The 24-note melancholy bugle call known as "taps&#; is thought to be a revision of a French bugle signal, called "tattoo,&#; that notified soldiers to cease an evening&#;s drinking and return to their garrisons. It was sounded an hour before the final bugle call to end the day by extinguishing fires and lights. The last five measures of the tattoo resemble taps. The word "taps&#; is an alteration of the obsolete word "taptoo,&#; derived from the Dutch "taptoe.&#; Taptoe was the command &#; "Tap toe!&#; &#; to shut ("toe to&#;) the "tap&#; of a keg.
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The revision that gave us present-day taps was made during America&#;s Civil War by Union Gen. Daniel Adams Butterfield, heading a brigade camped at Harrison Landing, Va., near Richmond. Up to that time, the U.S. Army&#;s infantry call to end the day was the French final call, "L&#;Extinction des feux.&#; Gen. Butterfield decided the "lights out&#; music was too formal to signal the day&#;s end. One day in July he recalled the tattoo music and hummed a version of it to an aide, who wrote it down in music. Butterfield then asked the brigade bugler, Oliver W. Norton, to play the notes and, after listening, lengthened and shortened them while keeping his original melody.
He ordered Norton to play this new call at the end of each day thereafter, instead of the regulation call. The music was heard and appreciated by other brigades, who asked for copies and adopted this bugle call. It was even adopted by Confederate buglers.
This music was made the official Army bugle call after the war, but not given the name "taps&#; until .
The first time taps was played at a military funeral may also have been in Virginia soon after Butterfield composed it. Union Capt. John Tidball, head of an artillery battery, ordered it played for the burial of a cannoneer killed in action. Not wanting to reveal the battery&#;s position in the woods to the enemy nearby, Tidball substituted taps for the traditional three rifle volleys fired over the grave. Taps was played at the funeral of Confederate Gen. Stonewall Jackson 10 months after it was composed. Army infantry regulations by required taps to be played at military funeral ceremonies.
Taps now is played by the military at burial and memorial services, to accompany the lowering of the flag and to signal the "lights out&#; command at day&#;s end.
One of the most important services of the VFW is to provide military honors in conjunction with the United States Military for those who have served honorably and have passed away. We mourn the loss of your loved one with you as every member of the military is also our brother or sister. We are honored to provide military funeral honors at your loved one's wake or graveside. Arrangements can be made through the funeral director or by contacting the Post Service Officer.
Veterans answered our nation&#;s call, surrendering their civilian constitutional protections so that we may live free. They have experienced combat, deployment, and many of the stresses that come with military life. They deserve our respect and gratitude at the time of death, not just on Veterans Day.
It is a great honor and privilege to care for the men and women who have bravely served our country, and to give a hero&#;s Final Salute in recognition of the veteran&#;s service and sacrifices. US Department of Veterans Affairs (VA) and other non-VA health care facilities caring for veterans find meaning and take pride in providing a Final Salute to veterans who spend their last days of life at their facilities. The Final Salute aligns with the mission of the VA: To fulfill President Lincoln&#;s promise &#;To care for him who shall have borne the battle, and for his widow, and his orphan&#; by serving and honoring the people who are America&#;s veterans.1 As health care professionals, we feel and grieve the loss when a veteran dies within our facilities. While some VA and community health care facilities honor veterans at the time of death, others have yet to implement a Final Salute program.2 How can we ensure that veterans at the time of death receive a hero&#;s Final Salute?
There are 26 million veterans alive today, representing about 8% of the total US adult population.3 Yet more than veterans die every day, representing about a quarter of all US deaths.4,5 Most veterans die in the community; only 4% of veteran deaths occur in VA facilities.5,6 This article highlights the unique tradition that a few VA and community health care facilities have launched to honor veterans whose journeys end under their care. This article also is a call to action to raise awareness of the importance of instituting the Final Salute program that is part of the end-of-life protocol for veterans.
