What could easily have been utter chaos in the hours immediately following the September 11 terrorist attacks on New York City and Washington, DC in fact was nothing less than the finest hours of medical service by health care professionals, firemen, police officers, and paramedics. The cooperation between the private sector and government agencies provides dramatic evidence our health care system is not nearly as bad as its detractors claim.
Disaster Teams at the Ready
In less than an hour, the Department of Health and Human Services (HHS) activated disaster teams in an unprecedented effort to respond to the thousands of injuries and fatalities resulting from the terrorists’ attacks on the World Trade Center (WTC) and Pentagon.
For the first time ever, HHS Secretary Tommy Thompson activated all 80 of the nation’s special disaster teams, established precisely to respond to national disasters, plane crashes, and bombings. Some 7,000 private sector health personnel serve on those teams, and they were prepared to go to the WTC or the Pentagon if called upon.
Thompson also advised burn unit teams, surgery units, forensic doctors, and dentists to “be ready” to go to the disaster sites. By Wednesday afternoon, four teams of doctors and paramedics were en route to Stewart National Guard Base in Newburgh, New York, north of New York City, and three teams went to the Anacostia Receiving Center in Washington, DC.
Each team consists of 35 physicians, nurses, and emergency medical technicians, plus enough equipment and supplies to make the team self-sufficient for 72 hours. The primary responsibility of each team is to perform triage and treat trauma victims at the disaster site.
Besides the medical teams, mortuary teams consisting of morticians, anthropologists, and forensic investigators–four to New York, three to Washington—were dispatched to identify victims and prepare them for burial.
By late Wednesday, the Military Sealift Command had dispatched the USNS Comfort to New York. A hospital ship carrying 935 medical and support personnel, the Comfort can treat at least 500 people.
HHS officials also worked with the Federal Emergency Management Agency (FEMA), as well as health officials in New York and Virginia, to “assess medical needs and provide medical and emergency personnel, ” according to a HHS news release issued September 11.
The Department of Veterans Affairs made available many emergency beds in its hospitals near the World Trade Center and Pentagon. Thompson also authorized the first-ever emergency use of the two-year-old National Pharmaceutical Stockpile, which delivered substantial medical supplies to the disaster sites.
The Centers for Disease Control (CDC) released one of its eight pre-packaged “12-Hour Push Packages,” which contain medicines, intravenous supplies, airway supplies, emergency medications, bandages, and dressings. Each “package” comprises “several truckloads of materials.”
In addition, the CDC provided 84,000 bags of intravenous fluid and other intravenous supplies, 350 portable ventilators, and 250 stationary ventilators. The Falls Church, Virginia-based American Red Cross Disaster Operations Center went on national alert and dispatched hundreds of disaster specialists to the scenes.
During a news conference the day after the attack, Thompson said in a White House press release, “It is now our mission to begin healing from this tragedy. From the moment we learned of these attacks, the Department of Health and Human Services began readying teams and resources to be sent to New York City and the Washington area to meet any needs of state and local officials. In short, we’re making the full force of the Department of Health and Human Services, both as resources and medical expertise, available to the areas that need our assistance.”
New York doctors and hospitals treated thousands of burned, broken, and crushed patients after the attack. Medical officials established temporary emergency rooms and triage centers and asked volunteers to help treat patients.
At hospitals in lower Manhattan, hundreds of doctors and nurses treated the wounded at the front lines of this new kind of war. Emergency rooms at several Manhattan hospitals filled with patients and medical staff, while hospitals in surrounding areas remained on standby.
New York University Downtown and St. Vincent’s hospitals received most of the patients. Dozens of wounded people arrived sporadically after the attack. By late afternoon, 300 patients had arrived at St. Vincent’s. Doctors treated patients for burns, broken bones, concussions, smoke inhalation, and eye injuries.
At Bellevue Hospital, doctors had treated about 125 patients by late afternoon, including between 30 and 40 with serious injuries. NYU Downtown had treated about 300 patients. In addition, emergency staff sent about 1,500 patients by boat across the Hudson River to tents and ambulances on the New Jersey shore.
National Public Radio (NPR) reported that an outdoor triage center was established just north of the World Trade Center, where doctors, nurses, police officers, and firefighters all helped with relief. Even film companies pitched in, providing lighting after the sun went down.
New York City Mayor Rudy Giuliani said by mid-afternoon that about 2,100 had suffered injuries in the World Trade Center attack, with about 600 taken to local hospitals. NPR reported approximately 1,100 patients were treated at city hospitals during the night. Giuliani also said some of the “walking wounded” returned to their communities in New Jersey and Long Island to receive treatment. In a CNN newscast on location, a visibly shaken Giuliani said, “The number of casualties will be more than any of us can bear ultimately.”
