequipment.38ThenonmedicalstandardizeditemsinDEPMEDSwereelectricalgenerators,dietarysystems,waterdistributionandutilitiessupportequipment,bathingfacilities,oxygen-generatingmechanisms,water-productionsystems, power distribution infrastructure, and environmental-control compo-nents.39Theseadvantagesoutweighed themajorproblemof the sets: their im-mobilityandexcessiveweight.ThesizeandweightoftheDEPMEDSforcedColonelJeromeFoust,Medical

ServicesCorps(MSC),commanderofthe44thMedicalBrigade,toreducethebulkof combat supporthospitals andMASHsduringOperationDesertStorm.ThisenabledtheDEPMEDStomovewithorganicvehiclesandkeeppacewiththecombatunits.40Inturn,thatledtothedualdevelopmentofamini-MASHandtothecreationofaContingencyMedicalForce.Themini-MASHdownsizedtheMASHunitfrom60bedstoa30-bedintensivesurgicalhospital.AdoptionoftheContingencyMedicalForce,firstutilizedintheBalkansduringthe1990s,furtherstreamlinedcombatmedicalsupport.41TheDEPMEDSfacilityalsowasvulner-abletobiologicalandchemicalwarfareattack.AfterthefirstGulfWar,plannersdebatedhardening theDEPMEDSequipment toprotect against biological andchemicalwarfare,buttheaddedweightandcomplexitywouldrenderitsuseex-tremelydifficultforafieldunit.However,intheimmediateaftermathofthewar,plannerscreatedaninsertfortheTEMPERtentsandretrofittedafilterfortheairhandlerstolessenthethreatfrombiologicalandchemicalwarfare.42

DoDarrivedatmedicallogisticalstandardizationofDEPMEDSbyconvening23panelsofexpertclinicianstoidentifytherapeuticregimenstotreatmorethan300combat-relateddiagnosesbasedonactualcombatdata.TheTask/Time/Treat-erdatabase,asitwasknown,detailedprecisesuppliesandequipmentrequiredtoprovide eachdiagnosis-specific treatment.43TheDefenseMedicalStandardiza-tionBoard (DMSB)graduallyassumed theoverall responsibility forobtainingequipmentanddeterminingstaffinglevelsfortheDEPMEDS.44

DEPMEDSbeganasalogisticalsystem,aphysicalfieldhospital,butwithtimeitalsobecameapersonnelelement.45AsubunitoftheDMSB,theJointServicesNurs-ingAdvisoryGroup,atri-servicetaskforcewithArmyNurseCorpsrepresentation,


originallycalculatedtherequirednursingassetsneededintheater.46However,theDMSBslashedtheJointServicesNursingAdvisoryGroup’srecommendations,rejectingtheproposednumbersandmixofnursingstaffbecausefieldstaffinghadtobe“austerebutadequate.”47NursescounteredthatwhiletheDMSB’sstaffinglevelswereaustere,theywereneitheradequatenorsafe.GeneralConnieSlewit-zkefelt that theMedicalCorpsandMedicalServiceCorpsofficersnever tooknursesseriouslywhentheytalkedaboutsafestaffinglevels.Manytime-consum-ingandacrimonioussessionsjustifiedandrejustifiedstaffing.48OnlyafterseveralyearsofstrugglecouldtheArmyNurseCorpsproducefirmevidencedemonstrat-ing the amount of time each nursing procedure consumed based on Sherrod’spreviouslydescribedNursingCareHourStandardsStudy.With theestablishedestimatesofthepotentialtypesandnumbersofdifferentpatientsrequiringcareattheDEPMEDSfacilitycalculatedagainsttheknowncareneedsforthesepatients,theArmyNurseCorpsusedSherrod’sstatisticstoshowanaccuratepictureofthenumbersandtypesofnursesrequired.49WithoutSherrod’shardwork,theArmyNurseCorps, in Slewitzke’swords,would “really have been behind the eightball.”50 By the 1990s, however, even thesemore realistic staffing levels seemed in-

adequateforcutting-edge,adequatemedicalcare.Atthattime,theArmyNurseCorpsrecognizedthatbasingmobilizationstaffnumbersonthetasktimesoftheWorkloadManagementSystemforNurses(WMSN),asthenrecommendedbyaManpowerRequirementsCriteriadocument,createdunrealisticandinsufficientnumbersofstaff.GeneralNancyAdamswrotethatevenamodifiedWMSNwasinappropriateforstaffforecastinginmobilizationsituations.Corpsleaderscon-cludedtheWMSNhadbeendevelopedmanyyearsinthepastandneededupdat-ing.Thesystem,moreover,wasneverintendedforuseinacombatsetting.Fieldconditionssuchasreducedcommunications,limitedelectricalpower,inadequateclimatecontrol,lackofplumbing,poorautomation,andrestrictedinfrastructureresources dramatically increased a nurse’s time to do even the simplest tasks.Combatnursingstaffnecessarilyspentmoretimeandenergybuildingandmain-taining thehospital,andonduties relating tonuclear,biological,andchemicalconcerns,sentryduty,fieldsanitationchores,staffofficeranddriverduty,erectingandmaintainingbunkers,fillingsandbags,andmanyotherunanticipatedrespon-sibilities.ThereweremanyotherargumentsagainstusingtheWMSNtogaugestaffing.For instance, therewas theerroneousbelief that theadministrationofmultipleantibiotics,thestandardofcarefortraumapatientswithcontaminatedcombatwounds,wouldbeunderestimatedandcountedintheWMSNasonlyonetask.Inreality,theadministrationofmultipleantibioticswouldactuallyrequiremoretimebecauselimitedpharmacysupportwasavailabletopreparethemedi-cations.Also,assumptionsthatlessnursingcarewasneededwithlimitedtech-nological equipment failed to comprehend the certainty that less-sophisticatedequipmentincreasedtheneedforone-on-onecare,demandingamorelabor-in-tensiveeffort.TheWMSNpresupposedthatnurseswereworkingfiveeight-hourshifts(40hours)aweek,butmobilizationstaffingassumedthatpersonnelwould


Throughouther assignment as chiefnurseof the121stEvacuationHospital and the18thMedicalCommandinKorea,aspicturedhere,andinhersubsequentroleasassistantchiefoftheCorps,Colo-nelTerrisKennedyusedherwealthofpracticalknowledgeaboutpersonnelstrengthissuesandreadi-nessconcernstoimprovetheabilityoftheArmyNurseCorpstosupportfuturecombatoperations.PhotocourtesyofColonelTerrisKennedy,Onancock,VA.

worklongershiftswithlesstimeoffduty.Adamsbelievedthatitwasunrealis-ticintimesofcontinuousoperationstorequirenursestoworkattheirpeakforlengthyperiodswithouttimeoffandwantedflexibilitybuiltintothesystem.Herofficestayeddedicatedtocreatingrational,meaningful,andvalidatedManpowerRequirementsCriteria standards for combatnursing.51 ColonelTerrisKennedy,theassistantchiefoftheCorps,subsequentlyrecommendedthattheHealthCare Studies/ClinicalInvestigationsAgencyatFortSamHoustonvalidateanddocument


actualnursingcarerequirementsformobilization.Untilsuchastudywascom-pleted,theArmyNurseCorpshadnowayofknowingifitsfieldstaffingrequire-mentswereaccurateandifthediscrepanciesidentifiedwithManpowerRequire-mentsCriteria’snumberswouldberesolved.52

Many Army Nurse Corps officers spent a great deal of time with the DEPMEDSprojectdevelopinganimprovedfieldfacilitywithfunctionalequip-mentandsuppliesandappropriatenursingstafflevels.LieutenantColonelCol-letteKeyser,anoperatingroomnurse,becamethefirstmilitarynursetoworkwithDEPMEDSasastaffer intheHealthCareOperationsOfficeintheSur-geonGeneral’sOfficein1983.KeysermeticulouslycomputerizedinformationandlistsofsuppliesrequiredforOperatingRoom/CentralMaterielSupplysetsandtrays.Sincenoothermilitaryservicehadassignedanursethatearlytothe DEPMEDS project, the sister services had to accept Keyser’s recommenda-tions.53LieutenantColonelRogerHopkins,whohadbeenassignedtotheAcad-emyofHealthSciencesandworkedwiththeManpowerRequirementsCriteriaprocessandhadexperiencewithTO&Ematters,chosewardequipment.54Colo-nelEilyP.Gormancollaboratedonthequadpanels.LieutenantColonelDianeCorcoran,whileassignedtotheProponencyOfficeoftheDirectorateofTrain-ing andDevelopment at theAcademy ofHealth Sciences, did extraordinaryworktojustifynumbersofnursingstafffortheDEPMEDS.55ThiswascrucialbecauseColonelDemetriosG.Tsoulous,akeyprojectofficer,drasticallyunder-estimatednursestaffingrequirements.Forinstance,hebelievedatotalstaffoftwopeoplecouldmanagetheholdingward24hoursaday/sevendaysaweek.Slewitzke’s comebackwas that theycould,but “theyaren’tgoing toget anysleep.”WhenTsoulousfailedtoadjusthiscomputations,CorcoranwouldnotifytheArmyNurseCorpsleadershipinWashington,D.C.,aboutwhatwashappen-ingbybackchannel,thusprovidingseniorofficerswithinformationtofightforthecauseofadequate, safe, levelsof staff.Slewitzke’sofficeworkedcloselywithCorcorandefendingrequirementsandprovidingrationalethatinturnshewouldcommunicatetoTsoulous.TheArmyNurseCorpsregainedsome—butnotall—ofitsauthorizednursingslots.56 LieutenantColonelElizabethWaners-dorferlatercarriedontheeffortwhensheservedaschief,hospitalnursing,andDEPMEDSnurseconsultantatMedicalResearchandDevelopmentCommand.Thereshemonitoredmorethan5,000itemsofmedicalsuppliesandequipmentandchairedtheQuad-ServiceNursingPanelthatdefinedintensive,intermedi-ate,andminimalcarepatientsforthemobilizationdoctrine,developedmobili-zationstandardsofpractice,andreviewedandrevisedtheDEPMEDSnursingdatabase consisting of nursing tasks, times, and treaters.57 At the end of the tumultuousperiodin1988,Slewitzkereflected:

