Volume 1: Beyond Ground Zero, september 2011 I can’t believe it is 10 years since September 11, 2001. It really seems almost like a movie—a terrible movie.

here’s nothing more pow- were there. The ripple effect of to participate in it. But after 10 erful and compelling than the pain inflicted that terrible day years, several say they may finally Thearing the facts about continues to affect and hurt many be ready for it. It should be made an incident directly from a first- families, friends and loved ones. available to them. person source. We have done We found that many marriages We found that counseling has that in the development of the and relationships dissolved or been offered to the children of four-volume historic report, Out ended in unfortunate divorces responders, but in many instanc- of the Darkness, presented here. after 9/11 because some indi- es, it hasn’t been offered to their To do so, we spent time with key viduals couldn’t understand or spouses and significant others personnel in each involved city accept the commitment, respon- who have been left to deal with to discuss the events of Sept. 11, sibilities or emotional baggage the ramifications on their own. 2001, and the aftermath of that being carried by the responder They need help too. unforgettable day. they loved. Those who were hired after We chose the title because so Yet, the people we spoke with 9/11 must be sensitive to those many of those we spoke to report- carry on with their lives. They who were there. And EMS manag- ed how that day went from being shepherd their children to school, ers must be mindful that assign- a picture-perfect day, to one of visit their mom, get promoted and ing affected crews to the same death, darkness and despair in a fall in love. Since 9/11, some have response zones and locations as matter of minutes. Many report- retired, and some have moved on their original source of emotional ed being trapped under debris in from EMS. Most remain with the trauma is not advisable because complete darkness and having to agencies they love, the agency the sights and sounds they’ll be crawl toward a ray of light or the that has been their second home forced to see and hear again can light from another person’s cell and source of comfort when they trigger horrible anger and anxiety. phone to find a source of fresh are down or depressed. It has been our great privilege air. And many report still having But what most understand to get to know these responders. dark, emotional days as a result now, with 10 years of hindsight, They aren’t superheroes. They’re of their experiences, as well as is that they belong to an exclu- ordinary people who did the the sights and sounds associated sive, dreadful club. A club none of very best they could in extraor- with their incident. them asked to join and every one dinary situations. We were struck by the lasting of them would rather not have We wish we could have inter- damage caused by the attacks been inducted into. However, viewed all of the 9/11 responders, on 9/11. For many, time has not they recognize that they have but we could not. However, we healed the emotional scars they been set apart from the rest of hope that what we have crafted sustained. For others, health humanity—damaged in a way no for you are documents that pres- issues caused from breathing one but other 9/11 responders ent not just important historical super-heated, microscopic dust and witnesses can understand. In facts about 9/11, but also the will plague them to the end of fact, many of the responders told many command and control, their lives. For a few, the emo- us they will only talk about 9/11 accountability, resource man- tional damage is less visible and, with others who were there that agement and emotional lessons perhaps, even more insidious. day—other members of the club. that have been learned at each What’s more, the damage from Many could benefit from coun- incident and must be passed on 9/11 doesn’t just affect those who seling but have been reluctant to others.

2 JEMS out of the darkness Dr. Glenn Asaeda saw the smoke kind of hovering and thought, “Today must be that day for the bioterrorists.”

39 Caution: Because we wanted to represent the actions and words of these providers as true to the events as possible, we have broken our normal policy on not publishing profan- ity. Therefore, some of the portions of the material you 47 are about to read contain graphic language. 52 54

Vice President/Publisher: Jeff Berend Editor-in-Chief: A.J. Heightman Out of the Darkness is a supplement sponsored by Boundtree Medical, Demers Managing Editor: Lauren Hardcastle Ambulances, Disaster Response Solutions, Emergency Products + Research, Laerdal, Oxygen Generating Systems and Southeastern Emergency Equipment, and pub- lished by Elsevier Public Safety, 525 B Street, Ste. 1800, San Diego, CA 92101-4495; Contributing Editor: Teresa McCallion 800/266-5367 (Fed ID # 13-1958712). Copyright 2011 Elsevier Inc. No material may be reproduced or uploaded on computer network services without the expressed per- Art Director: Liliana Estep mission of the publisher. To subscribe to an Elsevier publication, visit www.jems.com. Advertising rates are available on request. Contact Elsevier Public Safety, Advertis- Director of Production: Tim Francis ing Department, 525 B Street, Ste. 1800, San Diego, CA 92101-4495; 800/266-5367. Production Coordinator: Pippin Schupbach Production Assistant: Matt Leatherman

SEPTEMBER 2011 3 I started hearing this terrible sound in the background. I heard, “Jumpers, jumpers, everybody be careful!”

EMS Editor-in-Chief A.J. physician respond, we can actu- The impact and full tanks of Heightman, MPA, EMT- ally do a treat and release of the jet fuel set off a vicious chain P, and EMS Insider Edi- remaining patients. J of events. tor Teresa McCallion, EMT-B, We have 2,300 EMTs, 800 para- set out on a journey to each of medics and almost 500 super- the sites affected by the horrific visors in our system. It helps terrorist attacks on 9/11. They me to get to know them when didn’t know what the lives of I respond in the field, go to the those involved would look like stations and even to some gen- or how they’d been affected 10 eral calls. I’m really there to lis- years later. Although every per- ten, help them with their patients son interviewed in New York was and see if there are any issues. I present for the same incident, also assess what kind of educa- the stories are dramatically dif- tion they want or need. ferent—both of that day and their I can’t believe it is 10 years present lives. The most important since Sept. 11, 2001. It really goal they had was to let each per- seems almost like a movie—a son tell their story. Here’s what terrible movie. People just dis- they had to say. appeared. I know that they’re gone, but it’s almost like, OK Glenn Asaeda, MD everybody, come on out now, In New York City, we have mul- because unfortunately we didn’t tiple MCI [mass casualty inci- find bodies. The sheer energy and dent] 10-32 ground transport destructive forces generated by incidents daily, particularly with the collapsing structures pancak- school bus accidents. And it just ing down floor by floor in seconds doesn’t make sense and expanding the to bring all 40 kids forces and mass Glenn Asaeda to the hospital, par- exponentially ticularly if they aren’t just vaporized really hurt. That everything. would really start to shut our EMS sys- Arrival on tem and hospitals Scene down. We’d have That morning, I was to place the hospi- actually headed to tals on diversion. an American Heart So of the 40 kids, Association meet- let’s say, maybe five Division Medical ing and coming off or six actually have Director - FDNY the Long Island ­Office of Medical an injury that will Expressway. I was Affairs require transport. stuck in traffic and Read his 2001 story here. And by having a just happened to

4 JEMS out of the darkness I realized at that moment that all the medical training we had was absolutely worthless as we were helpless to do anything for these people. look over to the side of the Trade air, it’s a bad day for terrorism, hovering and thought, “Today must Center towers and saw what looked particularly biological terrorism, be that day for the bioterrorists.” like a line of smoke. I thought, “Oh, because anything that’s released I was in a marked department that’s interesting.” will go straight up into the air. So vehicle at the time, and the next Just one week earlier, I had if it hovers or even sinks, he says, thing I know, a big red truck next taken a CDC course held at FDNY that’s the day you have to really be to me started flashing its lights at on terrorism, particularly biologi- careful because that’s what terror- me, honking its horn and rolling cal terrorism. And I remembered ists want. They’ll release a product down his window. So I’m thinking the senior instructor saying, “Look so that it actually hovers close to it’s not unusual. People ask, “Oh at the smoke from smoke stacks. If the ground so people breathe it in. where’s the nearest gas station?” the smoke rises straight into the So I saw the smoke kind of all the time. A P h oto/C ao Soi C he on g

SEPTEMBER 2011 5 I thought somebody had closed the loading dock doors, but it was the debris that turned day into a pitch black night.

very small to me. I never imagined it could be a commercial airliner or that a second one could be on its way. As I was trying to figure out the best way to approach the scene, about 20 emergency vehicles are suddenly behind me. I’m the lead car! They’re following me! I’m like, all right, better make sure that you know how to get there. You know, take the best route. Where should I make that right turn? Where should I turn? All of a sudden, I looked in my rearview mirror and everybody starts making a right turn behind me, and they’re gone. That’s where I should have turned. So now I found myself actually going into downtown Manhattan. And I see thousands of people just running from the World Trade Cen- ter toward the Brooklyn Bridge, almost to a point where I have to stop and try to get through traffic. Women had kicked off their heels This is a diagram of the scene of the World Trade Center terrorist because they couldn’t run in them. attack on 9/11. Shoes were all over the street. And, you know, all my training Instead he says, “Did you see ambulance. World Trade Center in terrorism, hazmat and confined the fucking plane hit the building?” tower number one is on fire! This space rescue starts to kick in, and And I immediately looked at and is a hard-hat operation.” I’m thinking, “Always stay upwind.” listened to my citywide radio, but Oh my God, this is real! Then I realize that I’m actually driv- it was silent. I’m like, how could So I notified key EMS staff mem- ing through the smoke that’s com- that be, if something hit the tow- bers by cell phone that I was going ing toward my vehicle. ers, I would be hearing about it on to respond in on the job. While in I’m like, “What am I doing? I’m my citywide radio. the Queens-Midtown Tunnel, the breaking the first rule. Yeah, I’m Then I remembered that I had radios (at that time) didn’t trans- going through the debris cloud.” stopped to pick up a cup of coffee. mit well. So I can’t hear anything. But I had no choice at that moment. Usually, the radios turn on when But when I popped out on the Then, I turned the corner and the vehicle is started, but the ones other side, I see that NYPD and almost ran into Chief Downey’s in this particular vehicle, for some the traffic agency have stopped vehicle coming up to the same reason, you had to turn back on. all traffic. road. (FDNY Chief Ray Downey So I forgot to turn it on because I They saw my marked vehicle and was killed during the WTC attack. wasn’t paying attention, thinking directed me to proceed toward the He was the chief of special oper- about the conference and what I Trade Center. My adrenaline was ations command and the chief am going to be saying. really rushing. I had to calm myself for the New York City task force-1 So I was almost afraid to hit down a little bit ’cause it’d be very urban search and rescue team.) that on button, but I pushed the embarrassing if you hit something So I see all these emergency on button. Well, then I heard, and had an accident on the way to vehicles lined up. And so, I’m try- “Aircraft into the World Trade this big incident. ing to figure out where to park my Center. Send me everything you Because of the sheer size of the vehicle, all the while thinking, “I

f i g u re Cou r t esy fd n y EMS got. Send me every available building, the affected area looked have a meeting to go to. I have to

6 JEMS out of the darkness People were hanging on the sides of every aspect of that ambulance; on the bumper, on the side, everywhere they could. park where I can get out because this is probably going to be an all- day operation. I’ll check in, get to my meeting and come back.” What was I thinking? I must have been in denial. So I get out and remember it’s a hard-hat job. So I put my helmet on and begin to walk toward the command post. Little did I know that the next time I saw my vehicle it would be crushed by tons of fall- apologetic, like they were going to incident, all of a sudden, I heard ing debris. get in trouble. a loud sound. I looked up to see I said, “No, that’s fine. Just make a large piece of debris from the Initial Actions sure you guys stay safe. Is there tower fly over us toward the World On the way to find the command an officer here, a supervisor?” Financial Center. post, I stopped at the first ambu- They directed me to the front I started thinking, “This is not lance that I saw, which was on of the structure where they saw good! Debris is going past and the south side of the complex, the FDNY command post located, over us. We’re too close. We need underneath one of the bridges that and I did a face-to-face initially to consider moving our command crossed the West Street Highway. with Dr. Allen Cherson (another post further north.” The crew said “We had to stop medical director at the time). here (vs. proceeding to the stag- As Allen and I were trying to The Jumpers ing area) because patients started figure out how to provide medi- As we were figuring out how to coming to us.” They were almost cal oversight and direction for this manage this, I started hearing Many EMS providers are still haunted by the images and sounds associated with the 9/11 “jumpers.” P h oto A oto/Ri ch a rd D rew

SEPTEMBER 2011 7 All of a sudden, I felt this hot gas-like air overtake me. It felt like hot sand being blown at me.

Then I realized what it was. I’m people I saw holding hands and To read the award-wining story by like, “Oh, my God, they’re peo- jumping in pairs. Esquire Magazine about the photo ple! They’re people!” I couldn’t see That’s when I went, “No, no, on p. 7, respectfully called “The Falling them very clearly since they were no!” And then there were more Man,” visit www.esquire.com/features/ ESQ0903-SEP_FALLINGMAN. so high up. They were the size after them that were jumping. of ants from that distance. I was I remember looking at Allen, looking straight up and remember who was next to me. We were both this terrible sound in the back- thinking to myself, “No, no, no!” wide eyed. I said, “How are we ground. It wasn’t like metal com- And I thought, “For sure they going to manage this?” ing down. It was like watermelons must be falling out of the win- I realized at that moment that hitting the ground. dows and unconscious.” And sure all the medical training we had Then I heard, “Jumpers, jump- enough, there were some with no was absolutely worthless as we ers, everybody be careful!” motion like rag dolls all the way were helpless to do anything for I looked up and I thought down. Some were on fire. Then these people. to myself, “What kind of debris I started seeing the ones flailing We now have live video feeds moves? I’ve never seen debris their arms all the way down. Then, that help us manage large-scale move like that.” what really got to me were the incidents like this. We can see the entire building. We can now see falling debris and other hazards, including potential jumpers, so that we can keep our people away from there. But that day, it was hard to really scan the entire scene because we had to look straight up 110 stories, and that was dif- ficult to do.

The Situation Escalates The situation was getting worse and worse and worse. All those people jumping and dying before us was an indicator of how bad it was getting up there. We were hearing that patients were flowing south and north. So FDNY now has a state-of-the-art command center. Allen Cherson and I decided we were going to split. He went south, and I went north. There were tri- age sectors already established in each area. As I was walking north, I remem- ber debris on the sidewalk and cars in the street that were on fire. And I thought, “My God, these ter- rorists must have planted bombs as well.” It turned out the debris had come down and caught the cars on fire. When I arrived at the first north triage site located in the load- ing dock area of 7 World Trade Center, the first person I saw was One person is assigned to monitor hospital ED turnover delays.

P h oto s A .J. H e i gh t m an Abdo Nahmod who’s now Chief of

8 JEMS out of the darkness We began to encounter waves of people with fractures because people ran into things and fell over each other.

I ran toward a little area between the lobby area and the loading dock, and I shocked myself because I probably couldn’t do this if I tried it on a good day. But with my adrenaline flowing, I remember hopping up and across the area with one hand. I also remember other peo- ple running toward us. The glass started shattering throughout the lobby. And somebody’s yelling, “Shut that door! Shut that door,” because they wanted to secure the area. The door started to close, and then there was this big clunk. The next thing I knew, was the sound (or lack of sound) that occurred, and then it became pitch black and I couldn’t breathe. I thought that somebody had actually closed the loading dock doors, but it was actually the sheer volume of debris coming toward us that turned day into a pitch black night. It was the col- lapse of 2 World Trade Center, the second one to be hit, the first to come down. Then I remembered that same instructor saying during the CDC class that if you’re ever caught in a biological agent attack and you have no mask or anything, even if it was a handkerchief or a necktie, An FDNY EMS crew member assesses the area in front of the Mar- put it over your face, because 90% riot Hotel on West Street Highway. of the substance will be filtered. As I put my necktie over my EMS. Abdo was a captain at the couldn’t hear what he was hearing. mouth and nose, I was saying time. He gave me a run down and He then told me that a plane had to myself, “I hope they’re right,” reported they were triage tagging hit the Pentagon and that there because I didn’t know what was patients and putting the black tags were 11 other planes missing. surrounding me. It was pitch black, (deceased) off to the side. When he told me, I’m like, and lots of people were panick- As we managed this area, I said “Whoa, 11 planes missing? What ing. I remember everyone scream- to him—and he agreed with me— does that mean? Are they com- ing and yelling. Somebody said, that we needed to move our triage ing back?” “Everybody just shut up! Shut up!” area further north soon because of the debris and all the jumpers South Tower Collapse Trapped we were seeing. And we were right The next thing I heard was a hor- We were trapped behind mounds across the street from all this. rible rumble. It sounded like a of debris and didn’t know where Then I stepped outside and jet plane engine. So I was now the exits were because it was so heard a security person (with an sure this was one of the 11 planes dark. But then one ingenious per- earpiece in his ear) say, “Oh, shit.” being dropped on us again. At that son had a camera and started

I said, “What?” because I point, everybody ran. clicking it and flashing light in the P h oto Da v i d Han dsch u / New Yo r k Dai ly News

SEPTEMBER 2011 9 Dr. Asaeda said that at least at the crash of Flight 587, the responders had bodies they could recover.

Battalion 31’s haztech ambulance crew assesses patients minutes before the South Tower collapses.

air—not at us, but just in the air I remember seeing a hospi- hearing from him. I said, “What to give us this light. It was almost tal ambulance, one of the ambu- do you mean? What building? like a disco ball, and you could see lances that was an official unit What happened?” the images of frightened people in our 9-1-1 system. People were He said, “The … tower … fell. in different locations every time hanging on the sides of every Look behind you. Do you see it?” the camera flashed. This led us aspect of that ambulance; on the I looked. One tower was still to where the exit was, so we knew bumper, on the side, everywhere standing, and the other one now where to go. they could. is … gone. Then I ran into Abdo again, and I said, “Hey, you have to get That’s when I first realized, “Oh, he’s covered with soot and debris, off. If you guys are well enough to my God, the building fell.” as was I. And I said, “Thank God hang on to that ambulance, you I immediately started thinking, you’re alive.” can walk. I have some real patients “Oh, my God, Cherson went to that I also said, “Is everybody else I need to put in there.” side. Manny Delgado (one of the OK? Are we accounted for?” I opened up at the back, loaded paramedics that worked closely He responded, “Yes.” my patients in, hit the back, you with us in our office at the time) Then I said, “Let’s get the hell know, indicating for them to go. went to that side.” out of here.” I remember the EMT saying, I said to Eddie, “I think they’re There were a few walking “Where am I supposed to go?” gone. They’ve got to be gone.” wounded patients that were there My response was, “I don’t know, Then I said, “I have to go over with us, so we grabbed them and but it’s not here. Just keep on there.” So I start walking toward took them up with us. When we going!” the ruins of the South Tower and got out, I remember us running Then I saw Eddie Gabriel, a the remaining North Tower. but disoriented and not sure which deputy director at the time in our But then I stopped and thought, way to go. Don’t forget, we didn’t office of emergency management. “This is crazy. That second tower is know exactly what happened. He was covered, and I remember going to come down.” We made a right and then kind of smirking like, “Wow, you another right, following what lit- look funny.” But I didn’t know that First Contact tle light we could see like it was a I looked just as strange because I Then my pager went off. So I’m doorway opening for us. It turned couldn’t see myself. thinking, “Oh, my wife must be out it was the correct way to go That’s when he told me, “The concerned. She knew that I was because it opened us up to a park- building fell.” here. She must think …”

P h oto Da v i d Han dsch u / New Yo r k Dai ly News ing lot. I couldn’t believe what I was My department cell phone

10 JEMS out of the darkness Commisioner Cassano says that In the past 10 years, FDNY has become better prepared, better trained and better equipped.

kept running. Then, lucky for me, I saw a path that I knew along the West Side Highway. One that I knew was a straight shot, clear all the way to Chambers Street. So I knew that, even if the dust over- took me and I couldn’t see any- thing, if I kept running straight ahead, I would be OK. I’ve heard of many other peo- ple that were running, and once the dust overtook them, they had obstacles in their way; people were For the first time in history. NYPD and FDNY dispatch operations will running into cars and tripping over be located in one facility. each other. A lot of people got hurt wasn’t working. So I actually dug command post officials were that way. into my pocket and found a single killed or missing. And I had told I ran all the way to Chambers quarter and happened to see a line her I was going back to the com- Street. There, the dust was finally of public phones at the corner. I’m mand post near that tower. So starting to settle. We were all thinking, “What’s the chance that she immediately thinks I’m gone coughing or spitting up dust. this public phone is working when as well. I remember looking around and all forms of communication had realizing that there was now just failed? And I’m in Manhattan. It’s North Tower Collapse eerie silence, like a bad blizzard probably 50 cents, and all I have is I started walking toward the North had come by and blanketed every- a quarter.” Tower, and I looked at it and thing. Then there was the sound So I picked the handset up real thought, “That tower’s going to of firefighter PASS alarms signal- quick, amazingly got a dial tone, come down too, but I got to go get ing that they had stopped mov- dropped my lone quarter in, dial these guys; I’ve got to find them.” ing. I remember thinking, “Oh, my home, and my wife picks up. But no sooner as I said that when, God, what the hell happened to all I said, “I’m alive, but I think a lot all of a sudden, a plume of smoke those firefighters?” of others are not. I’m going back to appeared from the top of the tower the command post.” with the massive antenna that Lives Lost She was distraught. I said, was still standing. Then, I saw the You know, there’s never a great “Jaci, Jaci, I’m OK, but I think antenna start to come down. And time for terrorism. But for us here Allen’s gone. I think Manny’s people started turning and run- at FDNY, 8:46 a.m. was the worst gone. I think they’re gone! I have ning my way. time, because the firefighters to go back and find them. I have I was on the West Side High- change shift at 9 a.m. And there’s to go back to the command post. way, so I turned and started run- a family atmosphere at most fire- I have to go back to the tower and ning north with everybody else. I houses around the country. They find them.” jumped into the first alley that I get there an hour or two before She calmed down for a sec- came to, and when I turned into their shift, work out and have ond, and I told her, “I have to go it, there were 20–30 cops and fire- breakfast together. So not only did back, but listen, I’m not going to fighters there, kind of hugging the you have the first shift signed on do anything to endanger myself. wall. People running past us were for duty for a few more minutes, And I’m not going to be able to yelling, “You’re not far enough!” but extra firefighters three, four, call you for a while. I’m going So when we heard that, we all five deep jumping onto the trucks to be pretty busy. I’ll call you as started running. It seemed like I to go to this job. soon as I can. Oh, by the way, call had been running and running for So when that unit went out, my mom in California and let her a long time. Then, all of a sudden, you knew that the original com- know that I’m OK.” She said, “OK. I felt this hot, gas-like air over- pany on duty went out, but we Please be careful.” take me. It felt like hot sand being didn’t know about the four, five Unfortunately, a little while blown at me. additional personnel on the appa- later, she heard that the sec- I’m like, “Oh, God, heavy debris ratus. The same thing happened

ond tower fell and a lot of the has to be right behind it.” So I just with ambulances. People at the P h oto A .J. H e i gh t m an

SEPTEMBER 2011 11 Commisioner Cassano says FDNY is working on changing its safety culture and that everybody has bought into it.

A supervisor in the FDNY command center can have staff send 360-degree scene images or helicopter video to the incident commander. stations climbed into ambulances the debris, from anxiety, from respiratory problems and eye as they went toward the scene. the chest pain and things. But irritation because of the debris So accountability was very when those towers came down, clouds blanketing the area. difficult. it was like a war zone, completely Unfortunately, the devastation Our incident command sys- destroyed. And you suddenly real- from the first tower collapsing tem has definitely changed and ized, we don’t have any patients. left virtually no one around. After improved since 9/11, particularly Now, there were patients even the South Tower collapsed, you in the area of interagency, unified going across the water over to New no longer saw anyone or any- command. That day, we had a lot Jersey, and a lot of our patients thing. You didn’t see bodies after of communications failures and were suddenly gone. the collapses. little face-to-face. Usually our mission is to save And not only did we feel bad So after a few minutes to catch others, save lives, but it became about not having a significant my breath, I went back, again, a preservation of self for a while number of injuries to care for, trying to figure out who was left on 9/11. We were forced to evac- but so did the hospitals. And and who wasn’t. And I didn’t hear uate. And when the towers came they were even more frustrated it where I was, but communica- down, if you were in the buildings, because they didn’t see what’s tions outside that area were still you were unfortunately lost. You going on. EMS was at least on intact. So apparently, they did a were gone. the scene, treating patients. The roll call, calling everybody. But For those who happened to be hospitals never got that chance in there was no response. So every- outside and survived, we began many cases. one on the outside thought every- to encounter waves of people I’ve heard people say that there one was gone. with fractures because people ran were no survivors that day, but The other thing that was hard into things and fell over each that’s not true. We treated hun- to comprehend was that, before other. And a lot of the survivors dreds of people that day. What the collapses, we had a couple and previously uninvolved, inno- many people were unaware of is hundred potential patients from cent bystanders now had severe that when some of the initial EMS P h oto A .J. H e i gh t m an

12 JEMS out of the darkness One of the changes at FDNY is to bring fire and EMS services together more, including in joint training that now takes place. crews arrived on scene—they had seen making that decision to jump were there. the people from inside the eleva- to their deaths from 100 stories Every time I go for my annual tors that were burned by flam- above. I can’t imagine the horror FDNY health workup, and also at ing jet fuel that flowed down the of having to make that choice. It the World Trade Center monitor- shafts and burned and injured haunts me to this day. ing program, they always tell me people inside. There were a lot of You ask whether we are OK, that I have PTSD. So I realize 9/11 those patients that were triaged, and we have to answer that we’re affected me. But I think I’m like treated and moved rapidly from not sure. The panes of the glass most rescuers; we’re not very good the scene very early. The others were very thick, and it was all pul- at caring for ourselves. were trapped above the fire floors verized. So where did it all go? And I, like many others, like to or coming down stairwells inside It got mixed with fuser oil, and think we’re OK. So I’ve told my the buildings. all the stuff that was vaporized family, who have been great at let- I can’t remember it specifically, inside the World Trade Center. ting me kind of get things out, that but I think about 5,800 patients And we inhaled a lot of it. Losing I think I’m OK. But, I’ve also told were seen at the New York City 343 of our own that day was bad them that sometimes it’s very dif- hospitals related to World Trade enough on 9/11, but that number ficult for a person to “see” them- Center with nearly 10% being has grown significantly if you add selves. So I’ve asked them all to admitted. in all those we’ve lost since then. please not be afraid to let me When Flight 587 went down on A few days after the incident, know if I start acting strange, and Nov. 12, just two months after the the experts told us to get rid of at that point I will seek whatever Sept. 11 attack, we were sure it was the clothing we had worn on 9/11, counseling or help I need. the terrorists coming back. [In that but many people had already There are now certain things incident, an American Airlines Air- taken them off at home and that get me sad or angry that bus A300, crashed into the Belle washed them in the same wash- didn’t before. Deaths—in gen- Harbor neighborhood of Queens ing machines they washed their eral—get to me more now. I shortly after takeoff from JFK Air- family’s clothes in. So there has mean, I went to so many funerals port and resulted in 260 fatalities been a lot of fear of the unknown … particularly so many members on board and five on the ground.] and a fear that “they” are going to of our rescue team. They were the At least at the crash of Flight “attack” us again. real first line to go into a complex 587 we had bodies to recover. That I don’t really watch all the spe- incident. We lost so many that our job could be handled in a recov- cials that they have on 9/11, but USAR team could not deploy for ery and packaging manner that we I did go see the movie about several years after 9/11. We lost were accustomed to, unlike 9/11, United Flight 93. A lot of people half of our team members. where there was little to recover. didn’t want to see it, but I wanted I’ve done quite a few World But as many have said, even to see it. I needed to face some of Trade Center lectures that the though we responded and handled my demons. department sent me to, and that it well, it was too soon after 9/11 to What got me the most dur- has been very therapeutic for me, have to deal with all that death. It ing that movie was the time line just to be able to speak about it was like sustaining another head that they showed, because as they and pass along important mes- injury soon after an initial concus- were going through the time and sages to other providers. sion. It impacted a lot of people showing what was happening, I who felt that we just didn’t need was like, “Oh my God, you know, Learning from Tragedy that happening so soon here. seven minutes to go before that Although there was nothing good tower comes down.” And that’s about the World Trade Center Life after 9/11 when I felt it brought too much attack, there have been improve- I still have occasional nightmares back for me. ments in our response to terror- that wake me up. Several weeks My experiences on 9/11 made ism that have occurred since 9/11 after Sept. 11, what actually hit me appreciate my family, friends at FDNY EMS. me hard was seeing or hearing and life more. All the residual The Command and Control Cen- the profiles of all the people lost effects being seen, people get- ter in place today is a testament there, particularly the young ones. ting sick, people dying, scares me to how much we have advanced It made me wonder if any of those because I always fear for not only in our information, communica- profiles were of those that I had myself, but my fellow rescuers that tions, video reconnaissance and

SEPTEMBER 2011 13 In the past 10 years, we’ve dedicated ourselves to making sure this doesn’t happen to us again and to be more prepared.

data capabilities. So I ducked into an open garage ambulances that actually left the We’ve also upgraded our health until debris stop falling. Eventu- scene. I made sure I took my hel- surveillance—not just at the ally, I made my way to the com- met with me because if somebody fire department, but also in the mand post on West Street. [FDNY should find your helmet that’s Department of Health and at the Chief of Department] Pete Ganci usually a sign that you’re dead. I hospitals. We’ve always monitored took command as incident com- wanted to make sure that nobody health trends, but we do it in a mander. I worked as sort of his found my helmet and started look- much more robust manner now chief of staff. ing for me and calling home and because we worry about biological When the South Tower col- all that other stuff. agents as well. lapsed, we really didn’t know what I got to St. Vincent’s, and From the medical aspect, our happened. It wasn’t until we made then nobody was there. Nobody members all have antidote kits, our way out and looked up that we was coming. Nobody was being custom protective garments and realized the South Tower had col- treated. It was a bizarre scene. respirators designed to help them lapsed. That’s when Chief Ganci They were all waiting there— escape a bad atmosphere. We went to his command mode. He doctors and nurses waiting for also have special mobile vehicles was one of the best at it that you ambulances to come in, but no and antidote stock piles through- would want to meet. I needed ambulances were coming. out the city. some truck companies, so I went I was treated very quickly. I was Preparation is still the key. south and spearheaded the rescue banged up a little bit, but I was It’s also important to realize and effort. He asked me to make sure not going to stay there. So I ended accept that, at every incident, the North Tower was evacuated, up getting a ride back to head- nothing ever goes exactly as it if it wasn’t already or being in the quarters in a hospital’s scrubs. I was described in the textbook. process, and set up the command went to the FDOC [Fire Depart- We teach our EMTs, paramed- post further up north away from ment Operations Center] and took ics and officers that they will the North Tower, so that in case command of that because there always have to improvise and that did come down, we’d be out was nobody else there. My job was make things work. of the way. to try get a handle on how many As we always have in New York Pete went south with [Dep- people were missing. We had over City, we continue to learn a lot uty] Chief [Raymond] Downey 500 hundred people missing at from the multitude of drills we and [First Deputy] Commissioner the first count. It was mind bog- conduct. Every time we do a drill, [William] Feehan. I started to tell gling to think that, “Can we lose we try to improve, and after every people exactly what he wanted. 500 people?” drill, we tighten up our processes Then I began to work my way just a little bit more so we’re down back to go meet up with Life after 9/11 ready for the next incident. Pete. That’s when the North We all talk about our careers as, Tower came down. I started to “before Sept. 11” and “after Sept. Salvatore Cassano, run north. Then I didn’t think I 11,” and it’s totally different. It cer- FDNY commissioner was gonna out run this build- tainly has changed the way we do On Sept. 11, I was citywide tour ing, so I dove under an apparatus business. It’s changed our mind- commander in charge of Manhat- and weathered the storm until it set. It’s changed the way we think tan. I was at [FDNY] cleared. I was think- about our job in that we just don’t headquarters [in ing, “I just can’t fight fires anymore. We have so SALVATORE J. CASSANO Brooklyn] when believe I’m going many other responsibilities. In the the first plane hit to die under this last 10 years, we’ve dedicated our- the North Tower, apparatus being selves to making sure this doesn’t and naturally, I attacked.” happen to us again and to be more responded to the When I got out, prepared, better trained and better World Trade Center. I actually couldn’t equipped. We do it in the mem- I was getting out of walk. I had gotten hit ory of the 343 members we lost my car when I heard with some debris. A that day. what I thought was couple of EMTs with One of the first things we did— another explosion. a stretcher came, and was pretty much put into It turned out it was FDNY Commissioner and I was on prob- place only a month and a half after the second plane. ably one of the first Sept. 11 during the crash of Flight

14 JEMS out of the darkness We’re working on changing the safety culture of this department. Everybody’s bought into it.

FDNY EMT Moussa Diaz renders care to a severely burned female patient near the World Trade Center complex on 9/11. Many people were burned when jet fuel shot down the elevator shafts.

587 in Queens—is ensuring that it was even more valuable because fight fires. That’s what we do. We we don’t send all of our top com- it allowed us to pay it forward to go into a building; we evacuate manders to an incident. We lost somebody who really helped us the occupants, and we put the fire Pete Ganci, [Assistant Chief] Don- out. That’s why we thought it was out. And that’s what we thought ald Burns and [Assistant Chief] so important. we were doing that day. However, Gerry Barbara—three of the most We’ve changed our recall pro- we look at things differently now, knowledgeable people we had on cess. We have recall packages much differently. We look at the our staff—on one day, and I don’t now. We only call certain groups— type of incident. If it calls for a want that to happen again. maybe we want to call special defensive position, we’re gonna The incident management team operations people, maybe only take it. was another concept we imple- hazmat people. We can’t have We have never, ever stressed mented. It changes how we plan a total recall anymore because safety in my more than 41 and a an incident. It’s just not opera- who’s going to relieve whom? We half years on the job as much as tions; it’s logistics; it’s finance; know that if we’re going to recall, we have after Sept. 11. If you are it’s command, and you know, the we may recall 25% of our people not safe, you can’t protect the pub- five levels of the ICS. We actually so that there’s 50% of our people lic. We’re working on changing the built our operations center with who would relieve the other 50%. safety culture of this department. ICS in mind. Or we may only call special opera- Everybody’s bought into it. All the lessons learned from tions people because we need res- No matter where you are in the Sept. 11 helped us in 2006, go to cue and squad members. country, if you provide fire and New Orleans and help out the Before Sept. 11, we never ever EMS service, the first and fore- New Orleans Fire Department with thought—even though we had the most thing on anybody’s mind— Hurricane Katrina just like they bombing in ’93—this city would whether you’re a commissioner came up to New York after Sept. ever be hit by a major terrorist or the lieutenant or a firefighter 11 to help us. It was a tremen- attack and that we would suffer the or an EMT—you have to provide

dous. Once we put it into action, losses that we suffered. I mean we for the safety of your members P h oto J e nni fer S. Al t m an

SEPTEMBER 2011 15 An ESU cop started yelling, “Run for your lives. It’s coming down.” I looked up and the top eight stories were leaning over.

FDNY firefighters rapidly evacuate a critically injured patient in a basket stretcher.

and you do that through training, firefighting or medical emergen- for all the different functions. And through planning, through getting cies, including non-medical emer- now, we’re cross training them so the best equipment that you can. gencies, terrorist training, hazmat that they can be interchangeable Not everybody’s budget allows it, training—all the things a fire- at an operation. If you’re a fire- but whatever you get should be fighter has to deal with. We’re pro- fighter, but you know logistics, the best equipment to protect the viding training at every level of this you can be a part of the team. We people who work for you so you job like we never had before from have people in this job who are can reassure their families that staff chief to probationary fire- colonels in the National Guard, when they come into work, you will fighter. We send our staff chiefs to and they’re firefighters in the fire provide for their safety. Provide for all kinds of management schools department. They know how to the safety of your workers so that such as Columbia University, West plan. They know how to be lead- the workers can provide for the Point for Counter Terrorism Train- ers. We’ve looked at all of that. safety of the public we’re sworn ing and our own Fire Officer’s I worry every day about some to protect. Management Institute. Training is sort of an attack whether it’s on a It’s an all-hazard approach the key. subway, whether it’s in the finan- that we take now. It may not be One of the changes is to try to cial district, whether it’s Grand a terrorist attack. It could be a bring together the fire and EMS Central Terminal or Penn Station. tornado. Whether it’s a national services, including the joint train- We have so many different tar- disaster or man-made disaster, ing that now takes place. We just gets here. One of my biggest fears you have to be prepared, no mat- had a medal day event, and we is a Mumbai-style attack, because ter where you are in the country. had a great turn out from EMS for it’s the kind of attack that could If you’re not prepared, shame on what has traditionally been a fire happen anywhere and it is dev- you, because if you are prepared, ceremony, but they have been fully astating in its simplicity. Cops you can handle it. integrated into the medal awards. have a very difficult job in the city We’ve quadrupled our training We have over 200 people trained because it’s so massive.

Da v i d Han dsch u h / New Yo r k Dai ly News since Sept. 11 in all aspects of in our Incident Management Team Preparedness is one of the

16 JEMS out of the darkness Delaney says he doesn’t know why he turned around and ran away from the building. Two of his staff in the lobby perished. things that we founded after Sept. country, the world. Jack 11—the formation and staffing of Being that we were Jack Delaney Delaney, our Center for Counter-terrorism. fortunate enough to retired We needed a special unit with a be able to develop a paramedic chief who has a vested interest. We lot of different plans, I was with New York chose Chief Joseph Pfeifer, partly tools, equipment, Presbyterian for 27 because he was the first chief on procedures, we’d years. I’ve been out scene, and he lost his brother. love to share it. If you since 2006. I had We do close to a 100 differ- think you need help some surgery from ent drills a year with different with a plan and you 9/11 injuries that agencies like the NYPD, Port don’t have people didn’t go exactly Authority, Office of Emergency to put these plans Paramedic (retired) as planned, so Management, Department of together, we have Read his 2001 story here. I’m now disabled/ Health and even the U.S. Marine things that we would retired. Corps, just to name a few. If it love to share with fire departments We were walking toward the does happen, we know how han- throughout the rest of the country building, and an ESU [Emergency dle it. If we can’t prevent it, we on how we would handle an inci- Services Unit] cop on the lower, better make sure we know how to dent. These aren’t secret SOPs. right-hand corner of the build- mitigate it as safely as possible Maybe you don’t have the same ing just started yelling. He said, with the least amount of damage, staffing that we have, but maybe “Run for your lives. It’s coming with the least amount of injuries we can adjust it to your staffing. down.” I looked up, and to me, and deaths that we can. We’re all in this together, it looked like probably the top We needed a lot of help to whether you’re the smallest seven or eight stories were leaning recover after Sept. 11, and we got department in the country or over. I didn’t know whether to run it from a lot of different fire depart- the FDNY. We’re all in this battle into the building or turn around ments throughout the state, the together. and run away from the building.

After the towers collapsed and their contents were vaporized, everything was covered in dust. P h oto Cou r t esy Jo n G e tt y

SEPTEMBER 2011 17 People say that since their 9/11 experience they don’t have the same depths of emotion and now feel less emotion.

Designated staging areas kept ambulances a safe distance away and resulted in many lives being saved.

I figured if we’re going into the were in the lobby ended up get- district. At first, it started with building, at least we’ll be shel- ting killed. the smaller stuff that was coming tered from this piece of the build- When the tower fell, there were down, and then the stuff started ing that’s coming off. Don’t ask like 21 of us, and I mean, every- getting larger and larger and me why I turned around and ran body scattered. But there was larger. By the time these HVAC away from the building. Luckily, a group of us that dove under ducts and everything were com-

P h oto A P/Ma r k L e nni an we did, because our two guys that the stairs over by the financial ing down, we were really looking

18 JEMS out of the darkness One beam came down and decapitated one of those running with him, so, at that point, we felt it was time to take a dive.

Most present on 9/11 said almost everything in the pile seemed identifiable. to take a dive somewhere. One dawned on me that I wasn’t fad- the second building started to came down and just totally ing away. My heart rate started come down. decapitated [someone running to really increase. I was trying So he and I took off into a with me], so at that point we felt to breathe, but I couldn’t. I was bank. We kept going deeper and it’s was time to take a dive. faced down. I don’t know what deeper in the bank. So we were When we took our final dive prompted me to lift my head up, actually inside for the second ... I mean, I felt like Superman. I but I when I did, all the concrete collapse. was about three feet above the dust around was thick. When I After that I went back out. ground, and I was just flying finally was able to breathe, it was I met [FDNY EMS Chief] Andy because air pressure was just like not the most pleasant breath. McCracken. He assigned me to carrying us. It was so dark for so long. I one of the fire chiefs, and we I personally didn’t know what started crawling around the maze. were just we’re doing our thing happened. I was lying faced down Then I saw this window probably as the firefighters were doing on the ground, and there was five feet away. I was going to search and rescue. debris on top of us. I was lying go for it, sort of like feeling my I didn’t know at that time, but face down on the ground totally way. But if I had done that, there my C3, C4 and right shoulder and numb. To be perfectly honest, I was a fire stairwell [between me back were injured. I was probably thought that I was probably dead and the window] that would have numb. I didn’t leave the site until or on my way out, and I was just been like a 20-foot drop had I that evening. One of my crew lying there, just waiting to fade tried to go to that window. came down and saw me just as away. But, I wasn’t fading away. I I descended down the stairs Tower 7 was coming down. They realized that my pulse was prob- and was met on the stairs by threw me in an ambulance and ably in the high 30s after running a maintenance guy who opened took me to the hospital. That that distance. I wasn’t breathing, up a door, and we went into the was probably the first time I got and I was just lying there, but Financial Center. There was a lit- to feel what was going on. But I I wasn’t fading away. I was just tle canteen, and we took bottles signed myself out of the ER. lying there. of water and tried to gargle with We knew we had lost two Then, all of a sudden, I started it. I met one of my other guys in guys. We had been on the radio moving my fingers. All right, so there, and then he and I started with them just before the tower I have got my fingers, and then to walk back because we wanted fell. We knew that they were in

I started moving my feet. And it to go where our crew was. Then the lobby of Tower 2. They were P h oto E d Sa w i c ki

SEPTEMBER 2011 19 A good EMS aide can project what you’re going to do, they watch your back and know how to run interference for you.

one of the first ones, and they very, very fortunate. I obviously The aide serves as the eyes and were asking for additional sup- have severe respiratory prob- ears for the chief, helps the chief plies and that type of thing. I lems—sinusitis, rhinitis, GERD. maintain situational awareness assumed that they were either I have nodules on my lungs. I’m and manages lots of information. trapped or … now with the registry program. The aide helps the chief pro- When I signed myself out of It’s funny because although cess the information whether it’s the ER, it was probably about I’m retired, I’m sort of the liai- documentation, written records, 6:00 or 6:30 that night. I called son with the families of my guys administrative work that the chief their families and told them that who were lost, and I’m still very has to be processing or, in an we lost radio contact with them, heavily involved with the depart- operational sense, dealing with and the last known location was ment staff. I have the best of things like tracking units, keeping in the lobby of Tower 2. That was both worlds. track of who’s got what assign- a hard phone call. Very hard. ment, managing our command Very hard. Zachary Goldfarb, board and communicating on the You know, without going into former FDNY deputy radio. the detail, there’s a lot of rela- chief of EMS When we go to an incident, tionships that are no longer Two days before 9/11, my aide we have two or more frequencies together. It’s a little like telling Mary Merced and I were on a spe- going. We have a tactical chan- tales out of school, but a lot of cial, middle-shift rotation. Every nel where the chief directs the the guys and the gals have said deputy chief did that rotation resources on the scene. We have that they don’t every five to eight a command channel or dispatch

feel that they Zachary Goldfarb weeks. Back then, channel where we’re communi- have the depths FDNY called it a ‘six- cating with the dispatch about of emotion today Charlie’ car. That was what’s happening at the incident. that they had pre- a 10-hour/four shift The aide is responsible for 9/11—that they that ran from 10 p.m. managing the radios and com- are feeling less to 8 the following municating. They really are the emotion. morning. I remem- primary interface. It’s a really We were very ber that rotation well important role because the chief fortunate in because it was just can’t manage everything, espe- that we had a before the attack on cially when things get dicey. peer-counsel- the World Trade Cen- The chief is allowed to select Former FDNY Deputy ing program set ter, and we had just their aide through a selection Chief of EMS up before 9/11. Read his 2001 story here. received our new car process and with some spe- Because as every- (deputy chief’s Crown cific criteria. Once selected and body knows, at least from New Victoria). It was on the Sunday assigned to you and you begin York City, you couldn’t get a night to Monday morning shift, to work together, the chief/aide medic to go for any kind of coun- and it was very exciting. It’s not so team develops over time. seling if your life depended on it often you get a new car. The aide gets to know how because that could block them It had just 70 miles on it. It was their chief thinks and operates. from getting into the police or brand new and had every bell and They know what your intent is fire department. whistle on it. So when we came in when you get to something big Those who know me, if there’s Monday night, we spent the night like the World Trade Center job. a way around something, I find basically setting up the car, get- They know where you want to a way around it. So we had ting all our stuff traded over from position the car, how you intend our peer counseling within the the old car, getting it set up. You to operate, what their role is at department. Two of our coun- know the way life works in this the scene and what equipment selors were actually psychia- environment. You live in your car. you’ll want positioned out at trists. They were our department We even washed and waxed it the scene. They get it out, set it counselors, which made it really and did the wheels. up, move it. And they know how easy. everything works … everything. The bottom line is I guess The Chief’s Aide In the clinical setting, one there’s no rhyme or reason why I The chief and their EMT aide have of my criteria was always that am alive today. I look at it as being to operate as a cohesive team. they had to be an absolutely

20 JEMS out of the darkness The WTC complex was a small imprint in New York City that was larger in population than many small cities in America.

JEMS Editor-in-Chief A.J. Heightman visits with Mary Merced, one of the unassuming heroes of 9/11.

“Cracker Jack” EMT, because, very didn’t want to commute. When you pull into a situa- often, many of the calls we were So when I got to Brooklyn, I tion, you can project what they’re involved in required us to get started looking for an aide. I knew going to do, and, more impor- involved in clinical care. what I was looking for in an indi- tantly, they can project what It was a very important cri- vidual, and the way we usually do you’re going to do. And they know teria for me; to have somebody it is that we talk to the captains, how to run interference for you. who was respected as a clini- the station commanders and ask So we come on duty at 10 cal professional because often for some input. p.m. on Sept. 10th with our new when we got on a scene where Mary was one of several people car all geared up, and we go out a crew was working and needed suggested to me. I involved Marie on patrol. assistance, my aide went to work. Reis in the interviews because I Patrol for an EMS deputy chief And sometimes, they ended up, knew she would be a good judge involves a few things. One is by virtue of their experience and of who would fit with my opera- monitoring the status of the city position, giving guidance to even tional and managerial style. She on a series of radios, listening to paramedics. asked some very pressing ques- whatever is going on. The com- tions and helped me select Mary munication center gives us infor- My Personal Hero as my aide. mation on anything interesting or Mary Merced was my personal That was 1999, so I had a unusual that’s happening. hero of 9/11 because I wouldn’t good two years with Mary as my With my extensive background be sitting here if it weren’t for her. aide before 9/11. That’s impor- in special operations, I was That’s the truth. tant because that two years of always tuned in for anything that I came to Brooklyn from the professional bonding really gives was even the slightest bit out of Bronx in 1999. I had a great aide you that sixth sense about what the ordinary. in the Bronx—Marie Reis. I asked the other person is thinking. You Ironically, we had spent the her to come to Brooklyn with know what they’re going to say, last couple of days actually mak- me because she was exceptional. and you know how they’re going ing the rounds and checking

But she lived in Westchester and to react to a situation. on the status of our specialized P h oto A .J. H e i gh t m an

SEPTEMBER 2011 21 When we pulled out of the tunnel it was also dark, and the air was very turbulent. There was smoke and debris everywhere.

disaster response vehicles, our locations, what resources were sitting in this tunnel. We’ve got a mobile ambulance response on site that could help us—like big incident outside.” vehicles casualty (MARVs) and a first aid room, medical team or So I got out of the car and logistical support units (LSUs). response capabilities—what the started walking forward through At the end of our shift, my nearest hospitals were and what the traffic. boss, Assistant Chief Walter the best road accesses were. Kowalczyk, the Brooklyn division We actually had that in place Tunnel Triage commander at the time, said he before ’93 and used it then. We I got maybe 10 cars down and wanted to meet with me. So we spent a lot of time discussing somebody yelled at me from a laid over a little bit at the end of how we would set it up, partic- private car, “Help me, help me!” the shift and met with him in our ularly if we had debris for 10+ So I looked and asked what the Brooklyn office. So at around 8:30 blocks. We addressed how to problem was. A woman in the car or so, we headed home. create a parameter and where to then reported that her small son, We were driving east—toward locate, move, triage, treat and in a child seat and strapped in Pennsylvania Avenue—and all of transport patients. behind her, couldn’t breathe. a sudden we hear somebody yell- You have to realize that we are I thought to myself, “Shit.” ing on the police special opera- talking about a small imprint in So I go look and see that the tions radio that a plane just hit New York City that was larger in child is breathing but in distress. the World Trade Center. So I had population than many small cit- The mother then said that her Mary begin to reverse course and ies in America. We, in many ways, son had a stoma, that the stoma head over there. considered ourselves the “princes was clogged up by a mucous On our approach to the Brook- of the city,” and we took that plug, and she was trying to get lyn Battery tunnel from Brooklyn, responsibility very seriously. him to the doctor. we could see the tower burning. So we drive into the tunnel, So I said, “All right. As soon It was clearly a significant inci- which was already blocked off as this traffic clears, just pull dent. I was already on the radio by the police. We knew how to to the left as you exit and go requesting resources even though get into the mouth of the tun- straight down the highway to my shift was over because I knew, nel without sitting on the high- Bellevue Hospital.” as the citywide chief, that a lot of way blocked in traffic and started It was a true Tunnel Triage the staff chiefs and folks hadn’t to pipe our way through, going moment. The kid is alert, and my logged onto the radio yet. So I counter-flow—the wrong way. mission is sort of bigger picture took the responsibility for that. We sailed right through the than this one. I was talking to the citywide toll booth and got halfway I go five more cars and look dispatch supervisor. We were through the tunnel and came down, and somebody’s saying, talking about where to position to a dead stop. It was all emer- “Chief, Chief.” It was one of my mutual-aid units and some task gency vehicles, but the tunnel off-duty medics from Station 36 forces, because at that time of was stopped. So as we sat hope- who reported anxiously that his the morning, I knew that build- lessly trapped in the tunnel—not wife works in the Trade Cen- ing was going to be full of peo- moving. I assumed that there ter. He said, “I’ve got to go and ple. And from what I could see was something causing the delay get her.” from a distance, it was not a on the output (World Trade Cen- I again thought, “Oh shit.” Cessna that hit that building. ter) end, but I was not aware that I said to him, “All right, I’ll It was obviously something big the second plane had stuck the tell you what. I’m going to go that hit that big building. It’s a second tower and caused flames pull the traffic. My car is like big incident. And so experience and debris to shower the streets, 10 cars behind you. As soon told me that we were going to forcing the police to keep us as the traffic clears and we exit have a lot of patients. “safe” in the tunnel. the tunnel, just hook up on the We had pre-planned for MCIs So after sitting there for what back of my car. Follow me and at the World Trade Center. That seemed like an eternity (probably be careful. But in the mean- MCI pre-plan was similar in con- just a minute), I said to Mary, “I’m time, go back five cars to a cept to a fire pre-plan. It included going to go pull the traffic, so that woman whose kid is having the best approaches, any unique we can get through” because my trouble breathing. See if you aspects of the buildings like view was, “I’m the chief. I have to can help her out.” Another tri- underground access, staging get to the Trade Center. I can’t be age and delegation moment.

22 JEMS out of the darkness In 2001, we didn’t have video feeds and the “NBC view.” It was like looking at the side of a 70 story tall stick.

A Different World zone. It didn’t collapse on it. So big crazy incident. When we pulled out of the tun- somehow, the high heat, flames So we get out and put on our nel and looked to the right, which and debris after the collapses set helmets, turnout coats and MCI was north on West Street, our it on fire. vests. We also set up our MCI EMS colleague fell in behind us So we start unloading gear out command board. in his car. But now, what was of our new car and put on our We pulled out the stuff that we just an awesomely bright, clear, stuff. We take all our MCI stuff. In needed to manage an MCI. We beautiful day was, on the down- FDNY EMS, we always preached didn’t take triage tags because wind side, nothing but smoke that what you do in everyday triage and tagging was always a and plumes of fire. It was also EMS will go smoother during second-nature thing in EMS in dark, and the air was very tur- a crisis. You have to do triage, New York City, and all our ambu- bulent. There was smoke and debris everywhere. It was just a debris field. I was trying to connect the pic- ture of what I had going into the tunnel with what I was seeing now, which didn’t correlate. And I said to Mary as we were looking up and seeing the South Tower blown out, “Wasn’t that the North Tower that was burning?” Mary responded, “Yes, it was the North Tower.” tagging and transportation every lances and specialty vehicles car- My response was, “But we’ve day, so that it’s automatic. It’s ried a large supply of them. got fire in the South Tower.” part of a routine. Cell phones were not as For a minute, I was disoriented So everything we did was like prolific as they are now. And because my brain was trying to our everyday routine, whether it’s surprisingly, back in 2001, we figure this out, and it wasn’t mak- who’s on the radio, who gives usually didn’t carry our personal ing sense, you know? A plane hit what report or what the process cell phones with us. But this the North Tower; we saw it burn- was that we were doing. What day, we did. We took the depart- ing. But now, we have a massive equipment do we take? What do ment cell phone and our own fire in the South Tower. I didn’t we wear? It’s all routine. When personal cell phones. understand, and now we had all you get to the big, crazy job, it As we walked down the street, this debris. should be just routine. Things I looked up at all this stuff fall- Obviously something else like ambulance staging were ing down. I was thinking, “This is had happened, so I was thinking always practices in New York City. a mess but OK, you know, been something exploded, something One of the hallmarks in our here, done this before. Been at else. Am I thinking terrorism at response in ’93 was our ambu- the Trade Center, big job; we can this moment in time? No, not yet. lance staging. There’s a classic manage this.” I’m really not. picture of West Street completely Then, as I got closer to the So we proceed down West congested with emergency vehi- scene, I suddenly thought, “This Street, and Mary pulled over in cles from left to right, but there doesn’t look like that at all. This a place that seemed like a safe were few ambulances in that looks way uglier than 1993.” place to park. It was a block away, mess because the ambulances There was a lot of debris fall- south of the tower, a half block were staged further down the ing—not big pieces of building from Liberty Street. And that’s street. They knew how to respond. falling, but lots of things flutter- where we found the car two days They were staged where every- ing around. And there were body later, nothing but a bunt out body could get in and get out. parts in the street. shell; our beautiful new car (see So we’ve been doing that stuff So along with the medic from photo p. 27)! right in this town for a very long Station 36, we headed over I didn’t expect the Trade Cen- time. And by having it become toward the North Tower, which ter to collapse on it. And actu- routine, it’s going to happen the was the original incident build- ally, we were out of the collapse right way even when you have a ing. We traveled on the side of

SEPTEMBER 2011 23 After Mary Merced expressed concern about the Tower leaning, Goldfarb and Gombo got everybody inside under cover.

Photographer David Handschuh was saved by personnel from FDNY fire and EMS and the NYPD.

the street where we felt it would with a lot of the technology that paramedic go down to where the be safer—on the west side of the enhances visualization and situ- garage door was located at the street, not the east side. That is ational awareness with cameras. bottom of that driveway and set when we ran into the fire depart- They now have mobile stuff, wire- up the command board there. ment command post. Chief Pete less stuff and can get images of So Mary got it opened and Ganci was there in command, all the exposures and see the was on the cell phone to a dis- may he rest in peace. scene from helicopter level. We patcher getting the list of what They had pulled out of Tower didn’t have any of that in 2001. units were assigned and starting 1, which was where they were Jerry Gombo was in EMS com- to mark it up so we could set up originally. But when the second mand at that time. He was the our accountability board. plane hit, they pulled the com- first EMS chief on the scene. So Mary’s down there with the mand post out of Tower 1 to look I was second. And so, I called other medic, and I’m up at the at the big picture, to see both. him on our tactical channel and top of the apron near the curb. It was located in a good spot; it reported that I was at the fire And I had my orders from Jerry was actually a premiere place for command post in front of the [Chief Gombo], so I yelled down a command post because you Financial Center. to Mary that we needed to go. could see both towers. He told me, at that point, to go I said goodbye to Pete Ganci The strange thing, especially to the lobby of the South Tower [chief of the department] and for people who don’t know high- that had been hit by the second started to walk down the street rise buildings, is that back in plane and take command of EMS toward Tower 2. Now this is sig- 2001, when we were involved with at that tower. nificant: I had my helmet on, an incident about 70 stories in At that point, we were at a which often prohibits you from the air with a fire raging, you large apron to a driveway that led looking straight up or seeing didn’t have the “NBC view.” It was down into an underground park- things happening above your like looking at the side of a stick. ing garage. As I said earlier, it was head because the brim and Now there is a massive fire and a good place to set up. And what I face shield have a tendency to

P h oto d a v i an dsch u EMS operations center complete had done was have Mary and the obstruct your view straight up. So

24 JEMS out of the darkness Everything was covered with what seemed like snow, but it was actually pulverized debris. And the air was hard-to-breathe.

I didn’t immediately understand and went under the North Bridge just kept running. why people were waving their where a bunch of EMS members I literally lunged into that unit hands and motioning to me. set up staging on West Street, and pulled the doors closed. Then all of a sudden I hear north of Vesey. They were coming My next memory was all the Mary yelling, “Don’t go down down with stretchers and equip- debris hitting the ambulance. that street!” ment and stuff. So we gathered I just hear loud boom, boom, Again, this is important them together and I told the cap- boom, debris hitting the truck because it was a verbal clue to tain, Jace Pinkus, to take charge from above and the side. me that there was something off the group and bring them over The front windows were very wrong. I always liked for near the World Financial Cen- opened, and there was a lot of myself and my staff to be calm ter [across the multi-lane West smoke and debris that started and composed. And Mary knew Street Highway]. flowing in the truck. So I dove up that, and she, too, was always a There was a little plaza there front and powered the front cab very calm person. where I wanted them to set up windows closed. So now I hear her yelling, triage. Then, within a short time, I was saying to myself, “Some- “Chief!” and after Mary expressed concern thing real bad is happening out- So I’m like, “What are you yell- about the Tower leaning, I called side.” So I positioned myself ing about?” I knew it was a crazy them and said that they should on the floor, right where the incident, but I didn’t want us yell- get everybody inside under cover cab meets the box because I ing. But she continued to yell, in the lobby area. Mary had a knew that was the strongest part “Chief, just look over your head!” established a “fixed” focal point of the overhead structure. And So I leaned my helmeted head and had a sense that the building then I grabbed an oxygen mask way back and finally saw what she was leaning. off of a shelf and turned on the was yelling about. Big pieces of At the same time, a cop runs unit’s oxygen system so I’d be building were falling, and much by with machine gun and says able to breathe. of it was hitting the ground right that it’s a tactical area under Funny, but I remember being where I would have stepped had attack and we needed to move. It very calm. I wasn’t excited, and Mary not yelled for me to stop. was kind of a scary thing. I was just hoping the metal that There were loud booms, and a So I told Captain Pinkus to now made up the ambulance box lot of heavy debris started hitting get all the equipment, clear the would hold up. And I was con- the ground. street and get everybody inside cerned that my crews and Mary I was like, “OK, I guess maybe the building and away from the were safe. we’re not moving anywhere.” windows. I wanted him to button The radio was silent; nothing So we were now a block closer it up and establish accountability was going on. And I was just to where we left the car. In fact, for everybody who was there. thinking, “Is this it? Is this how this was the area where the first Soon after those orders were the picture ends?” firefighter who got killed. He got under way, Mary said. “Chief! I I thought about my family and hit by a jumper’s body. hear something,” and then yelled, wondered if this was the end of So I called Jerry back on the “Oh my God, it’s coming down!” the story. radio, said I couldn’t make it I get chills telling you this, Then, after what seemed like across the street and asked if but I remember looking up and an eternity—but was probably he had another chief that could seeing what I have described as a minute or two minutes—it access the South Tower. “the cloud of God” coming at us. started to lighten up outside a He said he would get someone That’s the only way I can say it. It bit, and I realized Mary was call- there and asked me to stay where was like, “Fuck!” ing me on the radio. I was and set up liaison with the So we took off running. Mary I answered her, “Are you OK?” fire commander. So I did that. was in the lead, and we were run- Mary was calling me from a And then in a matter of probably ning west on Vesey Street. I saw block away on a tactical radio, two minutes, Chief Walter Kowal- an ambulance in front of me, the not via a repeater. It was point-to- czyk showed up, took that posi- back doors open, saying, “Come point communications. tion as liaison with fire, and he in to me!” This is important for EMS assigned me to go to Vesey and I said, “Mary, let’s get in here,” operations managers to remem- West Street. but she was already past that ber. There was a misconcep- So we then packed up our stuff ambulance when I said that. She tion that FNDY fire and EMS

SEPTEMBER 2011 25 The car was incinerated. It was sad because it was more than a car, it was like our home. We lived in our department car.

had repeaters on the World which was right next to where nuke or something. We just really Trade Center and that the World these ambulances were parked, had no idea. But we’re starting to Trade Center structural collapse and I start collecting my troops think, you know, big picture. Like, affected our communications in and trying to get some situation what’s happening to the rest of a direct way. The reality is that awareness. the city? we did not have any repeaters There now were quite a few We figured it was some kind of there. The best information that people starting to show up and an attack. We wondered if there I have is that the composition of provide me with information, were more attacks happening or the building created electronic some accurate, some inaccurate. about to happen. We had no idea interference like electrons—elec- Things like who was missing, who of the status of our workforce, tronic interference in the air—for was lost, who was buried, etc. where our people were or what a while after the collapses. It was My first objective was, “let me was going on. like electromagnetic interference get these people out of harm’s Then, Chief Gamble came up caused by all the steel falling and way.” So we started looking for with the game plan of how we debris floating around. a better place to go. And so I were going to deal with the situ- She was at a corner on North scouted out an area moving west ation and ordered a withdrawal. End Avenue. So I told her where I from where we were, to North He was anticipating a large was and asked her to meet me so End Avenue where the Embassy number of casualties [because we could find our personnel. Suites Hotel was. We found a we didn’t know the building When I opened the rear doors path through the building and went down in eight seconds]. So of that ambulance, it was surreal headed that way. his decision was that we would and very quite outside. Every- Again, I need to point out that create a large perimeter in the thing was covered with what there was nobody on the radio. Lower Manhattan. seemed like snow, but it was Nobody is answering in the com- So we set up two points. One actually pulverized debris. And mand post, nothing! In fact, I was further north at the Chelsea hot fire. The air was thick and remember thinking, “I’m the Piers, and one was as far south hard-to-breathe. ranking officer left here. Should as we could go, which was the As people said in the 2001 I take command?” Staten Island Ferry Terminal. JEMS supplement [“Cour- Again, I had no idea that the It was decided that these age Under Fire”], “The sound of Trade Center has collapsed. would serve as our staging silence was deafening.” It was I don’t know that. I can’t see areas, and we would put all our totally silent. anything. There’s nothing. It’s a resources there and mobilize But I actually think I have a mess. I have no idea. Just clouds everything from there if we could. memory problem with the sound of smoke and debris. And whatever is on the scene, from that incident. I think my So we got our crews into the let’s try and reconstitute. We also memory turned it off as a defence Embassy Suites Hotel lobby and assumed that we wouldn’t be able mechanism so I would not set up a formal treatment area, to get to the city’s emergency remember the sound of the jump- triage and treatment. And then operation center, which is across ers’ bodies (coming down from we started getting patients. And the street from the north tower in the building), hitting the glass several of our chiefs gathered 7 World Trade, so we decided to canopies on the ground level. there, including Chief Gombo, go to Police Plaza, where the city’s I say that because when I and talked about needing a place former emergency operation cen- watched the video footage of that to like think and strategize a little ter (back up) was located. occurring and heard the sound, bit. So we go burrow our way into Two minutes after we got I instinctively remembered that I the building a little bit to a back everybody into the lobby, Mary heard that sound before. elevator lobby area where we said to me, “Chief, I hear that And that’s the last sound that I could collect our thoughts and sound again!” can recall. I remember the sound try to figure out what the hell was And I’m said, “Shit, it’s not of the debris hitting the top of my going on. Nobody had any idea going to happen again.” ambulance, but I don’t recall the what the hell was going on. And And she said, “Chief, I hear it.” sound of the Trade Center com- none of us knew, at that point, So I believe her and accept that ing down at all. that the building came down. more destruction is coming again. So next, Mary and I hurry back We were on our own, isolated. (We still didn’t know it was an to the World Financial Center, We didn’t know if it was a tactical entire building.)

26 JEMS out of the darkness We were not even partially recovered from this horrible incident when one month later, we had a plane crash in Rockaway.

And so, I said, “All right, let’s just get everybody into the hotel and hopefully, we’ll be safe.” Sure enough, as soon as we get inside, there’s a loud boom, and the Nouth Tower collapsed behind us. Once again, it was outstanding situation aware- ness by Mary. That’s what the aide does for the team. The chief is often focused on a problem or zeroing in on a sit- uation, but the aide has the big picture because one person can’t always process everything. And so the aide is looking at the big picture and saying, “I see this happening again.” And yeah, she got us under cover. She saved our lives.

We Find the Car At this point, we knew what was going on, and we realized we had to organize for a sustained operation. So we were going through this 12-hour on, 12-hour off mode. And so I’m assuming we needed some leadership to Zack Goldfarb and Mary Merced’s new Crown Vic EMS chief’s car set up basically on the overnight after just one day of being put in service on the street. shift so that we’re ready to go strong for the mornings. car. I know where it is. I think it’s wrecked ambulance that was We sent most of the bosses over here.” parked right next to it. And I home to rest. I volunteered to And she was right. It was went on the ambulance and I stay on the overnight shift, so totally incinerated, but the trunk found like a bag we used to put that means Mary is staying with was still propped open as we left blood tubes in, like a plastic me. So basically, we spent the it. It was sad because it was more bag, a Ziploc. I took that little overnight shift doing logistics than a car, it was like our home. piece of PalmPilot chip and put and planning so that we’d be We lived in our department car, it in the Ziploc and sealed it. ready to hand it over to the next so a lot of personal stuff was in And I said, “this is coming home operational period. that car. As it happened, that with me. At least I have some- So now if we move the clock particular day I had brought my thing.” And I walked away from forward, it’s Wednesday morn- laptop to work. My PalmPilot the car and never saw it again. ing at 9 a.m. We’ve been up was there with all the important since Monday night at like 10 papers and resources we worked Life Goes On p.m. We were relieved, and we on, things we accumulated over We were not even partially were trying to find our car to, like, time, all my books like response recovered from this horrible drive home, right? Yeah. That was plans, all sorts of stuff. incident when one month later, if the car was still intact. Things that I had accumu- we had a plane crash in Rock- As I’ve said before, we had a lated over 20 years in the busi- away that, for anybody in our saying that the aide was always ness were all gone. business, would have been a right. So when we got down near There was one piece of my career job. I mean, 285 people where the South Bridge once PalmPilot circuit board that was died on this big plane crash into

stood, Mary said, “I parked the recognizable. So I went to a an occupied community. And by P h oto z a ch ry g o ldf rb

SEPTEMBER 2011 27 Because of the size of crowds that were moving, different sectors were used instead of just a single triage/treatment area.

shit bad luck, it happened that I much of a role did 9/11 play in People have said “Life can go swapped a shift that day, and so that? You know, I guess, we can on, but not with the same cou- I was working. It was Veteran’s say, it remains to be seen. But ple anymore.” In other words, in Day, and I should’ve been off. clearly when I look back on my a lot of cases, people have told We had been doing this cycle life, one thing that happened was me personally, “I go my way. She with the pile at the Trade Cen- the communication in my house- goes her way. It’s not that I don’t ter and trying to get the job back hold broke down. love her anymore; it’s not that I together. But even a month later, Divorce is a personal tragedy don’t respect her, but we could everybody was really smoked. for me. It’s a horrible thing, and not continue down the same Mary and I were having coffee I had a great family, a great wife road.” in a diner. It was 9 in the morning and two great kids. An event like 9/11 totally and all of a sudden, again over When we finally reconnected, changes you. It changed me, and the police radio, cops started probably three days after 9/11 every day has not been easy. But screaming. “A plane is going to and we were together at one you know what? I have nothing crash!” point, I remember the fear and to complain about because I’m And we’re like, “Shit!” So we trauma of my kids and my wife here to complain, so I have noth- throw the food aside and raced when I told my story. ing to say. out. I remember responding I somehow came to some sub- out to Rockaway, and we could conscious thought that I could Final Words of Advice see the smoke pluming up from never have that kind of conversa- You play as you practice. So it’s this thing. But I was thinking to tion with them again because it important that you do the same myself, “Do I go to Rockaway, was too traumatic for them. Right processes during an everyday or is this a diversion? Is there or wrong, that was my decision. event that you want to do at a big another plane going in some- So it was never spoken of event. That can’t be overempha- where else?” again in my house. But you can sized because that’s really what My job was to think big pic- imagine, I spent the next six or gets you ready. ture, so I was totally thinking ter- eight months of my life living that And even though you don’t rorist attack. every day—for extended hours. I need triage tags when you only And that was a tough day. was away 16 hours a day at the have four patients in a car, these There were a lot of bodies there. Trade Center, running the city. So are the things where you build then it just created this huge gap. skill and confidence in your tech- Life after 9/11 So was that the only reason niques. You get good at it—using Healthwise, I really have no com- why we got divorced? No. There your radio protocol, using your plaints. I have some post-nasal were other factors. But that was staging concepts, using your inci- drip, which is from the debris a big reason, and that was prob- dent management concepts. inhalation. They told me that it ably the biggest change in my life. I tell everybody, “You may not will never go away, just continu- The job sent me to a mar- live in a town with big build- ally flush my nose with saline. riage counselor in 2005. Her spe- ings; you may not live in a village I had pneumonia a couple of cialty was 9/11 firefighters, police with subway systems, but bad times. Obviously, they say, “Yeah, officers and EMS personnel who things happen everywhere. And you got stuff in your lungs ...” were having marriage difficulties you never know when something The fact that I was able to dive in the aftermath of 9/11. And she bad is going happen, whether it’s inside that ambulance when the told me and my soon-to-be-ex a tornado hitting in Tuscaloosa or first tower collapsed, and we were wife that she had dealt with hun- Joplin, or some other kind of an somewhat sheltered inside the dreds of cases exactly like ours in attack that we don’t expect. You’d hotel when the second tower col- the past few years. better be trained, equipped and lapsed helped protect me. She said that although life is ready to respond.” I find that it’s very difficult to going on and things seem to be talk to people who are not “broth- OK, maybe not perfect, a huge Jerry Gombo, assistant ers of the flesh,” if you will. Peo- catastrophe happens. And then, chief FDNY EMS ple who would get it. for whatever reason, conversa- I was in headquarters when the And it’s hard to say why, but tion stops, or things start growing first plane hit. I’m an early person. part of my saga is that as time apart. I knew exactly what she was I’m usually here by 6 a.m., review- passed, I got divorced. And how describing to a “t.” ing the overnight shift activities

28 JEMS out of the darkness Your mind protects you. It refers you back to your training and previous experiences and exposure to trauma. and making sure the North Tower. were not at the concourse level. that we progress into JErry gombo So we went in But we saw a lot of people jump- the day tour with and made contact ing from the fire floors and the needed EMS with Chief Peter above as we walked there. You resources. If the sys- Hayden, who at the just needed to look up and you tem needs tweaking, time, was in charge saw what was going on. And you that’s the time you’re of the operations heard it. going to be able to sector. The reason You heard the thud ... thud. do it. Because once they set up in the Initially, we thought it was the world wakes up, lobby was because pieces of the building or parts of the meetings start, that’s where they a plane. The furthest thing from and you’re that much Assistant Chief ­of had the commu- our minds, at that point, was peo- further into the tour. FDNY EMS nications with ple having to jump as a means of It’s much more dif- Read his 2001 story here. the Port Authority escaping what they were expe- ficult to correct or personnel. riencing on the upper floors— tweak resource deployments. We weren’t there very long clearly above the impact. Chief Peter Ganci, the chief before the decision was made Walking near the towers, there of the department, actually visu- that we were going to move the were a lot of body parts. It was a alized the plane going into the command post across the street. rather graphic scene. North Tower. Ross Terranova, an We had a very difficult time trans- People ask, “How did you deal EMS lieutenant assigned to fire mitting via the portable radios with it?” It’s interesting how your operations, and I made our way because we were in the lobby mind protects you, in the sense downtown. Surprisingly, it wasn’t of this huge steel building. We that it refers you back to your difficult negotiating the traffic made our way across West Street training and previous experi- at the time. I think the Brook- in front of 2 World Financial Cen- ences and exposure to trauma. lyn Bridge was actually closed ter, in a large driveway. That’s As an instructor, we developed already because there are always where Chief Ganci and First Dep- drills and used a lot of mou- police officers stationed nearby. uty Commissioner Feehan were. lage. As I was walking into the Although we saw the towers We were able to transmit and World Trade Center, I was think- going across the bridge, it was let the citywide dispatcher know ing, “Wow, what a great movie set difficult to tell the scope of the where the command post was. this is.” You have the body parts incident. But, as we got closer, We had numerous resources lying around and the little pock- the size of the incident was very responding in. ets of burning fuel. evident. Because of the size of the This scene was like walking We parked a few blocks away, area, and knowing the size of through a drill area before you’d and as I walked toward the front the crowds moving, we were zon- allow the rescue workers come of the North Tower on West ing off different sectors instead in and do their thing. And that’s Street, I passed Lt. Bruce Med- of having just a single triage and really how I was able to remain juck and Capt. Janice Olszewski. treatment area. We were putting focused and do what needed to They had already set up tri- them on the four corners of the be done. age areas. I told them, “Don’t World Trade Center campus, a I was not looking up at the impede the flow of people.” When safe distance, so they would not time the second plane hit. How- you have a very large mass casu- be hit with debris. ever, I do remember seeing the alty incident (MCI) with a lot of fire ball out of the corner of my pedestrian traffic and “walking Staying Focused eye and feeling the heat from the wounded,” you have to make sure EMS units were staging at Church explosion. As soon as the second you don’t impede them from exit- and Vesey Streets. At the time, plane hit, I knew it was terrorism. ing. You don’t want to be tram- there wasn’t a significant amount One of my concerns was, what pled by them. Let them go. That’s of reported injuries. We saw a lot if there were chemical mate- really key to be able focus your of people leaving on their own. rials on that plane? I remem- limited resources on the patients Some of the injuries were due to bered listening to lectures from that really need help. people being trampled by other the experts that, should there We were told the command people trying to flee the area. be some kind of incident where post was set up in the lobby of The traumas and the burns there’s a lot of fire, flame, it

SEPTEMBER 2011 29 Gombo says there is no reason to go into the gory details with responders or others that were not “on the job” on 9/11.

would likely dissolve any chemi- cal agents.

First Tower Collapse Shortly thereafter, the South Tower collapsed. There was a loud, steady rumbling. When the rumbling started, everybody began to scatter. The sky got very dark, and the ground began to shaking violently. Some people ran forward toward West Street. We retreated back to the underground parking lot behind the command post. I don’t know what made some people stay on the street and oth- ers go down that driveway ramp. We’ll never know that. We went straight to the under- ground garage. There were about a dozen people down there with us. We all became trapped there for a while because the debris from the towers blocked that whole driveway. You have to keep in mind that this was a huge garage, designed for receiving truck deliveries. It was huge. The whole front of the garage was just covered with debris. Some worried chemicals brought on the plane would be dissolved.

Life-Changing Event department that were involved, Dan Nigro, former Without a doubt, 9/11 changed it was discussed. In that context, FDNY chief of the my life. Like many other survi- you were able to discuss it more department vors, I went through survivor guilt freely. Very few units responded to WTC for a while. My family was very Accountability of crews and for that one call. No units. I can’t supportive. My wife. My kids. My personnel also changed at FDNY think of one, actually. But peo- extended family. after 9/11. The riding lists were ple, yes. Today, I think you would My youngest son was 13 at tightened up to make sure that still have people on the perim- the time. He just got married. My there was an accurate roster of eter. They might not get on the older son was 15. At the time, my everybody on the rig. rig. Certainly if something big children were curious about what On the EMS side, we tightened is going on, there’s going to be happened at Ground Zero, but I up with mutual aid and the vol- a lot of people there. Now, if a never really went into the graphic unteers that assist us, whether on building came down, I don’t think details with any of them. There actual incidents, how they would you’d lose them inside the build- was no need to. report in to a staging location ing, but they would be there. Just There was no reason to go into or at drills. We were clear as to to be there. the gory details as far as the body how they would operate and how On 9/11, we had seven, eight parts and the brain matter and we would utilize them so that or nine people riding some rigs all that stuff even with the adults they would be able to assist with where there would usually be that were not “on the job” there. patient care but not put them at only five. And the few people There was no point in it. When any additional risk. And all their that showed up outside the com-

A P h oto/J erry T o rre n s I was with members of the fire people would be accounted for. mand post, when they were sent,

30 JEMS out of the darkness We are clear as to how crews must operate so that they can assist but not be put at any additional risk.

Shown above is a mobile emergency response vehicle (MERV), now used by FDNY.

Shown above is a mobile respiratory treatment unit (MRTU), which has multiple oxygen outlets located through to provide oxygen to multiple patients simultaneously. P h oto s Cou r t esy FD N Y EMS

SEPTEMBER 2011 31 I’m going to die? Is this how I’m going to die? It just struck me, “What a strange way for it to end.”

The MERVs are used with the MRTU is the rehab sector as well all major incidents.

they were sent like a unit. “Cap- through Times Square now, back to the door, but now a lot of tain, you take these four people you’ll see all the cops with res- firemen and EMS personnel tell and report to Chief … down- pirators strapped to their legs. At me they do that since 9/11. town.” So they were sent in as special events, all the crews wear When I’m at special events— a unit. them. You may not see them like the July 4th fireworks, New worn on the routine call, but you Year’s Eve in Times Square—as Lessons Learned will on any suspicious call. If they much as you go there with the from 9/11 go down to the subway, they’re thought that it is a celebratory Gombo: Our department as a supposed to have them. event, sometimes I go just to be whole takes a different posture It has also caused people to there with my family and not in a when it comes to planning and be more cautious, sometimes to working capacity and find myself training. We’re trained that if it’s excess. Here are a lot of people looking around since I, like all going to happen anywhere, this who always look at their phys- responders, have been trained to is where it’s going to be. And a ical location as a have a keen eye and lot of our safety equipment has potential “job” Dan Nigro see things that most improved with special PPE jack- (incident). They people don’t see. ets, pants, new boots, helmets, are always looking Nigro: For a long gloves, etc. We have radiologi- around even when time after 9/11, peo- cal detectors and carbon monox- they’re on duty or ple were very con- ide detectors. We use them daily, off duty. They look cerned about what routinely, which I would say is a around at a the- was coming next. good thing because the way you ater to see where We all expected behave on a day-to-day, call-to- the exit signs and something else. call basis is the way you’re going doors are. I don’t think I was to react when the big incident Usually, only Former FDNY Chief of alone in expecting occurs. cops would tell you Department (retired) something else to

P h oto Cou r t esy FD N Y EMS If you walk around or drive they don’t put their happen.

32 JEMS out of the darkness Subways are always a concern. If there would be an incident in the subways, it would be extremely problematic.

I often thought, “Was this the World Trade Center will now be Everybody and everything was last act they’re going to commit?” supported from the headquar- just covered by it. It muffled the I thought there’d be another ters FDOC. sound waves. You didn’t hear incident. Soon, I was happily sur- During the Times Square bomb anything. It was just silence. No prised that there wasn’t another incident, they were able to visual- birds. No planes. Nothing. incident. So I think it has gotten ize exactly what was going on and Nigro: The sound of the build- better. But I think, to this day, observe the perimeters via live ing coming down—those 11 sec- most, especially firefighters that feedback. While we were down at onds—is something I will always were working in the fire depart- the Trade Center on 9/11, we were remember. Where I was—it was ment in 2001, are still apprehen- there and we really couldn’t see just my aide and me—it was just sive when they go to work about the forest [for the trees]. an odd sound. If you want to the possibility. I have sons-in-law Nigro: Ironically, the rea- know what it feels like when you and nephews on the job that feel son I probably am alive today think you’re about to die, it feels that way. is because I walked around the very strange. You say, “I’m going Gombo: As a supervisor, when building to get a 360-degree view to die? Is this how I’m going to you tell a crew it is a hard-hat of what was going on like we do die? The World Trade Center job, they better pay attention to at any fire. We could only see this is falling on me. I never would the directive. I always felt that part of the building. So I said, “I’m have thought it.” way, but especially after 9/11. If going to walk around and take a It just struck me, “What a I tell you to stage the vehicles look at what the damage is from strange way for it to end.” over there, I am more emphatic all sides.” I’m sure people think that about it. I only got 180 degrees away same thought if they’re on a As a responsible supervisor/ when the building came down. plane or in a car and it suddenly manager, you want to make sure My size-up attempt probably goes out of control. I survived, you give clear direction, espe- saved my life. But today, the cam- but I still think, “Wow.” You do cially when safety is involved. eras and helicopter video feeds have a few seconds to think And if you need to move or stage provide a few commanders sta- about it. ambulances in a safer area, you tion further away to perform I remember that there was make sure that happens in a those functions remotely. a subway entrance that I could timely fashion. The WTC campus was huge. I have run down, but I missed When I came on the job, you was very familiar with the build- it. My aide and I found a deep were taught how to operate at ings, and that’s why we broke up doorway into a corner. It was a an MCI. Nobody was taught that sectors the way we did. It was just very safe spot. somebody’s out there who wants a massive amount of territory. Gombo: One of the most diffi- to kill first responders. Or, when You had to divide it into manage- cult things for me is that we were you’re at a scene, there may be a able areas. gearing up to treat hundreds, if secondary device. My aide that day, Lt. Ross Ter- not thousands, of people. But Now with the new recruits, ranova, was great. He functioned all that was remaining after the this is a part of their basic train- as my communications officer. collapse was soot, paper and ing. Now more than ever, it is part We worked as a team and really silence. That’s all there was. of the FDNY operation. The new covered a lot of ground. Watched Fire Department Command Cen- each other’s back as well. It’s not Going Home ter is a state-of-the-art internal a one-person operation. Gombo: I went home close to monitoring and command center midnight to see my family and that was established after 9/11 Collapse Aftermath change. I remember that my kids (see photos of the new FDNY Gombo: After the first tower came wouldn’t go to sleep until they command center on p. 8). down and we came out on the saw I was actually OK. I was OK, On 9/11, the FDNY lost so water side of the financial dis- at least physically, at the time. many members and command trict—the only way we were It was very emotional when officers due to the building col- able to get out—it was silent. I walked into my house. There lapses. The world changed dras- As JEMS reported in their 2001 were a lot of people in my house tically. And here we are. This supplement, “The silence was who couldn’t go back into Man- center is staffed and utilized deafening!” hattan, so we had a house full of 24/7. Another incident like the There was soot everywhere. adults and kids.

SEPTEMBER 2011 33 After the collapse, I started hearing the PASS alarms everywhere. It was the most dominating sound around.

FDNY placed triage centers at the four corners of the WTC campus a safe distance away from debris.

When I was initially able to communicate with my family after we made it to 1 Police Plaza after both collapses, my wife heard my voice and knew that I wasn’t myself. She didn’t believe me when I said, “I’m OK.” She thought I was in a hospital somewhere. They all just needed to see me at the end of the day. I wanted to get out of my uni- form and just take a shower and get that stuff off me. The next morning, Ross and I drove back to Ground Zero in our city car, which now had no intact side windows. People had punched them all out. Because of all the soot all around, people escaping from the towers, peo- ple literally punched the win- dows out of the car. They then stuck their heads into the car to breathe fresh air. We initially thought that that falling debris hit the car and broke those windows, but then After the collapses, EMS crews treated many for respiratory distress.

