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Cpt. Roddex Barlow, RN, was at work in the emergency room of Walter Reed Army Medical Center in Washington, D.C., when a colleague called to tell him a plane had hit the World Trade Center in New York. He and others raced to the waiting room to watch the news on television, as the disaster net alarm went off. Medical workers were discussing contingency plans for casualties in New York when Reed received a second call from his colleague, who told him the Pentagon, about six miles away, had been hit.

"About then, we realized that it hit home," Barlow said. "I mean really, really hit home."

Barlow, who had trauma training, was ordered onto an ambulance headed for the crash site. At first, the ambulance was halted 200 yards from the Pentagon because a fourth hijacked plane, which eventually crashed in Pennsylvania, was still in the air. Finally, medical workers were allowed into a triage area that had been set up by nurses and other medical workers from a nearby clinic, Barlow said.

Barlow took two patients into his ambulance-one was a man with a fractured right arm who had been singed a bit, the other a woman with hip pain and difficulty breathing. Once in the ambulance, the woman started having stridor-high-pitched breathing.

From his training in a burn life-support class, Barlow realized the woman was in trouble and should wait for a better-equipped ambulance.

He took on another patient, a man with two fractured legs, and started back to the hospital. The ride took 45 minutes because bridges across the Potomac River were closed. About five minutes from Walter Reed, the first patient began to have stridor, Barlow said. "I told the driver to step on it."

When the ambulance arrived at the hospital, Barlow was amazed at how it had transformed into a model of disaster relief efficiency. Ten litter teams greeted the ambulances. Everyone was in smocks and wearing ID tags. Beds were set up with IV bags and four-person teams waited at each bed. Medical teams put a trachea tube into Barlow's first patient and stabilized the other. Then Barlow grabbed some equipment and went back to the Pentagon. This time, he said, almost all the wounded had been evacuated.

"We were pretty much in a sit-and-wait mode, hoping to find a survivor," he said. But none came. "The devastation to the actual site was quite overwhelming," he said.

The only remnant of the American Airlines plane was part of the fuselage. Barlow could read "ICAN" on it.

Nurses at the site and at the hospital felt frustrated, he said. "We were kind of upset that we didn't get as many people back here as we anticipated." But he said there was no other place he would have rather been at that time. "That was the one place where the Army needed me with my training," he said. "That was somewhat fulfilling."

But as the crisis winds down in the coming days and weeks, Barlow said that he and his fellow caregivers are focusing on what the government will do in retaliation for the attacks. Unlike their civilian counterparts, nurses in the military fear the attack on the Pentagon may be only the beginning.

"We look at it as being on hold for us," Barlow said. "Not over."

Red Cross relief
From working at blood drives to helping emergency workers and families cope with the crisis, nurses-both paid and volunteer-have been on the front lines since the attacks on the World Trade Center and the Pentagon, said Nancy McKelvey, MSN, RN, chief nurse of the American Red Cross in Washington.

Nurses from around the country have jammed an 800 number set up Sept. 13 to take names and numbers of volunteers who will be available to relieve crisis workers in the weeks after the attacks, she said. The Red Cross now has enough staff and local volunteers to deal with the situation, she said, but it will need relief. Nurses who call (800) 333-8572 will have their names and information put on a list and they will be called as needed, she said.

Nurses from 60 organizations attending a conference on the nursing shortage in Reston, Va., drove to Washington to help with a blood drive there, McKelvey said.

Nurses who wish to help with blood drives should call their local Red Cross chapters, she said, adding that some regions accept and train volunteer nurses. Nurses have been helpful with the long lines of people who wish to give blood, McKelvey said.

"It's emotionally exhausting because people are so eager to help," she said. Nurses have been listening to blood donors' stories and offering suggestions on how to deal with their feelings, she said.

In New York and Washington, nurses are working with disaster teams, setting up compassion centers for families and providing mental health support, she said.

She advised would-be volunteers against heading to the disaster site or blood drives without contacting someone first. "We really discourage them from doing that," she said, but added that she does not want to discourage nurses from volunteering through proper channels.

"The historical roots of the American Red Cross were that nurses were a large contingent of the response to emergencies," she said. "Nurses want to do anything. The American people in general just want to do something to help. It makes you feel good."

Oklahoma outreach
As Dianne Miller-Boyle, MS, NP, watched television scenes of doctors and nurses lined along the sidewalk outside of St. Vincent's Hospital and Medical Center in New York waiting for victims of the World Trade Center attack, she recalled the atmosphere at Children's Hospital of Oklahoma in Oklahoma City after terrorists bombed the Alfred P. Murrah Federal Building in April 1995.

"I just remember that feeling, standing down in the ER, just waiting for families and children to come," she said. "We were helping to move beds and get ready for an influx of victims that, unfortunately, never came."

Nearly 170 people died in the Oklahoma City bombing six years ago, less than a tenth of the expected victims of attacks on the Trade Center and the Pentagon. That bombing also produced shock, horror and anger, as well as an amazing outpouring of support from people across the nation.

