EMS: NYTF-1 Response, by Carl Tramontana,

September 1, 2002, FireEngineering, EMS: NYTF-1 Response, by Carl Tramontana,

I responded to the World Trade Center (WTC) as a medical specialist with New York Task Force 1 (NYTF-1) and spent two months at the site as deputy chief of EMS operations.

On arrival at the site, I reported to an EMS command post on Chambers street. USAR medics from FDNY/EMS Operations and FDNY and New York Police Department specialty unit members were waiting there for the equipment.

We set up our base of operations (BOO) in a fenced-in school lot midway on Chambers Street, near West Street, a site we deemed to be safely away from potential problems. At the time, 7 WTC was well involved in fire and nearing collapse. We used an FDNY pumper that happened to be tied to a hydrant to wash away some of the almost two inches of cement, drywall, and other debris from the site.

Slowly, other NYTF-1 team members found their way to the BOO, where they could organize, stage equipment, establish communications, and set up rehab.

RESCUE OFFERS HOPE

On 9-11, a civilian was reaching the 13th floor of the North Tower when the tower collapsed. She had been working on the 64th floor and was on her way down with many of her colleagues. She was trapped under a beam that had pinned her head and legs but did not crush them. She was found near the top of this pile after a crane removed a steel beam above her. She was unconscious and did not respond initially to noxious stimuli. She was removed just as we arrived and lowered to our location, about 30 feet below where she was found.

We could not assess her. We were perched on a beam and had nowhere to put the stokes stretcher down. As the chain of rescuers quickly developed, we passed her to a location about 500 feet away, where two other USAR medics stood by in case any more patients were removed from this location. When she was finally passed to their location, they were able to more completely assess her condition (she was now on solid ground) and determined that she was alive. Although we were all scared and exhausted, there clearly was excitement in their voices as they relayed this information over the radio. I was so exhausted I could barely sit up when we arrived back at the BOO.

The team operated for almost three months. Eventually, the needs of the individual agencies (NYTF-1 is made up of members from the New York Police Department; Emergency Services; Canine; and Fire Department of New York Special Operations personnel from rescue companies, squads, and haz mat; and paramedics and doctors from EMS Operations) overwhelmed the team members' desire to stay together and continue operations.

SEPTEMBER 12

On September 12, my squad searched the area where the North Tower had stood. There were reports that some survivors might be there. So many agencies, invited and uninvited, were on the scene; it became critical to identify and use resources.

When we approached the North Tower area, we found FDNY personnel with handlines attempting to cool the area and reduce the fire load from underneath. Fire was coming from crushed and burning FDNY engines and other vehicles all around the site. We were walking on steel beams piled about 20 feet high. Each change of footing was precarious because of the equipment we were carrying and the voids we had to cross over. We were using special equipment carrying vests instead of our backpacks because the terrain was difficult and the now more obvious fact that there would be no live patients.

The rubble pile consisted of steel beams that were extremely hot because of the constant fire below. All of the concrete and glass from the towers was gone, vaporized to dust. This dust was all around. Without respiratory protection, you could not breath the air long before your nose, throat, and lungs became clogged with it. Everyone around was coughing to some degree. The heat partially melted the sides of my boots. The air was full of thick acrid smoke that was coming up from the material burning underneath.

LESSONS LEARNED AND REINFORCED

• Trust your training and personnel. FEMA team members know how to operate at a disaster. When their equipment was brought to them, they responded as if they had been deployed and worked together to set up operations and prepare for organized search and rescue. Training for these types of missions is such that regardless of the mission, environment, or incident's parameters, the team's structure, equipment, and organization will allow it to operate anywhere.

As difficult as this mission was—now knowing how many dead and missing members we had—I believe that all of the other NYTF-1 members who died would have done the same things and would have insisted that this team operate as it did.

The NYTF-1 cache provided medical and rescue equipment, communications (task forces carry their own radio and satellite cell capability), rehab areas (Western Shelter Tents), and other equipment that usually is needed at disasters.

