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Attacks provide first major test of USA's national antiterrorist medical response plans

2001; Elsevier BV; Volume: 358; Issue: 9286 Linguagem: Inglês

10.1016/s0140-6736(01)06119-0

1474-547X

Michael McCarthy,

Health and Conflict Studies

On Tuesday morning, Sept 11, just before 9:00 am, Anthony Gagliardi, medical director of St Vincent's Hospital in Manhattan, was sitting in his office at his computer making a Powerpoint slide when he heard a jet fly low overhead. “I thought, ‘Wow, that's really loud’”, Gagliardi says. “Not a minute later, the president of the medical centre called and said: “Tony, we have a problem… a plane just flew through the World Trade Centre.” Gagliardi, puzzled, asked if he meant a Piper Cub had flown between the twin 115-story high towers. “He said: ‘No, it went right through a tower. I see the fire.’” Gagliardi immediately called a Disaster “Code 3”, triggering a plan that sent his staff to prearranged assembly points throughout the hospital to prepare to receive victims from the north tower, which they later learned had been hit by a hijacked Boeing 767 passenger jet. While the St Vincent's staff waited, a second passenger jet slammed into the other World Trade Centre tower. Given the time of day, Gagliardi estimated that there might now be anywhere between 20 000 and 50 000 casualties in the towers. At the World Trade Centre, confusion reigned. Falling debris from the burning towers had forced the evacuation of the commandcentre of city's Office of Emergency Management (OEM). The 47-story building, in which the multimillion-dollar command centre was housed would soon catch fire and later collapse. The situation dramatically worsened when first one of the World Trade Centre's towers and then the second collapsed, killing almost all of the nearly 5000 trapped office workers inside as well as the hundreds of emergency personnel who had rushed into the building or were gathered in the streets below. Among the dead were some of the city's top emergency officials who were directing the rescue operation at the site. Due in large part to the city's disaster preparation efforts, New York's emergency medical services continued to act. Lewis Kohl, chairman of emergency medicine at Long Island College Hospital, who had worked with the OEM on the hospital preparedness, said the New York planners with whom he had worked had taken the threat of terrorism very seriously. “They felt terrorist action was inevitable. I don't think anyone imagined it on the scale that it happened, but they really felt something was coming.” As part of those preparations, St Vincent's had just held one of its regular disaster drills in August. The training had paid off, says Gagliardi. “The response was very brisk and very complete, so much so that within an hour of the disaster, before we had received any victims, we had 400 physicians on site.” Meanwhile, in Washington, DC, US Secretary of Health and Human Services Tommy G Thompson had ordered the first nationwide activation of the National Disaster Medical System, putting on alert 80 Disaster Medical Assistance Teams (DMATs) across the country. These teams made up of medical and support personnel, largely from the private sector, are specially trained and equipped so they can quickly move into stricken areas and provide emergency medical assistance. As a first deployment, five DMATs, composed of 211 personnel were deployed in or near New York City and Washington, DC. In addition, seven Disaster Mortuary Operation Response Teams (DMORT) were deployed, four to New York and three to the DC area. These teams are made up of medical examiners, pathologists, forensic experts, and other personnel who assist in the identification, processing, and disposition of human remains. The US Centers for Disease Control and Prevention (CDC) also deployed one of its 12-h “Push Packages” from the National Pharmaceutical Stockpile. Each package is made up of several truckloads of precollected medical supplies, including medicines, dressings, and bandages. The supplies arrived in New York by evening, within 7 h of deployment. In addition, the CDC sent more than 80 000 bags of intravenous fluids, 600 portable and stationary ventilators, and arranged for the shipment of more than 50 000 doses of tetanus-diphtheria vaccines. In New Jersey, just south of New York City, Fran Griffin, commander of the DMAT in that state, NJ-1 DMAT, did not wait for orders from Washington to move. When she saw the second plane hit the World Trade Centre on television, she said: “I assumed we were going out the door.” Griffin immediately started contacting her team over the internet and via telephone. Because the telephone lines were jammed, she said, “it was not until 1 pm before we got 'the Go'-but we were already moving personnel and supplies at that point”. By 1:00 am on Wednesday, the 26-member NJ-1 DMAT team and their tents, generators, and other equipment were in place at a field hospital that had been set up on a pier 20 blocks from the World Trade Centre. Ultimately, New York City Hospitals would see more than 3300 patients with injuries related to the attacks in their emergency rooms. Many of these would be rescue personnel injured while searching through the rubble for survivors. The most common injuries were trauma, burns, and inhalation injuries. 339 patients would be admitted and 12 of those hospitalised would die. Considering the number of people who were in the two towers when they were struck, the number who lived to reach an emergency room was “abysmally low”, says St Vincent's Galgliardi. As a result, the system's ability to handle large-scale casualties was never really tested, he says. “We saw our first victim at 10:15 and I bet you we didn't see more than one or two victims after 3 in the afternoon… we didn't see a lot of injured—they had died.” Fran Griffin's team was ultimately assigned to setting up its tents and generators closer to the disaster area to provide shelter for the DMORT teams that are performing the preliminary identification screening of the body parts being brought from the site. “DMORT is what this operation has really turned into”, she said.