Weareabletokeeponhammeringhomeourpointsothatwedon’t lose.AsIsaidmanytimesover,wearethepatients’advocate.Ifwedon’tdoit,therewon’tbeanyonetherethatwilldoitforthepatients...thereisnowayunderGod’snamethatourpeoplewouldnotbestressedoutbecauseofthecategoryofthepatientthatwearetakingcareof.Wefoughtmanyiterations....Wehavedoneanawfullotofwork.58


Withattentionsharplyfocusedonreadinessissues,theArmyNurseCorpsre-spondedtotheimperativetobetterpreparenursesforfieldoperations.Johnsonor-deredareviewofallArmyNurseCorpscoursestoidentifydeficienciesthatneed-edtoberemediedinsubjectssuchasfieldskillsandknowledge.59SheexpandedtheemphasisalreadybeingplacedonfieldnursingintheArmyNurseCorpsOf-ficerBasicCourse andOfficerAdvancedCourse atFortSamHouston,Texas.In July1983, theArmyNurseCorps initiatedaFieldNursingCourseat the

AcademyofHealthSciencesandatCampBullis,Texas.Thefirstclassmetfortwoweeks,butbudgetconstraintsforcedtheArmyNurseCorpstoshortenthecoursetooneweekthefollowingyear.TO&Echiefnursesandstaffnursesre-ceivedpriorityforattendance.AnyfurthervacanciesweresequentiallyallocatedtoTableofDistributionandAllowances/Augmentationchiefnurses,seniorArmyNurseCorpsofficers,andfinally,fixedunit staffnurses.60Faculty includedse-lectedTO&Echiefnurses,suchasMajorLynneConnelly,whotaughtclassesonthecareofnuclear,biological,andchemicalpatients.Othersprovided tutelageonvariousotheraspectsoffieldcare.Classeswereheldintents,andfieldtrain-ingexerciseswere thepreferredmethodof instruction.Gradually,morenursesattendedtheCombatCasualtyCareCourse(C4).However,becausemuchofthematerialintheFieldNursingCourseProgramofInstructionreplicatedthatofC4,ArmyNurseCorpsleadersdiscontinuedofferingtheFieldNursingCourse.61

BoththeNavyNurseCorpsandtheAirForceNurseCorpssponsoredsimilarcourses incombatnursing.TheNavalHealthSciencesEducationandTrainingCommandofferedanurseoperationalreadinesscourseforitsnursesforthefirsttime inSeptember1981 toprovide informationandpractice forfleetandfieldactivities.Originally,theNavylimitedthecoursetoclassroomactivitiesbutlaterexpandedthecurriculumtoCampLejeune,NorthCarolina,andCampPendleton,California,toprovidemorerealisticexercises.62TheAirForcegraduatedthefirstclassofitsquarterlyBattlefieldNursingCourseinJuly1982.Thecoursewasheldforfivedaystopreparenursesfortreatingbattlefieldcasualtiesandtodeveloppa-tientmanagementskillsinthefield.Instructionreliedonseminarsandlaboratoryandfieldwork.63Allthemilitarynursingserviceswerestrivingtoimprovelevelsofcombatreadiness.Anothermajorefforttopreparetri-servicepersonnelfortheircombatroleswas

theC4program.Intheearly1980s,theJointMedicalReadinessEducationCom-mittee,composedofthesurgeonsgeneralandthepresidentoftheUniformedSer-vicesUniversityofHealthSciences,establishedthiseducationalopportunitytoinstructhealthcareprofessionalsintechniquesofcasualtycareontheintegratedbattlefieldduringamid-tohigh-intensityconflict.Theeight-toten-daycourseatCampBullis,Texas,taughtAdvancedTraumaLifeSupportskills,careofcasual-tiesindeployedhospitals,thefundamentalsoftriage,managementofnuclear,bi-ological,andchemicalcasualties,patientevacuation,combatroles,preventionofenvironmentalproblemsincombat,selectionoffieldsites,andfieldlivingcondi-tions.64In1985,theJointMedicalReadinessEducationCommitteeimplementedanimprovedcurriculum,theC4A,designedtofocusonmedicaltreatmentfacilities


MajorLynneM.Connelly teachesaclass focusingon thedecontaminationofpatients in thefieldduringa1984iterationoftheFieldNursingCourseatCampBullis,Texas.HerethestudentsareinMissionOrientedProtectivePosture4gearwithgasmasks.PhotocourtesyofColonelLynneM.Connelly,Basehor,KS.

in the rearguard.65 Itwas similar to itsprecursor,withaddedsubjects suchascommunicationsandmanagementofmedicalresources.66 Atfirst only active componentMedicalCorps officers attended theC4.But

the “OneArmy” concept relied heavily on the reserve components (RCs) andcouldnotdeployonamajormissionwithoutreserveaugmentation.Becausethereserveswereessential,DoDbegantoincludeafewRCofficersinthecourse.Dentists,nurses,veterinarians,andphysicianassistantswerelaterassignedtothecourse,testimonytoitsgrowingsuccess.67MajorBarbaraJ.SmithwasthefirstArmyNurseCorpsofficertoattendtheC4courseinJanuary1983.68

Soon,moreRCofficershadtoattendtheC4thantherewereslotsavailable.Consequently,theOfficeoftheSurgeon,ArmyNationalGuard(ARNG),estab-lished itsownCombatNursingCourse,with instructionparalleling thatof theC4.ColonelAmeliaJ.Carson,whowasinstrumentalinsettingupthisprogram,organizedthefirstclassofnursesatFortMeade,Maryland,whereshecontractedwiththeUniversityofMarylandforAdvancedTraumaLifeSupporttraining.ThecoursealsolaterwelcomedRCMedicalandDentalCorpsofficersandphysicianassistants.69

Althoughdevelopingreadinessskillsandknowledge inastructured learningenvironmentwasanimportantapproachtheArmyalsounderstoodthevalueof


PicturedisColonelAmeliaJ.Carson,thefirstChiefNurseoftheArmyNationalGuard(1983).PhotocourtesyofArmyNurseCorpsArchives,OfficeofMedicalHistory,FallsChurch,VA.


fosteringlocalgrassrootsefforts toupgradereadinessamongindividualsoldiernurses.TheArmyNurseCorpsrepeatedlyemphasizedtheneedforitsofficerstomaintainfamiliaritywithskillsassociatedwithmobilization.Readinessfeaturedprominentlyatthe1980ProfessionalDevelopmentWorkshop,whereparticipantsrecommendedthatProfessionalOfficerFillerSystemofficersandMobilizationDesignees,thoseactiveandRCArmynurseswhowerepreassignedtounitsonacontingencybasis,trainwiththeirunits.70Thiswouldcreateanawarenessoftheunit’s capability andhow itspersonnel andequipment functioned.ParticipantsalsoproposedthatmoreArmyNurseCorpsofficersattendtheOfficerAdvancedCourseinresidencestatustostrengthentheirwartimeskills.AconsensusemergedthatitwasessentialforallregularArmynursestofinishtheResidentAdvancedCoursebetweentheirfourthandninthyearofservice.71 Slewitzkereaffirmedthattheprimarycombatrolesinvolveddutiesnormallyas-

sumedbynurseadministrators,operatingroomnurses,anesthetists,andmedical-surgicalnurses,butuponmobilizationalmostallpediatric,obstetrics/gynecology,psychiatricmentalhealth,andcommunityhealthnurseswouldtakeonthemedi-cal-surgicalrole.SheinsistedthatallArmynursesbereadytocompetentlyfunc-tionduringwarorpeaceandaskedthatArmycommunityhealthnursesreceivein-hospitaltrainingatleasttwoweeksannuallytomaintaincompetenceinnurs-ingtaskssuchasintravenoustherapyandtheoperationofequipment.Slewitzke assertedthatallArmynursesneededadequatefieldtrainingwithaTO&Eunittocompetentlycarryouttheirwartimeresponsibilities.72

