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Nurse Turns Back to Aid Patients

Excerpts from an interview with Lt. Col. Patty Horoho, assistant deputy, personnel and health management policy office of the assistant secretary of the Army for manpower and Reserve affairs, the Pentagon, regarding Sept. 11, 2001. Lt. Col. Horoho, a nurse, was serving in an administrative, rather than patient care, setting.

Interview conducted Sept. 27, 2001 by the Office of Medical History, Office of the Army Surgeon General.

I had decided that life is really fast paced, and I was going to look at how to slow things down and get things back into perspective. And so I was reading this book, God Is My CEO, on the subway, [thinking], "It`s a wonderful book." You know, how you just get that good feeling inside? So I got off of the subway and went and picked up a cup of coffee. And the person sitting behind the counter said, "Love the title of that book." I said, "I do too," and I said, "You know, it was just a great way to start my day." And so she said, "You have a great day," and I said, "You, too," and went down to my [Pentagon] office.

So I sat down and started working. As I was working, a couple of people in the hallway said that the World Trade Center had been hit. That a plane had crashed into it. So I got up . and looked at the TV. . It showed the second plane attacking. And I looked at it and said, "There`s going to be a series of attacks across the United States. We`re going to be next." . I just knew in my heart that that`s exactly what was going to happen.

I walked across the hallway into my office. And right when I walked into the door, it went boom, and you could feel the building shake. . People immediately just started evacuating the building. Nobody panicked. Nobody screamed. Nobody ran. It was very, very orderly, very. It was definitely not lollygagging, very focused, but very orderly.

As soon as I got out . I knew right where the crash site was that there were going to be victims, and I knew that`s where I needed to be. So I turned to [a coworker] and I said, "I`m okay. I`m going to the front of the building to take care of patients," because I didn`t want in all of this chaos for someone to . think I was back in the building and go back in or something like that.

So I turned to my left and ran and ran to the very front of the building. And when I got there, it was this huge gap. I mean it was just a huge opening blown out from the front of the building and the middle section of it. And at that time there wasn`t a fireball or anything. It was just a big, blown out section, a lot of smoke billowing out. Debris all over the place, but the debris was not huge pieces of debris that you`d think of from a plane. Very, very small.

So I just ran right up into the steps inside of the point where it actually occurred, and saw people start to come down that were injured, that were burned, that had smoke inhalation, were dazed or cut. And so just started directing, "You need to go back to where the guardrail is," . because I thought that would be a safe area and we can start triaging patients there.

There were people who had full thickness burns, partial thickness burns, and some were in shock from the explosion occurring, not even understanding what had happened to them. Those that were physically able would help carry those out. I mean it was wonderful how quickly people pitched in and just started working.

I think you take a horrible, tragic, evil situation, and then I think [God] intervened so that all of us could do our very best to make it better. An aid bag showed up, and I found out later, that a young, off-duty medic ran two miles from his house to the scene to help and to bring that bag. His actions truly saved lives. This is minutes after the explosion, as I was triaging, and people started ripping clothes off where the burns were so that it wasn`t constricting, and then also to try to cut or rip so that we could start IVs and . the aid bag was there.

And so I turned to the two people that were right in front of me . and I said, "I need you all to open up this aid bag and start pulling out IVs, trying to find tubing, trying to find needles." . I said, "I need you to help me prime these IV tubes." And then there were these two other guys that were right there that had smoke and everything that were obviously victims, but they were fine and standing. And I said, "I need you guys to help me prime." And their response was, "We don`t know what priming is." I said, "I`ll show you really quick." And I showed them, and they all just started . getting IVs and tubings primed, and holding them over their shoulder. A general gave me his belt because I needed a tourniquet. . After that, someone found gloves and we started using the gloves as a tourniquet because they stretch so well.

And so I started inserting IVs and assessing [people] you could just see by singed nasal hairs, the smoke that they had, the soot on them, that they were going to within an hour`s time have difficulty breathing. EMS responded very, very quickly, so . we were able to then get them oxygen, start intubating those that needed to be intubated. Prioritizing who needed to be evacuated out. . [Firefighters] had responded at this time, FBI had responded, Urban Search and Rescue had responded. Let`s see who else was there? Chaplains. I find this amazing. They just happened to have a chaplain meeting in the building, so there were like 32 chaplains in the Pentagon that responded outside, immediately. So as we were doing initial first aid, there were already chaplains on the ground, providing emotional support. . That emotional support is just as important as the medical support that we`re providing out there. . And that was from two-star chaplains down to a captain or a major. . And all denominations and faiths.

And then the whole time that this was occurring, I looked off to the left and there were a huge number of military personnel that had evacuated the building, but were standing so far down and not knowing what to do.

I ran down to a group that was there and picked whoever was the senior officer and said, "What we need to do is, this group, figure out who is medical, who has any medical background, who is non-medical, and make sure that we can break this group out to be used as litter bearers," because we didn`t know how many people we`d need. And so they all came up and then we got them organized for litter transport, as well as providing medical aid. So it was truly utilizing every available manpower resource that we had that time. And then we started getting much more manpower than we ever needed just because people were also evacuating the opposite side of the building at this time. And so once that medical mission was taken care of, those individuals then all came around to this area as well. So we had a tremendous amount of support over time.

But as this was all occurring, we still had air threats that were going on. . The FBI finally said that there was an unidentified aircraft that was two minutes out. And so what we did is we evacuated, all of those litter teams that we had set up, everybody evacuated all of the patients, and we moved them and relocated all of our medical operations underneath an underpass.

