“So we had to stop talking for a moment as the airplane went by, and then he looked at me and said, ‘We have airplanes flying over here, hundreds a day’,” said Carlton. “Why don’t we do an airplane hits the Pentagon?”

Carlton liked the idea and suggested having the plane hit some birds, lose an engine and then do a VMC rollover and crash into the Pentagon.

“Reagan airport has a real bird problem. It was a very realistic scenario,” said Carlton.

A tabletop exercise of the scenario was done in May that included the Arlington County Emergency Medical Services, as well as  the Army’s DiLorenzo Tricare Health Clinic and the Air Force Flight Medicine Clinic, both located at the Pentagon. The scenario involved 187 dead from the crash.

During that exercise, officials identified the command and control difficulties and that they needed to do team training. Additionally, they realized they needed equipment for the teams and a way to identify who was a doctor, nurse and EMT during a mass-casualty event. This planning resulted in the distribution of blue, flame-retardant vests that were labeled “Nurse,” “Doctor” and “EMT” for the medical personnel at the Air Force Flight Medicine Clinic and the Army’s DiLorenzo Tricare Health Clinic.

Because they did not feel they had done well enough, Carlton said they set up another mass-casualty exercise for August 2001 that involved medical personnel practicing treating the wounded and working on evacuation. A “get-well” date to correct deficiencies in their plans then took place in an exercise on Sept 1, 2011. 

Managing a Chaotic Situation

Officials credit the airplane scenario exercise with helping them manage the situation at the Pentagon on 9/11.

“I think partly because we had worked over the scenario so closely in May, things were actually fairly well organized for such a chaotic situation. The triage area was being set up. They had the vests available to identify your level of training -- physician, nurse, EMT, and so on,” Baxter said in an interview for Soldier to the Rescue: The Medical Response to the Pentagon Attack.

An Arlington County After Action Report also said that the exercise done with Arlington County EMS in May 2001 “helped response preparation for the Pentagon attack.”

Carlton said, for him, the exercises at the Pentagon and the resulting protective equipment that was issued were lifesaving. He recalls catching on fire at one point and one of the members of his team putting the fire out.

“In particular, it saved my life and the [life] of the kid behind me, because we had these protective vests on,” he said.

Another element of medical planning that Carlton said ended up playing an unexpected role on Sept. 11 was the use of the Air Force EMEDS. Carlton said he was not able to reach his hospital contact in New York to find out if they needed assistance. The Air Force went ahead and sent EMEDS as a system to provide back-up medical help to New York at McGuire Air Force Base, NJ. The assistance ended up not being needed, but it was good practice because it was the first time the entire EMEDS fleet was prepared to deploy with all of its assets, he said.

“It was a brand-new system for us,” Carlton said of EMEDS. “We had just gotten our teams equipped, literally just 11 days before. As it turned out, that was a great exercise to prove that we really could launch in a short window and we could respond both nationally and internationally.”

Carlton does not credit any of the planning or the Pentagon mass-casualty exercises that took place that year just to coincidence.

“I think it was purely providential,” he said.

Carlton currently is director of Innovation and Preparedness for The Health Science Center at Texas A&M University in College Station.

http://history.amedd.army.mil/memoirs/soldiers/toc.html

http://www.arlingtonva.us/departments/Fire/edu/about/FireEduAboutAfterReport.aspx

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