Misunderstandings and discontent surfaced about the need to gain or renewmedical-surgicalnursingaptitudes.Afewnurses,particularlyU.S.ArmyReserve(USAR)officerswithhighlyspecializedskillsdeemedirrelevanttocombatroles,voiceddissatisfactionwiththerequirement.Incivilianlife,USARCaptainMarkO.McMorriswasanobstetricsandgynecologypractitionerinahighlyspecializedcivilianpractice.HismilitarysuperiorsorderedhimtoreservedutyatEisenhowerArmyMedicalCenteronamedical-surgicalunit.McMorrisfeltuncomfortableinthisroleandobjectedtohisassignment,citingpatientsafetyandqualitycareis-suesandconcernsaboutprofessionalismandjeopardizinghisnursinglicense.Asaconsequenceofhisreservations,McMorris’reserveunitaskedforhisresigna-tion.OfficialsatHSCverifiedthatUSARnurseshadtobepreparedformobiliza-tionassignments.73 MajorChristineE.Cobb,anursecounselor(recruiter),respondedtoMcMor-

ris’predicamentbyaffirmingthat“nursesareseekingReserveandActiveDutynursingbecauseofandnotinspiteofitsperceivedchallenges.”Cobblistedthechallengesas“potentialmobilization,theprobabilityofcross-traininginadiffer-entspecialty,andtheneedtocreativelyutilizenursing’stightresources.”74 A fewmonths later, anotherUSAR obstetrics/gynecology nurse practitioner

incircumstancescomparabletothoseofMcMorrisspokeoutonamorepositivenote.FirstLieutenantM.DenisePalmeracceptedthatintimesofwarshehadtobe ready,according toherunderstandingof the responsibilities inherent inhercommission:


NotonlydoIagreewith thispolicy, Iappreciate thediversity.Membership in theArmyNurseCorpsoffersmanybenefitsandincentiveprograms,alongwithmanychallenges.Itisnoteasy,norisitmeanttobe,butitisworthwhile.Patriotism,leadership,teamwork,disciplineanddedicationareattributeswecanalladmire;myexperienceintheArmyReservehasgivenmeasenseofpurposeandindividualgrowthbeyondmyinitialexpectationsofa“part-timejob.”75

Skillsinobstetrics/gynecology,pediatrics,andotheruniquespecialtiesprovedinvaluable in subsequent deployments to Grenada, Panama, the Persian Gulf,Bosnia,Kosovo, andHaiti.Nonetheless, afirm foundation inmedical-surgicalnursingwasessentialforallArmynurses.Toboostnurses’readinessatWalterReedArmyMedicalCenter,LieutenantCol-

onelSharonBystran,chiefofnursingeducationandstaffdevelopment,developedapracticaltooltoserveasaguideandagaugeofpersonalpreparedness.Bystran’scomprehensive inventorydetailedplanning themobilizedofficer shouldmake,specifyinglegalresponsibilities,personalmilitaryequipment,clothing,comfortitems,andimmunizations.Itstressedtheimperativeforadvancedgroundwork,includedpracticalpackinghints,andprovidedanextensivechecklistfortheArmyspousewhowouldremainbehind.76ItislikelythatBystran’seffortsfacilitatedthemobilizationofmanyArmynurses,suchasthosewhodeployedsoonthereafterinOperationDesertShield/OperationDesertStorm.Anotherinnovativeplanthatimprovedreadinesswhilerelievingtheshortageof

Armynursescametofruitionin1984.Thatyear,theArmyNurseCorpsassigned180additionallyauthorizedofficerstoForcesCommand(FORSCOM)unitswithaMemorandumofUnderstanding(MOU)detailingtheagreementinwriting.Ingeneral,theMOUspecifiedthattheFORSCOMnurseswouldparticipateinanorientationtotheirfieldunitafterfirstsigningintoapostandsubsequentlywouldworkonamoreorlesspermanentbasisattheco-locatedmilitarytreatmentfacil-ity.TheMOUobligedmilitary treatment facility commanders to release theseFORSCOMnursesfromtheirfixedfacilityresponsibilitieswhentheirfieldunitconductedfieldtrainingexercisesorupondeployment.77 A controversial point surfaced in theMOU negotiations.All parties finally

achievedaconsensusontheissue,butonlyafterextensivedialogue.Theareaofdissenthadtodowithofficerefficiencyreportratingchains.FORSCOMwantedtheArmynurses,mostlyjuniorofficers,tohavetheirperformanceevaluatedbythelocalFORSCOMcommanders,usuallyanMSCofficer.Slewitzkeopposedthis idea,preferring thatothernurses (in thefixedfacilities) rate thenursesontheirclinicalnursingperformanceratherthanMSCofficersfromthefieldunitsratethemontheirfieldnursingskills.Shebasedherobjectiononafearthatsomeofthejuniorofficers’careerswouldbeadverselyaffectedbecausethe“MSC... commandersintheunit[s]weresometimesaproblem.”Intheend,Slewitzkepre-vailedbutonlyaftermakingapersonalvisittoFORSCOMatFortMcPhersoninAtlanta,Georgia,toclarifyherposition.Hervisionoftheofficerefficiencyreportratingschemeultimatelybecamereality.78 Butanotherglitchalsohadtoberesolved.Not infrequently, theFORSCOM

nursesheldkeypositions,suchasthatofclinicalheadnurseinthefixedfacilities.


Aschiefofnursingeducationanddevelopment,ColonelSharonF.Bystran,right,hadmanydiverseresponsibilities.HeresheisdepictedcelebratingonNurses’Day,1989,atWalterReedArmyMedicalCenterwithColonelJaneL.Hudak,left,andColonelBrookeSerpe-Ingold,center,wearingoldArmyNurseCorpsuniforms.PhotocourtesyofColonelSharonBystran,Aptos,CA.

Administrators in thefixedfacilitiesexpressedsomeforebodingaboutapossi-blemassexodusresultinginwidespreadvacanciesinthesevitalpositionswhenfuture deploymentswould occur.Despite the administrators’ reservations, Sle-witzkeinsistedonplacingArmynursesintoheadnursepositionsbecausetheircareerswouldbenegativelyaffectediftheywerenotaffordedleadershipopportu-


nities.79Slewitzkeoptimisticallyacknowledgedthat“therewillbesome‘growingpains’withthenewsystembutweareconfidenttheycanbeworkedoutthroughgoodcommunication.”80Inthefinalanalysis,sheconcludedthatfieldexposuresignificantly improvedArmy nurses’ ability to function in general. Before the FORSCOMprogram,almostallArmynurseshada“bigshock”whenconfrontedwiththeuseofpost–WorldWarIIfieldequipmentinthefieldhospitals.Althoughwithtimethenursesadapted,madedo,andlearnedtoimprovise,preemptivelyavoidingsuchcriseswasajudiciousapproach.81Inspiteoftheinevitablewrinklesthathadtobeironedout,theFORSCOMschemegreatlyenhancedreadiness.AnotheraspectofthereadinesspicturehadtodowithretiredArmyNurseCorps

officers,alargelyunknownquantityofrelativelyuntappedresourcesforuseinfutureemergencies.In1986,theHealthCareStudiesandClinicalInvestigationActivity atFortSamHouston surveyed retiredArmynurses younger than age60todeterminetheirpersonalandprofessionalreadinessformobilization.Theoverallresponseratetothequestionnairewas81.7percent,or748retirees.Ofthetotalsample,93percentwerecognizantoftheirpotentialtoberecalled,80per-centhad“hippocket”orders,and75.4percentwerewillingtoberecallediftheywerephysicallyable.82Almostall(93percent)stillmaintainedanursinglicensebut82percentfelttheyneededaboutsixweekstobecomeclinicallycompetent.Amongtheanesthetistswhoresponded,71percentcontinued toholdspecialtycertificationinanesthesiaand,ofthose,77.2percentwereactivelypracticinginthatspecialtyfield.83ThisstudyfurnishedtheArmyNurseCorpswithanestimateofthenumbersofretireeswhowouldbeavailabletoanswerthecallintimesofnationalneed.Mostwereremarkablywillingtoserveinsuchanemergency.Liketheretirees,thoseArmynursesassignedtoUSARorARNGunits,theciti-

zensoldiernurses,alsostoodreadyandcommittedtoactivatewhencalledtotheserviceoftheirnation.BothArmyandtheHealthServiceSupportAirLandBattledoctrineassignedasignificantmobilizationroleandanincreasedreadinessfunc-tiontotheRCsinthepost–VietnamArmy.TheSurgeonGeneralacknowledged, however,thatthemedicalRCunitswereinbadshapeintermsofmobilization.84 Slewitzkeconcurredafter reviewing thefindingsofa surveyshesent to3,000USARandARNGofficersin1982.85Thequalityofchiefnurseleadershipwasamajorproblem.Someseniorofficers,manyeducatedwithlessthanabaccalaure-atedegree,hadremainedintheirpositionsforalmost20years,thwartinganykindofupwardmobilityforbetter-educated,youngerArmynurses.Slewitzkeimple-mentedaregulationthatlimitedthetenureofRCchiefnurses,butbythattimethestagnationhadalreadyledmanymorejuniorofficerstoabandontheirreservecommissions.86Clearly,theUSARandtheARNGhadtorevamptheirorganiza-tion aswell as their readiness levels.The IndividualMobilizationAugmentee(IMA)programwasoneefforttoachievethisend.Asof1983,theReserveComponentsPersonnelandAdministrationCenterhad

