EMS Untold

I was getting a foot up on the day’s operation as usual. I got a rundown on my way into work from our emergency medical dispatch, which dispatches the ambulance. They briefed me on how the evening went. In addition, I got a briefing from the resource coordination center [RCC] on the previous night’s activities, a tour count and the type of chief coverage that I was going to have that day. The third briefing I got was from my overnight chief. I got to the office early, as usual. It was a beautiful morning.
–Jerry Z. Gombo, assistant chief of EMS operations, FDNY EMS

We were getting our breakfast at 8:45. We were at the counter; we usually order BLTs. They were making it, and we heard a rumble. The building we were in–the Woolworth Building–shook. Debbie, the girl [who works at the deli] looks at Pu and me, “Shouldn’t you guys go outside and check what’s going on?” I told her, “If they need us they’ll call us.”
–Orlando Martinez, EMT, FDNY EMS

Me and Bonnie, [my partner], went to our bagel place. We’re like, “We’re just gonna have an easy day. We’re not gonna buff any jobs. Let’s just go do what we’re supposed to do, and that’s it.” We’re sitting by this little old man’s house who always yells at us when we run our engine. Another BLS unit comes over, 52 Edward. We’re talking with them, and I’m like, “Turn off the engine.” Sure enough, the little old man comes out “¦ screaming at us.
–Jennifer Beckham, EMT, Flushing Hospital Medical Center

We were at an intersection by the Brooklyn Bridge. Me and my partner, Eric, were talking small talk. And I noticed–the World Trade Center was right in our view–a plane going down. It was flying low, and I interrupted him, “Eric, look at that! Look how low that plane is! It’s gonna hit. It’s gonna hit!” A few seconds later, it exploded. We just shook. Quickly I took my radio, and I thought, “I have one shot to get it right,” because the radios are terrible down here. You always have to repeat yourself, or they put us out with no response and stuff. I said,
“01 Charlie for the priority.”
“01 Charlie, go.”
“01 Charlie.
We have just witnessed a plane hit the World Trade Center.”
–Alexander Loutsky, EMT, FDNY EMS

Within an hour of the Trade Center attacks, 23 EMS supervisors had been dispatched, along with 29 ALS units and 58 BLS units. Eight hours later, 31 EMS supervisors had been dispatched and were working with approximately 400 on scene EMS personnel, including 47 ALS units (28 from voluntary hospitals) and 98 BLS units (23 from voluntary hospitals).

Few know that the entirety of EMS response in lower Manhattan began with one EMT’s call to dispatch at 0848 hrs on Sept. 11. It’s one of myriad stories we’ve not yet heard about the role of EMS in our nation’s greatest hour of need.

The day those twin beauties fell to the earth, editors at JEMS and FireRescue received more phone calls and e-mails than our office has experienced in years. Particularly stressful were conflicting reports as to the fate of our personal and professional friends in New York City. Several of us could be no other place than here–on the phone, watching TV, listening to the radio, corresponding online.

It wasn’t long before folks began asking us about the role EMS played in New York that fateful day. Truth be told, we didn’t know the EMS story for a long, long time. Like many of you, we found ourselves incapacitated with grief for the lost souls–from FDNY firefighters to NYPD and Port Authority police to courageous civilian and undocumented “other” responding personnel–all of them innocents.

Yet sometime about the 20th reference to “heroic emergency workers,” our mission became clear. We were frustrated as generic credit was given to “emergency workers” by our well-intentioned media peers who don’t understand the valuable role of EMS (paramedics, EMTs) in the emergency services triad. Witness this mention in the Sept. 24, 2001, issue of New York: “”˜They’re looking for their brothers,’ says an ambulance driver” [emphasis added].

Although the EMS losses pale quantitatively in comparison to our fellow firefighters and police, they have shattered the national EMS community in an undeniably qualitative manner. So during a staggeringly beautiful week last November, we flew east. Like you, we wanted to know where EMS personnel were at 0846 hrs when the first plane hit. What was the EMS preplan for a disaster of this magnitude? How many patients did they treat that day? How did they survive the crashes, the collapses and the emotional and physical tolls the event required of them? What were those first 12 to 24 hours like? Time and again, EMS providers from FDNY, hospitals and private services alike expressed a collective sentiment best articulated by FDNY EMT Eric Ramos in a note to us, “Thank you for coming to hear us. We were forgotten, and you have come to recognize New York’s best.”

We’ll tell you right now: We didn’t talk to everyone. We didn’t get every story and every detail. No one got every story or every detail. Likely, no one ever will. Therefore, we apologize now to those we inadvertently offend by unintentional omission. We submit this story as the beginning of an EMS archive of Sept. 11.

