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Experience at ‘ground zero’ prompts recommendations
Ophthalmologists who responded to relief efforts in New York City share advice for future disasters.
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In the immediate hours following the World Trade Center tragedy, a call went out from the American Academy of Ophthalmology requesting volunteers to to treat the myriad eye complaints that were anticipated. Many ophthalmologists in the New York City area heeded this call and volunteered to provide care at “ground zero.”
We and other ophthalmologists worked primarily in a makeshift triage center set up at Stuyvesant High School on Chambers Street, just blocks from the disaster site. From that triage center, we dealt with rescue workers from the New York City Fire Department, New York Emergency Medical Services, construction crews and other volunteers and city officials. The center was set up to care for the survivors of the tragedy, but because so few survived it turned out to be more of a support center for the disaster relief team.
We thought it would be wise to learn about how to handle a disaster from a medical point of view and more specifically from an ophthalmologist’s perspective.
The fallout from the collapse of the buildings was composed of drywall, gypsum, cement, marble, asbestos, steel and glass. The main ocular symptoms we treated were irritated eyes, burning sensations, dust in the eyes and painful eyes secondary to debris and corneal abrasions, as well as possible exposure to smoke and chemical fumes.
Irrigation with 0.9% normal saline was employed for the more severe abrasions. The patients were diagnosed by proparacaine HCl and fluorescein sodium ophthalmic strips and direct ophthalmic exam. In the triage center, a bench with standing IV poles and bags of normal saline were hung for the numerous patients who came in for eye irritation. Almost all of those treated returned to the site in a matter of hours.
Ready for action
It seemed clear to us that any city would be ill-prepared to deal with a tragedy like this, but New York City arguably has one of the most responsive emergency medical services in the country. The most efficient part of the rescue effort at the center was dispensing of food and water for the rescue teams.
However, there was some degree of disorganization. First, there was no strong chain of command, especially at the volunteer level. This may have been because so many medics and firefighters were killed. Second, although there were ample medical supplies, distribution of these supplies could have been better supervised.
Most of the rescue workers did not use safety goggles. As ophthalmologists, we commonly see ocular trauma when construction workers, particularly welders, lift their masks during welding to get a better look and subsequently get foreign bodies in the eye. When asked why they weren’t wearing safety goggles, most of the rescue workers said they did not know where to obtain them 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 made a difference in removing debris from the workers’ hands, faces, etc. These amenities were frequently requested by the workers.
Recommendations
Overall, our experience was positive. The shortcomings were overcome by the sheer power of team effort. We believe that in such situations, some guidelines must be in place to ensure preservation of the sight of those who work at the disaster. After discussion with patients and colleagues, we have some suggestions for formulating a more cohesive plan of action that could be put into use in the future:
- There should be a solid chain of command in the medical corps. All medical personnel should have ID cards. We frequently found unauthorized personnel inside the triage center. Due to the delayed arrival of the military medical corps, some level of security is needed for the civilian medical volunteers.
- Items such as respirators and goggles should be available to all workers at the trauma site. Despite the fact that an ample supply was present, no personnel were present to distribute the gear to individuals who would most need them, namely workers at the disaster site working under the cloud of potentially noxious fumes. Additionally, a quick briefing on the use of eye protection to educate rescue workers is advisable.
- Mobile showers are a necessity. If no water lines are open, saline bags or gravity-dependent portable showers can be quickly mobilized to the site.
- Medical supplies should be dispensed in an efficient, timely fashion by assigned medical personnel.
- The medical team chiefs in each specialty should have some mode of communication. A backup line of communication should be in place if cellular or land-line communication is not possible. Assistants responsible for scheduling of volunteer shifts, physician assignments and general organization of medical staff and medical supplies should be on-site.
- More and better communication is needed between command areas like the Javits Center and the triage centers at the disaster site.
For Your Information:
- Emerson T. Que, MD, can be reached at Westchester Medical Center, New York Medical College, Department of Ophthalmology, Valhalla, NY 10595; (914) 493-7662; fax: (914) 493-7445; e-mail: emersonque@hotmail.com.