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    9/11: Why Four USU Graduates Ran Towards Disaster

    BETHESDA, MD, UNITED STATES

    09.11.2021

    Story by Sharon Holland 

    Uniformed Services University

    Uniformed Services University alumni, faculty, staff and students were among the first responders in the aftermath of the attacks on America on September 11, 2001 -- at the Pentagon, World Trade Center, Shanksville, Pa., local Washington, DC-area military hospitals and clinics, with the U.S. Park Police, Armed Forces Medical Examiner’s office and at many other sites. Their extensive training and experience enabled them to react and mobilize quickly, many of them within seconds of the Pentagon attack. These are the stories of four USU graduates who had significant roles on 9/11.

    Dr. John Baxter, The Pentagon

    Retired Air Force Col. (Dr.) John Baxter is no stranger to the Pentagon. As head of the Pentagon flight medicine clinic, he has served with­in the five-sided seat of power for more than 26 years. Baxter, a USU class of 1989 alumnus, is also the physician to the Secretary of Defense and other senior Pentagon leaders.

    On September 11, 2001, Baxter and his staff were conducting a morning clinic, with several patients scattered throughout the var­ious screening rooms. What began as a routine day suddenly turned into chaos as American Airlines flight 77 slammed into the Pentagon at more than 500 miles per hour.

    Some of the staff of the fourth floor flight medi­cine clinic heard a loud, muffled noise which was followed by an alarm and shouts to evacuate. Thinking something had exploded, Baxter and his crew of physicians, nurses and techni­cians immediately grabbed emergency trauma supply bags and ran towards the tri-service DiLorenzo Tricare Health Clinic, their designated emergency rendezvous site.

    Several months prior, the flight medi­cine clinic had conducted mass casualty training exercises in conjunction with the DiLorenzo clinic, which was com­manded at the time by USU class of 1982 graduate Army Col. (Dr.) Jim Gelling. In an eerie twist of irony, the exercise simulated a jet airliner crashing into the building, and members of both health care facilities would soon realize how invaluable that training would be.

    Baxter and his staff were directed to the fifth corridor of the Pentagon, with reports of injured personnel. Running to the site, they found a severely burned Army officer who, despite his agony, repeatedly asked them to help co­workers trapped in his office. Even as dense, acrid smoke filled the air, Baxter sent part of his team to find additional victims said to be in the "C" and "D" corridors. He remained with the Army officer, starting an IV, administering morphine, and bandaging his most painful wounds until he was taken out on a stretcher.

    As warnings of an approaching airplane spread throughout the building, the health care crew grabbed their equip­ment and headed down the fifth and sixth hallways and upstairs searching for more injured personnel. Although they could barely see through the thick smoke, their eyes and lungs burning, Baxter and his staff ran as far as they could, shouting that they were medics and yelling for anyone who might still be there to "run this way" to safety. They repeated their actions on each of the floors below them in the affected hallways, finding no new patients.

    Baxter's team made their way to the Pentagon's center courtyard where they found an injured person lying on her back. At that moment, screams of "inbound, two minutes" filled the air, so they picked up the patient and ran with her back into the building and out to a predetermined triage site along Boundary Channel Drive. Outside in the triage area, Baxter's staff joined that of the DiLorenzo clinic to treat patients with burns, inhalation and blast injuries.

    Hear Dr. John Baxter’s story in his own words on the Veterans Affairs podcast, Borne the Battle, Episode 162: https://radiopublic.com/borne-the-battle-GEzqZv/s1!f510a

    Maj. Bridget Larew, The Pentagon

    Dr. Geiling had been at Walter Reed Army Medical Center and was blocked access to the Pentagon as he tried to return to help, until much later in the day. In his stead, then-Maj. Bridget Larew, a class of 1998 alumna of USU's Graduate School of Nursing family nurse practition­er program and chief of primary care, directed the efforts of the DiLorenzo clinic staff. Working alongside her were Doctor of Medi­cine graduates, then-Maj. (Dr.) Liza (Grapilon) Lindenberg ('96), an Army family physi­cian and then-Army Capt. (Dr.) George von Hilsheimer ('00), who had only been assigned to the clinic less than a week. The clinic staffers donned blue vests labelled with "physician," "nurse," or "EMT" for easy identification - an idea borne of their previous mass casualty exercise.