34 JEMS out of the darkness The minute I started talking, I started embracing the whole thing, able to function better mentally and sleep better. we looked around and saw that all the front windshields and the back window were intact. People literally punched the windows out of the car ... to breathe fresh air. When we got to Ground Zero, it was an eerie place. From the silence to ... like ... no desks, no sector for second alarms and we can provide O2 to multiple computers, no walls, no win- greater where every firefighter patients simultaneously. The dows, no nothing. needs to be filtered through. You best part is that our units are give them a quick evaluation. staffed and available for imme- Today Make sure they look OK. Obvi- diate response at all times. The most valuable thing that ously, if they’re complaining of We also now deploy triage we’ve added to our cadre of sup- something, they’ll be assessed. flags on our LSUs. Some of the plies after 9/11 is the everyday We now use our mobile post-9/11 feedback is that they protective equipment that the emergency response vehicles are very beneficial for the large EMS members have: the turn- (MERVs) and our mobile respi- jobs, because you can see them out pants, jackets and their MSA ratory treatment units (MRTU) easily from a distance. They are respirators. Not that there’s a for rehab sector, as well as 4–5' off the ground. When you big opportunity to use them, but patient care at MCIs. The MRTU have firefighters assisting with they’re there if they do need them. has multiple oxygen [O2] outlets the movement of patients, it We now also establish a rehab located throughout the unit so prominently shows them where

SEPTEMBER 2011 35 I have a couple friends who couldn’t deal with the whole situation, just couldn’t take it anymore.

to bring patients when there is a made it into the tube, and they disposal, but I managed to get a large crowd of people. saw there was a red tag, critical pair. Being a medic, I donned it, The two decisions I made on patient from the motorcycle, but and I jumped in one of the vehi- 9/11 at the World Trade Cen- there were also two full buses cles and went down to what’s ter that I feel made a really big that had collided as a result of now Ground Zero. difference was moving our peo- that first incident. Due to the fact that I was famil- ple away from the towers and Thousands of buses travel iar with the guys, they asked if making sure we did not impede through our tunnels on a daily I could set up the forward tri- the flow of people exiting/flee- basis, and there can be at least age with the various ambulances ing the buildings. a dozen buses in each tunnel at that were parked on West Street The operational plan for the a time. So think of the scope of just around the Marriott Hotel. I World Trade Center called for an incident if it involves a tun- guess there were about 15 vari- triage to occur in various loca- nel during rush hour. That’s why ous ambulances from all services tions throughout the facility. But we continually plan and train, there. Afterward, there were pic- because of all the hazards pres- so we’re ready for expected and tures of those vehicles all lined ent and the multiple jumpers, unexpected events. up in a row. we made sure that our crews There was a fire department left the perimeter. In retrospect, Al Kim, executive officer, who waved a team over probably not far enough. But director for to the lobby, and we proceeded under the circumstances at the Westchester EMS to walk toward the lobby. I was time, I thought we did OK. You My title then was the vice pres- between the South Tower and have to work within the confines ident of operations for a pri- the overpass bridge when the of the logistics of the structures vate ambulance company that, at tower fell. involved. If I could, I would pick the time, was MetroCare Ambu- We didn’t have the benefit of a spot for triage and then move lance. Now it’s watching it on tel- it another half a block away for TransCare Ambu- evision or from a Al Kim safe measure. lance. Currently, bird’s eye view, so And also, as I mentioned ear- I am the execu- we didn’t know it lier, making sure that our tri- tive director for was falling. I genu- age and treatment areas didn’t Westchester EMS inely thought it was impede the flow of people was in northern West- another airplane an important decision because chester [County] coming in. There if people were backed up into New York. I man- was no other way to the buildings and the towers age the four Stel- describe the sound. came down, it would have been laris health When we heard this a lot worse. hospital networks roar, it was clearly emergency medi- Executive Director for something incom- Westchester EMS ing. That’s when Future Threats cal services and am Read his 2001 story here. Subways are always a concern in involved in their everybody yelled. New York City. A lot of people emergency pre- So we ran. I ran use the subways as a means of paredness programs. under a New York Presbyterian’s transportation. As is, we have That morning, I was in my truck. I dove under it. I thought vehicular traffic gridlock every office, and I got a couple of I fell because it was so dark. I day. If there would be an inci- phone calls that the plane had thought I fell into a hole. dent in the subways, it would be hit. You know, you automatically The most eerie thing was extremely problematic. think it’s a small, private plane, the sounds of the motion sen- Tunnels are a big concern too. and I thought no more of it. I had sors going off on the firefight- We’ve done walk-throughs of the contacted people at OEM and ers’ coats. I never heard that tunnels to identify ambulance FDNY. They activated mutual aid before. I’ve been doing this for staging areas, because we had and said that it was not a private a long time, and I never knew an incident in the Lincoln Tun- small plane, but rather a com- that that existed. I started hear- nel not too long ago where a call mercial one. ing these alarms everywhere. It came in as a motorcycle struck, So I allocated ambulances. was the most dominating sound and there was one patient. They I didn’t have uniforms at my around that scene. Otherwise, it

36 JEMS out of the darkness When everything cleared up I needed to find my partner, make sure he was OK so could go in and go do our jobs again. was eerily quiet to be honest with department chiefs at that time tradition. I try not to be around you. It was really quiet. and a few of the other would-be it as much as I can. Not because Brian Washburn, Steve rescuers now covered in debris. it’s so traumatizing or anything, Zakheim and I began walking I assumed they looked like me. but, you know, I’ve done it. Now, south, and a guy started waving Somewhere I heard—and I don’t it’s become fun, you know? The us. It turned out he was a pho- remember how, because we had first couple of years, it was to tographer for the [New York Daily] no cell service, and there was not reflect and engross myself in News. He was waving us toward a much radio squawking or trans- the memorials. I went to tons firefighter on the ground. So we missions—that the Pentagon was of funerals. After people I knew went there. I still don’t know why, hit. I can’t speak for everybody, were buried, that served as but I put gloves on. It’s instinct. but looking around as far as our somewhat of a closure for me. Where we found him was eyes could see was, you know, The one last thing I’d like to do incredible. I mean, his entire bat- just destruction. It genuinely felt is to touch the pillar, but I can’t talion was wiped out. He ended as if this was some sort of, like, a get there. It’s in the construction up on the floor just south of new reality. zone. I’ve asked a couple of peo- the bridge overpass. Literally just That’s when people started to ple on the site for permission. outside of that area there was kick into action. You start think- I’m waiting. Maybe I could put “Al buried. He was covered in debris. ing in survival mode, and I dis- was here” or something. I’d like A firefighter and a 430 cop tinctly remember the changeover. to go there with Steve and Brian helped to mobilize him. We took You shake out of your stupor into maybe, just privately. Just touch him one block west into a park- survival mode. that darn pillar. ing garage where there were a There were some officers and bunch of people huddled. One of other personnel who went into Juana Lomi, paramedic the women said she was a phy- the stores. We got water, and That day was a defining day, for sician. She said she’d take care I will never forget putting two me but it was also a day of con- of him, so we left to go look for Snickers bars in my pants pockets firmation of what I, we, live life to more survivors. for—just in case. do. I feel like I have Apparently, Todd Maisel [the It felt surreal. It Juana Lomi made it out of this photographer] took a picture felt like the world one, so I’d better do of us. Months later that picture was ending. It was something. I’d bet- came out in the Daily News. It all “next things” ter keep doing what identified the firefighter as Kevin like, “What do we I’m doing, because Shea. They wrote a feature story do next?” That it must have been on him on the New York Times. faded when I finally God’s will that I They were trying to identify the saw people with should have been other people in the photo, and clean uniforms. there, and I should he made a comment that he There were people keep myself here assumed we all died when the telling me, “You until I can’t do the Paramedic with NYU second tower fell. have to get your job anymore. Downtown Hospital So right after we dropped Shea eyes checked,” that Read her 2001 story here. I am appreciative off, I was walking around West kind of thing, and of life even more. I Street trying to find other people, once that started to happen, I felt say “Wow. The next day, the next fire department personnel or any- a little calmer. second or the next hour, I could one to figure out what to do next. I had a slight corneal abrasion be gone.” Yes, that’s the word, a I’ll be honest. I don’t recall and burn, and I had some burns little more “prayerful.” us wondering about the second on my shoulder. I didn’t know The best thing I did was to start tower. We should have, but we [that] my uniform was burned off talking to people who are not didn’t. I was just one block west my back, but nothing lasting. the general public—people who of West Street when the North lost somebody, so they kind of Tower collapsed. I dove behind Life after 9/11 relate. They see me as a connec- a parking garage door. It was I’ll tell you the truth. I have not tion, and they want to talk to me. already on the ground, and I dove been in New York on Sept. 11 for The minute that I started talking, under it. Again, I was covered. 10 years. I go camping with my that’s when I started embracing I found a couple of other fire friends every anniversary. It’s a the whole thing and being able to

SEPTEMBER 2011 37 When we found out that she was alive that was the one thing that was keeping me together for a while—We saved someone.

function better mentally and able injury, but I had in the field. I’m to sleep better. surgery. It took me Frank Puma still working in the It took me a while to be able like a year and half. same area so I get to sleep. Most people just saw it I recovered, and to see before, after on TV, but I was there. And I had I have come back and now. I think to duck and move away—actually to work. I think I’m that’s what helped see people falling. It’s very hor- mentally capable of me cope with it. rific for anybody to see it from doing the job. Initially, it was like that point of view. As a medic, [My family] a nightmare, and you go to the scene to solve the always worry about you think it only situation. Once you step into the me when I don’t happened to you. scene, there is no more emer- pick the phone FDNY EMT (Retired) For months and gency. Whatever it is, you have to because, initially, I Read his 2001 story here. months, just going resolve it. So that feeling of help- used to spend most through the area, lessness and not being able to of my time off crying I got that feel- help those people falling—actu- and in the room locked up and ing. Then when they actually ally seeing them hit the ground. not really doing much. I started cleaned it up, I had to go on jobs It was very, very tough. I never writing what I was feeling—just there because there is a con- got in the scene where I actu- writing my emotions, what was struction site. ally saw the action of somebody going on. I just put it away, but When I went there for the falling. I only go when they are I’m in the process of trying to first time, I just I felt the goose threatening to jump or they were write a human story—not just bumps, and I felt a hole in stom- already on the ground. I just go 9/11 because of my background. ach and butterflies in my stom- there either to save their life or I come from a very humble ach and discomfort. I still have pronounce. I just remember walk- background. I’m Dominican. I that feeling of, this is sacred, you ing alone and actually walking grew up there, and I had to come know? A sacred place. In the end, around on the remains, and that here. I went to college. I became it’s always going to be. was painful. a volunteer at Beekman [now There was a picture of me from called New York Downtown Hos- Frank Puma, FDNY 9/11, but my face is very differ- pital]. Then I became an EMT, EMT, & Orlando Marti- ent there. It’s very sad and tired. and then I went to medic school. nez, Lt. FDNY EMS It was taken at 2 in the morning, My whole view of life changed Puma: That morning my partner, and I was working. It was sym- from coming from a very small Orlando, came in a few minutes bolic of the time; that’s why he town where everybody knew each late, which is probably the only [the photographer] selected me other to this big city and a new reason I’m sitting here right now. for the picture. He said my face language. Then I came to EMS, We were stationed to EMS Divi- was saying everything. So I said which at the time was a pre- sion 1, Station 4, which is down to him, “Wow. Imagine 10 years dominantly male environment. on South Street in Manhattan. from now. Well I wonder if I will For seven years, I was the only My ambulance was 01-Adam. be here.” female. So my whole view of life Our 89, our official street cor- His name is Joe McNally [for- had to really change drastically. ner, was Vesey and Church. So mer photographer for Life maga- Of the people who responded the Trade Center was our 89, our zine]. He came to look for me. that day, I’m the only one left. cross street location. He witnessed some of what was People leave for different reasons. When he came in, we checked going on when I was triaging My partner, Tamara Drummond, out our truck as usual, and then patients, and then he never saw she went into nursing. People we went to our bagel store to go me again. So he is the one who just moved to different careers or get breakfast. All of a sudden, we actually started looking for me just left EMS altogether. I have heard the loud boom; the ground because he wanted to know what a couple of friends who couldn’t was shaking a little bit, and we happened. He didn’t know if I deal with the whole situation, kind of made a little joke about it made it or not. just couldn’t take it anymore. It’s because that is what we do. I initially had some bubbles a hard life. Orlando and I looked at each like dust in my lungs for a year A lot of people, they are prob- other and I said, “I’ll go outside. that then went away. I had a knee ably so surprised that I’m still I’ll go see what is going on.”

38 JEMS out of the darkness Our patient’s family met us and said, “Thank you. God, you saved her! You gave us our daughter back.”

When I came outside, I saw every- Nothing ever made him change full of blood and he was just like, one running down Church Street. his facial expressions. He is just a “Oh, shit.” We rolled her over, I remember I looked up, and I very dry guy, very funny. and we tried to lift her up a little just saw that big ball of black Martinez: I don’t get too bit. We saw that her whole back- smoke coming out of the top of excited. side, from pretty much her shoul- the towers, and Orlando came Puma: Orlando has a darker ders down to her mid thigh and over to me and asked, “Puma, complexion. When I looked up both of her heels were taken off. what is going on? Puma, what and saw his face, it was as white I mean, you can teach anatomy is going on?” as he was trying as this paper, and I was like, “Oh, class off her. to shake me, and I just couldn’t shit.” That’s when I got scared. Martinez: Her blood pres- speak. I’m like, “Argh, argh, argh,” Martinez: Well, he’s scared. I’m sure is low. She was going into and then I grab my radio. He scared. shock. I don’t think she would ran to grab our ambulance, and Puma: We heard things bounc- have survived. When the whole I just keyed up over the radio. I ing off the top of the truck. We thing came down, if she was still didn’t even hear anything. I just were rattling all around. By the there, she definitely would not keyed up and I said, “01-Adam, time everything stopped, Orlando have survived. a fucking bomb just went off just looked, and I was like, “We’ve Puma: We pulled up to the in the Trade Center” and I just got to get out of here man!” Then hospital, the trauma team came remember the dispatcher going, I said, “Bro, just fucking drive.” running over and they’re like, “Stand by 01-Adam.” I’m like, We headed to NYU Downtown “What is wrong with her?” I’m “Yeah, fuck you.” Hospital, the old Beekman Hos- like, “I have no idea; all I know I jumped in the truck, and we pital. We already had three peo- is that her back is gone.” They’re went right to the corner of Ful- ple on the bench, one patient like, “What do you mean her back ton and Church. We were the in the captain’s chair and one is gone?” I said, “It’s gone.” We first ones there, and we got patient on the stretcher; nothing never expected her to survive, bombarded by all the patients, major. And he said, “Frank, I’m never in a million years. everyone just running out of the being flagged.” We just wiped everything towers. We were pushing all the Martinez: A civilian was flag- down, the back of the truck and people, “Just keep going, just ging me down. I looked down, ourselves, real quick and started keep going. Go that and so I guess I going back up. Orlando was going saw her before right back to the same spot that way. Brooklyn Bridge Orlando Martinez is that way. Go that him. You know, we were, at Fulton and Church. way. Just go.” I guess it’s just Out of the corner of my eye I saw We were there for second nature. a couple of ambulances going a few minutes right Somebody waves down toward the West Side high- before the second a hand, you stop way so I was like, “Dude, follow plane hit. We still and help. them. That is probably where the had no idea it was Puma: She staging area is.” planes. looks OK, you Martinez: I was just going back Orlando was in know? You to Church and Vesey where it the back of the truck couldn’t really originally started. He said, “No, FDNY EMS Lieuten- treating three to see anything. I go let’s go to a new staging area,” ant & Paramedic four patients. I was Read his 2001 story here. up to her head; which was Canal Street. He standing by the side Orlando is down said, “No, no.” I said, “All right, door when we heard by her feet. We we’ll go.” That’s the exact corner the second explosion. I slammed have a long board, and he is [Church and Vesey] where the the side door and Orlando was like, “All right, let’s just throw her buildings came down. already on top of the three on the board just to get out of Puma: We ended up near the patients, and I jumped on top of here.” I go to pick her up, and I World Financial Center on Vesey the other three patients. felt her skin just come up. It felt Street. We got out of the truck Orlando was on the job for, like it was coming off. I was like, to go get more supplies because I would say, at least 10 years at “Oh, that is not good.” Orlando we ran out of things like water the time. I had been there two or grabbed her feet. As he pulled and bandages. three years. He was cool as ice. his hands out, his gloves were Martinez: That’s where I left

SEPTEMBER 2011 39 I kept one of everything. I have it all in a box. I put everything in there, my shield, uniforms … everything.

back toward the West Side High- truck, got out and started to try way, back up to where my ambu- to find my partner, trying to find lance was. I got caught by the anybody I knew from my station. cloud of debris and smoke, and it I found Mike D’Angelo. He gets knocked me right off my feet. in the truck. We heard that they A few minutes past, when were redeploying all of us toward everything was starting to clear Canal Street. up, you’re coughing your brains When we got up there, I saw out trying to get a good breath of my partner, Orlando, doing jump- air, waiting so you can see more ing jacks in the middle of the than two inches in front of your street. He sees me; he sees our face. When everything cleared up, truck; he sees me coming out. I’m covered head to toe in crap, and Puma’s wife Jodi and son Frankie. I didn’t care about anybody else. I needed to find my partner and there he is, not a speck of dust to make sure he was OK so that on him. I go walking over to him now we could go in and go do our and I’m like, “Dude, I thought you jobs again. were dead,” and I go to give him I couldn’t find him. I’m scream- a hug and he was like, “Whoa, ing out, “Orlando, where are you? you’re dirty. Don’t touch me.” Orlando?” Going back to the truck, Martinez: He was filthy, dirty. It running around, and I couldn’t was a Kodak moment. find him. Now I pick up my radio, Puma: That was just his sense and I start screaming over the of humor. radio, “Orlando Martinez, if you’re Martinez: No sense of humor. on the air, say something,” and all It was just nerves. you heard were just the cries of I had heard on the radio. They help. “Somebody help me. We’re said to go north. I don’t think One-year-old Frankie with Puma. trapped” you know, “I’m stuck. Frank had the radio on. Maybe he him—at the ambulance to get Help me. Help me.” It was so bad did, but he didn’t hear it. I knew supplies. to the point that I just turned where he was. I told Frank, “Don’t Puma: And as he was doing down the volume. leave the vehicle.” I guess he lis- that, I started walking closer to As I walked back up to the tened to me. I was hoping Frank the towers, and my phone starts Trade Center, the second tower heard on the radio. ringing. It was my parents. At started to go down. And again, That’s why when they ran this point, I still didn’t know it everything just went dead silent, north, I knew we’ll be all right. was a plane. I answer the phone, and all we heard was the steel Knew he was safe enough. I was and I’m walking back up toward starting to buckle. So this time the closest one to the building the Trade Center. I said, “Listen, I didn’t even look up. I just ran where we get supplies. That’s why I’m all right. I’m OK. I think two toward my ambulance, and I I ran over there. There’s no way bombs just went off in the Trade turned it on and started driving. I would have made it to him if I Center. I’m right underneath the I got maybe about a block away towers.” Click. And that was when before the cloud of smoke caught the North Tower came down. up to me, and I just remember I It was just the eeriest thing just sat there and made sure the because everything was dead windows were closed. I shut the silent. All you heard was the engine off, then everything went sound of the steel starting to black. You could not even see crumble, and then all of a sud- your hands in front of your face. den you just hear “boom, boom, Everything is still coming through boom, boom,” like, the building the vents. I just remember saying, starting to pancake on itself. I “Dear God, just kill me quick, or looked up, and I just saw the top get me through this.” of the tower coming down. I was Then when everything started like, “Oh, shit.” I started running to clear up again, I just parked my Maddalena Martinez, age 4.

40 JEMS out of the darkness It turned out that the emotional roller coaster was that I haven’t found one [patient] to save.

After the towers collapsed, debris completely covered the interior of Martinez and Puma’s ambulance (Unit 01A) where it was parked at Fulton and Church Streets. came over. was them.” All the people who her wedding because her and Puma: He looked at me and he were outside were her family, her fiancé were supposed to was like, “Do not leave my sight so they came running over to us get married like, two or three again.” He was like, “We’re not like, “Oh, thank you. God, you months later, but they had to leaving each other.” saved her,” like, “You gave us our postpone everything because About two or three weeks later, daughter back.” They were hug- of everything that happened. we found out that the lady we ging us, kissing us. They were I think they wound up getting transported was alive. like, “We want to know every- married like two years later, but When we found out that she thing. Give us your names. We she told me that she was going was alive and that she was hit want your addresses.” This, that to dance at her wedding. by the landing gear of the sec- and the other thing, you know, About a month later, I broke ond plane, that was the one thing and Orlando and I just got so my hand, and I was placed on that was keeping me together for caught up in this we were like, light duty. They replaced me a while—the fact knowing that “Uh oh, we’ve got to go. We’ve on the truck. Last year, I offi- we truly did save someone from got to go right now.” It was cially retired after 11 years as an that day. like we couldn’t contain our- EMT because of an injury, and Right after we got off work one selves anymore. I was unable do my job. It was day, we drove up to the hospital. I actually went in two or three funny. When I retired, I went to She was intubated, but she was times after that to go see how return all my equipment and conscious. She was just look- she was doing. I remember the uniforms, and they told me I ing up, and I just see her point- first thing that she told me was was allowed to keep my dress

ing. It was like, “It was them. It that she was going to dance at uniform. I asked them, “Am I P h oto Ad a m S chre i bm an

SEPTEMBER 2011 41 The problem was the darkness, first of all. The complete, total, utter darkness!

I got engaged. Why cleared out OEM just 10 minutes allowed to keep Abdo Nahmod some of my duty wait? You know what after we arrived. A Secret Service uniforms?” I kept I’m saying? Life is agent made it pretty clear. He one of everything. too precious. I left said, “There’s a reported third I have it all in a Manhattan in 2005. plane headed toward the East box. I put every- Then I worked in Coast, and we’re warning every- thing in there: my Queens for six years body to vacate the building.” shield, uniforms as medic. I spent 18 Richie started head- and everything. years on the street, ing uptown. I met Dr. [Glenn] Everything that I and it was a time for Asaeda. We gathered a few vol- had left from this a change. I wanted untary crews and administration FDNY EMS Chief job, I put it in that something different. crews and began to set up triage box, “This is for I became lieutenant in one of the garages downstairs my son, to actu- on Feb. 14 this year. in 7 World Trade—huge garages ally see what I used to do one I like what I do. That’s good. with metal doors that open up. day.” I have all my photo albums I try to lead my men and women I tried to pull the EMTs and and everything there is going to in the right direction. Sometimes medics as close to the building be for him. they don’t understand why I’m as I could because of the debris telling them to do certain things. and the bodies that were fall- Life after 9/11 My experience makes me more ing on to the park in between Puma: Before I broke my hand, aware. I’m there for their safety, Tower 1 and Tower 2. It’s hard to we dreaded going above the you know? I make sure they get describe all your senses at the third floor in a building. We did home. I’m responsible for them. time, but you could smell jet not want to be in any buildings, fuel as you were working there you know? Abdo Nahmod, and hear the pops of debris and Martinez: Every job we had FDNY EMS chief people falling down on all differ- was a skyscraper, on [the] 20th Both Richard Zarillo and I ent directions. floor and 10th floor. I mean, needed transportation [from So we were there approxi- we were a little nervous. That’s Brooklyn], so get this, we had a mately 15, 20 minutes, trying understandable. Usually we stay lawyer driving a car that doesn’t to set everything up. Then the and talk to the patients about have lights and sirens going tower just collapsed. We were what’s going on and do an down to Little Manhattan. pushed all the way back to the assessment. Now, it’s “You want Nonetheless, we managed to landing, wedged between a to go to a hospital? Fine, let’s get over the Brooklyn Bridge. 3' concrete wall and the back go.” We’re out of here, unless He was worried about finding area—Glenn, myself and few of they had an injury to be treated. a parking spot, but we got him other folks. Puma: I can remember as if over that fear. I remember Glenn trying to it happened yesterday. It was The Office of Emergency Man- cover the elderly gentleman who rough because the whole area, agement (OEM) is located on came for triage, and I was trying you used to see people walking the 23rd floor of 7 World Trade, to help a woman who was look- around. All these people we knew so we were walking down toward ing for a kid. Everything at the because we were there every day it and we see a field of debris, front was completely blocked. were just gone. Downtown Man- you know, a big wheel from an The 30' garage was completely hattan was a ghost town. airplane and like teddy bears filled with debris. We managed Driving on the West Side and various parts. to go back through 7 World Highway, I still can’t bring myself Across the street were the Trade and make our way up to look on that side of the street. main two towers, and you can toward the west side. I drive with my head turned the see they were engulfed in flames. Throughout all that, you just other way and hope I don’t hit By then, the second plane had wonder, OK, this event is in a car in front of me. It’s tough. already hit. Manhattan, but there are other I try not to let it consume my At the time, the U.S. Secret things going on in the five bor- life. I still have my issues with it, Service and the FBI had offices oughs. My family was in the things that will never go away. above us, and both the Secret other five boroughs. You know, Martinez: It changed my life. Service and FBI came down and who’s back at headquarters?

42 JEMS out of the darkness Since that day, I don’t take anything for granted. I try not to sweat the small stuff. I value my family and friends.

Who’s still alive? At that point, training for our officers at the the tunnel. One bus hit him, and the things that go through your academy. We reviewed some of one bus was coming the other mind were like, “Where’s Richie the stuff, and then we found that way. As the bus hit him, it slid now? Did he go that way, or did training was very valuable for us, to the second bus, and behind he go that way?” And then this so we got it into the DHS train- it was a third bus that couldn’t whole thing that fell, full on ing model. stop. Three buses and a motor- to the people. We didn’t know. It’s the communication that cycle, just like that. We didn’t know 343 people happens in the face-to-face dia- So I ask myself, is this truly were gone. logue that makes it happen, not just an accident, or is this some- I turned around, went back the technology. When you get thing that has a far deeper plan? toward the towers for the next into an incident of this type, It turned out to be unrelated, two hours in hopes of finding you have to figure out a way but what keeps me up at night more people. It turned out that to collaborate. We’ve had dif- is something cheap, something the emotional roller coaster was ferent incidents along the way easy, and it only takes a group that I haven’t found one to save. where we’ve had to collaborate of people with an interest in a I’ll never forget when I made in order to get the job done. single cause. it home that Friday morning. My And one of the things I’ve tried It’s a very dangerous envi- wife kept the last message I sent. to do is develop these areas of ronment now. I think that EMS “Well, I think I’m going to be late trust, and we’ve done it through has to learn how to work with it. tonight; something’s happened joint training. So there’s been You learn to adapt. You become at Manhattan.” She hadn’t heard a lot more joint trainings since more suspicious. We’ve learned from me since. She said, “Deep 9/11, including full-scale events to work smarter and safer in this down inside, I knew you weren’t with multiple stakeholders. evolving world of EMS. dead, and I knew you were gonna We’ve also embedded folks in come back.” I just had every love the OEM, while working along- Janice Olszewski, feeling that day. side the police department and FDNY division chief others to make up this OEM for The problem was the darkness, Lessons Learned the mayor’s office. We have a first of all. The complete, total, That incident taught us a lot. chief assigned to 1 Police Plaza, utter darkness. It was so pitch First, how do we recall peo- for these inter-agency liaisons. black you didn’t know which way ple? There was no formal recall That never existed prior to 9/11. you were. We were all choking, before 9/11. Now a new, auto- To help pay for some of and I thought I was choking to mated file system includes these things, we death. I thought I everybody from our HIRS sys- have a whole unit was going to die Janice Olszewski tem, which is our resource foun- that works on get- right there. dation system. It has all your ting different types I heard people pedigree information and con- of grants. We want asking for help, tact information. So if there was to look into a few but I was not in a recall tomorrow, we recall cer- different things— the position to tain platoons and start to work. CFRD, some res- either be able to The other thing that we cue training, so we find them or help. learned is sustainability working have rescue med- I was struggling with the Incident Management ics who train with myself. That was a Team from the southwest. That’s the rescue branch. very difficult thing FDNY Division Chief when we got into the planning For surveillance, we Read her 2001 story here. for a caregiver to aspect—that you can plan for have on our boats, do—to know that the next 12 hour tour, use your cameras, helicop- there were people staffing model, set up relief, set ters all connected to the net- who needed your help, yet you up a rotation. We learned how work center command. couldn’t help them. So that was ICS plays a big role on that. a struggle mentally at the time In 2004 and 2005, Mayor Next Steps and since. Bloomberg comes out with I think it’s gonna be a transit I talked to somebody who was CIMS, which is the version incident. Two months ago, they right with me, and he said he of NIMS. We get a lot of ICS had a motorcycle speed down went back after the first collapse

SEPTEMBER 2011 43 It was almost as much of a struggle to get over that mentally than it was physically.

and there was nobody there. ground. I followed the red lights, assigning people to work down Somehow they were either and it got lighter and lighter. I got there. That was another hard helped or were able to get up out of the cloud, and there was thing. I was pretty much in and out themselves. That made the sunshine again. It was amaz- charge of getting the captains me feel better. Nobody was lying ing. It was shocking to me that I to spend about a month at a there. Nobody was buried. I took made it out. It’s shocking to me time down there apart from their that as a good piece of news. right this minute that I made it regular duties. It was difficult [The parked cars] were per- out. Every day I think of that. just because I knew it was hard pendicular to the block, so I I worked 12 days straight with- down there. just felt my hand along them out a break, 16-hour days and in Eventually, I had to try to get and went what I thought was the months after for about a year. a little closure. I had to go back north. I felt like how you might We were working on the recovery to retrace my steps. So I stood feel if you’re in outer space, just effort. Every single day was a con- there, and I looked across the sort of floating without know- stant reminder of what happened. street. It’s difficult to even tell ing which end is up. So immedi- I was working on recovering EMS what was where because it was ately, I was able to just say, “OK, vehicles and equipment. We lost such a mess. that’s a way to go, a way to walk, something like 11 vehicles of dif- But the Millennium Hotel was a way to stay on my feet and just ferent sorts, and there were so still there, obviously, so I went keep going.” many people down there, they to that corner and started there. Slowly, it got lighter and lost virtually all their equipment. I looked at where the building lighter, and I saw a single red Their uniforms were wrecked. used to be, and then I retraced traffic light. Seeing the light That was my role for the bet- my steps I took when I ran away snapped my feet back on to the ter part of the year—that and [from the collapse]. I passed

44 JEMS out of the darkness Here was Pete Ganci, Chief of FDNY, concerned at that moment about John Peruggia’s safety. You never forget that. the church there on the cor- and you got those speakers, and Life after 9/11 ner, and I was marvelling that it your whole chest is going. It was Since that day, I don’t take any- was still there in one piece and like that, only much worse, and thing for granted. I try not to untouched. I saw the subway that then the silence. So you had this sweat the small stuff. I value my I almost went down. People were carnage and this amazingly loud family and friends. I think of it running down there, and I don’t sensation, and then there’s total constantly. I could’ve missed this. know what became of them. I silence. That was so eerie. I could have been killed, and I thought—in the split second that I remember thinking, “I am all wouldn’t have had the chance I had time to think—that it was a by myself, “I am literally all by and to see little kids grow up. I death trap. The smoke could get myself,” which was preposterous appreciate every minute I spend sucked down there, debris could because there were hundreds of with them. pile up, and I thought the lights people around me, but it was so I think I had some classic signs would go out. People would be quiet. And it was so dark. I felt and symptoms of some post all over and on top of each other, incredibly isolated, and I thought, trauma for a while. I had some crowding and get crushed, so I “This is the most alone I’ve ever dreams. I had some depression, kept going. felt in my entire life.” anxiety definitely. I would cry a lot. When I drive past the site, and And the other sound I remem- First I didn’t at all. Then I cried a I do quite frequently, I get lit- ber is the PASS alarms on the fire- lot. That passed after two or three tle butterflies in my chest every fighters. They were not moving, so months. I didn’t have the time for time. I mean all this time later. they’re in trouble. the counseling. I’m tough, you It’s really very affecting. And then the last sound was know? I could get through. So I I did interview for a documen- busting back out in to life onto didn’t [go]. I should have. Even tary not long ago that’s going the street [Broadway] and just if you got over it fairly well, after I to be airing around the 10-year having people carry on their day think it’s just still in there. anniversary, and I cried. I couldn’t like it was nothing. Traffic going, A couple of years ago, I had a believe I did after all that time. It people walking, you know, obvi- very bad car accident, and I had just happened. I was feeling fine. ously looking at what’s going on. a real struggle getting over that I said, “I’m not going to have a But from what I had just been in emotionally. There was kind of a problem; it’s been so long.” to that, the contrast, was amaz- lot of drama going on with that. So then they wanted to redo ing. I just really felt like I came Post that, I had some struggles it, not because I cried, just to do out of hell. emotionally, and the doctors were it again, the whole thing. And I When the second building saying, “Well this could definitely told the producer, “I’m not going came down, I was a little far- be accumulation of 9/11.” It was to cry this time.” Right. All over ther north on Broadway. There almost as much of a struggle to again. In the same spot. were people coming out of the get over that mentally than it was I just had the emotion. Lis- collapses all covered with dust physically. I don’t think it would ten, I made it out relatively well. I and choking and everything, so have been as impactful if I hadn’t mean there are people who died I was trying to organize some gone through 9/11. and people who got horribly hurt, staff to start treating people. I and I’m still feeling this emo- had stopped, and they were look- Department Changes tional. Imagine how they feel. I ing at me like, “You need to go We have become fanatical about can. That’s how strong that kind to the hospital.” So I was like, safety, and I think the people who of trauma is. I think I got a little “Well why?” weren’t there can’t relate to that tiny piece of it, but I understand I wasn’t injured. I had hurt my obsession. They don’t want to do that kind of emotion now. Time thumb, but I didn’t even notice it the safety standards that we want goes by, and all of a sudden, for three days. I kept trying to do to impose. You’ve got these kids something you’ll say, or you’ll things, and I was just out of my who weren’t on the job then, and see something or hear something, mind. I was acting a little nutty, they have no perspective and they and it triggers it. You’ll feel like it I’m sure. Even though I thought can’t relate to it. just happened. I was probably composed, I most I just want them to wear the I remember the rumbling of certainly wasn’t. Finally, one of safety vest on the highway, and the building as it was falling as my supervisors, he kind of pushed they won’t wear the damn safety something that was so deep. It’s me into the ambulance. So they vest, and I go nuts. I’m like “What like when you’re at a rock concert treated me for smoke inhalation. is wrong with you? It’s for your

SEPTEMBER 2011 45 I pulled my way under a truck, and almost immediately, the world was black.

The scene after the collapses was like Armageddon—total destruction and choking air.

safety.” I can’t relate to not doing and the safety. We have mov- upon them that they didn’t something that simple, and they ing devices, but you’ve got to bargain for. We sit together in won’t do it. think about bumping somebody these training classes now and We also got fanatical about along the track. It depends on the do drills together, so we’re get- training. We’ve been pushing patient and their condition. ting to know each other better, incredibly hard since then. We’ve [The relationship between learning each other’s capabili- gotten funding, and we’ve taken EMS and fire] has improved tre- ties and disciplines. It was more advantage of that. There’s been mendously. There’s is a lot more of an awareness of each other on a huge amount of education and cooperation. I think that there scenes. I think it’s much better. awareness about terrorism—any is still a little bit of “us” against I still love the job. I think it is kind of catastrophe really. I’m “them,” but with the CFR [Cer- interesting, and every day is dif- shocked, but grateful, it hasn’t tified First Respondent] pro- ferent. I love that about it, the happened yet. It’s a relatively easy gram, there’s been an increased variety, and I don’t have to worry thing to do, especially simultane- amount of cooperation and about a wardrobe. ous IEDs around the city. respect for what each do. That’s I want to keep people safe We have trained on the sce- gotten much better, and the and to do the right thing by nario where we would have to abilities and acuity of their first the patients—to have more of relay a lot of people. It could be aid is improved, so it’s becom- a global impact. I mean to be deep in the tunnel, so we’re talk- ing more natural. It’s just some- in charge of a whole borough is ing about victim removal teams thing that the probies learn from very daunting, yet to have that and pairing up EMTs with fire- the beginning that this is what kind of impact for safety and fighters with carrying devices to they’re going to be doing. For training is something that I want get them out and having a relay the guys coming on the job, to do. Having been through the system going on, depending it just becomes part of their things that I’ve been through, on the environment, of course, day vs. something that’s thrust I can share that and have a

46 JEMS out of the darkness I didn’t see him again until four o’clock in the afternoon, and I was so angry at him for making me worry about him. certain sensibility about it. I When I arrived on the scene, There’s bodies and debris falling.” want to help out that way. it was about two minutes after I said, “I’m OK. I’m a big boy. I the second plane had struck. I got my helmet.” With that, he took John Peruggia, FDNY saw that it was going to strike the his arm off my shoulder and said, assistant chief of EMS building, because I was entering “I’ll see you later.” I remember I was on my way to the Battery Tunnel and saw this When I found out he was dead, work when the guys called me giant plane headed right to the I remembered that conversa- and said, “Hey, John, a plane just building. And I said, “Oh my God. tion because now it’s ingrained hit the World Trade Center. What This is terrorism.” At that point, it in my brain forever. Here was do you want us to do?” They was not, “Oops, somebody made Pete Ganci, chief of the New York were here at headquarters and a mistake. This is deliberate.” City Fire Department, fighting the I’m like, “Fuck you And I’m think- worst fire disaster in the history of guys.” And I hung ing about what else the world, and his concern at that John Peruggia up the phone, might be happening moment of time was John Perug- because Sept. 11 as I’m driving my gia’s safety. You never forget that. was my second day car through the Bat- After the first building col- back to work after tery Tunnel, think- lapsed, I was working my way a two-week vaca- ing, “Hey, if they back to find the command post. tion. These guys blow up the tunnel, As I’m approaching where the were going to start I’m going to drown.” command post was, some hun- messing with me And it scared the life dred feet from the North Tower, on my second day out of me. And then, I heard that noise and thought, back? As I went no pun intended, I “Oh, shit. I know what that noise Assistant Chief of over the Verrazano saw the light at the means. It means that building is FDNY EMS Bridge and saw Read his 2001 story here. end of the tunnel. coming down.” I heard the noise this massive plume And as soon as I got and simultaneously turned and of smoke, I thought, “Shit. It’s a out of the tunnel, I took a breath started to run. I’m no Olympic plane. And it’s got to be a big one. because I was holding my breath sprinter. I don’t know where the This is bad.” waiting for the walls of the tunnel hell I thought I was going, but I I immediately called back and to collapse. started to run. And I didn’t run said, “You guys need to find a When I arrived, I knew I needed far. Maybe 30', when a firefighter way over there. They’re going to to find the command post. I found grabbed me and said, “Chief, get need help, and when I get there, [FDNY Chief of Department] Pete down,” and grabbed me by my I’ll find you.” Ganci. I said, “Pete, I’m on the shoulders. And in one motion, I was the second officer from way to OEM. I already have some [the firefighter] grabbed me and EMS on the scene in the 1993 guys over there. As soon as I get flung me to the floor and said, bombing [of the World Trade Cen- there, I’ll get as much information “Under the truck.” ter]. And I knew we got our asses as I can. Anything you need right I pulled my way under a truck, kicked with patients and needed now that I can begin to work on?” and almost immediately, the all the possible help we could I remember like it was yesterday. world was black. There were two get. I knew I had really talented He put his arm around me, and trucks. He went under one. I went people working for me in plan- he looked up. I looked up with under the other. It was me under ning here. They needed to get him. Saw the huge conflagration, the truck all alone. I never figured over there and support the com- 70 and 80 stories high in the air. out who the firefighter was. He mand post. They’re going to need He goes, “These are the worst saved my life. people who are forward thinking. fires that we’ll ever see. And we’re The world was black, and I’m EMT Rich Zarrillo was our special not going to put them out. It’s underneath this engine. That event guy. He was the lead liai- impossible for us to put them out. was probably the scariest part. son with Secret Service in OEM. All we can hope for is that we can Because I’m saying, “Gee, am I Abdo [Nahmod] was my planning save some lives.” alive or dead? Am I ever going captain. Those were the kind of And I said, “You sure there’s to be able to get out of here? guys you were going to need to nothing you need right now?” What’s on top of me? Is there a help properly structure and man- He said, “Do me a favor. Be ton of rubble on top of me? Am I age this if it really was a big plane. careful walking across the street. going to suffocate under this truck

SEPTEMBER 2011 47 My wife, at the time, said, “What do you need to watch it for? You were there.” She didn’t understand.

