EMS Revisited: The Big One

This article originally appeared in the August 1995 issue of EMS Magazine.

It's the multi-casualty incident you train for, secretly hoping it will never happen in your city. Who among us will ever forget the images it has etched in our memories: Oklahoma City's nine-story Alfred P. Murrah Federal Building, reduced to a pile of rubble; dazed, blood-covered victims waiting for care; frantic parents and family members looking for loved ones who had been inside the structure; frightened, injured children who didn't understand what had happened or why they were in pain?

Before the dust settled on April 19, fire and EMS personnel headed to the smoky ruins, unaware of the disaster's exact site or cause. Coincidentally, Oklahoma City Fire Chief Gary Marrs was only 2 blocks away, on his way to a meeting downtown. As one of the first on scene, he became incident commander--a position he retained for the next 15 days.

Close behind Marrs was Michael Murphy, EMT-P, administrative supervisor for Emergency Medical Services Authority (EMSA), a private ambulance service that provides ALS response for the BLS-trained fire department. The blast dramatically impacted EMSA headquarters 6 blocks away.

"It was such a powerful explosion, it took windows out of our office and knocked down ceiling tiles," says Murphy, "so we knew something very significant had just happened. When we went outside, we saw a column of smoke coming from the direction of the Federal Building, so we headed toward it and were on the scene within 3 minutes."

EMS responders were completely unprepared for what they saw.

"We were met by a great throng of walking wounded who were covered in blood from lacerations," Murphy says. "There were citizens helping citizens, some carrying patients who were unconscious and severely traumatized. Besides the obviously critically injured from the Federal Building, numerous people who had been injured by flying glass came out into the streets from surrounding structures. The true heroes of the whole incident are the people who were injured themselves, bending down to help others who weren't able to walk.

"There was incredible cooperation from everyone. Of course, there was hysteria, shock, disbelief and total horror. But to my knowledge, we didn't have any patients who gave us a hard time by demanding to be treated first. We had to focus on the more critically injured because, as with any mass casualty, the walking wounded take a relatively lower priority. The first thing in my mind was to set up EMS incident command, treatment and triage, as well as determine the logistics of how we were going to bring in ambulances and how they would leave. On the north side of the building, we had our game plan figured out within 6 minutes after the incident began."

Approaching from the west, unaware of the explosion's exact location, EMT Gary Davis, commander of the EMS Division of the Oklahoma City Fire Department, encountered his first patients at the 14-story Regency Apartments.

"I treated about 30 people with minor injuries who came out of the apartment building," Davis says. "As I was treating them, I could see people everywhere at the bomb site, but I still couldn't see the building because of all the smoke from the cars that were on fire in the parking lot and on the street. When I finally walked to the comer and saw the Federal Building, I thought to myself, 'This is big. There are going to be a lot more people than I just treated.'"

Jana Knox, EMT-P, an EMSA paramedic, approached the scene from the east. Like Davis and Murphy, she and her partner were merely following the smoke.

"When we pulled up, we were literally pulled from our truck by about 20 or 30 people who were covered in blood," she says. "We had gotten a quick glimpse of the building and could see there was a lot of damage, so we knew we were going to have a lot of people hurt and dead. If anyone was walking and able to talk, we just directed them up the street to the treatment area because we knew we had critical people—we could see them lying in the street.

"The first guy we came to wasn't really critical at the time, but we knew we needed to get him out. He had an open-fractured arm, so I asked one of his coworkers to stay with him until I could get back. People were coming out of the garage area screaming, and we knew there were victims down there.

"It was pitch black in the garage and the sprinkler system was on," Knox recalls. "There was one lady alive, but I couldn't get her out because she was stuck in too much rubble, and I had to leave her for a few minutes to go for help. The fire fighters were busy putting out car fires, so I grabbed a bystander and asked if he could help me. To this day, all I know is that his name was Billy, and when I asked for help, there was no question. I told him he was risking his life, because the dust hadn't settled yet, debris was still falling and, where this woman was, you could hear the building cracking overhead. But he went with me, and we managed to pull the woman out. She was still alive at the time, but she had such a severe head injury—her injuries were so awful I can't even describe them. I found out later that she died in surgery. She was just too messed up."

As Knox released her patient, a fire fighter handed her partner a badly injured baby: Bayley Almon, the 1-year-old who appeared in the now-famous photograph with the fire fighter who carried her from the building.