assigned81IndividualReadyReserveArmyNurseCorpsofficerstospecificpo-sitions that theywouldoccupyuponmobilization.ColonelCharlesReddy, thechief, NursingDivision, HSC, encouraged allmilitary treatment facility chief


nursestomakefulluseoftheirIMAsintheirassignedpositionsduringannualtraining.87ThenumbersofIMAsslowlyincreasedovertheyears,andby1988,therewereabout144 IndividualReadyReserveArmynursesslotted into IMAassignments.88 Manytalented,accomplishedprofessionalsservedinIMAroles,suchasLieu-

tenantColonelMargaretMcClure,whoincivilianlifewasexecutivedirectorofnursingatNewYorkUniversityMedicalCenterandpresidentoftheAmericanOrganizationofNurseExecutives.McClure’sIMAmobilizationpositionwasasaseniorstaffofficeratHSC.Onactiveduty,shefamiliarizedherselfwithspe-cificroleresponsibilitiesandimplementedspecialprojects,includingoneontherecruitmentofciviliannursesthatcapitalizedonherdoctorateinresearchadmin-istration.McClurewasuniquelyqualifiedtocarryoutaresearchprojectfocusingontherecruitmentofciviliannurses.89Later,McClurewouldserveastheIMAtotheassistantchiefoftheArmyNurseCorps.TheIMAprogram,however,hadsomeproblems.Sometimeschiefnursesdidnot

activelysupporttheconcept.Atonelargemedicalcenter,forinstance,Slewitzke identified about 100 potential IMA positions, but the institution had only twoIMAsassigneddespiterepeatedguidancetojustifymore.ActiveArmyprejudiceagainstreservistspersisted,althoughthemajorityofreservistscouldworkwon-derswithproperguidance.90AschiefnurseatLettermanArmyMedicalCenter,then-colonelSlewitzkereliedonreserviststothegreatestpossibleextent.Whenoneparticularreservistcameforatwo-weekannualtrainingperiod,sheassignedtheindividualaschiefofambulatorycare.Thenextyear,shemadethesameas-signmentandallowedtheArmynursewhonormallyheldthatpositiontogoonleave.ShereasonedthattherewasalwayssomeonearoundtopreventtheIMAfromfailing.AttheFortBragghospital,anentirereserveunittookoverthefacil-itywhilethepermanentactivecomponenthospitalstaffdidtheirfieldtraining.91

AnothermeasuretakentoenhanceRCreadinessplacedofficersfull-timeinkeyUSARandARNGpositions.JohnsonpostedanactivecomponentWarCollegegraduate,ColonelAmeliaJ.Carson,totheARNGSurgeon’sOfficeasitschiefnurse.SlewitzkeincreasedthestaffattheArmyReservePersonnelCenter,for-merlytheReserveComponentsPersonnelandAdministrationCenter,fromoneArmyNurseCorpsofficertofive,anumbermoreappropriatetodealwiththeper-sonnelissuesofalmost7,000RCnurses.ShejustifiedapositionatFORSCOMtomanageRCconcernsandarrangedRCpositionsintheOfficeofTheSurgeonGeneral,QualityAssurance,andProcurement.92AnotherUSARofficer,Lieuten-antColonelDonnaOwen,servedonthestaffoftheASD(HA)intheDirectorateofManpower,Personnel,andTrainingasthedeputydirectorforreserveaffairsinJanuary1987.93 DuringthelastyearofSlewitzke’stenureaschiefoftheCorps,shedirected

herIMA,ColonelCatherineFoster,toprepareandproposelegislationtocreateanArmyNurseCorpsgeneralofficerpositionforthereserves.In1988,Congressapprovedthenewposition.94BrigadierGeneralDorothyB.PocklingtonbecamethefirstreserveArmynurseandthefirstfemalereserveofficertobecomeabriga-


diergeneral.95PocklingtonservedastheIMAtoAdams-Ender,thechiefoftheArmyNurseCorps,assistingheronmobilizationissuesastheyappliedtoboththeUSARandARNG.96Sherepresentedthechiefinboardsandmeetings;assistedintheformulationofRCintegrationandmobilizationpolicy;participatedinRCrecruitment,retention,andtrainingactivities;andincreasedRCvisibility.97 AfterthreeyearsinherIMAposition,Pocklingtonpioneeredanotherunusual

assignmentbyassumingresponsibilitiesofanon-branch-specificpositionasdep-utychiefforpublicaffairsontheDepartmentoftheArmylevel.Atfirst,Pock-lingtonconsideredhernewresponsibilitiesinpublicaffairsasworldsapartfromher former role as a nurse.After considering it, however, she concluded thereweresimilaritiesbetweenthetwomissionsbecausesurvivalwasthecrucialat-tributeofboththesedisciplines.IntheAMEDD,Pocklingtonenvisionedsurvivalofthesoldierasfundamental,whileinpublicaffairsthefocuswasthesurvivaloftheArmy’sreputation.ThisapproachprovidedherwithaframeworkthroughwhichtoviewherresponsibilitiesandallowedhertomakeuseofherAMEDDbackgroundtoenhancehercontributionsinpublicaffairs.Pocklingtonwasthefirst femaleandnurse toserve in thisatypical roleand thefirstgeneralofficerArmynursetofillapositionnotintheAMEDD.98 In 1993, BrigadierGeneral SharonVander Zyl blazed a parallel trail in the

ArmyNationalGuard.VanderZyl, likewise the first female general officer intheARNG,servedasspecialassistant to thechiefof theArmyNurseCorps.99 ManytalentedArmyNurseCorpsofficersintheActiveComponent,Reserve,andNationalGuardhelpedtowidentheaccesstofuturebranchimmaterialandcom-mandpositionsforArmynurses.Duringthe1980s,theArmyNurseCorpsmadeanefforttoimprovethequal-

ity ofRC training to enhance readiness skills.As early as 1981,MajorDianeCorcoran,chiefoftheNursingEducationandTrainingService(NETS)atFitz-simonsArmyMedicalCenter,andSergeantFirstClassDavidSteffenson,Non-CommissionedOfficerinCharge,NETS,tackledreadinessissuesonaunitlevelwhenreservistsarrivedattheirinstallationfortraining.Corcoranobservedthatthe reservists typically felt that their annual two-week active duty for trainingassignmentdidnot furnish themwithwhat theyneeded, indeed, they“weren’tevensurewhattheyweresupposedtoaccomplish.”100Consequently,thepairfor-mulatedareservetrainingprogram,theSystematicModularApproachtoRealis-ticTraining(SMART),toeducateofficersandenlistedtroopsabouttheiractualwartimeresponsibilities.Previously,thereservistsprovidedpeacetimehealthcareservicesduringtheirannualtrainingtime.101Thisimprovedroutinenursingskillsbutdidnot enhancecombatnursingproficiencies.SMARTwasoneanswer tothatproblem.Itbeganwithaprogrambriefing.Next,NETSfurnishedthepartici-pantswithbookletsthatdelineatedlearningobjectivesandassignmentsinspecificroles, suchaswardmaster, headnurse,practicalnurse,ormedic.Thebookletsexplicitlyoutlinedclinicalandadministrativetasksandspecifiedindividualandunittrainingresponsibilities.Thereserveunitsbecameaccountableforeachsol-dier’simplementationofthetrainingandtasks,whileNETSprovidedassistance


PicturedisBrigadierGeneralDorothyB.Pocklington,thefirstreserveArmynurseandthefirstfemalereserveofficertoserveinthegradeofbrigadiergeneral(1988).PhotocourtesyofDorothyPocklington,EllicottCity,MD.


PicturedisBrigadierGeneralSharonVanderZyl,thefirstfemalegeneralofficerintheArmyNationalGuardwhoservedastheSpecialAssistanttotheChiefArmyNurseCorpsforMobilizationandGuardAffairs(1993).PhotocourtesyofArmyNurseCorpsArchives,OfficeofMedicalHistory,FallsChurch,VA.


onanas-neededbasis.102Also,anevaluationofthesoldier’sperformanceservedtodocumenttrainingandcapabilities.By1984,afterthreeyearsofusingSMART,bothFitzsimonsstaffandreservistsagreedthatSMARTfosteredahigherleveloftrainingandbetterutilizationofactivecomponentandARNG/USARperson-nel.103Nonetheless,SMARThad itsdetractorsamonghospitalcommanders. Infact,someofthecommanderscreated“alotofflak”abouttheprogram.104SomeobserversfelttheaddedRCsupportinmeetingtheeverydayneedsofprovidinghealthcareinfixedfacilitiesintimesofpeacewasviewedasmoreimportantthanenhancingcombatreadinessknowledgeandskills.From1987to1989,USARnursesparticipatedinanumberofpracticalfield

exercises. They erected a pre-positioned, 1,000-bed hospital in Great Britainandfieldtesteditsequipment,e.g.,ventilators,infusionpumps,andsuctionma-chines.105Thenursesfine-tunedanevacuationplaninacombinedBritish–U.S.AirForceexercise.Theyalsorepackedthefacilitysothatitcouldbeputtousequickly if the reserve forcesmobilized.Other realistic trainingoccurred in thesummer of 1988,whenArmyNurseCorps officers andothers assigned to the399thCombatSupportHospitalstaffedafieldhospitalduringa15,000-soldierARNGtwo-weekfieldtrainingexerciseatFortHood,Texas.TheArmynursescaredforapproximately1,500patients,about75ofthesoldiersbeingadmittedtothehospitalfortreatmentofillnessorinjury.106

Throughoutthe1980s,ArmyNurseCorpsofficerscommittedthemselvestoim-provingreadinessandbuiltontheprogressachievedearlierintheimmediatepost–VietnamWaryears.Armynurses’preparednesssteadilyimprovedand,whetherrelief mission or combat operation,Army nurses were ready to provide care.


