As a deputy medical director with the Fire Department of the City of New York, my duties include responding to disasters. Sept. 11, 2001 will forever be remembered as one of the darkest days for our department, our city, and our nation. When it comes to disaster medicine and multi-casualty situations, we in New York City are proud that we do it often and well. Through education, training, drills, and real-life situations, we handle disasters on a daily basis. Sept. 11, however, was an entirely different situation. The magnitude of this particular disaster was one not previously seen by any system. We are not used to being under live-fire situations. ‘Some were on fire, and others fell motionless like rag dolls, but the 20 or so that I saw were flailing their limbs all the way down.’ The first aircraft struck Tower 1 right around the time of shift change. As the oncoming on-call medical director for the system, I was heading into midtown Manhattan for a meeting, and while stuck in traffic in the marked Fire Department vehicle, I actually saw what looked like the top floors of the North Tower on fire. The way that I was positioned, though, made the four smokestacks on the Brooklyn side of the East River look as if the smoke were coming from the industrial plant. I thought to myself that the smoke from the smokestacks really made the World Trade Center Tower look as if it were on fire, until the driver in the vehicle next to mine rolled down his window, honked, and flashed his lights to get my attention. This was not unusual because I am often asked directions and for the location of firehouses. On this occasion, the driver was alerting me that an aircraft had struck the tower. As soon as the driver informed me of this, the city EMS radio urgently crackled from the first unit on scene, “Confirmed aircraft into the North Tower! Send me everything you've got! This is a hard hat operation!” Smoke and Debris Hearing this, I attempted to notify the dispatcher repeatedly that I was responding to the scene but could not get through because of the sheer volume of radio traffic. Finally, I showed myself responding via the computer system. As I responded lights and siren through the midtown tunnel and south Manhattan toward the scene and neared the Brooklyn Bridge, I could see thousands of panicked people running away from the buildings with thick black smoke and debris everywhere. I had never seen anything like this before. I have never been in a war zone, but I imagine it must be similar to what I saw that morning. Finally arriving at the command post set up in front of the World Trade Center on West Street, I met up with Dr. Allen Cherson, the previous night's on-call medical director and Dr. Michael Guttenberg, our EMS fellow, to get an updated report of medical issues. At the same time, I looked up toward the towers, and saw to my horror, victims jumping from approximately 100 floors up. I could not believe that these were actually people. I was sure that this had to be debris from the building until I saw one person attempt to crawl from one window to the next and not make it. I was hoping that these victims were already unconscious. Some were on fire, and others fell motionless like rag dolls, but unfortunately the 20 or so that I saw were flailing their limbs all the way down. Hopelessness and Despair I have never felt more helpless in my life than at that moment. All of the medical training, all of the confined space rescue training, all of the terrorism preparedness training that I had gone through was absolutely worthless at that moment. I can only imagine the hopelessness and despair that these victims must have been going through to make the decision to jump to their deaths. It is something that I hope no one will ever have to go through again. As I came out of my brief daze and regrouped, I realized that we had a difficult task at hand. The other medical director and I decided to split up to set up triage and treatment areas on opposite ends of the World Trade Center complex to attempt to take care of victims lucky enough to escape the buildings. I proceeded north as my partner went south. As I approached the No. 7 World Trade Center building, I realized how close the initial triage and treatment area was set up by our EMS personnel, and made the decision to evacuate these patients being treated to an area further north. While we were attempting to make the transfer, the South Tower began to lean and then collapsed with what sounded like jet engines coming toward us. By sheer instinct and with no planning whatsoever, I grabbed my patients and dove for cover into an alcove between the lobby of No. 7 and the loading dock. I pulled my helmet visor down, grabbed the chinstrap, and squatted down against the wall, thinking that this was it for me. I truly thought this was where my life would end. Luckily, the direction in which I dove for cover turned out to be the correct