Copyright 2002 American Medical Association. All Rights Reserved.
Applicable FARS/DFARS Restrictions Apply to Government Use.2002
In the aftermath of the September 11, 2001, World Trade Center tragedy,
the American Academy of Ophthalmology informed us of the need for ophthalmologists
to treat the myriad eye complaints that ensued when the twin towers became
a noxious cloud of dry wall, gypsum, cement, marble, asbestos, steel, and
glass, released from the impact of the 2 commercial airliners hijacked by
terrorists. Many ophthalmologists in the New York City area heeded this call
and volunteered to provide care at "ground zero." It was a unique experience
that we would like to share with the ophthalmologic community. We worked primarily
in a makeshift triage center at Stuyvesant High School on Chambers Street,
which was the closest clinic to ground zero. From that triage/command center,
we dealt with rescue workers from the Fire Department, City of New York, and
the New York State Emergency Medical Services, city officials, various construction
crews, and other volunteers. We worked as part of the ophthalmology team at
this site and attended to various eye injuries. This center was set up for
survivors of the tragedy, but because so few survived, it became more of a
support center for the disaster relief team. We believe our observations may
be helpful to others who are creating contingency plans to deal with such
The leading ophthalmologic symptoms we encountered were painful, burning
eyes secondary to debris, corneal abrasions, and keratitis caused by exposure
to smoke and chemical fumes. Diagnosis was aided by using proparacaine hydrochloride,
fluorescein sodium ophthalmic strips, and direct ophthalmic examination. The
most common treatment was irrigation with 0.9% isotonic sodium chloride solution.
In the triage center, a bench with standing poles for bags of isotonic sodium
chloride solution given intravenously was used for the numerous patients who
came in for eye irrigation. Almost all of those treated went back to the site
again in a few hours.
New York City, with arguably one of the most responsive emergency medical
services in the country, was incredibly taxed by this apocalyptic disaster.
It seemed very clear that any city would be ill prepared to deal with a tragedy
such as this. Starting with the main "command" center, there was some degree
of disorganization. There was no strong chain of command, especially at the
volunteer level. Probably, the deaths of the top leaders of the emergency
and occupational/environmental medical services and the fire department in
the twin towers' collapse also contributed to this problem. The most efficient
part of the rescue effort at the center was dispensing food and water for
the rescue. There were ample medical supplies, although their distribution
was not optimal. Distribution of these supplies could have been better supervised.
Most of the rescue workers did not use safety goggles, which could have
prevented many of the eye injuries. The most common reasons for not using
them were that the workers did not know where to obtain safety goggles or
that the visor fogged too easily and impeded vision. A few said the eye shields
were too cumbersome. Virtually all agreed that availability of more showers
close to the site would have been valuable.
After discussion with patients and colleagues, we have some recommendations
to improve the medical care in such emergencies.
There should be an existing chain of command in
the medical corps, and identification badges should be issued for persons
who had previously volunteered to assist in such emergency efforts. We found
people who were unauthorized inside the triage center. Because of the lag
time for the arrival of military medical corps, some level of security is
needed for the civilian medical volunteers tending to the injured.
Respirators and goggles should be available to
all the workers at the trauma site. Despite the fact that an ample supply
was present, no assigned personnel were present or reachable to distribute
the gear to individuals who would most need them, especially the workers at
ground zero who were working under the cloud of noxious fumes.
There should be easy availability of mobile showers
near the site. If no available water lines are open, bags of isotonic sodium
chloride solution or gravity-dependent portable showers can be quickly mobilized
to the site.
There should be an efficient distribution of medical
Protective goggles that are light and not cumbersome
should be available to the rescue crew. A briefing on the use of eye protection
to educate the rescue workers is important.
The medical team chiefs of each specialty present
should have telephones or some mode of communication. In addition, a redundant
line of communication should be in place (ie, a short band radio if a cellular
phone or landline communication is not possible). Assistants who are responsible
for scheduling volunteer shifts, physician assignments, and general organization
of medical staff and supplies should be on site.
Finally, good communication is needed from the
feeder staging areas, such as the Javits Convention Center, to the triage
centers at the disaster site, communicating the need for required personnel
and supplies at ground zero. For example, the command center at the Javits
Convention Center was not fully aware that there was a need for certain specialists,
such as ophthalmologists and nurses, despite the presence of ample volunteers
for these positions.
Overall, our experience was entirely positive. The shortcomings were
overcome by the sheer power of team effort. It was an occasion we hope we
never see again. No one can be prepared for such a tragedy, but the spirit
of New York City, and ultimately, of the American people, demonstrated that
any challenge can and will be overcome by the many brave men and women who
risked their lives for the preservation of human life. In such calamities,
some previous planning will help preserve the sight of those emergency workers
who rush to the scene.
Corresponding author and reprints: Emerson T. Que, MD, Department
of Ophthalmology, New York Medical College, Westchester Medical Center, Valhalla,
Kurup SK, Que ET, Kauffmann Jokl DH. The World Trade Center Disaster: A Brief On-site Report From Ground Zero. Arch Ophthalmol. 2002;120(3):395-396. doi: