'As if it were yesterday': A 9/11 paramedic looks back
For a New York City paramedic who had seen it all, the attacks on 9/11 changed everything
By Greg Santa Maria
There is a time just before you awaken in the morning where your mind is as clear as a pristine new white board. Is represents the doorway between the world of sleep and consciousness.
As you begin to regain awareness, thoughts begin to rush in like waves crashing on a beach. What day is it? Saturday, great, no work can sleep a bit longer. What's up for today? Wife is working, need to cut the lawn, wash the car and clean the pool.
Then you look up to the skyline of your consciousness and there they stand. It's very much like they stood in Manhattan. Always there but sometimes just out of sight, looming just around the next corner of your thoughts. You never, not ever, dare to erase them. You have tried, but when they were drawn there someone used a permanent marker instead of a dry erase.
Now, clear as the day they were added, the twin towers of the world trade center loom in the horizon of your consciousness. If you dare to stare long enough, the day, as eager as a child, comes rushing back with all its vivid memories. It is a perpetual reminder that you inescapably belong to it, no matter how bad you want it to go away.
Show that paragraph to any first responder that was part of the rescue and recovery operation at the World Trade Center and they will more than likely say, "Exactly!"
I find it amazing that it has been so many years since the events unfolded, since almost 3,000 people from over 90 countries were murdered in a terrorist attack on the World Trade Center, the Pentagon and flight 93 that crashed in Shanksville, Pa., after its passengers decided they would not be taken.
The amazing part of the entire timeframe is that every day you wake up, it seems like only yesterday. I have quite a vivid recollection of the events of the day. More importantly, I remember the events that transpired after. For many of us, September 11, 2001, was just the first day of a long and exhausting time frame in which our lives were changed forever.
The day started out on a relatively benign note. I was actually going to work early to teach an ACLS class. My morning routine was to get off the subway at 12th street and 7th Avenue, which is right across the street from St. Vincent's hospital. (St. Vincent's, the closest level-1 trauma center to Ground Zero, was instrumental in the response to the terrorist attacks in Lower Manhattan.) Once off the train, I would stop on the corner and get a coffee and a roll or donut and then proceed to the office.
Well, I did all of that, and then my normal routine faded into the chaos that would become 9/11.
While I was at the coffee truck, I observed several key occurrences. A high rise fire truck went racing by, heading south, the hospital safety officer running east toward me, then past me into the facility, and then a crowd of people gathering on the southwest corner of 7th Avenue and 12th Street looking downtown. I gave in to curiosity and walked to the middle of 7th Avenue and took a look.
So many things went through my mind when I focused in on the canvas, but the predominant thought, "Holy Shit" is what I remember to this day. In a tried and true tradition that I have with my wife, I immediately called home and said, "Turn on the TV, I will be home whenever" and that was the last time we spoke for about 12 hours. The time was 8:55. It was approximately 7 minutes after American Airlines flight 11 made impact with the North Tower.
In the time it took me to get out of the subway, get coffee and walk into the middle of the street, life had changed forever.
When I got into the EMS office at St. Vincent's, which at the time was a set of offices inside the ambulance entrance of the emergency department, things were obviously buzzing with activity. Time raced, and then slowed down, there were some quick strategy conversations, but there was really no talk of terrorist attacks. Just then, one of our environmental services employees came in the office and said to me "Greg, another plane hit the second tower, they are both on fire now." Of course I didn't believe him; how could that have happened? So I went back out into the street and looked for myself.
9/11: This is when the fear hits
Working in the NYC EMS system as a paramedic it is inevitable that, after a few short years, you will have seen and done just about everything. Plane crashes, buses and taxis jumping curbs, people under trains, crawling into an overturn to disentangle an accident victim. One of the biggest realizations that I experienced on 9/11 was that I was never afraid to respond to any of those previously mentioned events. We were in control, always. But this was different. On 9/11, someone else was holding the cards and we were back on our heels trying to initiate a plan, something that might work and, by sheer luck alone, something that would not get anyone else killed.
Being part of the leadership staff, I couldn't respond down just yet (delay one), so we began to build a process to receive patients. Initially, we considered that there could be up to 15,000 patients. This calculation was based on the simple math that the trade center complex supported about 50,000 people, and the towers from impact points up could have easily housed a third of that group, so thanks to street math, that was the number.
We set up two receiving areas at the hospital, separated into ambulatory and non-ambulatory. It was an all-hands-on-deck event and we started bringing down all available beds, wheelchairs and office chairs to the front of the building. We then set up an EMS restock area so units could drop patients and get back down to the site.
Initial patient flows came by private means: in fact, the first arrivals came in a Lincoln Navigator that came the wrong way up 7th Avenue. Five or six people exited and they were pretty badly burned but extremely calm. Turns out they were in the basement waiting for an elevator when a plane struck, the fireball came down the shaft and flared out at them through the door. Seeing that, hearing that, made us rethink how many patients we were going to see.
Patient arrivals, including EMS unit arrivals, began to increase but were not unmanageable at the time. Then of course the unthinkable happens. The South tower collapses. Consider that for just a minute. One of the world's tallest buildings falls down on top of everyone. To this day it is so surreal that I can only believe it when I go to Manhattan and look at the skyline.