According to various news reports, hospital officials said they had received only those patients injured outside the World Trade Center. They fully expected the number of patients to rise “dramatically” after rescue teams began “digging into the rubble.”
At the Pentagon, patients poured into hospitals, while emergency teams treated patients outside the military facility, where officials may still find dozens of casualties in the wreckage.
Blood Supply “Adequate”
As thousands of Americans donated blood nationwide, both the American Red Cross and America’s Blood Centers said blood supplies were “adequate to meet the immediate demand” in the wake of the attacks.
Red Cross spokesperson Chris Thomas was quoted in USA Today as saying, “We’re mobilizing to be open 24 hours a day, and we’re shipping blood to New York and Washington.” He continued, “We have 80,000 units in inventory and we will commit to meet any need anywhere.”
Red Cross Vice President Dr. Jerry Squires added, “We’re working with the military in New York and New Jersey so we can get the blood in the appropriate hospitals.” Dr. Robert Jones, CEO and president of the New York Blood Center, said the demand for blood in New York was “less than originally feared.” Noting blood donation lines stretched along city blocks, he said, “We have had a remarkable response to donate blood. We have pretty much maxed out the ability of the city to collect blood right now.”
Around the nation, long lines developed at blood donor stations. Some lines were so long people were asked to return the next day. Nationwide, it was the biggest outpouring of blood donors since the Persian Gulf War in 1991. Over 3,200 pints of blood were shipped from donation centers across the country to New York City and Washington, DC. Red Cross President Bernadine Healy told reporters, “We have an obligation . . . to continue to maintain our blood supply and keep inventories up.”
USA Today reported the Red Cross has decided to donate up to 30,000 units to hospitals treating victims of the attack. Healy added the blood drives help people “console” each other. “This is wounded America. This is the spirit of giving. We don’t want to turn that off.”
The New York Times reported many donors are “acting out of compassion” as well as satisfying their felt need to do something. Steve Benson, a carpenter from Flagler, Colorado, said, “Giving blood is the only thing I can do at the moment because there are people in need in my country.”
Insurers Remove Restrictions
Several health plans with consumers in the New York and Washington, DC regions have suspended their restrictions on care following the September 11 attacks. Injured members of Cigna Insurance, for example, do not need to obtain prior authorization for hospital care in the two cities. Aetna Inc. and Oxford Health Plans have also said consumers injured in the attacks should not worry about authorizations or referrals. “This is an emergency situation, and we expect our members to go directly to seek emergency medical care, and we expect them not to worry about referrals,” Aetna spokesperson Dave Carter told the Houston Chronicle. Aetna added staff and extended hours in four of its service centers in order to process benefit payments more quickly.
Empire BlueCross BlueShield, headquartered in the World Trade Center, established temporary command centers at its New York offices in Albany, Staten Island, and Melville, according to Geoff Taylor, a spokesperson for the New York State Conference of Blue Cross and Blue Shield Plans. There were 1,800 employees in the twin towers at the time of the attack.
Bloomberg reports the loss of Empire’s office will “affect the company’s processing of Medicare claims and the operation of its health plan for Medicare beneficiaries.” However, a hotline operator at the Centers for Medicare and Medicaid Services said, “Empire processed about 55,000 claims [Tuesday] night, and we expect them to proceed under normal working conditions.”
The United Network for Organ Sharing has delivered 24 organs since receiving air clearance on September 11, with deliveries coordinated by regional organ procurement organizations. Anne Paschke, a spokesperson for UNOS, said the four-to-six hour lifespan of hearts and lungs intended for transplant makes “[q]uick delivery . . . especially crucial.” For organs such as kidneys and pancreases, viable recipients are determined based more on “tissue-matching than need,” and therefore those organs must usually travel longer distances.
The FAA cleared planes to fly for emergency medical purposes after blood centers were left seeking ways to ship vials of donor blood to testing sites. Accurate testing for HIV, hepatitis B, and other infectious diseases demands that the blood be tested within 72 hours of its being drawn.
Pharmaceutical Companies Take to the Road
Meanwhile, the country’s pharmaceutical industry had not received FAA clearance, prompting firms to respond to the demand for drugs and supplies solely by ground transportation. Companies were trucking drugs ordinarily flown to distributors and hospitals to ensure products arrived where they were needed.
Mark Grayson, spokesperson for PhRMA, said, “There is an average 90-day supply of each drug in the U.S. and plans made in preparation for possible disruptions with the Year 2000 changeover are helping companies allocate those products.” According to a report from Bloomberg News, representatives from Pfizer, the world’s largest drug maker, said “the grounding of air traffic isn’t expected to lead to shortages.”
As the health care system met the incredible demand, the chaos of terrorism was replaced quickly with order and heroism.