Notes

1.KarlE.Cocke,andothers,Department of the Army Historical Summary, Fiscal Year 1982 (Washington,DC:Center ofMilitaryHistory,UnitedStatesArmy, 1988), 81–82.DwightD.Oland,Department of the Army Historical Summary, Fiscal Year 1984 (Wash-ington,DC:CenterofMilitaryHistory,UnitedStatesArmy,1995),196–197.WilliamJoeWebb,Department of the Army Historical Summary, Fiscal Year 1988 (Washington,DC:CenterofMilitaryHistory,UnitedStatesArmy,1993),29.BernhardT.Mittemeyer,“ArmyMedicalDepartment,”Military Medicine148(November1983):833.2.AirLandBattledoctrine,acombinedarmsconcept,involvedanumberofinnovations

inoperations,training,andjointair-groundoperations.Itemphasizedtheoperationallevelofwarandstressedmaneuverwarfare,fosteredamajorchangeineducationandtrainingwithopposingforcesexercisesattheNationalTrainingandCombatTrainingCenters,andemphasizedcoordinationbetweenTrainingandDoctrineCommandandtheTacticalAirCommandoftheAirForce.HarryG.Summers,On Strategy II: A Critical Analysis of the Gulf War(NewYork:Dell,1992),139–50.FrankN.SchubertandTheresaL.Kraus,eds.,The Whirlwind War, The United States Army in Operations Desert Shield and Desert Storm (Washington,DC:CenterofMilitaryHistory,UnitedStatesArmy,1993),26–28.HealthServiceSupportAirLandBattlewas the template for theAMEDD’swartime structure.EmergingMedicalForce96andMedicalForce2000laterreplacedHealthServiceSup-portAirLandBattleandservedtooutlinethe21stcenturyfieldmedicaldoctrineandforcestructure.FrankF.Ledford,“SurgeonGeneralOutlinesPriorities forAMEDDAction,”HSC Mercury16(March1989):2.MedicalForce2000proposedreducingthestructurefromsevenhospitalsdown to amedicalholdingcompanyand fourhospitals.The fourhospitalunitswereaMobileArmySurgicalHospital,aCombatSupportHospital,aFieldHospital,andaGeneralHospital.RichardV.N.Ginn,The History of the U.S. Army Medi-cal Service Corps (Washington,DC:OfficeoftheSurgeonGeneralandCenterofMilitaryHistory,UnitedStatesArmy,1997),376,footnote7,411.“MF2KMedicalUnits,”PrintedHandout,n.d.,ArmyNurseCorpsCollection(ANCC),OfficeofMedicalHistory(OMH).BasictenetsofMedicalForce2000doctrineincluded“far-forwardsurgicalcare;afocusonreturningsoldierstodutyfromasfarforwardaspossible;increasedintensivecarecapabil-ityinthecombatzone;newmedicallogisticssystemsthatincorporateblooddistributioncapabilities;improvedgroundandairevacuationcapabilities;andimprovedmanagementofcombatstress.”FrankF.Ledford,“Army‘Innovative’inUseofFunds,”U.S. Medicine


25(January1989):41–42.“HSSALB:NewMedicalOperationalDoctrineReceivesAp-proval,”Medical Soldier’s Outlook, Army Medical Department Enlisted Training News 3 (Spring1986):1.FrankF.Ledford,“ArmyMedicineBalancingNeedswithResources,”Army40 (October1990):180–83,185.FrankF.Ledford,“MedicalSupport forOpera-tionDesertStorm,”The Journal of the US Army Medical Department, PB8-92-1/2(Janu-ary/February1992): 4.Theotherfivepillars ofHealthServiceSupportAirLandBattlewere “prevention, immediate far-forward care, a hospital structurewhich is deployableandmobile,atimelydedicatedevacuationsystemandacontinentalU.S.supportbase.”RaymondLeahey,“Implementing‘PillarsofWellness/FitnessandPrevention’,”Army 36 (March1986):46–47.“HealthServiceSupport,Futures,”AHSWhitePaper,FinalDraft,i-ii,March1989,ANCC,OMH.3.HazelW.Johnson,“NotesfromtheChief,USArmyNurseCorps,”1,March1983,

ANCC,OMH.4.TheAPFTconsistedof threecomponents. It involveda timed two-mile runanda

prescribednumberofpush-upsandsit-ups.Theregulationbasedtheminimumacceptablenumberofitemsineacheventonthegenderandageoftheparticipant.JosephKnapik,“TheArmyPhysicalFitnessTest(APFT):AReviewoftheLiterature,”Military Medicine 154(June1989):326–29.DepartmentoftheArmy,FieldManual21-20,“PhysicalFitnessTraining”(Washington,DC:DepartmentoftheArmy,1985).Priorto1982,theArmyal-lowedonlysoldiersundertheageof40totaketheArmyPhysicalFitnessTest,fearingthatitswidespreadimplementationacrosstheagespectrumwouldcontributetoincreasednumbersofsuddencardiacdeath.Topreventsuchcatastrophes,theArmybeganscreen-ingactivecomponentsoldiersoverage40in1982,evaluatingtheircardiacriskfactorsandsubjectingthemtophysicalexams.ThereservecomponentsimplementedtheOver-40Medical Screening Program in 1987. BernhardT.Mittemeyer, “FacingChallenges,ArmyGoalsEndure,”U.S. Medicine18(5January1982):41–42.BernhardT.Mittemeyer,“ArmyMedicalDepartment,”Military Medicine 148 (November 1983): 833.BernhardT.Mittemeyer,“ArmyTotalFitnessProgramaSuccess,”U.S. Medicine19(15January1983):29–34.KarlE.Cocke,andothers,Department of the Army Historical Summary, Fiscal Year 1982(Washington,DC:CenterofMilitaryHistory,UnitedStatesArmy,1988),81–82.DwightD.Oland,Department of the Army Historical Summary, Fiscal Year 1984 (Washington, DC: Center ofMilitaryHistory, United StatesArmy, 1995), 196. DonnaBolinger,“ReserveComponents toGetSameOver-40ScreeningasActiveDuty,”HSC Mercury 14(February1987):8.5.ClaraL.Adams-Ender,“MemofromtheChief,ArmyNurseCorps,”4,31December

1989,ANCC,OMH.6. Charles Reddy, “NursingNewsletter Number 84-1,” 1, 1 February 1984,ANCC,

OMH.7.“ArmyNursinginthe1990’s(NLNConf),”TypewrittenTextforSpeech,June1985,

ANCC,OMH.8.“ANCAnnualHistoricalReportFY85,”5,n.d.,ANCC,OMH.9.“ArmyNurseAimsforWorldGames,”HSC Mercury4(May1977):11.CarolynM.

FellerandDeboraR.Cox,Highlights in the History of the Army Nurse Corps(Washington,DC:U.S.ArmyCenterofMilitaryHistory,2000),48.10. Connie L. Slewitzke, “Memorandum from the Chief,ArmyNurse Corps,” 4–5,

March1985;ConnieL.Slewitzke,“MemorandumfromtheChief,ArmyNurseCorps,”5–6,July1986;and“ANCAnnualHistoricalReportFY85,”TypewrittenDocument(TD),11–12,n.d.(allinANCC,OMH).11. QuinnH. Becker, “Medical Readiness PrimaryArmy Focus,”U.S. Medicine 22


(January1986):39–40.12.OtherArmynurseswhoactivelyparticipatedinvariousphasesoftheprogramwere

captainsSandyYaney,CatherineSchemp,JillPhillips,andLeslieDempseyBrousseau,ma-jorsCarolynBernheimandMaryC.Davis,andlieutenantcolonelsAntoinetteHageyandSusanneAllen.JeannePicariellotoAuthor,E-mailCorrespondence,24March2003;and“ArmyNurseCorps(ANC)1986AnnualHistoricalReport,”24(bothinANCC,OMH).13. Jeanne Picariello toAuthor, E-mail Correspondence, 24March 2003.AlcideM.