In the next 60 pages, we provide the matte and frame for the stunning landscape that was EMS response on Sept. 11. Then we let the EMS responders paint the image for you themselves, in largely unedited transcriptions from the deeply moving and honest interviews they provided.

You’ll meet an EMT who went from applying hair gel on the drive to the Trade Center to struggling painfully with her own mortality in the aftermath. You’ll meet a paramedic mother of two who–after transporting patients to Beth Israel Hospital following the collapse of 2 World Trade–ripped an IV from her arm to return to Ground Zero on the back of a motorcycle. You’ll meet a paramedic who saw one of his best friends–also a medic–for the last time just moments before the South Tower collapsed.

Prepare yourself.

What you’re about to read is tragic and, at times, humorous. It encompasses the entire spectrum of human suffering and is painfully graphic. The entirety of the story we heard must be told, without omission, in order to understand what EMS personnel experienced in those first few hours. To edit those portions would be to delete history.

FDNY paramedic Phil Ashby (left) assists a patient on the east side of the Trade Center complex. Photo Jennifer S. Altman

 

The First Crash
After Loutsky delivered his priority call following the crash of American Airlines Flight 11 into the north wall of 1 World Trade at approximately 0848 hrs, a Signal 10-40 (aircraft crash) was transmitted over FDNY EMS’ Citywide frequency.

FDNY EMS personnel most proximate to the Trade Center at that moment included EMTs Loutsky and Ramos, the 01 Charlie crew. According to the Trade Center preplan, incoming EMS units were to stage at Greenwich and Vesey, just north of 1 World Trade.

01 Charlie quickly fled its post near the Brooklyn Bridge to join its fire and police counterparts, many of whom were already climbing the stairways of 1 World Trade to help evacuate occupants and access the involved floors. On the way to the preplan location, 01 Charlie was forced to stop at Church and Fulton to treat patients. “When we got there thousands of people were coming out of the building after the first plane hit,” says Loutsky. “They had terror and fear in their faces. They were running. They were screaming. We were inundated.”

Unbeknownst to Loutsky and Ramos, fellow FDNY EMS 01 Adam crew–EMTs Orlando Martinez and Frank Puma–was just up the street at the Woolworth Building–near their usual post on Vesey between West Broadway and Church (in front of 5 World Trade). After hearing and then visualizing the first crash, they proceeded west down Vesey toward the preplan location. Like the 01 Charlie crew, Martinez and Puma were inundated with patients escaping east from the Trade Center Complex. They stopped their vehicle and began treating them just yards from Loutsky and Ramos.

“When we first got to Church and Vesey, I called the station and talked to Lt. [Bill] Melaragno,” recalls Martinez. “I said, “˜Listen, we need backup. There’s nobody here. When’s the help coming?’ But they were already here. This building’s so large. “¦ I didn’t realize they were down the block.”

1 Adam’s crew received initial backup from St. Vincent’s Manhattan and NYU Downtown Hospital EMS units dispatched as part of the 9-1-1 system. Shortly thereafter, crews from New York Presbyterian Hospital, MetroCare and a host of other services formally requested by the 9-1-1 system responded accordingly. (For a list of all EMS resources that responded as part of the 9-1-1 system, see sidebar, p. 22.)

In that location–a slab of pavement running along Church Street from Liberty to Vesey–sprung a bona fide EMS staging area. There, EMS personnel aggressively triaged and treated the initial waves of critical and walking-wounded patients, who presented with such injuries as first- to fourth-degree burns, fractures, internal bleeding and inhalation burns. It’s important to note that the time spanning 0848 hrs to 0959 hrs (from the first crash until the South Tower collapse) was the busiest period of the event for EMS crews on all sides of the Trade Center. It was during this brief window of time that providers helped the most patients–even if it was just directing them away from the madness above.

As patient triage and treatment developed on the east side of the Trade Center, a separate EMS staging area was born nearer the Hudson at West and Vesey streets in and around the pedestrian North Bridge. After hearing Loutsky’s initial transmission over the radio, first-due FDNY EMS officer Lt. Rene Davila was skeptical. “My reaction was, “˜These guys are bananas. I gotta go over there and straighten them out,'” he recalls. “I thought they had lost it–until I heard [Martinez and Puma’s] call seconds later. Then the radio started charging up with voices.”

Davila immediately left his post at Battalion 4 and headed north, confirming the incident over Citywide. He also requested all available resources, including FDNY EMS’ Mobile Emergency Response Vehicles (MERVs). Nearing the Trade Center, he tried to stage at Greenwich and Vesey per the EMS preplan. However, like the 01 Charlie and 1 Adam crews, he was forced down to West Street. Davila parked in the northbound traffic lane just across from 1 World Trade and, as the highest ranking EMS official on scene at the time, established EMS operations.

