Emergency medical Activity at the Pentagon Following the Al Qaeda Terrorist Attack: Recollections of Captain John P. Ferrick, MC, USNR.
Recollections of Captain John P. Feerick, MC [Medical Corps], USNR, and Captain Stephen S. Frost, MC, USNR, who were at the Pentagon to attend a meeting when the Pentagon was struck by hijacked American Airlines Flight 77.
Adapted from: "Picking Up the Pieces." Navy Medicine 92, no.6 (Nov.-Dec. 2001): 14-17.
Feerick: I felt a rumble. It was near the subway entrance and I thought it might have been the subway.
Frost: We were right outside the Reserve Affairs Office for the Assistant Secretary of Defense. We followed the people out of the building and saw a policeman outside directing people. We went over to him and said we were physicians and that we would stand by if needed. He called his command center and directed us to the area where some injured lay on the front lawn by the impacted area near the helipad. We were the only physicians there at the time.
Feerick: There were still some walking wounded stumbling around, and parts of the building still caving. There were still small pockets of what I presume was aviation fuel flaring up. There were windows popping, and glass and particles in the air. CAPT [Captain] Frost immediately entered this maelstrom and started triaging and ministering to victims.
Frost: We saw many blast injuries, people with swollen faces and reddened skin and severe bums. The burns were the worst part. We really did not have much equipment. One of the EMS [Emergency Medical Service] trucks had their stuff out there, so we had a limited number of IVs [for introducing intravenous solutions into bloodstream] and bags. And that is basically what we were doing - starting IVs and just evaluating the injured for the severity. It was actually CAPT Feerick who was able to get the EMS people to start transporting the people out of the area.
Feerick: Our heads were down when we hit the deck, but when I got to look up after stabilizing the patients that stumbled into me, there were ambulances coming all along that line. We had many, many people onsite. Who was medical and who was not was impossible to say at that point. Civilians and military were helping people. Those who had skills helped, and those who did not stood by and helped where they could with transport and carrying patients.
We saw about two dozen major injuries. I am sure there were more than that, but we did not manage more than six to nine hard cases and half a dozen other “maybes” - people that could develop respiratory problems or who might have spinal injuries.
Frost: After working near the impact point and evacuating those patients, we moved back to an area where the civilian EMS had set up a triage area.
Feerick: It was on the "knoll," about a couple of hundred yards on the other side where the tunnel goes into the South Parking Lot. But with multiple aviation threats - people calling in "Everyone get out. There is another air strike coming in,” - all this was disestablishing and scattering people. At that point I thought it was essential to get people under cover so that we could have a fixed base.
There were a lot of people telling other people what to do and my concern was that the chain-of-command was not being followed. My training was that the civilian on-site command medical officer was the director of all military and civilian activities. And I identified him as Dr. Jim Vayfier, an emergency room physician attached to the Alexandria Fire Department. He was superb; he was excellent. He was the best of the best, providing command support and assistance at all levels in reasonable, effective management.
I thought the underpass was a safe, secure place. It was cool, out of the sun, and there was good ventilation. Even though there was smoke all over the place, we had a wind blowing through there that cleared what did come in. We had the curb, two lanes, a middle island, two lanes, and another curb. We set up our medical supplies along the curb. Dr. Frost set up his triage area in the center, and I had the ambulances lined up on the other side. Fortuitously, also, it was close to the helicopter landing spot which was just outside.
When we were setting up teams on that site, CAPT Frost and I discovered MAJ [Major] Michael Moore, an Air Force officer who has experience in triage and disaster management. I put him in control of the triage program.
I made the decision early on to designate the civilian medical director to tell us what he wanted with us and to keep the military team together to form the backbone of the major medical supply. Civilian response was basically EMT [Emergency Medical Technician] teams - ambulances. The major casualty care was going to come from the military teams with many attending civilians. I made the decision early in the process that we would use the EMS system and not bypass to go to military hospitals. I triaged and transported. I did not identify who was in what service, their serial number, and to what unit they belonged.
Frost: In our fullest capability we had seven teams ready to treat people. We saw maybe a dozen people the first few hours after the disaster. There was a team from the Navy Yard Clinic that responded on their own. They brought corpsmen, a couple of PAs [Physician's Assistants], a couple of docs, and some nurses. There were actually a fair number of civilian nurses and I do not have their names. There was a nearby civilian pediatric physician who closed his office and came over. There must have been 50 to 100 people that were there just to help with logistical problems.