LaNoue toBarryR.McCaffrey, 6April 1994; JerryA.White toAlcideM.LaNoue, 5May 1994;NancyR.Adams to JerryA.White, 20May 1994 (allTypewrittenLettersinANCC,OMH).Sometimelater, theArmyPanelonSexualHarassment’sfindingsofunfairnessinstigatedthesettingofnew,higherArmyPhysicalFitnessTeststandardsforwomensoldiers.Theexistingwomen’sstandards,datingbackto1986,becamemorestrin-gentandmorecloselyapproximatedthosesetformensoldiers.“ArmytoRaiseFitnessStandardsforWomen,”Minerva’s Bulletin Board(Summer1997):3.“NewArmyFitnessTestImposesHigherStandardsofWomen,”Minerva, Quarterly Report on Women and the Military4(Spring1986):72–73.14.“ArmyNurseCorps(ANC)FY87AnnualHistoricalReport,”10,ANCC,OMH.15. Hudak and Mouritsen identified readiness as “the overriding reason for [the]

AMEDD’sexistence.”RonaldP.HudakandPaulB.Mouritsen,“ImprovingtheArmy’sPrimaryCareDeliverySystem,”Military Medicine153(June1988):282–86.16.RosemarieSkaine,Women at War, Gender Issues of Americans in Combat(Jeffer-

son,NC:McFarland&Company,Inc.,1999),154.17.QuinnH.Becker,“The‘WeCarePeople’ inArmyMedicine,”Army36(October

1986):240–43.18.“MedicalReadinessoftheArmedServices,HearingsbeforetheSubcommitteeon

ManpowerandPersonneloftheCommitteeonArmedServices,UnitedStatesSenate,97thCongress,2ndSession,May4,26,1982” (Washington,DC:U.S.GovernmentPrintingOffice,1982),2.19.WilliamE.Mayer,“MedicalReadinessDoDTopPriority,”U.S. Medicine21(15

January1985):7–10.“HearingsbeforeaSubcommitteeoftheCommitteeonAppropria-tions,HouseofRepresentatives,99thCongress, 1stSession,”Part 3 (Washington,DC:U.S.GovernmentPrintingOffice,1985),1022,1026–27,1069.20.WilliamE.Mayer,“DoDNotMedicallyReadyforWarNeeds,”U.S. Medicine 22

(January1986):13–14.21.“HearingsbeforeaSubcommitteeof theCommitteeonAppropriations,Houseof

Representatives,99thCongress,1stSession,”Part3(Washington,DC:U.S.GovernmentPrintingOffice,1985),1022–23.22.DonaldRobinson,“TheMessinMilitaryMedicine,”Reader’s Digest126(February

1985):52.23.LawrenceH. Fink, “MilitaryMedicine Is aTerminalCase; It’sTime toPull the

Plug,”Washington Post (24November 1985):C1,C4.A number ofwriters, includingtheArmysurgeongeneral,penned letters to theWashington Post editorcountering thisextremeviewpoint.QuinnBecker,EdwardWeiss,EileenMatthews,andNicholasDunlap,“Letters,”Washington Post(30November1985):A25.24.DavidWhitman, “UnderAttack:MilitaryCare,”U.S. News & World Report (27

January1986):69.25. “U.S.ArmyMedicine, from the Ferment, Profound Changes,”Army 36 (March

1986):22.26.TerrenceGough,Department of the Army Historical Summary, Fiscal Year 1986


(Washington,DC:CenterofMilitaryHistory,UnitedStatesArmy,1989),61.27.JohnF.Beary,“DepartmentofDefense,”Military Medicine148(November1983):

857–63. JohnF.Beary, “MedicalReadinessDoD’sMainGoal,”U.S. Medicine 19 (15January1983):9–12.“MedicalReadinessoftheArmedServices,HearingsbeforetheSub-committeeonManpowerandPersonneloftheCommitteeonArmyServices,UnitedStatesSenate,97thCongress,2ndSession,May4,26,1982,”(Washington,DC:U.S.Govern-mentPrintingOffice,1982),5,27–28.28. “U.S.ArmyMedicine, from the Ferment, Profound Changes,”Army 36 (March

1986):23.29.BernhardT.Mittemeyer,“‘Volatile’YearSeesArmyMedicalGains,”U.S. Medicine

21(15January1985):15,16,21.DwightD.Oland,Department of the Army Historical Summary, Fiscal Year 1984(Washington,DC:CenterofMilitaryHistory,UnitedStatesArmy,1995),197.“HearingsbeforeaSubcommitteeoftheCommitteeonAppropriations,HouseofRepresentatives,99thCongress,1stSession,”Part3(Washington,DC:U.S.Gov-ernmentPrintingOffice,1985),1071.“DEPMEDStheLatestinPortableMedicalCare,”Army Reserve Magazine 33 (Fourth Issueof1987): 26–27.KevinRopp, “ReviewHitsDEPMEDSShortages,”HSC Mercury17(June1990):10.AcademyofHealthSciences,Deployable Medical Systems Users’ Manual, Final Draft(FortSamHouston,TX:1989),1–4,SmithCollection,U.S.ArmyMedicalDepartmentMuseum.QuinnH.Becker,“Medi-calReadinessPrimaryArmyFocus,”U.S. Medicine22(January1986):39–40.30.TerrenceGough,Department of the Army Historical Summary, Fiscal Year 1986

(Washington,DC:Center ofMilitaryHistory,UnitedStatesArmy, 1989), 61. “MedicsTraininNewFieldHospital,”HSC Mercury14(October1987):12.By1990,theArmyhadfieldedmorethan40DEPMEDSfacilitieswith17,560beds.CaptainClyburn,“StatusofDeployableMedicalSystems(DEPMEDS)Fieldings,”InformationPaper,28February1990,ANCC,OMH.31. “DEPMEDS the Latest in PortableMedical Care,”Army Reserve Magazine 33

(FourthIssueof1987):26–27.32. Department of theArmy, Headquarters, U.S.Army Health Services Command,

MedicalServices,“AMEDDProfessionalOfficerFillerSystem,”MemorandumNo.40-2,13November1973,RecordGroup112,NationalArchives.TheProfessionalOfficerFillerSystem(PROFIS)program’sintentwastopredesignateofficers“forforwarddeployedanddeployingunits”soas“tohastenthemobilizationprocess.”BernhardT.Mittemeyer,“Fac-ingChallenges,ArmyGoalsEndure,”U.S. Medicine18(5January1982):41–42.DwightOlandandJeffreyGreenhut,Report of the Surgeon General, United States Army Fiscal Years 1976–1980 (Washington,DC:Office of theSurgeonGeneral,U.S.Army, 1988),301.NeliaSchrum,“PROFISPutsProvidersThereWhenNeeded,”The Mercury24(May1997):12.CleoBrennan“PROFISSoldiersOfferTwo-For-OneService,”The Mercury 26 (January1999):12.By1982,thesystemhadslotted3,600physiciansandnursesintova-canciesforcombatroles.“MedicalReadinessoftheArmedServices,HearingsbeforetheSubcommitteeonManpowerandPersonneloftheCommitteeonArmyServices,UnitedStatesSenate,97thCongress,2ndSession,May4,26,1982”(Washington,DC:U.S.Gov-ernmentPrintingOffice,1982),25.33.FuertesCaminos(“strongroads”inSpanish)wasanannualArmyReserveandNa-

tionalGuardrotationthatimplementednation-buildingprojects,suchastheplanningandpavingofroads,theconstructionofschools,thedistributionofclothing,andmedicalout-reach inCentral andSouthAmerica. JohnD.Sherwood, “U.S.ArmyOperationsOtherThanWarsince1989,”5–6,7April1995,ANCC,OMH.34.CarolynM.FellerandDeboraR.Cox,Highlights in the History of the Army Nurse


Corps(Washington,DC:U.S.ArmyCenterofMilitaryHistory,2000),61.35. Frank F. Ledford, “ArmyMedicineBalancingNeedswithResources,”Army 40

(October1990):180–83,185.36.“MedicsTraininNewFieldHospital,”HSC Mercury14(October1987):12.37.“OperationDesertShield/Storm,LessonsLearned—DEPMEDS,”TD,n.d.,ANCC,

OMH.KevinRopp,“ReviewHitsDEPMEDSShortages,”HSC Mercury17(June1990):10.38.“MedicsTraininNewFieldHospital,”HSC Mercury14(October1987):12.39.“StandardFieldEquipmentComingThisYear,”HSC Mercury14(April1987):1.40.Anorganicvehicleisapieceofequipmentpermanentlyassignedtoaunitbasedon

theTableofOrganizationandEquipment(TO&E)forthattypeofunit.RichardV.N.Ginn,The History of the U.S. Army Medical Service Corps(Washington,DC:OfficeoftheSur-geonGeneralandCenterofMilitaryHistory,UnitedStatesArmy,1997),435.UnitedStatesGeneralAccountingOffice,Military Personnel and Compensation, Committee on Armed Services, House of Representatives, Operation Desert Storm, Full Army Medical Capabil-ity Not Achieved,GAO/NSIAD-92-175(Washington,DC:GAO,August1992),4,40–43.41.ColonelJeromeV.Foust,InterviewbyCaptainDonaldHall,March29,1991,Type-

writtenTranscript,10,22,RichardV.N.GinnCollection,OMH.“ArmyIdentifies‘LessonsLearned’fromDesertStorm,”U.S. Medicine28(February1992):1,3,26,27.FrankBestandNancyTomich,Medicine in the Gulf War (Washington,DC:U.S.Medicine,1991),6,8,9. IngeborgSosa,“TheJournal Interviews—MGMichaelJ.Scotti,Jr.,MC,Com-mandingGeneral,7thMedicalCommand,Europe,”The Journal of the US Army Medical Department, PB8-92-1/2(January/February1992):insertbetweenpages34and35.Inge-borgSosa,“TheJournalInterviews—LTGFrankF.Ledford,Jr.,SurgeonGeneral,UnitedStatesArmy,”The Journal of the US Army Medical Department,PB8-92-3/4(March/April1992): insert betweenpages30and31.WilliamR.Smith andPhilipLisagor, “Experi-enceofthe31stCombatSupportHospitalinOperationDesertShieldandDesertStorm,ACommander’sStory,”The Journal of the US Army Medical Department, PB8-92-11/12(November/December1992):4–10.42.“OperationDesertShield/Storm,LessonsLearned—DEPMEDS,”TD,n.d.,ANCC,