In those early moments, Davila struggled to focus personnel on triage. “I wanted to start the START system to triage patients,” he recalls. “I didn’t have the capability to treat any patients. People were coming out with first- to fourth-degree burns after the explosion–unbelievable what I saw coming out of this disturbance.

All I wanted, once I got 10 to 15 units on the scene, was to triage because I knew the magnitude of people that [was] going to be coming out of this.”

The influx of FDNY and voluntary (hospital, private and other EMS services that respond as part of the 9-1-1 system) units on scene made it difficult for Davila to establish an incident command system (ICS). As personnel scrambled out of their rigs to treat nearby evacuees, Davila and Loutsky, the staging officer at West and Vesey at that time, attempted to control the unfolding chaos. “My concern was triaging patients, but my first concern was everybody’s safety,” recalls Davila. “Numerous times I was yelling that it was a hard-hat operation. I’m standing here watching the rescue units run inside Tower 1. I’m transmitting, and I’m praying to God that I get some more bosses to the scene.”

From 0848 hrs until 0903 hrs, first-in EMS units on the east and west sides of the complex had to negotiate a staggering amount of debris in order to do their jobs. American Flight 11–a Boeing 767 on its way from Boston to Los Angeles–carried more than 20,000 gallons of jet fuel. Upon impact, the plane exploded, sending debris (from the plane and the structure) toward the south, east and west areas of the Trade Center Complex. “Those [I-] beams were the size of Buicks,” remembers FDNY EMT Jonathan Moritz. “You had debris that looked like windowsills, glass and concrete. The magnitude of the debris that came down was unreal.”

As minutes ticked by, incoming units were generally told to stage at West and Vesey where Davila had established EMS operations. Due to unstable conditions many detoured to such locations as Church and Fulton (again, on the east) or West and Liberty (to the south) near the pedestrian South Bridge.

A fire department vessel loaded with evacuees departs N.Y. Harbor. Photo Ronald Jeffers

 

The EMS Command Post
Unbeknownst to Davila, FDNY EMS Assistant Chief of Operations Jerry Gombo (the No. 2 in EMS command) was on his way, having detoured at Church and Fulton to clear EMS units treating patients in the middle of the exposed street.

Once at West and Vesey, Gombo checked in with Davila and proceeded to FDNY’s fire Command Post–then located in the lobby of 1 World Trade. There Gombo conferred with Chief Peter Hayden, the fire incident commander, and formally established the EMS Command Post. “We set up our Command Post in close proximity to [the fire department’s]–within arm’s reach,” says Gombo. “This way, if they’re in need of anything, they know exactly where we are.”

Minutes later, Hayden alerted Gombo that they were to relocate the Command Post from the lobby of 1 World Trade to a driveway area at 2 World Financial Center. The new Command Post lay just west of the Trade Center Complex and south of where Davila had set up EMS staging. Gombo followed suit, re-establishing EMS command there as well.

As he evacuated 1 World Trade, Gombo ordered all EMS personnel out of the building. “When I left the initial Command Post, I gave clear direction that EMS personnel were not to be in the building,” says Gombo. “As far as our protocol with high-rise complexes, EMS personnel are not outfitted with SCBAs and bunker gear. If there were any patients, they would have been brought out to us–either by firefighters or other civilians.”

At the new joint Command Post, Gombo issued the following directions to his FDNY EMS officers:
1. Division Chief Walter Kowalczyk–assume the role of the EMS operations officer for the entire incident;
2. Deputy Chief Charles Wells–proceed to West and Liberty to assess EMS ops at that location; and
3. Capt. Janice Olszewski and Lt. Bruce Medjuck–proceed to Church and Fulton to assess EMS ops at that location.

Also present alongside Gombo at the fire Command Post were FDNY Fire Chief Peter Ganci, FDNY Deputy Commissioner William Feehan and FDNY Division Chief John Peruggia–among others.

For the next few minutes, these officials prepared their respective EMS and fire strategies–completely unaware of what lay ahead. Meanwhile, EMS personnel worked vigorously at locations on the east, west and south sides of the Trade Center Complex. Most first-in personnel shared one thought: This was an accident. “In training they always stress the secondary device,” says Moritz. “Nobody would have ever considered a second airplane being utilized as a secondary device–ever! At this stage in the game, nobody was expecting anything else.”

