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All CPR-qualified hands report to the forward paint locker immediately!” Sailors were running frantically all over the ship, and in the distance, a large huddle of men surrounded the paint locker door. The first man was carried out and laid on the deck. The man’s skin was very pale and his blood looked as if it were ready to explode out of his skin. With no regard for personal safety or hygiene, three sailors pounced on the man and immediately began CPR. Other sailors emerged from the paint locker carry- *ng two more shipmates, and CPR again began without hesitation. One of the dying men vomited into the mouth °f the sailor trying to resuscitate him. The sailor spit and continued his effort. Despite the valiant efforts, all three men died.
This tragedy could have taken place on any ship in the fleet. In fact, it struck the CSS Sumter (LST-1181) during the summer of 1992,
While I was on board for second-class cruise. I always have had valuable learning experiences on cruises, but this time I witnessed another side of the Navy—the wickedly dangerous and unforgiving side. The deaths of these three sailors left everyone on the Sumter questioning what had gone wrong. I began to question my own leadership abilities and how I would handle safety issues and training as a junior officer. When I saw the families of those sailors, I was hit by the reality of being responsible for someone’s spouse or child.
I learned some valuable lessons.
I watched in disbelief as the crew members of the Sumter Worked frantically to save the lives of their shipmates. I overheard someone say the sailors had been performing a PMS (pre
Accidents are going to happen in our business, and people are going to die, but it is an officer’s job to ensure that no life is lost because of a mistake that could have been prevented.
questioned their abilities. But something had failed. I wondered how many safety lectures had been given to the men and to how many they actually had paid attention. Safety is an issue of paramount importance in the Navy, and it should never be handled lightly.
All of the training schedules were up to date on board
ventive maintenance) check on the locker’s C02 system. “PMS check,” I thought, “Men are not supposed to die doing a routine check on a system. What went wrong?” The investigation started immediately. Over the next four days, I saw more admirals come on board the Sumter than I had seen in my entire life. Reporters camped outside the pier, hoping to get information. It was a tense period, and no one escaped scrutiny. I felt sorry for the young division officers being questioned.
LST-1181. Obviously, the men had been trained thoroughly on all topics important to the Navy. Or had they? Training should not be a boring and rigorous routine that everyone dreads. It would be very easy for division officers to just pick up a training packet and go over it with their divisions, lecturing for an hour so they can check off the necessary block for inspections. It takes a little more effort to make training interactive, but it is worth it. The trainer must take an active part and encourage the men and women to ask questions and participate. People learn much more when they take an active role in the training.
Another good idea would be to put one of the senior people in the division in charge of some of the training. People in the division may respond better to a new face or a different approach, and they may feel more at ease asking questions. It might take a little more time for the division officer to prepare the person leading the training, but it definitely would be worthwhile if the sailors in the division learned something that could save their lives one day. It also would show that the division officer has confidence in his sailors.
The men and women who join the U.S. Navy want to do their
jobs to the best of their abilities. An ensign—or any officer
must have complete confidence in his people, and they have to see that. They need to be able to go to their leader with problems and know that he or she will listen. If something breaks that was just fixed, the sailors should not be afraid to report it. On the other hand, an officer must hold his people accountable for their jobs. Do spot inspections on PMS checks and let the crew members know you care about what they are doing. You may see something they missed. Do not jump all over them; everyone makes mistakes and can learn from them. The sailors in a division want to do their job correctly; do not tempt them to take shortcuts.
The tragedy on board the Sumter happened early on a Friday afternoon. A division officer told three men that they could knock off as soon as they finished the PMS on the forward paint locker C02 system. The sailors entered the locker without any breathing devices, dogged the hatch, and did not remove the needle that punctures the C02 canisters. All of this is addressed on the PMS card. They then discharged the system and were asphyxiated. It eventually was decided that the men went into
the paint locker with no intention of doing the PMS. Perhaps they were going to remain in the locker for some time, report v the check had been done, and then go home. Instead, something went wrong, the system discharged, and the men lost their lives c over a few hours of liberty. This was the most valuable lesson I learned that cruise: Do not put sailors into positions where g they are tempted to cut comers. 1
The second valuable lesson I learned was that, as a division officer, I will be responsible for the lives of my sailors. I will '
never forget the look on the commanding officer’s face as he <■
talked to one of the men’s wives t
about the death of her husband. I (
would not have wanted to see the looks on the faces of the officers 1
who had to travel to inform par- 1
ents that their sons had been killed doing a maintenance check. '
The morning of the memorial service was a long one. The : two division officers who escorted the families into the chapel 1 had the hardest job of anyone: they had to walk with and face 1 the families of the men for whom they had been responsible. They carried a heavy burden of guilt, but incredibly the fami- | lies did not seem to blame them. Their sons, brothers, and husbands had died in the service of the United States, and they were proud of that. At the service, the commanding officer spoke of these men as if they were his sons. The family is the backbone of the United States, and the naval family is the backbone of the Navy. .
The Sumter will always hold a special place in my heart. It is where I met QM1 Ackerson, who taught me about being a caring leader and motivating men. It is where I learned that the Navy is more than just driving ships and sitting off the coast of some country I can neither pronounce nor find on a map- The Navy is about leading people. Equipment must be taken care of for the ship to run properly, but the crew must be taken care of for the equipment to run properly. Accidents are going to occur in our business and people are going to die. It is our job as officers to ensure that no life is lost because of a mistake that could have been prevented. The Sumter opened my eyes to the side of the Navy they don’t put on the ballcaps.
Ensign Mosley, a 1994 graduate of the U.S. Naval Academy, is serving on recruiting duty in Tennessee prior to reporting to Supply School in Athens.
I thought, "Men are not supposed to die doing a routine check on a system. What went wrong?"
Integrity: In All Circumstances
Ensign Aaron Rouland, USN
Several posters hang on the wall outside the Naval Academy’s Fourth Battalion office, one of which reads, “Honesty . . . The Best Policy,” and shows a picture of Walt Disney’s Pinocchio.
I laughed the first time I saw it, because it looks like it belongs in an elementary school. Something else about the poster struck me: The words don’t sound right.
“The Best Policy.” Is that all? What if it does not always appear to be the best policy? Who decided that honesty is the best policy, anyway? The poster indicates a more pervasive trend: to consider a quality or principle (such as honesty) not for its intrinsic value or goodness but for its likely effect in a situa
tion. If the outcome is good, the means of producing the outcome must also be good.
Situations arise in which the unscrupulous course of action appears to be the most attractive. We may even convince ourselves that what we are doing is right, simply because something good comes as a result. Must we always be honest—even when it seems unnecessary or counterproductive?
Yes, when we are faced with ethical dilemmas, we must cling to what we know is inherently right. We must throw off all other temptations. We must be honest, fearless of the consequences.
The next question is obvious and sometimes troublesome: How can we know what is necessarily right and necessarily wrong? Who decides what is good and bad? Can we ever agree? No, we can’t. We won’t agree on everything, but there are some things on which we will all agree: