 analysis. Borman drew the teams on disassembly, ground emergency provisions, and inflight fire emergency provisions. Williams monitored the spacecraft and ground support equipment configuration, test procedures review, and service module disposition. George White, quality and reliability chief from Headquarters, was responsible for investigations into test environments, design reviews, and historical data. An associate of Thompson's from Langley, Geer handled the groups on the analysis of spacecraft fractures, the board's administrative procedures, and the safety of the investigation operations themselves. Strang was left with the panels taking statements from witnesses, handling the security operations of the inquiry, and writing up the final report.
When Seamans made a second preliminary report to Webb, on 14 February, it was clear that the fire was indeed a fire, and not an explosion leading to a fire. Physical evidence indicated that the conflagration had passed through more than one stage of intensity before the oxygen inside the cabin was used up. By mid-February, the work of tearing down the command module had reached a point where a two-shift six-day week could replace round-the-clock operations.
On the day of the scheduled launch of AS--204, 21 February, the board gave preliminary briefing to George Mueller and a dozen other top NASA officials in preparation for a major briefing of Seamans. Thompson told Seamans the next day that 1500 persons were directly supporting the investigation--600 from government and 900 from industry and the universities--and that the board planned to complete its report by the end of March. Although the history of the fire after it started had been minutely reconstructed, the specific source of ignition had not been--and might never be--determined. On 25 February, Seamans prepared a memorandum for Webb, listing early recommendations by the board that the Administrator could present to Congress:
That combustible materials now used be replaced wherever recognize the possibility of cabin fire. (18)
The astronaut member of the Thompson Board assured NASA's top officials that he would not have been afraid to enter the Grissom crew's spacecraft that January day. Working with the board, however, Borman and everyone else had come to realize the substantial hazards that had been present but not recognized before the fire. (19)
As its final report was being put together, the review board recognized that there had been ignorance, sloth, and carelessness, but the key word in, all the detailed information was "oversight." No one, it seemed, realized the extent of fire hazards in an overpressurized oxygen-filled spacecraft cabin on the ground, according to the summary report the board issued on April:
Although the Board was not able to determine conclusively the specific initiator of the Apollo 204 fire, it has identified the conditions which led to the disaster--:
- A sealed cabin, pressurized with an oxygen atmosphere.
- An extensive distribution of combustible materials in the cabin.
- Vulnerable wiring carrying spacecraft power.
- Vulnerable plumbing carrying a combustible and corrosive coolant,
- Inadequate provisions for the crew to escape,
- Inadequate Provisions for rescue or medical assistance,
Having identified the conditions that led to the disaster, the Board addressed itself to the question of how these conditions came to exist. Careful consideration of this question leads the Board to the conclusion that in its devotion to the many difficult problems of space travel, the Apollo team failed to give adequate attention to certain mundane but equally vital questions of crew safety. The Board's investigation revealed many deficiencies in design and engineering, manufacture and quality control. (20)
The Thompson Board report came to almost 3000 pages; divided into 14 booklets, it made up a stack about 20 centimeters high. The six appendixes were: (A) the minutes of the board's own proceedings; (B) eyewitness statements and releases; (C) the Operations Handbook for spacecraft 012; (D) final