Heroes Wear
Scrubs Too
With All
Systems Down, Teamwork Was Essential to Saving Lives at
Ground Zero
On
September 11, no one near the World Trade Center (WTC) in
Lower Manhattan was fully prepared for the tragedy that
unfolded that day—not even medical professionals
trained for emergency disasters. NYU Downtown Hospital, a
small community hospital, was one of the treatment
centers for victims. This is an account of how its
medical staff worked together after the terrorist
attacks.
“The whole team in the emergency department that
day was absolutely essential; we could not have survived
without them,” said Dr. David Goldschmitt, medical
director of the emergency department at NYU Downtown
Hospital. “The whole hospital worked together as an
incredible team.”
NYU Downtown received 100 times its normal flow of
patients. Goldschmitt recalled, “Normally, we see
100 patients per day in the emergency department. In a
three-hour period, this would be 12 patients. On that
day, the hospital saw close to 1,200 within that same
three-hour time frame. Everyone got seen and taken care
of.”
The hospital had 36 critical patients (when the medical
staff first found these victims they assumed these people
were going to die). “We were able to save all but
three,” Goldschmitt recounted. “We’re
not a trauma center or a major teaching hospital. There
was no reason for us to gear up for a major disaster. And
here we are—a small community hospital in the
middle of the disaster with no power, no steam, and
communication problems—and we still managed to do
it (save lives).”
Josie Joliver, assistant nurse and in-care coordinator
for NYU Downtown, started work as usual at 8:00 a.m.,
replacing the night shift. Little did she know she would
be serving as a triage nurse in a few hours.
After the staff heard the first explosion and confirmed
the crisis, they activated their disaster plan. To
communicate internally they used the intercom system. The
operator, via the pager, informed all hospital areas that
there was indeed a disaster.
“You cannot say we were overwhelmed because we were
ready to help,” Joliver said. About 10 patients
waiting for beds were evacuated to prepare the emergency
room for victims. The team had to open other hospital
areas (for example, the cafeteria) as patients
arrived.
Teamwork, Leadership, and the Incident Command
System
NYU Downtown implemented the incident command system
(ICS), recognized by the Federal Emergency Management
Agency (FEMA) as an effective system for managing
emergencies. Goldschmitt explained the
system:
- In the case of disaster, a worker is assigned as
the incident commander—usually the most senior
person who knows the hospital.
- This commander is in charge of five
people.
- Commanders are set up for communications,
clinical, finance, operations, and engineering
sections.
- Each leader is responsible for five people who
become section leaders themselves, until the pyramid
form is complete.
With this setup, you’re not waiting for a
supervisor to arrive for work; automatic supervisors are
poised for action. “There are always lines of
communication; you know who you are reporting to, what
you’re doing, and who you command. That’s how
you run the hospital during the disaster,”
Goldschmitt noted.
Joliver explained how ICS worked that day, “We had
people working in critical, minor surgery, minor trauma,
major trauma, and inhalation treatment areas. We were
divided into teams; each team had two doctors, two
nurses, and other workers from the hospital. By midday,
other hospitals were assisting (orthopedic doctors and
surgeons, for instance).
“Following the earlier WTC bombing in 1993, NYU
Downtown was very proactive about having a lot of
disaster drills and working out the best disaster system
we knew because we assumed we were a prime target for the
next time,” Goldschmitt confided. “We were a
little ahead of everyone else in the planning we were
doing for a disaster.” (The city of New York
recommended an ICS to all hospitals a year and a half
ago, but it didn’t make the system
mandatory.)
In January 2001, NYU Downtown instituted a new ICS, but
by September the hospital had only trained about one half
of the staff because training was so time consuming.
Fortunately, that was enough to prepare for September 11,
Goldschmitt said.
NYU Downtown was built as a result of a disaster in 1922,
when a building on Wall Street was bombed. City officials
decided they had to have a place to put the victims, so
they created the hospital. “Of any hospital in the
entire country, we’re the only one that has had to
deal with this many disasters at one time,”
Goldschmitt said.
When asked if ongoing staff relationships and previous
disaster training helped, Goldschmitt commented,
“We’ve had working relationships with all of
the departments; we’ve practiced a lot and that was
very important. Working with the city agencies was more
of a problem because all communication was lost—and
the city lost its command center. So we were on our own
most of the time.”
Hospital staff communicated mainly via two-way radios.
When staffers went to manage the triage centers at Ground
Zero and One Liberty Plaza, they literally ran back and
forth across three blocks to relay
messages––it was easier than trying to figure
out how to get enough walkie-talkies. “We had
enough walkies for the hospital,” Goldschmitt
explained. “Unfortunately, we couldn’t find
enough for both the hospital and Ground Zero. Our bigger
problem was communicating with the rest of the city. We
had gotten reports that our hospital had been closed and
evacuated. We had no power, so we knew it was going to be
getting dark––patients still needed to be
triaged out in the ambulance base so we needed overhead
lights for outside.”