The Second Crash
Approximately 18 minutes after the North Tower was hit, United Flight 175–also a Boeing 767–slammed into 2 World Trade Center. The effects of this secondary device further endangered rescue workers and hampered EMS operations as debris from the explosion pummeled the areas below the South Tower. Many on scene didn’t know what had happened until the debris–and the people–began raining down on them.

Gombo, who stood in an exposed area at the joint Command Post, clearly recollects the scene following the second crash. “Before I really had an opportunity to react, there was another flood of people, running out of the [South] Tower. There were plane parts falling on the ground. Things burning. We weren’t even sure what was burning, whether it was jet fuel falling to the ground or what,” he says.

After the second crash, Gombo sent Davila east to Church and Fulton to assess the EMS operation there. In spite of a second plane crash, the process of identifying and setting up EMS sectors continued. Key staging locations at West and Vesey, Church and Fulton and West and Liberty streets remained, and informal treatment areas surrounding the Trade Center Complex cropped up as incoming EMS units–while attempting to drive into the area–encountered patients in need of treatment and transport.

Chaos Ensues
FDNY, hospital, private and volunteer ambulances continued streaming in after the second hit. EMS units, including MetroCare, Hatzalah, Columbia Presbyterian and Maimonides, staged in the southbound lane on West Street just under the pedestrian South Bridge. EMT Jennifer Beckham, Flushing Memorial Hospital, reports that hers was the first unit in a line of ambulances staged to the south with their engines running and rear doors open. FDNY officers at West and Liberty asked crews to stand by to receive patients from 2 World Trade as they were brought from inside the tower. As EMS personnel stood ready, debris–and victims–continued streaming down on them.

Aside from the loss of their EMS peers and other innocent bystanders, most personnel present on the 11th carry the burden of witnessing victims who jumped or fell from the towers. A contentious subject, the spectacle of the jumpers was an unqualified constant in our conversations with responding EMS personnel. The majority of those interviewed for this story vividly recollected–without solicitation–those who jumped.

From eyewitness reports, the incidence of jumpers increased when the South Tower was hit. By this time 1 World Trade had been aflame for nearly 20 minutes, its heat offering no mercy to those above and just below the involved floors–96—103. Moritz saw six or seven jumpers from 1 World Trade when he arrived on scene. When 2 World Trade was hit, the pattern repeated, forcing those above and just below involved floors 80—86 to endure the heat or flee the building by leaping.

“I can’t tell you the feeling I felt [when those people were jumping]. I kept saying, “˜Our guys are on the way up to you. Why are you people jumping?'” recalls FDNY EMS Chief Robert McCracken, who arrived south of the Trade Center Complex after the second plane hit. “I had no idea the stairwells were inaccessible. And when the flames really roared, you knew they had no choice. They weren’t unconscious; they knew what the hell they were doing.

“The thing that really bothered me the most [were] the ones that were so far away from the buildings,” he says. “You wonder how an individual can get 40—50 feet from the building. You can’t jump that far. Were they blown out? Was it the atmosphere? Were they running and saw light?”

It’s difficult to imagine how providers on all sides of the Trade Center Complex negotiated the massive debris from the building, much less the emotional and physical challenges presented by people leaping to their deaths. Whether on the job two months or 20 years, providers are haunted by what one FDNY EMT describes as “falling tear drops.”

The jumpers were a painful symbol of the patient care reality Sept. 11: EMS could do nothing for those who fell. “I kept saying, “˜Do not look at where they’re coming from. They’re coming from 90 stories up. They’re dead the second they hit. There is absolutely no reason for us to go over and even check. They’re dead. That’s it,'” says Jack Delaney, director of EMS, New York Presbyterian Hospital. “It put a whole different spin on emergency medicine. It truly was a war zone. Protocols were out the window. It was a matter of survival at that point.”

EMS Ops Post-Crash 2
The moment United 175 slammed into 2 World Trade, a paradigm shift occurred in the minds of most EMS personnel on scene. “Two planes–that’s much more than coincidence,” says Gombo. “In my mind, I switched from accident to terrorism.”

Operationally, FDNY EMS maintained its staging commitments at West and Vesey, Church and Fulton and West and Liberty. Smaller staging and treatment areas evolved in the vicinity as patients escaping the Trade Center rushed to incoming EMS units, begging for assistance.

Post-crash No. 2, EMS officials focused on two concerns: 1) EMS would need more resources to handle the thousands of anticipated patients, and 2) personnel in exposed or debris- riddled areas were more vulnerable than ever to injury.

