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Dan
The following narrative was authored by Michael Karch, MD, an orthopedic surgery resident at Georgetown University Hospital who took it upon himself to rush to Ground Zero on September 11, 2001. It was originally emailed to associates and friends and has since been passed around the Internet. There are some excellent insights here for anyone who finds themselves in the middle of any natural or manmade disaster (some of his conclusions are focused on an urban situation such as he experienced, but most are universally applicable). We have formatted this for easier reading.
Saturday, September 15, 2001
Medical personnel,
It's Saturday morning and I am sitting down at my computer trying to collect my thoughts after spending 48 hours in a MASH unit at Ground Zero.
As most of you live in or around major metropolitan areas and, unfortunately, may be responsible for future mass casualties, I am writing this experience down for you to use as an example of how to prepare (timing, equipment, supplies, clothing, etc.)
Tuesday morning in Washington, DC, we went on level 1 Terrorist alert at approx. 0900 after the Twin Towers were hit. Most of us were shocked and frankly watching the TV not thinking that this would actually happen to us about 40 minutes later. When the news came that the Pentagon was hit we scrambled to set up with expected ER admissions in the hundreds. Only one patient actually came, with severe 3rd degree burns and smelling of jet fuel. Nothing, of course, came afterwards because most of the victims died.
Feeling extremely frustrated, I jumped on a train and headed for NYC. I packed a backpack filled with food, water, water filter, stove, headlamps, clothes and medical supplies (dressings, Silvadine, trauma scissors, suture kits, plaster, ace, etc.). No thought was given by me to bring a helmet, gas mask, goggles, rain wear, or multiple socks...all of which I needed in order to work and all of which I eventually obtained but could have used right away.
Outside NYC Penn station the air was smoky with ash in the air. I took a cab initially to St. Vincent's Hospital but they said more help was needed at Pier 61 (Chelsea pier) about 20 blocks from Ground Zero. I took a cab there and began working. Chelsea pier at that time was a combined clinic for the walking wounded and morgue. As the clinic was becoming less and less busy by the time I got there and the morgue more and more busy, I was assigned to carrying body bags from a truck and lying them out on the ice (Chelsea pier is a ice skating rink). After about 2 hours of this, word came out that the fire at Ground Zero had been controlled enough so that forward medical personnel could go in. They called for volunteers and I and 2 other physicians (ER and general surgery) went.
Actually getting to Ground Zero was no small feat as there is a check point about 10 blocks out where no reporters, civilians, etc. can go past. For future reference please bring ID, medical license, credentials. Fortunately I had taken these and I was shuttled up to about 4 blocks from Ground Zero and dropped off as there was no road left. We walked up about 2 more blocks and dropped off gear at a local high school which had been deemed a medical and general supply staging area. And then we left for the front.
To get to Ground Zero, one has to walk thru a maze of 6-12 inch ash, paper, twisted iron, mud, junk, rubble....it looked like a tornado had hit the city. Next, you have to walk through a bombed out portion of 2 World Financial Building... it is essentially a pitch black 150-200 meter tunnel with water up to your boot line. This is where the "Atrium" dining area used to be with high vaulted multifaceted glass ceilings and palm trees looking up at the Twin Towers. It was decimated as the steel structure supporting the huge glass windows had caved in...there was cable, and iron, electrical lines, glass, mud, ash, and running water everywhere. Through this and in the backdrop of smoke one could see the outside front wall of the North Tower which was now only about 5 stories high atop a huge pile of burning rubble and leaning 45 degrees...Hollywood could not have created a scene as bad as this. The tunnel then continued on for another 100 meters or so past underground mall shops and stores with the front windows smashed in on blast impact until one finally reached the outside and Ground Zero itself.
Up to this point, my understanding of the event had been limited by what the TV cameras had shown me. I was immediately struck by the immensity of destruction and the fact that it wasn't just the Twin Towers... it was a 2 block radius of decimation. The smell of rotting flesh and ash hit me like a wave. Cars, busses, a fire truck were smashed, thrown, turned over. There was a body in one of the cars and another flattened on the ground who had apparently jumped. Body bags were being brought in empty and being returned only half filled. This was the most horrific thing I have ever seen. All the buildings still standing around the perimeter were severely damaged and some were leaning and ready to fall into the "pit". Fireman, the hard-asses of NYC, were dazed, crying...it was an unexplainable sight. The three of us set up a MASH unit at the base of a building in what became known as MASH Unit Ground Zero West. I dumped my backpack supplies and went back thru the "tunnel" to the staging area 2 blocks back to pick up more supplies while the others set up the mini hospital. I ran this shuttle 4 or 5 times with my pack full of dressings, betadine, and saline eye wash which was desperately needed ... each time, I was convinced that the "tunnel" was going to collapse on me ... thank God for speed workouts on the track as my heart was racing about 250 beats per minute.