As threats were continuing and everybody was underneath the tunnel, we used that time to continue treating. Patients were getting packaged to be able to be airlifted out. And we also at that time separated all of the personnel that were underneath there into two groups, one that was non-medical personnel and then a group that was medical personnel. And the medical personnel ranged from physicians, to nurses, to paramedics, to LPNs to someone who had CPR, anybody that had any medical background whatsoever. And then what we did is we got a role of silver tape from the fire department and put that on their arms so that in the middle of chaos you could at least see who was who and you`d be able to utilize that.

While we were underneath the bridge, some of those [medical supply] vans from Bethesda [the National Naval Medical Center, Bethesda, Md.] came in. We broke down the teams into four-man teams, a medical person and then three support personnel, and . we asked them to offload all of the vehicles and lay out all of the supplies functionally . We did that because what we knew was once the air threat was finished, then we were going to reestablish ourselves and so we wanted things to be logically laid out.

[During the wait under the bridge, qualified medical personnel demonstrated how to prime IV tubing, how to place patients on litters and carry them, and other support skills that might be needed. Once the all-clear was given, medical areas were re-established and staffed.]

By this time they had brought in construction teams that broke down some of the construction barriers and sawed the guardrails so that we would be able to transport patients back and forth without having to kind of lift them over. So they were working real closely with all of us to coordinate that, to facilitate.

During all of this, the response of medical people was tremendous. I mean we had physicians from Walter Reed. We had physicians from Bethesda. We had physicians and nurses from all civilian hospitals in the area, as well as the medical students from the Industrial College of the Armed Forces. They saw the smoke and the explosion near the attack and drove as far as they could, parked the car and then ran all of the way until they got there to offer their support. So the stories were absolutely amazing. A pediatric physician heard of the attack, closed his medical practice and responded. So you had an outpouring of people assisting in every way they could.

While all of that was going on, in the center area there were multiple, secondary explosions. So you`ve got a lot of fire, a lot of billowing smoke. Firefighters were not able to go into the building. . [We realized the recovery operation would be long] because clearly there was a big lull and there wasn`t anybody else coming out of the building. You knew that the chance of getting people out alive was decreasing quickly and that it was going to turn into a recovery operation. And so we needed to be able to have manpower available for extended hours, which then required us to have logistic support. It required us to have [communications]. Required us to have food. Required us to have tents for shelter. Required us to have porta-potties, because of the thousands and thousands of people that were out there. We were going to need generators . lighting. This was not a 24-hour operation; this was going to be an extended operation over weeks. . We started planning for future [operations] while we were taking care of our simultaneous current ops.

All of a sudden Salvation Army showed up, volunteers from everywhere. By late in the afternoon, about suppertime, they started serving pizza, chicken and coffee. They had that whole operation set up so quickly. It was tremendous.

So after the plan was all put in place, then to be honest, it was in the waiting mode. You were waiting until you got clearance from Urban Search and Rescue, the incident commander, to be able to enter the building, which did not occur all of that night and not even until the following morning. So it was just a long wait. Later in the evening, we ended up releasing a lot of the medical assets, because it was clear . we only needed enough medical assets on the ground to be able to respond to the responders. And so everybody else was kind of released.

I left at, I think it was 12:30 that night, and got home about 1:30. And then I called my mom, talked to my mom and dad, who were a wreck. Talked to my sister and my brother. . My husband was, I was not able to call home until about six hours after the event occurred to say hey, I`m ok. That`s what I did, I called him and said, "I`m ok. I`m taking care of patients." . He got the kids. He [also military] had to go into work. . He`s been working 14- and 16-hour days since. So it`s completely changed our home life.

But neighbors were wonderful. They pitched in with taking care of the kids, cooking meals, mowing our grass. [They] put up this huge banner when we came home one night that covered both of our garage doors. It was in red, white and blue on sheets and it said, "Patty and Ray, your friends thank you for all that you`re doing for our country. God bless and be safe." And I thought, just amazing, the outpouring of concern and I think love that has gone across all of America, and actually across the world. . And I thought, you know, a lot of good has come out of a truly evil, horrible situation, and it has changed our world completely. And it`s changed our way of life and has taken away that feeling of not having to worry and now realizing that you are vulnerable and our nation is vulnerable. It changes the whole focus.

I was talking with a friend of mine and said, you know, the words "United States," you never really think of it, and now the word "united" has taken on a whole different meaning, because I think we truly are a united country. And we are focused on one thing, and that is protecting our freedom and our way of life.

I truly believe as an Army nurse, I didn`t do anything different than any other Army nurse would have done had they been in that situation.

It makes me, and I have always been, very, very proud to be an officer, a soldier and an Army nurse. And I think it just reinforces exactly why we wear the uniform and why as Army Nurse Corps officers it is imperative that we always remember the "N" in our caduceus, and that we don`t lose the clinical skills. Regardless of what staff job we`re doing, what makes us important to the Army Medical Department is our clinical skills. So that reinforced that to me.

And I think you`re just very, very thankful. It`s hard to sum up all of those feelings that you have. You`re dealing with the loss of friends and the loss of coworkers. You`re dealing with the realization that God spared your life, for whatever reason, and there were others that were not as fortunate. . Feeling very, very guilty that you`re alive and that you were able to wake up and see the sun rise. You`re able to enjoy your family and your kids, and you realize that there are so many families out there that are hurting and suffering, and they don`t have the same life that you are afforded.

It does truly impact your life. It`s one of those moments where I think all of us who survived received a second chance. All of us have that opportunity to reassess what`s important in life, and to refocus, and to realign your priorities. . It does change your life.

For immediate release, Sept. 6, 2002.