FDNY”ˆEMS Deputy Chief Zachary Goldfarb, who had been sent to West and Vesey, encountered 40—50 EMS personnel under the pedestrian North Bridge. They had parked their vehicles on the southbound side of West Street (North of Vesey) and were awaiting patients. Standing in the middle of West Street, Goldfarb called for nearby officers. His goal was to set up a casualty collection point for the injured in that area, as well as to maintain egress for the ambulances. He instructed Capt. Jace Pinkus and a lieutenant to move all EMS personnel underneath the North Bridge up against the exterior of 3 World Financial Center–across the street–away from falling debris. He also requested they document all personnel in that location. “One of my big issues is accountability at the scene,” says Goldfarb. “As an EMS supervisor, I never want to be ringing anybody’s door saying, “˜Johnny’s not coming home tonight.'”

As his orders were carried out, Goldfarb looked back on the scene. “I said to myself, “˜I don’t like the way this looks,'” he recalls. “I think I saw things that I now don’t want to remember. I called Pinkus on the radio and told him to move the operation inside 3 World Financial and do an accountability check. I told him to get the whole thing buttoned up in the building.”

As the upper floors of both towers burned, compromising the buildings’ construction, Goldfarb’s foresight at West and Vesey, along with McCracken’s simultaneous activities south of the complex, likely saved many EMS lives. McCracken, who had parked south of the complex on Rector Street, proceeded north on foot, attempting to divert incoming EMS personnel south–away from the towers. “My main objective was to get everybody off Liberty, get them off West Street. A couple of my trucks were there–on Liberty facing the West Street corridor,” he says. “They thought I was kidding. I said, “˜Get out of Liberty because [2 World Trade] looks very unstable.'”

McCracken continued giving directives to fire and EMS personnel in the area. His goal was to have all EMS vehicles facing south to evacuate patients to the South Street Ferry area. “I also reminded everybody about using [their] natural body senses–hearing, taste, smell,” recalls McCracken. “Don’t ask me why. I’ve never said that before on a command.

But it was something you had to rely on because this was a bad feeling all the way around. When I pulled up, I said, “˜This is a bad one.'” While clearing the Liberty area of EMS and fire personnel, McCracken was called via radio to the Command Post. He never made it there.

Shelled ambulances line the southbound lane of West Street just beneath the pedestrian South Bridge. Photo Steve Spak

 

South Tower Collapse
As McCracken journeyed north on foot, John Peruggia was receiving disturbing news at 7 World Trade. “We got some information from a buildings person or an engineer that there was significant structural damage to the towers and they were in danger of immediate collapse,” recalls Peruggia. Shortly thereafter, Peruggia heard an unforgettable screeching sound. McCracken was overcome with the noise as well: “Just as I got out of Liberty the sound under my feet was like an earthquake. It sounded like a jet engine screaming in my ear. “¦ I thought it was another plane coming in.”

Back at the Command Post, Gombo was busily discussing EMS resources with Commissioner Feehan. “It must have been just minutes–at least that’s the way it felt–[from the South Tower being hit] when something very strange started,” he says. “All of a sudden, the sky got very dark. We felt the ground vibrating and heard a tremendous roar. For a second, I thought it might be another plane. But when I looked up it appeared the sky was coming down.”

Nearby, Kowalczyk saw a plume of smoke erupting as 2 World Trade began to fall. He ran with Gombo and several others toward the underground garage at 2 World Financial. “I’m saying, “˜Fool, why am I doing this?'” says Kowalczyk. “My thinking and my training says I’m basically running into a dead end. What’s going to prevent this debris from following the natural course of the driveway into the garage?” It did follow. Most pedestrians near the Trade Center Complex were consumed by a stultifying cloud of debris and dust as the South Tower crumbled. To the east at Church and Fulton, Davila escaped into the Millennium Hotel, where he was knocked to the ground. “The hotel lobby was dark. I saw a light and went toward a door,” he says. “I was a chicken-shit, scared supervisor. I was panicked. The noise I heard was something like I never heard before in my life. You could still feel the doors shaking, the metal in the hotel bending.”

Then Davila experienced an emotional cycle described by many EMS personnel who lived through the first collapse: feelings of fear, acceptance, then anger. “I went through a warped feeling. I think we all shared it–all of us there through the collapse period. We’re always in dangerous positions, and there’s always that life-threatening possibility,” he says. “But I knew I was dead. All of sudden my feeling was, “˜OK, I’m gonna die. Calm down. Die with some dignity.'”

After momentarily absorbing his perceived fate, a survival instinct kicked in. Amazingly, Davila found a working phone; he called his wife. “You could hear her hysterical because she worked up Church Street and saw the building collapsing,” he says. “She told somebody in her office, “˜Call 9-1-1!’ “I said, “˜Fern, I am 9-1-1.'”

