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Table of Contents.
The World Trade Center Attack: Lessons for disaster management.
Ronald Simon 1 author and Sheldon Teperman 1.
© BioMed Central Ltd 2001.
Published: 6 November 2001.
As the largest, and one of the most eclectic, urban center in the United States, New York City felt the need to develop an Office of Emergency Management to coordinate communications and direct resources in the event of a mass disaster. Practice drills were then carried out to assess and improve disaster preparedness. The day of 11 September 2001 began with the unimaginable. As events unfolded, previous plans based on drills were found not to address the unique issues faced and new plans rapidly evolved out of necessity. Heroic actions were commonplace. Much can be learned from the events of 11 September 2001. Natural and unnatural disasters will happen again, so it is critical that these lessons be learned. Proper preparation will undoubtedly save lives and resources.
Introduction.
New York City is unique in many respects. According to the 2000 Census [ 1 ], over 8 million people live within the five boroughs making it the largest city in the United States. Over 1.5 million people live within the 34 square miles (88.4 km 2 ) that make up Manhattan Island. Manhattan's population density is the highest in the country, with almost 70,000 people per square mile (27,000 per km 2 ) [ 2 ]. New York City also has more trauma centers than any other city: six in Manhattan, two in the Bronx, four in Brooklyn, three in Queens, and two in Staten Island.
The World Trade Center. (1) 1 World Trade Center, North Tower - Communications Antenna; (2) 2 World Trade Center, South Tower; (3) 3 World Trade Center - Marriot Hotel; (4) 4 World Trade Center; (5) 5 World Trade Center; (6) 6 World Trade Center; (7) 7 World Trade Center - Office of Emergency Management.
What happened.
Soon after the first plane struck the north tower (1 World Trade Center) at 08:46, New York City OEM began directing resources to the area. This role was short lived. Its building was heavily damaged at 10:29 by the fall of the north tower and was evacuated. Command and control was re-established elsewhere. Damage by falling debris and fire caused 7 World Trade Center to collapse less than 9 hours after the initial strike. The coordination of the response of the Emergency Medical Systems (EMS), the New York Police Department, and the FDNY was significantly impaired by the loss of its center of communications and many key personnel.
By 09:00, before the second attack had even occurred, our hospital went into a state of disaster preparedness. Patients in the Emergency Department were quickly moved to our urgent care area adjacent to the main Emergency Department. Plans were made to transfer subsequent acute patients (those unrelated to the World Trade Center incident) to North Central Bronx Hospital, our sister hospital approximately 4 miles (6.4 km) away. Within3 hours, 20 intensive care unit beds were available. All elective surgery was halted and six operating rooms were fully staffed and open. Within 4 hours, almost 100 critical and acute beds were created and large areas for the minimally injured were prepared. No physicians, nurses or support staff were allowed to go home. All area hospitals, including New York, New Jersey, and Connecticut, whether 911 call receiving or not, prepared in various ways to accept the expected hordes of patients.
In the first 2 hours, over 350 patients walked or were taken to New York University Downtown Hospital, a nontrauma center, which is 0.2 miles (0.32 km) from the World Trade Center. St Vincent's Hospital is about 1 mile (1.6 km) from the scene. As the closest trauma center, it was quickly swamped with over 300 walking wounded and critical patients. Bellevue Hospital, a trauma center approximately 2.5 miles (4.0 km) northeast of the World Trade Center, also received some of the early injured patients both directly and in transfer. Nineteen burn patients were taken to New York Hospital-Cornell Medical Center, the only burn center in Manhattan.
Scene management was especially complex during this attack because of the diversity in the EMS response. Communication between most hospitals and coordinators at the scene was almost nonexistent due to the early disruption of its communications tower and, later, the office of the OEM itself. Telephone communication either via landline or cell phone did not exist in lower Manhattan. Helicopter transport did not occur because the skies over New York were closed except for military aircraft. Triage from the scene of more stable patients to hospitals outside the immediate area did not occur due to the loss of OEM coordination. Only FDNY ambulances were in communication with central dispatch in Maspeth, Queens. NonFDNY ambulances took patients to the nearest hospital without any knowledge of available resources, or back to nontrauma centers in Brooklyn and New Jersey where they originated. Physicians, nurses, and ancillary professionals at St Lukes-Roosevelt Hospital, a trauma center only 3 miles (4.8 km) north, sat idle and frustrated, while staff at St Vincent's and New York University Downtown Hospital worked under extreme conditions.
