September 26, 2001
Nurses prepared for the worst
Triage sites were ready, but expected flood of survivors never came

Within minutes of the attack on the World Trade Center, emergency services workers, nurses and other health care professionals were bracing for the days and nights to come - the hectic, unnerving, all-important mission of saving lives.

Erik Mortensen, a visiting nurse from Brooklyn, rushed over the morning of Sept. 11 and helped set up a triage site at Stuyvesant High School. His team quickly arranged treatment areas for different types of injuries and even established a temporary operating room. They were ready.

"We were so hopeful that we'd get hundreds of patients," he said. "We never got any of them." The same thing happened all over the metropolitan area.

"More than anything else, there was an overwhelming feeling of disappointment," said Anne Goldman, a registered nurse and special representative to the Federation of Nurses/ United Federation of Teachers.

"It was the lack of survivors." FN/UFT is the New York City affiliate of the Federation of Nurses and Health Professionals/New York State United Teachers.

Eye, respiratory ailments "Even the major hospitals in the city did not receive the number of injured they expected," said Dorothea Meinecke, also from Lutheran, who chairs the FNHP/NYSUT Advisory Committee. Most of the few patients who came to Brooklyn had eye and respiratory ailments, she said.

"There's a sense of purpose in the first hours, a sense of meaning and accomplishment dealing with traumas and intervention," Goldman said. "That's the easy part. That's what we're prepared to do." On Sept.

11, she said, "the initial part was trauma, but then the issue was, where were they? There were no more victims."

When the World Trade Center was bombed in 1993, "we had school buses full of people all day long and into the night," Goldman said. "This time, the trauma piece is minimal."

Visiting nurses

The biggest effect in health care may have hit Visiting Nurse Service - New York City's massive home care agency. With 9,700 employees, it is the largest and oldest in the country. The FN/UFT represents all VNS nurses.

VNS normally cares for more than 5,000 patients in Manhattan alone. After the disaster, "we got a tremendous amount of admissions because the hospitals were trying to put people out to home care," to make room for expected new patients, said Michael Soccio, Manhattan borough coordinator for FN/UFT. "The census was definitely up."

Add that to the unprecedented difficulties getting around and communicating in Manhattan after the attack - not to mention hundreds of patients in homes without electricity or water or both - and you had a recipe for another disaster.

Thanks to the visiting nurses, however, a second disaster was averted.

The Manhattan VNS office on 32nd Street buzzed all day into the night, even when the area was evacuated. "Our building was empty except for our six floors," Soccio said.

"Nurses from our agency - after finishing work, and on scheduled days off - stayed on to help," he said.

"Every patient was triaged based on their needs. We were shuffling cases, and anybody we considered a 'must' visit was seen."

According to the VNS, half of its Manhattan patients are over age 65, 44 percent live alone and 20 percent have no caregiver, except for their visiting nurse or aide.

"Everybody who can do anything is out there working," said Joanne Adams, FN/UFT chapter leader for VNS.

"Everybody's making sure the services are still in place." Nurses were working 12-, 16-, 18-hour shifts, going home for a couple of hours of sleep and heading right back into the breach, she said.

Like other New Yorkers, VNS workers were struggling with their own crisis, as well.

"Many of our nurses and business staff have lost people they know they're never going to see again, yet they continue to come to work," Adams said. "It's a little melancholy, such a psychological thing for many of our nurses who have been affected personally, directly, indirectly and on the job.

"New York is unbelievable," she said. "Everybody's together in this."

Lower Manhattan

The biggest problem was getting to the area of Manhattan below 14th Street, home to 4 percent of the city's 8 million people, said Soccio. Public transportation was closed and the streets were barricaded by police officers.

"You couldn't really get below 14th unless you lived there," he recalled. "The first day, I was stopped by officers with machine guns. They wanted to see our licenses, went through our bags and equipment." The nurses got through, of course, and soon the police were helping with transportation, providing vans that helped drop off nurses and aides in the closed areas of the city.

The VNS set up drop-off points through what they call congregate-care buildings, single-room-occupancy nursing satellites that are found in most neighborhoods. They established spots where vans could stop to drop off messages and supplies near restricted areas. That saved the nurses from going all the way back uptown to the main office for supplies.

The agency provided nurses, aides and escorts below Canal Street with face masks, as "the air quality down there really, really stunk," Soccio said.

The nurses had a big problem with lab services, as lab workers couldn't get to the homes to collect samples.

Some pharmacies were closed, and many supplies and equipment couldn't be delivered. Phone lines and computer connections failed, crippling the normal reporting process.

Despite obstacles, "the agency handled it pretty well," Soccio said.

"Everybody is out there," Adams said. VNS hospice nurses actually went down to the site to help as part of the grieving assistance effort, she said. "This agency's response has been fantastic."

Regional hospitals

Hospitals throughout the region were on high alert for survivors, but shared the disappointment of the city trauma teams.

"As far as patients or victims, we haven't seen any," said Barbara Lipski, president of the Brookhaven Memorial FNHP in Suffolk County. "It's a lot like TWA Flight 800," the airliner that crashed just off Long Island a few years ago. "We were all prepared, but we never got any patients."

At St. Catherine's of Sienna in Nesconset, Long Island, "everybody who reported for work Tuesday morning was told they would have to remain indefinitely," said Ed Kelly, president of the Federation of Health Professionals local union. "But by the end of the day shifts, people were allowed to go home."

Still, the World Trade Center disaster definitely reached the eastern end of Long Island: "We saw people coming off the trains all covered in soot," Lipski said.

- Ned R. Hoskin

Standing in soot - washing out eyes

Erik Mortensen, a member of FN/UFT in the Brooklyn Visiting Nurse Service, headed over the Brooklyn Bridge for the World Trade Center within an hour of the attack. Walking through lower Manhattan, the sights were bizarre.

"We walked through four or five inches of soot on the ground, saw the buildings burning. City Hall looked like a black-and-white movie, all gray. Number 5 World Trade Center was all bright and orange," he said. It was in flames.

Ending up at Stuyvesant High School in a triage center where trauma patients never arrived (see above article) Mortensen and others headed for the rubble.

"We put on the masks and went right out on the site, in the sidewalks and the streets, and started washing people's eyes," he said. "We developed a technique that was pretty good for cleaning the outside of the eyes, then the inside, and we did that pretty much for the next four days."

It took two or three minutes per person, but it provided more than just relief from the irritation, he said. "We did it in a very nurturing way.

"It made all the difference feeling that I was able to do something," he said. "After that first morning, I didn't go to the triage center, because the workers didn't want to go to the triage sites. They wanted to keep going."

Mortensen and a partner also brought goggles, respirator masks, chewing gum and Tylenol to the workers on the front lines. Just as they were reluctant to pause to have their eyes washed, the rescue workers wouldn't leave the site to get those other things, which Mortensen viewed as essential.

"We're going to find out about the asbestos," he said.

Respirators were needed; he arranged shipments of them from Texas and Missouri, and was calling other states for more. He wanted to try and get protective clothing for workers, too.

"It's upsetting because we don't know about the exposure," he said. "We've never seen a building the size of the World Trade Center reduced to dust."