    When the plane hit, Larew, a 16-year Air Force veteran at the time, said clinic staffers didn't see or hear a thing. They didn't even get a whiff of burning jet fuel. In fact, many people were watching televised cover­age of the World Trade Center attacks. She said it wasn't until another officer ran into the clinic and told them to evacuate that they knew something was wrong, exactly what was still unknown.

    Instead of immediately leaving the clinic, Larew and the clinic's chief nurse went into action. Larew said they initially had to evacuate patients already in the clinic, even as people injured from the crash began arriving. Some had serious bums. Most people, those with less serious injuries, were examined at triage sites that Larew helped set up outside.
    "It was hard to keep track of time, everything was in slow motion," said Larew. A second order to evacuate came with reports that another plane was heading toward the Pentagon. Even with that, she said more than an hour passed until they knew for sure that a fuel-laden commercial airliner had already struck the building. "It didn't register that a plane had hit, even though you knew about the World Trade Center," Larew said. "I just clicked on autopilot."

    Larew and team gathered up as many supplies as they could and took them outside to the triage site. She asked people for their backpacks. She identified nine medical team members and created three teams of three people each, and equipped each group with a bag filled with medical supplies. “And I said, ‘you’re on a team; if you go, you have to go together.’ And I did that for the three different teams,” she recalls.

    “I remember standing there with all the other people who had evacuated their offices, and I remember thinking, does anyone have a car in this parking lot? Does anyone have the keys to that car? We did evacuate our patients who needed immediate attention via private vehicle to the hospital. When an ambulance did arrive, Larew jumped in the back, thinking it would take her back to the main site, but when the doors opened, she was in the Pentagon’s center court.

    Larew recalls an unforgettable scene in the courtyard: hundreds of volun­teers, "smoky and hazy and very smelly," an area she says she hasn't returned to since that day.

    She helped set up a triage area there with three providers and several techs. Larew was responsible for establishing communications and ensuring availabil­ity of medical supplies. In addition to treating the injured, they administered IV solutions to the firefighters to ensure they didn't suffer from dehydration while fighting the fire.

    “We didn’t really get many casualties. We were there for the fire crews. If they needed anything, we were there for them. We also set up a morgue, knowing that eventually we would need it. However, we didn’t need it that day; it came up later and it was moved outside,” she says.

    "I remember thinking (around 3 p.m.), it's not fair," she said. "I'm supposed to have some transition time to get ready to treat patients under fire. You know, traveling to a war zone and preparing the patient care sites."

    The long day eventually turned into evening. It was past 8 p.m. when Larew finally left the Pentagon. But first, she went to the crash site on the west side of the building. "I could see file cabinets and offices completely out in the open. Chairs, clocks, flags," she says. It wasn't until she got home that what had happened really regis­tered with her, even though she had known by 3 p.m. there was little chance anyone would be brought out alive.

    “I was back the next day at 4:00 in the morning, and we stayed at 24/7 operations for about six weeks,” Larew relates. “We kind of augmented the teams from Walter Reed and Andrews (Malcolm Grow Medical Center) for casualty collection areas and treatment areas for wounded, and made sure they had what they needed. We were their support agency at that point. And at night, we were just there in case anyone else who was working 24 hours needed medical care. That lasted for about six weeks.”

    Through it all, Larew says the one memory that sticks in her mind most is calling home to her parents to let them know she was okay. Fighting back tears, she says, “I called home and my sister answered the phone and she said, ‘Whoever this is, we’re waiting for my sister to call my parents.’ And I said, ‘I am your sister!’ And she was like, ‘Oh my God, you’re alive!’ I remembered how relieved they all were.”

