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Former head of TRICARE Management Activity remembers how the world changed

Photo of the National 9/11 Pentagon Memorial. The Pentagon Memorial was created to remember and honor those family members and friends who are no longer with us because of the events of September 11, 2001 at the Pentagon. Photo of the National 9/11 Pentagon Memorial. The Pentagon Memorial was created to remember and honor those family members and friends who are no longer with us because of the events of September 11, 2001 at the Pentagon. (Courtesy photo by Kevin Dwyer)

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It was a magnificent fall day on the Eastern Seaboard, a day no one would have anticipated a terrorist attack. 

“It was a day I clearly remember. Beautiful blue sky,” said Tom Carrato, a retired rear admiral with the U.S. Public Health Service. “Within hours [of the first attack], we knew the world had changed.” 

Carrato was in charge of the TRICARE Management Activity, the predecessor of the Defense Health Agency (DHA), the military’s medical system. As he attended meetings in a building a short distance from the Pentagon on Sept. 11, 2001, news came of a plane hitting one of the twin towers of the World Trade Center, and then another striking the second tower. While those in the room watched the TV reports, gripped by the site of flames and smoke pouring from the gaping holes in those structures, someone in the meeting saw a plane cross unusually low over their building. 

“We couldn’t actually see the Pentagon, but we could see the aftermath of the plane crash,” he said. “Right after that, we realized it was an act of terror but weren’t sure if it was an act of war. We talked about what we should do next to help.” 

The immediate answer was to let the emergency responders do their jobs. Shortly after, senior medical leaders from all the services met to map out what needed to be done in the short term and in the future. 

“One problem we recognized immediately was the operations plan was still in the Pentagon,” said Carrato. “We met with the senior folks to try and determine what we needed to do. We monitored the news, stayed in touch with those with a better vantage point, and really just rode it out that day.” 

Force health protection came to the forefront of the planning for the future. Carrato and the senior leaders he met with knew they had to have a “medical ready force and a ready medical force,” a motto the DHA still uses to this day. Carrato couldn’t anticipate what would happen, but he knew they had to be ready for anything. 

“We weren’t taking brand-new steps, but it was a redoubling of efforts and moving forward,” he said. “As the wars continued, we made sure our force was medically ready and protected, and we invested in dealing in what we were seeing in terms of battlefield injuries.” 

Carrato said military medicine evolved as the combat arms portion of the military progressed. Doctors, nurses and medics used new techniques and treatments as they deployed to areas of conflict to support the troops and tend to the wounds of war. He cited the irony in how something as tragic as war resulted in the best survival rates for those wounded in the history of warfare. And it’s taught clinicians how to deal with the long-term effects of repeated deployments on those shipped to the front and those waiting at home. 

“Dealing with the multiple deployments, dealing with traumatic brain injuries, both mild and severe, post-traumatic stress. And the advancements in care of those with amputations, prosthetic care, burns and other signature injuries, and how we prepared our warriors and how we deal with the long-term effects of the seen and unseen injuries, not just for the service member but also for the family,” said Carrato. “So there are a lot of issues we’re still dealing with.” 

There’s been a great deal of technology and technique transfers to civilian hospitals as well, according to Carrato. There are skills and treatments that started on the battlefield that now save lives in car accidents and gunshot injuries. 

He added a lot of investments in the military medical system have been made to the point where some doctors say a battlefield clinic can be a better choice than even the best hospitals in America. 

“One of the surgeons general used to say, if you had some kind of traumatic blast injury, such as the loss of both legs, where would you rather be, in front of Johns Hopkins or in Afghanistan?” he said. “The punchline would be you’d rather be in Afghanistan, because you had a much better survival chance.” 

Carrato wants to see the level of care for our military members and their families continue to improve and change, just as the world changed 15 years ago. 

“Our men and women of our military medical system were ready for that change, and they all stepped up and forward and met the challenge,” said Carrato. “I’m very, very proud of how folks responded on that day and from that day forward.”

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