Some of the nurses who responded to the Oklahoma City bombing said they are seeing many similar situations in New York City and Washington, and offered support and advice to their colleagues in those cities.

Realizing that most victims would not come out alive from the bombed-out ruins "was probably one of the most demoralizing things" for nurses who volunteered in the rescue effort, said Mary Peterman, MS, NP, a clinical instructor in the nurse practitioner program at the University of Oklahoma Health Sciences Center College of Nursing.

Peterman, a student in the nurse practitioner program at the time, went with other RNs to nearby St. Anthony Hospital and waited for victims. When they didn't come, the nurses began looking for other ways to help.

"It turned out that those with the greatest needs were families," she said. "They were in such a state of shock and grief."

Peterman and other nurse volunteers worked in church shelters set up for families waiting for news of their loved ones and for people who had been displaced by the bombing. Nurses brought them snack crackers, apples, water and blankets.

Many distraught family members forgot to eat or to take medications, she said. She heard stories of some mothers who had children inside the Federal Building day care center who forgot to pick up their older children at school and needed someone to call a relative to help them.

"Even if what the nurses were doing didn't feel like nursing, it did take their nursing skills to realize the needs and the problems and help decide what to do," Peterman said.

Not only families, but also homeless people and others displaced by the bombing needed support and care, said Miller-Boyle, also an instructor in the family nurse practitioner program at the University of Oklahoma. "There was a lot to do once we could refocus our direction," she said.

Nurses in Oklahoma City immunized rescue workers in a clinic set up at the site of the bombing. With physicians, they set up a small pharmacy using donated medicines, which were dispensed to people who needed them. At first, Peterman said, it was hard for nurses who wanted to help to figure out where they were needed most.

She recommended that nurses volunteering in New York and Washington go through some sort of organized effort. She particularly emphasized that volunteer nurses should respect the expertise and authority of Red Cross nurses and others trained to respond to disasters.

American Red Cross nurses have gone through special training and have their own protocols, said Peter Page, MD, senior medical officer with the American Red Cross Blood Program in Washington. Even volunteer nurses who collect blood for the organization have gone through a six-to-eight week training program, he said.

But nurses who have not been trained and wish to volunteer at blood donation sites can help people complete their paperwork and observe them after they have given blood, he said.

The organization also is using some untrained nurse volunteers to draw blood samples from people in line to determine their blood type and set up appointments to donate later.

"[Nurses] also can donate blood if they weigh more than 110 pounds," Page pointed out.

When the public health department was asked to set up an immunization clinic for volunteers at the bombing site two days after the bombing, Toni Frioux, MS, NP, chief of nursing service at the Oklahoma State Department of Health, was told it would take a few hours. She spent three weeks on the site, giving immunizations and coordinating volunteers.

"One of the challenges that we faced was really dealing with the generosity of the response," she said. Her first priorities were to centralize health care services and to make sure everyone providing health care was properly licensed. "We had some people posturing as health care providers," she said.

She had volunteers rotate four-hour shifts. Limiting shifts not only decreased the stress on volunteers, she said, but also gave more people a chance to work at the site and feel they were doing something positive.
"It takes time to get things in place," she said. "You can't do everything at once." She also recommended volunteers realize that they won't always know how the crisis will affect them.

One of the most difficult scenes for the nurse volunteers in Oklahoma City, she said, was watching the rescue dogs. The dogs got excited whenever they found someone, then became depressed when they realized the victim was not alive, Frioux said.

Nurses and health care workers in New York and Washington need to remember to take care of themselves, said Maribeth Moran, MSN, RN, assistant professor at the University of Oklahoma College of Nursing.

Moran worked in Children's Hospital on the day of the bombing and at a clinic near the bombing site. She remembers exhausted but cheery firefighters coming into the clinic to be greeted by exhausted but cheery nurses.

"Volunteers need to be aware that they may be affected in ways that they never even think about until they have trouble eating and sleeping," Moran said.

She found herself thinking she didn't need the debriefings mandated by organizations in charge of the rescue efforts. After the debriefing, she was glad she went. Now, she said, she thinks it was even more helpful than she thought at the time.

Once people in Oklahoma City got over their shock and anger, they began to pull together, Moran said. Although the city is not back to where it was before the bombings, the wounds have healed considerably, she said.

People in New York and Washington, she said, will realize that last week's horrific events will not dissolve their community, but will make it stronger. "Nurses can play a part in that," she said.

After the bombing, Peterman said she and fellow students volunteered at the site every day for three weeks. It was all they could think about, she said. Finally, the director of their program insisted they come back and write their exams.

"Our director called us in," she said. "We got a lot of opportunity to talk about grief, our own grief. Almost all of us knew someone in the building."

Many nurses she knows who rushed to help after the bombing have started talking to each other again, she said.

"A lot of us were beginning to move on," she said. "Now people are looking shell-shocked again. A lot of us need to go find each other. This is opening it all back up."