direction. Only 50 feet stood between whether I would be lucky enough to go home and see my wife and kids again or be one of the unfortunate thousands still missing. After the large thunderous crash and pitch black darkness, those of us in the alcove realized that we were still alive. At that point, the thick smoke and soot made it extremely difficult for anyone to breathe as we tried to determine how to evacuate the building. Luckily again, we made our way through the darkness west and north of our location. At the first ambulance about a block away, we loaded our patients and told the crew to “just go north.” Heroic Efforts At that point, after accounting for all of our EMS personnel, I headed back toward the World Trade Center complex, fearing that the other physician as well as most of our personnel initially at the command post were lost. As I cautiously headed back toward the remaining tower on West Street, I saw in a dream-like sequence the North Tower start to collapse. Once again, I headed North and ran as fast as I could only to be covered by warm smoke and soot. As we attempted to regroup again with our EMS personnel and set up triage and treatment areas, we were advised by the police department to evacuate our location because of suspicious packages nearby and gas leaks from the buildings. Finally, a decision was made to set up a temporary morgue and field hospital at the Chelsea Piers sports facility, a mile and a half from ground zero. Throughout the first few hours, many health care professionals arrived on the scene to assist patients. Unfortunately, they failed to realize the magnitude of this disaster — there was no one to save. If you were lucky enough to be out of the buildings when they collapsed, you survived; if you weren't, you were lost. Among the 5,000 or so lost in New York City, many first responders also unfortunately perished: the Fire Department lost 343 firefighters and two paramedics; the New York City Police Department lost 23 officers; the Port Authority Police Department lost 34 officers; and other EMS agencies lost six personnel. This loss is a devastating reminder of the heroic efforts of front-line responders in saving the lives of complete strangers. They say that time heals all wounds. This wound would seem to require an eternity, but the only true way of honoring all of those lost is to live life to the fullest, remembering all of the victims of this devastating attack.
Introduction: The 2010 American Heart Association Guidelines stated that “cardiopulmonary resuscitation prompt and feedback devices may be useful for training rescuers and may be useful as part of an overall strategy to improve the quality of CPR for actual cardiac arrests.” We sought to assess the effect of one such device on OOHCA outcomes in a large, urban setting. Methodology: Out-of-hospital cardiac arrest data from two consecutive twelve-month periods was analyzed: August 1, 2010 - July 31, 2011 (control) and August 1, 2011 - July 31, 2012 (CPR feedback). During the CPR feedback period, defibrillators capable of providing real-time audible and visual CPR feedback were added to standard prehospital resuscitation care. Results: There were 850 and 748 bystander witnessed arrests of cardiac etiology in the two periods. Patient and arrest characteristics for the two groups did not differ with respect to age, gender, race, response time, bystander witnessed status, or the frequency of bystander CPR. As compared to the control period, the addition of real-time CPR feedback resulted in a significant improvement in immediate outcomes: return of spontaneous circulation, or ROSC (39.59% vs. 47.71%, p=0.001); sustained ROSC (31.17% vs. 36.14%, p= 0.037). However, there was no improvement in survival to hospital admission (24.88% vs. 25.32%, p=0.85) or survival to hospital discharge (5.63% vs. 6.72%, p=0.43). In addition, among those survivors for whom neurologic status is known, the addition of CPR feedback did not significantly change the proportion of survivors considered neurologically intact (70.37% vs 65.63%, all p=0.78). Conclusions: The addition of real-time CPR feedback to a large urban EMS system’s resuscitation care resulted in significant improvements in immediate survival but did not affect overall survival rates. It is also possible earlier introduction of these devices (through their use by first responder and/or earlier arriving basic life support units) may provide greater benefit. Further data analysis is required to determine the specific effect of CPR feedback devices on long-term survival and to optimize their use in resuscitation care.
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Though variable, many major metropolitan cities reported profound and unprecedented increases in out-of-hospital cardiac arrest (OHCA) in early 2020. This study examined the relative magnitude of those increases and their relationship to COVID-19 prevalence.
