may 2002
Pentagon Medics Remember Sept. 11 - Matt Pueschel
Didi Nguyen, Maryann Ramos, Antonia Lopez (l-r)
were among the Pentagon's Sept. 11 first-respo
WASHINGTON-Although it's been eight months since last September's terrorist attacks, for many of the medical personnel on duty that "horrific day" at the Pentagon, the memory of their experience is "permanently etched" in their minds, according to Maryann Ramos, MPH, an occupational health certified physician assistant for the Pentagon's Civilian Employees Health Service (CEHS).
Ramos was the physician assistant pictured comforting another Pentagon worker on Sept. 11 in a prominent cover photo in the January issue of U.S. MEDICINE. Taken by an Army photographer, the photo did not carry the names of the pair at the time, but fortunately a colleague of Ramos's at the Pentagon later recognized her when she saw a copy of the newspaper. The worker informed Ramos, who then contacted U.S. MEDICINE and tracked down the man in the photo whom she helped that day. "I'd like to find out his name and shake his hand," she wrote in an email to U.S. MEDICINE in January.
The man in the photo turned out to be Maj. Lincoln Leibner, USA, a communications officer for the secretary of defense. Both of them, as well as some of Ramos's other Pentagon medical colleagues who helped treat the wounded on Sept. 11, generously agreed to be interviewed by U.S. MEDICINE in early February to share their experiences. What follows are the names and personal stories behind the photo, what led up to it and the events that followed.
When The Plane Struck
Ramos was inside the Pentagon halls walking toward the metro station when the plane struck the west side of the building last Sept. 11 at about 9:40 a.m. "I felt the building shake and it felt like something fell on us," she said. "I went down to the metro, to the lowest level. I just missed the train."
Had Ramos arrived seconds earlier and caught the train, her experience that day would have been completely different. "The station master evacuated us from the metro," she said. "He said, 'Just go, go up.' Nobody told us anything. I had just seen the planes [that hit the World Trade Center] on CNN. When the first hit I thought it could have been an accident. When I saw the second, I thought, 'This is very bad.' "
Ramos emerged from the subway on the southeastern side of the Pentagon to see black smoke billowing out into the sky. She walked toward its source, outside around the Pentagon's wall until she was stopped by security guards. "They wouldn't let me go that way," she said. "I had no white coat, only my badge and purse."
Wanting to reach what she thought at the time was a "bomb site," Ramos convinced guards she was a physician assistant desiring to help with the wounded. "They let me go through," she said.
Ramos arrived on the crash scene to find several trucks, a mix of physicians, defense personnel and civilians aiding in the rescue and care of victims. The only two people she recognized were Lt. Antonia Lopez, a physician assistant and women's policy deputy for the Navy, and Didi Nguyen, an RN and hearing conservation program manager for CEHS, who were both working in the nearby Navy Annex that day and came over to help after the explosion.
"The interesting thing was that they were all strangers helping people, except for those two," Ramos said. "The rest of the [CEHS] clinic [based in the lower north side of the Pentagon] went out the north side. When they came back, they went into the center court [to care for victims who made it outside that way]. Smoke was coming from the north side and over the Pentagon into the five acres in the middle."
Ramos said she went to the first person she saw dressed in a white medical uniform. "I think it was one of the Virginia docs," said Ramos. "I said, 'I'm here to help. I'm a PA.' "
As victims staggered from the building, Ramos couldn't tell what had wrought the destruction. There were no signs of a plane. "All I could see was a giant hole in the building," she said. "I thought it was a Piper cub [small plane]. I found a couple little, thin pieces of twisted aluminum, that's all, on the ground. I gave it to the FBI. There were lots of flames at the top, a black hole and smoke."
It was at about that point that Ramos spotted Maj. Leibner, who was working feverishly to help remove victims from the building. "He was coming out," Ramos said. "Police let us meet them half way. He went in several times to get people out."
When Maj. Leibner seemed to stumble away finally, Ramos went to treat him. "I thought he was dazed," she said. "I checked his mouth and he had swallowed a lot of hot air. His whole mouth and throat were red. He was coughing. He couldn't get his breath. I got a small tank of oxygen. In the photo I was getting him to one spot so he wouldn't faint. I put his oxygen mask over his mouth."
Maj. Leibner had trouble catching his breath. "He moved [the mask] to the top of his head," Ramos said, who wrote his name and social security number and next of kin on his shirt for identification. "He had smoke inhalation."