"She was just too far gone to do anything for her," Knox says. "My partner has 5-year-old twins, and the look on his face was so awful that I knew we had to get her out of our area. We didn't want to just lay her in the street, so I picked her up, carried her to the triage area and put her into the back of one of the ambulances where we had fixed a temporary morgue."

By 9:17 a.m., 15 minutes after the blast, EMSA officials declared a Stage 3 MCI alert and began to deploy mutual-aid resources, says Jim Taylor, EMT-I, EMSA's disaster coordinator.

"By that time, we had started getting calls from 8 or 9 blocks away, and we knew we had a major mass-casualty incident that our current resources wouldn't be able to handle," he says. "At 9:25, we began staging all primary mutual-aid resources and committed them to the scene about 9:27. At that point, we attacked the scene from all directions with the remainder of our resources, which drove all of the walking wounded to a central point. Once there, we quickly got them onto buses. We transported more than 100 patients in about an hour."

Because the entire north wall of the Federal Building was destroyed, most of the survivors were brought out through the south entrance, where a triage station was established with the help of Mid-west City EMS, a mutual-aid responder that covers the eastern section of Oklahoma County.

"Although we were requested to respond by EMSA, our only communication at that point was with the Oklahoma City Fire Department," says Larry N. Terry, EMT-P, quality-improvement coordinator for Midwest City EMS, "so we got information on hospital availability and began instructing additional vehicles from our service into the area. As more Midwest City and EMSA units arrived, we began removing patients from that location, which was isolated from the other triage area. There was no way we could transfer patients all the way around the building to reach the triage zone set up, so we had several small cells of treatment and transport areas in the location. I think we cleared about 20-25 red- and yellow-tagged patients, and about 25-30 walking wounded were evacuated via buses. We designated which ambulances would transport next, and they moved out in a fairly methodical manner. Of course, with the number of people in the area and the chaos, some patients were just taken by bystanders to the nearest ambulance without being reclassified at the triage area."

Watching parents search for their children who had been in the building was extremely difficult, says Terry.

"They kept asking if we'd seen their babies," he says, "and when the kids were brought out they were so covered in dust you couldn't tell if they were boys or girls, black or white. A lot of the adults who had been in the building and were awaiting transport were in shock. They sat silently on the curb like they couldn't comprehend what had just happened, and the looks on their faces were pretty eerie."

Personnel arriving from the south were completely unaware of the destruction on the building's north side, says Terry.

"Some trees obscured part of the building and, although we knew a bomb had gone off and there was a lot of damage, we had no idea that the whole north face of the building was gone," he says.

Eventually, Jana Knox moved to the east side of the building, where several spectators reported a man, who they insisted was still breathing, sitting in a window on the second floor. Knox and two police officers constructed a makeshift ladder from a piece of fence, placed it against a slab of cement and climbed to the second floor.

"Of course, the man was dead," she says, "so I covered him up and searched around, but we didn't find anyone else alive. We then moved around to the south side of the building and found the area where the day-care center had been. Some of the babies didn't have a scratch on them, but the pressure of the bomb probably blew out their little lungs. Others were so messed up you couldn't recognize them."

MUTUAL AID

As with any major disaster, Oklahoma City was overwhelmed by individuals who wanted to help—both requested and unrequested. Because all of the city's fire resources were committed to the incident, mutual aid was called in to cover the rest of the city, says Murphy.

'There were units in the downtown area that just got sucked into the vortex and were there before they were officially requested," he says. "We also got phone calls immediately from further outlying areas saying, 'We have a unit on the way; where do you want them to report?' There was a tremendous response, which is typical."

The outpouring of help from the medical community actually became a problem for a time, Murphy adds, simply because the need for assistance was so brief and the response so intense.

'The doctors, nurses and ambulance crews were ready, willing and able, and had a genuine desire to help, and it was difficult to turn them away and tell them, 'We don't need you,'" he says. "We tried to control and stage them, but a lot were on foot, and everytime we turned around, there was a spontaneous triage area set up by well-intentioned people who were trying to help. We eventually had enough personnel from the hospitals and doctors' offices with their own equipment that we actually established a field hospital in one of the vacant warehouses."

Part of the problem, adds Taylor, was a message carried by local television and radio stations that requested all medical personnel in the area to report downtown.

