On the Ground After September 11

Mental Health Responses and Practical Knowledge Gained

Yael Danieli, Robert L Dingman

• Publisher: Routledge
• Year: 2014
• eBook ISBN: 9781317717850
• Topic: Politics & International Relations
• Subtopic: National Security
• Index: Politics & International Relations

A heartfelt collection of extraordinary first-person accounts that delve into every level of the experience of 9/11

Out of the infamy of 9/11 and its aftermath people rose up with courage and determination to meet formidable challenges. On the Ground After September 11: Mental Health Responses and Practical Lessons Gained is a stirring compilation of over a hundred personal and professional first-hand accounts of the entire experience, from the moment the first plane slammed into the North Tower of the World Trade Center, to the months mental health professionals worked to ease the pain and trauma of others even while they themselves were traumatized. This remarkable chronicle reveals the breadth and depth of human need and courage along with the practical organizational considerations encountered in the responses to terrorist attacks.

The goal of any terrorist act is to instill psychosocial damage to a society to effect change. On the Ground After September 11 provides deep insight into the damage the attack had on our own society, the failures and victories within our response systems, and the path of healing that mental health workers need to travel to be of service to their clients. Personal accounts written by the professionals and public figures involved reveal the broad range of responses to this traumatic event and illuminate how mental health services can most effectively be delivered. Through the benefit of hindsight, recommendations are described for ways to better finance assistance, adapt the training of mental health professionals, and modify organizations' response to the needs of victims in this type of event. Reading these unique personal accounts of that day and the difficult days that followed provides a thoughtful, moving, rational view of what is truly needed in times of disaster.

On the Ground After September 11 includes the first-person experiences and lessons learned from the people of:

• NYU Downtown Hospital
  
• NYC Department of Health and Mental Hygiene
  
• NY Metropolitan Transportation Council
  
• St. Paul's Chapel
  
• St. Vincent Hospital - Manhattan
  
• Safe Horizon
  
• LifeNet
  
• WTC Incident Command Center at NYC Medical Examiner's office
  
• New Jersey's Project Phoenix
  
• Massachusetts Department of Mental Health
  
• the military psychiatric response to the Pentagon attack
  
• Connecticut's Center for Trauma Response, Recovery, and Preparedness
  
• the Staten Island Relief Center
  
• Barrier Free Living Inc. for people with disabilities
  
• the Federal Emergency Management Agency
  
• Alianza Dominicana, Inc.
  
• Staten Island Mental Health Society
  
• the United Airlines Emergency Response Team for Flight 93
  
• The Center for Trauma Response, Recovery, and Preparedness (CTRP)
  
• Disaster Mental Health Services (DMHS) at Dulles International Airport
  
• the American Red Cross
  
• the Respite Center at the Great White Tent
  
• HealthCare Chaplaincy
  
• The Salvation Army
  
• the Islamic Circle of North America
  
• The Coalition of Voluntary Mental Health Agencies, Inc.
  
• F*E*G*S
  
• the Jewish Board of Family and Children's Services (JBFCS)
  
• and many, many more
  

On the Ground After September 11: Mental Health Responses and Practical Lessons Gained poignantly illustrates that regardless of profession, culture, religion, or age, every life touched by 9/11 will never be the same. This is essential reading for counselors, psychologists, psychiatrists, social workers, therapists, trauma specialists, educators, and students.

PART I:
THE FIRST DAYS

— 1 —
The Hospital in Its Community

William Wang

New York University Downtown Hospital is located in the center of Lower Manhattan, four blocks away from the World Trade Center; it is the only hospital in Lower Manhattan. It serves a large residential community, from Battery Park to Houston Street, and a business community, including Wall Street, which is the most important and largest financial district in the world. The residential population is 300,000 and the business population is 250,000.

SEPTEMBER 11, 2001

September 11, 2001, was a beautiful, typical early fall day. Thousands of people filled the streets of Lower Manhattan at rush hour on their way to work. Everything was as usual until 8:46 a.m. when the first plane hit the North Tower of the World Trade Center (WTC). The whole world changed at that moment.