A study shows that mortality of 9/11 responders is nearly 20% higher than for those not involved at the scene.

because I’m going to run out of I was the department’s planning a real eerie feeling, because what air? Is the weight of whatever is on chief. I was there as an intergov- did that actually mean? And what top of me pressing down [so] that ernmental liaison with OEM, so happened to everybody who the tank of water over my head is I didn’t really know what was was there? going to rupture and I’m going to going on in the EMS part. We’re proceeding up to Cham- drown in a muddy bath?” I’d managed big EMS inci- bers Street and West Street where I was wiggling and moving. I dents, but usually I walk in and we decided we would establish a was able to move my legs. Then have an idea of what’s going on. command post. I can hear stuff all of a sudden, I felt tugging at All I know is two of the biggest on my EMS portable, but I wasn’t my leg. It was a couple of firemen, buildings in the world have just able to transmit. It got damaged they were walking down, and they collapsed. There are thousands of under the truck with all the dirt. saw this leg. They pulled me out. people dead. And I had no idea I heard one of the deputy chiefs, It had felt like an eternity to what we were doing, but now J.P. Martin, telling them that he me. In reality, it turned out to I’m going to be in charge. And was leading a task force that be somewhere around 15 or 18 where’s all my friends who were was assembled on Flatbush Ave- minutes. There’s a radio trans- the other chiefs I’ve worked with? nue in Brooklyn, right outside of mission of me assuming med- I ran into one of the staff fire headquarters here, and he would ical command shortly before chiefs who was at the time the fire assume the medical command. 11. So that puts it around the prevention chief. I said, “Where’s With that, I thought, “Oh, my God, 20-minute mark. Maybe 20 min- the command post now? I need he’s not even close to here. It utes or so after the collapse of to get to the command post.” must be true.” the second building, I assumed And he said to me, “It’s only me There was an EMS officer’s the role of medical branch offi- and you, kid. We’re going to take vehicle parked on the road that cer. Prior to the second col- over. You’ll do EMS, and I’ll be we were able to get access to, lapse, I was not in an EMS role. the incident commander.” It was and I came up on the citywide

48 JEMS out of the darkness I’m here at the scene, and unless you’re talking to someone else at the scene, then I’m going to assume the medical command. radio and said, “Listen, I’m here deliver this message.” And then Well, that’s great, but, you know, at the scene, and unless you’re the building collapsed. And then Rich’s my friend for, at that time, talking to someone else at the the other building collapsed. I 18 years. And his wife, Wanda, scene, then I’m going to assume hadn’t seen Rich, and I couldn’t was my friend because we were the medical command.” At which get in touch with him. I thought, volunteers together in the ambu- point, I did. I’d sent one of my best friends ... lance. His daughter and my oldest Martin said, “What do you want and he was dead. were the same age. us to do?” What I was trying to Weeks later, we were reviewing Andy McCracken and I were focus on at the point was col- some video that we had gotten, good friends for a long time. lecting whatever EMS people we and there was a video from one When I saw Andy McCracken, I could get in touch with, to have of the news station that showed was relieved. “Our chief is still them assemble somewhere at a Rich running up to the command here.” At the same time, shortly safe location, just to account for post, being met by Pete Ganci’s after I found Andy McCracken, who we had. And then figure out aide and then being walked over Deputy Chief John McFarland, how we were going to restructure to Ganci. He had his hand around who I had operating at a forward an operation. Ganci’s shoulder and his other operational area at the World I found out that [FDNY EMS arm around [First Deputy Com- Financial Center, called me and Chief] Andy McCracken and some missioner] Bill Feehan’s shoulder. says, “Listen, you’re the first per- others were down at the ferry Rich said, “That’s when I was son to know this; we’re fairly con- terminal, but we couldn’t get telling them, ‘John said to tell you fident we have Pete—Pete Ganci’s in touch with them. Their radio that he has information.’” And as remains.” I went over and I told equipment was down. Peter Car- he’s delivering the message, and Andy. I said, “Andy, I just spoke rasquillo, who’s another EMS he’s narrating for me and oth- to John. They have Pete Ganci’s division chief, showed up out of ers as we’re watching the video, remains. He’s dead.” nowhere and asked, “What do you you see them all look up and Andy and Pete were close. want me to do?” What I wanted run. And then the camera went Andy’s like, “You should tell Dan to say was, “You’re a much senior blank. That’s when the first build- Nigro.” Dan Nigro was the chief chief than I am. Here, it’s yours.” ing collapsed. of operations on Sept. 11, and he But I asked him to go forward The second building was the and Peter Ganci were best friends. and do a forward post and let me one that killed them [Ganci and Dan Nigro was my immediate know what resources he found Feehan]. What happened was boss. He was the chief of opera- or how he could structure. So it they all ran into the garage area tions. But before he was chief began to evolve. of the World Financial Center. of operations, he was the staff So Division Chief Walter Kow- When they came out of that, Rich chief in charge of planning, and I alczyk and I ended up running the said to the chief, “Listen, I want to was his executive manager. Then I operation until 6 a.m. the next go back and look for John.” And got elevated to the chief of plan- morning. I had some injuries, and he said, “Fine. You go make sure ning, just a few months before I was just a disaster. Two of my he’s OK. We’re going to go over Sept. 11, when he became the friends were missing. I had sent to the hotel and see what’s going chief of operations. So I walked Richie, a good friend of mine who on over there.” And then when back over to the command post was working for me, to deliver a the North Tower came down, they and grabbed Chief Nigro. He was message to Pete Ganci that the were killed. there with [former Fire Commis- towers were in imminent danger Rich and I, it turned out, were sioner] Thomas Von Essen. of collapse. maybe less than 20 or 30' apart I said, “Dan, I need to speak to There was someone who we from each other when the second you in private.” The two of them thought was an engineer—only to building began to come down. came over. I said, “This is really find out afterward he was a Secret He went one way, and I ended difficult. I just got notified that Service guy with an engineering up going another way. Then I they found Chief Ganci, and he’s degree—who said, “The buildings didn’t see him again until like dead.” It was like a shock. This are shifting. They’re in danger of 4 in the afternoon, and I was so was the guy’s best friend and collapse.” I couldn’t get through angry at him for making me worry the chief of the department. It on the radio or the phone, so I about him. was really difficult. They imme- sent Rich to the command post. He said, “Well, I knew you were diately went down there, and I said, “It’s really important to OK, bro. I heard you on the radio.” John McFarland met them. Then,

SEPTEMBER 2011 49 There was no way to visualize what was going on 130 stories above the street.

Responders on 9/11 never believed the Twin Towers could collapse. They did within minutes of this photo.

50 JEMS out of the darkness Many responders lost close friends and colleagues on 9/11.

A New York Presbyterian Hospital EMS crew advances on the scene with their equipment. shortly after that, they found “None of our guys would ever do you’d disappear into a hole. Bill Feehan, who was everything that, so get the EMS guys to do That structure was also impor- in this department. He was the it first. Maybe others will follow.” tant for us to ensure we rotated first deputy commissioner. He I wrote a memoriam for Pete people in, so as not to over- was a firefighter. He was a chief Ganci as an acknowledgment in work them. Everybody who was of department. He served every my final paper. there just never wanted to leave rank. It was a really difficult. Today, I think incident com- and to continue to work until we mand is really important. When accounted for everybody, but we Life after 9/11 you just don’t know what the inci- knew we couldn’t do that. It just That day changed your whole dent is going to be, it’s really would physically and mentally aspect on everything. From that important. Not only to ensure have been exhausting. point on, you almost don’t want that your resources are going to When I got home on the morn- to make plans for the future with be structured appropriately to ing of the 12th, I showered and friends or family. You know what? address their mission and serve then hugged my family. Then I I want to wake up tomorrow and our client base, but it’s criti- proceeded to sit on the couch live tomorrow. And if I get through cally important for the safety and put the TV on. My wife, at the tomorrow, I’ll wake up the next and accountability of the mem- time, said, “What do you need to day. And live for that day. Live to bers. Clearly, afterward, it was just watch it for? You were there.” enjoy the moment. Carpe diem. a giant, big mess that we were “Yeah, I was there, but I didn’t Seize the moment, because you searching for bodies. see this. You won’t understand don’t know about tomorrow. You The importance of structure what I saw. And even if I explain just don’t know. was needed to account for peo- it to you, you won’t understand. I graduated from Executive ple, because we had people work- I want to see what everyone else Fire Officer Program. I’m proud ing on piles. We had people saw. See what they thought was of my diploma there, and I was working in confined spaces. We going on. To see how uninformed the first person in the history of needed to ensure we knew who they were of what was happening the department to graduate. And was where and when, because there on the ground.” the reason I went to the program you never knew on that pile if What we heard—the sounds was because Pete [Ganci] said, you’d walk in a spot and boom, we heard and the sights we saw

SEPTEMBER 2011 51 Life has changed significantly for those who were on the scene of the 2001 WTC job.

happened within 24 hours: a grad- uation of my nephews into the fire service, a resuscitation, then we find Bobby. A few months later, I get a phone call saying the cardiac arrest at the probie graduation on New Year’s Eve had survived. He made it home, and his whole fam- ily are firefighters. I was able to meet him. He had said to me that he had wanted to see his grand- son graduate from the fire depart- ment. These little things started to make me feel better. So time went on. We had the closing ceremony in May at the site. I was part of a group of around 70 Boston EMS and FDNY EMS bicyclists that took a memo- rial ride from Boston to Roanoke, Virginia to the EMS Memorial, which was a very heartfelt trip. We had the closing ceremonies, and An ambulance site is destroyed after being hit by falling debris. I continued on with my career. I and the smells that we smelled— So I had to go to work that got a promotion to division chief no video footage can ever dupli- night. When I get off in the morn- from deputy chief in 2004, and I cate it. That was the freakiest, ing, I went down to the site was in charge of Staten Island and weirdest experience I ever had. I because my brother in law, [FDNY Brooklyn South, EMS Division 5. hope to never, ever have to relive Lieutenant] Bobby Regan, was Things went pretty well. anything like that. I hope that no still missing, as well as all the In 2007, I see myself com- one really does. men in his company, Ladder 118. ing up on 30 years of service, I go to bed, but I was having and I decided to retire. I’m now Charles Wells, a hard time sleeping. Around 3 the director of response for the director of response for o’clock, I get a phone call. It’s Red Cross, working with the fire American Red Cross Bobby’s captain, and he says, department. When there’s any On New Year’s Eve 2001, my twin “Charlie, we found them all.” I type of a residential fire or [if a nephews Keith and Kevin Bac- said, “OK, I’ll be right there.” I building is] being vacated due to cari graduated from the FDNY ran down, and where we found eminent danger, we will respond Fire Academy. We all them (Ladder with the team and help the resi- went to the gradua- Charles Wells 118) was in the dents find temporary housing and tion. At the gradua- Marriot Hotel— give them financial assistance. tion, I’m in the lobby, the same build- and all of a sudden the ing I was in when Life after 9/11 doors burst open and the South Tower Since 9/11, my youngest son, a couple of guys are collapsed. When I Craig, has gone into FDNY EMS. carrying this elderly figured out where He’s currently a Haztac instruc- man who is blue, in I was and where tor and looking to become a fire- obvious cardiac arrest, Bobby was with fighter. My oldest son, Charlie, and I say, “Get him on his company, we blessed us with my first grand- the ground.” We start Director of Response were like 75 feet daughter, Emily, who is now doing CPR. The units for American Red away from each 12 years old. My second oldest come, and they get Cross other. son—I have four sons—Chris- him back with a pulse. Three things topher married a beautiful girl,

52 JEMS out of the darkness Thank God for the counseling unit that we have in our department because they’ve been miracle workers, with me anyway.

Marie, and they just had their sec- We were heading east on Lib- the boat. ond daughter, Nora Francesca, on erty toward the south hotel lobby We kept in touch all these Nov. 29. Matthew is the third old- where there were burn victims. years but have not seen each est son of the four. We got within 50 feet of the 10-10 other for the last couple of years. I’m bringing this all up firehouse when we felt this hor- Then this past St. Patrick’s Day, I because out of the total devasta- rible earthquake. It sounded like was marching with the fire depart- tion, things still need to grow and a jet engine, like a rumbling loco- ment. I’m in uniform, and I’m nurture, and fortunately for me, motive. We ran, but it just came walking up Fifth Avenue and all it’s been quite positive. There’ve down on us and pulled us up and of a sudden, there’s a tap on my been setbacks along the way. You tumbled us all over the place. shoulder. There’s Dave, and he get nightmares. You get times When I crawled out of that, I just grabs me and gives me a hug where you have these feelings heard this click-clicking sound, and a kiss. Someone took a pic- of impending doom. Thank God which was the light bar of the ture of us. It was really nice to for the counseling unit that we engine nearby. You don’t see see him that day. have in our department because fire trucks being tossed around So finally, they took me in they’ve been miracle workers, like toys. an ambulance over to St. Vin- with me anyway. I couldn’t breathe. I was wheez- cent’s to get my breathing and In the beginning, I didn’t go ing bad. My eyes couldn’t see. my eyes straightened out. All of because we all were egotisti- It was like being in a fog. My 7th Avenue in front of St. Vin- cal and self-righteous. We don’t corneas were scratched up really ny’s [St. Vincent’s Medical Cen- need that stuff. Then one day bad. I couldn’t see for two days, ter] was lined with stretchers. I said, “Well, it can’t hurt. Let and then my father took me the There must have been a hun- me try it.” After two sessions, very next day to an ophthalmolo- dred stretchers out there, and the nightmares started to go gist, and he treated me. By Thurs- nobody was on them. away, and I started to sleep bet- day I could see. I went back to The emergency room was ter at night. My wife wasn’t com- work Friday when Bush showed empty and I asked them, “Did plaining about me thrashing up down at the site. you guys get people up here?” around, because I would be quite After the collapse of the North And they go, “No, not really.” violent sometimes. Tower, I dug out, and I went to the I say, “Everybody died?” They My health has been very good. west side of the Battery City Park. said they had a bunch in the My lungs have been good. They There was a bodega, and I crawl beginning, but this is like 2 or have deteriorated and devel- through the window. I was clean- 3 in the afternoon. I was there oped some issues, but they actu- ing my eyes out. A voice behind with two cops, two firemen, and ally improved, which is rare. We me says, “Are you Charlie Wells?” we’re looking at each other and have annual medical every year, That was Dave Handschuh, a New they go, “Chief, we gotta get the and that is part of the WTC Medi- York Daily News photographer. He fuck out of here.” Because now cal Monitoring. was instantly recognizable even we felt guilty. It was like, “I’m That day, I was buried, but though he’s completely grayed breathing OK. Let’s get the hell it could’ve been a hell of a lot out. He said, “My legs are broken.” out of here.” worse. There were about 70 or I said, “OK, brother, I’ll you help They had deconned us when 80 people around me who were out.” So we cleaned each other up we came into the emergency also digging out from the Tall and I go, “How many truck bombs room, so all our gear was Ship Pub [in the Marriott Hotel] went off? Then he goes, “There bagged in the garage, which that we ran into. As we were ain’t no truck bombs, Charlie. The has been converted to a decon regrouping out on West and Lib- towers came down.” He was pho- shower. We went back out there erty streets, the second collapse tographing the South Tower, and and started ripping out the bags that was the North Tower blew then when it came down, he got until we found our gear. I just us across this grassy area by the clipped. Some firemen carried put all my contaminated gear World Financial Center and into him into the bodega. He ended back on. We hijacked an ambu- the plate glass windows. up having up a bad fracture. I put lance and made it back down to I was at Liberty and West, him on a police boat, and they the pile job. leading a triage team with fire- took him to Jersey. Someone took I had gotten about 50 EMS fighter Timmy Brown, who was a picture of a fireman, a police persons all together. Everybody assigned to OEM for Rescue 3. officer and me carrying Dave to was wandering around shocked

SEPTEMBER 2011 53 The morning of 9/11, New York Daily News photog- I remember a young, rookie police officer started to rapher David Handschuh was in his car on the West run over to one body, but stopped when I told him ‘there’s Street Highway, sitting in heavy traffic and monitoring nothing you can do for him!’ his scanner, when he heard a Manhattan (FDNY) fire unit Seeing all those falling bodies was a shocking, but announcing that they had just witnessed a plane strike the awakening, moment for me because I knew then how awful World Trade Center. Handschuh, rearranging items in the conditions had to be up on the affected floors to force office he calls his car, looked up and saw a gaping hole in people to choose to jump from that high up rather than the building. remain in the inferno that existed where they were. “Because it was so high up and the towers were so I walked north to south and took some photos, many massive, it looked like the hole was caused by a small of which you are seeing for the first time; I never published Cessna, not a larger commercial aircraft,” says Handschuh. them before this supplement dedicated to the 9/11 first He was on his way to teach a class on photo journal- responders,” says Handschuh. ism at NYU, but instead, he called his office, gave an initial When 2 World Trade collapsed, Handschuh was report and then headed to the scene like hundred of first standing across the street from the Marriott Hotel on West responders. He, as well as well as Rescue 1, were now on Street, just 100 yards from the building. a mission. Theirs was to save lives. His was to record their “When Tower 2 started to crumble, my first inclina- heroic actions for history. tion was to aim my camera toward the sound. But some- “I remember Rescue 1 responding southbound in thing told me that I should turn and run like others were. I the northbound lanes of the West Street Highway. So I did turned and then a powerful surge of air and debris literally what every other news photographer probably would have picked me up, carried me a half block away and tossed me done; I crossed over a divider and followed them all the under an FDNY chief’s Suburban. The debris that came way to the World Trade Center,” says Handschuh. behind me buried me face down. He still remembers the rear doors to Rescue 1 wide Everything got amazingly quiet and. I thought it was open and firefighters waving to him as he followed them all over. Every breath I took was full of that awful, chalk-like to what would be their last alarm. soot. It was choking me. “It’s very sad, but what I was watching was 11 guys I called for help and, after what seemed like an eter- riding to their final call. I think of them every time I seen an nity, a group of fire fighters from Engine 217 in Brooklyn FDNY rescue truck traverse through traffic in the city. When rescued me. I’m sure I would have died if they did not pull we stopped, I parked in what I thought was a safe spot front me out of that debris. of the AT&T building, north of the towers,” he says.” Then two FDNY hazmat guys, Bill McArdle and Jeff Handschuh knew immediately that he was recording Borkowsi, on their way to Tower #2 to do radiological history because, in his previous 21 years as a reporter and monitoring inside the massive structure, saw that I had photographer, he had responded to and photographed a severely injured leg, so they carried me a block away to hundreds of scenes. But never before had he seen an the safety of a delicatessen in Battery Park, just behind the incident scene as multi-dimensional, chaotic and rapidly World Financial Center. evolving as this one. Those two guys later told me that I saved their lives “My first visual memory is that there was a snow- because, had they not stopped to assist me and carry me storm of papers beginning to reach the street level and a block away to safety, they would have been in the tower there were a lot people standing there with their breakfast when it collapsed. in their hands and their mouths wide open. Everything They placed me on the delicatessen’s tile floor. There appeared to be moving in slow motion. were other fire fighters and police officers in the deli, I looked down at the curb in front of the towers and including NYPD officer Jim Kelleher. Suddenly, the ground had an awful visual experience. There, on the ground, shook again and the other tower came down. Kelleher was a popular magazine laying open to a two-page threw his body over me to shield me from glass crashing spread that had a beautiful model on it. And all around in from the deli’s plate glass windows. that intact magazine were body parts. A few minutes later, a big guy in turnout gear Then things suddenly started to get worse because climbed through the deli door. He had been trapped in people started falling from the sky. And, it was not just a the collapse and was seeking water to clear his eyes and few people, but a barrage of humans falling to their death. throat, which were packed with the dust. He saw a ‘fridge

54 JEMS out of the darkness aged his injuries, which included a shattered leg, burns, lacerations to his arms, legs, elbow and neck and respiratory distress. He was then transported to Bayonne hospital by a crew from McHugh EMS. He was off work for nine months recovering from his injuries. “Every September 11th, I meet up the crews from Engine 217 and Lt. Tom McGoff, their company officer after Ground Zero remembrance services and buy them a few cocktails. They saved my life and lost two guys that day. I always meet up with Lt. Tobin as well and give her David Handschuh and Charlie Wells reunited at the a big hug. 2011 St. Patrick’s Day Parade in New York City. I met Charlie Wells again a few months after my leg with soda and water in it, opened it up and started to wash healed. But we hadn’t seen each other for a couple of years out his eyes and mouth. He then yelled, “Anyone in here prior to this year’s St. Patrick’s Day parade. At this year’s want a drink of water?’” parade we had a chance encounter along the parade route. “I remember thinking that the guy looked like Deputy His sons were with him that day so we all met up later that EMS Chief Charlie Wells, who I knew from covering many day and reflected back on 9/11. I had never met his sons, city EMS incidents. But I wasn’t positive because he, like but they instantly knew who I was when he introduced me. everyone in there, looked like a statue—covered in that We spent the afternoon catching up on each other’s lives,” gray dust. So I said, ‘Is that Charlie Wells? Hey Charlie, can says Handschuh. you get me a Snapple?’ Handschuh says that the events of 9/11 had a lasting Charlie looked down at me and said, ‘Who the fuck effect not just on him, but also America. is that?’ “Most of my nightmares are gone after 10 years. Those I replied, ‘It’s David bad memories are like little grem- Handschuh. Can you please get lins that live under your bed. They’re me a Snapple? And he did!” says not bad gremlins; they just come Handschuh. out every now and then and need to Wells, Kelleher and an be exercised. unknown fire fighter then carried him After this incident, we now look on their arms to North Cove Marina at world completely different. We no where an NYPD Harbor patrol boat longer initially think ‘accident’ when was staged. They put Handschuh on we see a Cessna fly off course and the bow of the ship for a quick trip into a building. We react, we remem- over to a New Jersey pier. ber and we think terrorist attack,” “I looked up at Charlie, Charlie Wells, center, with his four says Handschuh. thanked him and told him I would sons, Christopher, Charlie, Matthew Handschuh ended our inter- never forget what he did for me. We and Craig at Craig’s Sept. 15, 2008 view in a philosophical way, noting gave each other a hug and the guys FDNY EMS Academy gradution. that, on a perfectly clear, beautiful left and went back to get their teams day in the city, many first respond- back together,” says Handschuh. ers and survivors of the World Trade Handschuh then encountered Center disaster say “it’s a 9/11 day.” NYPD lieutenant Terry Tobin who, “That’s because, Sept. 11, although badly injured, offered 2001, was a perfectly clear, beau- him what he describes as “emo- tiful day in Manhattan. Then, at tional first aid.” 08:49, it turned into the darkest, “Despite her serious injuries, most ugly day you can imagine. she really calmed me down and Only those who were at or near the used her cell phone to let my family World Trade Center the morning of know my status,” says Handschuh. Charlie Wells and his son, Craig, at 9/11 can understand the meaning The boat took him to a Liberty Craig’s FDNY EMS Academy gradua- of 9/11,” says Handschuh. Island triage area where crews man- tion at LaGuardia College. —A.J. Heightman, MPA, EMT-P

SEPTEMBER 2011 55 We never ate that day. No one ever ate that day.

for a time. So I said, “Come on my mother-in-law and Lynn [wife] The other thing I realized, we over here. Let’s get the gear out were there at the front door, and never ate that day. No one ever of that truck,” and we got about [sons] Craig and Matt came out ate that day. When I talked to three or four stretchers. I said, and met me. Obviously my sis- guys who were there, nobody ate “Let’s see if we can find victims.” ter was beside herself because that day. It was almost 24 hours, We passed this Mexican restau- Bobby hasn’t called at all. I had and I just wasn’t in the mood rant on I wanna say Vesey Street, been looking around all that after- for eating. I think that had to do and I said, “Let’s go in here. Let’s noon and evening and couldn’t with the adrenaline. Your appe- get a drink, some soda,” because find anybody. So I told her, “A lot tite decreases when you’re in that our throats were still burning of guys have been hurt. A lot of fight mode. I just sat there. Then from the dust. wives haven’t heard from the guys Lynn gave me a hug and took So we went in there. There yet, so we have to wait and see.” her mom home. When she came was no power. There was a com- I had a lot of pain in my hip back, I fell asleep in the couch plete blackout in the area, and the and my knees. When the debris that night. I didn’t wanna go to phones weren’t working. But this hit you, you’re black and blue all bed for some reason. phone worked. I said, “You guys over. I deconned myself in the We had the TV on because call your loved ones and let them backyard. Craig talks about it to I told them, “Put the TV on know you’re all right.” So while this day, that there was this big ’cause maybe we’ll see Bobby they get that all done, I went to gray circle in the lawn in the back- or one of the guys from 118.” So the back to get a couple of drinks yard when I was done from all the Craig would always be watching to hydrate us. stuff that came off me. for Bobby. I called my wife, who was at They brought me inside, and I The next day, I knew Bobby

work. I said, “Lynn, it’s Charlie.” took a shower and went into the wasn’t coming back. JEMS She goes, “Oh, where are you?” living room. We just sat there, So I go, “I’m at the Trade Cen- and no one said anything for A.J. Heightman, MPA, EMT-P, ter. The towers came down.” She a good five minutes. Lynn was is the Editor-in-Chief of JEMS said, “You’re not supposed to be holding my hand. Nobody was and specializes in teaching mass there; you’re supposed to be in crying. I think Craig finally said, casualty incident management. Brooklyn.” Her whole mind-set is, “Did you see Uncle Bobby down Teresa McCallion, EMT-P, “Oh that happened in Manhattan. there?” I said, “No, I didn’t see is the editor of EMS Insider and He’s in Brooklyn.” I was assigned Uncle Bobby out there. He’s prob- freelance public safety writer. as deputy chief from Brooklyn.” ably still at work.” So they were That night, when I got home, all, “OK, OK.”

Academy staff wanted this memorial constructed adjacent to the entrance to the facility so that their students and staff would pass the memorial every time they entered and left the training center.

56 JEMS out of the darkness The sponsors of Out of the Darkness.

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SEPTEMBER 2011 57 The sponsors of Out of the Darkness.

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58 JEMS out of the darkness Volume II: Safe Harbor, SEPTEMBER 2011 photo courtesy steven cohen For a few, the emotional damage is less visible and, perhaps, even more insidious.

here’s nothing more pow- were there. The ripple effect of to participate in it. But after 10 erful and compelling than the pain inflicted that terrible day years, several say they may finally Thearing the facts about continues to affect and hurt many be ready for it. It should be made an incident directly from a first- families, friends and loved ones. available to them. person source. We have done We found that many marriages We found that counseling has that in the development of the and relationships dissolved or been offered to the children of four-volume historic report, Out ended in unfortunate divorces responders, but in many instanc- of the Darkness presented here. after 9/11 because some indi- es, it hasn’t been offered to their To do so, we spent time with key viduals couldn’t understand or spouses and significant others personnel in each involved city accept the commitment, respon- who have been left to deal with to discuss the events of Sept. 11, sibilities or emotional baggage the ramifications on their own. 2001, and the aftermath of that being carried by the responder They need help too. unforgettable day. they loved. Those who were hired after We chose the title because so Yet, the people we spoke with 9/11 must be sensitive to those many of those we spoke to report- carry on with their lives. They who were there. And EMS manag- ed how that day went from being shepherd their children to school, ers must be mindful that assign- a picture-perfect day, to one of visit their mom, get promoted and ing affected crews to the same death, darkness and despair in a fall in love. Since 9/11, some have response zones and locations as matter of minutes. Many report- retired, and some have moved on their original source of emotional ed being trapped under debris in from EMS. Most remain with the trauma is not advisable because complete darkness and having to agencies they love, the agency the sights and sounds they’ll be crawl toward a ray of light or the that has been their second home forced to see and hear again can light from another person’s cell and source of comfort when they trigger horrible anger and anxiety. phone to find a source of fresh are down or depressed. It has been our great privilege air. And many report still having But what most understand to get to know these responders. dark, emotional days as a result now, with 10 years of hindsight, They aren’t superheroes. They’re of their experiences, as well as is that they belong to an exclu- ordinary people who did the the sights and sounds associated sive, dreadful club. A club none of very best they could in extraor- with their incident. them asked to join and every one dinary situations. We were struck by the lasting of them would rather not have We wish we could have inter- damage caused by the attacks been inducted into. However, viewed all of the 9/11 responders, on 9/11. For many, time has not they recognize that they have but we could not. However, we healed the emotional scars they been set apart from the rest of hope that what we have crafted sustained. For others, health humanity—damaged in a way no for you are documents that pres- issues caused from breathing one but other 9/11 responders ent not just important historical super-heated, microscopic dust and witnesses can understand. In facts about 9/11, but also the will plague them to the end of fact, many of the responders told many command and control, their lives. For a few, the emo- us they will only talk about 9/11 accountability, resource man- tional damage is less visible and, with others who were there that agement and emotional lessons perhaps, even more insidious. day—other members of the club. that have been learned at each What’s more, the damage from Many could benefit from coun- incident and must be passed on 9/11 doesn’t just affect those who seling but have been reluctant to others.

2 JEMS out of the darkness It has been our great privilege to get to know these responders. They’re ordinary people who did the very best they could in extrodinary situations.

2 Exodus Across the Hudson Caution: Because we wanted to represent the actions and words of these New Jersey After 9/11 providers as true to the 12 events as possible, we have broken our normal policy on not publishing profan- ity. Therefore, some of the The Story Behind the 9/11 Logo portions of the material you The JEMS 9/11 logo was adapted from original artwork are about to read contain created by Robert Zagami. Zagami works for American graphic language. Medical Response (AMR) and was deeply moved by the events of 9/11, so he created the “911 - I Remember” logo for use during EMS week 2001 in his region. He used the term “I Remember,” rather than “We Remember” because he wanted each person who reads it to remember that horrible day when so many lives were lost. He allowed JEMS to modify his original logo and add in the shape of the Pentagon and the map of Pennsylvania to represent the Arlington, Va., and Shanksville, Pa., incidents as well.

Vice President/Publisher: Jeff Berend

Editor-in-Chief: A.J. Heightman Out of the Darkness is a supplement sponsored by Boundtree Medical, Demers Ambulances, Disaster Response Solutions, Emergency Products + Research, Managing Editor: Lauren Hardcastle Laerdal, Oxygen Generating Systems and Southeastern Emergency Equipment, and published by Elsevier Public Safety, 525 B Street, Ste. 1800, San Diego, CA 92101-4495; 800/266-5367 (Fed ID # 13-1958712). Copyright 2011 Elsevier Inc. Contributing Editor: Teresa McCallion No material may be reproduced or uploaded on computer network services with- out the expressed permission of the publisher. To subscribe to an Elsevier publi- Art Director: Liliana Estep cation, visit www.jems.com. Advertising rates are available on request. Contact Elsevier Public Safety, Advertising Department, 525 B Street, Ste. 1800, San Diego, Director of Production: Tim Francis CA 92101-4495; 800/266-5367. Production Coordinator: Pippin Schupbach Production Assistant: Matt Leatherman

SEPTEMBER 2011 3 When the towers collapsed, thousands were killed instantly, and hundreds of rescuers and survivors were trapped or covered in debris.

f the Twin Towers of the of rescuers were in place and had When the towers collapsed, World Trade Center (WTC) set up triage, treatment, stag- thousands were killed instantly I in New York City remained ing and transportation opera- and hundreds of rescuers and intact and did not collapse on tions on all sides of the massive survivors were trapped or covered Sept. 11, 2001, the incident would WTC complex—a sprawling mini- in debris. Victims freed them- have been, in all probability, one city of office towers, hotels, res- selves and became rescuers. Fire- of the biggest mass-casualty inci- taurants and above ground and fighters, EMTs, paramedics and dents (MCIs) ever managed by subterranean stores, plazas and police officers, who often squab- prehospital personnel. Hundreds subway stations. bled with each other because

photo ap photo/ Matt Moyer An injured firefighter is placed onto a boat for transfer to a triage area on a pier in Jersey City, N.J.

4 JEMS out of the darkness Their uniforms, hair, eyes and airways were coated with the paste-like material that swirled through the financial district.

Mickie Slattery personnel managed a seemingly endless stream of urban refu- On 9/11, Mickie Slattery was a gees who arrived by the boatful paramedic on Jersey City Medical for hours within eyesight of Ellis Center’s critical care team. She’s still a Island near Liberty State Park. paramedic, now employed full time by JFK Medical Center in Edison, N.J. This is their story. Mickie Slattery I was down at the [Jersey City] waterfront with Bob [Casey, RN, MICP, of Jersey City Medi- cal Center EMS] and Phelan of traditional pride, separatist trauma care, and psychological [Timothy Phelan, MICP, spe- attitudes, jealousy and inbred first aid. cial operations chief of Jersey professional competition, extri- When JEMS prepared the 2001 City Medical Center EMS] when cated one another and marched Courage Under Fire supplement, the planes hit [the WTC]. We through hellish conditions. the EMS industry’s comprehen- were at Exchange Place hav- They all joined forces to sive look at the EMS response ing coffee. search for, and rescue, any sur- to the 9/11 incidents, a New Jer- After the second plane hit, I vivors they could find. Their uni- sey EMS official reported that looked at both of them and said, forms, hair, eyes and airways his team on the New Jersey side “We just saw two planes hit over were coated with the paste-like of the Hudson had triaged more there. What are we going to do material that swirled through the than 1,000 patients in two hours. over here?” financial district like the omi- When asked how he knew so By this time, people were nous cloud of a hurricane. many people had been man- coming out of the office build- Under that cloud, people ran aged in such a short period of ings down on the Exchange in all directions, many finding time, he said he knew the num- [Jersey City financial district]. I temporary refuge on the water- front. Suddenly, the vast water- Sean Boyle craft flotilla that traverses the On 9/11, Sean Boyle had been a Hudson River and transports Bayonne firefighter for just two years. people to and from New Jersey He was also a per diem EMT with on a daily basis came to their res- EMTAC, the transportation arm of the cue, freeing thousands of injured, St. Barnabas Health Care System. He exhausted and dyspneic individu- now has 12 years on the job with the als from the choking Manhattan Bayonne Fire Department and is back air. It quickly brought them to a at the Jersey City Medical Center as a safe harbor in New Jersey. per diem EMT. Waiting on the New Jersey side of the Hudson were a group of ber exceeded 1,000 because his looked at a battalion chief and dedicated emergency responders agency’s supply of 1,000 triage said, “We have a big problem.” whom most civilians and emer- tags stored on its specialized He said, “Yeah.” And I said, gency personnel outside their MCI response truck had become “No, no, not over there. What region never heard about. exhausted at the two-hour time are they [the terrorists] plan- This “group” was initially less mark. ning on doing over here? Not than 200. These dedicated provid- So while crews in Manhat- the financial center over there, ers could have easily abandoned tan cared for those they could the financial center over here!” their positions on the New Jer- find and rescue—and many who sey waterfront to join the rescue fled the area and became over- Sean Boyle efforts underway in Manhattan, come by the debris and thick, The worst part was that there but they remained at the ready chalky, acrid air that perme- was bad information [early on to manage what soon would be ated the area—New Jersey EMS, in the incident], and the bad thousands of people in need of fire, law enforcement, dispatch information was compounded decontamination, medical and and emergency management by no information.

SEPTEMBER 2011 5 No sooner had I gotten into my vehicle than the first tower began to collapse. Everyone I had been working with died in that collapse.

H. Mickey McCabe H. Mickey mccabe On Sept 11, I was one of the first “official” EMS represen- On 9/11, H. Mickey McCabe was EMS coordinator for Hudson County Office tatives from New Jersey to of Emergency Management (OEM) and reach the WTC site. Having EMS director for the City of Bayonne, had been there in 1993 for the N.J.—a position he continues to serve in first attack, and having had today, 10 years later. worked with Paul Maniscalco and John Peruggia from FDNY EMS at that time, I was aware of the “plan” and the staging areas. However, as I was driv- ing down Broadway toward the for multiple large windows to from my organization. I joined site, I knew this job was going be smashed to allow more to in as FDNY firefighters were to be different. I was shocked exit. brought to the New Jersey by the number of people who While operating at the tow- docks in boat. Only then did I were jumping from windows ers, I was notified by radio that begin to learn of the enormity above the impact floors. there were a lot of people from of the losses suffered. Our plan, which we used in the towers being received on The most shocking state- ’93, included plucking people Ellis Island, which sits right off ment and life-changing words off the roofs of the twin towers the coastline of Jersey City. that I heard in those earliest by helicopter, so I just could Insomuch as that area was in moments were that “all fire not comprehend why they Hudson County and therefore command officers had been were jumping to their deaths. my responsibility, I announced killed,” a reference to the As they would land, their bod- that I had to go back to New many high-ranking and sea- ies would literally explode, or Jersey and that I would return soned FDNY fire command- worse yet, land on someone and bring more help with me. ers who were operating on the at street level and kill that per- No sooner had I gotten into streets below the towers when son also. my vehicle than the first tower they unexpectedly collapsed, Once I got to West and began to collapse. Everyone killing them instantly. Vesey Street, I entered 1 World I had been working with died Trade with members of the in that collapse. Without time Mickie Slattery Port Authority Police Depart- to digest what had just hap- My partner and I were down ment Emergency Services Unit. pened, I drove out of Man- on the waterfront having break- We began evacuation proce- hattan, through the Holland fast with a friend of ours, Dave dures in the lobby. It was hot, Tunnel and was back in New LeMagne, a Port Authority noisy and filled with smoke and Jersey in less than 20 minutes. police officer and also one of our the smell of fuel. At one point, When I arrived at Ellis Island, per diem paramedics. He was a so many people were trying to my son Michael had set up tour chief with us. That day, he escape, it became necessary command, along with others was working Port Authority.

The first attack on the World Trade Center (WTC) they were evacuated from the damaged structure. occurred on Feb. 26, 1993, when a truck bomb was There was no active fire on the upper floors, and detonated in the parking garage below the North multiple people were evacuated from the rooftops. Tower of the WTC. The 1,336 lb. urea-nitrate- Hundreds of fire, EMS and police personnel were hydrogen gas-enhanced device was intended to strategically positioned throughout the structures knock the North Tower into the South Tower, and in designated triage and rehab sites on desig- bringing both towers down and killing thousands nated floors of the towers. of people.1–3 The second attack, on 9/11, presented rescuers It failed to do so, but it did kill six people with a multitude of hazards and obstacles when the and injure thousands, many of whom spent hours massive passenger airplanes full of fuel were flown in the dark navigating down smoky stairwells as into the towers. The planes sliced through the struc-

6 JEMS out of the darkness I remember it was a beautiful morning. But that beautiful day suddenly turned ugly.

Personnel triage and assess hundreds of patients being brought to them from Manhattan.

We were just sitting there “Well, I gotta go. That’s ‘our’ you heard it hit. Dave LeMagne watching all the people go by. building. That’s where our caught the last PATH train going I remember it was a beautiful offices are.” through from Exchange Place [in morning. But that beautiful day We said, “Dude, stay here Jersey City] to the Trade Cen- suddenly turned ugly. with us. Don’t go over there. ter. He worked constantly once And all of a sudden a fire We’re probably going to need he got on scene. There are pic- ball came out of Tower 1. I you here anyway.” tures of him coming out of the was in the ambulance listening But he left us. And a little while tower carrying a victim. He did to the news. At first they said later, we watched the second that right up until the first tower it was a helicopter. Then they plane hit. Bob Casey [mobile came down. said it was a small plane. Then intensive care nurse] said, “Here they upgraded it to an airliner. comes another one.” And with Eileen Van Orden So, with that, Dave said, that, you just saw a plane, and They say that when he was tures, incapacitated elevators, collapsed stairwells References and ignited fires that trapped thousands above the 1. Whitlock C. (July 5, 2007.) Homemade, Cheap and fire floors. The fires forced many occupants to jump Dangerous. In The Washington Post. Retrieved Aug. 10, more than 100 stories to their deaths. Therefore, 2011 from www.washingtonpost.com/wp-dyn/content/arti- emergency crews were not able to enter, reach and cle/2007/07/04/AR2007070401814_pf.html. set up identical operations at the 9/11 site. 2. Childers J, DePippo H. (Feb. 24, 1998). Hearing on “Foreign The 1993 attack was planned by a group of con- Terrorists in America: Five Years after the World Trade Center.” spirators. In March 1994, four of the terrorists were In Internet Archive Wayback Machine. Retrieved Aug. 10, convicted of carrying out the bombing. The charges 2011 from http://web.archive.org/web/20071227065444/ included conspiracy, explosive destruction of prop- http:/judiciary.senate.gov/oldsite/chichild.htm. erty and interstate transportation of explosives. And in 3. Wright L. The Looming Tower: Al-Qaeda and the Road to November 1997, two more terrorists were convicted. 9/11. Vintage. 178. 2007.

—A.J. Heightman, MPA, EMT-P P hoto Courte s y R ee n a o e Si b aya / T he Jer ey Jour al

SEPTEMBER 2011 7 When we got over to the pier, there were already patients streaming in.

eileen van orden because most were shell- shocked. People were very On 9/11, Eileen Van Orden was a para- open to suggestions. medic with Jersey City Medical Center (JCMC). She’s still an active paramedic with JCMC. Mickie Slattery Yes, you could have told them to “go over there and sit in the corner and cry,” and they would have.

Ed White We herded them like cattle. found, he had a stair chair with phones lit up. Agencies said, him. In the one photo, he’s “You’re getting casualties Dr. Bob shown carrying a victim on a because everybody who’s sup- There was a construction site door! posed to be able to help is there, with an air-conditioned dead.” trailer in it. There was an iron Dr. Bob So we spent the next hour fence around it. We told five It was like Dunkirk. You have on the Jersey City waterfront big construction guys to “get to understand. People were between 70 and 90 Exchange rid of the fence and open up jumping into the Hudson River Place, at the York Street Pier. that trailer,” and they did with- and swimming. Fishing boats, That’s where we started the tri- out argument. pleasure boats, anything that age area. They attached some kind of could float. Initially, it was just me and a crane or something to it— that cop. Bob Casey and Pablo pulled the hell out of it. Within Mickie Slattery Lopez were coming in, and a few minutes … it was gone! When we saw the second plane then Martin drove a mass casu- And then we were able to put come in and hit, and heard him alty response unit (MCRU) the asthmatics who couldn’t throttle up before he hit the down to us. breathe into the air-condi- second tower, we knew it was When we got over to the tioned trailer. intentional. It was like watch- pier, there were already People also brought down ing fireworks. It was dead silent patients streaming in. And to roller chairs from the office for that second after impact, complicate matters, we had a complexes. And they started and then you heard the explo- lot of people coming out of wheeling people in with office sion. And that’s when Timmy the buildings near the pier. We chairs. The other thing civilians Phelan [our tour chief] decided had to block those people from did was rip Venetian blinds off we needed to come up [to the entering where we were trying the office windows and pile waterfront]. to set up. them up because we ran out We have a comprehensive of splints. disaster plan because we’re Sean Boyle We used the Venetian blinds second due for New York City. It was relatively easy to take and wrapped cord around So we returned to the hospi- control of people that day them as splints. tal to review it and stock our ambulance with whatever we robert lahita could. On 9/11, Robert Lahita, MD, PhD, was We got some fresh radios a physician and EMS medical director and were sitting down in the for Hudson County. He’s also known tour chief’s office when we saw affectionately by his EMS friends as the first tower came down. “Dr. Bob.” Today he is vice president, And then we started getting chairman of medicine and director of reports of boats coming over quality at Newark Beth Israel Medical from Manhattan with lots of Center (part of the St. Barnabas Health Care system). injured on them.