Lessons learned.
Communication and coordination.
The lack of communication probably resulted in more problems than all other factors combined. Military strategists do not place their headquarters on the front line. The same should be true for all key civil communication and coordination centers. These centers should be housed in areas unlikely to be direct targets or at risk for collateral damage. There should also be redundancy in the communications network so that one blow will not be a knockout. The OEM must be able to communicate with all local and regional hospitals. These facilities must keep the OEM informed of their status on a continuous basis. Constant assessment of operating room, intensive care unit, and floor bed availability must be made. The state of these resources should be used to direct field personnel to the most appropriate facility.
If the OEM is, for whatever reason, unable to assess and direct available local resources, hospitals closest to an incident should be prospectively set up to triage stable patients out to other hospitals. As long as hospitals see patients as their 'property' and do not transfer them until overwhelmed, optimal care in the event of a disaster cannot be possible.
Triage and patient movement from the scene.
The belief that patients will lie quietly at the scene while they are evaluated, triaged, tagged and transported does pertain to this type of situation. It is clear from this attack and other disasters that local hospitals will rapidly be swamped by anyone that can get there on their own. Communications will be unreliable and expected transport routes and methods may be unavailable. Without guidance, EMS crews will bring the injured to the closest hospital, further stressing existing resources. The triage of patients in urban and rural disasters is different and needs to be re-examined.
Hospital preparation.
Not all hospitals within 100 miles (160 km) of a disaster need to prepare at the same time or to the same extent. Significant time, effort, and resources were wasted and unnecessary anxiety was created at sites remote to the World Trade Center attack because of lack of direction and information. If appropriate communication existed, remote hospitals could begin limited preparation at the time of the incident and would be ready as hospitals near the site reached capacity. As need became more evident, additional resources could be activated as necessary.
Effective intrahospital communication must be available. At our institution, Nextel DirectConnect cell phones are routinely used for communication. These phones not only act as a standard cell phone, but also act like multichannel walkie-talkies. During our preparation immediately following the World Trade Center attack, additional phones were given to key people in administration and in nursing, improving coordination. We were fortunate that our cell phone service remained intact. If it were interrupted, the Nextel system would have been disrupted. We have plans to obtain backup walkie-talkies in case the Nextel system fails.
Physician response.
The concept of 'Mobile Army Surgical Hospital' areas set up at the scene of disasters to receive and dispense initial trauma care is attractive. However, it is unlikely to be effective in this type of situation because of the logistical difficulties in rapidly moving such resources to the scene. Several local hospitals sent teams to the scene early on after the attack. It is unfortunate when a trained rescuer loses his life in the line of duty. However, they are trained and prepared to work in suboptimal and dangerous environments. Most physicians have no such training and it is often a resident who is least prepared for the field environment that is sent. In this scenario, the risks to the providers are high and the benefits small. Optimally, patients should be evaluated and stabilized at the scene by trained prehospital personnel, or even by uninjured bystanders, then triaged and transported to hospitals with available resources. This may not, however, be the optimal response for mass casualties in remote areas where transport times may be prolonged.
If health care providers are not brought to the immediate scene, what about their role at local hospitals? The question here revolves around physician qualifications and credentialing. There is a process via the National Disaster Medical System [ 3 ] through which physicians can obtain federal credentials to work anywhere in the country in the event of a disaster. The time commitment for this is so onerous that few physicians have signed on. We need to consider a statewide credentialing system for physicians and nurses to enable them to work in any hospital in their state in the event of a disaster.
The future.
The world, and especially New York City, will never be the same after 11 September 2001. We live in a time when movie disaster dramas come true and our very best intentions lay wasted. We need to anticipate all possible scenarios because the unthinkable is now a reality. Cities need to have disaster plans that are tailored to specific scenarios and locations, not preconceived generalized plans. Airport plane crashes, stadium catastrophes, and remote mass transit accidents are all vastly different to this attack and require different responses. Communications need to be standardized and backed up. Triage needs to be thought out more clearly. Scene control to prevent access from unauthorized medical personnel is important. The problems of a collapsing building need to be addressed by engineers and EMS planners. The general public need to be trained in initial care of victims in the same way Basic Life Support is taught. Hazardous material training must become standard not only for trauma centers, but also all hospitals.