"The message actually went out around the world," he says, "and we had calls from as far away as London and Australia. That was a case of someone neglecting to coordinate with the local EMS system before sending out the message."

"It's natural to want to help your fellow citizens during a disaster in any way you can," says Gary Davis, "but I had to get a little rough with some well-meaning people. I had a doctor and three nurses who wanted to set up a triage station, and I told them they couldn't do it. The doctor's response was, 'You don't understand; I'm a doctor.' I just had to tell him, 'I need your help, but if you set up a triage in this area, I'm going to have to remove you from the incident.' At that point, they moved to another area where we had about 70 patients who needed help."

Unfortunately, the desire to help ended in tragedy for one nurse, who entered the building and was killed by falling debris.

"It's a tragedy, and my heart goes out to her family, but she never should have been there," says Taylor. "She was not a rescuer, and her place was at the hospital or one of the clinics. There were places we could have sent these folks where they would have been more productive, but the scene wasn't the place. Security broke down almost immediately. Instead of setting up the security perimeter and letting EMS and fire personnel handle the rescue operations, the police officers got involved in carrying victims out of the building. As a result, we ended up with a lot of chaos and people into the scene who shouldn't have been there.

"The police reestablished security later on and did a very good job after that. I know the Sheriffs Department tried to maintain security, but when you're dealing with a downtown area with thousands of people, you need every officer you can muster to maintain some form of security. Even after the police department and FBI became involved, it was a challenge to keep out those who shouldn't be there."

As quickly as the need for EMS began, it was over.

"After 3 hours into the incident, the rescue stopped," Davis says. "We waited and waited, and there was no more. After all the people were initially transported and treated, and things calmed down, we only pulled three more people out. The last live one was taken out at 10:35 p.m."

The majority of mutual-aid responders were released by 1 p.m., but EMSA kept its vehicles on standby for the next several hours.

"We were getting reports that there were pockets of 50 survivors, and there could eventually be 100 to 200 patients coming out of the building," Murphy says. "Unfortunately, that did not come to fruition. By nightfall, we were standing by with only four units because we knew that if anybody was coming out, it would be a slow extrication process and we didn't need a large number of ambulances. Eventually, our role switched over from standing by for patients who might need transport to covering the scene for rescuers who might be injured. We maintained coverage there up to the last day."

HOSPITAL RESPONSE

Within minutes of the incident, every hospital in the city went on disaster mode, says Murphy. St. Anthony's Hospital, which is only 4 blocks from the incident, and Presbyterian Hospital received most of the patients, and others were sent to University and Children's Hospitals to avoid overloading any facility.

"I pretty much slammed St. Anthony's and Presbyterian, which violates the mass-casualty tenet of 'leave the closest hospital alone, because it will be overrun with walking-wounded casualties,'" Murphy says. "I used them because whenever there has been a multipatient incident, St. Anthony's has traditionally opened its doors and taken them in, and Presbyterian told me they could handle 50 criticals. For the size of Oklahoma City, we have incredible hospital capacity, with 12 major hospitals in the city, so that was never a problem. In fact, it was the opposite. They were all geared up and wanted to know why they didn't get more patients."

Mary Rowe, RN, clinical coordinator of St. Anthony's ED, wasn't on duty the morning of the incident, but was called in as part of the hospital's disaster protocol.

"Actually, I had worked late the night before, and the explosion was so loud it woke me out of a dead sleep,--and I live 40 miles away!" Rowe reports. "The windows in my house shook. I immediately turned on the TV to see what had happened and knew I would be called in." Most of the patients who came from buildings around the Federal Building sustained injuries from flying debris and glass, so many were treated for fractures, lacerations and eye injuries.

"I got here about 9:30 a.m. and didn't leave until 2 a.m.," Rowe says, "so it was a long day. Patients trickled in all day, but after the initial influx, we didn't see too many. As one of the Red Cross workers said, everyone was glad they weren't too busy after the influx--until they realized the reason was because most of the people had died."

Some of the victims who came to the ED were simply in shock.

"About 3 p.m., a young gentleman who had been working in the Federal Building wandered in with his nice white shirt and dress pants all ripped, and it was obvious he had just been roaming," Rowe says. "I don't know where he'd been for 6 hours; he just looked dazed."