P hoto s A .J. H eight m a n Our communications center

8 JEMS out of the darkness When people came off the boats, many didn’t talk [much]. They just said, “I want to go home.”

Mickie Slattery ed white People were literally lined up and waiting around to help us On 9/11, Ed White was the chief fire alarm operator with the Hoboken Fire ... they just walked out of their Department. Today, he remains active offices with chairs wanting to with Hoboken Volunteer Ambulance help get people off the boats. Corps. and serves as a trustee on the agency’s board or directors. Dr. Bob When it became clear we needed more bandages, I remember someone saying that there were those commer- cial first aid boxes on the walls Mickie Slattery Trying to get word to people in the offices nearby. So we When people came off the at home was the worst. We had sent people inside, and they boats, many didn’t talk. They no cell phones. There was no ripped all these boxes off the weren’t sure of what hap- communications. Then employ- walls and brought them down pened. They just said, “I want ees from a computer company in stacks to us. to go home.” at 90 Exchange Place came I had an oxygen tank in I remember one guy from outside with two 4'x 8' folding the back of my car, but when Hatzolah Ambulance Service tables and ran phone lines out we finally needed to use it, who had two fractured legs he to them. They said, “Here, call we couldn’t find the wrench. sustained when the towers col- home. Don’t worry about where I remember running around lapsed. He gave me his tour- you’re calling. Just make sure yelling, “Where the hell’s the niquet from his glove pouch. someone knows you’re alive.” wrench? Goddamn wrench!” I started his IV with his own There were also people who That’s all I needed was a tourniquet, and I gave it back were burned or whose clothes wrench. to him. got destroyed. As we were

Paramedic Mickie Slattery assesses an injured patient soon after his arrival at a Jersey City pier. P hoto Courte s y R ee n a o e Si b aya / T he Jer ey Jour al

SEPTEMBER 2011 9 We triaged and deconned anywhere from 21 and 2,200 people, but only ended up transporting 179.

decontaminating and treating at the same time. One of them back via the trains from New them, people came out of one was coming from uptown; one Jersey—back to New York. building with their arms full of of them from downtown. So, So until the authorities deter- what looked like janitorial uni- not wanting any cross-contam- mined whether the trains were forms and hung them up for ination, we set up two differ- safe to use, these people were people who needed clothes ent lines for people. If they just milling into the area. We to use. were covered in debris, we then had a crowd-control issue sent them in one direction. that the police had to manage. Ed White Everybody on the “clean” ferry I remember at one point We were yelling, “We need was sent in another direction three firefighters in FDNY turn- water!” and the next thing you We actually did something out gear came up to the street know, C&C Cola Company the military said it couldn’t do; level, having just gotten off a came in with two trucks filled we decontaminated anywhere PATH train. I said, “Guys, what with 64-ounce bottles of water. from 11 to 12,000 people. are you doing here?” The Hoboken Fire Department They said to me, “Where are Mickie Slattery hazmat team did a great job, we? Are we in Manhattan?” Walgreens brought us a pallet of building a giant shower out of I said, “No, you’re in saline solution for people to use PVC piping and in-line spray Hoboken.” to rinse their contacts lenses. heads. They had three fire Without saying a word, they engines feeding them. turned and walked back into Ed White St. Mary’s Hospital set up a the tunnel, which was now We also did ferry boat triage. mobile hospital there. We tri- closed to train travel. We knew the departure docks aged and deconned anywhere They walked all the way of ferries that docked right in from 21 and 2,200 people, across, the whole way back to front of the transit terminal, so but only ended up transport- Manhattan from Hoboken! as they’d come over, we could ing 179. Most did not need tell which part of New York City medical care. But the problem Dr. Bob they were coming over from. was then getting them home. We treated the full spectrum of We had two ferries pulling in To go home, they’d have to go injuries that day. Obviously, lots

An injured firefighter is moved to an awaiting ambulance. P hoto s (right a nd oppo ite page) c ourte y b ill ayer

10 JEMS out of the darkness I couldn’t get psychiatric care for these hysterical people for a while, so I had to make determinations about who was fit to go where.

steven cohen requested. That saved a lot of people, On 9/11, Steven Cohen was the EMS but when we heard that our educator for Capital Health System and friends were missing, we all a per diem paramedic at Jersey City Medical Center. Shortly after 9/11, wanted to go over to find our Cohen became the EMS educator at friends. But now we couldn’t. JCMC and is currently the assistant So it was a double-edged emo- director of EMS. tional sword. We had so many people com- ing over here who needed to be taken care of that morning, so we didn’t have a problem with of inhalation stuff, burns, aller- were having anxiety attacks, that. But later that day, when gies, broken bones, pelvic frac- saying to our crews, “I’ve got no we knew so many were missing, tures, lacerations. And we had place to go. I don’t know where we all felt a need to participate. a lot of people who were very I’m going to go.” We eventually did, but it was in upset. I remember a fireman sit- a coordinated manner. We went ting on the ground talking to his Steven Cohen over as a strike team. wife with one of those phones I was in Pittsburgh at the We transported a man who set up on the table. This guy National Association of EMS was critically burned in one of took his helmet off, and he was Educator’s Conference when the towers from Jersey City just a mess. the incidents all happened, with Medical Center to the burn I asked for a tent for psychi- several other New Jersey EMS center at Saint Barnabas Medi- atric care and for some psy- managers and educators. We cal Center. chiatrists from the hospital. I were the first ones to leave That morning, he had to mail couldn’t get psychiatric care for the conference because I had a letter, and something told him these hysterical people for a driven there. Most of the other to go outside and do it. When while, so I had to make deter- attendees had flown in, so they he was walking back through minations about who was fit to were stranded there with all go where. planes now grounded. While driving back, we found Mickie Slattery out that our agencies had not Everybody was still in such sent crews over to Manhattan. shock about what was going That was everybody’s initial on and what had happened. concern—particularly when we And people … were just sit- began hearing how many were ting there. Then they started lost or missing after the collapse to leave. But some left with- of the two towers—because in out their pets. We were ask- 1993, we had a lot of crews on ing, ‘Why are these people not scene at the towers. bringing their animals back?’ People have asked why we Then we realized that they had did not send a lot of ambulances no place to go back to. So we and crews over to Manhattan on also had to manage dogs and Sept. 11, 2001. cats on the waterfront. For weeks, some of the Mickie Slattery empty commercial buildings in We did not send a lot of ambu- Jersey City were turned into lances and crews over to Man- shelters. It’s something the hattan on Sept. 11 because “outside world” never knew or the plan was changed in 1999, paid attention to. And we had and we did not allow any self- to continue to operate on an dispatching or the dispatch of expanded basis with our EMS resources that were either not resources. You know, people on the response plan or not

SEPTEMBER 2011 11 I had to send runners for the police because I had no radio communications.

And ambulances were also seen as a potential risk, capable of carrying terrorists and bombs. Immediately after 9/11, we would get stopped just driving down the waterfront. And even though we knew all the Jersey City cops and they knew us, everyone was treated the same. They would stop us and search our ambulances before we were allowed in the area. Life, and operations, really began to change after 9/11.

Ed White I’ll tell you what gave us a great feeling of comfort that day— when those U.S. fighter jets came overhead. It gave us a feeling like “We can do what we’ve got to do. I don’t have to worry about nothing coming at us out of the sky anymore!”

New Jersey crews carefully remove an injured patient from a ferry Mickie Slattery boat on 9/11. The influx of patients into New the revolving doors, a fire ball check points to stop people Jersey was mainly in the morn- came down through the eleva- from going into New York. We ing, until probably noon. And tor shaft and blew him back showed our IDs at each one. after that, it was like, nothing. out the door. He was all fron- It was fortunate that we had tal burns. them with us. Dr. Bob My story is pretty strange. I was Steven Cohen Ed White at St. Vincent’s Hospital, about a As we drove back to New Jer- If you didn’t have your ID or quarter of a mile from the tow- sey through Pennsylvania, we “shield,” they were just turning ers. I had parked my car in Jer- heard about the plane that had you back. sey City that morning because crashed into the Pentagon. of horrendous traffic entering Someone said, “Well, we’re Steven Cohen the Holland Tunnel. So I took right here. Maybe they need After that day, we started issu- the PATH train over. help there.” We couldn’t get in ing letters of essential person- I arrived in the clinic at 7:30 touch with anybody. We didn’t nel. The state required us to a.m. A little while later, I heard know where we were going. issue them to everybody. this big kaboom, and a nurse There was no GPS at that time. It was a war, you know. And who had a portable TV on her So we decided to just keep rumors were flying all over the desk said to me, “Take a look going back to New Jersey. Lit- place. There was a rumor about at this.” Then I saw the tower tle did we know that a plane a man driving around with on fire. was about to crash into a field in nukes or chemical weapons in I went outside then. You could Shanksville, not far from where his vehicle. see the WTC from our location. we were driving. And then I started hearing all As we got close to New Mickie Slattery these sirens. Then I realized that York and New Jersey, there Even trying to get gas for our my vehicle, fully loaded with were check points along the ambulances was difficult. Every- EMS supplies, was back in Jer-

photo c ourte s y ree n a ro e i b aya / T he j er ey our al way. The state police had one was suspicious of everyone. sey City.

12 JEMS out of the darkness Life, and operations, really began to change after 9/11.

William “newbie” newby So we just started triaging people. But soon, we were On 9/11, William Newby was a para- overwhelmed. I mean, there medic and EMS tour chief with Jersey were hundreds and hundreds City EMS, a position that he still holds today. of people coming over to us. Harry Baker was at the end of pier. To this day, Harry actu- ally doesn’t even like to talk about it. He was so traumatized by this. Things began to take shape by about 10 a.m. We had tarps Then a nurse runs in and says, Dr. Bob laid out for the red tags, yellow “You’re not going to believe So they said to me, “Doc, you’ve tags and green tags, and we this, but I think a second plane got to go to the pier.” were starting to have transport hit.” So I walked over to the TV I said, “What pier?” and all the things that a mass- set again, and I could see the They said, “The York Street casualty event would have. second plane hit on a replay. Pier. There’s a lot going on I said, “I’ve got to get the there. Go there.” Ed White hell out of here.” So I ran I pulled up to the pier, and And, while this was under- … and I got on the subway; I met Mickie Slattery and Bob way, somebody abandoned a the PATH train on 14th Street. Casey there. And all hell was briefcase, and somebody yells Nobody there really knew what breaking loose. The towers “Bomb!” was going on. As I came up to had collapsed, people were The only ones who were the street level in New Jersey, swimming, jumping, you name in there at the time were you could see the two towers, it. And boats were docking at first responders. So now you smoke, flames, everything! the pier. see this mass exodus of first I got in my car at the station Initially, it was an eerie feel- responders running out of the and turned on my red lights ing because our radios didn’t train station because they think and siren and tried to get back work. Nothing worked. I had it’s a secondary device. over to Manhattan. But I had to to send runners for the police Then a crowd of people a turn around because the Hol- because I had no radio com- block away sees cops, firemen land Tunnel was completely munications. In fact, I also sent and EMS people running, so sealed off by the police. runners up to the hospital to they also started running. But it get more help, to get EMTs, was just a briefcase that some- Ed White to get more police, to get any- body had left there. Yeah, they had the cops with the body who could come who automatic weapons stationed could be beneficial, because William Newby out in front of the tunnel. there was nobody there except I was in Siesta Cape, Fla., on for a lot of bystanders. vacation when all this hap- pened. I was in the pool when my wife came in, and she said, “A helicopter just crashed into the World Trade Center.” I said, ‘’’bout time,” mean- ing that I knew it was going to happen one day.

A.J. Heightman, MPA, EMT-P, is the Editor-in-Chief of JEMS and specialized in teaching MCI management.

David LaMagne (at foot of improvised stretcher) lost his life on 9/11.

SEPTEMBER 2011 13 New Jersey EMS, fire and law enforcement agencies rallied to offer assistance.

uch has happened in New casualty incident (MCI) response, 9-1-1 hospital responders on MJersey since 9/11. Often terrorism training and prepared- 9/11 and throughout the long overshadowed by the massive call ness—as they should be. weeks that followed. volume of the New York City EMS New Jersey EMS, fire and law Immediately after 9/11, New system, the EMS agencies in the enforcement agencies rallied to Jersey State EMS officials, the Garden State are proud of their offer assistance to the New York New Jersey First Aid Council achievements in the area of mass Fire Department and its affected and its member agencies and

Most people don’t realize how important the New Jersey piers were on 9/11. photo s te v e n c ohe

14 JEMS out of the darkness The dust wasn’t breathable. There were flames everywhere. It was like Armageddon, like a nuclear bomb went off. the hospital-based ALS services state during future events. press in. I was wearing blue cov- joined to form the New Jersey We also asked respond- eralls with “medical director” writ- Emergency Medical Service Task ers who were involved in EMS ten on them and a pair of combat Force (NJEMSTF) to prepare for, response and care on and after boots. I was completely covered plan and respond in a unified 9/11 to tell us how their sys- in dust and sweating. It was hot, manner to catastrophic events tems—and more importantly, and I had blisters on my feet the in New Jersey or any region of their lives—changed after 9/11. size of quarters. the country that needs their Their candid responses should When I went into the OEMS assistance. serve as an important lesson trailer to ask where the morgue This section of the New Jer- for others who are called on to was, I ran into Bob McCracken, sey 9/11 EMS story describes the respond to future incidents. then FDNY chief of EMS. He said work of the NJEMSTF in coor- to me, “Everybody’s going over dinating major regional and Personnel Head to to Liberty State Park, Doc. You statewide EMS planning and pre- Ground Zero ought to get back there sometime paredness initiatives. Through Robert Lahita: When we left for tonight because they’re bringing state and federal grant funds, Ground Zero, I met up with a Jer- bodies over.” New Jersey bolstered the train- sey City ambulance; Former Direc- I said, “How many people?” ing and resources of their ser- tor Chris Rinn (then an active His response, “Well, I suspect vices and established a statewide paramedic) was there, and he was about 20,000.” staging area management plan all covered in dust. While I was I said, “WHAT? 20,000?” for EMS and trained staging area there, the third building [7 WTC] McCracken said, “That’s the managers. It’s a unique project collapsed behind us. report I’ve been given.” that should pay dividends for the The police would not let any You know, I just couldn’t believe the number. So I got back in an ambulance; it was an FDNY ambulance. Not surpris- ingly, I was with a couple of very depressed paramedics. I ended up just leaving them in their ambulance. You see, FDNY [EMS, fire] and police officers were pulling peo- ple out. There were a lot of dis- traught police officers and a lot of paramedics who wouldn’t talk. I mean catatonic and probably in significant emotional shock. The dust wasn’t breathable. There were flames everywhere. It was like Armageddon, like a nuclear bomb went off. I can tell you things I saw that ... I mean, I had a couple months of psychotherapy out of this. Pieces of the planes were everywhere— wheels, tail sections … and there were lots and lots of body parts. The police were going around with red bags, picking up the body parts, sealing the bags and putting them in refrigerated, 18-wheel trucks that were parked on West Street. I’ll never forget that. There

SEPTEMBER 2011 15 Pieces of the planes were everywhere; wheels, tail sections … and there were lots and lots of body parts.

were just mountains of body parts inside. After leaving the FDNY EMS crew, I took some of the ED nurses with me and went to Chel- sea Piers (Pier 6). The FBI had closed it down, and it was turned into an operating theater. There were at least 10 operating tables in place, and a bunch of guys were all gowned and gloved and ready to go. But there were no patients, no patients whatsoever. I left there, got back to my car and headed toward the Holland Multiple disaster response trailers (above) were placed in service Tunnel to go over to Liberty State throughout New Jersey after 9/11. Park. But I couldn’t get through the Holland Tunnel. The police So they pulled the truck back, State Park [all set to assist with now had an 18-wheeler blocking and I’m the only guy in the tun- the management of thousands the entrance. nel, by myself … myself and a few of bodies], but there were just I said to an officer, “I’m a doc- nurses that I took along with me two bodies there. One was the tor. I have to get back because from Ground Zero. hemi-sected body of a fireman, there’s 20,000 people.” We went straight to Liberty and the other was a fireman who P hoto Courte s y H e n ry Corta c a ns

16 JEMS out of the darkness Every single day, every shift, I wind up at some time or another going to a suspicious call.

New Jersey rescuers had to flee across this Ellis Island access bridge after someone mistook an abandoned briefcase for a bomb. was in horrible shape—just bits The police yelled back, “Get bigger than a fist. and pieces. out,” and they tossed the EMS Lahita: And there were trees I didn’t understand why they bag right out of the building. Then that no longer had any leaves were bringing bodies across everybody hurried over the con- on them—just paper from the the river, but I assumed it was struction bridge from Ellis Island hundreds of offices, pieces of because the New York City and back onto Liberty State Park. clothing, like dresses and shoes morgue was overloaded already William Newby: You know, and stuff. and they didn’t know where they you can’t even compare the 1993 I would look up—there was were going to put them all. bombing to 2001. The incident in catastrophe. I would look down— But there were no other bod- ’93 was an explosion, an inside there was catastrophe. Every- ies. There were dozens of ambu- explosion. There was a seven- where I looked, things were lances standing by, ambulances story hole in the building. Win- burning. It was like something I’ve from everywhere, but no bodies. dows were blown out, and smoke never seen. And I hope I never see Sean Boyle: On the New Jer- went up. But at least you … knew it again. sey side, [after the second col- what it was. One of the firemen I was work- lapse], EMS crews were setting The 2001 incident was vastly ing with a few days after 9/11 up another triage site on Ellis different because almost every- made an observation that is still Island, which is located across thing was in a million pieces, unfathomable to me and many the water from Liberty State Park. reduced to microscopic size by others who were at Ground Zero. And all of a sudden, the park the escalating tonnage on its way He noted that, after the collapse, police came running through to the ground. you did not see any contents of because they had a report of a Lahita: I remember seeing just the towers that were intact or in secondary device. boots. The boots were there, but their original composition—no So everybody got thrown off there was nothing else. I couldn’t chairs or desks or file cabinets, or Ellis Island. They came through in see body parts. I mean, medically windows, or computers … Just a force yelling, “Leave, leave!” speaking, there were no identifi- lot of dust. The crews yelled back, “But able bodies. It was like everything was

that’s my jump bag.” Boyle: There was nothing totally vaporized. And I mean P hoto a. j . height m a n

SEPTEMBER 2011 17 It was a few years before I could even go back to New York City, and I have never returned to Ground Zero.

New Jersey providers now see the Freedom Tower when they look across the river.

that. There was nothing that was through these masks. I went I’m a seasoned physician who recognizable. Everything was lit- through those two boxes of masks had seen death and destruction erally vaporized. in about 20 minutes. before, but nothing to this magni- As I walked around, I saw tude … nothing like this. It both- Health Issues ambulances that were totally flat- ered me and many other people Lahita: The next day, I went over tened—and still burning. There for many months. to Ground Zero on a police boat must have been 30 ambulances When you ask what the most early in the morning and carried that were totally flat. vivid memory I have of 9/11 is, two boxes of surgical masks that There were cars on their roofs what represents the most emo- I had procured from the hospi- that were piled up like somebody tional stress on me and many oth- tal. I also snuck along a Star-Led- had taken a crane and piled them ers that day, it was the smell; the ger reporter with me because they up. And every one was burning. smell of death. wouldn’t let the press in. I put an The dust was probably 3' deep. You know, we’ve all smelled EMS hat on him. To this day, I Everyone and everything was dead bodies, freshly dead bodies. regret that I did not have a pho- covered with dust. I just remem- I’m not talking about decomposed tographic record of what we saw. ber the plane engines and all bodies [that have a distinctly dif- Then this guy from OSHA the apparatus; you talk about ferent smell]. At Ground Zero, approached me with this big mask mangled steel. The hoses on the there was that smell of blood and on, the type with the two gizmos front of the pumpers were sliced death … coupled with the smell [filter canisters] on it, and I was through like a knife would go of lots of things burning. on the pile with lots of police, through hot butter. And the cabs Ed White: It’s hard to compre- construction guys and firemen. of the fire engines were filled hend ... not a body or a desk or They’d worked through the night. with paper and dust. a chair ... there was nothing left. He said, “You can’t just put a As I walked through the desola- Nothing! Anybody who has ever surgical mask on them. They need tion with the reporter, he couldn’t tried to hacksaw through the leg these masks.” talk; he was just as shocked as of a chair knows what I mean. I said, “Where are they going to I was. We walked from Battery Eileen Van Orden: Do you still get those masks?” Park up to the Twin Towers. There smell the smell [from that day]? With a puzzled look on his face, wasn’t a soul. There were just Boyle: Absolutely! he said, “I don’t know, but those windows blown out or broken in. Van Orden: You can’t even put surgical masks give them a false There were stores where rescuers a description on it. This wasn’t sense of security.” had broken in to get some water just death, though. I said, “Well, this is all I’ve got.” to flush out their irritated eyes or Boyle: This was beyond

P hoto ra bb it75i s to ck At least they could breathe to drink. decomposition. It was beyond

18 JEMS out of the darkness I will no longer sit with my back to the door since 9/11. structure fire. It was the most with them if they are deployed at partner and pull him back and be acrid combination. a suspicious call or area where it like, “Wait a minute. Something’s may involve terrorism. We advise not right here.” And they will say Complacency crews to carry these items with “Ahh, come on.” White: Ten years after 9/11 and them because if they’re left in I stand firm and say, “No, many people are still very com- the truck, they’re not going to something’s not right here.” placent about terrorism. do them any good. They’re going Van Orden: You take Joe Pub- down the escalator into the PATH The Emotional lic who wasn’t involved in 9/11, station and see all these people Aftereffects wasn’t downtown, wasn’t in New flopping on the ground and seiz- McCabe: My life was changed dra- Jersey or New York City on 9/11, ing, and there will be nothing matically by 9/11; quite simply, living far from the threat, and they can do to save themselves it will never be the same. There they don’t look at terrorism or the threat of terrorism the same way we do. So many people have become very complacent. Whereas in countries like Israel and Northern Ireland, places like that, terrorism has been with them their entire lives, and it’s a constant thought on their minds. Cohen: I spent five years as a kid in Israel. The heightened level of awareness among the people there is so much higher than it is in the United States. We see signs here that say, “See something, say something,” but people don’t follow through on it. In Israel, if because they won’t have time to is a very profound “desensitivity” the public sees a backpack lying go back up. If they don’t have that settles in after experiencing somewhere, they report it, and that protection with them, it’s not something as catastrophic as the within minutes, a bomb squad going to do them any good. WTC. Dissimilar to a war zone, has taken care of it. Newby: We are so complacent! no one ever expected such an White: Many times now, while Every single day, every shift, I attack to occur and have such a sitting in the traffic, I watch a truck wind up at some time or another horrendous outcome. Never did go by and think, hmmm. going to a suspicious call. we expect those next to us to be Lahita: I do that all the Van Orden: If you look at those dead in moments, and never did time, particularly when I see an of us who have been in EMS for a we expect hundreds of emergency unmarked truck. long time and the ones who are services workers to die on the White: It’s the truth. You’re sit- just coming in, it’s a whole other same site. ting there, and you’re looking at attitude now among respond- No event can ever compare chemical trucks go by. You think to ers. There’s a complacency by the to 9/11, and therefore no matter yourself, what if they get a hold of newer personnel because they what type of call you go on, in these tankers? You’re walking by have not lived through what we your mind, it always seems very them thinking, “Son-of-a-bitch!” lived through. As Dr. Bob said, manageable and small in scope Newby: I just came back from we look at things. We look at the [compared] to what I witnessed Vegas, and on the plane, my wife trucks and stuff like that differ- and experienced on 9/11. had me set up to knock the shit ently because we’ve been a part A lot about that day and the out of four people. She said, “If of 9/11. But the personnel that days that followed is a blur, but he goes to the bathroom, you fol- were 7 years old, 9 years old at the that is probably the way the brain low him!” time, they don’t get it. It wasn’t a is wired so you don’t constantly Cohen: We have people who part of their life. And they don’t revisit the horror. However, my don’t want to carry nerve-agent look at things the way we do. I’ll thoughts about that day never antidote kits and escape hoods stop at a scene, and I’ll grab my end. Every time I look across the

SEPTEMBER 2011 19 Nobody thought those towers would ever come down. And we had to adapt to what we had.

river from Bayonne at Manhattan, Boyle: I don’t discuss the 11th Cohen: That’s what we do; we I remember that day as vividly as I outside of work. And I mean EMS help people. We fix people. But did during the event. work. It’s not even a topic in our Ground Zero was much different It was a few years before I firehouses. It only comes up with because we just sat there and could even go back to New York some of the partners I have at Jer- waited. We watched the smoke City, and I have never returned to sey City EMS who were actually continue to rise. And all we saw Ground Zero. around on 9/11. were bodies coming out. But My family says all the time that Van Orden: My marriage ended there was nothing for EMS per- a part of me “died” that day, and after Sept. 11. It went down- sonnel to do. It was horrible! it is a part that will never come hill rapidly because he wasn’t Boyle: We all kept saying, back. And I really cannot disagree involved at all with emergency “Let there be voids. Let there be with them. services and did not understand something.” Lahita: I am not the same guy the way I changed. I started look- that I was 10 years ago. ing at [life] differently after 9/11. Advice to Others Van Orden: None of us are. I started prioritizing things differ- Lahita: From my standpoint, as a Lahita: I still respond to ently. My child became a major physician, I would advise all EMS emergencies all the time, and focus. But I also started looking personnel to always be aware my family and friends watch out at my surroundings differently. of their surroundings. We teach for me to make sure calls don’t I became a lot more aware [of crews to be aware of the poten- bother me since 9/11. Because threats and potential threats], tial for secondary explosions, but of the nasty things I saw and and that made him crazy. we also have to now make sure, experienced on 9/11, they set me I went to a marriage coun- after the collapses that occurred up with this psychologist. There selor, trying to salvage the mar- after the WTC collapses, to be were a number of us who were riage. I remember her saying aware of the potential for second- going to her. She did a great job. to him, “You are heartless. You ary collapses. It was helpful; we have learned have no understanding that her The kicker is that we always to deal with it. awareness is different because teach our EMTs and paramedics Boyle: I’m from a public safety she lived through hell.” to be aware of what’s going on: family, so most people in my fam- He couldn’t be a part of 9/11 wires that are down at a motor ily understand the issues, share because he couldn’t understand vehicle accident, violence erupt- the same concerns and have the 9/11. He was so sheltered. He ing at a bar fight, etc. But we have same mentality. couldn’t grasp 9/11. to expand their thought process But I will no longer sit with Boyle: [About photography] to look around before they go my back to the door since 9/11. I would have been mortified to into an area where a terrorist No one gets between me and take down a camera to Ground incident might be involved. the door. Zero. I was looking for friends. A simple response to a motor Most responders today have I was pissed off whenever I saw vehicle collision [MVC] in a tun- the mind-set that they have to people with cameras. nel, or on a bridge, isn’t so sim- walk around with their head on a Van Orden: Some people ple anymore. An MVC in a tunnel constant swivel. would say, “Oh, do you have could be a setup by terrorists to Van Orden: I talk about it with pictures?” or “What do you trap and kill the responders with my son occasionally. It’s amaz- mean you were down there poison gas, explosives or other ing how much they absorb and and you didn’t take pictures?” things that could conceivably become aware of. We were watch- I would say, “I don’t have to be used. ing a Disney movie that opens up take pictures. Those images are Cohen: Supplies are also and scans the New York City sky- engraved in my mind. I can close important. You need to have sup- line. The Twin Towers are on it. I my eyes and recall what I saw plies ready to respond immedi- remember ... he was 2 1/2, maybe that day.” ately when you need them. We 3, and I remember him pointing Cohen: The worst of it was now have waterfront MCI trail- to the TV and saying “those were there was nobody to help. ers. They came after 9/11, thanks the towers the bad men made fall Van Orden: That was the to the planning and efforts of the down.” I can remember sitting hardest part. There was nobody New Jersey State Task Force and there, just bawling when he said to help at Ground Zero. You felt State EMS Task Force. They’ve that. He was just 3 years old. helpless, and we were helpless. been deployed to all the cities

20 JEMS out of the darkness My family says all the time that a part of me “died” that day, and it is a part that will never come back. on the waterfront, all along Hud- from 9/11 is that we were running another state or somebody from son County. They are stocked with behind the terrorists in our lim- another country. By getting out multiple port oxygen delivery sys- ited training and preparation for and taking advantage of the edu- tems and six huge oxygen tanks these mass attacks. cational opportunities that are in them along with extra back- We cannot let that happen in out there, beyond what’s being boards, Stokes baskets, genera- the future. We must always be a offered locally, you can learn a lot. tor, mister fans and lights. step ahead of them and preplan That one little snippet that you A couple of them are air con- for care at mass gatherings, con- learn and bring back to your crews ditioned, so once you empty certs, shopping malls, sporting might save you or hundreds of them out, you can use the trailer events, etc. other people. for treatment or rehab (to read Cohen: The thing you have Yes, we’ve trained them, but more about New Jersey’s system to constantly think about is not also alienated some of them. enhancements, go to p. 22). what’s going to happen, but what They’re afraid to go to other train- Van Orden: I don’t necessar- could happen. ing, because they’re afraid it’s ily know that we know what the Van Orden: Particularly the going to be boring. next “big one” is going to be. new personnel coming in. Boyle: People tend to become Nobody thought 9/11 would hap- Lahita: They have to think complacent because they have pen. Nobody thought those tow- about the unthinkable. not seen a terrorist attack or ers would ever come down. And Van Orden: People seriously major event in this area since we had to adapt to what we had. concerned about preparing for 9/11. And unfortunately, people What we have trained for may the next “big one” need to attend are going to get hurt, because not totally prepare us for the next classes that broaden their hori- you don’t have crews out there one. So what we really learned zons. Go hear a lecture from that are as experienced as other

SEPTEMBER 2011 21 And unfortunately, people are going to get hurt, because you don’t have crews out there that are as experienced as other crews.

crews. And you have people who really expand that section and second nature to them. don’t get out of their ambulance make sure their employees, volun- and do a 360-degree scan of the teers or students pay close atten- Change scene. Unfortunately, sometimes, tion to it. Because people still Mickey McCabe: Significant you have people get out of the tend to come into their boards or changes have occurred in New Jer- bus yapping on their cell phone. exams with an attitude that scene sey since 9/11. Many groups have Newby: You have to always safety just encompasses BSI, and been formed and have worked be aware of what is going on that’s it. together for a more organized around you. We have a tremen- We need to teach crews what to MCI response. Plans have been dous potential for disasters in look out for, what warning signs written for catastrophic events on this area of New Jersey. Three they need to be looking for, and the land, in the air, on the rails major airports, Tropicana with make sure they always have an and at sea; drills have been con- 200 million gallons of anhydrous escape route in mind. We also ducted with the police, fire, EMS ammonia on site and some of need to make sure our crews have and dispatch agencies, as well the most heavily traveled miles of all the protection they need. as the Coast Guard, U.S. Public highways in the country. Crews should also use the ICS Health, FBI, etc. Van Orden: We can work the structure on more incidents than All 21 county OEM [Office of MVA. We can do the roll-over, we have in the past. When they Emergency Management]-EMS because we do it every single day. get to a motor vehicle accident coordinators in New Jersey have But you have to also plan for what that has two patients, they need been given a New Jersey State you’ll do if 15 canisters of a deadly to institute the incident com- Police radio with a private fre- chemical are set off or blown up mand system; establish com- quency that only they can talk somewhere. mand, assign key roles and go on. We have also established Cohen: I recommend that man- from there. Regional Staging Areas, as well as agers and instructors, when talk- By doing it more frequently, local staging areas for better coor- ing about scene safety in any EMT they’ll get better at it. Then, when dination and control of resources. or paramedic class or orientation, the “big one” happens, it will be No longer is there a “calling all

There are several key reminders of the as well as notes of thanks to all the rescuers he heroic efforts by New Jersey respond- found attached to his damaged sculpture a month ers on the piers on 9/11. JEMS Editor- after 9/11. So he collected all the messages and in-Chief A.J. Heightman, MPA, EMT-P, welded them to the piece exactly as he had found visited the site with Jersey City EMS them. personnel. The “Empty Sky,” a New Jersey 9/11 monu- A twisted steel beam from the ment, was recently dedicated on the grounds of Towers has been incorporated into a Liberty State Park in Jersey City. It was constructed 9/11 Memorial Plaza, featuring a granite in parallel with where the Twin Towers of the World marker with the likeness of the Twin Towers facing Trade Center once stood so that visitors to the the Manhattan site of the new Freedom Tower. memorial will always remember their prominence Adjacent to the steel beam and granite monu- in the Manhattan skyline. The inscription on the ment is the famous sculpture by J. Seward Johnson memorial reads, “On the morning of September 11, that was relocated from Ground Zero to the Jersey 2001, with the skies so clear that the Twin Towers City pier used by responders on 9/11. It was dubbed across the river appeared to be within reach, the “Double Check” because emergency responders at very essence of what our country stands for free- Ground Zero initially thought they’d miraculously dom, tolerance and the pursuit of happiness was found a “victim” alive and trapped under the tons of attacked. This monument is dedicated to the New rubble they dug through. It was actually Johnson’s Jersey’s innocent loved ones who were violently bronze statue of a man working on a bench in the and senselessly murdered that day at the World plaza of the World Trade Center. Johnson was Trade Center, the Pentagon and in Shanksville, Pa.”

deeply moved by the messages of “love and pain,” —A.J. Heightman, MPA, EMT-P P hoto A .J. H eight m a n

22 JEMS out of the darkness The “Empty Sky,” a New Jersey 9/11 monument, was recently dedicated on the grounds of Liberty State Park in Jersey City.

cars” mentality. Every request for since 9/11. Many groups have coordinators in New Jersey have additional ambulances must now been formed and have worked“Empty Sky”been given a New Jersey State go through the county OEM-EMS together for a more organizedmonument Policein radio with a private fre- coordinator, and only the num- MCI response. Plans have Lbeeniberty Statequency Park. that only they can talk bers of vehicles actually needed written for catastrophic events on. We have also eastablished are mobilized. on the land, in the air, on the Regional Staging Areas, we well New Jersey has received a sig- rails and at sea; drills have been as local staging areas for bet- nificant amount of financial aid conducted with the police, fire, ter coordination and control of through grants, which have been EMS and dispatch agencies, as resources. Change well as the Coast Guard, U.S. To learnNo longermore aboutis there the aNew “calling McCabe: Significant changes Public Health, FBI, etc. Jerseyall cars” memorial, request click for here additional. have occurred in New Jersey All 21 County OEM-EMS ambulances. They must now go P hoto Ste v e n Cohe P hoto A .J. H eight m a n

“Double Check” First Responder tribute. P hoto A .J. H eight m a n P hoto Ste v e n Cohe

SEPTEMBER 2011 23 No longer is there a “calling all cars” request for additional ambulances. Requests must now go through the County OEM-EMS coordinator.

through the County OEM-EMS treatment and EMS incident plan- help immediately after participa- coordinator, and only the num- ning. No transportation compo- tion in a horrific event to attempt bers of vehicles actually needed nent exists, because that task is to avoid long-term effects. I am are mobilized. one of the roles of each county just one of thousands of emer- New Jersey has received a sig- EMS coordinator. gency workers who suffered post- nificant amount of financial aid The key lesson that 9/11 taught traumatic stress disorder from through grants, which have been me was to assume nothing and Sept. 11. used to purchase EMS equip- expect anything. Be alert, be pre- Cohen: Our dispatch center ment that is strategically located pared and realize that there is a now has multiple transmitters around the state. We have mass risk of death in what we do. What and receivers so if one goes down, care response units (MCRU) I cannot forget, and will never there’s now an automatic switch- that ALS and BLS equipment on forget, is witnessing the dozens over to a back-up system. them and can provide aid to over of innocent people jumping 100- Ed White: There is now redun- 150 patients. plus stories to certain death and dancy in communications, and In addition to the assets men- the many close associates and co- you’ll see that in all police, fire

tioned, we have also formed the workers I was working with who and EMS agencies. JEMS NJEMS Task Force, which con- lost their lives. A.J. Heightman, MPA, EMT-P, is sists of over 200 specially trained Responders to such an inci- the Editor-in-Chief of JEMS. members used for staging, triage, dent should seek professional

he New Jersey Emergency Medi- Among many of them include plan for EMS. Tcal Service Task Force (NJEM- two projects: the Statewide EMS The plan identifies four STF)—an organization born Staging Area Management Plan regional locations in New Jer- from the Sept. 11 attacks—was and the Statewide Helicopter sey where large amounts of EMS designed to prepare, plan and EMS Helibase Management Plan. resources can check in, be cre- respond to catastrophic events dentialed, be NIMS-typed and be in New Jersey, the region, or Statewide EMS Staging organized into strike team(s) and/ through the Emergency Manage- The lessons learned from the ter- or task force(s). They can also be ment Assistance Compact, any- rorist attacks in New York City deployed in an efficient and effec- where in the country. NJEMSTF (1993, 2001), the Northeast Black- tive manner to major events. coordinates major regional and out of 2003 and other major In addition to these regional statewide EMS planning and pre- events, pointed out a need for bet- areas, all of New Jersey’s 21 coun- paredness initiatives. With home- ter EMS coordination and deploy- ties have identified “County EMS land security grant funding, they ment—particularly in Staging Staging Areas,” where the same also provide specialized equip- Area Management. The NJEMSTF process would take place—except ment, resources and trained per- drafted New Jersey’s first state- to support smaller-scale-type sonnel to support the plans. wide staging area management or geographically closer events.

24 JEMS out of the darkness The NJEMS Task Force consists of over 200 specially trained members that are used for staging, triage, treatment and EMS incident planning.

NJEMSTF also has possession of 17 EMS staging trailers (region- ally and strategically located), which are deployed to a stag- ing area when the plan is acti- vated. These equipped trailers give staging area managers and their team a sheltered structure to work and conduct such activi- ties as check-in, accountability, and assembling resources and other items. The trailer’s interior consists of an “administrative-type” office with white boards, computers, printers and file cabinets. The trailers also are equipped with useful items to establish and maintain a staging area, such as traffic cones, tables, chairs, gen- erators, signage, lighting, maps, GPS devices, communications equipment, ICS forms for stag- ing and ICS vests for all the stag- ing positions. The plan also includes GIS

P hoto n a s layers of data that assist the Map of New Jersey’s regional and county EMS staging areas. NJEMSTF and emergency man- agement officials in resource allocation and deployment strategies. The plan has been exercised and implemented sev- eral times. As such, it has been vetted and remains a benchmark in all large-scale EMS responses statewide. The plan is included within the memorandums of Understanding and Response Plan to the cities of New York and Philadelphia.

Statewide Helibase Management Plan New Jersey EMS units staging at Holland Tunnel to respond to New As the ground staging area York City mutual aid request for December 2010 blizzard. plan was in its final phases of approval, a new project The plan illustrates access GPS coordinates and other rel- emerged. NJEMSTF, the New Jer- and egress routes to all these evant information (e.g., signage sey State Police Aviation Bureau locations, identifies security and facilities). These sites are and the participating Airport ar d Bu c ha n a and/or law enforcement agen- all managed by trained staging Managers of New Jersey brain- cies that would “sweep” assets area managers, from the NJEM- stormed together. Once again, checked in, dictates a commu- STF and County Office of Emer- they adopted lessons learned

nications strategy and provides gency Management staff. The and best practices from other P hoto b y H o w

SEPTEMBER 2011 25 Fourteen sites can accommodate a minimum of 20 aircraft and other larger facilities.

organizations around the nation to produce the Statewide Heli- copter EMS Helibase Manage- ment Plan. The plan identifies areas in New Jersey where large amounts of air medical helicopters (rotary wing aircraft) can converge on, check-in, receive tactical assign- ments and be coordinated by a Helibase Management Team from the NJEMSTF. To get the project started, the NJEMSTF sent out a questionnaire and assessment tool to all of New Jersey’s airport managers. This tool was used to assess partic- ipation interest and contained detailed questions on each air- port’s capabilities, infrastructure and real estate. Those airport managers who supported the concept, and who had the requirements that were appropriate to support the plan. were designated as HEMS heli- bases for New Jersey. Fourteen sites can accommo- date a minimum of 20 aircraft and other larger facilities. This plan doesn’t replace existing policies and procedures for day- to-day medevac requests and is to support catastrophic-type or anticipated major events that typically have multiple opera- tional periods. The plan not only identi- fies the location and provides detailed GIS information about each site, but it also describes the notification process, initial actions that will be taken, per- sonnel responsibilities, commu- nications, helibase management and demobilization. The EMSTF also trained 24 team personnel in a course similar to the National Wild- fire Coordinating Group’s S-371 ar d Bu c ha n a helibase manager course. When activated, the plan calls for the deployment of a staging area management trailer to deploy to P hoto b y H o w

26 JEMS out of the darkness Staging area management and the New Jersey EMS staging strategies are a vital and important process. ar d Bu c ha n a P hoto b y H o w P hoto n a s New Jersey’s HEMS helibases. ar d Bu c ha n a P hoto b y H o w P hoto De v i n Keri ns New Jersey EMS Task Force staging area management team. Helibase management team in training. the airport where the operation is of the New Jersey EMS Task Force being conducted. since its inception in 2004. Staging area management and He has been involved in EMS the New Jersey EMS staging strat- and emergency management for egies (produced by the NJEMSTF more than 20 years. He serves for ground and air ambulances) as the project manager for major are a vital and important process regional and statewide planning

for better coordinated responses initiatives and provides admin- ar d Bu c ha n a Map of NJ’s HEMS Helibases to anticipated or actual large- istrative and operational support scale or high-impact events. From to the organization. the check-in and credentialing He holds a master’s degree process to incident assignment from Fairleigh Dickinson Univer- P hoto b y H o w Helibase management plan and demobilization, the success sity, specializing in terrorism and exercise at Meadowland Sta- of your operation depends on a securities studies and emergency dium, using 11 aircraft. well-established, well-organized management administration. and well-managed staging area. He’s also a certified emergency manager through the Interna- Henry P. Cortacans, MAS, tional Association of Emergency CEM, NREMT-P, serves as the Managers and is a New Jersey state planner assigned to the state and nationally registered Urban Areas Securities Initiative paramedic.

SEPTEMBER 2011 27 The sponsors of Out of the Darkness

We are proud to be sponsors of this historic, four-volume JEMS sup- plement that documents the heroic and unprecedented efforts by the responders to each tragic event on Sept. 11, 2001. Their efforts, the physical and emotional costs they have had to bear and the opera- tional advances made by their agencies since 9/11 are an important part of emergency service history.

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28 JEMS out of the darkness The sponsors of Out of the Darkness

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SEPTEMBER 2011 29 Volume III: Strike on the Pentagon, SEPTEMBER 2011 photo arlington county fire department We present you with command, accountability, resource management and emotional lessons that have been learned from each incident.

