This crisis, coming as it does on the heels of all the urgent work following our commercial power loss at Walter Reed and a similar event at DeWitt [Army Community Hospital at Fort Belvoir] has severely stressed many of our staff.

We are accustomed to assisting sick and dying patients in a hospital setting where death is often an expected end of life, and mutual support systems are in place and well practiced. To be up close to violent death on a large scale, or even to be awaiting patients who do not arrive at one's facility because they did not survive, is the ultimate frustration for those trained to help and save lives.

We need to focus on three main points as we go forward. First, we need to understand we must be ready to deal with the full range of possible events that may follow this one in the months and years ahead.

Second, we must be attentive to support each other -- some of us were personally close to tragedy, others were not, but all need to adapt the support we normally provide so well to these unique circumstances.

Finally, we must practice and improve our verbal communication down all supervisory chains. Messages such as this, town hall meetings, and other mass communications are good up to a point, but every supervisor needs to ensure key information gets out quickly to all levels of the organization. The accuracy and fidelity of the information must also be checked with those who received it last to make sure it got through.

[North Atlantic Regional Medical Command and Walter Reed Army Medical Center commanding general Maj. Gen. Harold L.] Timboe and I deeply appreciate the dedication, professionalism, and caring each one of you have shown and are showing as we support America's recovery and response to this tragedy.