    As for the aftereffects from the terrorist attacks, she said they were almost as bad as the crash itself. "We had to set up an emergency command post, (and) host tenet units such as the critical incident stress management teams and environmental monitoring units. We were not prepared for dealing with all of the different uniformed services demanding information in their format, on their schedules. How we fixed this was we creatively organized all the data each service wanted into one report we put out daily so that we did not dupli­cate work." And because of Sept. 11 the very nature of her job changed, she added. "Our mission changed from a primary care clinic to being first responders in a high value target."

    Weeks after the attack there was still work to be done in the fight against terrorism as Pentagon medical teams screened more than 1,000 workers for anthrax. And exactly one month after the attack, her team provided support for a memorial service attended by more than 20,000 people. “We roamed the crowd. We had to anticipate another attack and we were ready to set up as clinics, if needed. Fortunately, nothing happened that day, but we were prepared for the worst.” Larew worked 12-hour shifts until Thanksgiving.

    Larew said she is confident that all of the patients treated that day received the best medical care possible. But then she quickly reflected back to the horror of Sept. 11. "I still get a chill up my spine when I smell smoke and hear sirens, but it will help me keep alert so that I will never forget that day."

    She says the events of September 11, 2001, have made her a stronger person, more confident in her work abilities. “I did a large study in disaster medicine after 9/11. I got to learn the difference between military triage and regular triage, and you have to separate that in a non-war situation, triage is so different than in a war situation. It’s been an enlightening experience for me. I feel like I can do anything, with limitations. I work at Virginia Tech now and last year was my first year. We were seeing 300-350 patients a day -- 50 patients per person my first week. It ran that way for four weeks. My coworkers were like, ‘You’re new here...how are you doing that?’ And I said, ‘you just do what you need to do and keep pressing on.’”

    Larew admits that the events of the day have also left her with PTSD. “I don't like crowds. I was very angry that I wasn’t prepared mentally. I became very aware of local terrorism and domestic terrorism. It’s part of my PTSD. I’m very heightened -- I make sure whenever I go somewhere I’m always looking for exits, and I sit with my back to the door. I don’t go anywhere without thinking about the potential for a mass casualty situation.”

    For Larew, 9/11 left her with one important lesson learned: It can happen anywhere, so be prepared. “You don’t think about things until you need them. You need to be as realistic as you can when you’re training because you never know when it’s going to happen.”

    Looking back, Larew says she doesn’t think she would change anything about her response.

    “I think I was as prepared as I could be. In retrospect, when I started studying about it, I’m surprised that I did all the things right. I was trained to do those things, and I did them right. It was the wrong place, wrong time, but I did the right things.”

    Dr. Douglas Knittel, Armed Forces Medical Examiner/Dover Port Mortuary

    Dr. Douglas Knittel recalls watching television and seeing the planes impact their targets. Not a unique memory, he says, certainly one that everyone in the United States has of that day. But right then, he had the sense that his role in the military and the course of the rest of his career had fundamentally changed; that what he thought he was going to be doing in the military, what he thought the military as a whole was going to be doing, was no longer valid. He knew that things had changed irrevocably that day.

    “When you think about your life and when you think about demarcation points, that morning it was very clear to me that my life was going to be different; that all of our lives were going to be very different,” Knittel says. “For those of us in the military, the difference was that that image marked a significant point of departure in our lives. Things were going to be different for a very, very long time.”

    Within one hour of American Airlines flight 77 crashing into the Pentagon, reducing layers of infrastructure into flaming rubble, then-Navy Cmdr. Knittel ('85), was on the phone to the Armed Forces Medical Examiner’s office. Knittel, a forensic pathologist assigned to the Naval Medical Center in Portsmouth, Virginia, who was one of only six U.S. regional armed forces medical examiners worldwide, knew he would be needed.