I hope that the experience of the World Trade Center attack will lead to a disaster response system that is capable of dealing with the many scenarios possible today and tomorrow.
RS is a member of the New York Regional and State Trauma Advisory Committees, and has been involved in Jacobi Medical Center's disaster committee preparations. He has also attended multiple hazardous material training symposia.
ST the lead surgeon on Jacobi Medical Center's disaster committee and has been involved in the upgrading of their disaster response to include nuclear, biological, and chemical weapons.
Abbreviations.
EMS = Emergency Medical Systems.
FDNY = Fire Department of New York.
OEM = Office of Emergency Management.
Declarations.
Acknowledgements.
The authors wish to acknowledge all the emergency workers involved in this event. The physicians at Jacobi Medical Center are proud to work with such skilled and committed people.
This article, and the series it is part of, is dedicated to the first responders - fire, police and medical personnel - who attended the World Trade Center disaster of 11 September 2001. They did not hesitate to place themselves in harm's way to rescue the innocent, and without their efforts many more would have perished. They will not be forgotten.
Competing interests.
Authors’ Affiliations.
References.
City of New York, 2000, Census tables [ ci. nyc. ny. us/html/dcp/html/poptable. html ] Demographia [ demographia/dm-nyc. htm ] Office of Emergency Preparedness [ ndms. dhhs. gov/NDMS/ndms. html ]
Papers, Zotero, Reference Manager, RefWorks (.RIS )
EndNote (.ENW )
Mendeley, JabRef (.BIB )
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Developing a Resilient Organization.
Lessons Learned from the World Trade Center Disaster.
Steve Freeman, Ph. D., University of Pennsylvania, Center for Organizational Dynamics.
Marc Maltz, MBA, TRIAD Consulting Group LLC and the William Alanson White Institute.
Target audience: Those responsible for crisis preparedness and human resources in an organization, including senior Human Resource professionals, Chief Operating Officers and other senior leaders whose role it is to manage the health of the organization.
A Basic Understanding of Organizational Resilience A Model of Organizational Resilience The Application of the Resilience Model to One’s Organization An Understanding of an Organization’s Key Vulnerabilities The Development of a Preliminary Organizational Resilience Action Plan.
General Preparedness – What does it take for an Organization to be resilient?
1. What is Organizational Resilience?
Participant Introductions and Critical Incidents.
Participant’s definition of Organizational Resilience.
2. Organizational Resilience Defined: A Model Preparedness: Reserves, depletion and replenishment.
Measures of health and reserves: social and technical systems, finances, social and technical networks and human resources.
Examples of resilience and its absence.
Analysis of the effects of disaster.
Identifying the most critical factors of resilience.
Key questions covered:
What levels of reserves are desirable? How do you strengthen your organization’s health and reserves? What is critical to your organization’s continuance and necessary for its basic functioning? What are your organization’s vulnerable leverage points? Who cares that your organization continues and why? How can this strengthen it?
Participants apply their learning about resilience to their own organizations as preparation for day II.
Day II: Developing an Organizational Resilience Action Plan.
5. Organizational Diagnosis.
Participant puts her/his organization through a diagnostic on key resilience factors:
Financial Resources Human Resources Social and Technical Systems Social and Technical Networks The organization’s culture and values.
6. What is your organization’s diagnosis and what are its priorities?
The organization’s priorities are identified and compared/contrasted to the diagnosis.
Actions for developing organizational readiness are identified.

Lessons learned from the world trade center disaster about critical utility systems

On the morning of September 11, 2001 two hijacked commercial jetliners roared out of the sky and were deliberately flown into towers one and two of the World Trade Center.
The total destruction of the World Trade Center complex from the initial collapse of towers one and two to the subsequent fires which completed the devastation of the complex produced an environmental disaster unparalleled to any experienced in modern times in an urban environment in the United States. The destruction of the World Trade Center produced an initial dust cloud which covered the southern portion of Manhattan Island. In addition, the fire which followed the collapse of the towers burned for months and was the longest lasting commercial building fire in U. S. history. In total, ten major buildings experienced partial or total collapse and approximately thirty million square feet of office space were evacuated.
In the days immediately following September 11, 2001, federal, state and city agencies, including the United States Environmental Protection Agency, were called upon to initiate air monitoring activities to better understand the ongoing impact from this event. These efforts resulted in a report dated October 2002. 1 Some of the relevant findings of that report were:
The monitoring data indicated that air concentrations of World Trade Center hazardous substances from the event did not decrease to background levels that were characteristic of pre-WTC event levels in the New York City metropolitan area until around January or February of 2002.