• Know about the federal government's Federal Response Plan and the Emergency Support Functions (ESF). Remember that the goal of the FEMA USAR program is to assist local agencies with their incident, not to take over their operation. Call for assistance as soon as you recognize that your resources will be overwhelmed and depleted.

A total of 20 out of FEMA's 28 teams were deployed to New York over five weeks.

Although FDNY EMS is a very large system, it never would have been able to provide the resources for this extended event. It used ATVs and some ambulances staffed with EMTs, paramedics, and all of its officers for transport. Mutual aid provided the rest of the transport services. More than 5,000 injuries were treated during the extended operation. Many of these patients were treated for conditions related to respiratory and eye ailments, brought about or exacerbated by the smoke and dust that plagued the site for months. Among the totals in the respiratory category were coughs, 252; sore throats, 125; congestion, 89; difficulty breathing, 81; cold, 47; sinus-related, 47; asthma, 21; nasal congestion, 17; allergic reaction, 14; and nasal irritation, 7. Eye complaints included eye irritation, 180; eye injury, 36; eye (unspecified), 37; eye/foreign body, 23; eye pain, 16; conjunctivitis, 5; eye abrasion, 3; eye scratch, 2; eye sty, 2; eye growth, 1; eye lid infection, 1; and eye strain, 1.

In addition to the WTC response, FDNY/EMS responded to 3,208 emergency calls on 9-11. After recognizing the extent of the operation and setting up a very dynamic EMS operation on-site, it became clear that more resources would be needed. The Federal Emergency Response Functions (ESF), under ESF #8, can provide Disaster Medical Assistance Teams (DMATs) to assist local agencies in managing patient care when their resources are overwhelmed.

The DMATs allowed us to focus on getting our system back up and running while they handled the patient load. They came prepared with medical and logistical equipment for a 10-day deployment. Twenty teams rotated throughout the WTC disaster. They were efficient and assisted with many tasks. We requested a change in the tracking mechanism they normally used. They faxed hourly reports to the unified command post indicating the number of injured treated by each team, the types of injuries, the names of the injured and their organizational affiliations, and the final disposition. These logistics were logged in a computer.

Initially, five DMAT teams operated on-site. Each was in a different geographic location. As the operation continued and the number of injured decreased, the number of DMAT teams was reduced.

Finally, a private company was brought in to manage the final phases of the operation.

FDNY EMS had an officer and an EMT/paramedic presence until the final phase of recovery operations.

• Control your incident site. When the NYTF-1 arrived at the site of the Oklahoma City Bombing on April 20, 1995, at 1800 hours, the site was secured. Military personnel were at checkpoints, and a fence enclosed the site. It took longer to gain control of the WTC site for many reasons. Starting on 9-13, I spent many hours chasing well-meaning doctors, nurses, and other "rescuers" who came from all over the country off the site. It was obvious that we needed a way to track all the potential patients found and the injuries to rescue personnel. I saw doctors start IVs on dehydrated firefighters and then remove the IV lines so that the firefighters could go back to work on the rubble pile. They all wanted to put forth a full effort to find their brothers and other victims, but they were putting their health at great risk.

As the WTC site became more secured, it became easier to track injuries. At the conclusion of the incident, someone is going to ask for an accounting of vehicles, equipment, patients, and personnel resources used at the scene. This information is needed for budget preparation and also as a record for organizations so they can account for resources and how they were used. As an example, no one is willing, as yet, to discuss what the long-term health effects of exposure to the many hazardous materials at the WTC incident might be. All the people who came to help might have just reduced their respective life expectancy; there would be no easy way to track them if you didn't know they were there.

CARL TRAMONTANA, EMT/P, is a deputy chief with Fire Department of New York EMS Operations, where he has served for more than 24 years. He is the medical specialist (paramedic) for FEMA's NYTF-1. He is an adjunct instructor for the National Fire Academy and at George Washington University, teaching hazardous materials and weapons of mass destruction.