The collapse of the south tower changed everything. Although we knew that first responders were killed or injured after the second plane hit, it was certain that the collapse would have claimed thousands more victims, and among them would be hundreds of first responders. As if an attack on New York City was not enough, the crisis now became very, very personal to every first responder involved.
We also knew that the clock was ticking on the North Tower.
More patients arrive and I finally am boarding an ambulance to get downtown to get in the game. You have to realize that I didn't consider myself in the game yet, although we were receiving numerous patients and running our tails off right where we were, my place is in the street, at the call. Once again I get "reassigned" (delay 2) to set up the decon unit so that we can decontaminate arrivals from the collapse, in case there was any HAZMATS identified.
The North tower collapses as we set up the decon area.
Frustrations set in after 9/11
After several delays and two building collapses, I get my chance to respond.
Getting down to ground zero post-collapse was disorienting at best. Humans rely on familiar surroundings and landmarks to pinpoint locations, at least I do, but there was very little to see. The air was thick with floating debris, paper, burning things and an unending amount to the gray dust that seems to be the culprit in the continued deaths of rescue and recovery workers to this day.
Being a Roman Catholic Italian, I have a great deal of respect for the dead, so I don't tell gory war stories, but I will share with you some things that touched me once I was there. The first thing I saw was a framed picture, it was in perfect condition and clearly from somebody's desk. It was a family shot, mom, dad and two kids. My thoughts went to wondering who belonged to the picture; did these kids lose mom or dad? I saw a business card for a man who worked on the 101st floor, is he not far from his card buried under the rubble? Is he home? To this day, I do not know.
There was a good deal of movement heading out of the collapse zone and that was good, the faster people got out the better things would get. There was a lot of smoke and fire. The smell was like burning wires; you could smell that fire for months coming uptown when the wind was right.
Upon our return to the Medical Center, frustration was high. Out of 15,000 estimated patients, fewer than 700 came through the doors of St. Vincent's hospital. Other hospitals saw patients too, and we know that close to 3,000 people did not get a chance to make it out. These victims all have names, business cards and family pictures, and are dearly missed. Sometimes it's easier to not remember that, but the easy path is not always the righteous one.
First responder determination
In the days and weeks to follow, first responder agencies counted and mourned their losses. The world had reached out a helping hand to New York City and there were first responders from everywhere among us. It showed me, in clear detail, that our EMS families are borderless and that we truly do go anywhere. Closer to home, our St. Vincent's family endured a lot and were blessed at the same time. Out of all the EMS personnel that we sent down, all eventually went home to their families. We eventually became a sort of epicenter of healthcare preparedness and I realized, finally, that I was in the game all along.
EMS people are key players in so many arenas, but our most important arena is bringing the field and the hospital together as a single unit. And that's exactly what we did under extreme circumstances.
9/11 Survivor guilt
At first, I was quite angry that I did not get down to the site early on. It bothered me for months, and I'm not sure if it was survivor guilt or bruised ego. As of this writing ten years later, I am grateful for the little things that happened to keep me away long enough to remain safe.
In October of 2001, while standing at the edge of where the towers once stood, I had a conversation with the chaplain of the Oklahoma City Fire Department. His words paved a path that I follow to this day. He told me that people survive these things for a reason, and that I shouldn't overlook these "delays" as a sort of divine intervention. He said "You need to tell people what happened here, what people sacrificed, this is your calling now. You need to tell them so this never happens again."
So sometimes, as painful as it can be, I follow my calling on a daily basis.
Unfortunately, over 400 emergency workers gave their lives that day and many hundreds more have died in the aftermath. Recovery workers who have been exposed to the toxins at ground zero are falling ill at alarming rates and their cries for help are falling on sometimes deaf ears.
I would task each and every one of you to take some time out of your day and get involved in bringing their cause to light. There are a lot of response and recovery workers just like you and I out there who are in need of medical care and they need your voice in Washington to ensure that they, like our brothers and sisters who fell on September 11, 2001, are not forgotten. There is much to be done, and this call is not over just yet.
About the author
Greg Santa Maria is the Emergency Manager for Sanford Health in Sioux Falls, SD. He is a Nationally Registered Paramedic and EMS Instructor Coordinator. Mr. Santa Maria also holds certification as a SD Emergency Manager and is a Certified Healthcare Emergency Professional. He is one of six recent graduates of cohort one of an international fellowship in emergency management.
A New York City native, Mr. Santa Maria served as the Director of Prehospital Care and Education at St. Vincent's Hospital in Greenwich Village. In addition, he served as the facility emergency preparedness coordinator and decontamination team leader. As EMS Supervisor, Mr. Santa Maria received a distinguished service award for his participation in the response to the terrorist attacks on the World Trade Center, September 11, 2001.
He has authored several EMS related review books, participated in numerous television, print and radio broadcasts and has spoken nationally on issues of preparedness and disaster response.
This article was originally posted Sept. 8, 2011. It has been updated