Once Ground Zero West was fully stocked we began treating the fireman...The guys are complete animals and it was like a football game mentality patch them up and get them back to the pit to work (mostly laceration, eye washes, inhalation, burns, etc.).
The firemen began bringing out bodies in bags and placing them down at the edge of the pit which was in front of the MASH unit...the smell became incredibly bad and I soon found myself on a crew carrying these bodies back thru the "tunnel" to the outside perimeter. We piled them in a bread truck to be taken back to the ice rink morgue. Out of the 17 that we carried out, only one was a complete body. In fact one bag was so light that when we picked it up we thought it was empty and cast it aside, only to find out that it had only half of an ankle and foot inside, there was no more. At about 0100 Thursday morning a report came out that there were people with a cell phone trapped below us. The WTC has a 5 story underground mall beneath it. The 3rd, 4th, and 5th floors were crushed but apparently the bottom 2 were intact The crews began digging and trying to find these people. Unfortunately, the crews couldn't get there and the fear is that by now the mall itself has filled with water from the fire hoses.
Firemen have a bond that is stronger than brotherhood. New York firemen live and die by this creed and the New York ironworkers and cops are of the same breed. These men are the American heroes. They truly felt that the only reason that they themselves were alive is because they were late for work that day, or their truck got caught in traffic, or they were on vacation, or it was their day off, etc. So when their shift was over in the "pit" they would not leave, but just stood there at the edge of the pit waiting for their buddies to get pulled out. Time flew by and their "rest" period was over and they had to go back into the pit unrested. These men were starting to get tired, even dazed, and this can be very dangerous around heavy equipment, fire, twisted iron, etc. It was just a matter of time before someone got hurt. My respect for the American fireman, cop, iron worker, medial personnel, red cross, Guardian Angel, volunteer in any form is at an all time high...these are unbelievable people who live in an incredible place and will overcome this. I never had a chance to see the infamous WW-II generation at its peak but I did get to see America at its finest hour on September 11, 12, 13, and 14, 2001.
This continued on like this until early afternoon Thursday. The building that I was set up under shifted which caused a mini mass panic and actually resulted in 3 ankle fractures from running. All the small, ad hoc MASH units (Ground Central West, Ground Central East, Church Street, etc.) were ordered to move back thru the "tunnel" and set up a hospital at Stuyvesant High School, the old supply staging area. This hospital was masterminded by a Sloan Kettering ER physician by the name of Rich Hutchinson (?) I can't remember his full last name). By this point we had a staff of about 100 (docs, nurses, techs) with about 100 more Red Cross and Guardian Angels. We had no power nor communication system so we set up a system of runners just like we had created with the forward MASH units a day earlier at Ground Zero. The plan included a triage area up front, a surgical/burn/ortho/laceration area, respiratory, medicine, dermatology (blisters), eye wash/ophthalmology, pharmacy/supply, and psychiatry areas down stairs at ground level with a food, rest, and massage area upstairs. In addition, we kept a temporary MASH unit up and working while we built the hospital. We literally cleared an entire wing of the high school and then set up. Rich deemed team leaders in each of the specialties so that each of the team leaders would set up their subunit and he would supervise.
I was put in charge of the surgical/ortho/burn/laceration unit and I created it in this way: Two Code Red beds up front with code cart, ambu bags, intubation, chest tube capabilities. This was set up with easy access to the front door to bring people in quickly and with a clear path to a back exit to move them out to be carried to an ambulance down the street. Directly behind this was the Burn Area with stock piles of IV catheters, fluids, clean sheets, silvadine and dressings. The rationale behind this was that if a burn victim needed to be intubated in the code red area, there would be easy access to the burn care facilities just behind the code area. The Orthopaedic area was set up in a semi-separate classroom area with stockpiles of plaster, ace and kerlex as there was no webril cotton padding. The rationale behind this was that there was no narcotic pain medication available and a door could be closed before the fracture was reduced "live" to reduce noise. Laceration beds were set up complete with irrigation, betadine, suture materials to each bed.