Ramos had to practically order him to take the oxygen. "He [finally] said, 'Okay, I'll put it [back] on my mouth,' "
Ramos further wanted Maj. Leibner to catch the next ambulance. "It was my idea he could collapse at any time," Ramos said. "We had nothing to test him there. He kept saying, 'I'm not so bad, save the ambulance for someone worse than me!' I had to argue him into the ambulance by saying the next plane was about to hit, so we had to clear anyone even slightly injured from the helipad site. It was touching to me that he did not want to take up space in the ambulance. I started to argue with him. I actually shoved him into the ambulance. I said, 'You have to clear the area because another plane is due to hit. It's an order.' "
'I Saw It Hit'
Maj. Leibner had actually seen the plane crash into the Pentagon, and may even have been the first person to respond to the scene. He hadn't been scheduled to go to work in his Pentagon office on the north side of the building (two levels above the clinic) that day until 10 p.m., but after watching both World Trade Center crashes on television, he couldn't wait. He had originally thought it was just an accident, until he saw the second plane hit the towers, and that's when he decided to go to work early.
Maj. Leibner drove in and made it as far as the south parking lot, where he got out on foot. "I heard the plane first," he said. "I thought it was a flyover Arlington cemetery."
From his vantage point, Maj. Leibner looked up and saw the plane come in. "I was about 100 yards away," he said. "You could see through the windows of the aircraft. I saw it hit."
The plane came in hard and level and was flown full throttle into the building, dead center mass, Maj. Leibner said. "The plane completely entered the building," he said. "I got a little repercussion, from the sound, the blast. I've heard artillery, and that was louder than the loudest has to offer. I started running toward the site. I jumped over a fence. I was probably the first person on the scene."
A tree and the backend of a crash truck at the heliport near the crash site were on fire and the ground was scorched, Maj. Leibner recounted. "The plane went into the building like a toy into a birthday cake," he said. "The aircraft went in between the second and third floors."
At that point, no one was outside. Spotting a Pentagon door that had been blown off its hinges, Maj. Leibner went in and out several times, helping rescue several people. "The very first person was right there," he said. "She could walk. I walked her out onto the grass."
Maj. Leibner said a police officer pulled up onto the grass and began to help. "Everybody was hurt," Maj. Leibner said. "They were all civilian females. Everybody was burned on their hands and faces. I was in a ground floor window passing people down."
During the whole time, Maj. Leibner didn't stop to reflect on what had happened or worry what might happen next. "I never lost my cool," he said. "I was highly analytical the whole time. I was overwhelmed two months later."
At some point, Leibner and other rescuers were told to evacuate the building. "People told us to get out," he said. "I couldn't really walk at that point. I was done."
As he staggered away from the building on the grass, he encountered Ramos. "She was just there," he said. "She came up to me. She tried to get me the mask."
Ramos led Maj. Leibner to a triage area about 35-40 yards from the building. "There was a tree and it was a nice little grassy area," he said. "There was a lot of confusion at that point. Maryann and everyone else were doing what they were supposed to be doing and had no idea who anyone was. Maryann was great."
Maj. Leibner refused the oxygen at first because he was starting to cough. "I also didn't want to waste any medical supplies," he said. He said he endured burns and superficial cuts on his hands, but that he's fine now. The blood seen on his shirt in the photo was not his own.
'You Felt Hopeless'
When she thinks of that day, Ramos also recalls another burn patient whom she treated just after getting Maj. Leibner into the ambulance. "I turned around and a burn patient was coming out," she said. "I was afraid I'd be caught with her in the line of fire."
The woman's clothes were literally exploded off her body, Ramos said. "Her legs were so bad that her skin was coming off," she said. "She was really in shock. She had like a vacant stare. She was all sweaty, her legs were burned, and her clothes were blasted off her back because her back was bare. We got her onto a stretcher face down and DiDi started an IV, and they were ready to take her into the ambulance. We evacuated at that point."
They later heard that the burn patient died a couple of days afterward.
The victims exited the building in waves, but after a short while they stopped coming out. "After the first hour, it was very frustrating," Ramos said.
"You felt hopeless," added Lopez. "You can't go in and no one is coming out."
Ramos said she still gets galvanic skin responses when she recalls the events of that morning. "Everything was so busy, you couldn't remember everything," she said.