All of the hospitals did an incredible job, says Terry.

"As a unit came in, the patient was unloaded, and our crews never even entered the ED," he says. "That enabled our people to restock their equipment and resulted in a turnaround time of about 5-6 minutes. It was really impressive.

"I was lucky enough to participate in citywide disaster training back in January, when we went to each hospital and presented them with a group of 'patients' to test their disaster plan, so it hadn't been that long ago."

COMMUNICATIONS

Not everything went according to the book.

"We had a major breakdown in hospital communication," Murphy explains. "When the blast first occurred, we lost all cell phone and land-line capability, and we were left with just our radios and the 911 system."

The major problem, he says, was with the universal frequency, known as HEAR, which allows emergency units to contact hospitals during a disaster to determine their status and how many patients they can accommodate. But because the radios hadn't been used recently, most hospitals had either turned down the volume or switched them off entirely.

"We ended up sending police officers to each hospital to tell them to turn up their HEAR frequency so we could find out what they could handle," Murphy says. "It was probably 30-45 minutes before I actually got a disposition of who could take what. Of course, every hospital just said, 'Throw us whatever you need.'"

Davis is critical of the communications system, which has fire, police and ambulance service on different frequencies. It resulted in supervisors having to do a lot of walking to contact police, city crews or other resources that were need ed at the scene, he says.

According to Terry, arriving mutual-aid units had no means of communicating with EMS incident command.

"EMSA had a triage area on the north-east comer, and I had one on the south-west, which is where I was directed to come," he says. "So, I started the process and never knew about the other triage area. The saving grace for us on the south side was that I was able to communicate with Oklahoma City Fire Department to find out what was going on, as well as with other incoming mutual-aid units."

Although the blast temporarily knocked out EMSA's outgoing lines, the agency was bombarded with incoming calls, says Jim Taylor.

"We received a grand total of 1,056 calls," he says. "It's interesting that Southwestern Bell was intending to reroute our 911 system, which currently goes through St. Louis, into a local circuit, but they decided to postpone it that week because of the weather. If that had been completed, we probably would have lost all of our telecommunications resources. Looking back on it, it's pretty ironic."

SEARCH AND RESCUE

Another bit of irony is that a contingency of EMS personnel from Oklahoma City had participated in disaster-management training in Emmitsburg, MD, just a year before the bombing. At that time, says Taylor, the group was told public-safety providers could probably expect a disaster in their area within a year, and that they shouldn't expect help from any state or government agencies for at least 24 hours because it takes that long to mobilize. Actually, Taylor notes, it took less than 1 hour.

"Within 45 minutes of the incident, we had helicopters here from Ft. Sill, which the U.S. Army just sent unrequested," he says.

Due to the enormity of the disaster, and because it involved a federal building, the Federal Emergency Management Agency (FEMA) lost no time in mobilizing its task forces. Of 25 task forces nationwide, 11 of the 56-member teams reported on alternate schedules to the Oklahoma City site. The first team to be activated was from Phoenix, AZ, followed by the one based in Sacramento, CA.

Because the disaster involved a bombing, the Federal Building immediately became the largest crime scene in U.S. history, which necessitated involvement by the Federal Bureau of Investigation (FBI), Drug Enforcement Agency (DEA), Central Intelligence Agency (CIA), Secret Service, and Bureau of Alcohol, Tobacco and Firearms (ATF), among others.

"There was some consternation at first about who had command of the building: law enforcement, urban search and rescue assets or Oklahoma City Fire," says Chase Sargent, battalion chief of the Special Operations Division of the Virginia Beach Fire Department in Virginia Beach, VA. "Finally, Oklahoma Fire did the best thing they possibly could and said, 'We are in command of this building. This is our incident, and everybody's working for us'--which is the way it should have been. We were briefed on what we were looking for as far as evidence collection and what was expected of us, and it worked well. At the end of every debris line was a federal agent going through everything for evidence."

Sargent had been at a conference in New York City at the time of the incident, but caught up with Virginia Task Force #2 a few days later and was assigned as one of the night operations officers. His initial reaction probably sums it up for everyone who was there.

"I was as stunned as everybody that it actually happened in the United States, which we've been projecting for a long time," he says, "and that it was one of our own people who did it. Also, just the absolute evil of the act, targeting innocent people, who did nothing except show up for work, and the kids, who happened to be at the day-care center.