End part one
Dan
Dan
The following narrative was authored by Michael Karch, MD, an orthopedic surgery resident at Georgetown University Hospital who took it upon himself to rush to Ground Zero on September 11, 2001. It was originally emailed to associates and friends and has since been passed around the Internet. There are some excellent insights here for anyone who finds themselves in the middle of any natural or manmade disaster (some of his conclusions are focused on an urban situation such as he experienced, but most are universally applicable). We have formatted this for easier reading.
Saturday, September 15, 2001
Medical personnel,
It's Saturday morning and I am sitting down at my computer trying to collect my thoughts after spending 48 hours in a MASH unit at Ground Zero.
As most of you live in or around major metropolitan areas and, unfortunately, may be responsible for future mass casualties, I am writing this experience down for you to use as an example of how to prepare (timing, equipment, supplies, clothing, etc.)
Tuesday morning in Washington, DC, we went on level 1 Terrorist alert at approx. 0900 after the Twin Towers were hit. Most of us were shocked and frankly watching the TV not thinking that this would actually happen to us about 40 minutes later. When the news came that the Pentagon was hit we scrambled to set up with expected ER admissions in the hundreds. Only one patient actually came, with severe 3rd degree burns and smelling of jet fuel. Nothing, of course, came afterwards because most of the victims died.
Feeling extremely frustrated, I jumped on a train and headed for NYC. I packed a backpack filled with food, water, water filter, stove, headlamps, clothes and medical supplies (dressings, Silvadine, trauma scissors, suture kits, plaster, ace, etc.). No thought was given by me to bring a helmet, gas mask, goggles, rain wear, or multiple socks...all of which I needed in order to work and all of which I eventually obtained but could have used right away.
Outside NYC Penn station the air was smoky with ash in the air. I took a cab initially to St. Vincent's Hospital but they said more help was needed at Pier 61 (Chelsea pier) about 20 blocks from Ground Zero. I took a cab there and began working. Chelsea pier at that time was a combined clinic for the walking wounded and morgue. As the clinic was becoming less and less busy by the time I got there and the morgue more and more busy, I was assigned to carrying body bags from a truck and lying them out on the ice (Chelsea pier is a ice skating rink). After about 2 hours of this, word came out that the fire at Ground Zero had been controlled enough so that forward medical personnel could go in. They called for volunteers and I and 2 other physicians (ER and general surgery) went.
Actually getting to Ground Zero was no small feat as there is a check point about 10 blocks out where no reporters, civilians, etc. can go past. For future reference please bring ID, medical license, credentials. Fortunately I had taken these and I was shuttled up to about 4 blocks from Ground Zero and dropped off as there was no road left. We walked up about 2 more blocks and dropped off gear at a local high school which had been deemed a medical and general supply staging area. And then we left for the front.
To get to Ground Zero, one has to walk thru a maze of 6-12 inch ash, paper, twisted iron, mud, junk, rubble....it looked like a tornado had hit the city. Next, you have to walk through a bombed out portion of 2 World Financial Building... it is essentially a pitch black 150-200 meter tunnel with water up to your boot line. This is where the "Atrium" dining area used to be with high vaulted multifaceted glass ceilings and palm trees looking up at the Twin Towers. It was decimated as the steel structure supporting the huge glass windows had caved in...there was cable, and iron, electrical lines, glass, mud, ash, and running water everywhere. Through this and in the backdrop of smoke one could see the outside front wall of the North Tower which was now only about 5 stories high atop a huge pile of burning rubble and leaning 45 degrees...Hollywood could not have created a scene as bad as this. The tunnel then continued on for another 100 meters or so past underground mall shops and stores with the front windows smashed in on blast impact until one finally reached the outside and Ground Zero itself.
Up to this point, my understanding of the event had been limited by what the TV cameras had shown me. I was immediately struck by the immensity of destruction and the fact that it wasn't just the Twin Towers... it was a 2 block radius of decimation. The smell of rotting flesh and ash hit me like a wave. Cars, busses, a fire truck were smashed, thrown, turned over. There was a body in one of the cars and another flattened on the ground who had apparently jumped. Body bags were being brought in empty and being returned only half filled. This was the most horrific thing I have ever seen. All the buildings still standing around the perimeter were severely damaged and some were leaning and ready to fall into the "pit". Fireman, the hard-asses of NYC, were dazed, crying...it was an unexplainable sight. The three of us set up a MASH unit at the base of a building in what became known as MASH Unit Ground Zero West. I dumped my backpack supplies and went back thru the "tunnel" to the staging area 2 blocks back to pick up more supplies while the others set up the mini hospital. I ran this shuttle 4 or 5 times with my pack full of dressings, betadine, and saline eye wash which was desperately needed ... each time, I was convinced that the "tunnel" was going to collapse on me ... thank God for speed workouts on the track as my heart was racing about 250 beats per minute.