Southeast of the complex, McCracken found himself in a corridor unable to see his hand in front of his face. “All I heard, before the darkness really got in [was] this woman screaming, “˜My baby! My baby! My baby!'” he remembers. “While I was in this corner, pulling my helmet and my face shield down, I felt something between my legs. [I reached down and felt] a child between my legs. Don’t ask me how it got there.”

McCracken began swirling through the fear, acceptance, anger cycle. “You start to think you’re going to die,” he says. “I started to think about my children, and, for the first time, I actually prayed to the Mother Mary. That was gonna get me through.”

A rush of air blew through the corridor he was in, and windows broke as dark descended. “It got so quiet,” says McCracken. “I said, “˜This can’t be death; this can’t be death.’ … Somebody yelled, “˜Is everybody OK?’ As I opened my mouth to respond, I got this total mouthful [of debris]–as if I was buried in the sand. I said, “˜Oh my God, I’m going to suffocate here. I cannot believe it.'”

 

Struggle to Survive
During the next 29 minutes, Gombo, Kowalczyk, Davila and McCracken worked their way out of their respective entrapments. EMS personnel previously staged at the three EMS sectors around the Trade Center Complex were scattered by the collapse.

During this period EMS personnel faced difficult odds. Most of them were seriously incapacitated. A 110-story office building had collapsed on them. The incinerating, murderous souffle of steel, concrete, office furniture and airplane parts made personal survival the moment’s priority.

Lone personnel searched through a snowstorm of particulate for their partners. Ambulances and command vehicles closest to the towers lay crushed and burning. Those vehicles lining streets closest to the perimeter stood abandoned, their back doors open, covered with inches–even feet–of debris. Even the most physically fit providers struggled simply to inhale, much less to walk, amid the melee. When they could stagger in any direction, it was difficult to discern where to go because no one could see where they had ended up after the blast of the collapse. And no one knew where to go, anyway: On-scene communications proved difficult at best. Department radios transmitted spottily, if at all, during this period. Cell phones–personal or departmental–proved worthless without their signals.

As the particulate matter began dissipating in pockets around the Trade Center, happenstance reunions occurred on the perimeter of the Complex. EMS personnel joined with police and fire fighters to assess their surroundings and develop any kind of response strategy. The injured, who emerged from beneath fire vehicles, shelled-out buildings and various nooks and crannies, required eye rinses and respiratory assists. EMS personnel were jolted from the mental and physical shocks of the collapse to aggressively focus on patient treatment–even if it meant looting ambulances for oxygen and saline.

Gombo and Kowalczyk’s group, which had escaped from the Command Post, worked their way through 2 World Financial and exited the west side of the building. They proceeded past the Winter Garden area to West Street. There, they met up with Goldfarb, who after moving his people off the street at West and Vesey into nearby 3 World Financial, had propelled himself into the back of an ambulance as the SouthTower collapsed.

Together at West and Vesey, FDNY EMS brass began relocating resources, such as moving vehicles west toward North End Avenue. “The triage team in 3 World Financial had re-established in the lobby of the Embassy Suites building,” reports Goldfarb. “We were getting patients–evacuees. A lot of public safety people, civilians–about 25—30 cardiac and trauma patients. We also had a lot of walking wounded drifting in and out. We had fractures. Smoke and dust inhalation. Shock. They were injured in the [first] collapse as opposed to the initial events.”

The aftermath at Church and Vesey, a major EMS triage location prior to the collapses. Photo Adam Schreibman

No Reprieve
Still somewhat south of the Trade Center Complex, McCracken searched desperately for his personnel and directed everyone to proceed south. “All I know is [as] I went looking for the Command Post, here it came again–the sound–a low roar [like] an engine coming at you. You felt like you were getting sucked into the [engine] intake,” says McCracken.

Disoriented, he looked for a street sign or a building marker. “The most frustrating thing was seeing fire trucks collapsed, crushed. Firefighters bent over trying to get air. PASS alarms going off. No command structure anywhere,” he laments. “I didn’t see anybody of rank in my area at all. The next thing I knew I was running from the next tower. That’s when it struck me that the first noise I had heard was [2 World Trade collapsing]. This was the next tower chasing me.”

Indeed, as most Americans watched the nightmare unfold on their television sets, on scene EMS personnel in lower Manhattan had virtually no idea that the South Tower had completely fallen down–much less that they were enduring the second collapse. As the North Tower pancaked to the ground just yards from their location in the Embassy Suites Hotel, EMS officials, who had been attempting to regroup after collapse No. 1, knew the operation was about to take a dramatic turn.

