WASHINGTON, DC—In the wake of a shooting spree last month at Fort Hood that left 13 dead and dozens injured, federal officials are trying to make sense of the tragedy. One step is piecing together warning signs that may or may not have been ignored. Was it possible to predict that the Army soldier who has been charged in the shooting spree posed a threat? Army Major Nidal Hasan, the accused killer, was an Army psychiatrist. He attended medical school at the Uniformed Services University of the Health Sciences and received medical training at the Walter Reed Army Medical Center before transferring to Fort Hood this summer.

In addition to a federal criminal investigation, the President has ordered a full review of the sequence of events that led up to the shootings. “The purpose of this review is clear: We must compile every piece of information that was known about the gunman, and we must learn what was done with that information. Once we have those facts, we must act upon them. If there was a failure to take appropriate action before the shootings, there must be accountability,” he said on November 14.

A separate 45-day review headed by former Army Secretary Togo West and former Chief of Naval Operations Admiral Vern Clark was also ordered by Department of Defense Secretary Robert Gates to determine whether there are any “internal weaknesses or procedural shortcomings in the department” that would make the department vulnerable to such attacks. Gates said this review will have three areas of emphasis to locate possible gaps or deficiencies in DoD’s process for identifying service members who could pose credible threats to others. Secondly, the review will assess personnel reliability programs, medical screening programs, service member release and discharge policies and procedures, pre-and post-deployment health assessment programs, periodic counseling sessions, and procedures on the reporting and handling of adverse servicemember information. Thirdly, the review will examine the sufficiency of both the department’s domestic physical security programs and its emergency response capabilities for mass casualty events at its facilities.

Gates said that the review will also look at how DoD is helping its healthcare providers deal with stress. “You go to the hospitals, and you talk to the nurses and the doctors and those who care for these grievously wounded young men and women, and their level of commitment and I can’t imagine the burden on them of doing that all day, every day. And so I think one of the things, for their own benefit, if nothing else, is for us to take a look at how are we helping them deal with stress, given the circumstances that they face,” he said. The Army, he said, will conduct a more in-depth, detailed assessment whether Army programs, policies and procedures reasonably could have prevented the shooting.

Dealing with a Tragedy

Meanwhile, the Fort Hood community is coping with the aftermath of the shootings. Leaders announced that there would be a behavioral health campaign plan to address the psychological and emotional needs of the community. According to a Fort Hood press release last month, there are currently 245 behavioral health professionals at Fort Hood, including psychiatrists, counselors, and Army chaplains.

Jim Campbell, PhD, a clinical psychologist who is president of the Rhode Island Psychological Association and the former disaster response coordinator for Rhode Island, told U.S. Medicine last month that “an extra level of violation” is felt in a community when this type of incident occurs in a place that people typically identify as safe, such as a church, home, or military base. “When it has occurred in a setting where ‘its not supposed to occur’—certainly soldiers dying on battlefields is a horrible event—but when it occurs in a place where people believe it should be safe, I think that it can shatter that sense of safety as well as that sense of predictability.” In tragedies where a community’s sense of safety is violated, there is typically not only anger towards the perpetrator, but also authorities, he said.

While psychological services are important in recovery, most people affected by these types of tragedies will rely more on their “natural support systems,” in their recovery, such as friends, family, and religious institutions. One advantage in the recovery process of Fort Hood is that its infrastructure was not destroyed. “I think a community has a harder time, say after a disaster like Katrina or Hurricane Andrew, when the whole infrastructure of an area is obliterated,” according to Dr Campbell.

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