A Final Salute ceremony (also called Honors Escort or Honor Walk) takes place when a veteran who dies in the hospital or nursing home is transported on the gurney from the location of their passing to the funeral home vehicle or the morgue. Staff, family members, visitors, and other veterans silently line the hallways from the veteran&#;s room to the health care facility exit and pay their respects to the deceased veteran. A Final Salute is a quiet, yet profound and powerful way for care teams to ensure that the deceased veteran does not leave alone.
There are many acts of remembrance at the bedside from the time of death to the time when the veteran&#;s body approaches the funeral home vehicle or the doors of the morgue. Tonya Ross, social worker and Honors Escort program manager at the Robert J. Dole VA Medical Center (VAMC) in Wichita, Kansas, reported that following the death of a veteran, there is a bedside remembrance that begins with a flag ceremony. Afterward, the veteran&#;s gurney is draped with the American flag, and as the procession moves through the medical center, the veterans salute, and all others place their hands over their hearts.
Chaplain Michael Halyard at the Ozarks VAMC in Fayetteville, Arkansas, reported that following the death of a veteran, the chaplain greets family members with condolences and allows them to grieve and reflect on their life with the deceased veteran. On arrival of the funeral home team, an announcement for an Honor Walk is made. Staff, visitors, and family are lined up on the first floor of the hospital waiting to pay their final respects to the veteran. A slow processional of the veteran covered by a handmade quilt is escorted by a VA police officer and the chaplain. The processional stops in the middle and the chaplain announces, &#;Let us pause for a moment of silence as we honor one of our own US Army veterans who has completed the journey of life.&#;
The Final Salute at the VA Wilkes-Barre Community Living Center (CLC) in Pennsylvania begins with a bedside flag ceremony. Afterward, the veteran&#;s gurney is draped with the flag, and as the procession moves through the CLC, all who are standing along the route offer their respects. Throughout the ceremony, a team member remains with the family of the deceased, providing comfort and support. Once the ceremony is completed, the team member remains with the family to ensure all issues are addressed and all questions or concerns are answered.
Residents of the Philadelphia VAMC CLC in Pennsylvania have found a way to say a last goodbye to fellow veterans in a unique and dignified manner. Bettyanne Corkery, nurse manager for the Heroes&#; Crossing hospice and palliative care unit explains, &#;Our Honor Guard evolved from our residents&#; requests. We used to drape a flag over the body of veterans leaving us for the last time, but our residents came to us and said they wanted to do more.&#; CLC residents wanted to form an Honor Guard and say goodbye with dignity and grace. Gerry Donlon, a US Army Vietnam veteran and president of the residents council and chief program coordinator, explained that Honor Guard members are called to the deceased&#;s room and stand guard until the hearse comes. Donlon adds, &#;We proceed forward, along with the family, and the speaker system for the hospital plays patriotic songs, including Taps. When we get to the lobby, we stop, and I say a prayer. We fold the flag military style and hand it over to the family members, we render a Final Salute, and then the veteran is taken to the hearse.&#;7
Texas Health Arlington Memorial Hospital (THAM) has honored 531 veterans with Final Salutes since . Before the official procession begins, designated employees drape the patient&#;s body with the flag. Physicians, nurses, and volunteers escort the body in a silent procession along with the family. On leaving, the veteran&#;s family receives the flag in honor of their loved one. A specially designed medallion has been placed in the lobby floor at the location where the Final Salute is rendered. Christi Evans, RN, BSN, ACM, manager for care coordination at AnMed Health, Anderson, South Carolina, witnessed a Final Salute at THAM for a relative and took the idea to Mike Johnston, Director of Spiritual Care to establish the program at AnMed Health, which has provided 118 Final Salutes since .
For more information, please visit hospital taps.