"As for the operational theater, it's what we train for, so it was exciting, even though it was extremely dangerous. Our task force was in early, doing the shoring on the interior of the building. What's funny is that it took 100 lbs. of explosives to bring down the building and another 43 lbs. to take out the shoring."

The operation stretched everyone's physical capacity to the maximum.

"On about the sixth night, I was just out on my feet," Sargent says, "and I knew my decision-making ability wasn't what it should be, so I had a few hours of sleep and went back to work. As a professional, I had to be able to take myself out without letting my ego get in the way. In some instances, we literally had to tell people, 'You're in over your head, and it's time for you to take a break.' I think everyone who spent any time there had to take at least a day off laterjusttocatchup.

"The thing that personally got to me wasn't the bodies or the scene itself, because that's what I do for a living," Sargent continues. "It was the memorial services, especially for the kids. While we were there, someone laid a rose in the middle of the rescue operation, and it became like sacred ground. People started adding wreaths, and we finally had to move it to the spot where they held the big memorial service."

DOGS TO THE RESCUE

Responding with the Sacramento S&R unit was Annie Lerum, EMT, and her dog, Colter. One-third of the taskforce support, or eight teams, are located in California, Lerum explains, as are 13 of the nation's 17 urban disaster-qualified dogs. Lerum and her husband are professional dog trainers, with 15 years of experience in search and rescue.

"Although the state Office of Emergency Services in Sacramento gives wonderful support to the teams, all expenses of training, testing, buying the dog and veterinary bills are covered by individual handlers," says Lerum. "That's why we don't have a lot of certi- fied dogs. But once you're on deployment, you're compensated by the federal government for the time you're there, so that helps."

The main breeds used for search and rescue are German shepherd, Labrador and golden retriever, Doberman, boxer and Border collie, which are all intelligent, strong and agile. A good dog can be trained for area searches (looking for lost people) in about VA years, with another year needed for disaster work. Between disasters, Lerum says, the dogs are used in area searches and, as frequently as possible, train on rubble fields.

"You can't sit the dogs down in front of a video and say, 'This is what you're going to do,' so we get people to donate rubble piles and we hide live victims in them," Lerum says. "The state OES underwrites it and provides a 'hold-harmless' agreement to the owners. Unfortunately, rubble piles are few and far between, and these dogs need to be on rubble a couple of times a week to maintain a high level of workability for disaster situations."

The Sacramento team went in early on day 2 and worked for 18 hours, using the dogs 20 minutes on and 20 minutes off because of the work's intensity. After the initial shift, they worked 12-hour shifts, from 1 a.m. to 1 p.m., with the next 12 hours off. On the first day, says Lerum, Colter cut the top of one foot when he slipped through a plate of glass in the nursery area, but a veterinarian put in 8 stitches and sent him back to work. The handlers avoid putting boots on the dogs, she says, because it decreases their traction.

"The best traction for a dog is God-given," she says. "If you start putting wraps on them, they slide all over and get hurt. Because of the amount of blown-up glass and particles there, and the fact that they were working on rubble, their pads did get very worn, and by day 3 we had some dogs that were pretty lame. But they have so much heart; they were back there just working their bot- toms off in the pile anyway.

"There was also a problem with dust," she adds. "The trainers were in heavy-duty masks, but we couldn't use them on the dogs. We just tried to hydrate and air them as much as possible, and try our best to keep the dust down."

During training, the dogs are taught to distinguish between live and dead victims.

"In the aftermath of a big disaster, you don't want your dog wasting time digging up or alerting on dead people--they can't be helped," Lerum says. "Later on, you want body recovery, but in the first 3 days, when the chance of human life still exists, you want them looking only for live people. So, we train for a very enthusiastic bark alert that can be heard even from outside the pile if it's in a potentially dangerous area. When the dog hits it, you can say unmistakably, 'There's a strong hit; dig here.' They also hit very strongly on cadaver body scent, and they use a more subdued bark. Generally, they just dig or paw at a cadaver, and they certainly had a lot of opportunity to show that in Oklahoma City.

"The coolest thing about dogs," Lerum says, "is, with all of our advanced technology, a well-trained urban search dog is still the absolute, most efficient, most effective way to find a buried victim. We have fiber optics, cam-recorders and seismic equipment, but if you want to locate a person alive with minimum manpower, your best chance is with a good dog."