Help From The Annex
Lt. Lopez said the plane came right by the annex building, where she was working that day. "I could see the smoke and flames," she said. "We ran out the door from the annex [and onto the scene]. There were four or five medics there. We started IVs and treated burns. The paramedics turned over their unit to me."
"I just went where the smoke was," recalled Nguyen, who usually works at the Pentagon clinic, but happened to be performing her one weekly rotation at the annex that day. "I was worried about the Pentagon and the workers."
The three women found each other in the midst of a chaotic scene in which they saw few familiar faces. "At first I was on the helipad, 15-20 feet from the Pentagon," Ramos said.
"Initially we were about 100 yards away," Lopez said. "You could inhale the smoke. They saw a lot of the walking wounded. We immediately treated burns and covered up [wounds]."
The first responders set up red, yellow and green tarpaulins to treat the wounded, based on their levels of injury. "A triage nurse decided which ones got what," said Ramos.
Nguyen said supplies were short early on and they were running out of things like vaseline gauze. Ramos said they set up big plastic bins containing gauze sponges, tape, IV bottles and tubings. "We had to find needles and tubings and every time we moved we had to move everything," she said. "I had two stethoscopes and gloves in my waistband."
Nguyen said the paramedics arrived with supplies not too long after the crash. "But before that, you had nothing," she said.
It was a warm and sunny early fall day, and the aim was to get the wounded to shady parts of the grass. "We put vaseline and gauze on them," Nguyen said. "We used water if there was no more gauze."
Sometimes the basics were just putting a patient under a tree," said Lt. Lopez. "Then we started working with the bins. We had teams formed first."
Lopez said time seemed to be suspended. "Time was not even an element," she said. "It just kind of blurred. [Time] seemed to move very rapidly or very slowly. It was weird."
Ramos said she treated at least ten patients that day. "It was hard to count because sometimes you would just help in a group," she said.
She recalls treating a civilian defense reporter who worked at the Pentagon and who had decided to stay in the building after the crash to file his story before he left. "He had smoke inhalation," said Ramos, who helped him walk to the medical station.
She also remembers a firefighter from Fort Myer who had a bad shoulder capsule injury suffered from diving under a truck to take cover from the planes.
The Collapse
Although the crash section of the Pentagon eventually collapsed, Ramos said a $25 million renovation project had recently been completed on that wing so that the steel foundation of the floors had been strengthened. "People underneath [the crash spot] and above could get out," she said. "Plus, the sprinkler system worked. The windows were shatter-proof and not too many people were moved in there yet. We were very lucky."
Lt. Lopez said she could hear the building as it was coming down.
"That picture was [taken] after I had been in the building, and right before or right after the building collapsed," Maj. Leibner said of the photo that appeared on the U.S. MEDICINE cover. "We were still on the grass, 30 yards from the building. The flames became increasingly bad. I think when the building collapsed, it was very dramatic. I felt fine when I was in the building. I didn't think it would."
The Second Plane
When a rumor spread among the relief workers that a second hijacked plane was headed toward Washington, security personnel ordered everyone to move farther away from the building and to find cover. "That, to me, was probably the most frightening part, because they said it was headed toward Washington," said Lt. Lopez. "They figured it was a tandem. So we were told to try to get our patients moved back, take care of them and ourselves."
Lt. Lopez said she participated in Operation Desert Storm and she described the morning of Sept. 11 as a more frightening experience. "It was worse here," she said. "We were right out in the open. You felt defenseless."
But the medics had to press on. Ramos said they had a few palettes they were using to keep the medical supplies in. "We had to carry everything," she said. "We moved from the grass to underneath the Route 27 underpass. We were the yellow team. We sent some patients into ambulances and hurried the rest and the entire mass casualty setup under the Route 27 underpass."
Maj. Leibner said the talk of a second plane coming was a "really bad moment." "That was ugly," he said. "You couldn't go anywhere. It started to get packed with vehicles. It ended up being the crash in Pennsylvania, so it was a true report."
Ramos and the rest of her team carried the yellow tarp supplies away for cover. "We were very worried and trying to concentrate," Lt. Lopez said.
Ramos said a construction team made a hole in a jersey barrier there to allow supplies and personnel to pass through more easily.
Meanwhile Maj. Leibner endured a chaotic scene inside the ambulance. "There were two paramedics, the driver and four patients in it," he said. "We hit two or three cars on our way to the hospital. [But] the people in the ambulance were outstanding."
