The mettle of the nation's healthcare industry was put to the ultimate test last week after the terrorist attacks in New York and Washington, and the industry proved it was up to the challenge as thousands of victims and their families were cared for by providers around the country.
Hospitals throughout the Northeast mobilized within minutes after devastating terrorist attacks left an untold number of victims at New York's World Trade Center, the Pentagon outside Washington and a field in southwestern Pennsylvania, steeling themselves to test the limits of long-practiced disaster preparedness plans.
But the wounded never came in the numbers first feared, then prayed for by hospital workers.
Kathleen Hill Zichy was at home just 10 blocks from the World Trade Center when she heard the first explosion, a commercial jetliner crashing into the north tower. She immediately ran next door to 149-bed New York University Downtown Hospital, where she is senior vice president for corporate development.
"It sounded like the end of the world," Zichy said. "There was a huge billowing cloud of debris that looked almost like an atomic explosion."
Thousands in the street ran for their lives, streaming into the community hospital for refuge. Emergency generators kicked on when the neighborhood lost power. Under war-like conditions, hospital workers tended to the injured and distributed face masks and water to panicked citizens. The hospital sent 21 medical workers to ground zero, all of whom returned safely.
The first wave of injured brought people suffering from burns, lacerations, broken bones and eye problems related to the smoke and debris. There was pandemonium and a flood of unimaginable images, Zichy said. There was the elderly woman, speaking only French, who was evacuated from her Battery Park residence near the towers, unable to remember her daughter's name. A distraught mother dropped to her knees in the emergency room, praying for the safety of her son. There was the little boy who was separated from his parents when his father ran back to the disaster area in search of his wife, a story with a rare happy ending, as the three were eventually reunited.
Hospital workers from NYU Downtown tended to 368 patients, admitting 24. There were four fatalities, two who were pronounced dead on arrival. A third patient died of massive pelvic fractures and internal bleeding.
"Then all of a sudden there was nothing. Absolutely nothing," Zichy said. "We have since concluded there were no critically ill patients. They were much more likely to be fatalities."
In the eerily quiet days after terror struck, the hospital, still running on generators, concentrated on its community, Zichy said. Workers mobilized volunteers to tend to a housing complex across the street where 5,500 people, most of them frail and elderly, were without water and electricity. Social workers were making home visits.
Saint Vincents' central role
At 978-bed Saint Vincents Hospital and Medical Center, Chief Executive Officer and President David Campbell heard the roar of the first airplane while holding a management meeting in the Greenwich Village hospital, the closest trauma center to the World Trade Center. The emergency room director rushed in seconds later to bring the news.
"The management meeting became the command center," Campbell said. "Phones were set up; walkie-talkies were brought in." They followed the disaster plan, which had been finely tuned after a bomb blew a massive hole in the trade center in 1993. Hospital workers responded to the scene. Saint Vincents lost an ambulance in the collapse of the buildings.
The hospital beefed up its emergency department threefold. Volunteers rushed to help, including a nurse all the way from Baltimore. A triage unit was set up outside, and a press area was cordoned off with yellow tape across the street. People, helplessly searching for ways to help, lined up to donate blood. Volunteers brought food, drink and clothing and set up tables to take cash donations.
The eight-hospital system treated 786 patients by Thursday and admitted 95 at its Staten Island hospital across the water from the twin towers of the trade center. There were five fatalities. But on the second day, the trauma center treated only 25 patients.
On a leafy street of brownstones less than two blocks away, the hospital set up a "family center" for those searching for loved ones. It posted a list of names of people treated at all of New York's hospitals, an effort coordinated by the Greater New York Hospital Association. In the hushed stillness, people walked in an orderly way through a line of barricades into the center where the list was posted.
Almost without thinking about it, the hospital shifted its focus from the physical needs of the victims to the emotional needs of the survivors. Social workers, psychiatrists, psychologists and counselors gravitated to the family center to console the families and friends, many of whom wandered from hospital to hospital.
More than 5,000 people passed through the family center, said Bernadette Kingham, a spokeswoman for Saint Vincents. Almost no one went away with good news.
Waiting for patients who never came
Across town at 1,245-bed Beth Israel Medical Center, it was a similar scene. The emergency room was empty as workers waited for patients who never came. A social worker greeted people outside, most of them searching in vain for loved ones. Upstairs in the hospital's command center in the board's conference room, five hospital workers answered a bank of telephones from people with the same wrenching questions.
"We were very busy for the few hours, but by late afternoon the emergency room started to quiet down," said Gail Donovan, chief operating officer for Beth Israel and St. Luke's-Roosevelt Hospital. "The largest frustration as the night wore on was the incredible sense of despair among the clinical community that they could not do more."
After the first rush, most of the rest of the first two days was devoted to giving out patient information, Donovan said. The hospital received a faxed list of 1,700 employees at a law firm with offices above the 100th floor of one of the towers-none of whom has been heard from since. By Wednesday night, the hospital, which had treated 198 patients and admitted 21, disengaged the disaster plan. Elective surgeries resumed on Thursday.
New York-Presbyterian Hospital lost three of its own: paramedics responding to the attack who were crushed in the collapse of the towers. Seven hospital-owned ambulances and two command cars also were destroyed. Each ambulance was staffed with at least two employees from the 2,346-bed hospital.
"The fact that we lost only three people is nothing short of a miracle," said William Greene, vice president for operations. The survivors had dived under abutments and girders, then dug themselves out, he said.
The 16-hospital system treated more than 500 patients in the wake of the disaster, including 25 of the worst burn victims, at its New York Weill Cornell Medical Center. Triage units continued at the scene throughout the week. The hospital sent "vast quantities" of saline to flush out irritated eyes, Greene said.
Across the Hudson River in New Jersey, state officials put all hospitals on alert immediately with instructions to prepare for as many as 5,000 wounded, said Kerry McKean, a spokeswoman for the New Jersey Hospital Association. On the first day, 1,500 people-mostly "walking wounded"-were ferried to Liberty State Park in Jersey City for triage. About 500 people were treated and released at New Jersey hospitals, primarily for chest pains and respiratory problems associated with the debris.
Strangely back to normal
By day two, in "a curious return to normal operations," state health officials took hospitals off alert and allowed them to resume elective surgeries, McKean said.
By week's end the GNYHA reported that 3,750 patients had been seen at New York and New Jersey hospitals.
The situation was much the same in Washington-area hospitals. In the wake of the plane crash at the Pentagon, the hospitals implemented external disaster plans, cleared emergency rooms and rescheduled elective procedures. In total, hospitals treated about 95 patients, fewer than they had prepared for.
On Tuesday in Johnstown, Pa., 20 miles from the crash site of United Airlines Flight 93, which carried 45 passengers and crew members, 450-bed Conemaugh Memorial Medical Center shifted immediately into a high-alert mode, said John Moryken, an executive with parent Conemaugh Health System. Conemaugh, the nearest trauma center to the crash site, prepared for an onslaught of severely traumatized patients, Moryken said, while another Conemaugh hospital, the nearby 67-bed Windber (Pa.) Medical Center, also called in more staff members.
Almost as quickly, just 35 minutes after the first report of the crash, the order came to stand down. Rescuers "determined early on that there was little likelihood of any survivors," Moryken said. A staff celebration had been scheduled for noon the day of the crash to mark the climb of patient satisfaction scores above 90%, Moryken said.
The celebration was canceled, replaced by a prayer service with nearly 1,000 employees lining the landings overlooking the hospital's atrium, he said. The 30-minute service ended with the singing of "God Bless America."
-With Vince Galloro and Ed Lovern