That in no way minimizes the importance of the human rescue operation, which was intense, packed with emotion and exhausting. For a time after the blast, paramedics and EMTs worked inside the structure, bringing out victims alongside police officers and fire department personnel, says Mike Murphy.

"As time went on, the building was cleared and secured, and EMS personnel stayed outside as support for possible patients," he says. "About 9 p.m., one live patient was found, and a doctor who happened to be here jumped into the hole instead of the paramedic who was supposed to go in. Early on, one of our EMTs was with the young lady whose leg was amputated. But we pretty much stayed out of the building after the first 8 hours or so."

One exception was Gary Davis, whose responsibility was to oversee medical care for the rescuers.

"I developed a medical plan that sometimes changed hourly, depending on how many people were in the building and what area they were working in," he says. "I had to make sure I had sufficient paramedics on staff, and I kept dedicated standby ambulances on the scene 24 hours a day for the full 15 days.

'There were 39 injuries to rescuers, and six were transported, although the transports were more precautionary than anything. There were some second-degree burns from rescuers' torches, as well as scratches, small cuts and objects in eyes. I was also responsible for decontaminating the rescue workers from body fluids, and every time a body was pulled out, we deconned the area where the body had been. We had a well-meaning volunteer who accidentally mixed the decontamination fluid incorrectly, and I had to transport a couple of people when it got in their eyes. Because of the dust in the air, we went into high-efficiency masks at the beginning. After day 5, I had the CDC, Air Quality Control and State Health Department do a walkthrough, and they downgraded the masks to dust masks, which saved a lot of money and were easier to breathe through."

HANDLING MASS FATALITIES

Ray Blakeney, director of operations for the Oklahoma State Medical Examiner's Office, was unaware of the disaster that had taken place in Oklahoma City until well after noon on April 19. He and his wife had left home early to drive to Little Rock, AR, to visit his father in the hospital.

"When I arrived at the hospital, I was immediately informed," he recalls, "so I called my office and began giving directions about what course to take. Then I began the trip back, which took about 5 hours, during which time I communicated with the office by cellular phone. There were three considerations: taking care of the dead people at the scene; taking care of the office and making the decision whether we could handle the number of bodies within this facility; and establishing a family-assistance center to take care of the victims' families."

A temporary processing facility was set up at First Christian Church, located across the street from the Federal Building. Bodies were brought there for documentation, number assignments and possible identification. From that point, they were transported directly to the medical examiner's office or stored in a refrigerated truck until the facility could accept them.

"We had a system set up early on where, once a body was located and could be moved, a team from the medical examiner's office went into the building and removed it," Blakeney explains. "If it was an area that was extremely precarious, it was sometimes done by a rescue team, but in most cases, it was a medical examiner team. That was so we could document where and how the body was found, which was important later for our report and for possible identification."

Identifying most of the bodies was accomplished by fingerprints and dental records, says Blakeney--never by visual means. It's too easy for family members to misidentify their loved ones under such traumatic circumstances, he says. Three of the children were identifiable only after DNA testing.

CISD: A MUST

While some seasoned EMS veterans question the value of critical incident stress debriefing (CISD), in Oklahoma City it was automatic.

"We brought in a CIS team within a matter of hours," says Mike Murphy. "Next week, we're having another session just to identify and help people who are having problems. A lot of the medics have dealt with it quite well, but some are still feeling the effect of what they saw, like the dead children and the overload of patients. We're dividing people into groups according to their function during the disaster, so supervisors are separate from street medics. One of the tenets of CISD is, if you're going to talk about something, you don't have your boss sitting next to you; you do it in peer groups. Bringing in families will be considered down the road, but it's going to be a long-term process. Initially, we went through the defusing; now we have to go through debriefing and let everyone know what might happen to them in the next 6-12 months, and that their reaction is OK, no matter what happens."

Just being able to talk about the experience helps, says Jana Knox, but her sleep patterns have definitely changed.

'There are times when I still wake up at night with images like a video replaying in my head," she says. "I haven't had a bad call since that day, but if I had to run on a child, I think it would be really hard."

Larry Terry regrets that his EMS system neglected to counsel individuals on a professional basis that first day, and emphasizes that immediate CISD debriefing will now be incorporated into the disaster plan.