Once Ground Zero West was fully stocked we began treating the fireman...The guys are complete animals and it was like a football game mentality patch them up and get them back to the pit to work (mostly laceration, eye washes, inhalation, burns, etc.).
The firemen began bringing out bodies in bags and placing them down at the edge of the pit which was in front of the MASH unit...the smell became incredibly bad and I soon found myself on a crew carrying these bodies back thru the "tunnel" to the outside perimeter. We piled them in a bread truck to be taken back to the ice rink morgue. Out of the 17 that we carried out, only one was a complete body. In fact one bag was so light that when we picked it up we thought it was empty and cast it aside, only to find out that it had only half of an ankle and foot inside, there was no more. At about 0100 Thursday morning a report came out that there were people with a cell phone trapped below us. The WTC has a 5 story underground mall beneath it. The 3rd, 4th, and 5th floors were crushed but apparently the bottom 2 were intact The crews began digging and trying to find these people. Unfortunately, the crews couldn't get there and the fear is that by now the mall itself has filled with water from the fire hoses.
Firemen have a bond that is stronger than brotherhood. New York firemen live and die by this creed and the New York ironworkers and cops are of the same breed. These men are the American heroes. They truly felt that the only reason that they themselves were alive is because they were late for work that day, or their truck got caught in traffic, or they were on vacation, or it was their day off, etc. So when their shift was over in the "pit" they would not leave, but just stood there at the edge of the pit waiting for their buddies to get pulled out. Time flew by and their "rest" period was over and they had to go back into the pit unrested. These men were starting to get tired, even dazed, and this can be very dangerous around heavy equipment, fire, twisted iron, etc. It was just a matter of time before someone got hurt. My respect for the American fireman, cop, iron worker, medial personnel, red cross, Guardian Angel, volunteer in any form is at an all time high...these are unbelievable people who live in an incredible place and will overcome this. I never had a chance to see the infamous WW-II generation at its peak but I did get to see America at its finest hour on September 11, 12, 13, and 14, 2001.
This continued on like this until early afternoon Thursday. The building that I was set up under shifted which caused a mini mass panic and actually resulted in 3 ankle fractures from running. All the small, ad hoc MASH units (Ground Central West, Ground Central East, Church Street, etc.) were ordered to move back thru the "tunnel" and set up a hospital at Stuyvesant High School, the old supply staging area. This hospital was masterminded by a Sloan Kettering ER physician by the name of Rich Hutchinson (?) I can't remember his full last name). By this point we had a staff of about 100 (docs, nurses, techs) with about 100 more Red Cross and Guardian Angels. We had no power nor communication system so we set up a system of runners just like we had created with the forward MASH units a day earlier at Ground Zero. The plan included a triage area up front, a surgical/burn/ortho/laceration area, respiratory, medicine, dermatology (blisters), eye wash/ophthalmology, pharmacy/supply, and psychiatry areas down stairs at ground level with a food, rest, and massage area upstairs. In addition, we kept a temporary MASH unit up and working while we built the hospital. We literally cleared an entire wing of the high school and then set up. Rich deemed team leaders in each of the specialties so that each of the team leaders would set up their subunit and he would supervise.
I was put in charge of the surgical/ortho/burn/laceration unit and I created it in this way: Two Code Red beds up front with code cart, ambu bags, intubation, chest tube capabilities. This was set up with easy access to the front door to bring people in quickly and with a clear path to a back exit to move them out to be carried to an ambulance down the street. Directly behind this was the Burn Area with stock piles of IV catheters, fluids, clean sheets, silvadine and dressings. The rationale behind this was that if a burn victim needed to be intubated in the code red area, there would be easy access to the burn care facilities just behind the code area. The Orthopaedic area was set up in a semi-separate classroom area with stockpiles of plaster, ace and kerlex as there was no webril cotton padding. The rationale behind this was that there was no narcotic pain medication available and a door could be closed before the fracture was reduced "live" to reduce noise. Laceration beds were set up complete with irrigation, betadine, suture materials to each bed.
End part one
Dan