The World Trade Center Disaster: A Brief On-site Report From Ground Zero FREE

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 disasters.

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.

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, NY 10595.