Following my daily routine, I came to the office early to get things ready for the day. Just as I was making my first phone call I heard a big noise from the west side of my office. I wondered but quickly rejected that it could be a bomb, thinking that the WTC would not be bombed a second time (the first time was 1993). I didn't take it seriously until 9:03 a.m. when the second plane hit the South Tower. As I hung up the phone and looked down from my fifteenth-floor office, I saw many people running. Now I knew something terrible had happened. Running from my office building and rushing down to the street, I followed the crowd and, looking at the sky, I saw both WTC buildings in flames. I just couldn't believe the huge fire and smoke coming from the towers. I could not describe my feelings at that moment. Someone told me it was a terrorist attack. I realized there would be a lot of casualties, and I ran to the hospital, where a code yellow had been called: The hospital was under a disaster and medical emergency. By the time I got to the hospital, everyone was in position, getting ready for the victims. Ours is not a big hospital, so the cafeteria was set up as the medical care area. The doctors, nurses, and other medical staff were already there and all necessary supplies were ready.

Moments later, as I was in the main lobby directing people, I saw the South Tower coming down. My heart went down too. It was not just the building, which was such a big part of the New York skyline that was wiped out completely; it was that I knew thousands of lives would be buried there. Within seconds, dust and smoke surrounded the hospital and we could see nothing outside. Right after the collapse, people started rushing to the hospital. The police brought many people to the hospital. Some were brought in by people whom they did not even know. Because our hospital is just four blocks from the WTC, we received hundreds of victims in a very brief period.

People came to the hospital with different kinds of injuries. Some of them were bleeding and were immediately treated in the cafeteria. Hundreds of people came in covered in gray, their whole bodies caked with dust so that we could see only their eyes. We started to clean them up in the lobby. It was so devastating. At that time I was running for oxygen tanks, masks, and water that were needed for the patients. I also realized how well people were united during this disaster. They were all working hard to help one another. Everyone was lending a hand to help cope with this tragedy.

I had never seen a disaster such as this in my life. To see all these people coming in—people who were in a panic, many crying, wandering, or trying to remain silent—was an awful picture. At that moment, I just wished I could give more to help them. Unfortunately, all I could worry about was treating people with injuries. There was no time to deal with them emotionally.

By about 2 or 3 p.m., no more victims were coming in. It was then we realized that most of the people were buried in the debris. We wished more injured would arrive. We were hoping more could have survived.

By then, the hospital had lost its power and phone system. We were totally isolated. We had no idea what was happening outside the hospital. The downtown area had become a battlefield, and our hospital was in the center of a war zone. Police blocked all streets and military personal set up many checkpoints in the area. No one could enter this area. It w as devastating.

That day, our medical staff worked tirelessly, treating hundreds of victims within a short period of time. Our surgery operating room was running all day. On September 11 we treated more than 1,000 victims, including more than 250 police officers. Our hospital remained at code yellow for days.

WHAT DID WE LEARN?

We learned many things from the events of September 11. The most important lesson is that taking care of the community is as important as taking care of the patients. We came to realize the need for a great deal of organizational and personnel changes:

We need a team for noninjured people in the hospital. After the WTC buildings collapsed, hundreds of wounded individuals came to the hospital for medical treatment. However, hundreds of people who did not have any injuries also came to the hospital just for shelter because they felt the hospital was a safe place to stay during the disaster. So besides treating the injured, we also tended to many people with no injuries, while keeping them from interfering with other persons' medical treatment. Of course, the priority of the hospital is to provide medical assistance to victims and save lives. But we should also have a team for the noninjured people who come in just for safety. That team should include staff for crowd control and social workers who can provide on-site counseling and emotional support to prevent panic. On that day, I saw many people who were frightened, crying, staring, and wandering while they occupied our lobby. The team should also have someone who can provide updates so people know what is going on. In addition, it should have someone just to care for people's comfort needs. For instance, the need for water, chairs, or facial tissue and tissue paper could have been addressed by this team during this crisis.