    “At the time, I was the regional Medical Examiner at Naval Medical Center Portsmouth, but attached to the Armed Forces Medical Examiner’s office in Rockville, Md. (now in Dover, Delaware),” Knittel recalls. “I remember I was in my office and the planes in quick succession hit the World Trade Center and the Pentagon and clearly I knew we were going to be involved somehow. I left the hospital and was on the phone all day, calling as many uniformed pathologists, other specialists, techs and photographers as possible to assist in the task of identi­fying victims' remains because I was the Navy pathology specialty leader at the time. Essentially, I was just getting ready to go.”

    Within 24 hours, Knittel departed for Rockville, and from there, he went on to Dover, where a team of more than 50 Armed Forces Medical Examiner staff members met at the Dover Air Force Base, Delaware, Port Mortuary on Sept. 13 to begin the job of receiving the remains from the Pentagon. He spent a little more than a week there, head down, completely focused on his duty to conduct autopsies to determine the exact causes of death, collect specimens for DNA analysis, and identify bodies.

    “We had a job to do. We had a lot to do. Once the Armed Forces Medical Examiner took over jurisdiction of the remains at the Pentagon, the plan was to fly the remains from the Pentagon to Dover. We were not at the Pentagon because there was no facility there to handle that number of remains and so we were busy, and I really didn’t have a chance to think about the larger picture during my day to day work. When you have a chance to reflect and think about the chain of events that caused these individuals to be there in front of you, it was quite momentous; it was something that was shocking.”

    Knittel says overall everyone was exhausted, but were kept going by the thought they "were helping people get back to their loved ones and providing information or evidence to enable the FBI to catch whoever was responsible. It made the fatigue go away.”

    The FBI reached out to Knittel and the AFME team for assistance with the United Flight 93 crash victims. “We were asked to consult on remains from Shanksville [Pa.] because the medical examiner there had never seen a high velocity, high G impact, and its effect on the body before. I think it was the FBI who flew the remains from Shanksville out for us to look at, and then back,” Knittel says.

    The events of 9/11 were only the beginning for Knittel and his Armed Forces Medical Examiner colleagues.

    “After we finished the 9/11 cases, there was the invasion [of Iraq] and we started getting remains back in Dover. At the height of the Iraq invasion, it was almost nightly that there would be a plane with remains coming in from both Iraq and Afghanistan. The people in Rockville -- the Armed Forces Medical Examiner -- they couldn’t do that all themselves because it was ongoing, so we would all rotate in and out at Dover for a week, two weeks at a time. At the same time, we were tasked with deploying to Iraq and Afghanistan for a variety of contingencies.”

    Shortly after the invasion, in the summer of 2003, Knittel was deployed to Iraq to a place somewhere south of Mosul to do some work on mass graves believed to have been as a result of genocide against the Kurdish population in the region. Also in 2003, the Space Shuttle Columbia accident happened, and Knittel was sent “on loan” to NASA to Barksdale Air Force Base, Louisiana, for a week immediately afterwards to assist in that forensic investigation.

    While these seemingly non-stop tragic events have had an effect on Knittel, he doesn’t dwell on it. Instead, he changed careers, switching specialties to psychiatry and neuroscience.

    “I got interested in traumatic brain injury because we were seeing it in the remains of the casualties coming back from Iraq and Afghanistan at Dover. Work was being done in this area by psychiatrists and others, so in mid-career, the Navy was kind enough to retrain me, and that’s what I’ve been doing for the past 15 years.” Knittel retired in 2020, and went back to graduate school, receiving a degree in bioethics from Harvard Medical School in May 2021. He says he will be teaching a neuroscience course at the Eastern Virginia Medical School and to psychiatry residents at Naval Medical Center Portsmouth.

    In thinking back on his experiences, Knittel offers this to those who may be following in his footsteps.

    “I think that all physicians and all healthcare providers make a difference in the world; make a difference in ameliorating human suffering. However, if you view 9/11 as the start of a continuum, of essentially the start of a war that has been unending for the past 20 years, I think there’s very few situations in the medical career where you could do more to alleviate human suffering than doing exactly what you’re doing, which is being a physician in the military.”