&

here’s nothing more pow- were there. The ripple effect of to participate in it. But after 10 erful and compelling than the pain inflicted that terrible day years, several say they may finally Thearing the facts about continues to affect and hurt many be ready for it. It should be made an incident directly from a first- families, friends and loved ones. available to them. person source. We have done We found that many marriages We found that counseling has that in the development of the and relationships dissolved or been offered to the children of four-volume historic report, Out of ended in unfortunate divorces responders, but in many instanc- the Darkness, presented here. after 9/11 because some indi- es, it hasn’t been offered to their To do so, we spent time with viduals couldn’t understand or spouses and significant others key personnel in each involved accept the commitment, respon- who have been left to deal with city to discuss the events of Sept. sibilities or emotional baggage the ramifications on their own. 11, 2001, and the aftermath of being carried by the responder They need help too. that unforgettable day. they loved. Those who were hired after We chose the title because so Yet, the people we spoke with 9/11 must be sensitive to those many of those we spoke to report- carry on with their lives. They who were there. And EMS manag- ed how that day went from being shepherd their children to school, ers must be mindful that assign- a picture-perfect day, to one of visit their mom, get promoted and ing affected crews to the same death, darkness and despair in a fall in love. Since 9/11, some have response zones and locations as matter of minutes. Many report- retired, and some have moved on their original source of emotional ed being trapped under debris in from EMS. Most remain with the trauma is not advisable because complete darkness and having to agencies they love, the agency the sights and sounds they’ll be crawl toward a ray of light or the that has been their second home forced to see and hear again can light from another person’s cell and source of comfort when they trigger horrible anger and anxiety. phone to find a source of fresh are down or depressed. It has been our great privilege air. And many report still having But what most understand to get to know these responders. dark, emotional days as a result now, with 10 years of hindsight, They aren’t superheroes. They’re of their experiences, as well as is that they belong to an exclu- ordinary people who did the the sights and sounds associated sive, dreadful club. A club none of very best they could in extraor- with their incident. them asked to join and every one dinary situations. We were struck by the lasting of them would rather not have We wish we could have inter- damage caused by the attacks been inducted into. However, viewed all of the 9/11 responders, on 9/11. For many, time has not they recognize that they have but we could not. However, we healed the emotional scars they been set apart from the rest of hope that what we have crafted sustained. For others, health humanity—damaged in a way no for you are documents that pres- issues caused from breathing one but other 9/11 responders ent not just important historical super-heated, microscopic dust and witnesses can understand. In facts about 9/11, but also the will plague them to the end of fact, many of the responders told many command and control, their lives. For a few, the emo- us they will only talk about 9/11 accountability, resource man- tional damage is less visible and, with others who were there that agement and emotional lessons perhaps, even more insidious. day—other members of the club. that have been learned at each What’s more, the damage from Many could benefit from coun- incident and must be passed on

9/11 doesn’t just affect those who seling but have been reluctant to others. JEMS

2 JEMS out of the darkness There is nothing more powerful and compelling than hearing the facts about an incident directly from a first-person source.

8 Background 36 Building a System of Systems

9 Deceptive Size 38 Post-9/11 Focus Areas

10 Pentagon Facts 38 New Focus on Crisis Counseling

12 Preparedness, Planning & Vision 40 Blast Pack Contents

13 Command & Control 41 Health & Emotional Aftermath at the Pentagon

43 Vigilance & 18 Personnel Accountability Service Area Pre-Planning

19 System Cohesiveness 44 The Last Word

20 EMS Operations 48 Insight from Ed Plaugher

23 Early Command Caution: Because we & Triage Actions wanted to represent the actions and words of these providers as true to the 30 Integrating Military Personnel events as possible, we have broken our normal policy on not publishing profan- 33 Communication Centers ity. Therefore, some of the portions of the material you are about to read contain graphic language. Vice President/Publisher: Jeff Berend

Editor-in-Chief: A.J. Heightman Out of the Darkness is a supplement sponsored by Boundtree Medical, Demers Ambulances, Disaster Response Solutions, Emergency Products + Research, Managing Editor: Lauren Hardcastle Laerdal, Oxygen Generating Systems and Southeastern Emergency Equipment, and published by Elsevier Public Safety, 525 B Street, Ste. 1800, San Diego, CA Contributing Editor: Teresa McCallion 92101-4495; 800/266-5367 (Fed ID # 13-1958712). Copyright 2011 Elsevier Inc. No material may be reproduced or uploaded on computer network services with- out the expressed permission of the publisher. To subscribe to an Elsevier publi- Art Director: Liliana Estep cation, visit www.jems.com. Advertising rates are available on request. Contact Elsevier Public Safety, Advertising Department, 525 B Street, Ste. 1800, San Diego, Director of Production: Tim Francis CA 92101-4495; 800/266-5367. Production Coordinator: Pippin Schupbach Production Assistant: Matt Leatherman

SEPTEMBER 2011 3 Arlington crews, aware of the WTC attacks, had no idea that a plane was headed for the Pentagon.

Photos Arlington County Fire Department

n the early morning of Manhattan. It was even more Sept. 11, 2001, emergency difficult for incident command- Iresponders throughout ers on the ground to view and America were checking out their fully assess the involved fire vehicles, making them response floors 1,300 feet above them ready. At the Pentagon in Arling- while looking straight up at the ton, Va., a fire crew assigned to a massive, towering, nearly flat- crash rescue vehicle was at the sided structure. facility’s helipad, checking out As the Arlington crews their apparatus and making sure watched the tragedy unfolding, everything was at the ready for a they had no idea that another special guest due to arrive later jet would soon fly into the sec- that afternoon by helicopter. ond tower in New York City. Nor President George W. Bush was did they imagine that a third jet, scheduled to arrive at the Penta- American Airlines Flight 77, was gon in the presidential helicop- hijacked and headed for the Pen- ter, Marine One, soon after his tagon—located in the eastern- return from a trip to a Florida most section of their response school, where he read with young area, just across the border of children who were excited to have nearby Washington, D.C. the nation’s leader visit them. They also were not aware that The normal morning rou- a fourth plane was also headed tine of the responders on duty in their direction—a fact that at the Arlington County (Va.) would later cause them to have Fire Department (ACFD) was to retreat from positions at the suddenly interrupted, and their Pentagon and prepare for a sec- attention was redirected to tele- ond air assault. vision sets throughout their sta- We won’t review all the circum- tions. News reports were stating stances of the Pentagon response that a small plane or helicopter because the ACFD did a master- had accidentally flown into one ful job of detailing the Pentagon of the towers of the World Trade disaster in a 222-page after-action Center in the heart of the Man- report on the response to the hattan financial district. 9/11 terrorist attack on the Pen- The scope of the incident was tagon that’s available to you by difficult to judge for news crews clicking here. and the public viewing heli- We sat down with key copter aerial footage high over ACFD responders that were in

4 JEMS out of the darkness The crews had to take action as a result of the threat of additional planes being directed toward the Pentagon. command roles on 9/11 to get emergency responders that bright, to make decisions about whether their perspective on an incident sunny morning in Arlington, Va. to evacuate the nation’s military that was overshadowed by and We reviewed the preplanning, nerve center or allow occupants high death toll experienced in response, command and control to remain in the structure to meet New York City after the collapse operations at the Pentagon in and develop the next steps in of the Twin Towers. This special detail. The crews there had to take their response to these acts of war report on the Pentagon response action as a result of the threat of against America. presents EMS command and additional planes being directed The firefighting hazards, struc- patient care aspects carried out by toward the Pentagon. They had tural access obstacles, hazardous

The incident involved heavy smoke and fire conditions, and building collapse.

SEPTEMBER 2011 5 The military nerve center was not fully evacuted, allowing military command to develop their next steps.

Firefighting operations at the Pentagon were conducted in one of the world’s largest and most sprawling office complexes. materials, triage and treatment areas required—and injuries and crowd control issues encoun- tered—were similar to those being experienced in New York City. However, this was all conducted in one of the world’s largest and most sprawling office complexes, instead of 1,000 feet in the air in the Manhattan skyline. Most Americans never knew that if the crash happened a few hours later, the President’s heli- copter would have been posi- tioned less than 100 yards from where the plane went into the structure. The two firefighters that staffed the helipad’s crash res- cue vehicle that day were stand- ing there at 9:38 a.m., inventorying their vehicle, making sure every- thing was in good working order for President Bush’s arrival. Then, they heard the roar of jet engines

6 JEMS out of the darkness Fire crews conducted a difficult interior fire flight in dark, smoke, debris-filled areas.

and watched as a passenger plane in a massive structure. They were skimmed dangerously across the confronted by extremely high antennas of a nearby government heat and jet-fueled fire condi- complex—across busy Interstate tions. They conducted a difficult 95 and into a wing of the Pen- interior fire fight in dark, smoky, tagon, causing a massive explo- debris-filled areas, and they had sion and fire as the plane literally a limited ability to change air disintegrated. bottles early in the incident until On 9/11, the fire, EMS and law a mechanism was in place to enforcement personnel who han- shuttle replacement cylinders to dled the Pentagon attack worked the multiple fire floors within the

SEPTEMBER 2011 7 Until a shuttle system was in operation, crews had limited ability to change air bottles.

put into operation at the Pentagon incident. Today, Plaugher serves as director of National Programs and is assistant executive director for the International Association of Fire Chiefs (IAFC). When Plaugher joined the ACFD, he focused on developing a more fully integrated fire and EMS response capability. He formed battalion management teams, consisting of an EMS captain who works with each battalion com- mander and with the fire/EMS offi- cer assigned to each station. This command pairing is responsible for all EMS training in the battalion. This guarantees a better-trained EMS force and the availability of two EMS captains at all times. Captain Edward Blunt and Captain Alan Dorn were both on duty the morning of 9/11. Following the March 1995 Sarin nerve-agent attack in a Tokyo subway that killed 12 commut- ers and injured hundreds more, Chief Plaugher, Assistant Chief for Operations James Schwartz and Assistant Chief for Technical Support John White recognized that their first responders weren’t trained or equipped to handle such terrorist attacks and large- scale emergencies. TK TK TK TK TK As chairman of the Washington Metropolitan Area Council of Gov- Pentagon. Background ernments Fire Chiefs Chemical/ They battled and contained the The ACFD field force of 266 career Biological Committee, Plaugher complex incident in one of the firefighters is organized into three asked Council of Governments world’s largest concrete and steel shifts with a minimum daytime Chairman Jack Evans to send a structures, but their efforts were staff of 67, including 15 paramed- letter to the President. The let- overshadowed by the fires that ics. Last year, the ACFD responded ter described the risk of a terror- raged high above the New York to nearly 24,000 emergency calls. ist attack and sought assistance City skyline and by the collapse of Edward Plaugher was fire chief in planning and preparing for such the towers. of the ACFD on 9/11. He became an event. The public, and more impor- chief at ACFD in December 1993, As a result, the U.S. Public tantly, most emergency respond- following 24 years with the Fairfax Health Service (USPHS) invited ers, therefore, never really knew County Fire and Rescue Depart- the Council of Governments to the efforts of the Virginia and ment. He also served as Arlington participate in a watershed proj- Metropolitan Washington, D.C., County’s emergency coordinator. ect to develop the nation’s first responders who had primary The morning of 9/11, Plaugher locally based terrorism response responsibility for handling the assumed the role of senior advisor team with hazardous materi- incident. This is their story. in the incident command structure als, medical management and

8 JEMS out of the darkness The ACFD field force consists of 266 career firefighters with a minimum daytime staff of 67, including 15 paramedics.

The ironic fact that America never knew was that if the crash happened a few hours later, the President’s helicopter would have been positioned less than 100 yards from where the plane went into the structure. mass-casualty decontamina- years of experience with the ACFD tion capability. Plaugher and the at the time and proven leadership ACFD volunteered to work with skills—to serve as the ACFD inci- the USPHS to develop the first dent commander for the 10-day prototype capability. duration of the Pentagon fire and This pioneering work produced rescue operations. the framework for the Metropol- White’s extensive experience as representative at the Joint Opera- itan Medical Response System EMS captain, and later as EMS tions Center (JOC). (MMRS), now in place in more battalion chief, served in three crit- than 100 U.S. metropolitan areas. ical capacities during the Pentagon Deceptive Size It was the predecessor to the response. Schwartz first assigned The Pentagon, headquarters of the National Medical Response Team White as commander of the EMS Department of Defense, is one of (NMRT), which played an impor- Branch. White had spent 10 years the world’s largest office build- tant response role at the Pentagon. supervising ACFD EMS operations. ings. It was occupied by more So the successful operations Next, White was directed to than 23,000 people on 9/11— and incident management at the establish the incident command more people than the World Pentagon terrorist attack inci- system (ICS) logistics section with Trade Center towers. Ironically, dent was the result of signifi- a capability of sustaining fire and the groundbreaking ceremony cant preparedness, planning and rescue operations and support- for construction of the Pentagon operational discipline—and out- ing the entire response force for took place on Sept. 11, 1941, less standing leadership. 10 days. than three months before the U.S. At the Pentagon incident, Once the logistics section entered World War II. Plaugher designated Schwartz— was fully operational, White Built on a site previously a career firefighter who had 18 became the incident command known as Arlington Farms, the five

SEPTEMBER 2011 9 The Pentagon, headquarters of the Department of Defense, is one of the world’s largest office buildings.

The tremendous size of the Pentagon complex can be seen in this photo, which shows nearby high- ways and bridges. surrounding roadways dictated perimeter, which included 200 created the Metropolitan Medi- its pentagonal shape. The Penta- acres of lawn, kept the public cal Strike Team [MMST], which gon’s placement was personally and news cameras a great dis- became known as Metropolitan approved by President Franklin tance from the military nerve Medical Response System [MRSS]. Roosevelt to avoid obstructing center. Therefore, the Penta- We were able to get $300,000 the view of the U.S. Capitol from gon appeared to the many who worth of MOPP [Mission Oriented Arlington National Cemetery. watched the incident unfold to be Protective Posture] protective gear And although not as tall as the much smaller than it actually was to be used in a toxic environment World Trade Center Twin Tow- (see “Pentagon Facts,” below). (i.e., during a chemical, biologi- ers, the substantial, five-story, cal, radiological or nuclear strike). multi-tiered structure was no less Preparedness Military MOPP gear was given to expansive. And because of the Ed Plaugher 120 cities, which was a huge deal high level of security necessary After the 1994 subway attacks in and a lot of money at the time. to protect the Pentagon and its Tokyo, Japan, my colleagues in That’s a drop in the bucket of what occupants, an extensive security the Metropolitan D.C. area and I the government is spending on

Pentagon Facts from the nearby Potomac River, were processed into 435,000 The expansive Pentagon facility is nearly seven million square cubic yards of concrete and molded into the Pentagon form.1 feet and has 3,705,793 square feet of office space—three times The Pentagon has five sides, five floors above ground, the floor space of the Empire State Building. The Capitol could two basement levels and five ring corridors per floor, with a fit into any one of the five wedge-shaped sections. total of 17.5 miles of corridors. The Pentagon includes a five- The Pentagon is virtually a city in itself. It’s a massive, acre central plaza, which is shaped like a pentagon. Ironically, sprawling facility in which its 23,000 military and civilian the plaza had informally been known as “ground zero” since employees work on a daily basis to plan and execute the the Cold War based on the presumption that the Soviet Union defense of our country. would target one or more nuclear missiles at this central loca- On any given day, there are approximately 8,770 cars tion in the middle of the Pentagon if a nuclear war were to parked in 16 parking lots. The facility has 131 stairways and break out.2 19 escalators. Construction of the Pentagon was completed on January 1. U.S. Department of Defense. (n.d.) Pentagon Facts. In The Pentagon. 15, 1943. More than five million cubic yards of Earth and Retrieved Aug. 29, 2011, from http://pentagon.osd.mil/facts.html. 41,492 concrete piles contributed to the building’s founda- 2. Wikipedia. Aug. 24, 2011. In Wikipedia. Retrieved Aug. 22, 2011, from tion. Additionally, 680,000 tons of sand and gravel, dredged http://en.wikipedia.org/wiki/The_Pentagon.

10 JEMS out of the darkness After the 1994 subway attacks in Tokya, Japan, the Metropolitan Medical Strike Team was created.

Ed Plaugher Homeland Security right now. Its current budget is forecast at some- Edward Plaugher was fire chief of the where around $42 billion. And we ACFD on 9/11. He became chief at were declaring victory at $300,000 ACFD in December 1993, following 24 worth of surplus, military MOPP years with the Fairfax County Fire and Rescue Dept. He also served as Arling- gear to prepare for a chemical ton County’s emergency coordinator. attack in ’95 and ’96. The morning of 9/11, Plaugher assumed In 1997 and 1998, we were still the role of senior advisor in the incident having a hard time getting any- command structure put into opera- body to give us even the time of tion at the Pentagon disaster. Today, day. Eventually, we did receive Plaugher serves as director of national some additional traction. We got programs and is assistant executive some additional equipment, and director for the International Associa- our team became operational tion of Fire Chiefs. and started creating a footprint. But it was really starting to lose momentum [before 9/11]. It was getting harder and harder for people to grasp and understand the complexities. After the Tokyo Sarin gas attack, Admiral Young, who was the director of the Office of Emer- gency Preparedness for HHS [U.S. Department of Health and Human Services], brought together a group of about 100 folks and led a discussion on the way to deal with a chemical attacks in the United States going forward. The product of that was the mirroring of the urban search and rescue team ability for EMS. And so, they wanted a team, an After the Tokyo Sarin gas attack, ACFD established plans and sup- urban search and rescue-like plies that could manage an incident of similar size and scope. team. So we created what we called the MMRS, which was all

SEPTEMBER 2011 11 Arlington picked 5,000 doses to stockpile antidotes because that’s the number of people who were affected by the Sarin gas attack in Tokyo.

[Disaster Veterinary Team] and all that sort of disaster vets and disaster morticians. The creation of MMST for Washington, D.C., led to the cre- ation of Washington, D.C. hav- ing an NMRT [National Medical Response Team] as part of HHS. As part of that HHS team, we [Arlington County] asked for, and got, the NMRT. A pharmaceutical stockpile was recommended to us by the Sol- diers Biological Chemical Com- mand. The reason why we picked 5,000 doses was simply because that was the number of people affected by the Sarin gas attack in Tokyo on March 20, 1995. So we based it on a real incident. We had to have a baseline and that’s what we built it around. We also had to have it some- where it could be refreshed and not out of date, as well as guarded and managed closely. So it was actually stored for us and American Airlines Flight 77 crashed into the west side of the maintained for us at the Veter- Pentagon, just beyond the heliport, at 9:38 a.m. Fifty-eight an’s Administration (VA) Center passengers were on board, as well as a crew of six. over in D.C. They kept the drugs from expiring. They would draw about chemical preparedness. It known chemical agents at the the drugs out, use them in their was all about decontamination time. system and order replenishments. and pharmaceuticals. And it was The HHS officials at the Office They maintained and did all of all about patient flow. of Emergency Preparedness were that as a contract with HHS. We actually practiced the abil- so impressed with our MMST, But to bring it into the civilian ity to flow hundreds of patients and were so concerned about the environment, the VA is very care- through decontamination and Washington metropolitan area ful about who has the authority treatment. We had all the tools that they said, “We’re going to to utilize the medications. Our and equipment, trailers. We built convert that team to the fourth team had all the physicians and mobile decontamination trailers National Medical Response the physicians for the NMRT. We in which we could decontaminate Team ... NMRT.” And so they had had already figured out all the tort walking victims, and that was on three mobile teams: L.A., Denver protection necessary for them to the outside of the trailer, and and Winston-Salem, N.C. They be able to go across state lines then victims that were being car- already had three mobile NMRTs, and to have that ability. So we had ried in baskets or on stretchers, and so we created the fourth one, all the mechanics worked out. But on special stretchers—that was which was fixed for the Washing- VA said, “We’re concerned about on the inside. ton, D.C. area. We never designed this. We want to make sure there We worked out with U.S. Army ours to be able to be moved is absolute control on who can get Soldier and Biological Chemi- across the country or to another that stuff out of there.” So we had cal Command the percentage location. It was at the same time very rigid controls as to who could of bleach solution and all that they were creating the DMORTs get stuff out of there and use it. sort of stuff necessary for effec- [Disaster Mortuary Operational We had it broken down where

P hoto A .J. H eightman tive decontamination for all the Response Teams] and the DVETs we could bring an element of a

12 JEMS out of the darkness The Pentagon facility comprises nearly seven million square feet and has 3,705,793 square feet of office space.

metal and jet fuel hurtling into the solid mass of the Pentagon is the equivalent in weight of a die- sel train locomotive, except it’s traveling at more than 400 miles per hour. More than 600,000 airframe bolts and rivets and 60 miles of wire were instantly transformed into white-hot shrapnel. The resulting impact, penetration, and burning fuel had catastrophic effects to the five floors and three rings in and around Pentagon Cor- ridors 4 and 5. The 260,000-pound Boeing 757 was loaded with 11,466 gallons of This purposeful act of ter- jet fuel in its tanks. rorism killed 184 people, 120 people inside the Pentagon, 59 few hundred ... 500 elements … Command & Control passengers and crew members at a time, if we had to. And we On 9/11, American Airlines Flight on Flight 77. would. We’d actually bring it for- 77 left Washington Dulles Inter- ward. As a matter of fact, every national Airport at 8:10 a.m. with Ed Plaugher time there was a State of the just 58 passengers on board ,along I was in the Fairfax, Va., area when Union address at the Capitol, we with a crew of six, en route to Los I heard the incident dispatched moved elements of that stock- Angeles, Calif. The Boeing 757 can and immediately headed for the pile to the Capitol to make sure carry 243 passengers. The 260,000- Pentagon. It took me about 20 we had the ability to protect the pound aircraft took off with 11,466 minutes to get there. I was sur- leadership of the United States, if gallons of jet fuel in its tanks. prised with my ability to get down necessary. It headed west across Virginia Interstate 66 and to the Pentagon. So on 9/11, there were four and West Virginia and suddenly It was wide open. NMRT available in the United made an unscheduled left turn at That day I was a “two-hatter” States. Three of them were mobile, the Ohio/Kentucky border. when I arrived at the Pentagon and one was fixed for Washing- At 9:03 a.m., air traffic control- incident. I not only wore the hat ton, D.C. It doesn’t exist anymore. lers lost contact with the airliner. of the Arlington County fire chief, I understand they’ve totally dis- At 9:37 a.m., in Arlington but I was also the county’s emer- abled it. County, Captain Steve McCoy and gency coordinator. So I was also in We have now spent millions the crew of ACFD Engine 101 were charge of the county’s emergency to support the MMRSs around en route to a training session in operation center. Because of the the country. I think it’s currently Crystal City, traveling north on complexity of the Pentagon inci- funded at about $30 million a Interstate 395. Their conversa- dent, and because of all the emer- year. Although next year it’s not tion about the World Trade Cen- gency service partners who knew a discrete budget item, the Sec- ter attack earlier that morning was I would be involved in the inci- retary of HHS has recently been interrupted by the sight and sound dent, it was clear to me that this given that responsibility again. of Flight 77 in steep descent, bank- incident was going to need what’s They are allowed to fund the Met- ing sharply to its right before dis- called a senior advisor. ropolitan Medical systems. But appearing beyond the horizon. If you look at the pure ICS sys- I think what they will tell us is At 9:38 a.m., American Airlines tem, there is only one person who that the Metropolitan Medical Flight 77 crashed into the west can supervise the incident com- Response Systems are now so side of the Pentagon, just beyond mander, and that is the senior much more robust and solidified the heliport. It was traveling at advisor. That is the person who than they ever were before and about 400 miles per hour. truly has the 50,000-foot view of are a very viable replacement to The destruction caused by the the entire incident and all of the those previous innovative efforts, attack was immediate and cata- moving parts. which were available at the time. strophic. The 270,000 pounds of So somebody had to

SEPTEMBER 2011 13 The senior advisor at the Pentagon incident commandeered a National Park Service helicopter to go up and assess the scope of the incident.

orchestrate the federal partners. Somebody had to make all the proper requests, have the ability to request resources and commit funds.” Our command structure that day was an extension of our normal command, except for a few enhancements due to its size and scope. I knew the incident was going to have a lot of moving parts. I knew there was going to be a million distractions, and I didn’t want anything to distract from the operation of the incident. So I had our Assistant Chief of Opera- Ed Plaugher, senior advisor at the Pentagon incident, comman- tions, Jim Schwartz, now the ACFD deered a National Park Service helicopter to go up and assess how fire chief, run the operation. I’m much of the massive five-sided, five-ringed building was involved.

Editor’s note: Ironically, that morn- I assumed the role of senior I said, “I think I’ve seen everything I ing, the County of Arlington gave Plaugher advisor. My job was to coordinate need to see. Take us down.” the financial capability to spend up to with the multitude of respond- I could literally see fire blowing $50 million. He was called that morn- ing local, state and federal agen- out of the third ring, which told me ing and told by then Arlington County cies and make sure that we would how far in it was involved. But that Director of Management and Finance, have the right type of environment wasn’t the main point. The point Barbara Donnellan, that, after learning for success. was to get the global view—trying of the attacks on the World Trade Center So the first thing that I wanted to get my arms around it. facilities in New York, she had called a to find out was exactly how big this Immediately after that helicop- New York financial source and had estab- incident was. The Pentagon is 6.6 ter assessment, Schwartz and I lished a line of credit of $50 million. It million square feet. So I went and partnered to run the incident. We was up to Plaugher to use it the best way commandeered a helicopter from partnered to make sure all the he saw fit in the event of an incident in the National Park Service [that moving parts were in place. Arlington County. This advanced action had landed at the scene]. I wanted A lot of decisions were being helped Plaugher get things done fast that to make sure I understood exactly made, such as, whether we would day. It was what Plaugher termed and how much of this five-sided, five- allow military personnel and office “immediate empowerment by government” and a ringed building was involved in staff to stay in the Pentagon. A tremendous help to him on 9/11. this incident and how much of the high-ranking official from the regional resources we were going Office of the Secretary of Defense a firm believer that the normal to need to bring to bear. came up to me and said, “We do way we operate in the fire service I walked up to the chopper, not want to leave the national is, if the incident is run well and pointed to the shield on my hel- command post because our nation all the pieces are in place, you met, and then pointed upward to is under attack, and we’re not sure don’t disrupt the overall incident signal that I needed to get a bird’s how complex it is.” And I’ll never approach. You monitor the prog- eye view of the damage. forget this. I looked at the guy and ress and reserve the right to make So I went up, just the pilot and said, “But I don’t want you making changes at another time. I, got a great view of the incident, national decisions based on an When we pull up in front of a understood the complexities and environment full of carbon mon- house fire, we don’t change com- understood how many of the Pen- oxide, because the very first thing mand 25 times. If things are going tagon’s five rings were involved. that happens is that you start to well, the fire chief doesn’t step I’ll never forget, the pilot came do irrational things.” in and take over. So why should on the intercom and said, “Chief, And so we agreed that we were we change direction now just if I get any lower, we’re going to going to supply them with breath- because it’s now an incident at suck smoke into the engine, and I ing apparatus and do air monitor- the Pentagon. don’t think we want to do that.” So ing to make sure that the national

14 JEMS out of the darkness The Pentagon has five sides, five floors above ground, two basement levels and five ring corridors per floor.

Early in the incident, fire was blowing out of the third ring of the structure.

The command post was located in the Arlington County Police Department’s command vehicle, under an overpass near the Pentagon.

SEPTEMBER 2011 15 The Pentagon has a total of 17.5 miles of corridors that had to be traveled and searched by rescuers on 9/11.

command center at the Pentagon, air quality. And we had every- keep account of the units that the military’s command center, body who was initially in there were around them and with them. was not going to be impacted by in breathing apparatus. We only Also, we knew we had to refresh the hazards of the incident and had a couple that were not and the crews with air bottles and that all the systems were isolated. ended up with a couple of hospi- rehab operations. We wanted to make sure that talizations. And we ended up with The crews sent in to do the inte- there were certain things in place. a couple of probably long-term, rior attack each took two SCBA I was able to get myself in the very protracted illnesses from that. air bottles in with them because, position to make those decisions, But I have a comfort level that we remember, this was a massive because the fire fight was being had a sense of what was going on structure [heavily involved in jet- run by Chief Schwartz. You’ve got there. We also implemented a very fueled fire and smoke conditions]. to be able to do that. You cannot elaborate set of decontamination They were doing all those types get yourself trapped into being an procedures for our personnel, a of extraordinary things. And “jack- operational chief. byproduct of our earlier planning ing” [pulling hose] lines and get- Our command personnel were for the NMRT. ting adequate water supply. These co-located in the police depart- We also had mandatory physi- are all very difficult things to do ment’s command vehicle. We cals for our personnel, which helps in a large, heavily damaged, occu- secured their mobile command you after an incident like the Pen- pied, government-controlled, top- unit and located it under an over- tagon. Based on age, each member secret, office structure. pass on the road leading into the had annual/semiannual physical, We had our rescue squad cut South Park Plaza of the Pentagon which included lung scans, blood the guard rail down, so we had … just simply to make sure it was work, etc. That gives you a baseline immediate access through to protected. for all of your personnel. Route 27 and to the helicopter We set up there and started pad, where the plane went in. That operating out of that self-con- Personnel Accountability opened up the area for assets to tained command vehicle. We oper- A.J. Heightman arrive and enter. ated in that vehicle for the next People have a tendency to self- We soon accomplished account- several hours to make sure that we dispatch and respond to incidents ability through a series of chief had resources, that we were mak- in their service area or other dis- officers and command presence. ing progress with the fire fight. We tricts. At the Pentagon, you also We also knew we had to have were making sure we were leverag- had thousands of military person- a tight security perimeter estab- ing all our regional resources. nel who flooded the area after the lished. So one of the very first The operations chief and I were crash and wanted to help. But self- things that I did was order 2,000 located there, and I was in con- responders can also make a scene feet of chain link fence and had stant communication back to the look like ants at a picnic. it installed to gain full control of county’s emergency operations I understand that the military the scene. center. The ops chief was in con- personnel, who work under strict Our parks department had a tact with the front-line firefighters command and control princi- contract with a local fence com- through multiple means: radios, ples, while initially swarming the pany. We invoked that contract, operations channels, as well as scene, soon recognized your com- and they brought a massive through some runners. We were mand structure. And when you amount of fencing and supplies having trouble with communica- said, “Don’t let people go back right out and put it up. I requested tions. But he was in communica- into the building,” you had some a six-foot fence. tions with his chief officers. He guys physically posted to keep They asked me how long and had divided it and established fire that from happening. how tall, and I said, “Six foot, 2,000 suppression branch, river division, feet.” Somebody later asked me, EMS division and an A-E division. Ed Plaugher “How did you know you needed It was divided up into basically the We didn’t do it very well initially. 2,000 feet?” And I said, “I didn’t. I inner courtyards and the exterior. But we knew that we had to make figured when we ran out at 2,000 They were attacking from two dif- sure that we were accounting feet, we’d know how much more ferent places. for everybody. We were able to we needed.” So away we went. We started air-sampling moni- account for everybody who was It was also difficult to find toring immediately and had the engaged in the incident, in the fire victims inside that building EPA give us assurances about fight. The forward commanders because it is a massive, complex

16 JEMS out of the darkness More than five million cubic yards of Earth and 41,492 concrete piles contributed to the building’s foundation. structure—unlike any other office building in the world.

A.J. Heightman You had crews on various levels. As your after-action report stated, they were doing their best to refill their air bottles and rescue peo- ple. How difficult a task was that? firefighters, all operated in that from fire, EMS or police agencies Ed Plaugher environment and did a great job in this area. They performed in an extraordi- under the most adverse situation. At one point, early in the inci- nary fashion, and only they can dent, we had to have unarmed best describe it. We had a cou- Edward Blunt, Sr. firefighters, the biggest ones we ple hundred firefighters that were Accountability was a big issue for had at the time, physically restrain truly dragging hose, truly com- a while, not just getting control people from going into the burn- bat fire fighting at the Penta- of all the military personnel and ing structure. It was touch and go gon. Firefighters from Arlington, Pentagon employees exiting the for a little while. Montgomery, Prince Georges’ and building and wanting to assist us, Once again, there was a lot Fairfax Counties, as well as D.C. but it was also people who weren’t going on, so we couldn’t control

It was difficult to find victims inside the building because it’s a massive, complex structure.

SEPTEMBER 2011 17 The Pentagon was occupied by more than 23,000 people on 9/11.

The interior crews were doing their best to refill their air bottles and rescue people. It took a little bit of time to Ed Blunt develop, but we had it opera- Edward Blunt, Sr. was a fire and EMS tional at the scene. Captain with the ACFD and EMS department on 9/11, a position he still Carl Lindgren holds today. One of the changes we made in our mass-casualty command after 9/11 is a position called incident check-in. It’s based on the principle of the FireScope incident command system. When you call for assets, that’s everything at one time. But once relationships with departments where the assets will report to— we were able to wrap our arms from the Washington Metropoli- to a base. around the good intentions and tan Airport Authority, Alexandria, We have had a mass-casu- emotions at the scene, things Fairfax, Loudon and Prince Wil- alty incident manual since 2007 got a little more stable and liam counties. that reflects what alarm the units understandable. We also had a few depart- are going to respond to. That is You’ve got to remember, there ments that self-dispatched. very helpful if you’re the EMS was so much going on. People Credentialing is a very impor- branch or medical group super- were so fearful everywhere. It was tant aspect of any large-scale visor because you know what unprecedented. They were wor- scene. And it makes a big differ- units are going to be coming ried about what was going on in ence to identify who’s who, where in, and it eliminates some of the country, particularly the Pen- they’re from, what their capabili- the issues associated with ambu- tagon employees. ties are and what they bring to lance response and assignments. Our normal mutual aid partners the show. Since the early 80s, MCI responded in, and we worked well We basically ended up creat- response was a collaborative together. We trained together, ing a funnel that incoming per- effort between the Northern VA so we had well-established sonnel had to come through. EMS Council and the region’s

18 JEMS out of the darkness At 9:03 a.m., air traffic controllers lost contact with American Airlines Flight 77.

For a while, accountability was a big issue because military personnel and Pentagon employees exited the building and wanted to assist the emergency crews.

EMS Officers. In 2007, because all It’s taboo now to do it at all. You you can be reached 24 hours a Fire/EMS 911 service is provided can have a unit that’s closer, but day. And they’ll text message you by the Fire Service, the manual unless they’re going to make an and say, “Red team’s activated; was included as one of the docu- extreme difference in the out- report to fire station #2 at 01:00 ments approved by the Northern come of the call, they stay out of hours for your briefing.” VA Fire Chiefs and included in the the assignment. Our whole area regions’ operational plans. has pretty much adopted that Liaison Officer In addition, we’ve obtained philosophy. To build that liaison with these three medical ambulance buses And since 9/11, we’ve created big institutions, we have a liaison that are capable of transporting red and blue teams for call-back officer. In the case of the Penta- up to 20 patients and medical purposes. Now, when something gon, it is a full time, on-site posi- care support units, which provide big happens, our personnel call tion. In Gil Cook’s case, he was medical supplies for the treat- in and the communications cen- assigned there for seven years. ment area and other areas. ter will tell them what team is It’s an important position being activated and what their when you consider that there are Edward Blunt, Sr. assignment is. 23,000 employees there. They We don’t self-dispatch any more. Each staff member provides us knew him, and he knew the in That’s something we used to do. with a telephone number where and out of everything. It has built greater coordination for us. You Carl Lindgren could do the same thing with uni- On 9/11, Carl Lindgren was a captain versities or other large facilities. and EMS supervisor. Today, he’s a Battalion Chief in charge of EMS for System Cohesiveness ACFD. He was one of several fire/EMS Ed Plaugher responders on 9/11 who were also The success of every incident is cancer survivors, and who were either always about the cohesiveness cleared of, or receiving treatment for, of the incident. In other words, cancer at the time of the Pentagon does the incident have all the incident. cohesive elements necessary for success? You can have the best

SEPTEMBER 2011 19 At 9:37 a.m., the crew of ACFD Engine 101 saw Flight 77, in steep descent, disappear beyond the horizon.

ACFD made sure they had enough EMS assets, staging enough personnel and vehicles to run the triage center.

EMS structure in the world, but what other things were planted personnel and vehicles to run if you didn’t bring your supplies in it. our triage center. That was one with you, you really don’t have an There were a lot of other mov- of the things I was constantly EMS system. ing parts that were going on. pinging, “How are we doing with So you need that cohesive- I worked on the plan develop- EMS resources?” ness to operate the incident ment for those seven years and And I kept being assured, “We effectively. I had led the pre- understood that there was a key have transported everybody that paredness for the Washington regional leadership role that had we have received. We have plenty Metropolitan region since we’d to be played as well; like bringing in staging. We’re not running out started this effort in 1994. I also in the USAR teams from Fairfax of EMS resources.” served as chair of the fire chief’s and Montgomery Counties. Early on, we were only using subcommittee for terrorism pre- We brought the USAR resources the central triage area marked by paredness. So there were rea- to the incident as regional mutual colored tarps. sonable preparedness things aid resources before we ever John Jester, who was in charge that actually only I could do. I got federal permission. And so of the Force Protection Agency mean things that only I had the we were activating things on a at the Pentagon—their police ability to do. regional front because Washing- department—had his personnel The stockpile of pharmaceu- ton, D.C., does have some great, inside monitoring the rest of the ticals for the Washington Met- robust resources. We were lever- Pentagon for smoke and flame ropolitan region, which was the aging those. extension. only stockpile of pharmaceuti- Again, that’s what a fire chief They evacuated most of the cals in the nation, was within my does. Leverage those resources; Pentagon, and force protection jurisdiction. We had the ability to stage resources; make sure we was making sure it was evacuated treat up to 5,000 patients with our had movement of the resources and staying evacuated, except for stockpile. I had the total access from the outer to the inner areas. the national command center. to that and was the only person After the impact, they imme- authorized to issue items out of EMS Operations diately started a process to fig- it. So we weren’t sure what was We made sure we had enough ure what they were going to do on that airplane. We weren’t sure EMS assets, staging enough about opening the Pentagon the

20 JEMS out of the darkness At 9:38 a.m., Flight 77 crashed into the west side of the Pentagon, just beyond the heliport at 400 mph.

When they said there was another plane coming, we said, “Go, just load and go. Just go.” And they just took off. They all went in different directions. next day. So we sat down, and >> Control the airspace, which Edward Blunt, Sr. we said, “Look, if you can get was being patrolled by At that moment, I think we your construction crews in and the U.S. Air Force out of had about 15 people who were build wooden barriers, we can Andrews Air Force Base severely injured. And we had carve off sections of the Penta- >> Start securing the parame- them laid out, and we were gon and open it back up.” We all ter and repost people. working on them. When they felt we needed this. It’s a symbol said there was another plane of our military and a symbol of Carl Lindgren coming, we said, “Go. Just load our nation. So we wanted to get Units on scene were then advised and go. Just go.” And they just it back functioning. by command to evacuate to safer took off. They all went in differ- When the threat of a second grounds due to a reported third ent directions. plane came, the decision was to plan heading to our location. That was a choice we made. To get our people out of harm’s way. People started yelling, “Another just have the units take off. Get as And we think that saved a lot of plane is coming. You need to many patients as we could in and lives, as well. The rapid move- evacuate.” And looking up and just have them go. ment of those 15 or 20 people seeing where all our people are, who were outside expedited their I’m going, “There’s no way all Carl Lindgren transport and care. And we did those people can evacuate.” There weren’t any great choices. that twice. That allowed us to do But actually, it was one of the That single choice, I think, saved a lot of things: best things that happened for all of those peoples’ lives. >> Clear the area to make sure the patients. It wasn’t necessar- everybody was safe; ily textbook EMS, but because of Edward Blunt, Sr. >> Rapidly move and then the fear that another plane was Yeah, it was interesting. After organize all the volun- coming and the reallocation of that, we initially moved the teers who were showing things, five and six patients at patients and all our stuff under up to assist. a time were loaded into medic an overpass. But we eventually >> Force everything away units and transported to local came back after that. [from the structure]. hospitals. And what was interesting was

SEPTEMBER 2011 21 The destruction caused by the attack was immediate and catastophic.

EMS vehicles were staged adjacent to the triage and treatment areas, with convenient access to the nearby highways.

that, after that first evacuation [which turned out to be a false alarm], there was another evac- uation order, and nobody really took it seriously. By that time, we were tired of running back and forth. We were emotionally drained. Everybody had had enough of the crap. We were all just kind of going like this to the air saying [middle finger raised in the air], “Screw you. Come on, if you’re going to bring it on. Come on. Bring it on.” Again, [although stressful], each evacuation allowed us to Some critical patients that self-evacuated were taken by citizens or gain more control. It was the fellow employees to area hospitals in private vehicles. worst thing that could possibly happen, but it was the best out- coordinator, and deputy to the them now.” come possible. It gave us the EMS Branch Director. There was We said, “What patients? We ability to get our arms around a point in time when there were have not sent you patients in a it. To me, those were the valu- no more victims. We hadn’t while.” They said, “Well, we are able lessons. transported anybody for two, still getting patients coming to two and a half hours. our ED.” Carl Lindgren Then we started getting calls Here, what happened was that The strangest thing happened from area hospitals wondering people who had some non-life- when I was functioning in the dual why we were not informing them threatening injuries, first went role of medical communications of “the patients being sent to home, washed, changed, or met

22 JEMS out of the darkness The Pentagon includes a five-acre central plaza, which is shaped like a pentagon. up with their loved ones. And then there about 1:13 after the call unfolded, we immediately went to a hospital ED for care, came in for a plane that struck assembled at Arlington Station hours after the main incident. the Pentagon. I pulled in to 1 for role assignment. Additionally, some critical the scene in my Suburban at I didn’t initially have a for- patients that self-evacuated the same time as Alan Dorn, ward medical role. I was initially were taken by citizens or fellow another EMS captain. assigned the EMS supervisor employees to area hospitals in I met with Battalion Chief job to protect the citizens of the private vehicles. And many of Bob Cornwell; we were actu- county [while the Pentagon inci- the incoming or returning medic ally parked beside each other. dent was underway]. Then I was units were flagged down by citi- At that particular time, we were assigned to NMRT response, zens before reaching the Pen- positioned right near the heli- handling the medical caching tagon and asked to treat and copter fuel depot, which was not down at the Pentagon. transport patients with signifi- a good place to be because, if I soon moved into a dual role cant critical injuries that had the barrels started to blow up, of handling the medical commu- been moved outside and never they would have been going all nications coordinator role, along taken to a patient collection and over the place. So we elected to with serving as one of the depu- treatment area. move rapidly away from there. ties assigned to assist the EMS My initial assignment was branch director, Chief Bonzano. Early Command & part of the incident command Fairfax County Fire Cap- Triage Actions system. At the time, we called tain Richard Yuras was the Ed Plaugher it EMS control officer. I had to other EMS supervisor assigned Driving in on Interstate 110, I set up the triage and treatment to assist Bonzano in the EMS saw that column of black smoke areas and identify those areas. I Branch. pouring out of the Pentagon. I just kind of get the ball rolling. was in my Crown Vic, by myself, It was such a big incident that probably traveling at 90–95 you had to take it in little pieces. miles per hour. I saw it and said, Things weren’t going to hap- “Oh, shit.” pen like they normally do, where And the reason is because I had everything was at your disposal. attended and spoken at multiple So it was going to take a little conferences where I told audi- bit of time. ences that someday I was going to be standing on the highway look- Carl Lindgren ing at the Pentagon smoking. My initial role was more of a I said, “Here we go. Let’s see support role. I was a very new Personnel driving in on Inter- how far along we are on the pro- captain. I had been promoted to state 110 could see a column of cess for preparedness. This is the rank of Fire/EMS captain and black smoke pouring out of the the test.” It wasn’t any trepida- serving as a shift EMS super- Pentagon. tion. It wasn’t any anguish or visor on 9/11, having served in fear. It was ... we’ve worked hard. that capacity for 10 years as a I later assisted with the screen- So I thought, “OK, let’s go. lieutenant prior to the position ing of personnel at the incident Let’s do it. Let’s make sure we’ve being reclassified. credentialing area that was estab- got all the pieces in play. Let’s As luck would have it, I, and lished to ensure accountability. make sure we have the right at least half of the command I continued to serve in the 50,000-foot view at all times. staff from several of the vari- operation section, and as a Let’s make sure we have all the ous county fire/EMS and public safety officer while at the Pen- right components in place. Let’s safety agencies, were attend- tagon. I also split time between make sure we have prepared all ing a county management sem- there and covering the county these folks to perform capably.” inar at our community center. in my as shift EMS battalion This allowed the influx of addi- captain during for the first two Edward Blunt, Sr. tional officer/commanders to weeks after the incident. I was the EMS captain assigned be infused into the overall ICS to the south battalion which structure sooner in incident. Gil Cook includes the Pentagon. I arrived So when the incident The wedge where the aircraft

SEPTEMBER 2011 23 Ironically, the plaza of the Pentagon had informally been known as “ground zero” since the Cold War.