The ambulance driver was initially told to go to George Washington University hospital in Washington, D.C., but Maj. Leibner said there was too much traffic that way and they were forced to go to Arlington hospital instead. "People were fleeing the city," he said. "When I got to Arlington, there was no second wave [of victims to treat]. There were not too many survivors. The ones that got out, got out quickly."
Prepared
Although the courage and determination of the medics helped carry them through the ordeal, Ramos said they had also taken part in a mass casualty training exercise at the Pentagon eight months prior to Sept. 11. That exercise involved a simulation of a plane flying off course that struck the Pentagon.
When Ramos thinks of the medical care provided for the Pentagon victims, she thinks of "teamwork." Fear for oneself was overcome. "You didn't care about who was doing what," she said. "You just did it. When it happens, you just react. It's the way you've been trained. I wanted to get in there and help. That's what people in medical care feel they should do. That's why we get all worried [when we had to wait], because we're not able to help. I was worried when they said another plane was coming, but I wanted to help. I said, 'What the heck. [If something happened to me] it would be [while I was] doing what I wanted.' "
Ramos said there was a mix of EMS workers and civilian and military volunteers working on the scene, including a pediatrician dressed in jeans and new nursing students. "Every piece of grass [was being used], helicopters picked up the wounded and brought supplies," she said.
Maj. Leibner said there were many helicopters on the scene. "Everybody was great at the scene, all the medical response," he said. "People were doing fantastic, general officers, privates and civilians lifting stretchers. It was just absolute grassroot efforts. At every level, the medical response was outstanding. Everybody did great there."
Nguyen said nurses and physicians came from several different area medical centers to help. "A nurse from the Oklahoma City bombing incident, in town for a meeting, was also there," she wrote in a January email. "A Marine officer, kindly holding an IV bag, was comforting a burn victim while waiting for the ambulance. An Air Force officer offered to lift heavy supply boxes for me from one station to another, while another officer helped carry a heavy oxygen tank as I was assisting a respiratory-distressed person to a rest area."
Nguyen also cited the assistance and cooperation of individual medics, pharmacists and others in setting up IVs, triage points, pharmacy supply chains, communicating news from the radio, and moving medical supplies and equipment by motor cart later in the day. "Everyone of us has had our own personal experiences, but for myself, this experience has enhanced my professional as well as personal growth," she wrote. "We may have come from different backgrounds and have different responsibilities, but together 'we are a family' and share common goals and interests."
Ramos said local organizations and businesses brought in sandwiches, fruit and water for the rescue workers and injured at about 11:30 a.m. "We were there until 8:30 p.m.," said Lt. Lopez. "Some military [nursing] teams stayed over night to cover the firefighters."
Ramos said she and Nguyen stayed on the scene until 7 p.m. and remained on call the next week. Meanwhile Maj. Leibner left his hospital bed and returned to his Pentagon office later in the day. "I stayed until 9:30-10 p.m.," he said. "It was completely burning. The next several days were amazing. They couldn't get the fires out for a week."
Lengthy Healing Process
During the Feb. 5 interview with U.S. MEDICINE, Ramos said she had seen a female patient before the interview who still had coughing and upper respiratory problems stemming from Sept. 11. On that horrific morning, the woman had left her Pentagon office to go for a coffee, and returned to find that 23 of her co-workers had died in the crash. "We're still seeing patients with smoke inhalation and sinus infections," Ramos said. "There was mold left over on desks. When you have a whole plane with jet fuel, there will be [lingering] problems."
It took some time before Ramos, Maj. Leibner and others were able to talk openly of their experiences that day. "We went to several debriefings," Ramos said.
"Nothing's the same there," Maj. Leibner said of the Pentagon. "Priorities have changed."
Meanwhile, construction is ahead of schedule to repair the damage done to the Pentagon, and a dedication ceremony is planned for the one-year anniversary date of the attack. Ramos also said some workers have started a little memorial on the helipad near the crash site. www.ctrl.org DECLARATION & DISCLAIMER ========== CTRL is a discussion & informational exchange list. Proselytizing propagandic screeds are unwelcomed. Substance—not soap-boxing—please! These are sordid matters and 'conspiracy theory'—with its many half-truths, mis- directions and outright frauds—is used politically by different groups with major and minor effects spread throughout the spectrum of time and thought. That being said, CTRLgives no endorsement to the validity of posts, and always suggests to readers; be wary of what you read. CTRL gives no credence to Holocaust denial and nazi's need not apply.
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