    Dr. John Lyszczarz, Navy Special Psychiatric Rapid Intervention Team
    Among the first responders to the Pentagon was a team given the daunt­ing assignment of counseling those immediately affected by the Sept. 11 attack. The Navy Special Psychiatric Rapid Intervention Team (SPRInT) was dispatched on Sept. 12 to provide support for those fortunate enough to have survived the attack, but who were in danger of suffering the effects of post-traumatic stress disorder (PTSD).

    Among the team members, USU alumnus then-Lt. Cmdr. (Dr.) John Lyszczarz (‘93) provided counsel­ing for 20 days following the attack. Lyszczarz says his initial experience was very similar to many Americans; he first learned about the attacks on TV. He was recalled from paternity leave as a member of the SPRInT team and was appointed Lead Psychiatrist for the team.

    “On September 12, our SPRInT team travelled to the Pentagon, met with the Pentagon Clinic director who gave us a tour of the damage and oriented us to the rescue efforts. Our role was providing stress/crisis debriefing to Navy and Marine Corps personnel at the Navy Annex, just up a small hill from the Pentagon.”

    By the end of their deployment, Lyszczarz and the SPRInT members had made contact with 1,749 active duty and civilian personnel. One woman who was helped by the team was subsequently interviewed for a news report in which she said that SPRInT sessions "allowed us a chance to take care of ourselves." This was especially important for staff members who, immediately after the attack, had to concentrate on supporting the nation's response.

    Lyszczarz said the experience was humbling, both then and afterwards.

    “Knowing, really knowing, that there are those who hate America and what it stands for enough to die was hard for me to digest. On the other hand, I was inspired by the outpouring of goodwill, whether evidenced through heroic rescues that risked life and limb or the amount of donations and letters of support sent to helping organizations like the American Red Cross.

    “The value of compassion and interpersonal support came into clear focus for me,” he continues. “Being there to support those traumatized and grieving service members and military civilian employees felt right. I believe that we helped many grieve substantial losses and begin to process how their world had forever changed. ‘Being there’ with compassion and support for not only patients but teammates and family became a top priority.”

    However, Lysczarz says he remembers one of the SPRInT members disseminating posters urging
    people to come see the team so as to “not let the terrorists win,” an approach he opposed because he felt it misdirected feelings of patriotism and seemed to induce certain people to expose themselves to traumatic content they weren’t prepared to confront yet.
    “The Navy and Marine Corps working groups that I encountered were collaborating intensely with razor-sharp intensity and tremendous sense of purpose. They were brothers and sisters fighting a righteous battle and supporting each other. I think it important that we as mental health leaders not overstep our supportive role and assume a grandiose sense of importance,” Lyszczarz says.

    Still, Lyszczarz says the events of 9/11 solidified his philosophy regarding human resilience.

    “People can handle a lot more than they think they can. Often, they can handle a lot more than we mental health experts think they can,” he says.

    These days, there are also more tools to assist them. According to Lyszczarz, there is more access to virtual treatment, essentially increasing access to mental health care, and a number of useful apps such as those promoting meditation practices.

    “There are other systemic resources such as the Center for Deployment Psychology and Operational Stress Control programs that promote resiliency, self-help, and continuing education for caregivers,” Lyszczarz says. “We’ve gone a long way towards destigmatizing mental health, a great achievement. Unfortunately, many consequently see themselves as victims or mentally ill patients rather than resilient survivors.”

    Each anniversary of the 9/11 attacks brings opportunity for Lysczarz to explain the tragic events and his role to his children, two of whom were just under 2 years old, and two weeks old, respectively, in 2001. His three other children were born after that. He said they’ve already watched several special presentations this year analyzing 9/11 and its aftermath. One of the big takeaways for Lysczarz? “Hatred in the world is a big problem! We all really need to start with ourselves and be the change we’d like to see in the world.”

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    NEWS INFO

    Date Taken: 09.11.2021
    Date Posted: 09.13.2021 07:18
    Story ID: 405062
    Location: BETHESDA, MD, US 

    Web Views: 90
    Downloads: 0

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