Feerick: We probably had 150 medical personnel on the site at one time. Before we were through, CAPT Frost had built himself a fleet hospital down in that underpass. You could have done open heart surgery. Later on, I brought the EMS director who was then in charge down to see what we had. He looked at what CAPT Frost had set up and said, "There is no way I am going to change this. Leave it as it is." He agreed with me that it was safe and secure, totally well organized. Had we actually had livable casualties, it would have been the busiest place in town.
Initially, supplies were available but there was a mal-distribution. However, nothing affected patient care. We had more than enough for the few casualties we saw.
Frost: Initially, we had some supplies, perhaps a dozen IV set ups and bandages. We did not have a lot of splinting material. We were concerned at first that we were going to have a big influx of patients which never occurred. Nevertheless, we got those supplies within the next hour or two.
Feerick: As for the burn patients, they were pretty much evacuated from the site. Maintain an airway, get a line entry for shock, and get them out.
Frost: The worst burns were the ones we saw initially at the helipad area. And after that the burns we saw were just minor. The major injuries were the ones that came out the first 20 minutes to half hour.
Feerick: We had a lot of help from our sister services. Lieutenant Colonel Patty Horaho, Army Nurse Corps, was tireless, energetic, and fearsome in her staff organizational ability to get the job done and get the information out. She was also a key player in maintaining the chain-of-command. COL [Colonel] Craig Urbauer is the Assistant Deputy for Health Care Policy at the Pentagon. He was invaluable as a source of information to me trying to organize what was essentially a joint command - air and ground operation. COL Urbauer let me know who to ask for what I wanted. There was Rich Neel, an Air Force Medical Service Corps officer. COL [James] Geiling from the Walter Reed Clinic who was at Walter Reed at the time of the impact. He arrived late on the scene, physically running because the bridges were blocked. He demonstrated a "warrior-physician" ethic, a physically fearless and heroic behavior pattern that emboldened the troops and provided the Army people with an inside presence. He re-established his clinic in the building. I should also mention MSGT [Master Sergeant] Noel Sepulveda. He was the senior enlisted person at the site who was tireless and invaluable in his efforts to maintain communication and control between the different sites.
I must also mention COL Gladys Gonzalez, Army Medical Corps from the Assistant Secretary of Defense, Office of Reserve Affairs. She was sharp and on top of things. She was also a "center of gravity." There were people who were centers of gravity, people who gathered people around them who were looking for leadership. One of my concerns is that I do not know all of the people that should be talked about.
One person we really need to mention is RDML [Rear Admiral, Lower Half] [John] Mateczun who was on-site and invaluable. He was also physically heroic at a time when the building was unstable and the situation was fluid. He provided me with invaluable information as to what was going on at the upper levels and he was there to provide some form of verification or legitimacy to the operation.
Lieutenant General [James] Peake [Army Surgeon General] was on-site showing the flag through his command. The Sergeant Major of the Army was there when I asked for stretcher-bearers, thinking we were going to bring people out. He was tireless in his efforts rounding up his troops. The medical teams functioned fabulously well.
Frost: People commented on how well organized the people from the Navy Yard were. They stayed on until about 4 o'clock in the afternoon when we were consolidating the medical assets. When it became obvious that they were not needed, half stayed anyway as a reserve in case of a catastrophe with the fire crews.
Feerick: Throughout the evening I had been cutting back our forces to basically just one team from Walter Reed. The Navy assets finally went home in the morning when they reported to their clinic. CAPT Frost and I remained on scene until relieved by RDML Mateczun. And it was pretty much 24-hours, at which time we went back to BUMED [Bureau of Medicine and Surgery headquarters in Washington DC].
This was not a Navy action. This was Army, Air Force, Navy. It was also civilian. We had civilian and military personnel with no medical training at all on-site who instead of running in the other direction ran to where they were needed, and in the face of hideously wounded and burned people. They showed the courage necessary to stand by and do what they could. Everybody acted up to their level of skill and far beyond it. At that point, rank did not matter. The people who knew the job and had a job did their job. Other people assisted them. It was the natural selection process. Many senior officers took a back seat to someone who was a better organizer. Many officers took direction from senior enlisted people who happened to have medical training when they did not. I had a Marine - a colonel or a brigadier general - show up in the tunnel and say, "Show me how to carry stretchers, show me how to start IVs. Give me a job." People did not care about rank and they did not care if they were trained or not. When everybody was running away they went toward.
11 August 2002