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Diane Fulton, RN, MSN, was the ED clinical coordinator at Saint Anthony Hospital when the Murrah building was blown apart 10 years ago. She says it was a few hours before she realized what was happening was for real.

In the heart of downtown Oklahoma City, there stands a pair of monolithic bronze-clad granite gates. A peaceful reflecting pool stretches between them, beside a gentle slope on which 168 chair-shaped monuments stand. Visitors move quietly around the grounds speaking in hushed tones, if they speak at all, as befits hallowed ground.

Shortly before 9 AM on April 19,1995, ex-Army sergeant and antigovernment activist Timothy McVeigh parked a yellow Ryder truck beside the Alfred P. Murrah Building, where the memorial now stands, and walked away. The truck was packed with 5,000 pounds of explosives, and when it detonated at 9:02 AM, the world ended for nearly half the building’s workers and many others in nearby offices.

At Sant Anthony hospital, just five blocks away, windows blew out from the force of the blast. Head ICU nurse Ann Burkle, RN, BSN, heard and felt the explosion and thought that perhaps a boiler had blown up. Nearly two miles from the blast at Children’s Hospital of Oklahoma (now Children’s Hospital at OU Medical Center), PICU director Rhonda Flowers, RN, didn’t feel the explosion, but some of her nurses did. They ran to the roof and saw a massive cloud of black smoke rising from downtown.

Fast response

Within minutes every hospital in the area was aware of the blast and had activated its disaster plan. Of course, in those pre-9/11 days no one’s plans included contingencies for terrorist activity, especially in America’s Heartland. Nevertheless, the plans were flexible enough to provide immediate response. Within minutes, emergency workers had arrived on the scene, triage areas were being set up, and the hospitals were prepared to accept patients.

It didn’t take long. Within three minutes, victims began to arrive at Saint Anthony. “The first ones we saw were what we called the walking wounded,” remembers Diane Fulton, RN, MSN, clinical coordinator for the ED at the time. “They literally walked or ran to the hospital. Some of them had a child tucked under each arm. The wounds were primarily from the shrapnel — lots of eye injuries, lacerations, puncture wounds, and percussive injuries. I remember immediately calling surgery. I told them, ‘I don’t know what’s happened, but if you have any 9 AM cases you haven’t started, just hold off.’”

At the University of Oklahoma College of Nursing, instructor Francene Weatherby, RNC, PhD, had just come out of a meeting when she learned about the blast. “A number of our clinical students were based at Saint Anthony, and they were called to the hospital right away to help care for the wounded.”

And then the trickle of wounded arriving at Saint Anthony turned into a torrent, with victims arriving by ambulance, private vehicles, and anything else that rolled. The hospital accepted about 200 patients in the first two hours after the bombing, and with so many patients with eye injuries, decision-makers quickly converted the hospital’s dental clinic into an eye care center.

“It worked really well since we had dental chairs and excellent lighting there,” Fulton says. “We had one floor that was closed, and within 20 minutes the staff had gone up there, opened it up, and had it ready for patients. We called the emergency room and told them we could take 20 more patients whenever they were ready.”

Surprisingly, the facility was able to accommodate all who sought care there. “The ER filled up very quickly, but the good thing is that the patients were triaged very effectively,” Fulton remembers. “Minor injuries went to our outpatient clinic for suturing, people who came in with eye injuries were sent to the dental clinic, and when the ER became full of critical patients, we sent them directly to ICU.”

At Children’s Hospital, Flowers told her staff to expect a huge influx of patients. “Since we’re an intensive care unit, we thought we’d be taking patients regardless of whether they were pediatric or not, so we immediately went into that mode,” she recalls. “But we received just a few patients — the last one came in about 11 PM. And then we waited, and waited, and waited. It was a horribly sad situation because we thought we’d be getting tons of patients, but they were all gone. Just lost.”

One thing none of the hospitals experienced was a shortage of help. “We didn’t need to call anyone in — there was a tremendous outpouring of help, with people coming in from off shift,” recalls Cyndy Ray, RN, who was assistant head nurse at Integris Southwest Medical Center at the time. “When it became clear that this wasn’t going to be a short-term event, I actually had to start sending people home to get some sleep so they could come back and help the next day.”

Reality sinks in

Many nurses and other workers couldn’t help but be profoundly affected by the experience as the long day wore on. “I guess at first I was in shock and didn’t realize it was real,” Fulton says. “It was a couple of hours into it when I became aware of all the glass crunching under my feet as I walked through the hospital. I remember slipping on blood in the back of an ambulance at one point, and that’s when it hit me: ‘This is not a drill. This is real.’”

For Burkle, the worst part of the day was when the flow of patients ended. “As long as we had patients and kept getting more, we felt like we were helping and making a difference,” she says. “But when the patients stopped coming, that was very difficult.”