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.