A training exercise is held at Inova Fairfax Hospital, just outside Washington, DC, which is based around the scenario of a terrorist attack with a chemical weapon. [Washington Post, 11/8/2001; American Hospital Association, 2002, pp. 27 
; New York Times, 1/6/2002] The large-scale exercise involves local, state, and federal participants, although which particular agencies take part is unstated. It centers around a simulated attack on the Fairfax County courthouse with sarin, a deadly nerve gas. [American Hospital Association, 2002, pp. 27 ] The simulated scenario is intended to overwhelm the medical system with hundreds or thousands of victims. Dr. Thomas Mayer, chair of Inova Fairfax Hospital’s emergency department, will later explain: “You say, ‘Here’s the scenario: We have 160 victims. How do we triage them? Where will they go? How will they be handled?’” [New York Times, 1/6/2002]
Model Tested in the Exercise Works Well – The “command hospital communication concept” is tested in the exercise. This model involves the “command hospital”—Inova Fairfax, which has the appropriate communications system—serving as a link to other hospitals in the area and being responsible for ensuring that patients with specific needs are sent to the appropriate medical facilities. The exercise is reportedly a success. “Everything worked fine,” Patrick Walters, a senior vice president at Inova Health System, will say. [American Hospital Association, 2002, pp. 27 ; Condon-Rall, 2011, pp. 186]
Hospital Responds to the Pentagon Attack on September 11 – Inova Fairfax Hospital, the largest hospital in Northern Virginia, is located 10 miles from the Pentagon. [ACP Hospitalist, 1/2007; Washington Post, 10/10/2010] On September 11, it will activate its disaster plan following reports of the attacks on the World Trade Center (see (Before 9:37 a.m.) September 11, 2001). [US Department of Health and Human Services, 7/2002, pp. B3 ] After being informed about the attack on the Pentagon, hospital officials will quickly clear over 200 beds for the anticipated casualties. [Washington Post, 11/8/2001] However, although the regional plan process works well when tested in today’s exercise, on September 11 it “didn’t work at all,” Walters will say. [American Hospital Association, 2002, pp. 28 ]
Before 9:37 a.m. September 11, 2001: Washington, DC, Area Hospital Alerted to Approaching Plane; Activates Disaster Plan
The air traffic control tower at Washington Dulles International Airport notifies Inova Fairfax Hospital—the largest hospital in Northern Virginia—that a hijacked aircraft is missing. It passes this information to Dr. Thomas Mayer, the chair of the hospital’s emergency department. [Goldberg et al., 2007, pp. 117] At around 9:32 a.m., air traffic controllers at the FAA’s terminal control facility at Dulles had “observed a primary radar target,” later determined to be Flight 77, “tracking eastbound at a high rate of speed” (see 9:32 a.m. September 11, 2001). [9/11 Commission, 7/24/2004, pp. 25; 9/11 Commission, 8/26/2004, pp. 33] Mayer will later recall: “We knew that something was headed towards the national capital area. We didn’t know where. But we knew we needed to get ready. So we immediately went on disaster planning mode.” [Goldberg et al., 2007, pp. 117] The Arlington County After-Action Report indicates the hospital in fact initiates its disaster plan earlier than Mayer suggests, stating: “Inova Fairfax Hospital activated its disaster plan following reports of the World Trade Center attacks. Subsequently, the hospital received emergency notification of a missing airliner from the Washington Dulles International Airport tower.” The hospital cancels elective surgeries until 6:00 p.m. and makes eight trauma teams available within 20 minutes. The regular emergency room is relocated to an alternate site, and nearly 100 nurses and doctors prepare to respond in the event of an attack in the Washington Metropolitan Area. [US Department of Health and Human Services, 7/2002, pp. B3 ] Due to the strategic importance of the region, Inova Fairfax and the other hospitals and clinics in the Washington area are particularly well prepared for mass casualty incidents. They regularly conduct drills to practice for chemical or biological attacks. [Goldberg et al., 2007, pp. 115]
