8 November 2001

The World Trade Center Attack -
The experiences of health care professionals and the lessons to be learned

In this month's Critical Care, health care professionals who were personally or directly involved in the rescue efforts of 11 September offer their perspectives, and suggest ways in which health care systems can better prepare for future disasters, be they natural or acts of terrorism, including those involving biological agents.

Their views are recorded as a series of reviews, including an eyewitness account by Louis Cook, paramedic on the scene on 11 September:

"My chief and I were asked to organize a safe and, if possible, covered way out for self-evacuating civilians and to create a triage area on a floor in 1 World Trade Center below the fire. Before much could be achieved, however, the second aircraft hit Tower 2."

The next review discusses the experiences of Charles Martinez, Deputy Chief Surgeon of the New York City Police Department, and Dario Gonzales, Medical Director for Clinical Affairs:

"At first chaos and confusion reigned. This was initially because communications were severely hampered...but this initial confusion was minor compared with the huge loss of personnel and resources as the FDNY command center was buried when the south tower (Tower 2) collapsed."

In another review, J David Roccaforte from Bellevue Hospital Center, only 2.5 miles from the World Trade Center, describes how the response of the hospital was adequate, but that "this may not have been the case if the attack had been biological or chemical."

David Crippen, an intensivist in Pennsylvania with vast rescue experience, takes a look at the wider view of how we respond to disasters, comparing the devastation caused by the terrorist attack with his experience of the 1988 earthquake in Armenia. He suggests that the best approach to saving lives may be to teach life-supporting first aid to the general public so that uninjured bystanders can help those worse affected.

Jeffrey Hammond and Jill Brooks, from the Robert Wood Medical School, New Jersey, look at preventing psychological problems faced by disaster victims and rescuers. They describe the role of "critical incident stress debriefing", a peer-driven, therapist-guided group therapy to help prevent the development of post-traumatic stress disorder (PTSD). This is especially important, since treating PTSD after it has established is minimally beneficial.

Three reviews examine the lessons that can be learned from the terrorist attacks on New York and how we can be better prepared for future disasters, including the threat of bioterrorism.

Ronald Simon and Sheldon Teperman, members of the Jacobi Medical Center Disaster Committee, highlight the weaknesses in the response of New York City to the crisis:

"The lack of communication probably caused more problems than all the other factors combined." Furthermore, "Significant time, effort and resources were wasted...because of lack of direction and information".

The question of preparing for future attacks is examined further by Kenneth Mattox, Professor of Surgery at the Baylor College of Medicine in Texas, who asks perhaps the most difficult question in response to the New York attacks - to what extent are health care bureaucrats able to prepare for future disasters?

Answering this question requires "leaving egos and personal agendas at the front door and working for a common benefit", he warns.

The threat of bioterrorism is addressed by Vlad Kvetan, who warns that because the Internet has disseminated details on all aspects of bioterrorism it is important that comprehensive guidelines are drawn up to deal with potential outbreaks of diseases like anthrax and smallpox.

###

All these articles will be published in the next issue of Critical Care (5:6)

http://www.biomedcentral.com/ccf/wtc.asp

Any articles published using the material featured in these reviews should reference Critical Care, a journal published by BioMed Central.

To read further press releases from BioMed Central visit:

http://www.biomedcentral.com/info/pr-releases.asp

Critical Care is a journal published by BioMed Central http://www.biomedcentral.com, an independent online publishing house committed to providing immediate free access to the peer-reviewed biological and medical research it publishes. This commitment is based on the view that open access to research is essential to the rapid and efficient communication of science. In addition to open-access original research, BioMed Central also publishes reviews, abstracts and subscription-based content.