The wedge where the aircraft impacted had just been remodeled and hardened. Impact anywhere else would probably have caused more damage and fire extension.

impacted had just been remod- Gil Cook eled and hardened so that prob- ably was the only positive aspect On 9/11, Gil Cook was an EMS super- we had going for us on arrival, visor and fire captain with the ACFD, because it would probably have assigned in January, 2002 to serve as caused more damage and fire the Pentagon Liaison Officer. He was stationed at the Pentagon on 9/11. extension if it had impacted one of the less structured wedges and rings of the building.

Edward Blunt, Sr. We moved quickly out onto what was I-110. There was a big patch we’d get the largest flow of vic- right to you, right there, in real- of grass there, and that’s where tims coming out. But in hind- ity they’re not going to walk back I initially wanted to set up the sight, one of my biggest lessons through that hole where the treatment and triage area. learned was that, even though plane entered. They’re going out My thinking was because it we always train people to set through the other end. was near the massive hole in the up right in front of the incident If I ever have it to do over building … that that was where and think that victims will come again, I’m going to make sure people are on all sides. Editor’s note: The morning of 9/11, a supervisor from the company con- We soon began to wonder tracted to move furniture back into the unoccupied area in the recently reno- where all the injured were. We vated wedge saw what had happened at the World Trade Center and called and were getting a few, but obviously, ordered her staff to leave the Pentagon. She feared that, since it appeared to be there were 25,000 people in the a terrorist attack on America, the Pentagon could be targeted next. Her workers facility and we weren’t getting followed her directive and left the section of the Pentagon that was destroyed the kind of numbers we thought by the plane minutes later. Her actions saved the lives of her workers. we would. It turned out that victims, as

24 JEMS out of the darkness The 270,000 lbs. of metal and jet fuel that impacted the Pentagon was the equivalent of a diesel locomotive at 400 mph.

It turned out that victims as well as uninjured employees were exiting out a lot of different areas. well as uninjured employees, When I was pulling onto the huge issue to get response vehi- were exiting out a lot of different Pentagon property ... talk about cles to the site. areas. They went to clinics within looking like a movie ... it looked Before we responded, we were the Pentagon itself. And a lot just like a movie in that peo- fully aware of what was going on of people with less severe inju- ple were walking away from their in New York City. So we knew as ries self-transported themselves vehicles on the highway and had soon as they said a plane had to different places where they felt just left their cars on the roadway. gone down [at the Pentagon], they could get treatment, such They just left. They ran. They were that there was a 99% chance it as hospitals, fire stations, urgent literally running. People weren’t had something to do with that. care centers. dumb. They knew what had hap- The Fort Myer Fire Depart- Many found their way to the pened in New York. They knew ment provided aircraft crash res- parking lot, got in their own car there was a potential for a second cue at the Pentagon. They had a and drove themselves. plane, second attack, whatever. truck positioned near the facil- What also happens …. I’ve People were so scared that ity’s helipad. found from the human behavior they just abandoned their vehi- Our Station 5 ladder and way of things … is that people cles on the roadways. So I told engine were on scene rapidly. drive back and forth to work their the police to start hooking [tow- It was a big, giant scene, so it whole careers, and they don’t ing] as many cars as they could, was really hard to initially size really pay a whole lot of attention and give us one lane, at least, so up everything and collect all the to it. But when a tragedy like this we could go north and south with information that you needed, occurs, they actually remember that one lane. The police did a at one time. With your typical that there’s an urgent care cen- really, really nice job of doing it scenes, you can geographically ter here and an urgent care there, in a quick amount of time. put it all together. But at this inci- like near their gym or supermar- A few vehicles, including a taxi dent, it was so big, so many dif- ket, and they were nailing those cab, had been hit by plane debris, ferent entities. places pretty heavily. and a light standard near the We set up the treatment/triage Some people arrived at fire highway had been clipped off as area and used the START Triage stations in pick-up trucks. I mean, the plane came in. It came in that process to initially triage victims. severely injured people. low and flat. This all created a It was something we practiced

SEPTEMBER 2011 25 More than 600,000 airframe bolts and rivets and 60 miles of wire were instantly transformed into white-hot shrapnel.

When crews approached the Pentagon scene on the highways that surround the Pentagon property, many described the scene as looking like a movie. People just stopped their vehicles on the highway and got out to see what had just occurred.

26 JEMS out of the darkness The control of bystanders, building occupants and responders can be a major challenge to incident managers.

Many were scared or in shock from what they had just witnessed and simply walked or ran away from their vehicles, leaving them there on the highway, still running. They knew what had happened in New York. They knew there was a potential for a second plane, second attack, whatever.

With so many vehicles abandoned on the roadways, incident commanders had police start towing away vehicles to give them open lanes to access and egress for emergency vehicles. fairly regularly. didn’t really come out of the replaced by what is referred to Actually, it went pretty much structure in the numbers or in the as RHCC, [The Regional Hospi- to plan—the way that we had time frame that you would have tal Coordination Center], and it’s trained for it. We treated over in a drill because there was fire separate from the hospital. But 250 patients. involved, a building collapse and it’s through a grant, and its func- At the time we had a radio sys- a massive building complex with tion is still the same, which is tem called MEDCOM at Fairfax multiple points that they either to coordinate within the North- Hospital. I had our team notify exited or were extricated from. ern Virginia Regional Hospital MEDCOM fairly early in the inci- Cell phone was our only commu- Coalition. Basically, to ensure dent, so they started clearing nications with them that day. better resource allocation and house at the hospitals to take on availability, surge capacity and a large number of victims. Carl Lindgren communications. The issue was that the patients Today MEDCOM has been One of the good things that

SEPTEMBER 2011 27 This purposeful act of terrorism killed 184 people, 120 of which were inside the Pentagon.

occurred early was that almost all the Virginia hospitals and the hospital across the river in the District of Columbia stopped people from coming in for elec- tive surgery and discharged a lot of patients. By doing so, they created a larger surge capacity, which was something that had been talked about or practiced prior to this event. One of the good things that occurred early was almost all the Virginia hospitals and the hospi- tal across the river in the District of Columbia stopped people from coming in for elective surgery and discharged a lot of patients. The D.C. hospitals actu- ally got many of the patients. Because the Pentagon is so close to the D.C. area, it was more convenient to go there just based on the traffic pattern than it was to try to get ambulances swung around to go to Virginia hospitals. So, as far as patients, we ini- tially were only getting “dribs and drabs.” We kept waiting Caption TKTKTKTK. for the big surge of patients to come, and they weren’t coming early in the incident. If people were ambulatory, they were gone. They weren’t going to stay around. I mean the fear—it was just so evident in their faces.

Carl Lindgren Then, after we were all set up and receiving patients, we had to evacuate the area rapidly because we were being told there was another plane on its way. We ran and sought cover underneath one of the bridges adjacent to the Pentagon. But when you’re in a complex as expansive as the Pentagon with wide open parking lots and A few vehicles, including a taxi cab, had been hit by plane debris bus parking areas, there’s not a and a light standard near the highway that had been clipped off as lot of protective cover to be had. the plane came in low and flat. This occurred not only when

28 JEMS out of the darkness If you look at the pure ICS system, the only person who can supervise the incident commander is the “senior advisor.”

Triage and treatment areas were set up early, and crews used the START Triage process to initially triage victims. the plane went down in Shanks- there was another plane on its for and headed for our area. ville, Pa., but several other times way. We ran. The military was also getting when we were told to evacuate reports of the same danger. And the area. Then, after we were all Edward Blunt, Sr. a big factor that added to our set up to receive patients, we The police and FBI on the scene anxiety was that as they turned had to evacuate the area rap- were getting intelligence that planes away from coming into idly because we were being told more planes were unaccounted Reagan. You could see them off

SEPTEMBER 2011 29 The ICS senior advisor is the person who has the 50,000-foot view of the entire incident and all of its moving parts.

in the distance, turning. So you weren’t sure whether they were the good guy or the bad guy. You could just see them banking back toward Baltimore. It wasn’t a very comfortable feeling. There were a lot of emo- tions. You were angry about the whole thing because you’d already seen what had gone on in New York. You knew what was happen- ing to the country. You couldn’t help but think about your own family, where they were and what was going on with them at the time. My wife was on a plane headed to Chicago, so I worried about the status of the plane she was on. And then, with all planes in the United States grounded, she was trapped there [in Chicago]. cell towers were too jammed Integrating Military So my kids ended up at a neigh- up. They eventually brought Personnel bor’s for five days. in COWS [cellular towers on Gil Cook It was the following day before wheels]. She finally was able to Chris Coombs, our liaison from I spoke to my wife because we get through to a neighbor. That the Washington field office of didn’t have any communica- neighbor then got a hold of me. the FBI, was linked up with Chief tions for a while because the It was the craziest thing. Schwartz and Lt. Bill Stout from

30 JEMS out of the darkness The ICS senior advisor at the Pentagon incident commandeered a National Park Service helicopter to go up and assess the scope of the incident.

Edward Blunt, Sr. We had military personnel show- ing up everywhere; even inside the building. We were trying to orchestrate and control things with bull horns. And to their credit, the military staff com- posed themselves and really fell in line with what our inci- dent command plan was, and, together, I think we ended up working very, very well together. We had all the help you could have ever imagined at every level. The D.C. hospitals got many of the patients because nearby We also organized military per- bridges and access roads made it more convenient for sonnel into groups to stand by ambulances to go there rather than to Virginia hospitals. and run backboards, portable stretchers and supplies wherever the PFPA (Pentagon Force Pro- military personnel and took a they were needed. tection Agency). They had a uni- great deal of discipline for them I think our command system fied command established within to listen to the fire department and vests helped them realize, the first 15 minutes. We also had and not go in the building, back hey, there’s a structure here we’ve a lot of military officers, ren- into the crash, collapse and fire got to follow. In addition, we ovation and building manage- site due to unsafe conditions and involved some of their senior offi- ment personnel that came and their lack of necessary PPE. cers in our command operations. assisted us. The significant number of That was a huge help. trained medical staff members I think they needed to see Carl Lindgren provided to us by the military was some of the scene leadership Capt. Blunt had a significant flow incorporated into our treatment coming from their own line of of patients coming to him along areas. Their highly trained, physi- management. with a lot of military personnel cians, PAs, RN and medics were who wanted to help, because just used and managed by the fire Gregg Karl as in the fire service, they don’t department personnel assigned I was a rookie. The Pentagon was want to leave anybody behind. as the red, yellow and green treat- definitely one of those things It was very, very hard on the ment area managers. you don’t expect when you’re

Many military officers that came and offered assistance at the command post.

SEPTEMBER 2011 31 The Pentagon is a massive structure that has 131 stairways and 19 escalators.

coming out of recruit school. I was Gregg Karl assigned to Station 4 in Claren- don. They had all of us report in at On 9/11, Gregg Karl was a new fire- Station 1 for further assignment. fighter for ACFD. He’s now a lieutenant. With units were coming in from other jurisdictions, I ended up with one of my captains on an Alexandria engine running all the normal calls around Arling- ton for the better part of the day. I think that’s the thing a lot of people forget about when there’s a disaster. You have to keep run- ning calls in your response area. We were running all day. We ended up handling a pretty good rolling kitchen fires by ourselves. Dispatch told us, “You’re going. That’s it. Good luck.” We probably ran seven to eight medical calls. The normal day is going on outside of the incident. You’re waiting for ambulances to show up and things like that. Later that evening the depart- ment sent a bus around to all the fire stations and said, “Time to get fresh crews down there. Everyone get your gear and get on the bus.” They took us down to the Pen- tagon and switched out person- nel, and then we started working from there. When you pulled up, you had no idea. You watched it on TV from the station and could see the smoke as you looked down the road. But when you pulled up, you realized that TV just didn’t do it justice. You are there and absorb everything that is actually going on there. With TV, you get a really good picture of it, but not all the noise, the smells, everything that’s hap- pening there. Everyone got off the bus and just kind of stood there for a few seconds. “Yeah, OK, let’s go to work now.” You get to know people really quick at a disaster. I remember

32 JEMS out of the darkness The senior advisor has 2,000 feet of chain link fence installed to gain full control of the scene. going to the courtyard of the Pen- the next thing you know, you’re It’s such a massive build- tagon, with then Captain (now paired up with three or four peo- ing, but it doesn’t look that big. chief) Reshetar. ple you’ve seen but don’t neces- When you see one side of it, one You know, when you’re a sarily know personally. A lot of wedge of it, it doesn’t look that rookie, you don’t know many peo- strong friendships are made at big. But when you get inside and ple from the other shifts. And those incidents too. start moving through the corri- dors and down the hallways and sections, you realize quickly that you have no idea where you just came from. It’s actually laid out in a systematic way and hasn’t changed much since 1944.

Communications Centers A.J. Heightman The Arlington County command officers told me something that was really profound. And that was, “You know, we always said Arlington handled the Pentagon with a first alarm fire assignment or like a first alarm.” I understood from that com- ment that it was just handled like it should be handled. It wasn’t like you had to call for third or fourth alarm once the call was underway a few minutes.

Ed Plaugher There is a famous tape record- ing from Arlington County Truck 5, who had an acting captain on duty on 9/11. He told the commu- nications center, “We have a plan. Give me a third alarm assignment at the Pentagon.” The use of alarm structures did not happen ever again. In other words, there was never any deci- sion or request that needed to be made to call a second alarm, third alarm. We simply added all the resources we felt were needed during the initial assessment. Part of it was that the dis- patch center had taken the ini- tiative to just force everything there. So there wasn’t any need to call additional alarms. They were Military personnel were organized into groups that stood by and pushing everything they could. moved backboards, portable stretchers and supplies wherever they And so the units were just being were needed. pushed there. And so it kind of

SEPTEMBER 2011 33 Although EMS crews were assessing and treating, they were forced to evacuate because of a report that another plane was on its way.

stepped out of the norm. Our norm was exactly what the act- ing captain said, “Give me a third alarm.” And Battalion Chief Bob Corn- wall just simply said, “I think we need an assessment, before we do that.” In the meantime, the dispatch center was amass- ing resources because they had a bird’s eye of what was going on at the World Trade Center because of the television cover- age and other reports they were receiving. So they knew that we were under attack. Not just an airplane crash.

A.J. Heightman There are dispatch centers that aren’t allowed to be proactive like that. To me, a lesson learned from the Pentagon and others is: We need to allow our comm centers to function the way they really should—as resource cen- ters. There are parts of this coun- try where you can’t get a medical helicopter dispatched unless the fire chief tells you it’s OK, or you can’t proactively send a coro- Dispatch Centers need to be empowered to send resources ner or medical examiner unless whenever they have indications that they will be needed. When someone asks for it. If they know they know there’s a plane into a building, dispatchers shouldn’t it’s a plane crash or MCI they have to wait for an incident commander to get on scene to request shouldn’t have to wait for some- resources such as technical rescue teams, medical helicopters and one to ask for the mass-casualty additional ambulances.

34 JEMS out of the darkness We need to allow our communications centers to function the way they should—as resource centers. vehicle. They need to be able to talking, in most cases, in most doesn’t understand? You can send it. systems, to the dispatch ele- only transport two patients. And ment that is making decisions. you’re going to be a command Ed Plaugher Then some departments tell vehicle initially. So what is it that And we often had “regional” sit- their dispatchers, “You can’t you don’t understand?” uations [and we planned for it make decisions.” Now, wait a and empowered our communi- minute. You’ve got a firsthand Ed Plaugher cations center to be proactive in observer, in a “forward position?” Again, I think we need to say the dispatch of resources.] This So why would you not want them we’re going to trust the system. wasn’t the first regional situation. to make decisions based on that And the system is now built with I mean, when I was with Fairfax kind intelligence. some great capabilities. We’ve County, we had two and a half Look at the crash on the Hud- got AVL [automatic vehicle loca- million gallons of gasoline run- son. Some of the first video came tion], GPS, all those type of ning down the streets from a from a guy who saw it firsthand. I things. Let’s use them. pipe line rupture. We had mass- mean it was on YouTube before I think if you describe life after casualty incidents in the region the dispatcher even dispatched. 9/11 for the responders that were in 1982 with the Air Florida and So why would you not want to involved as anything less than a Metro subway system crashes. take advantage of that and truly roller coaster, you’re in denial, So there was a certain degree start to leverage your system to because you have enormous of regionalism that is ingrained. its fullest extent. highs and enormous lows associ- As a matter of fact, the fire ser- I think we need to shift our ated with these types of incidents. vices in Northern Virginia have decision point to saying, “We’re Stress is a legitimate price no political boundaries, and going to start asking certain that we pay for what we do. Our the dispatch centers send what- questions to the persons who are goal was to make sure that we ever agency assets are closest to intimate with the incident and kept the department emotionally the incident scene. So we had a make our decision point based healthy. You can’t allow yourself “norming” of resources through- on that. And that is trust the dis- to feel stress because it erodes out the region, and that actually patcher to get the “injects.” And your security. It erodes your con- started in 1978. then after the injects come, make fidence because you’re not living To me, it always had been some decisions. in a bubble, you are living as part “What information is the dispatch It’s just like emergency medi- of a community. You’re living as center using to make their deci- cal dispatch. They’re getting a part of an environment. sions?” And one of the things set of facts, and they’re making We were unique, and it’s talked that has always been a shortcom- decisions based on that. Why about in the after action report, ing of our systems in this country would you not do that for every- because we actually believe is we don’t give enough credit to thing else in your community? stress management begins way the individual who is the real first “Hey, I’m looking and this bus is before the incident ever starts. responder—the person who is overturned and there are people ACFD does a strengthening pro- at the incident when it occurred. hanging out all out of this place.” cess that is part and parcel to The civilian who’s at the incident Well, guess what? You’re going to the organization. is the real first responder. need a second and third alarm for The entire organization goes There is a tier of professional the fire and EMS resources. through an emotionally strength- first responders that the system ening process that affirms there is going to send: fire, police and A.J. Heightman is emotional cost for the job that EMS, but the real first responder I reviewed an incident recently you do either as a firefighter or to the incident is John Q. Cit- in which a state trooper called a paramedic. And if you’re pre- izen, the first person who is dispatch and reported six peo- pared for it and you understand there. The public now has a ple injured at the scene. And the your feelings and yourself, then pretty amazing communications communications center will say, you’re better able to manage capability: cell phones with still “Do you want additional units?” the consequences of it. They get photo and video capability and And the first arriving ambulance emotionally strengthened every direct access to the communica- will say, “Wait ’til I get there.” six months. tions center—the public safety The dispatchers said to their We did a study after the Mur- answering point. And they’re supervisor, “What is it that crew rah Building in Oklahoma City.

SEPTEMBER 2011 35 ACFD changed its planning scenarios to prepare for bombs and bullets in the future.

They lost 10% of their organi- zation to post-traumatic stress. We cut that in half to 5%. That’s still horrific, and we believe that could still be cut more. And so there’s still a lot more work that needs to be done. Every six months they go through a peer debriefing. It’s a reaffirmation of their stresses and a way to make sure it’s being addressed. They go as crews and don’t have to say any- thing. But they have to go and experience it. I always called it emotionally hardening, and the ACFD made a conscious deci- Gill, to become the overall counselors and the people who sion to solidify their employee administrator. run the program hated that so assistance program, which they I think the schools had three we’ve changed it and called it do in-house. They merged the counselors, and the county gov- emotional strengthening. Per- schools and the county gov- ernment had two counselors, haps a better term for it is resil- ernment together. And when so they combined them for five ience strengthening. they did that, they hired the counselors and then had to What had happened was that school administrator, Dodie pick a new administrator of the

building a system of systems And when I look back and I look at that particular piece and I’ll never forget. I was at a closed session meeting of my peers what had happened, there is a self-satisfaction that I was able, at the Change conference in Phoenix, and Alan Brunacini asked with the tremendous support of the organizations that were me to do a presentation on the Pentagon incident. So I show around me (Fairfax fire officials, Arlington, the Alexandria fire up there and have all my stuff with me. And Alan says, “What officials, the D.C. fire officials) to bring about some programs we want from you is not the standard presentation. I don’t want and changes. They let me lead them in this change process. That the corporate spiel. Your colleagues here really want you to talk is an amazing feeling. about it from the … You’re the fire chief. You’re responsible. And so, when Alan Brunacini told me, “Now, wait a minute, Talk about it from your perspective.” you’ve been to the Super Bowl,” what does that really mean? Then he said, “Because nobody else in this room has been What it meant was that the larger Washington, D.C., metropoli- to the Super Bowl.” tan area went to the Super Bowl, and I had a chance to be the And you know what? That hit me like a ton of bricks, quarterback on that incident. because he was right. In your career, how many of us ever get We as a region handled the Pentagon and I got to play a the chance to go the Super Bowl? How many of us ever get part. And I think every fire chief has the opportunity to do that. a chance to command, direct and lead a national, worldwide Every fire chief has the ability to step up and play a part in the recognized incident? preparedness of their region. Every community has their own As the police chief in Arlington used to say, “It was a local Pentagon out there. Every community has the ability to have incident that has global repercussions.” a mega incident. So every command officer has the ability to A terrorist incident is a local incident that has global make a difference. repercussions. And so that stopped me in my tracks once it was If you read the book, From Good to Great, by Jim Collins, phased that way. he tells you that the difference between good and great is the It forced me to then go back and do some introspection. people that the leader puts on the bus with him. So, even the It comes out like this. We had spent the seven years prior to stoic, “can’t think out of the box” individuals can find somebody that, which were my seven years of leadership, going through an to put on the bus with them to become successful and do the entire morph of the entire organization to address the risks and things that will be enabling for their community. the associated risks in our structure during my tenure. Every organization, and I genuinely believe this, has ele- That is what every fire chief is expected to do in their com- ments within it that, if enabled, will shine. The art is the enable- munity. That is—match up their resources with the risks involved ment of that. Getting the best, getting the brightest and then and then make the adjustments necessary to address those. giving them a platform for success, that’s the art of leadership.

36 JEMS out of the darkness A few vehicles, including a taxi cab, were hit by a highway light standard clipped off as the plane came in.

program. So Dodie came from the schools where she had 30 years of school experience. Her time spent with the schools had taught her that the only way a teacher can success- fully manage the stressors of what are called the school wars, par- ticularly high school teachers and middle school teachers, is that you have to be regularly nour- ished and supported emotionally. You don’t do it after they’ve had a crisis with a student or a crisis sit- uation in the classroom. She then said, “Wait a min- ute. If that’s been so successful in the school systems, maybe that’s a pathway forward for police, fire and EMS.” And so The ACFD believes stress management begins way before the she went to the police chief incident ever starts. So they do a strengthening process that’s and me as the fire chief, and part and parcel to the organization. we agreed that we would try her

That’s the art of crafting. Building that we were going to be attacked and the potential Now it has to have management, it has to have oversight. was there that it could be a chemical and we’ve got to make It has to have all the components built into it. Collins says sure we are ready for it. that the most effective leaders he studied took good compa- What I was building was a network of people and agen- nies and made them great companies. And he said in every cies that had the confidence to deal with anything in the case that it was leadership. Washington metropolitan region, because we had a “system And it was leadership in the non-traditional sense. They of systems” that trusted each other. That worked together on were quiet, they were reserved. They were not flashy. They a regular and daily basis. were usually very introverted, but they had the gift to put As a matter of fact, in March of 01, we took every fire chief people on the bus with them who were extraordinary and then and every police chief to a two-day session at the National created an environment to allow them to succeed. Fire Academy and just worked on how we were going to com- And so I think it’s for every leader out there, whether mand a major terrorist attack in the metropolitan Washington they are in a fire or EMS agency, whether they’re director of area. That’s extraordinary when you stop to think about it— a hospital, to tap into those resources that are available to March of 2001, just six months before Sept 11. them and then have the ability to let go. Why? Because it was part of our process. It was part of Having the ability to empower assistant fire chief Jim building a platform for success. It was creating an environ- Schwartz, assistant fire chief John White, assistant fire chief ment that said, “When this incident occurs, we were going to Shawn Kelley to be the incident commanders at the Pentagon, have everybody in there that matters. They were going to know was crucial because they were really good at what they do. how to work with each other.” They did a superb job. That’s what they did every day. And you know what has happened, all those people that If you haven’t built a platform for success, don’t expect we took up there that day, they’re still out there and they’re it. In other words, if you haven’t consciously thought through still successful. the ingredients, if you haven’t orchestrated what and how that They might be the police chief of Philadelphia. But I still platform is going to look, feel and operate, you’re going to hear from that guy on a regular basis. They might be Terry have trouble. You can’t just expect success to occur. Gainer, who leads the President into the State of the Union It is the ability to create. I was building confidence in addresses, because he’s in charge of safety and security for Arlington County and the Washington metropolitan area that the Senate. But he was there that day. And he has full faith we would have the ability to handle a chemical attack. Why? and confidence in our ability of this region to be there and to Because they taught me in Tokyo and then in the Murrah be effective. —Ed Plaugher

SEPTEMBER 2011 37 People were in shock were walking away from their vehicles on the highway and had just left their cars on the roadway.

pathway forward. And it was just federal agents at fire station 1. knew that we needed to do but remarkable. It was accepted by They were wearing masks, you couldn’t ever get the political the community and by our fire- know, the whole blacked-out body to agree to. Of course, after fighters. Dodie is now retired outfits, and they weren’t there to 9/11 happened, communications and runs a company called New be your friend. They were there issues surfaced, and there was Millennium that does contract strictly as a protective resource, all the dialogue about interop- counseling for Arlington and and they were asking for IDs. erability. I’ve always been a firm Alexandria fire departments. And of course, I didn’t have believer that the issue is opera- one on me because I was work- bility, not interoperability. Edward Blunt, Sr. ing out that morning that day Interoperability was a way to I’ll tell you a funny story about and had my coveralls on origi- sell radios. Operability is, do use of IDs and tight accountabil- nally and went to the Pentagon we have the complete commu- ity. That night, when I got back to that way. All my credentials were nications pathway structured to Station 1, we did a debriefing and at the station. communicate to who we need to they sent me over to another area So I had to get several people at the appropriate time when we to talk to a health psychologist. to verify who I was so I could get need to? So it’s a pathway mech- All my stuff was everywhere, inside and get my stuff. anism systems design. and I had my bunker pants on We now have a very exact- cause it was well into the night. Post-9/11 Focus Areas ing operability platform. And So I went to get back into the Ed Plaugher so we would never have got- main part of station 1 to change We made a few changes after ten any of that unless we had into my regular clothes. And as 9/11 but not many. Mostly, it had some sort of landmark inci- I tried to enter, I was met by affirmed some things that we dent that changed the opinions

a new focus on crisis counseling start to implement that, it will exude confidence back out One of the things the IAFC is evaluating is a type of creden- there for the people who are providing the service delivery. So tialing system for counselors. It’s a huge void in our current it’s a confidence delivery. system. After a big incident, people say, “You really need The IAFC was founded in 1873 for one purpose, and one to seek counseling. You really need to seek help.” And then purpose only, and that is to provide leadership on national those crews end up at a counselor who doesn’t have a clue. issues. The wrong person could send you down the wrong path. At the time, it was actually to find a way for hose There is a strange set of dynamics going on. There are couplings to fit together. We borrowed the premise for the some places that still have their heads in the sand and don’t creation of the IAFC, which at the time was called the Chief address it at all. But those that are addressing it, you’ll find Engineers Association. It was realized back then that leader- all sorts of differences. Some don’t address it at all until the ship was the element that was necessary to get national solu- incident and some don’t address it at all even after they’ve tions set forward. had an incident until there is a crisis. So, that’s the business we’re in right now. We’re still in It’s an issue within our community that goes back to the business of finding those solutions sets and put them confidence in their leadership. We’re expecting people to do forward. Get them forward to a place where they can be imple- some pretty hairy things for our community. And for that, mented to provide the confidence leaders need. they should be able to expect a confident and competent I mean, ages ago they put steamer engines on flat cars, leadership. And that confident and competent leadership is sent them from Washington D.C. to Baltimore, because demonstrated by the infrastructure that they have provided Baltimore was burning down and the firefighters were stand- to their workforce. Right now many government officials don’t ing there and couldn’t hook the hoses up. have a clue about how to deal with this issue. There are no There was probably confidence present when it pulled up guidelines. There’s no affirmation about whether these things on the flat car. And there was probably even better confidence work, and some do not work. when the horses took it out to where the building was burn- Some of it is not very well supported anecdotally. It’s ing, but the fact that they couldn’t put the couplings together often just bar room talk. So what we said is let’s help build said, “Wait a minute now, these people don’t really know what a confidence in leadership’s decision-making because we’ve the hell they’re doing.” given them a definitive analysis of the best way forward for What they needed, at that time, and we need today, is this issue. And when we do that the leadership will have the the same set of dynamics that says let’s deal with this as a answers they need for the pathway forward. And once they national solutions set, a leadership issue. —Ed Plaugher

38 JEMS out of the darkness The ACFD has spent a considerable amount of time concentrating on homegrown threats. about our need for this kind of Pentagon is an unbelievable facil- all the mail comes into the Pen- infrastructure. ity. It’s huge. There are 18 miles of tagon. There’s a cart team located The nation is getting ready to corridors in there. here from 8 a.m. to 5 p.m.. That do the same thing with broad- We had to shuttle in a lot of air cart team is available into our band. If we’re going to embrace bottles, because the crews were Pentagon response process and the way forward, we need a not able to easily come back out dispatched to transport firefight- broadband system to be effec- to the street. We shuttled a lot of ers and equipment rapidly to tive at it, and we’re going to need everything. wherever safe interior areas they to have that formally anointed After most of the injured were need to go. and capable of performing on managed and sent away from Developing and coordinating our way forward, because tech- the scene, our formal triage and that resource and process is one nology is going to be a huge part treatment areas were used to of the tasks of the FD liaison of what we do. rehab our crews. We had a lot officer assigned to work at the of lot of heat-related conditions, Pentagon. Edward Blunt, Sr. mostly exhaustion. Some of our The whole Pentagon response Rehab continues to be a priority personnel also sustained minor would be different now because for us. Because search and res- injuries such as ankle injuries. force protection has hardened cue operations were complicated But, overall, we were very, very the structure. However, at the by the size and complexity of the fortunate. same time, it’s difficult for first multilevel facility, rehab of our responders to gain access with personnel was very important on Gil Cook vehicles. 9/11 at the Pentagon. There is a location [not identified The exterior approaches and You have to remember that the here for security reasons] where perimeters changed after 9/11.

SEPTEMBER 2011 39 The Pentagon’s Force Protection Agency monitored the rest of the Pentagon for smoke and flame extension.

We now have a 75-foot berm that Edward Blunt, Sr. the team for about 20 years. only allows access and egress Our concentration is certainly In addition, every single one way in and one way out. not just on the Pentagon. It’s Arlington County firefighter We conducted several table-top on our entire response area and ALS provider is trained to exercises after 9/11 to address and always has been. We real- be part of what we call a Res- this. Let’s just say [for secu- ize that a plane hitting another cue Task Force. Their opera- rity reasons] that there are cer- building is probably less likely tion changed after Columbine tain areas that would be more than either homegrown terror- so that we no longer wait for preferable for staging than oth- ism and/or something that will the SWAT team outside a struc- ers. So we have established sev- occur at the local level, such as ture. The battlefield concepts eral possible staging areas that an active shooter. So we have of tourniquet application, use we’d send ambulances to in the spent a considerable amount of clotting agents and all those future. of time concentrating on home- things have had such profound We also now have a more grown threats. success in Iraq and Afghanistan robust logistics system to supply that our personnel are trained air bottles, water and rehab at Carl Lindgren to use them all, have the equip- these types of incidents. There’s We are better prepared now than ment available and will team also more resources within the we were 10 years ago for a multi- up with two police officers and building itself for the workforce tude of incidents, such as active form teams to make entry. Not and for the first responders. shooter cases. The national into the hot zone but in the For our daily medical planning scenarios were geared warm zone, with the goal of response and fire emergencies, toward WMD-type responses, rapidly deploying life-saving we have access code words and and that was a really good start- intervention. are assigned a police escort. For ing point. That, NIMS, and the All of our fire and EMS larger scale incidents, there are “all hazards approach,” has response vehicles carry are what additional code words distrib- greatly assisted us in our prepa- we call “blast packs” that can be uted to our crews in order for ration, preparedness, response used to take care of a large num- them to gain access into the and recovery. ber of patients that are encoun- building. We have a very progressive tered at bullet-type incidents. Rehab changed consider- medical director, Reed Smith, The blast packs are contained ably as well. It’s enforced more MD. Smith realized the need in sealed, waterproof packages now. If you don’t meet your for emergency medical support and capable of being stored in requirements or parameters for at police tactical operations a a small space in each unit. They your vital signs, you will not long time ago, and along with store supplies essential to car- be released from the rehabilita- former assistant fire chief for ing for multiple/mass-casualty tion sector. You can’t go back. operations William McKay, and incident victims with wounds We just don’t allow it. And if a firefighter Blake Islen, trained created from blasts, explosions medic says you’re done, you’re ACFD firefighter SWAT medics or active shooters. Funding for done. and had them assigned to assist the blast packs was obtained We have also acquired a med- the County Police SWAT team. through an MMRS grant. ical ambulance bus for MCIs and This is not new. They have We changed our planning rehab at some incidents. been dedicated exclusively to scenarios to reflect that bombs

Blast Pack Contents 1 Nasopharyngeal Airway 30fr 1 CELOX Trauma Gauze 1 14-gauge 3.25" Decompression Needle 1 Hyfin Chest Seal 1 4" ACE Bandage 1 H Bandage 1 M.E.T. Tourniquet 2 PriMed Compressed Gauze

40 JEMS out of the darkness You know that you’re susceptible to anything. And it does change you. You realize you’re not living in Oz anymore. and bullets are going to be the things we really need to be pre- pared for. In fact, one day when I was driving home, we did have an active shooter at the Pen- tagon that people have read about. That threat was taken care of, but it did, once again, emphasize the need for the Res- cue Task Force. Protective gear and specialized equipment in easily deployed bags is carried in our north and south EMS supervisors’ vehicles. We also have a fully fur- nished, complete improvised explosive device [IED] team that works closely with the Arlington County Police Department bomb squad. We have brand-new bomb trucks. And all our providers have ACFD had to continually refresh their crews with air bottles because been through the New Mexico of their location on the interior of the massive Pentagon complex. training school. One thing we’ve tried to increase as far as a response occurs when you meet with, plan the continued joint meetings, mechanism and as a byproduct with and train with other agen- regional SOPs plus regional of training since 9/11 is to con- cies. We do this on a routine training exercises have sustained tinually meet with and use name- basis with our various response these vital relationships. face recognition and know what agencies and departments, both The ACFD Pentagon after- everyone is capable of doing. So in Northern Virginia and our action report cited our advanced I don’t have to go up to someone Region’s COG [Council of Gov- logistics and resource processes and say, “What is your job? What ernment] that includes Wash- as reasons why our response was do you do again?” You know what ington, D.C., Northern Va., and so successful and stressed the their specialties are. You antici- the portion of Maryland that need to maintain these relation- pate. “This is my go-to guy for is considered to be part of the ships, consistency, shared pro- logistics. This guy can get me encompassing Washington met- cedures and overall goals for our some resources.” [If] someone is ropolitan region. region, which we have continued needed to help me porter some These liaisons, along with to do. people back and forth, I know those we have with key federal, who can organize that for me. local and state partners, is one Edward Blunt, Sr. We continue the valuable of the success stories of 9/11. To me, one of our biggest chal- name-face recognition that And with attrition, promotions, lenges after 9/11 is for our

SEPTEMBER 2011 41 If you’d been on the job here for 20 years, it put you at 27 years.

personnel to realize you can Remember, we were not just thinking in a lot of places. If snip- never know enough. It went from involved in management of the ers ran around in rural areas, that having to be able to be ready Pentagon incident. On the heels would also change attitudes. for Mrs. Johnson’s house fire to of that, we had anthrax, and her heart attack to the hazardous then we had the snipers riding Health & Emotional materials call, to now where we around shooting everyone in the Aftermath have to be ready for a chemical area. So we’ve had it at all differ- Edward Blunt, Sr. attack. We have to be ready for ent levels. Ironically, we were just recently multiple shooters. We now have I think the accepted fact is, it’s approached by the CDC. They’ve to be ready for chemical sui- not a question of if we’re going offered to incorporate the Pen- cides. When you add all that to to have an attack, it’s when. tagon first responders and the training that we already do, A lot of departments outside respondents into the registry it feels like it’s gone up ten-fold. of the major urban centers in system regarding the aftereffects We were well trained before- this country do not believe it of 9/11. hand. That probably helped us can happen to them. So they You almost have to fully expect the most through the whole often tend to avoid extra train- that we’ll have some health issues incident, but we have since ing and planning. But the reality later on, too. Obviously not to the engaged in a lot more train- is that it can. extent that New York City had. ing at a lot of different levels. People have come to expect Ours was a little different. But we It’s good because it gives you a it to happen in D.C., New York, had a lot of the same chemicals much broader scope—an idea LA, Chicago and Philadelphia. If and components involved in this of what’s out there and what’s terrorists were ever to hit Middle massive incident. available to you. America, that would change the In New York, they had first

42 JEMS out of the darkness Why do pre-plans? Because of any highly populated areas of our response could be the potential target of terrorists. responders trapped under a lot of my time. on the job here for 20 years, it debris for a period of time, and And one of the craziest things put you at 27 years. they inhaled all that. So that’s about this being at the Penta- And you know, EMS supervi- predictable. And many worked gon is that I grew up in Arling- sors, we go on “the good calls,” at Ground Zero on debris that ton, and my dad worked in the but they don’t come without smoldered for weeks. Pentagon. When the Martin costs. In our case, it was a fire, and Luther King riots were occur- If another job like the Pen- a lot of our crews couldn’t get to ring, I remember looking at the tagon occurs, I don’t believe it where they needed to operate TV, and I saw all the smoke and would affect my performance. I under air. So it required people I asked my mom, “Is Dad ever mean, you have 30 years on the to go where they normally would going to come home?” Fast for- job, you don’t feel like another have gone without air on earlier. ward to 9/11, that was the last incident would. You feel [with Since then, efforts have been time they [my family] ever asked your experience level] you’d be undertaken to try to limit that so if I was going to come home. undaunted in performing your that we’re able to use carts to do When I came home after 9/11, duty. shuttling of bottles and to have they just didn’t want anything to And, well, I don’t have any- that as being a thought of how do with me. thing else but me to affect right are we going to manage that. So Maybe I was different. I don’t now. No, I’d do my duty. That’s there were health issues, but no know what happened. part of the reason I’m staying on way near the depth of the New All I can say is that 9/11 can’t the job. I want to make sure I fin- York health issues. be blamed entirely, but it was a ish [my career] on my terms. I think you realize that you great accelerant. If you’d been I’m also here to make sure are susceptible to anything. I worked the Air Florida crash, and that was an accident. Then we worked the Pentagon attack. Then we worked the anthrax issues. Then we worked the sniper issues. And so you know that you’re susceptible to any- thing. And it does change you. You realize you’re not living in Oz anymore. It’s probably harder for our families than it is for us. Yeah, much harder. Every day you go to work after something like 9/11 gives your family a differ- ent perspective about you com- ing home.

Carl Lindgren I paid a lot after 9/11. I went from having a family, to needing their help, to them leaving. And I don’t even see them anymore. I can’t contribute it all to 9/11, but from that point forward, I never went to work anymore. I went to work after 9/11 knowing I had to make sure that every- thing I did made sure that we EMS and fire crews were forced to evacuate their positions multiple were ready in the event that this times because of word that additional planes were headed toward happened again. But it occupied the Pentagon.

