October 2001 Bulletin

Sept. 11, 2001—not just another Tuesday

New York medical community meets challenge of World Trade Center devastation

It’s early morning, Tuesday, Sept. 11, 2001. New York City is getting ready for a workday that promises blue skies and temperatures in the upper 70s.

Early morning TV commentators report Washington is considering tax breaks to boost the sagging economy. Traders at the New York Stock Exchange wonder if more gloomy earnings forecasts are headed for the market. Commuters read about a teacher arrested in Mt. Vernon, N.Y. for hijacking a plane 30 years ago; more Mideast violence; and reviews of the 2002 spring fashions. The Yankees are in first place; the Mets in third.

It’s primary election day, otherwise there’s nothing special about this particular Tuesday.

Howard Beaton, MD, chief of surgery and emergency services at New York University Downtown Hospital, is at the 200-bed hospital in lower Manhattan. Somewhere in his office is the hospital disaster plan that staff tested only six weeks earlier.

Hospital officials have been very conscientious of being prepared since a wake-up call in 1993—the bombing of the World Trade Center only five short blocks away.

The disaster drill proves to be most fortunate. So is the fact that shortly before 9 a.m., the hospital is fully staffed.

At 8:48 a.m. a hijacked jetliner rams into the north tower of the World Trade Center. Fifteen minutes later, another hijacked jetliner plows into the south tower.

The hospital and the entire New York medical community is alerted. At NYU Downtown Hospital, one surgery is in progress; all other surgeries are cancelled. At the Hospital for Joint Diseases, all elective surgeries are cancelled. Joseph Zuckerman, MD, chairman of the department of orthopaedic surgery, has 14 operating rooms ready for the casualties.

Elsewhere, New York Presbyterian Hospital gets ready to handle the trauma cases and the orthopaedic cases will go to the adjacent Hospital for Special Surgery, where Thomas Sculco, MD, chairman of the orthopaedic department, has 18 operating rooms ready for surgery.

The injured begin to arrive at NYU Downtown Hospital; St. Vincent’s hospital, two miles away; and Bellevue Hospital Center, a level I trauma center.

At NYU Downtown hospital, physicians and staff stabilize many patients and send them on to affiliate hospitals. Orthopaedic cases are sent to the Hospital for Joint Disease, others go to Mt. Sinai and elsewhere.

Once in the disaster mode, Dr. Zuckerman says the plan is to send as many patients as possible, conditions allowing, to hospitals in New Jersey and Staten Island. About 1,500 injured people were ferried across New York harbor for treatment in New Jersey.

Physicians at the Hospital for Joint Diseases treat injuries ranging from minor contusions to open elbow fractures and significant lower limb injuries. They perform 14 surgeries the first day or so, says Dr. Zuckerman.

NYU Downtown Hospital treats 444 emergency patients. Twenty-four patients are admitted, two are dead on arrival and two die after reaching the hospital, says Dr. Beaton.

When the 110-story towers collapse, Dr. Beaton and staff brace for another wave of injured. They are warned to expect 500 more cases.

The hospital has no electricity. The telephones don’t work. Cell phones are dead.

Hundreds of doctors and nurses working in different facilities are all part of one big M.A.S.H. unit. Several out-of-town trauma physicians leave a convention in Midtown to help at a triage center set up on a TV studio lot and at NYU Downtown hospital. Doctors from other hospitals also volunteer.

The hospital gets electricity generators and emergency CAT scan. NYU medical students from first through fourth year serve as runners and draw blood from donors. NYU School of Medicine sends truckloads of supplies and equipment to NYU Downtown, the Hospital for Joint Surgery, St. Vincent’s Hospital and other staging areas.

But by Tuesday evening there are empty beds in the NYU Downtown hospital. Few of the operating rooms are in use at the Hospital for Joint Diseases. Everyone waits for more casualties, but there are few. Nor is there a wave of injured on Wednesday.

Many people have made it out of the towers and ran or walked through thick clouds of smoke, dust and debris, some stopping at hospitals along the way for treatment of fractures, abrasions and eye irritations. As of Sept. 14, about 4,000 people were treated in New York and New Jersey hospitals.

In a disaster, there are three categories—the dead, the trauma casualties and those with lesser fractures, says Dr. Sculco. In this disaster, there were few in the middle group. "Unfortuntely, they didn’t survive," says Dr. Sculco. A week after the disaster, more than 6,300 people are missing and 240 are dead.

The bright spots are few and far between in this week of tragedy. A young woman with significant lower limb and soft tissue injuries is brought to NYU Downtown Hospital. An initial decision is to amputate the woman’s legs, but orthopaedic surgeon Nelson Botwinck, MD, has another solution. He operates and saves the woman’s legs, so, as Dr. Beaton explains, she can dance at her wedding next year.

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