Particulate matter (PM), metals (lead, chromium and nickel compounds), PCBs, dioxin-like compounds, asbestos, and volatile organic compounds (VOCs) were identified as chemicals of concern for risk assessment purposes based on monitoring data collected during the WTC event. These substances are included because monitoring indicated that they correlated with the disaster site in both time and space, and because they pose a potential concern for health effects.
As the director of litigation in the United States and later consultant for Deutsche Bank AG, an owner/occupier of over one million square feet of office space in the vicinity of the World Trade Center, I was tasked with assisting the bank in assessing the impact of contamination from the event on its building structures in that location.
My participation in this process enabled me to observe not only the bank's but other parties' reactions to the World Trade Center event. As with all tragedies of this magnitude, there were important lessons learned that should and must be shared with others so that we are all better prepared for disaster events (fires, floods, explosions) which can impact high rise office buildings, even if not the result of an event of the scope and magnitude of the World Trade Center event.
1. Can a World Trade Center type event happen to your company? If your company is the owner or tenant of a high rise office building the answer is emphatically yes. Statistically throughout the world we are increasingly living and working in urban and, thus, high rise environments.
Losses from weather related and man made events are increasing.
Terrorists have targeted private enterprises. The chart below demonstrates that losses resulting from terrorist type events are predominantly incurred by non-governmental entities.
All of this serves to demonstrate that it is necessary and appropriate for entities with high rise properties to properly plan for a catastrophic event.
2. Can what happened at the World Trade Center serve as lessons for high rise building owners and tenants?
For years business enterprises and governments have planned for disruptions caused by catastrophic events by having, for example, back-up data centers and communication systems and even offsite emergency office space. However, the World Trade Center event brought into stark focus the fact that high rise building fires, floods, and explosions create significant, potentially hazardous, environmental conditions which need to be properly evaluated as part of the assessment of the cost and feasibility of remediating a damaged building.
The USEPA concluded that the airborne dust from the collapse of the World Trade Center towers blanketed lower Manhattan with a complex mixture of building debris and combustion by-products, including among other things, asbestos, lead, glass fibers and concrete dust. Emissions from fires that burned until declared extinguished on December 19, 2001 produced particulate matter, various metals, polychlorinated biphenyl's (PCB's), volatile organic compounds (VOC's), and polycyclic aromatic hydrocarbons (PAHs), and dioxin. According to the USEPA, there did not exist on September 11, 2001 health-based benchmarks for short-term and acute exposures for pollutants of concern resulting from the World Trade Center towers collapse. Further, health-based benchmarks did not exist for assessing the risk to human health from exposure to the combination of air pollutants emitted during this catastrophe.
High rise building fires, explosions and floods by their nature are infrequent (but as indicated herein are becoming more frequent), of high severity, and cause environmental consequences that are difficult to assess because of the lack of:
guidance from the governmental or the scientific community on human health risks, background contamination levels and remediation standards.
It is of critical importance for business entities and governments to properly prepare for these events as part of normal emergency planning.
The conclusion of a review conducted by experts of a limited number of fires in high rise office buildings over the past thirty years was that the environmental damage to a high rise building from a fire or explosion can exceed the actual physical damage. Among the examples of this phenomenon was a 1981 fire in a New York State office building (44 Hawley Street, Binghamton, New York). While the actual physical damage consisted of a basement fire involving a transformer, the building was contaminated with PCBs. Rather than demolishing the building, which cost about $17 million to construct, a decision was made to clean the building. The cleaning of the building cost approximately $50 million and took almost 13 years to complete. A similar result occurred in a fire on the 19th floor in a file room of the Delaware Trust building in Wilmington, Delaware and a fire on the 19th floor of 1 Meridian Plaza in Philadelphia, Pennsylvania.
With respect to the Deutsche Bank building located at 130 Liberty Street, New York, New York, the building sustained significant physical damage, but the environmental contamination of the building by the World Trade Center event caused experts retained by the bank to conclude that it should be demolished.
Corporate management faced with a decision whether to remediate or demolish a building impacted by a catastrophe has to make difficult and often complex decisions. Among the issues management will have to deal with are:
Can the building be made "safe" from a human health point of view for reoccupancy? How does management determine what is safe in the absence of guidance from government and science?