"Those of us who were involved sat around and talked it out among ourselves, but we learned that you have to let people debrief before they go off duty after an incident," he says. "We had a lot of assistance from Midwest City Fire Department, but we're probably going to be sending some of our people to CISD training,"

As mother of a 3-year-old, it was especially distressing to search through the nursery among the toys, smashed dolls and bicycles, says Annie Lerum.

"I knew I could go someplace and break down if I needed to," she says, "but you obviously don't want to do that on deployment. CISD was available to us 24 hours a day, and it's still ongoing now that we're home, with task-force leaders calling to make sure we're fine. One thing that really helped was that Southern Pacific Bell gave us unlimited long-distance calling, so we could call home and talk to our loved ones a couple of times a day if we needed to. And just having the dogs there was incredible. You can always play with them or go for a long hike with them to relieve some stress. Also, the community was so supportive. We were just showered with love every day from the people of Oklahoma City. It was really an incredible experience."

OVER, BUT NOT FORGOTTEN

On day 15, at 11:50 a.m., the Oklahoma City operation was called to a halt, with two people still believed missing. The area in which they were thought to be was too dangerous to search. According to Davis, after the building was imploded and the debris removed, crews found that it was even more unstable than they originally thought.

Although EMS received far less media attention than the fire department or search and rescue teams, their impact on the outcome was significant, says Mike Murphy.

"Our medics handled themselves incredibly well," he says. "We didn't have any hysterics. Working with police, fire and citizens, they just kicked into gear, said 'we have a job to do,' and put the shock and horror behind them to do what had to be done. This is a large city EMS system, so our medics get exposed to critically injured patients on a regular basis; however, you can't comprehend or prepare for the scale they were exposed to. They made me extremely proud with the way they handled themselves. They did things on their own without being directed to do so, and they went above and beyond the call of duty, risking their own lives trying to save people. They crawled in the rubble with debris falling around them and looked at it as part of their job. My hat goes off to all the EMTs and paramedics who were there."

Keeping your head and being creative with resources are key to the success of a disaster operation, says Jim Taylor.

"Luckily, we had a plan and a good idea of what we needed to do," he says, "and we got the job done fairly quickly. Of course, there were some problems, which there will always be with something of this magnitude. You can always look back in retrospect and say, 'Maybe we could have done this a little better,' but, overall, I think everyone did a great job. Of course, we can't afford to let our guard down right now because we're at the peak of tornado season and we can't rest on our laurels. We have to look ahead and stay prepared. We don't think anything will happen, but no one ever thought in a million years there would be a terrorist attack in Oklahoma City."

In spite of the horror of the incident, it was a good learning experience, says Chase Sargent.

"Everytime we go to one of these things, it just reinforces the need for good incident management at every level, whether it's a structure fire, a trench collapse or one like this," he says. "The other thing I realized is there is no way you can get fully prepared for something like this as a jurisdiction. You can train your people to a certain level to keep them alive, and they can do a lot of good things initially, but I'm not sure there's anybody in the world who can get an instant grip on something of this magnitude. One of the things we've been preaching about for 10 years is team integrity and decision-training concepts--accepting the team as a living, breathing entity with a common focus and a common goal, and the attitude that 'you don't have to like it, you just have to do it.' I think that kept us going, kept us proficient and kept us safe.

"This was really the first big test of the Urban Search and Rescue Program, and I think people's eyes have been opened to the availability and necessity of resources. And, hopefully, America woke up to the fact that we aren't immune from any type of terrorist activity. This could happen again, and I don't think it's 'if.' I think it's 'when.'"

Jana Knox has adopted a more philosophical outlook on life as a result of her experience.

"I've been doing EMS for 12 years, and my partner has been in it for at least 14, so everything was pretty automatic," she says. "But when I had a minute or two to look around into the eyes of seasoned fire fighters and police officers and coworkers, the reality hit me, and it was so overwhelming. I just wanted to crawl under the truck and hope it would go away, because it was so unreal.

"For me, what used to be important isn't very important anymore. You just look at things so differently. You grasp onto every day, because you don't know what tomorrow is going to bring. I didn't know any of the people who died, but when those babies were handed to me--when I carried little Bayley up to our triage area--I became a mother, I'm not really a mother, and it's hard to explain, but seeing those babies just killed me. The whole thing was so senseless."