Hospital Teamwork Amidst Crisis

On September 11, 2001, no one near the WTC 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," reports Dr. David Goldschmitt, medical director of emergency at NYU Downtown Hospital. "The whole hospital worked together as an incredible team."

NYU Downtown received 100 times its normal flow of patients. Goldschmitt recalls: "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 timeframe."

The hospital had 36 critical patients.

"We were able to save all but three," Goldschmitt says. "We're not a trauma center or a major teaching hospital. There was no reason for us to gear up for a major disaster. Here we were, a small community hospital in the middle of disaster with no power, no steam, and communication problems, and we still managed to save lives."

Josie Joliver, assistant nurse-in-care coordinator for NYU Downtown, started work that morning at 8 a.m., replacing the night shift. Little did she know she would serve as a triage nurse in a mere few hours. After staff heard the first explosion and confirmed the crisis, they activated their disaster plan. To communicate internally, they used the intercom system. The operator informed all hospital areas via pager that a major disaster had occurred.

NYU Downtown implemented the incident command system (ICS). The city of New York recommended ICS to all hospitals a year and a half ago, but it didn't make the system mandatory. Following the 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 confides. "We were a little ahead of everyone else in the planning we were doing for the disaster."

In January 2001, NYU Downtown instituted a new incident command system; by September, the hospital had only been able to train about half of the staff because training everyone was so time-consuming. Fortunately, that was enough to prepare for 9/11, Goldschmitt attests.

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 ones that have had to deal with this many disasters at one time," Goldschmitt says.

"You cannot say we were overwhelmed on 9/11, because we were ready to help," Joliver says. About 10 patients waiting for beds were evacuated to prepare the ED for victims. The team had to open up other hospital areas (e.g., the cafeteria) as patients came in.

Did ongoing staff relationships benefit the situation? "We've had working relationships with all of the departments; we've practiced a lot and that was very important," says Goldschmitt. "Working with the city agencies was more of a problem because all communication was lost and the city lost its command center."

Hospital staff communicated mainly via two-way radios. When staffers went down to man the triage centers at Ground Zero at One Liberty Plaza, they ran back and forth across the three blocks to relay messages--it was easier than trying to figure out how to get enough walkie-talkies.

"We had enough walkie-talkies for the hospital," Goldschmitt explains. "Unfortunately, we couldn't find enough walkie-talkies to man both the hospital and Ground Zero. Our bigger problem was communicating with the rest of the city. We had received reports that our hospital had been closed and evacuated. We had no power, so we knew it was going to get dark--patients still needed to be triaged out in the ambulance base so we needed overhead lights for outside."