SEPTEMBER 2011 43 Agencies must pay attention to lessons learned about personnel accountability at past incidents.

that, no matter what happens, would be bags of flashlights, my crews are ready. My job, I feel, and socks and T-shirts and is to continually say, “Never stop underwear, slippers and pillows thinking it can’t happen here.” and tents ... just surrounding my vehicle. I’d have to try to throw Edward Blunt, Sr. it all inside. There’s a definite level of help- Good-doers. [There were] lessness that you feel when neighbors banging on the door, you’re involved in an incident bringing food over. I would take like this. I’ll never forget the it to the firehouse. Take whole helplessness, the absolute grip- turkeys and chickens. You name ping feeling I had when my wife it. Hams. was “unaccounted for.” And at The outpouring from the that particular time, there were community was just unbeliev- some law enforcement people able, and that helps you get who were saying that planes had through some of it, but you also been diverted or been hijacked always have your demons when from O’Hare Airport. it comes to this kind of stuff. Just So at a point in time, three like in any tragic event you wit- hours into the incident, they ness, whether it’s family or on were trying to relieve me of duty. the job. You’re always going to My immediate supervisor said, have that. “We want to get you out of here.” Our department did a good And I said, “Where am I going job. We had a lot of CISM—a lot to go? What the hell good am of support from day one. I going to be anywhere else? There are some employees, Just let me finish doing my job. even to this day, that do not like Here I’m the most comfortable. the flight restrictions. Some of There’s nothing I can do, and the commuter planes are still this is my other family right able to land at National Airport. here. This is who I need to be The mental health professionals with right now. My kids are fine. at the Pentagon still talk about I know they’re fine.” it. The plane flies overhead at No schools have been struck. very low cloud ceiling because That type of thing. I wasn’t stu- they have to, and some of them pid. I knew she was on that are loud prop jets. People are plane at 9:15 in the morning ... affected by it. and I stayed. There are little triggers like They let me stay, and that was that out there. A lot of people the best thing that ever hap- are still dealing with a lot of pened ... for me. these issues. But as others have For days, when I got home … said, you really appreciate your incident or for people like you I was numb. Oh, yeah. I made family and your friends more [A.J. Heightman/JEMS] coming the kids stay with the neighbors. [after an incident like occurred to help other responders learn I didn’t really want that inter- on 9/11]. It really brought both important lessons from the job. action with them [presenting the fire department and the We have our coping mecha- any stories or sorrow to them], community together. nisms, and you can blot a lot of because we were still in the That’s kind of drifted apart it out. My goodness, if we had to business aspect of this whole over the 10 years. But the people remember every call we ran, we thing. There was still a lot to do . that were there that day? It’s not couldn’t do the job for 30 years. And it consumed everyone a day that we frequently bring It’s ironic, but my first inter- around you. When I would get up. We don’t talk about the Pen- view after 9/11 was with A.J. up in the morning to leave, or tagon outside of people that Heightman and now my last in the middle of the night, there were intimately involved in the interview, 10 years later, just

44 JEMS out of the darkness We have to be smart about what happened in the past, capture that and learn from those experiences.

If the terrorist piloting American Airlines Flight 77 pulled up on the controls, cleared the first wall of the Pentagon, crashed into the center courtyard area and continued into the rings on the opposite side— where it was fully occupied—there could have a significantly higher number of injuries and fatalities. before I retire from the job, is be involved in an incident or be top of structure. with A.J. Heightman. the potential target of terrorists. This is probably one of our [Pointing to a large struc- bigger soft targets [pointing to Vigilance & ture on the opposite side of the nearby Crystal City]. There are Pre-Planning highway from the Pentagon] The many “unprotected” areas in our Gil Cook plane came across the massive, response area, like the Metro We constantly plan for inci- eight wing, Navy Annex—origi- transit system. dents at all large or highly pop- nally used to house the auxiliary We’re faced with a lot of ulated areas of our response work force of the Pentagon—so things other cities and commu- district because they too could low that it hit the antenna on nities have to deal with as well,

SEPTEMBER 2011 45 This country needs to think forward, not just thinking of getting past the next big crisis.

The Federal government must develop an infrastructure and funding mechanism similar to what they did for to establish and maintain our interstate highway system and the FAA. This will build, fund and maintain an EMS and terrorism preparedness infrastructure.

46 JEMS out of the darkness If you stop to think about it, we’re really good at thwarting outside influences and attacks, but how good are we at thwarting the Columbines?

Resources The comprehensive Arlington County After- experience with 9/11. And that’s Action Report on the Pentagon featured 222 recommendations, 110 why we were sent there, for that of which related to the fire service. Click the link below to download reason. And to their credit, we this resource. did not get any resistance from • ACFD Pentagon After-Action Report the locals systems; they were The International Association of Fire Chiefs has published a glad to get our assistance and checklist that can be used for managment of major incidents. It’s benefit from our experience. available by clicking the link below, along with several other impor- We were also able to bring tant resource documents. forward some of the lessons we • Terrorism Response: A Checklist and Guide for Fire Chiefs learned from the accountabil- • Model Procedures for Response of Emergency Vehicles ity system we developed at the During Hurricanes and Tropical Storms Pentagon. They told us some • Medical Evaluation Task Force: Mega Issue Responses police uniforms had been sto- len from dry cleaners in New places where a large number of addition to the Northern Va. Orleans, so they weren’t sure people congregate: schools, sta- Regional Response System that who the actual police officers diums, shopping malls. includes our regions fire, police, really were. The Pentagon City Shopping emergency management, and So within a few days, we Mall is a place where you can CEOs, we work closely with our assisted the federal police agen- find probably 50 buses of school partners in close proximity—in cies in developing and incorpo- children every day, going through Montgomery County and Prince rating a log-in system, and that this big tourist attraction. Georges County [Md.] and also made a big difference. Soon, the And special event cover- the District of Columbia and the federal policing agencies knew, age takes on a different tone Council of Governments. Every- by who was wearing a tag that since 9/11, especially events like body meets collectively and was issued, who was properly the Marine Corps Marathon, plans together. This enables us credentialed. the Army 10-miler, the vari- to obtain grant and resources I think a lot of the lessons ous marches we have. We now faster. we learned from incident com- assign more resources to those mand through the Pentagon and events than we did before, and Edward Blunt, Sr. resource building, things of that there is a bigger law enforce- Carl and I got to see the flip nature, went into play there. ment presence as well. The pro- side of what happens without moters of these events charge significant regional pre-plan- The Last Word a little bit more to cover the ning, asset accumulation and Ed Plaugher increased expenses involved. the ability to get them relatively There are some elements that quickly when we were sent to are definitely a pathway forward. Gregg Karl New Orleans, early into the Hur- We should never lose sight of Our training has also changed. ricane Katrina disaster. that. We’ve always got to be We still teach all the basics, but When we arrived in New focused on the pathway forward. now the crews get even more of Orleans, we found that it was We have to be smart about what the WMD and terrorism training. not as well organized as the Pen- happened in the past and cap- And we’ve definitely changed tagon response because their ture that and realize that. That’s our recruit school curriculum communities had apparently why we spent so much time to meet the demands of today’s not worked as closely as ours doing the after-action report. expanded treats to the crews had ahead of time. But at the same time, the and our community. So we basically built an EOC pathway forward has to be con- for them, including all the radio stantly shaped by the things that Carl Lindgren equipment and all the comput- are going on around it. I think the Because the ordinary strate- ers and everything. We moved current economic situation offers gic initiative that identifies cit- it from their city hall to a hotel the opportunity for our industry ies and localities that have and built a giant system quickly. to blossom because the product the most likely targets, multi- Our initial drawing was on a of this situation will be the affir- ple regions work very closely cocktail napkin, believe it or not. mation of the services we pro- together. In this region, in That really occurred from our vide to our communities each

SEPTEMBER 2011 47 So are we in that same dilemma right now where we are involved, where we are still not thinking forward?

and every day. Force us to pick a couple of years before 9/11 and preparedness equipment, they’re and do the right things, not just told them that we truly needed going to buy the MRI or the CAT do things. to revisit how we do mass care scans, because they need them And so, we are, in some in the United States. I told the and because, obviously, there is cases, literally infighting and House Committee on Govern- a financial incentive to be able destroying ourselves, and claw- mental Reform that we needed to offer those services. There’s ing each other away, bickering to create a federal trust fund that not a financial incentive to buy and fighting. And after a while, would be used to allocate mass the ability to deal with mass care people are going to say, “Wait care casualty and disaster pre- casualty equipment. a minute, now. Let’s really get paredness resource equipment. I’ll never forget a prepared- our arms around this—like the The design was similar to ness expert from Canada that Pentagon—and then really start what we do for both the inter- said that America sold its civil focusing on the important stuff state highway system and the defense equipment, including for the way forward.” FAA fund. When you buy an air- stainless steel autoclaves, for There is a repeat element to plane ticket, there’s money set pennies on the dollar, and Can- the environment that we’re in. aside to operate the FAA, so ada kept every bit of theirs. That’s Natural disasters can be com- that our infrastructure is always kind of shocking when you stop pared with where we are with our protected. to think about it. So are we in constant debate about health- So how are we building or that same dilemma right now care. The element of healthcare protecting the infrastructure for where we are involved, where we that has always concerned me mass care casualty? If a hospi- are still not thinking forward? is the financial forced choices tal is tasked with making a deci- This country needs to think we’re making. sion as to whether to buy a CAT forward, not just thinking of get- I testified in front of Congress scan or an MRI, or to buy disaster ting past the next big crisis. We

Insight from Ed Plaugher I actually told Congress that I knew how to fund it. I told The need for a national disaster them that they should put a $2/day federal tax on every occupied infrastructure & funding mechanism hospital bed in America, being paid for by the insurance (which is being paid for by the American public). That’s not even a blip On 9/11/01 at the Pentagon, we had to display that confidence on the radar screen. In a matter of a few years it will amass to bil- in our ‘system of systems.’ How do we do that? Did we display lions of dollars. And since it’s a trust fund, it will be used for only confidence in our system of systems after Katrina? Have we one purpose, to build the infrastructure for disaster medicine. displayed our confidence in our system of systems after that? When we were at a crossroads in the United States, trying I think that’s our next way forward—making sure that we build to figure out how to do this thing called air travel, when we were upon this system of confidence. trying to figure out how to build interstate highways, which were And, of course, along with that, you also have to have going to cut across states and had to have certain elements, competence. And doing that means a carefully crafted process. configurations and design, the Federal Government created two And that carefully crafted process means “have you carefully federal trust funds. They said it was so important for our infra- looked at the things that are necessary in order to accomplish structure that we had to create these trust funds because we had that immediate turn-on of a system?” to create a mechanism to fund and support programs for which When I say immediate, that’s immediate based on the funds couldn’t be raised or diverted any other way. circumstances. Have we really done a diagnostic on how long Have you been to some of these remote airports where it takes us to turn our community into a 10,000-bed mass care you look around at their facilities and say, “How in the world did casualty unit? And you know what? There is a tremendous they build this airport here?” They were built out of the FAA trust amount of capacity in our medical care. There are medical pro- fund. And you look at the infrastructure, the physical infrastruc- cedures that are being done that are not critical. There are many ture of our airports—they’re amazing. There are two millions that can be deferred. There are all those type of things. But have take-offs and landings each year. So, you know there must be we really looked at it? Have we really scrubbed it down? And some infrastructure somewhere that’s pretty terrific. who has the decision to make it happen? So every time we faced a crossroads in this country and We must provide a way forward with infrastructure similar did something to create a change that is dynamic in design and to what we did for the interstate highway system, similar to what leadership, it’s been followed by financial resources as well. [But we did for the FAA, build certain infrastructure elements and this has not really happened in disaster response nationwide.] then find a way to fund it. To me, this is a perfect example of where Federal leader-

48 JEMS out of the darkness All the terrorists have ever tried to do is shake the confidence people have in their form of government.

need to affirm how we’re going to the Washington Hospital Cen- series of events in 1994. For look at our infrastructure needs, ter, which carefully orchestrated me, the 1994 subway attacks how we’re going to look at our the system that was going to be in Tokyo were a key element in ability and our capabilities. used to make the political and the my thought processes, because All the terrorists have ever operational decisions. when you looked at that particu- tried to do is shake the confi- And for the first time ever, lar incident and looked at Arling- dence people have in their form a decision tree/flowchart was ton County, you realized that of government. And shaking of published [that day] on who, you were talking about the same the confidence happens in mul- where and what decisions we type of incident potential that tiple fronts. So as a fire chief, were going to be needed under could happen here. Tokyo was a one of the most important things what umbrella. homegrown terrorist attack that I could do for my community on The document ironically out- was followed up by the attack on 9/11 was to be calm, steadfast lined many important things the Murrah Federal Building [in and show that not only were we that would be instituted by the Oklahoma City]. working on this dilemma, but we hospitals later in the day, like If you stop to think about, were also continuing to provide stopping elective surgeries and we’re really good at thwarting services for heart attacks and other things we now see as outside influences and attacks, fires, while we’re fighting fire standard throughout the coun- but how good are we at thwart- and dealing with a terrorist inci- try. But they happened because ing the Columbines and the dent at the Pentagon. Plaugher and others had talked internal attacks? What we have On 9/11/01 ... irony of all iro- to them about months before to do is look at our vulnerabili- nies, the Washington Metropoli- 9/11. ties and then start to do what tan Area released their biological Lulling is something this we can, system-wide, to address

preparedness plan that day—from country experienced after a those. JEMS

ship is necessary. One of the things you can do with Federal We give physicians permission to practice medicine trust funds is develop and implement long-term projects and in this country. I believe we should have all the training use trust fund payments to pay it off. It’s just like a mortgage on centers provide a baseline level of emergency medical train- your house. You don’t have to pay for your house today. You can ing because they are part of our national infrastructure and live in and pay for it while you’re living there. because, in a disaster, people are going to go wherever they What’s nice about a federal trust fund is that it represents know they offer some level of medical care: urgent care cen- the good faith of the government. There’s going to be sick peo- ters, surgery centers. They’re going to go anywhere they can ple in beds and I’m going to get two dollars a day and use that find help. to pay off the creation of this necessary medical infrastructure. We’ve got to create a pathway forward that says that, as I also think it would relieve a lot of the burden on our part of our nation and part of our infrastructure, there are a EMS and healthcare system, because our healthcare system is few things we are going to do. And, like the interstate high- walking a very fine line. The hospitals know they’ve got to do way system that moves goods and produce and the FAA, that preparedness, but they also have to stay profitable and have all enables us to fly from point A to point B, there’s a certain level these managed-care costs. of EMS and mass casualty care that you can expect. If we were going to say we’re going to help them along the I liken it to the fact that, in 1918, when we had the way, this is a way that we could. First, assure a level of prepared- Spanish flu, every State in the United States went out and ness and, second, make sure that they are not using the lack immediately put together public health laws. And those pub- of dedicated funds as an excuse for not designing the kind of lic health laws created a baseline of public health mandates systems that are necessary. and requirements; All across the United States. How many physicians do we have in America that got their So, that worked on the state level. Fast forward now, state license without having one day of emergency medicine? to 2011. Have we had that same reaction for mass casualty That should never have happened. Every physician should care? No. So that means we’re going to do something differ- have a baseline. Why? Because they’re part of our national ent. What other successes can we point to? We could say, we’ve infrastructure; they will become part of our national resources tried allowing the states to do it. That didn’t work. So, now we when it comes to healthcare. So part of the system should be need the Federal government to provide the financial resources how we educate our nurses, doctors and anesthesiologists. and requirements to use those financial resources and fit into a We have to make sure we have all of these pieces in play, par- system. —Ed Plaugher ticularly when a major disaster hits the United States.”

SEPTEMBER 2011 49 The sponsors of Out of the Darkness

We are proud to be sponsors of this historic, four-volume JEMS sup- plement that documents the heroic and unprecedented efforts by the responders to each tragic event on Sept. 11, 2001. Their efforts, the physical and emotional costs they have had to bear and the opera- tional advances made by their agencies since 9/11 are an important part of emergency service history.

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50 JEMS out of the darkness The sponsors of Out of the Darkness

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SEPTEMBER 2011 51 Volume IV: on stable ground We present you with the command, accountability, resource management and emotional lessons that have been learned from 9/11.

&

here’s nothing more pow- were there. The ripple effect of to participate in it. But after 10 erful and compelling than the pain inflicted that terrible day years, several say they may finally Thearing the facts about continues to affect and hurt many be ready for it. It should be made an incident directly from a first- families, friends and loved ones. available to them. person source. We have done We found that many marriages We found that counseling has that in the development of the and relationships dissolved or been offered to the children of four-volume historic report, Out of ended in unfortunate divorces responders, but in many instanc- the Darkness, presented here. after 9/11 because some indi- es, it hasn’t been offered to their To do so, we spent time with viduals couldn’t understand or spouses and significant others key personnel in each involved accept the commitment, respon- who have been left to deal with city to discuss the events of Sept. sibilities or emotional baggage the ramifications on their own. 11, 2001, and the aftermath of being carried by the responder They need help too. that unforgettable day. they loved. Those who were hired after We chose the title because so Yet, the people we spoke with 9/11 must be sensitive to those many of those we spoke to report- carry on with their lives. They who were there. And EMS manag- ed how that day went from being shepherd their children to school, ers must be mindful that assign- a picture-perfect day, to one of visit their mom, get promoted and ing affected crews to the same death, darkness and despair in a fall in love. Since 9/11, some have response zones and locations as matter of minutes. Many report- retired, and some have moved on their original source of emotional ed being trapped under debris in from EMS. Most remain with the trauma is not advisable because complete darkness and having to agencies they love, the agency the sights and sounds they’ll be crawl toward a ray of light or the that has been their second home forced to see and hear again can light from another person’s cell and source of comfort when they trigger horrible anger and anxiety. phone to find a source of fresh are down or depressed. It has been our great privilege air. And many report still having But what most understand to get to know these responders. dark, emotional days as a result now, with 10 years of hindsight, They aren’t superheroes. They’re of their experiences, as well as is that they belong to an exclu- ordinary people who did the the sights and sounds associated sive, dreadful club. A club none of very best they could in extraor- with their incident. them asked to join and every one dinary situations. We were struck by the lasting of them would rather not have We wish we could have inter- damage caused by the attacks been inducted into. However, viewed all of the 9/11 responders, on 9/11. For many, time has not they recognize that they have but we could not. However, we healed the emotional scars they been set apart from the rest of hope that what we have crafted sustained. For others, health humanity—damaged in a way no for you are documents that pres- issues caused from breathing one but other 9/11 responders ent not just important historical super-heated, microscopic dust and witnesses can understand. In facts about 9/11, but also the will plague them to the end of fact, many of the responders told many command and control, their lives. For a few, the emo- us they will only talk about 9/11 accountability, resource man- tional damage is less visible and, with others who were there that agement and emotional lessons perhaps, even more insidious. day—other members of the club. that have been learned at each What’s more, the damage from Many could benefit from coun- incident and must be passed on

9/11 doesn’t just affect those who seling but have been reluctant to others. JEMS

2 JEMS out of the darkness One person at street level, firefighter Daniel Thomas Suhr, is hit by a jumper and dies.

Caution: Because we wanted to represent the actions and words of these 4 Flight 93 providers as true to the events as possible, we have broken our normal policy 8 The Plane that Vanished on not publishing profan- ity. Therefore, some of the portions of the material you are about to read contain graphic language.

Vice President/Publisher: Jeff Berend Editor-in-Chief: A.J. Heightman Managing Editor: Lauren Hardcastle Out of the Darkness is a supplement sponsored by Boundtree Medical, Demers Contributing Editor: Teresa McCallion Ambulances, Disaster Response Solutions, Emergency Products + Research, Laerdal, Oxygen Generating Systems and Southeastern Emergency Equipment, and pub- Art Director: Liliana Estep lished by Elsevier Public Safety, 525 B Street, Ste. 1800, San Diego, CA 92101-4495; 800/266-5367 (Fed ID # 13-1958712). Copyright 2011 Elsevier Inc. No material may Director of Production: Tim Francis be reproduced or uploaded on computer network services without the expressed per- mission of the publisher. To subscribe to an Elsevier publication, visit www.jems.com. Production Coordinator: Pippin Schupbach Advertising rates are available on request. Contact Elsevier Public Safety, Advertis- ing Department, 525 B Street, Ste. 1800, San Diego, CA 92101-4495; 800/266-5367. Production Assistant: Matt Leatherman c o ve r P h oto A oto/FB I

SEPTEMBER 2011 3 Some of the passengers decided to attempt to regain control of the aircraft.

he morning of 9/11, Capitol in Washington, D.C.1 An of Pittsburgh and 150 miles United Airlines Flight alternative suggestion has been northwest of Washington, D.C. T 93 was scheduled to fly the White House, possibly in All 44 passengers on board, transcontinental across the U.S., hopes of killing then President including the four hijack- from Newark (N.J.) International George W. Bush. But that morn- ers, died. Of the four aircraft Airport to San Francisco Interna- ing, the president was visiting an hijacked on 9/11, Flight 93 was tional Airport. Approximately 46 elementary school in Florida. the only one that failed to reach minutes after takeoff, however, After the hijackers took con- the hijackers’ intended target.2 the Boeing 757–222 aircraft was trol of the plane, several pas- What follows are firsthand hijacked by four al-Qaeda ter- sengers and flight attendants accounts from the Shanksville rorists as part of the planned were able to make telephone incident, thoughts about the EMS attacks on American targets. The calls and learn that attacks had response that day and effects hijackers breached the aircraft’s been made on the World Trade caused by the crash in this rural cockpit and overpowered the Center in New York and the Pen- area of western Pennsylvania. flight crew. One of the terror- tagon in Virginia. As a result, On 9/11, Christian Boyd was ists, Ziad Jarrah, a trained pilot, some of the passengers decided a full-time EMT with Somer- took control of the aircraft and to attempt to regain control of set Area Ambulance Association diverted it back toward the east the aircraft. During the attempt, Inc., assigned to the agency’s coast of the U.S. however, the plane crashed into satellite station on U.S. Route 30 Although the evidence remains a field in Stonycreek Township, in Stoystown, Pa., 10 miles from inconclusive, it’s widely presumed near Shanksville, in Somerset their main station in Somerset, the intended target was the U.S. County, Pa., 80 miles southeast Pa. The station houses one ALS

Photo Courtesy Christian Boyd

Christian Boyd, EMT.

4 JEMS out of the darkness I knew something was going on when local state police and FBI agents arrived within the hour. ambulance and is staffed 24/7 salvage business a few hun- Between the angle and the speed by an EMT and paramedic crew. dred yards away. I knew some of the aircraft on impact, it was Boyd was in his second week people who worked there and clear it was a non-survivable of paramedic class, assigned to knew exactly where the address crash and there would be few work with and drive for a para- was [Skyline Road]. I noticed intact bodies to be recovered. medic on 9/11. a large depression in an oth- At first, Boyd didn’t think it He grew up in a family of nine erwise flat, strip-mined field. was part of a terrorist attack. teachers and was in college in There was light smoke in the air “Initially, it was very difficult hopes of becoming a teacher. and spot fires throughout the for me to grasp what had hap- His parents have more than 70 nearby woods. I noticed very pened—a plane crash in my years of teaching combined. He small pieces of debris but noth- rural community. And, at the finished college in May 2001 ing larger than the size of a car time of our dispatch, we still and hadn’t found a teaching job. hood. I only remember seeing weren’t completely up to speed He had taken an EMT class in one tire intact. on the Twin Towers. However, I college, so he decided to get I knew a side road that could knew something was going on involved in EMS until he could get me closer to the scene. I when local state police and FBI secure a full-time teaching posi- started to make a left-hand turn agents arrived within the hour. tion. He figured he could work on this side road and met a Then, people began talking on as a substitute teacher on his Stoystown Fire Company mini the scene about New York City. days off because he worked two pumper and Shanksville Volun- It wasn’t until around lunch time 24-hour shifts per week. teer Fire Company’s first-arriv- that we heard anything about Early in his shift on 9/11, Boyd ing engine. They waved me to go the Pentagon. and his partner, paramedic Kevin in ahead of them. It was a small, Dealing with all the federal Huzsek, made a trip into Somer- single-lane dirt road. and state agencies (and the set. While at their main station, My partner gave the initial press) that swarmed the scene they heard about a plane crash- radio report, stating that it was was unnerving. Many of the peo- ing into the World Trade Cen- a large commercial-type aircraft ple were unsure of who some ter. They watched on television crash and that we would be out of of the others were. Some were as one of the towers fell. Boyd the unit investigating after repo- dressed in suits, some had turn- remembers mentioning some- sitioning closer to the scene. We out gear on. I remember see- thing to his manager, Jill Miller, got out of our unit, and I put on a ing people with cameras and about the date being “9-1-1.” helmet and rescue-style gloves— bystanders trying to get closer, Boyd was involved in some the reason for the gloves I can- past the state police perimeter,” routine maintenance chores not explain. We walked toward says Boyd. when the call came in for a plane the massive depression in the Although Boyd doesn’t crash five miles from their sta- field and began scanning for any remember any ambulances or fire tion. It was 10:06 a.m. survivors. departments jumping the call, he “We serve a very rural area The Somerset County Com- does remember off-duty EMS with no major airport in our munications Center dispatched providers and volunteer firefight- region, so it never dawned on us additional ambulances from ers showing up in personal vehi- that this could be a large plane, our county and nearby Cambria cles. He says law enforcement let alone be associated with the County. They also dispatched officials screened incoming per- New York incident,” says Boyd. a disaster trailer from Conem- sonnel on the perimeter on their “Being only five miles away, augh Hospital in Johnstown, Pa., arrival. That function was later and driving the first emergency at Huzsek’ request. A team of handled in a formal manner when vehicle to arrive, it was tough for physicians was also alerted and a temporary command post and a 22 year old to fully grasp what sent to the scene from Conem- a staging area were established happened and know exactly augh Hospital, the closest Level in the Rollock Inc. scrap business what to do. There was a lot of 1 trauma center.” property. EMS command was radio traffic and some chaos for In less than five minutes, established by Somerset EMS a while. Boyd and Huzsek realized there Supervisor, Jill Miller. When we first approached the were no survivors. The impact A camera was set up and photo scene, we pulled in above the appeared as though the plane IDs were taken to begin organiz- crash site, at Rollock Inc., a local entered the ground nose first. ing clearance. The perimeter was

SEPTEMBER 2011 5 I remember money blowing all over the place, a burning Bible, and pictures, wallets and drivers licenses all over the area.

Christian Boyd noticed a large depression in an otherwise flat, strip-mined field. then guarded by state police, have a photo ID taken, which we crash site. It wasn’t until Novem- both mounted and on foot. They wear on duty or carry on our turn- ber 2002, that Boyd drove past the remained at key posts that eve- out gear. site on his motorcycle. ning and throughout the next Our treatment protocols He says there are things that few days. haven’t really changed that much, he remembers seeing that day “Before returning to quarters and the number of mutual aid that he hasn’t spoken to others that day, our last assignment was services is still about the same, about. “I remember money blow- to drive the perimeter and pass so help is still far away. But our ing all over the place, a burning out bottled water and rations to MCI plan now involves more Bible, and pictures, wallets and the police officers who would be ambulances, police agencies and drivers licenses all over the area. guarding the area that night. I can hospitals, and the use of more The ambulance I drove on 9/11 remember the sun setting, and specialized teams (hazmat, Urban is still in service, and I have been it was almost dark as we neared Search and Rescue, Red Cross). assigned to it as a paramedic. the last few stops on the drive,” Our communications systems That’s not a bad thing, but it’s still Boyd says. have improved since 9/11. We there as a reminder. It is gener- now have more channels, more ally used as a reserve ambulance, The Aftermath tower sites and a CAD system but it’s tough not to think about Boyd feels the region is now bet- that enables us to have better it [9/11] when you walk past that ter prepared to manage a similar linkage to mutual aid and out-of- ambulance to go out on a call. incident in the future. county units that would respond I found that if I refrain from “We have taken [National Inci- to a large-scale incident in the talking about it, it goes away, and dent Management System] NIMS future. It’s also easier for us to I don’t think much about it. My classes. It helped me better under- talk to more distant units as they wife was on the scene that day as stand how to manage and partici- respond with the newer porta- a member of the local fire depart- pate in a mass casualty incident ble radios purchased after 9/11. ment. She knows what happened. and what resources are available But I feel the use and reliability We don’t talk about it. Usually, I to assist. And many of us have [coverage area] of cell phones in leave town for the day and watch attended mass casualty training. our area is the most noticeable a college football game at nearby We also have a mass casualty change since 9/11.” Penn State. I just try to avoid trailer in Somerset Ambulance’s Boyd says that no matter how all the traffic and everything that main station now. he tries to forget the crash of goes with it. All responders now carry iden- Flight 93, he still has vivid memo- The anniversary date isn’t tification in the event that they ries and subtle reminders of the really a special day in my family need access to a scene. After 9/11, incident. And, like other respond- yet, mainly because we are busy all fire and EMS providers in the ers in New York City and Arling- in September with the start of region were required to register ton, Va., after that day, he initially school and raising two children.

P h oto Stoy s town A r e a Hi tori c l So i ty/Da ve E sche ri ch with the local 9-1-1 center and refrained from returning to the My wife is also a teacher and

6 JEMS out of the darkness Having lived in the area my entire life, I’m still uncertain if I am in full support of the memorial planned for the site. referees soccer this time of year, designed 8½" steel mesh escape something to remember that day and I stay busy coaching football capsule, with supplies, was suc- but he’s unsure whether a large after school. My children are too cessfully lowered into Rescue memorial is a good fit for the young to know anything about it. Hole No. 1 at 12:30 a.m. on July quiet, small area, which is primar- When they are older, I plan to sit 28. Rescuers had successfully pin- ily used for agricultural develop- down with them and explain what pointed the miners’ location and ment and mining. happened. But for now, I treat it were able to place the capsule Through all of the difficulties as another day and try not to dis- into a void where the men had Boyd faced responding to Shanks- rupt the daily routine.” languished in fear and hope for ville and the Quecreek Mine col- And although his physical 77 hours. Due to recurring chest lapse, he’s learned a few key health wasn’t affected that horri- pains, foremen Randy Fogle was lessons that he wanted to pass ble day in September, Boyd finds chosen to be the first rescued on to his colleagues. that he gets stressed very eas- miner and arrived on the surface “Don’t get tunnel vision. Take ily now and has trouble being as at 1 a.m. The removal order of the in the entire scene; think before patient as he was before 9/11. rest of the crew was based upon you speak on the radio; commu- He says he doesn’t have trou- weight, the heaviest to lightest, as nicate clearly and learn how to ble sleeping since the incident, the last would have no assistance multi task,” Boyd says. as reported by many of the 9/11 getting into the capsule. The min- responders, but had an interest- ers were brought up in 15-minute Boyd Today ing observation to pass along intervals, and all nine miners were Christian Boyd became a para- to other agencies that become on the surface at 2:45 a.m.3 medic after 9/11 and worked as a involved in a similar incident, Boyd points out that, although career firefighter/paramedic for particularly those in rural com- the incident seems smaller than the city of Johnstown and as munities. “It was tough to get the plane crash in Shanksville, a chauffeur on Truck Co. #1. sleep that evening because of there were no survivors in that He finished his college educa- our station’s proximity to the incident and there was the poten- tion and is currently a seventh crash site and the number of tial for survivors at the Quecreek grade history teacher at a local people stopping in to ask ques- Mine collapse. He says taking that school district. He still works tions,” Boyd says. first 9-1-1 call, and the experience part time as a paramedic for of working EMS standby at the Somerset Ambulance and is an Other Stressors rescue site—not knowing what assistant chief with Stoystown

Boyd feels that although many to expect or if anyone was alive Volunteer Fire Company. JEMS of his post-incident stress symp- for several days—was tremen- toms may be related to his experi- dously stressful on all the rescu- References ences at the crash site, some may ers involved, let alone those who 1. Shuster D. Sept. 12, 2006. 9/11 be exacerbated by several high- had also handled the Shanksville mystery: What was Flight 93’s stress calls he was on soon after disaster aftermath. target? In MSNBC. Retrieved the 9/11 incident, including the Boyd says he’s also concerned July 20, 2011 from www.msnbc. Quecreek Mine disaster that riv- with others who share stories com/id/14778963. eted the world in 2002. about the day but weren’t there 2. Wikipedia. Sept. 6, 2011. Boyd was working as a dis- to participate in emergency United Airlines Flight 93. In patcher on July 24, 2002 and took response efforts. He also has Wikipedia. Retrieved Sept. 6, the first call reporting the entrap- concerns about the size of the 2011 from www.wikipedia.org/ ment of 18 coal miners at the memorial and the changes it wiki/United_Airlines_Flight_93. Quecreek Mine in Lincoln Town- may bring to this small, close- 3. Wikipedoa. Aug. 20, 2011. ship, Somerset County. The min- knit community. Quecreek Mine Rescue. ers accidentally dug into the “Having lived in the area my Retrieved Sept. 6, 2011 from abandoned, poorly documented, entire life, I’m still uncertain if I http://en.wikipedia.org/wiki/ Saxman Coal/Harrison #2 Mine, am in full support of the memo- Quecreek_Mine_Rescue. flooding the room and pillar mine rial planned for the site, the prop- with an estimated 50 million gal- erty losses, increases in traffic and A.J. Heightman, MPA, EMT- lons of water. commercialization of the event,” P, is the editor-in-chief of JEMS After four long days of dig- Boyd says. and specializes in teaching mass ging and rescue efforts, a specially He feels that they should erect casualty incident management.

SEPTEMBER 2011 7 What I remember most about that day is the utter shock that there was actually a plane that had crashed.

remember a distinct odor at the crash site “I just after I arrived. It lasted for a few hours. It was an aroma I can’t explain. It wasn’t bad or good—just a definite smell,” says Somerset Area (Pa.) Ambulance Association Assistant Manager Jill Miller. What I remember most about that day is the utter shock that there was actually a plane that had crashed. The plane crashed into unsettled Earth, which was then thrust into the air and com- pletely covered the plane in the ground. There was very lit- tle debris and even fewer pieces that appeared to be a plane,” says Miller. “Although several responders report seeing personal effects or plane parts, I did not see that. I saw nothing I could clearly iden- tify as a plane or the 40 passen- gers on board. My most painful memory is that we could not help any of the

8 JEMS out of the darkness We immediately started preparing to allow arriving and departing ambulances access along a narrow roadway. passengers. In EMS, that is what you do; that is what you want to do. It’s what you educate yourself to do. But, on that fateful day, we could not. Our medical director, John Kar- duck, MD, arrived on scene early into the incident. I can tell you I was never so happy to see any- body in my life. He stood along- stuff,’ but see the bigger picture. the miracles bestowed upon me side me and helped put the next With over 31 years in EMS and fire and my family, and am happy just phase of operation into motion, service on both a volunteer and waking up each morning. not by dictating, but by work- paid basis, you become acutely That day, I learned that, when ing side-by-side with me. And aware that people face devastating you think you have it all figured together, we made some very injuries and death at a moment’s out, you don’t. In the days and good choices for the EMS provid- notice,” says Miller. weeks that followed the crash, we ers, the recovery teams and the “No patient of mine has had personnel on site 24/7. We families whose lives had just been ever gotten up in the morning were asked to staff the morgue, changed forever,” says Miller. and expected to be seriously ill, which had been set up in a local injured, or worse, dead by night- Army facility. This resulted in more Life after 9/11 fall. Yet I see this every shift. There- stress and decisions because we Although Miller’s life has not fore, because of Sept. 11, 2001, were asked to assist with fam- changed significantly since her and the culmination of many other ily members. It is something we experience on 9/11, what has EMS experiences I don’t dwell on all wanted to do, but it further changed is her outlook on life. the nagging inconveniences of stressed our resources. “I tend not to dwell on the ‘little each day but am thankful for all Because of the events of 9/11,

Many providers in Shanksville were in disbelief that a plane had crashed deep into the ground. P h oto A oto/K e it Sra k o c i

SEPTEMBER 2011 9 The sky was bright blue, and the sun was shining. I pay more attention to those kinds of days now.

On 9/11, Jill Miller was the manager of Somerset Area Ambulance Association Inc. and a practicing paramedic. She’s currently a paramedic and assistant manager.

the ‘that will never happen here’ mass casualties; our area; attitude we may have once had >> We called for any avail- >> We forgot to take the hospi- no longer exists. We learned able off-duty personnel to tals off alert, as we should many lessons from 9-11: some respond to the scene; have, when we realized big lessons and some painful for >> We immediately started there were no survivors. us to admit, and many small les- preparing to allow arriv- They stayed on high alert sons that we can put into use in ing and departing ambu- for quite some time and future mass casualty situations,” lances access along a weren’t very happy with us; says Miller. narrow roadway. >> Although we called for available off-duty person- nel to respond to the scene, it was wrong because the scene was not determined to be free of chemical weapons, and we placed a lot of people at risk. “I am definitely operating safer since 9/11, and there are more guidelines in place for our crews Lessons Learned Conversely, what we could to follow now. Before Sept. 11, Miller says, “Some small exam- have done better: 2001, I never imagined that we ples were what we did right: >> When we called for air could be exposed to terrorism or >> We called for air medical medical support, we didn’t that there was the potential for it support from anybody even realize until many hours to land in our back yard. That is close enough to consider; into the call that they were the lesson we learned on Septem- >> We called all surrounding all grounded because of ber 11th, and I have carried with hospitals and put them on the crash and the air space me since that day,” says Miller. alert for possible incoming that the FAA had closed in Miller also learned other

10 JEMS out of the darkness That day, I learned that, when you think you have it all figured out, you don’t. lessons that day. at the site, their resources were To attest to the caliber of the “Don’t expect that if you once again taxed. All the while, people aboard Flight 93, one of request something, it will be they had to remember that they the family members mentioned coming or can be coming, (e.g., were a rural EMS system that had to one of our crew members, ‘I air medical support); Expect the to fulfill its needs and not for- feel bad for you (our EMS crews), worst and hope for the best,” says get about the local people they that you were not able to help Miller. serve every day—the people that any one that day.’ Can you imag- That morning, as Miller stood expect them to be there. They ine the grief that family member at the crash site, she was unable had to work extra hard not to was going through, and yet, she to comprehend what had hap- stretch their resources too far, was thinking of us. These fami- pened. She says she initially Miller says. lies were amazing, and you can thought it was an insurmount- “Several days after the incident, see where those aboard got their able task to get the site organized when I was made aware that the strength and courage and came and proceed to the next level that plane was actually beneath the together as one to thwart the would be needed. But with a lit- ground where we first parked and intended mission,” says Miller. tle bit of luck and a quick prayer, walked, I could not fathom the “My rawest emotion is that we the personnel and resources she possibility of it all. I remember were not able to help any of the needed fell into place quickly, that it was one of the most beau- passengers—not being allowed, efficiently and professionally, in tiful fall days I could ever recall. by sources out of our control, to almost the blink of an eye. The sky was bright blue, and the fulfill our EMS obligation,” says

Additionally, as dignitaries sun was shining. I pay more atten- Miller. JEMS and politicians began to arrive tion to those kinds of days now.

SEPTEMBER 2011 11 The Sponsors of Out of the Darkness

We are proud to be sponsors of this historic, four-volume JEMS sup- plement that documents the heroic and unprecedented efforts by the responders to each tragic event on Sept. 11, 2001. Their efforts, the physical and emotional costs they have had to bear and the opera- tional advances made by their agencies since 9/11 are an important part of emergency service history.

designed to operate in the harshest conditions and environments. There are plenty of demands on ambulances during major incidents, so you should not have to worry about excessive vehicle idling or fuel con- Bound Tree Medical sumption. We’ve engineered efficiencies into our 800-533-0523 vehicles to take care of that for you. www.boundtree.com The new ECOSmart System, exclusive to Demers ambulances, offers you the innovative ANTI-IDLING, Bound Tree Medical specializes in emergency medi- automatic fuel saving feature that will save you thou- cal equipment, supplies and product expertise for sands of dollars in fuel costs. This new system is fully fire departments, military, government institutions automated, approved by OEMs and does not neces- and other EMS organizations that provide prehospi- sitate mechanical modification. It is available on all tal, emergency care. We support our customers with Demers ambulances and offers: our team of EMS-experienced account managers, • Higher operational efficiency product specialists and customer service represen- • A reduction of 48-52% in idling time tatives, backed by strong vendors and a national • A greater than 40% reduction in fuel con- distribution network. From everyday disposable sumption items to extensive capital equipment, we offer thou- • Fuel savings of between $1,500 to $2,000 sands of quality products from leading manufactur- annually per vehicle ers to help our customers save lives. We strive to • A noteworthy impact on the environment,

truly understand the needs and demands of EMS with the reduction of approx 4.5 tons of CO2 providers and deliver the products and services that emissions/year address those needs. www.demers-ambulances.com/ company/sustainability

Disaster Response Solutions, Inc. is dedicated to producing quality custom trailers and vehicles Demers Ambulances are built to provide the crew designed to enhance operations at mass casualty and patients with optimal protection in the cab and incidents and to provide support at disasters. “Built patient compartment of every ambulance we build. by EMTs and paramedics for EMTs and Paramedics” Our vehicles exceed all testing standards and are www.mcitrailers.com

12 JEMS out of the darkness The sponsors of Out of the Darkness

Remembering 9/11: 2001–2011 We recognize 9-11 as a day of selfless heroism and Mobile oxygen generators can play an essential role honor the memory of every First Responder; every at major incidents and should be capable of oper- Police Officer, Firefighter, Paramedic, EMT and Good ating completely self-sufficient in the event of an Samaritan, who sacrificed all in their endeavor to emergency or disaster situation. help save lives. Thank You. Always Remember. Oxygen Generating Systems is proud to be a www.laerdal.com sponsor of Out of the Darkness and is committed to its mission to provide a continuous supply of oxygen in a completely self-sufficient package that can be easily deployed and put into operation at emergency scenes. OGSI’s turnkey oxygen generating systems are fully automated, incredibly user friendly, and have minimal maintenance requirements. Contact us to get more information and learn about grant funding opportunities to prepare your system for future events. www.ogsi.com Your mission is to respond and manage the most difficult situations and in the most complex envi- ronments. Our mission at Emergency Products + Research is to manufacture products that will serve you well and meet all your service and scene needs. To do this, we test all our products in real life situa- tions to guarantee their optimal performance. We are SERVICE – it’s the natural instinct of emergency honored to be a sponsor of this JEMS editorial sup- responders. After September 11, 2001, we at South- plement, which carefully documents and recognizes eastern Emergency Equipment began to receive calls the extraordinary efforts by so many responders at from our customers saying ‘if this had happen to such complex and challenging scenes on September us we would be ill equipped to handle it; what can 11, 2001. you do to help us prepare to best SERVE our com- www.epandr.com munity in such an event.’ Out of this came our MCI/ [email protected] WMD Division. We pledge to continue to support the efforts of emergency responders in their operational and educational planning and training efforts and in their management of major incidents in the future. www.seequip.com infoseequip.com

SEPTEMBER 2011 13