The hospital should provide some space for shelter. Right after the buildings collapsed, the entire downtown area started evacuating, especially those residents who lived in the buildings near the WTC. Most people went to the homes of family members, friends, or relatives for shelter. Unfortunately, many seniors came to the hospital asking for a place to stay because they had no relatives or friends or anywhere else to go. It was too far for them to walk to a shelter outside this area. At that time, no transportation was available in the downtown area at all. So we provided them with rooms.

We must take care of community needs. Once the disaster happened, the hospital focused on treating victims, saving lives, and taking care of those who needed medical help. Our hospital operated twenty-four hours a day for a week, including our cafeteria where we served meals day and night. The meals were not just for our hospital staff but were open also to anyone in the community, including police officers, firefighters, and rescue workers, because Lower Manhattan had become a war zone. There were no grocery stores, no restaurants, no power, and no phones. All businesses were closed. It was a ghost town. Our hospital was the only public building open in Lower Manhattan.

A day after the disaster, workers from a nearby nine-building residential complex came and asked for help feeding their residents, who had had no food for two days. Most of them were seniors, many living on the higher floors and not able to come downstairs to find food without working elevators. Without power, refrigerators also could no longer store food. Since no food was available in the area, we were the only place they could ask for help.

Sure, we said we would do it. We never thought we would have to feed people outside the hospital. Under these circumstances, providing food was as lifesaving as medical treatment. Since saving lives is our duty, we would deliver hot food to their residents in three hours.

We also realized that if we just sent the food to the buildings, many seniors still could not receive it because of the powerless elevators. We gathered more than forty volunteers from the hospital, including staff, nurses, doctors, and board members, to do this job. Within two hours, the food was ready. Our team went door-to-door and floor-to-floor to deliver these hot, fresh meals to each resident in this nine-building complex. Residents could not thank us enough for what the hospital team had done for them.

The hospital must remember that people need medication. A number of residential complex buildings are located near our hospital, and most of the residents are seniors. Many of them have to take medication every day, and Lower Manhattan not only did not have any stores open but pharmacies were closed as well.

After a doctor went to the residential buildings to check his patients, he realized that many seniors taking medication regularly were likely to run out, which might become life threatening. He came back to the hospital and suggested that we should send a team there to examine everyone who was on medications. I volunteered to organize the team, which consisted of nurses and volunteers.

The following day, two nurses and eight volunteers went to the residential complex. First we asked the building social worker for a list of people who took daily medications. Following the list, volunteers walked to the apartments and knocked on doors, asked if they had enough medication for the next few days, then brought prescriptions to the nurse to check whether they needed to be refilled. If needed, a volunteer would bring the prescription to our hospital pharmacy, get it filled, and bring it back to the patient. Since our hospital does not carry all kinds of medications, a volunteer would take any unfilled prescriptions and walk to Midtown, where the pharmacies were still open, to get them filled and bring them back to the residents. The team spent the whole day examining three residential complexes and made sure that everyone in the community had been assessed and assisted.

CONCLUSION

When hospital personnel prepare for a disaster, they should plan to take care of not only injured victims but also noninjured people. In addition to caring for people in the hospital, taking care of community needs must also included in the disaster plan. When a disaster takes place near a hospital, that hospital may be the only place people can to go ask for help.

