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Luck or Divine Providence?

By: Lt. Gen. (DR.) Paul K. Carlton, USAF (Ret), Daedalian Honorary Member #50038

FBI agents, fire fighters, rescue workers and engineers work at the Pentagon crash site on Sept. 14, 2001. Department of Defense

We planned and practiced the 9/11 attacks on the Pentagon well before the attacks occurred. The story goes back to November 1999, when I was assigned to be the Air Force Surgeon General. I tried to think through the various ways that the USA could be traumatized or attacked by those who do not agree with our way of life. We had just completed an overhaul of our medical response assets, Expeditionary Medical Support (EMEDS) in September 1999 and had been thinking about how to respond to different kinds of medical emergencies for a long time. I tried to put myself in the mind of a terrorist, to think through how they might attack us and what our response should be.

I decided that if I were a terrorist, my primary targets would be Washington, D.C. and New York City. So, I began discussing mass casualty management with the Washington Hospital District and the NYC Hospital Council. We exercised with the Public Health Service response teams and took the Public Health leadership to Scott Air Force Base to see how air evacuation worked and what capability the Air Force had to respond to an event that would produce casualties in the CONUS or overseas.

Lt. Gen. (Dr.) Paul K. Carlton, USAF, right, and Master Sgt. Noel Sepulveda, USAF, center, along with Pentagon employees provided critical medical care after the 9/11 Pentagon attack. Department of Defense photo

In February 2001, I was standing in a stairwell with the Pentagon Clinic Commander, an Air Force Colonel, discussing his need for an exercise involving the Pentagon. An airplane taking off from Reagan Airport flew over us, and we had to stop talking because of the noise level. He looked at me and said, “Why don’t we do a scenario where an airplane hits the Pentagon after suffering a bird strike on takeoff.” I said it had already happened in the early 1980s when an Air Florida plane crashed from icing, and concurred with his recommendation. We then started the planning and coordinating process for such an exercise scheduled for late May 2001.

That exercise was conducted and we, the medics, did not do well. The after-action report cited numerous areas for improvement: better evacuation routes and better training and equipping of our medical people, including protective vests to identify who was who and to add a layer of defense from an expected fire. A repeat exercise was required to validate these fixes.

We repeated the exercise on Aug. 28, 2001, and did much better in the eyes of the evaluators. I reported to the Air Staff on Sept. 4 that we were now prepared to respond to an airplane impacting the Pentagon.

On Sept. 11, 2001, the briefings at our Tuesday staff meeting, with a new Chief of Staff and new Secretary of the Air Force, were interrupted with a video of airplanes impacting the World Trade Towers in New York City. The meeting was terminated, and I ended up in the office of the Vice Chief of Staff, General John Handy. As we were discussing how we, the Air Force, might respond, the building shook and smoke filled the air. It was very obvious that the Pentagon had also been struck by something.

9:38 A.M. SEPT. 11, 2001

I knew my role was to head to a preselected evacuation point to be moved out of the building. At the same time, I felt I should go to the scene of destruction. However, I also knew I was the senior medical officer in the Pentagon, so I headed to the Pentagon Clinic to pick up a team and set up a triage station.

At that point, the fire had moved to the inside of the building. I thought those remaining to flee from the fire would head away from the flames, making them come to the inside — the Center Courtyard. That was my thinking when I got to the clinic, so I told the commander I would take the Center Courtyard and he needed to set up outside to pick up those casualties exiting there.

9:47 A.M. SEPT. 11, 2001

I put on a newly arrived blue vest, picked up a volunteer team of about 40 and headed to the Center Courtyard. We saw that the smoke and fire were worst near the 4 Corridor exit, so we set up our triage station there. I did some quick review of triage categories, divided our team into immediate, delayed, minimal and expectant. The next most senior medical officer was a Lt. Col. dentist, so I put him in charge while I went to find other casualties.

9:50 A.M. SEPT. 11, 2001

I asked a fireman near the exit where the casualties were located, but he didn’t know. At the same time, another man came out of the exit and said, “I can take you to the casualty area, if you want to go.” I did, and volunteered the closest four men to go with me and bring litters.

