Scores of people were injured, trapped. Before he made his way to the triage area where medics from all services would gather to treat and send off victims in ambulances, the senior Air Force medic waded through fire, smoke and chest-high debris looking for victims inside the Pentagon.
"The clock was ticking," retired Lt. Gen. (Dr.) Paul K. Carlton Jr. later told People Magazine. "I thought, 'If we wait for normal rescuers, we won't have anyone alive.'"
It was Sept. 11, 2001.
At first he thought it had been a terrorist bomb, "but then I saw the landing gear," Carlton said. "It was on the ground in the alley between the B and C rings. When I saw it there, not only did I realize an airplane had struck the Pentagon, but it was clear that the plane had come through the E, D and C rings to get there."
Aerial view of the Pentagon after the E Ring collapsed Sept. 11, 2001. (Dept. of Defense photo)
The terrorist attack on the Pentagon 10 years ago shook the nation; however, the aftermath could have been much worse if not for Carlton's efforts months earlier.
One of several Airmen awarded the Airman's Medal for lifesaving contributions on Sept. 11, 2001, Carlton was the Air Force surgeon general when American Airlines Flight 77 slammed into the Pentagon. He wasn't thinking about it at the time, but the tragedy was replete with ironies. First of all, Carlton's office wasn't in the Pentagon; it was across town at Bolling Air Force Base, Washington, D.C. The fact that he was there when the plane hit was a coincidence.
But the biggest irony -- if not saving grace -- was that he had approved what were apparently the first-ever mass-casualty exercises at the U.S. military headquarters earlier in the year.
The origin of the May 2001 exercise was a stairwell conversation in February 2001 between Carlton and now-retired Col. John Baxter, who was the Air Force's Flight Medicine Clinic commander in the Pentagon at the time. Baxter suggested a mass casualty exercise. Intrigued, Carlton and Baxter tried to come up with a scenario until their conversation was interrupted by a jet taking off from nearby Reagan National Airport.
"We had to stop talking because the jet noise was so high," Carlton said. "Then we resumed our conversation."
Baxter suggested the idea of an aircraft hitting the Pentagon. He did not suggest wild-eyed terrorists bent on murder. In fact, Baxter's idea was mundane compared to the reality of what was to come.
"'Why don't we have an airplane hit a bunch of birds, lose an engine, do a VMC rollover (which means one engine is out and the flying speed is not enough to prevent the airplane from rolling over on its back) and hit the Pentagon?'" Carlton said, repeating Baxter's suggestion.
"I thought it was a great idea," Carlton said.
The tabletop exercise, developed by Baxter and approved by Carlton, included the Army's DiLorenzo Tricare Health Clinic and the Air Force Flight Medicine Clinic, both housed within the Pentagon. Representatives from Arlington County Emergency Medical Services and various agencies also participated.
Carlton said they "did not do very well on the exercise" and set a "get-well" date for Sept 1, 2001. Even so, Col. James Geiling, then-commander of the DTHC, later said this exercise prepared them well to respond to the Pentagon attack on 9/11. For example, the Air Force Flight Medicine Clinic retooled its trauma packs and staffers from both clinics were issued special blue vests labeled "physician," "nurse," or "EMT," to allow for easy identification.
The "get-well" exercise in early August was a mass casualty exercise that involved a practice evacuation and treatment of wounded. Retired Gen. Lance Lord, then-assistant vice chief of staff of the Air Force, was a participant. He later told Air Force Space Command News Service: "(It was) purely a coincidence; the scenario for that exercise included a plane hitting the building." Lord also said that on 9/11, "our assembly points were fresh in our minds" thanks to this practice.
The irony didn't stop there for Carlton. When he became Air Force surgeon general in October 1999, Carlton chose two cities to work on for mass casualty management: Washington D.C. and New York City. Prior to 9/11 he had lectured on the topic to the New York City Council of Hospitals and the Washington Hospital District.
Carlton said that like many folks directly involved that day, it was difficult for him to talk about for quite a while. His Airman's Medal citation, which focuses on the very beginning of his September 11 experience, offers insight as to why.
"General Carlton entered a room filled with chest high debris," according to his Airman's Medal citation. "Although half the room was engulfed in flames and smoke filled, General Carlton and several other rescuers located a trapped victim who was stuck under some fallen debris. The men could see the trapped victim, but could not quite reach the man. One of the rescuers cleared the debris while General Carlton tried to pull the victim free.
"He then placed a water-soaked tee shirt on the victim's face to aid his breathing. The victim was roused, and realizing the imminent danger they were all facing, rolled to his left far enough for General Carlton to grab him. They were then able to move the victim to safety. All the while, the room continued to rain fire and debris on General Carlton and the others.
"As the fire intensified and moved closer in the room, General Carlton continued to sweep the room for other victims. There was a loud noise, the flaming ceiling began to fall and one of the rescuers shouted for all to leave the area. As the metal caging in the ceiling gave way, General Carlton helped the others to escape the burning room."
Today, Carlton is the director of innovation and preparedness for the Health Science Center at Texas A&M University in College Station, Texas. He has consulted on homeland security and disaster response for many organizations -- most recently the destroyed medical center in Joplin, Mo.
Ten years after the Pentagon attack, Carlton is optimistic but cautious.
"We have faced a determined foe who has shown us repeatedly that life has no meaning, and used a weapon we did not expect him to use," he said. "Our enemy out-thought us. We can never let that happen again!"
He also kept the blue vest.
"It's a reminder that we live day-to-day," he said.
By G. W. Pomeroy, Air Force Surgeon General Public Affairs
Air Force News Service
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