Cath Lab Digest

Leaders of the Collapse Rescue team and Special Operations and Police Emergency Service Unit personnel were virtually eliminated, leaving an enormous void in tactical experience and leadership. Satellite triage and evacuation sites were established around the World Trade Center in churches and restaurants. A major center was set up at the Chelsea Piers on the Hudson River a few blocks from the towers. Unfortunately, many of these well-equipped triage and treatment centers also were underutilized.

  The focus of the rescue efforts turned to finding victims believed to be trapped within crevices and environmentally friendly habitats within the debris field. Emergency teams from around the United States were dispatched to the site - the largest emergency medical/fire/rescue response ever in the United States. The National Medical Emergency Response System was activated. Medical personnel in every conceivable category called publicized phone numbers to acknowledge their availability. By Wednesday morning, the system had received more than 7,000 volunteers. Dr. Cantor, as a podiatric surgeon with expertise in wound salvage, was placed on a high priority list. His group arrived in New York City on Wednesday at noon, escorted by police as part of a convoy of fire and rescue personnel and equipment and dump trucks and garbage trucks needed for debris removal. They were stopped by police at various checkpoints and all personnel and vehicles were subjected to search.

  As they entered New York City, Dr. Cantor was first struck by the overpowering odor of burnt wiring, materials, and structures. As they headed south toward the site, they saw the ground color change to white, covered in ash, dust, and debris. "It was odd to hear no horns and see no taxis or pedestrians," says Dr. Cantor. "It was even more shocking to see Army soldiers in Humvees patrolling our streets and to see and hear the steady drone of swirling F-16 and F-15 fighter jets overhead."

  The site of Ground Zero was paralyzing and emotionally overwhelming. A virtual mountain range of debris, steel, cement, and carnage encompassed the World Trade Center complex and surrounding streets. The stunned volunteers reported to a command post/triage center where they waited to provide surgical/rescue support. If a victim needing surgical extrication was located, they were prepared with gear and equipment to provide any primary amputation procedure required. Dr. Cantor and his group agonized over this possibility. "We devote our careers to limb salvage, and here we knew the only way to save some lives was to perform battlefield amputations. We did not know what to pray for... we were exhausted, overwhelmed, and cognizant of the fact that our talent and expertise would likely be employed in a manner we never could have imagined."

  The collapse of the remaining six stories of one of the towers aroused momentary fear, as the sight of a dust cloud, billowing smoke in an enormous roar, filled the volunteers with worry abut additional injury to the rescuers. Fortunately, the partial collapse claimed no additional victims. But the volunteers were still faced with the horror of standing among streets and sidewalks littered with human remains. "The site was ghastly," Dr. Cantor says. "The smell was sickening. Our eyes were irritated and our throats were sore from coughing and bringing up mucus. Even for the hardened medical/surgical/rescue personnel, these conditions were taxing."

  The hardest part was the waiting with no call for a surgical team. One false alarm sent Dr. Cantor's rescue team to a leg that was discovered in the ruins. As rescue workers gently tried to extricate it from the debris, they realized that the leg was the only evidence of a human body. An awareness that the death toll would be incomprehensible and the need for medical services would be minimal grew.