9:51 A.M. SEPT. 11, 2001

Our team of six then headed down the 4 Corridor but were turned back by fire and smoke at the entrance to the D Ring. We retreated to the exit for the AE Corridor and headed into the alleyway. Immediately upon being able to see and breathe again, I watched a Navy SEAL catch a woman who jumped off the 5th floor, which planted him solidly on his face. A second woman jumped, but this time, the man had the presence of mind to hit her like a football tackle, turning her vertical motion into a horizontal motion, saving a second life! He then got up and reported in to me that he thought some people were still alive in the Navy Communications Center, where the B-757 landing gear had come through, creating a big hole in the D Corridor wall. He had heard screaming in that room just before our arrival.

The hole in the AE alleyway through which Lt. Gen. Paul K. Carlton, USAF (Ret), and his team gained access to the Navy Communications Center to rescue three persons. It was made by the landing gear of the B-757 as it disintegrated in the building.

This hole was about 10 feet wide and high, full of debris on fire, with fire blowing out the top and hitting the opposite wall of the AE corridor. We had to go through the hole to reach any potential casualties. The landing gear was laying against the opposite wall of the AE corridor, burning as we discussed this about 10 feet away.

Debris in the bottom half of the hole was not burning, so I asked my team to burrow through it to get inside. I did the same and found the smoke overwhelming as soon as I entered. I came back out, found a crowd of men, asked them to remove their undershirts, soak them in water and give them to me. Then I re-entered the debris pile, passing out the water-soaked shirts to the rest of the team. It helped to breathe through the cool, wet shirt material in the smoke-filled room.

Fire was burning on top of the water that had come from the fire nozzles, but we were able to push the fire away from us with debris from the entrance hole. It was very hard to breathe with fire and smoke filling all but the bottom 18 inches of the room. Metal was dripping from the ceiling putting us on fire, too.

My team found two women passed out from the smoke in the middle of the room, and we pulled them out on hands and knees. Outside, the woman I helped partially woke up, looked at me about two inches from her face and thought I was the devil himself with a black face and fire all around. She related this to me 10 days later when we got together for a debrief.

I noticed a man not on our team who seemed to be trying to lift something off to my right. Then, he stopped lifting, got on his back in the flames and did a leg press. I went over on hands and knees, and saw a face looking at me from under a fire waterfall that the leg press had revealed. The fuel above him had come down on fire and made three separate fire falls as it struck various items above this man’s head. He was not responding to my order to come to me in my loudest military voice, so I threw my wet towel onto his face and he reacted — he was alive. The man doing the leg press, Lt. Cmdr. Dave Tarrantino, was unable to lift the table pinning this man down, so got under the table to do his leg press, allowing us to reach the man and facilitate his escape. The man moved toward me about 6 inches, enough for me to go over the body of Tarrantino, and pull him out. He was intact, and we passed him out to the AE corridor.

I then sought cover under the table that Tarrantino had lifted. He told me he heard screaming off to his right and indicated he wanted to go in that direction. By this time, the outside team had passed flashlights, fire extinguishers and face masks to us. As we tried to figure out how to put the face masks on in the smoke, we heard a voice say, “GET OUT!” We were now armed with fire extinguishers, could see a little bit with flashlights and were able to actually breathe with masks, so we were not anxious to leave.

9:58 A.M. SEPT. 11, 2001

The damage done to the Pentagon by the terrorist attacks on Sept. 11, 2001. U.S. Air Force photo/Tech. Sgt. Cedric Rudisill.

But the voice got louder, “GET OUT NOW!” So, I grabbed Tarrantino, pulled him toward where I thought the hole was located and headed out. As we moved to the hole, we ran into a man’s legs, holding up the building as it collapsed. It turns out that our guardian angel, the Navy SEAL, had heard the noise increase, figured the building was collapsing, and came back in to rescue us. As we neared the hole, the blast wave from the building collapse blew us out of the hole into the AE Corridor.

All three of us and the team survived, and we had the privilege of saving three people from a certain death!

I returned to the triage location in the Center Courtyard. We received no more patients. The Air Force then launched our new EMEDS to help New York City, and we put 400 beds of medical and surgical capability into McGuire Air Force Base by 4 a.m. Sept. 12, 2001.

This is a perfect example of creating a realistic exercise that might make great practice for a real event! The entire sequence is outlined in chapter 10 of “Firefight in the Pentagon.”