OMH.43.“MedicsTraininNewFieldHospital,”HSC Mercury14(October1987):12.Acad-

emyofHealthSciences,Deployable Medical Systems Users’ Manual, Final Draft (FortSamHouston,TX:1989),1–3,SmithCollection,U.S.ArmyMedicalDepartmentMuseum.44.TheDefenseMedicalStandardizationBoardbecametheJointReadinessClinical

AdvisoryBoardinthe1990s.KathrynL.Boehnke,“SlotAuthorizationforArmyNurseCorp[sic]OfficeratJRCAB/(DMSB),”TypewrittenLetter,16June1998,ANCC,OMH.45.ConnieL.Slewitzke,InterviewbyBeverlyGreenlee,354,n.d.,USAWC/USAMHI

SeniorOfficerOralHistoryProgram,ProjectNo.88-8,ANCC,OMH.46.EilyP.Gorman,“JointServicesNursingAdvisoryGroup(JSNAG),”Typewritten

Memorandum,10March1988;JohnW.Funk,“JointServicesNursingPanelofClinicalExperts,”TypewrittenLetter,22February1988;AlcideM.Lanoue,“Request forAddi-tionalHealthCarePlanningFactors,”TypewrittenMemorandum,13January1988;WalterF.Johnson,“RequestforAdditionalHealthCarePlanningFactors,”TypewrittenMemo-randum,15January1988;AlcideM.Lanoue,“RequestforAdditionalHealthCarePlan-ningFactors,”TypewrittenMemorandum,30October1987;andSusieSherrodtoAuthor,E-mailCorrespondence,26March2003(allinANCC,OMH).47.BernhardT.Mittemeyer,“QualityAssurance:MajorArmyFocus,”U.S. Medicine 20

(15January1984):55–59.Aswellasausterebutadequate,thenewU.S.Army’sDeploy-ableMedicalSystemwasintendedtobe“affordable,maintainable,andrelocatable.”Acad-


emyofHealthSciences,Deployable Medical Systems Users’ Manual, Final Draft (FortSamHouston,TX:1989),1–2,SmithCollection,U.S.ArmyMedicalDepartmentMuseum.48.ConnieL.Slewitzke,InterviewbyBeverlyGreenlee,346,349,n.d.,U.S.ArmyWar

College/U.S.ArmyMilitaryHistoryInstituteSeniorOfficerOralHistoryProgram,ProjectNo.88-8,ANCC,OMH.49. Connie L. Slewitzke, Interview byBeverlyGreenlee, 355, n.d.,U.S.ArmyWar

College/U.S.ArmyMilitaryHistoryInstituteSeniorOfficerOralHistoryProgram,ProjectNo.88-8;andSusieSherrodtoAuthor,E-mailCorrespondence,26March2003(bothinANCC,OMH).50. Connie L. Slewitzke, Interview byBeverlyGreenlee, 360, n.d.,U.S.ArmyWar

College/U.S.ArmyMilitaryHistoryInstituteSeniorOfficerOralHistoryProgram,ProjectNo.88-8,ANCC,OMH.51.NancyR.Adams,“CoordinationDraftManpowerRequirementsCriteria(MARC)

StudyDocument (MSD) forHospitalWardNursing (AOC66J/H,MOS91B/C),MCNSO4,”MemorandumforDASG-HCD-O,TD,14January1992;andJeannetteS.James,“ManpowerRequirementsCriteria(MARC),”BriefingSlides,n.d.(bothinANCC,OMH).52.TerrisE.Kennedy,“CoordinationDraftMARCforHospitalWardNursing,”Memo-

randumforDASG-HCD-D,TD,8March1993,ANCC,OMH.53. Connie L. Slewitzke, Interview by Beverly Greenlee, 354–55, n.d., USAWC/

USAMHISeniorOfficerOralHistoryProgram,ProjectNo.88-8,ANCC,OMH.CarolynM.FellerandDeboraR.Cox,Highlights in the History of the Army Nurse Corps(Wash-ington,DC:U.S.ArmyCenterofMilitaryHistory,2000),55.54.ConnieL.Slewitzke,InterviewbyBeverlyGreenlee,343,344,345,n.d.,U.S.Army

WarCollege/U.S.ArmyMilitaryHistoryInstituteSeniorOfficerOralHistoryProgram,ProjectNo.88-8,ANCC,OMH.55.“ANCAnnualHistoricalReportFY85,”3,ANCC,OMH.56.ConnieL.Slewitzke,InterviewbyBeverlyGreenlee,345,347,372,n.d.,U.S.Army

WarCollege/U.S.ArmyMilitaryHistoryInstituteSeniorOfficerOralHistoryProgram,ProjectNo.88-8,ANCC,OMH.57.“ArmyNurseCorps(ANC)1986AnnualHistoricalReport,”16–17;andElizabeth

Wanersdorfer,“ANCHighlightUpdate,”TypewrittenMemorandum,11July1990(bothinANCC,OMH).58. Connie L. Slewitzke, Interview byBeverlyGreenlee, 373, n.d.,U.S.ArmyWar

College/U.S.ArmyMilitaryHistoryInstituteSeniorOfficerOralHistoryProgram,ProjectNo.88-8.59.“NursesWorktoRespondtoReadiness,”HSC Mercury8(March1981):5.60.CarolynM.FellerandDeboraR.Cox,Highlights in the History of the Army Nurse

Corps (Washington,DC:U.S.ArmyCenter ofMilitaryHistory, 2000), 56.CharlesD.Matthews,“MemorandumforRCChiefNurses,”InformationPaper,26September1983,ANCC,OMH;BernhardT.Mittemeyer,“ArmyTotalFitnessProgramaSuccess,”U.S. Medicine19(15January1983):29–34.BernhardT.Mittemeyer,“QualityAssurance:Ma-jorArmyFocus,”U.S. Medicine20(15January1984):55–59.61.LynneT.ConnellytoAuthor,E-mailCorrespondence,1July2003,ANCC,OMH.62.LewisH.Seaton,“NavyMedicalDepartment,”Military Medicine148(November

1983): 842. J.WilliamCox, “NavyTransitionBrings Progress,” U.S. Medicine 19 (15January1983):73,74,76.63.MaxB.Bralliar,“AirForceMedicalService,”Military Medicine148(November

1983):850.MaryC.Smolenski,DonaldG.Smith,andJamesS.Nanney,A Fit, Fighting Force, The Air Force Nursing Services Chronology (Washington,DC:Officeof theAir


ForceSurgeonGeneral,2005),38–39.64.OfficeoftheAssistantSecretaryofDefense(HealthAffairs),“PlanforExpanding

theCombatCasualtyCareCourse,”TD,2,December1987,ANCC,OMH.DaleC.Smith,“MilitaryMedicine,” inEncyclopedia of the American Military,ed.JohnE.JessupandLouiseB.Ketz(NewYork:CharlesScribner’sSons,1994),1625.65.JimMarkiewicz,“CourseTeachesMedicalLeadership,”HSC Mercury13(Novem-

ber1985):12.66.OfficeoftheAssistantSecretaryofDefense(HealthAffairs),“PlanforExpanding

theCombatCasualtyCareCourse,”TD,3,December1987,ANCC,OMH.67.OfficeoftheAssistantSecretaryofDefense(HealthAffairs),“PlanforExpanding

theCombatCasualtyCareCourse,”TD,2,December1987,ANCC,OMH.68.CarolynM.FellerandDeboraR.Cox,Highlights in the History of the Army Nurse

Corps (Washington, DC:U.S.ArmyCenter ofMilitaryHistory, 2000), 55. Barbara J.Smith,InterviewbyConstanceJ.Moore,Transcript,2March1995,ArmyNurseCorpsOralHistoryCollection,OMH,12.69.ConnieL.Slewitzke,“MemorandumfortheChief,USArmyNurseCorps,”4,July

