EXPERIENCE OF 9/11 IN LONG TERM CARE SETTING
Joseph J. Tomaino, MS, RN
For many years as a nurse executive in both acute and long term care, I have been involved in emergency preparedness planning. Earlier in my career, we called it “disaster planning”. Through my volunteer activities with the American Red Cross, I have participated in disaster planning on a county and regional level. All of that experience was put to the test on September 11, 2001.
I had just crossed the bridge into Manhattan that fantastically beautiful fall morning when the first reports of the attack came over the radio. By the time I reached Florence Nightingale Health Center, a 561 bed facility at 97th and 3rd Avenues, the heavy smoke could be seen in the distant gap between the building on Lexington Avenue where I parked my car. Fire engines were screaming from every direction, and I remember making eye contact with some of the firefighters on them and wondering to myself what they were going to be facing.
The other senior management members were attending a conference in Queens, which I was unable to attend as I was scheduled to meet some medical students that morning. It would be some time (late that evening actually) before they would be able to get to the facility. As I entered the nursing office I notified my staff to activate the disaster plan. An assessment of our situation was that communication within the facility by phone and radio was intact, but external calls could not be made. Occasionally, external calls came in, like the one from the husband of one of my staff nurses who called from the 103rd floor to tell her that the smoke was coming in and they were breaking a window for air and to pray for him. (That nurse was later sitting in my office when word came that her husband’s tower had collapsed). Our only way to get messages out of the facility was computer email. We had a few empty beds that could be used to decompress local hospitals if there space was needed for critically injured.
Immediately, I assigned a security officer to the fire pull box down the block with a walkie-talkie. Should we have an emergency in the facility requiring fire or ambulance, we could radio to him and he could pull the alarm and direct the responders to us. I sent staff to our two nearest hospitals with information on bed availability and our willingness to accept patients if they needed to decompress to take mass casualties—at that time we were expecting them.
Next, I assembled the department heads and nurse managers. We checked on fuel supply—there was plenty—as was the case with food and emergency water. The Chaplain and Director of Social Service agreed to help staff who had loved ones involved, and to monitor the residents for reactions. Environmental services prepared sleep space for staff should they need to stay over.
Through monitoring the NYC Department of Emergency Preparedness Web Site, we were aware that vehicular traffic into the city was halted, and that subway service—which most of our staff relied on for transportation—was erratic. We then communicated with the day shift staff that they would be held over until the evening shift made there way in.
As the day progressed into evening, it became apparent that there would not be the need for hospital decompression, and our focus turned to supporting staff and residents, and making plans for getting people to and from work. Schedules were rearranged so that staff who lived in Manhattan could come in earlier, and staff living in outlying areas were rescheduled for later in the week when transportation would hopefully improve.
The key to our success that day was the cooperation and team work of everyone there. I still get chills when I think of my aides who knew they had family members who might have been involved, but who nonetheless remained at their posts and cared for the residents. One aide’s daughter, a model, was scheduled to do a photo shoot for a public service ad with the mayor at just the time the attack occurred.
When I made my final rounds that evening, some of the residents were still awake and huddled around the nursing stations, singing a constant melody of “God Bless America”. The residents had spent much of the day glued to the TVs in the day rooms watching the events evolve. We struggled with whether or not we should limit their viewing, but for the most part for competent residents the decision was theirs—and most wanted to watch. The nursing staff went about their duties as efficiently as possible, but as the building shook from fighter jets overhead during the afternoon, there clearly was a sense that things would not be normal for some time.
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