Wednesday, 15 July 2015

Without war, Dover mortuary, lab roles shift

For the better part of 14 years of war, the transfer cases and bodies never seemed to stop arriving at Dover Air Force Base.

"We used to look at the casualty board and hope for a break," said James Parsons, an embalming technician with Air Force Mortuary Affairs Operations, the only U.S.-based funeral home dedicated to the nation's fallen military. "Now? Now it's good."

In 2007, the worst year of the fighting in Iraq and Afghanistan, some 1,020 military casualties were shipped home, according to Air Force Col. Dan Merry, AFMAO's commander. Last year, the overall total fell to 60. "And it has gone down gradually since," said William Zwicharowski, Port Mortuary branch chief, who was with AFMAO, and the agencies that preceded it, for the entirety of the conflicts.

So trimming, and training, are now the watchwords at AFMAO. Its next-door neighbor at Dover, the Armed Forces Medical Examiner System, has also shifted gears, from performing autopsies on every returned casualty from Iraq and Afghanistan to studying lessons learned, taking on more emerging historical DNA identification work and helping non-defense agencies with medical legal death investigations.

"We're staying busy," said Army Col. Ladd Tremaine, director of AFMES, noting the group's increasingly worldwide responsibilities for the federal government. "Most of our work is not done back in that autopsy suite. Most of my examiners are on the road."

It's been a remarkable shift. A total of 6,852 U.S. military personnel have died overseas since 9/11. All were carried off a cargo jet ramp, one by one, and into the complex that houses the two agencies. Even as stunned family members were welcomed, comforted, even counseled, the remains were being scanned (for explosive material), catalogued, autopsied, embalmed and prepared for burial.

Now, the number of dignified transfers from overseas has slowed to a crawl.

"We are not used to it," said Zwicharowski, a former Marine. "We've almost slammed the brakes on now. Which is great. ... It's probably the best problem I've ever had in my life, [which] is to not have 10, 20, 30 bodies to process a day. So it's a good problem to have."

The slowdown is giving AFMAO time to take stock of itself. Recently borrowed mortuary personnel are being returned to other bases - as well as to Dover's Air Force Reserve unit, the 512th Airlift Wing, which it has relied on heavily during the wars. AFMAO could get even smaller, Merry said.

AFMAO has 50 personnel assigned, but that could be halved "if we stay this way for a year or two," Merry said – adding that this could quickly change if the U.S. keeps increasing its small combat presence in theater.

"If we get 30 or 40 thousand boots on ground, in harm's way, we'd start plussing back up," Merry said.

To prepare for the unexpected – a mass casualty event, e.g. – Merry is implementing a more efficient rapid "recall" system. "We're looking at a system where we can hit a button and get everybody we need back here, fully trained, fully checked out, ready to go," he said.

"It's not a matter of if," Zwicharowski said. "It's a matter of when, unfortunately."

That was the case when 11 Louisiana National Guardsmen were killed in a March helicopter crash during training in Florida. All the troops were brought to Dover; AFMAO reached out to the Navy to borrow licensed embalmers to help out, Merry said.

With fewer permanent personnel on staff, Zwicharowski said, "We're turning to training on mannequins, restorative art training, embalming training, and licensing."

Training is particularly important for specialists who sometimes handle bodies in far worse shape than those that typically arrive at a mortuary. Roadside bombs were the No. 1 killer in these wars.

Tremaine's AFMES is responsible not only for worldwide U.S. military autopsies but medical legal death investigations for the entire federal government across the globe – agencies such as the FBI and NASA – which is why his examiners often find themselves traveling.

"The sheer numbers have decreased," Tremaine said. "The complexity of our cases has increased. Department of Justice has been using us extensively over the past year." He pointed to the police shooting death of Michael Brown in Ferguson, Missouri, which was investigated by the FBI.

"When something like Ferguson occurs, you're going to have the locals investigate it, and … the same thing happened here in Baltimore recently – you're going to have the family request a second autopsy," Tremaine said. "Who's going to be the ultimate arbitrator or make sure that everybody's playing on an even field? Who's the honest broker? Well, we've essentially become that honest broker. We come in as a federal entity; we get to see all the evidence and information; and potentially do a tertiary post-mortem examination, independently. And then we present that to the Department of Justice."

In addition to its autopsy work, AFMES recorded in detail war injuries with an eye toward improving combat trauma care. Tremaine wants to make that database more easily accessible.

"All throughout the war, we've been very active in identifying the glaringly obvious, and getting that information out quick," he said. "Now it's time to sit back and look at all the information in its totality, and discover those non-glaring issues that will only be captured through more in-depth research. Can we discover something else that can potentially change techniques, tactics and procedures in the future?"

AFMES' DNA Lab will also stay busy performing DNA analyses on remains from past conflicts, such as those of the sailors and Marines who died at Pearl Harbor aboard the USS Oklahoma who were buried, unidentified, in mass graves in Hawaii and are now being exhumed.

Wednesday 15 July 2015


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