“We decided to retreat from the scene and pull back,” explains Goldfarb. “We didn’t know what the next hit would be. We decided to evacuate our assets, set up remote staging areas, bring in heavy-duty mutual aid to support staging and set up distant CCPs [casualty collection points] because we anticipated thousands of casualties–injured. We were trying to figure out where OEM was going to be.”

Operationally, EMS was reorganized as follows:

• All EMS personnel close to what is now known as Ground Zero would remain in their locations until more information became available;
• Kowalczyk was sent to organize an EMS triage sector far north at Chelsea Piers;
• Gombo and Goldfarb went to 1 Police Plaza (former site of OEM”ˆand the city’s Emergency Operations Center before it moved to 7 World Trade, which was now aflame) to coordinate EMS activities from that location;
• EMS personnel would continue triaging to the south at South Street (Staten Island) Ferry.

The Millennium Hilton served as both backdrop and shelter for personnel before and after the towers collapsed. Photo Alan Saly

Hundreds if by Sea
As his senior staff endured collapse No. 2 and strategized to his north, McCracken emerged from the building he’d been in and took to the streets. “Visibility got a little better, like a snowstorm,” he says. “I went back to the south and made my way down to the harbor. There were little Coast Guard boats and police launches evacuating people. It seemed like a small amount of people. I didn’t see any injured.”

At Robert Wagner Park (just west of the South Street Ferry), he encountered an estimated 1,500 people. “You could not see lower Manhattan from there, but for some strange reason, this little piece of real estate had good air quality,” McCracken says. “Everybody kept saying, “˜We got to go through [the smoke and debris cloud].’ I kept saying, “˜I don’t know what’s on the other side of that smoke. We’re not going. We’re staying at least where we’re in a safe haven.'”

From that location, he assisted people onto tugboats and ferries and had them evacuated to New Jersey. Water evacuation was a tremendous asset in this incident. Early on, a staging area was established at South Street Ferry. Prior to the second collapse, police, fire, Coast Guard, Port Authority and private sea vessels were approaching the west shore of lower Manhattan.

From north Battery Park City to Robert Wagner Park and points below, these vehicles helped evacuate the injured to such locations as Staten Island and Liberty Park in New Jersey for treatment and transport to medical facilities.

Chelsea: Abundant Resources
At the north triage sector, Kowalczyk focused on set-up. “Chelsea “¦ became a mobilization point for anything medical. We started to give birth in a matter of minutes to an EMS system almost as large as one of our own divisions,” he says.

Kowalczyk began assessing and organizing resources–from personnel to supplies. Crowd control overwhelmed even law enforcement officials at that location. “Here we were in the middle of the only exit from Manhattan,” says Kowalczyk. “It was an evacuation route and thousands of people were exiting north. Meanwhile, picture the amount of people coming into New York, streaming toward the towers.”

With only minutes between the tower collapses, many EMS personnel, desperate for air, escaped into vehicles. Photo Adam Schreibman

EOC Improvised
Gombo and Goldfarb arrived at 1 Police Plaza and established EMS command. At the time, they were the only FDNY personnel there. “We knew it was going to take time to get FEMA assistance,” says Gombo. “But we needed to do whatever we could until those resources reached us. We anticipated thousands of patients.”

Knowing that local hospitals couldn’t accommodate such large patient quantities, Gombo and Goldfarb identified several locations for CCPs: the Javits Center on the west side, the Brooklyn Navy Yard to the east and the Yankee minor league stadium in Staten Island to the south. “The plan was “¦ to set these locations up, staff them with hospital personnel–primarily surgeons and doctors–secure medical equipment and have it brought to those locations and send patients there,” recalls Gombo. “We planned to activate these locations by 1800 hrs.”

Sadly, Gombo and Goldfarb would ultimately scale back the operation. At 1800 hrs”ˆtwo of the three CCPs were demobilized due to a lack of patients.

By late afternoon, McCracken had made his way to the newly established EMS Command Post at West and Chambers. Nearby Stuyvesant High School, which had seen a fair number of patients earlier in the day, was being used by EMS”ˆmostly to treat on-scene emergency personnel (police, fire, and so forth). Kowalczyk had been relieved at Chelsea and joined McCracken and others to plan the ongoing EMS presence on scene.

“Our biggest urgency after 7 [World Trade] went down [just after 5 p.m.] was regrouping,” says McCracken, “trying to figure out who was left and making sure we could account for everybody.”

That evening, Kowalczyk and Goldfarb stayed to organize ongoing EMS”ˆcommitments for the disaster. The remaining EMS”ˆsupervisors were officially sent home. Less than 15 hours after American Flight 11 hit 1 World Trade, the need for EMS”ˆresources to care for critically injured patients was, for the most part, over.