1986,ANCC,OMH;andConnieL.Slewitzke,InterviewbyBeverlyGreenlee,470,n.d.,U.S.ArmyWarCollege/U.S.ArmyMilitaryHistoryInstituteSeniorOfficerOralHistoryProgram,ProjectNo.88-8(bothinANCC,OMH).70.TheMobilizationDesignees“wereusuallyReservistsandNationalGuard...who

wereactivatedasbackfillandtofillexistingvacanciescreatedby[the]mission.”FrankMetcalf toAuthor,E-mailCorrespondence, 25April 2003,ANCC,OMH.BruceAron,“AllYouEverWantedtoKnowabouttheReserves,”HSC Mercury9(October1982):7.71.“1980ANCProfessionalDevelopmentWorkshop,”inHazelW.Johnson,“Informa-

tionforAllANCOfficers,”7November1980,Inclosure2,ANCC,OMH.72.ConnieL.Slewitzke,“MemorandumfortheChief,USArmyNurseCorps,”10–11,

October1984;andConnieL.Slewitzke,“Memorandumfor theChief,USArmyNurseCorps,”11,December1986(bothinANCC,OMH).73.MarkO.McMorris,“NurseTraining,”LetterstotheEditor,HSC Mercury16(May

1989):2.74.ChristineE.Cobb,“NurseTraining,”LetterstotheEditor,HSC Mercury16(July

1989):2.75.M.DenisePalmer,“USARNurseCommentsonTraining,”Letter toEditor,HSC

Mercury16(October1989):2.76.SharonBystran,“DeploymentChecklist,”1986;andConnieL.Slewitzke,“Mem-

orandum from theChief,USArmyNurseCorps,” 8,December 1986 (both inANCC,OMH).77.CharlesJ.Reddy,“NursingNewsletterNumber83-2,”1November1983;HazelW.

Johnson,“NotesfromtheChiefU.S.ArmyNurseCorps,”3,March1983;andTerrisM.Kennedy,InterviewbyConstanceJ.Moore,Transcript,217–19,24October1995(allinANCC,OMH).78. Connie L. Slewitzke, Interview by Beverly Greenlee, 40–42, n.d., USAWC/

USAMHISeniorOfficerOralHistoryProgram,ProjectNo.88-8,ANCC,OMH.79.ConnieL.Slewitzke,InterviewbyBeverlyGreenlee,353,n.d.,USAWC/USAMHI

SeniorOfficerOralHistoryProgram,ProjectNo.88-8,ANCC,OMH.80.ConnieL.Slewitzke, “Memorandum from theChiefUSArmyNurseCorps,” 1,

October1984,ANCC,OMH.81. Connie L. Slewitzke, Interview by Beverly Greenlee, 41–42, n.d., USAWC/

USAMHISeniorOfficerOralHistoryProgram,ProjectNo.88-8,ANCC,OMH.


82.TheArmy issued someofficers,upon their retirement,hippocketorders that as-signedthemtoaparticulardutyataspecificpostintheeventofanationalemergency.ThehippocketordersincludedaUnitIdentificationCodethatspecifiedamobilizationstation.83.TerryR.Misener,MarthaR.Bell,HedyMechanic,andValerieP.Biskey,“Mobili-

zationReadinessofRetiredArmyNurseCorpsOfficers,”Report#HR86-002(FortSamHouston,Texas:UnitedStatesArmyHealthCareStudiesandClinicalInvestigationDivi-sion,1986),ii-iii.84.TheSurgeonGeneralLieutenantGeneralQuinnBeckerreiteratedthat70percentof

theArmy’smedicalsupportwasdestinedtocomefromtheArmyReserveandNationalGuard. “U.S.ArmyMedicine, from theFerment,ProfoundChanges,”Army 36 (March1986):43.“TSGMeetingwithCSA,2July1987,”TypewrittenOutline,ANCC,OMH.85.Another result of this surveywas the 1986 establishment of a policy barring re-

servenursepromotionsabovetherankofmajorwithoutabaccalaureatedegreeinnursing.GeneralSlewitzkewasabletoimplementthisstandardbecauseeducationalfundingwasavailabletosupportreservistsintheirpursuitofthedegree.ConnieL.SlewitzketoAuthor,TypewrittenComments,29September2003;and“ArmyNurseCorps(ANC)1986AnnualHistoricalReport,”20(bothinANCC,OMH).86.ConnieL.Slewitzke,InterviewbyBeverlyGreenlee,464–65,n.d.,U.S.ArmyWar

College/U.S.ArmyMilitaryHistoryInstituteSeniorOfficerOralHistoryProgram,ProjectNo.88-8,ANCC,OMH.87.CharlesJ.Reddy,“NursingNewsletterNumber83-2,”3,1November1983,ANCC,

OMH.“ARPERCENandRCPAC,WhatDoTheyDo?”Army Reserve Magazine(Winter1985):10–11.88.COLBlake,“PracticeRequirementsforUSARNurseCorpsOfficers,”Typewritten

Memorandum,4January1988,ANCC,OMH.89.“ProgramBoostsReserveReadiness,”HSC Mercury13(December1985):5.Jerry

Harben,“CompetitionforNursesGetsTough,”HSC Mercury16(August1989):6.90.ConnieL.Slewitzke,InterviewbyBeverlyGreenlee,393–94,n.d.,U.S.ArmyWar

College/U.S.ArmyMilitaryHistoryInstituteSeniorOfficerOralHistoryProgram,ProjectNo.88-8,ANCC,OMH.91. Connie L. Slewitzke, Interview byBeverlyGreenlee, 396, n.d.,U.S.ArmyWar

College/U.S.ArmyMilitaryHistoryInstituteSeniorOfficerOralHistoryProgram,ProjectNo.88-8,ANCC,OMH.WesleyG.Byerly,“AMutualSupportProgrambetweena1,000BedTDAAugmentationReserveHospitalandanActiveComponentArmyCommunityHospital,”Military Medicine149(October1984):565–69.JamesH.Carter,“MutualSup-portandMobilizationPreparedness:TheMethodofanArmyReserveHospital,”Military Medicine155(August1990):379–81.92.TheofficerinOTSGwasLieutenantColonelMarieP.Alire.MarieP.Alire,“Inputto

ReadinessIssueonANCStrategicPlan,”TypewrittenMemorandum,June1988,ANCC,OMH.ConnieL.Slewitzke,InterviewbyBeverlyGreenlee,466–68,n.d.,U.S.ArmyWarCollege/U.S.ArmyMilitaryHistoryInstituteSeniorOfficerOralHistoryProgram,ProjectNo.88-8,ANCC,OMH.ClaraL.Adams-EnderandAmeliaJ.Carson,“CapabilitiesofArmyNurseCorpsOfficerGraduatesoftheUnitedStatesArmyWarCollege,”Medical Bulletin of the US Army, Europe43(September/October1986):27–29.93.DonnaF.Owen,“AnnualHistoricalReport,”TypewrittenMemorandum,2Decem-

ber1989,ANCC,OMH.94.LorraineMirabella,“ArmyReserveGeneralWearsOneStarbutTwoHats,”Howard

County Sun(6August1989):4.95.“NurseNamedBrigadierGeneral,”Army Times50(21August1989):2.


96.DorothyPocklington toAuthor,E-mailCorrespondence,3,22August2003; andDorothyPocklington toLTCMittelstaedt,TypewrittenLetter,13January1995(both inANCC,OMH).97. Dorothy Pocklington, “BG Pocklington’s OER Support Objectives & Contribu-

tions,”TD,March1988–June1991,ANCC,OMH.98.DorothyPocklingtontoAuthor,E-mailCorrespondence,4,22August2003,ANCC,

OMH.99.Michael J. Foster, “Minutes of theArmyNurseCorps StaffMeeting on 2April

1993,”TD,5,5May1993,ANCC,OMH.100. Sonnie Scarlett, “Academy, FORSCOMDevelop a SmartTraining Plan,”HSC

Mercury15(January1988):1.101.DianeCorcorantoAuthor,TelephoneConversation,9April2003.102.“ReserveTrainingProgram,”InformationPaper,2July1985,Enclosure5,inCon-

nieL. Slewitzke, “Memorandum from theChief,USArmyNurseCorps,”April 1986,ANCC,OMH.103.ConnieL.Slewitzke,“MemorandumfromtheChief,USArmyNurseCorps,”10,

October1984,ANCC,OMH.104.ConnieL.Slewitzke,InterviewbyBeverlyGreenlee,471,n.d.,USAWC/USAMHI

SeniorOfficerOralHistoryProgram,ProjectNo.88-8,ANCC,OMH.105.TheAMEDDtermedthisnotionofpre-positioningahospitalthe“warm-basecon-

cept.”Itinvolved“theremotestorageofageneralhospitalsetattheintendedsiteofitswartimeuse.Asaminimum,thehospitalcore[was]established,includingtheoperatingrooms, centralmaterial service, laboratory, radiology and 100 intensive care beds.Theremainderoftheequipment[wastobe]storedcontiguouslytofacilitateexpansiontothefull1,000bedcapacity.”QuinnH.Becker,“MedicalReadiness:Army’sTopPriority,”U.S. Medicine24(January1988):45–46.106.BarbaraJoFoleyandJosephE.Foley,“OnWorldwideCalltotheArmy,”American

Journal of Nursing89(October1989):1310.

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