Power Down, We Need Lights!
NYU Downtown couldn’t get these lights right away
because the city’s supply was being shipped to St.
Vincent’s Hospital, the designated trauma center
even though St. Vincent’s wasn’t seeing any
patients at the time. Staff quickly turned to General
Electric, which came through with a large supply.
“For everything we did, we had to circumvent the
system because of the lack of communication,”
Goldschmitt said. “The hospital had enough
generators until the full repair of electricity, partly
because people also brought their own lamps,”
Joliver added.
Following the tragedy, hospital administration reviewed
how the disaster unfolded. They discussed:
- What was good.
- What was bad.
- What worked in spite of the plan.
- What worked because of the plan.
Two problem areas for NYU Downtown were communications
and record keeping. It was impossible to document
everything that was done that day because there were too
many patients. The hospital has redesigned those parts of
the system to make them more efficient.
“The Joint Commission on Hospital Accreditation
reviewed all of the plans we did and the things we
accomplished and they were more lenient than we
were,” Goldschmitt explained. “They thought
we did an incredible job; we were more critical about
what we might have been able to accomplish.”
Communications Between Hospitals Needs Work
The biggest issue to work on for the future is secured
communication between city hospitals. Goldschmitt brought
this to the City Council’s attention through a
committee on which he serves. He described the dilemma
faced, “When we were getting all of the patients in
we had to transfer some out so that we didn’t fill
the hospital completely. We had to get supplies; we had
no steam so we had to get our equipment sterilized. We
had no way of contacting the different hospitals to do
that. Even though the city could set up a borough command
for police and fire with walkie-talkies and communicate
with the hospital if they chose, it was hard to get
anybody identified who had any idea of what was going on.
Without the command center, you had four or five
different agencies all trying to man the disaster
simultaneously. But nobody was reporting to one central
agency.
“Even if the command center is lost, the city has
to have alternatives for communication so there can be
the same pyramid structure to answer to one group or
person in the city as well as in the different hospitals.
The hospitals have to have some kind of secured
communication lines, whether it is a special phone line
that goes through or cellular phones that will work even
if there’s a satellite problem. The exact way of
rectifying the problem we don’t have yet because
we’re one hospital out of many. We can’t
influence the decisions for other hospitals as well. That
is something the city is going to have to
decide.”
The issue with documentation turned out to be something
fairly simple, said Goldschmitt. The hospital created a
new one-page form that can list all important patient
information. This form consists of check-offs and quick
fill-ins that capture the information NYU Downtown needs
to have names and addresses of people being treated,
notify family members, and list prior medical treatments.
“Our problem was that we didn’t have enough
clerks trained in registration and medical record keeping
to get all the information. Documentation was one part of
our system that wasn’t for just anyone to handle.
Now we have a sheet that anybody can pick up and use.
That’s the key to ICS success—anybody can do
it,” Goldschmitt noted.
The hospital is working on handling other potential
issues now: bioterrorism, hazardous materials, and
nuclear radiation exposure. The renovation of a mass
decontamination unit is set to break ground in the
fall.
The NYU Downtown medical staffers are proud of the work
they did that fateful day. Departments kept closely in
touch despite loss of communication with the outside
world. Doctors and nurses overcame the horrific trauma
and saved many lives. On this overwhelming day, NYU
Downtown provided historic help to the local community
that quickly became the nation’s community.
ERIN FLYNN is founder of Flynn Media, a New
York-based communications firm that offers writing,
editing, and publicity services. She can be reached
through her Web site at www.flynnmedia.com
.
More About NYU Downtown Hospital
When Mayor Bloomberg proclaimed March 11, 2002, as NYU
Downtown Hospital Day, he noted, “On September 11,
2001—with less than 10 minutes to prepare—NYU
Downtown Hospital organized the most extensive hospital
disaster response in U.S. history. Amid the avalanche of
bleak news from Ground Zero at the World Trade Center,
the hospital became known to the world as “the
little hospital that could,” emerging as an island
of hope in a sea of chaos. Just three blocks from the
disaster site, medical staff and volunteers worked with
emergency generators under war-like conditions, treating
more than 500 victims, including 150 police,
firefighters, and emergency personnel. Hospital workers
escorted more than 200 people over the Brooklyn Bridge or
uptown to safety, made home visits to assist elderly
neighborhood residents, sent medical assistance and
supplies to Ground Zero, and provided 9,414 hot meals
through September 17.”
NYU Downtown Hospital (a part of Mount Sinai NYU Health)
traces its roots to the New York Infirmary for Poor Women
and Children, founded in 1883 by Elizabeth Blackwell,
M.D., the first licensed female physician in the United
States.
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April 2002 News for a Change
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