Upsetting Role Reversal
The legacy of EMS involvement at the Trade Center disaster will evolve as time passes. While providers overcame tremendous odds to treat and transport hundreds of patients from the site early in the incident, they ultimately faced a cruel reality: What initially looked to be the largest MCI in American history–one that would have required an unprecedented EMS”ˆresponse–never materialized.

Data collected from five Manhattan hospitals report 790 injured survivors from the Trade Center attacks were treated between 8 a.m. Sept. 11 and 8 a.m. Sept. 13. But these figures account only for reported injuries and only for patients seen in Manhattan during the time period. At press time, 3,023 people were confirmed dead or still reported dead or missing.

For now providers seem grossly disappointed with the turn of events that Tuesday morning. And most anguish over having become victims themselves. “My personal frustration is that we went down there with the expectation of saving a lot of lives,” says Delaney. “In actuality … we were concentrating on saving our own lives. Anybody we came across, we helped. But we were retreating instead of going in.”

The author wishes to thank every source who so willingly gave of their time and resources during the preparation of this article.

Sidebar: Gator Gratitude

At most MCIs, some thing–product, strategy or other–often emerges as the call’s MVP. On Sept. 11, that was the Gator. All-terrain vehicles that FDNY EMS originally brought in as part of the department’s Y2K preparation, they proved indispensable for quick transportation amid Ground Zero’s daunting terrain.

“On the 11th, the first Gator arrived with an EMS unit–two paramedics–from Queens on it,” explains Kowalczyk. “They were tremendous assets because the urban environment of lower Manhattan quickly lost paved roadways. The terrain we had to go through made the Gators the most maneuverable for people, victims and equipment.”

 

Sidebar: Main Characters: EMS Personnel Who Responded to the Trade Center
The following services were requested by FDNY Citywide Dispatch to respond to the Trade Center disaster on Sept. 11 from the time the event occurred through 0900 hrs on Sept. 12.

• Beth Israel Medical Center
• Brookdale University Hospital and Medical Center
• Cabrini Medical Center
• Flushing Hospital
• Jamaica Hospital Medical Center
• Lenox Hill Hospital
• Long Island College Hospital
• Lutheran Medical Center
• Maimonides Medical Center
• Montefiore Medical Center
• NYU Downtown Hospital
• New York Hospital of Queens
• New York Hospital-Cornell Medical Center
• New York Presbyterian Hospital
• North Shore University Hospital
• Parkway Hospital
• St. Clare’s Hospital
• St. Luke’s-Roosevelt Hospital Center
• St. Vincent’s Catholic Medical Centers: Bayley Seton
• St. Vincent’s Catholic Medical Centers: Manhattan
• St. Vincent’s Catholic Medical Centers: Mary Immaculate
• St. Vincent’s Catholic Medical Centers: St. Mary’s
• St. Vincent’s Catholic Medical Centers: St. John’s Queens
• St. Vincent’s Catholic Medical Centers: Staten Island
• Staten Island University Hospital
• Victory Memorial Hospital

Community-based volunteer ambulance corps:

• BRAVO Volunteer Ambulance Service
• Flatlands Volunteer Ambulance Service
• Broad Channel Volunteers Inc
• Little Neck-Douglaston Community Ambulance Corps
• North Shore Rescue Squad Volunteer Ambulance

In addition to the above organizations, mutual aid requests made by OEM and the New York Department of Health resulted in additional on-scene EMS resources from commercial and volunteer ambulance services in New York and New Jersey as the event unfolded. Source: FDNY EMS

 

Sidebar: Addresses & Acronyms
1 World Trade Center
North Tower=1 World Trade
2 World Trade Center
South Tower=2 World Trade
7 World Trade Center
7 World Trade=home to OEM

Citywide: The FDNY EMS frequency used for MCIs, special events, etc. 
LSU: Logistical Support Units–vehicles that carry supplemental EMS supplies and are positioned on scene at an MCI; three were dispatched within the first hour of the attacks. 
MERV: Mobile Emergency Response Vehicle–a special EMS vehicle used to process multiple patients at once; can also be used as a mobile surgical unit; two were dispatched within the first hour of the attacks. 
OEM: Mayor’s Office of Emergency Management; formerly housed on the 43rd floor of 7 World Trade Center; also the location of the Emergency Operations Center (the “war room” of any emergency effort in which representatives from local, state and federal health and disaster resources must work together to solve problems). 
RCC: Resource Coordination Center–an FDNY EMS division that coordinates and ensures EMS resources (units, personnel) throughout the city are appropriately distributed.