Gold & Silver Forum - An MD's report from 9-11...

Excerpts:

Get to the site as soon as possible�In this case, many of the rescue leadership (Fireman chiefs, higher level cops) were either taken out immediately or busy (physicians, nurses, techs) at local overwhelmed hospitals. Think about it, if the Pentagon and White House had been taken out as planned, all central leadership would have been out. Recovery and/or retaliation requires organization to be effective. When I got there, there was mass chaos and a systematic medical infrastructure complete with an understanding of triage as well as a communication system of runners had to be made.
Take a large backpack so that supplies can be shuttled to the front zone.
Take water and a filtration system.
Take food, canned, MRE, bars, etc.
Wear boots and durable paramedical type pants with multiple pockets, not scrubs which provide no warmth and are for all intents and purposes useless.
A helmet, gas mask with filters, goggles, are a must. Asbestos levels are considered high at 1.25. They were measured at 5.2 at Ground Zero 48 hours after the fact and at 1.75 at the Stuyvesant High School "hospital" 72 hours after the fact. Without goggles, the dust was blinding. Eye washing consumed 75% of our effort. I had my eyes washed out 6 times and I never took my goggles off.
Fractures are common with ankle fractures being the most common. Take plaster with you to a MASH unit.
Nylon suture is needed for small lacerations to get these men back on the field working.

Silvadene is a must as is betadine.
We used literally cases of B&L saline contact eye solution to wash out glass, fiberglass, and dust from eyes.
Most injuries are extremity related, so roll type dressings (Kerlex) actually work much better that 4x4 with tape for example as these dressings fall off with sweat.
Headlamps�remember there is no power and it is impossible to sew in the dark much less get anywhere in the dark without a light. Extra batteries.
Raingear, raingear, raingear...even if it doesn't rain, the firehoses drench everything.
Extra socks. In fact, all extra clothes packed in large ziplock bags to keep dry.
Anything can be made with duct tape, knife, pliers, clothes hanger wire.
A large black marker for making signs.
This is the most important lesson I learned: Once a true field hospital system has been established, pick one leader to organize and establish a chain of command who is not involved in patient care and have that person stand in the middle so they are easily seen and obtainable. We had no form of communication other than runners and therefore we needed to know where this person was at all times. Logically, this person should be either trained or experienced in mass casualty or ER trained as this is essentially an ER that is being created. Pick subleaders in each field and have them design their subunits as they see fit. There is no point in having a surgeon tell a pulmonologist how to triage inhalation injuries or visa versa.
In mass casualty, one person who is not to be involved in any patient care, and therefore can stay relatively objective, is to be assigned the primary triage role. This triage "captain" should stand outside near the entrance so that the triage decision is made right away and is not made in the havoc of a busy hospital. The initial triage decision should obviously be major vs minor casualty but someone who is objective needs to make this decision and this person then, thru a system of escorts, directs patients into the hospital to each respective subunit.
Further, when actually providing patient care in mass casualty, focus on the one patient that you have in front of you at that time, not the other 50 around you. Move that one patient thru as quickly as possible and then focus on the next.
Once patients are treated, move them out of the hospital ASAP or, in our case, upstairs to a rest area�just get them out of the way so new patients can be seen efficiently.
Security was an issue at our field hospital as there were three bomb threats. Hospitals are likely and effective delayed second targets from a terrorist standpoint. Design a security detail to block all ports of entry except one entrance exit.

Hold meetings with your entire staff every 8 hours minimum and with your leadership staff every 4 hours to address any rising concerns, issues, and to fix problems early before they magnify.
Establish an organized pharmacy/supply area in the back with a checklist of incoming and outgoing inventory. In our case we had Guardian Angels serving as runners to the back staging areas 6 blocks back who would then bring needed supplies forward.
Establish either a communication or runner system to the ambulance line when a transport bus is needed. In our case we designated one "systems" man who was in direct contact with the physician team leaders. When a physician deemed that an ambulance was needed, the systems man called a runner to run back 2 blocks to the ambulance line. The runner then contacted a "transport" man who then directed a crew of EMTs to carry a stretcher forward and retrieve the victim.
A Psychiatry unit is necessary and should be placed in a quiet location away from the rest of the hospital. Many people have either underlying psychiatric issues or primary issues that are brought out in these disaster situations.
The non-medical units (food area, rest area, massage, change of clothes) are needed but need to be placed away from the hospital area to avoid large crowds.
Finally, not only the fireman needed rest. So did we as exemplified by my staggering around Penn station in a wasted state. We should have established a better shift system for sustained endurance. Maybe we did and I should have just taken a break but, like the fireman, this is difficult to do and makes much more sense now than it did then. 48 hours on call in a clean hospital is grueling but it is entirely different than 48 on call (after an entire normal workday) in a mass casualty unit.

http://www.equipped.org/groundzero.htm