— 2 —
Reflections on the Public Health and Mental Health Response to 9/11

Neal L. Cohen

Serving as commissioner of both the New York City (NYC) Departments of Health and Mental Health since 1998,I was faced with a unique perspective, opportunity, and challenge to address both the public health and mental health issues that would emerge from the 9/11 attack. New York City had anticipated the need to coordinate and plan emergency response to a wide range of potential large-scale disasters (including terrorism) with the creation of an Office of Emergency Management in 1996 that established protocols and practice in responding to both “desktop” and “real-time” drills. As a result, upon receiving a call on my way to the office on the morning of September 11 notifying me that an airplane had crashed into the North Tower of the World Trade Center (WTC), I immediately sped to 7 WTC to the city's state-of-the-art Emergency Operations Center. Upon arriving, I was unable to enter 7 WTC as it had become the site of a fuel oil fire that would lead to the building's collapse by late afternoon. I saw Mayor Giuliani and several of his senior cabinet members there, and I joined him as he established a makeshift outpost at 75 Barclay Street, from which he contacted the White House, confirmed that the nation was under attack, and sought military air cover to protect New York City from further attack. After about fifteen minutes, at 10:05 a.m., we heard a loud rumbling, someone shouted, “It's coming down! Hit the deck!” and a dark cloud seemed to cover the windows as the building trembled. Despite several locked doors, we were led out through a smoke-filled basement maze to exit on Church Street into a throng of ghostly, ash-caked pedestrians who were struggling to get away from the storm of debris raining down after the collapse of the first tower.

With cell phones disabled and land lines not working, we trooped north for about ten blocks before finding a firehouse with communications equipment that worked. The immediate focus after the attack was on assessing the health impact and mobilizing the resources needed to handle the public health and medical emergency. With the collapse of two office towers that could each accommodate 25,000 people on a busy workday, we expected large numbers of injuries that would strain the “surge capacity” of the health care system throughout the metropolitan area. However, in fact, relatively small numbers of seriously injured people came to the city's emergency departments; nevertheless, about 8,000 people were seen over the next several days throughout the tristate area (New York, New Jersey, Connecticut) for injuries, both physical and emotional, sustained on 9/11. One important lesson to be learned from this is that terrorism creates health impacts that reach far beyond the immediate boundaries of a disastrous event, because people will, whenever possible, seek to leave the immediate area and return to their homes.

An additional public health focus of immediate concern was the secondary environmental issues, especially asbestos, dust, smoke, and chemical inhalation. The public health response was further complicated by the fact that, at Ground Zero, fires continued to burn for many weeks, with the ongoing release of particulate matter into the air. Public health surveillance was also prioritized to monitor the potential illnesses that might emerge from the disruption of the physical infrastructure (e.g., water- and food-borne diseases). With hundreds of restaurants losing power, rotting food and pest control needed to be addressed.

At the firehouse, we were able to turn on a small television set to view the reports of the chain of events while the mayor was communicating with both government and media. The videos of the planes hitting the towers with great thrust and the subsequent explosions and fires were shown repeatedly that morning. Watching the broadcasts as we prepared to move city government to a more secure site, I knew that they were signaling the urgency of a looming mental health crisis that would require an unprecedented public health response.

Later that day, when I was able to speak to my own staff, I asked them to review the literature on the sequelae of the Oklahoma City terrorism bombing. I knew that the bombing had stimulated a significant series of studies on the development of post-traumatic stress disorder as a consequence of terrorism and might provide a framework for crafting the public health response which would be needed in New York.

Initially, we responded to the mental health needs with the model of crisis counseling and support we had used in the 1990s, through prior management of the psychological sequelae of mass violence and terrorism. An arson that killed dozens of people in a Bronx dance club in 1990 led to the creation of a Division of Crisis Intervention Services at the Department of Mental Health (DMH). We began to build a series of crisis teams that could provide crisis intervention services throughout the city with a mobile outreach capacity. Furthermore, the WTC bombing in 1993 and two airline crash disasters in the late 1990s gave us experience mobilizing large numbers of volunteer mental health professionals to support the needs of...

Table of contents

• Cover Page
• Half Title Page
• Title Page
• Copyright Page
• Table of Contents
• About the Editors
• Contributors
• Foreword
• Acknowledgments
• Introduction
• Part I: The First Days
• Part II: The First Few Weeks
• Part III: The First Two Years
• Part IV: Three Years Later And Beyond
• Part V: Remembering For The Future
• Epilogue
• Index