What are appropriate clearance standards for any cleanup project?
How much will it cost to make the building "safe" and does the company have appropriate insurance coverage to pay for the cleanup?
How long will it take to clean the building?
When cleaned will the value of the building be permanently impaired resulting in a possible adjustment in its value on the company's books?
What are the risks of future liabilities of the building's owner or manager to building occupants, remediation workers who clean the building and the community around the building and for the disposal of waste created by the catastrophe?
These are not questions which management is normally equipped to make because it requires:
an understanding of environmental contamination and its impact on human health;
contamination sample collection and analysis;
a team of architects, engineers, construction managers, remediation experts and others to evaluate if the building can be successfully cleaned for a reasonable price and in a reasonable time-frame;
bright-line standards to assess health risks from environmental contamination in an office building context which do not exist; and.
information on the background (pre-existing) environmental conditions in the building or the local area where the building is located (was the building already contaminated before the event?)
In order for management to take prompt and cost effective action in these situations, it should do the following before any catastrophe:
Develop and document a systematic emergency response program to enable management to assess the environmental and physical condition of the building. This plan should be part of your business interruption plan and should provide for the following:
(a) offsite storage of as-built drawings of the building and all improvements thereto;
(b) offsite storage of an up-to-date inventory of tenant improvements, furniture, equipment and data processing and communication equipment;
(c) collection and storage of current baseline environmental test data regarding the building;
(d) retaining the services on a standby basis of an environmental consulting firm with environmental emergency response capabilities and experience;
(e) reviewing insurance coverages on an annual basis to ensure you have adequate coverage;
(f) activating on a test basis of the environmental response team; and.
(g) assessing the vulnerability of the building to man made and weather related catastrophes.
1 NCEA, Office of Research and Development, U. S. EPA, October 2002.
Frank E. Lawatsch, Jr. is currently Of Counsel to Pitney Hardin LLP and is President and Chief Executive Officer of Expert Alliance, LLC, a firm of consulting scientists. He has served as general counsel to three large publicly owned corporations and as a Managing Director and Senior Counsel for Deutsche Bank AG.
Law Business Media, 104 Old Kings Highway North, Darien, CT 06820.

GIS in the World Trade Center attack—trial by fire.
GIS technology proved its value in emergency operations in response to the World Trade Center attack on 11 September 2001. This unprecedented emergency subjected the use of GIS and spatial data technologies to perhaps their most severe test ever. GIS and related spatial technologies were widely used to support the response, rescue, and recovery efforts and, under the dire conditions of that emergency, they proved to be extremely valuable. This paper will describe the establishment of the Emergency Mapping and Data Center (EMDC) and its operations over several months. It will also provide information on the experiences and lessons learned from that experience. The City Office of Emergency Management recently conducted a post-emergency critique of all aspects of the EMDC and the GIS Utility. The findings of that critique reveal many valuable lessons based both on the successes and problems experienced during the World Trade Center response.
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Mr. Kevany has 40 years of experience in the fields of GIS, urban information systems, and emergency management. Mr. Kevany earned his BS from UCLA in 1962. He served in various capacities in the Los Angeles County Regional Planning Commission for five years. He was employed as a project manager with System Development Corp. for 5 years where he was part of the Public Safety Group that developed the EOC concept and structure, used nationally. He was also a consultant to the US Bureau of Census, Census Use Study, in which the DIME (later evolved to TIGER) concept was created. He spent one-and-a-half years with DATUM ev. in Germany. On return to the USA, Mr. Kevany spent 3 years as an Assistant Professor with the University of Tennessee developing emergency management applications. He returned to SDC for 5 years where he assisted in the development of the 9/11 computer aided dispatch system for the City of Los Angeles, prepared an emergency plan for the State of Pennsylvania, and designed anti-terrorist safeguards for the transport of nuclear materials. For the past 15 years, Mr. Kevany has been a Senior Vice President with PlanGraphics where his most recent assignments include projects in New York City, where he also served in the EOC during the response to the WTC attack, and manager of projects in Charleston, New Castle, and Anne Arundel counties.
Mr. Kevany is a co-author of Geographic Information Systems: A Guide to the Technology and has authored numerous articles in a variety of books and publications. He has also been active in professional associations, including UDMS and URISA.