Central Maine Healthcare (CMH), which operates 3 hospitals, provides 2 ceremonies. The Final Salute occurs prior to the veteran&#;s passing and the Honor Walk gathers hospital personnel outside the patient&#;s room as they are moved. During the Final Salute, with the approval of a veteran&#;s family, a veteran employed by CMF presents the veteran with a folded flag and certificate and thanks them for their service and hospital employee salute. After the veteran dies, staff members gather in the hallway for the Honor Walk. Ascension Sacred Heart (ASH), Florida, where on average 260 veterans look for treatment every month, has taken the Final Salute to all 4 of their hospitals. Sabrina Granese, BSN, RN, Military Service Line Director at ASH explains, &#;Patients that are active duty or veterans are identified at the time of admission. When a veteran passes away, with the approval of a veteran&#;s family, &#;Code veteran&#; will be heard over the hospital intercom. Staff members will have 5 minutes to make their way to the main hospital entrance for the Honor Walk.&#; Similarly, the skilled nursing facilities operated by Bethesda Health Group, St. Louis, Missouri, have implemented the Veteran Escort Ceremony. Employees, volunteers, family members, and residents line the hallways during the procession to salute and honor the passing of the veteran&#;s body.
Simple yet magnificent, a Final Salute shows that a veteran is &#;gone but not forgotten&#; and also shows families they are not alone as they too made sacrifices to allow their loved ones to serve in the Armed Forces; it signals the hope of healing and closure.8 &#;The staff came to pay their respects,&#; recalled Cindy Roberts, a social worker at the VA Bay Pines, when her relative died at the Ozarks VAMC. She explained, I wasn&#;t expecting as much because it was 2 am. I have never in my life had an experience like that. I wish there were words to describe it; I wish every VAMC in the country did that.&#;
Hope Danishanko, social worker at the VA Wilkes-Barre CLC, said veterans are appreciative of the program. &#;I have had many CLC residents tell me that the Honors Escort allows them to have closure. They also feel it provides respect to the veteran who has passed.&#;
Bettyanne Corkery noted that the Philadelphia CLC Honor Guard program is unique because it is veteran driven. &#;They have sessions in which they talk about what works and what doesn&#;t, and they recruit new volunteers themselves,&#; she said. &#;It has evolved into the most beautiful ceremony, and they are constantly tweaking it.&#; According to Gerry Donlon, &#;When you see all 8 members of the Honor Guard get a call at 2 am, and everyone shows up, you know there&#;s personal satisfaction. I&#;d like to see every CLC [throughout VA] do this. I really would.&#;7
&#;Family members tell us they feel blessed and honored to be a part of the program. They are so grateful for the way we pay tribute to their veteran loved one,&#; says Leslie Schaeffer, support services manager and bereavement coordinator and coordinator of the Veteran Escort Ceremony at Bethesda Health Group communities.
Privileged and humbled&#;that is how staff and family members describe feeling after participating in a Final Salute. Its impact on the families has been amazing. Between the tears, there are thanks for the recognition of the sacrifices their loved ones made. When one family was informed of the ceremony by Reverend Tricia Lytle, Manager of Spiritual Care at AnMed Health, the &#;whole family responded by explaining how much that meant at such a difficult time. They began sharing stories about his service and how proud he was to be a veteran,&#; she reported. &#;As I [Rev. Lytle] leaned over to present the flag at the bedside, the wife reached up and took hold as she tearfully accepted it and embraced it close to her heart. The staff in the hallway looked on respectfully also in tears.&#;
The Final Salute is a brief ceremonial procession demonstrating that the mission to care for America&#;s veterans does not end at the bedside. It ensures that no veteran&#;s body is alone when led out of the health facility room to the exit. With these Final Salute practices, I hope that the rest of VA and community health facilities caring for veterans will implement a Final Salute program to better honor veterans who depart in their care.
The author would like to express gratitude to everyone who so openly shared their stories&#;your insight, advice, and encouragement are inspiring and invaluable. Thank you to all the facilities that consented to be featured in this article.
Disclaimer
The opinions expressed herein are those of the author and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, or any of its agencies.
Author disclosures
The author reports no actual or potential conflicts of interest or outside sources of funding with regard to this article.
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