Forward Triage on the 34th Floor
JR
On the day of the World Trade Center (WTC) incident, several of the early morning radio transmissions from the emergency medical service (EMS) dispatcher were preceded by sounded alert tones, warning the paramedic units about hazardous road conditions.
At 12:21 hours the alert tone again sounded, but this time, the EMS dispatcher transmitted a smoke condition at the WTC. An EMS lieutenant and several paramedic units responded. They were advised to give a status report on the NYH-EMS citywide frequency. The first-arriving paramedic unit transmitted a report that this was more than just a smoke condition. This unit immediately became involved with a cardiac arrest and transported the patient to the hospital. Once the EMS lieutenant arrived, he requested all available resources to respond to the incident. This unusual request and the grave inflection in his voice prompted the EMS dispatcher to increase the response to the incident.
Shortly thereafter, the New York Hospital/Cornell Medical Center EMS was requested to respond to the WTC EMS staging area. Under the guidance of the hospital EMS director, a mobile task force was assembled, consisting of four ambulances, two rapid response units, one mobile emergency response vehicle (MERV)—a mobile triage unit that stabilizes patients for primary care—IS paramedics, one emergency room doctor, and the hospital fire safety engineer, who was designated the safety officer for the task force. To maintain the primary’ hospital EMS response, all off-duty staff members were ordered to report to duty.
The NYH Task Force was deployed onto the FDR Highway southbound. While en route, many ambulances were transporting patients northbound to local hospitals. This tactical highway approach was east of the WTC, which enabled the NYH Task Force to circumvent the WTC under the Battery Park tunnel. Thus, the task force advanced into the staging area without any vehicle congestion.
AT THE SCENE
From the staging area, EMS command assigned the NYH Task Force to WTC Tower 2. The operations chief for Tower 2 directed the task force to set up a forward triage on the 34th floor, where the task force encountered a woman in premature labor being transported down from the upper tower level. The Tower 2 operations chief also directed the MERV unit to relocate in front of Tower 2 (side 1). Many patients from Tower 2 were treated in the MERV unit before being transferred to an appropriate level of prehospital care.
Prior to ascending the stair tower, the paramedics gathered emergency medical equipment, including portable oxygen cylinders, cardiac monitor defibrillators, advanced and basic lifesupport equipment, a portable pulseoximeter (for measuring the oxygen saturation of hemoglobin in a blood sample), and nonmedical but necessary equipment such as floodlights, rope, and flashlights. Each task force member was assigned several pieces of equipment to transport on their backs up to the 34th level, since the tower’s electricity and emergency lighting were not operational.
Smoke filled the stair tower from the lobby level upward. At intermittent levels, emergency personnel provided some light and guidance to WTC occupants who were evacuating. Scores of people were making their way dowm the stairs; their emotion increased as they approached the exit. Emergency crews instructed the evacuees to stay to the right side of the stair tower; rescue personnel used the left side to ascend. The climb to the 34th floor took 40 minutes. On several occasions, task force members had to stop to rest.
On arrival at the 34th floor, the NYH Task Force was directed to a corporate conference room filled with numerous patients. One patient, in her late 20s and in an agitated state, was lying on the floor with her legs flexed. She was alert and oriented and complained of a severe headache. Her companion informed the medical team that the patient was seven months pregnant, had made routine visits to her physician, and had had no prior complications from this pregnancy. Further evaluation revealed that the patient was extremely hypertensive. She was diagnosed with preeclampsia and immediately was placed on a high concentration of oxygen and started on an l.V. She began to exhibit petit mal seizures. The seizure activity did not subside, and the patient began to exhibit central cyanosis and a palpable systolic blood pressure of 240, which prompted the decision to pharmacologically intervene to control the seizures. The unavailability of extrication equipment made it necessary to strategically secure the patient in a stokes basket (under normal conditions, strapping a pregnant patient is not done to avoid possible injury to the mother and unborn child) to protect the patient and baby as the rescuers carried her dow n 34 floors. Just before her departure, her blood pressure was measured at 190/100 and central cyanosis was abolished. The NYH Task Force transferred the patient to another paramedic team, which continued her care throughout the vertical evacuation. The patient subsequently was transferred to a New’ York hospital, where she gave birth by a cesarean section. The mother and her premature infant were reported to be doing wrell.
Other patients located in this area exhibited a wide range of medical conditions including smoke inhalation, asthma, chronic obstructive pulmonary’ disease (COPD), exhaustion, and hysteria. Without delay, the NYH Task Force performed a primary’ survey, triaged patients, and began treatment of the most severely afflicted under the medical direction of the team physician.
Several EMS teams were deployed to the upper levels to evaluate nonambulatory patients. Patients assessed as having possible cervical spine injuries requiring immobilization —but who had no other medical complications and were in no immediate danger— were left with rescue workers to be mobilized when additional resources became available. Patients requiring immediate medical attention were transported to the forward triage station. EMS personnel deployed from the forward triage station to a specific location were monitored by the safety officer to be reassigned. In addition, the safety’ officer organized a group of rescue personnel to go on scavenger hunts throughout the various floor levels to acquire bottled water, cups, first-aid kits, ice, oxygen cylinders, portable-battery radios, and other needed items.
SECOND TRIAGE CENTER
Later into the incident (during the latter part of the aftermxm ). additional EMS personnel arrived at die forward triage area. A second triage area for ambulatory patients who had minor medical conditions, such as exhaustion, was established on the floor. After a brief rest, these people could continue their trek down to the lobby. During these operations, reports of another device exploding on the 65th floor surfaced. They were disproved after a thorough search had been made. This false report may have heightened the anxiety levels of our personnel, but it did not deter them from administering the medical care that was needed.
Using the area along the exterior wall as the triage center enabled us to use the natural daylight as lighting and to preserve our battery power for nightfall. Since portable lighting was limited and there was no indication of when utility power would be restored, the patient population was consolidated and the work area reduced. Ambulatory patients needing no assistance were released after a quick rest and some refreshments. Ambulatory patients needing assistance were released with other evacuees capable of assisting them. Nonambulatorv patients or those with medical conditions that could have been exacerbated by their self-evacuation were packaged and transported by fire/police personnel and accompanied by EMS personnel.
Hours after the initial blast, the lighting on part of the floor was restored. The forward triage function was moved laterally to the lit area. Patients presented at this time had no severe medical complications. They were evaluated, permitted to rest, given refreshments, and sent on their way. The last group, all young children, had walked down from the observation deck on the 110th floor They were in excellent spirits, and the attending physician, a pediatrician, interacted with the children and determined that they were fine.
Approaching the end of the initial incident day, the NYU Task Force waited for the search and rescue crews to secure the floors above the 34th level and then demobilized. They were able to use an elevator to descend to the lobby.
Several hundred people were treated for various ailments during the forward triage operation. The behavior exhibited during this incident was uplifting, as people reached out to help ail in need
