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Where were you on the morning of September 11, 2001? It’s a question people will ask each other over the years to come. Everyone remembers exactly where they were on days when history is made. The morning of September 11, John Chovanes, DO, of Narberth, PA, was packing his car, getting ready to go on vacation, when a friend called to tell him a jetliner had crashed into the World Trade Center. Chovanes is a second-year resident in emergency medicine at UMDNJ-School of Osteopathic Medicine (SOM). He’s also a former paramedic. "Something told me to throw my rescue gear into the trunk, too," he recalls. On the road, he almost turned off at Allentown, PA, where one of his brothers lives. But on the car radio, he heard New York Mayor Rudy Giuliani appeal for medical personnel to come immediately to the site and help. Chovanes didn’t hesitate. "I wasn’t about to sit and watch CNN when there’s a disaster happening," says the physician. He headed straight for New York City. Nancy Hamstra, Director of Emergency Medical Services (EMS) at UMDNJ-University Hospital (UH) in Newark, was on the New Jersey Turnpike, headed for a meeting in Trenton. Her radio was turned off and she was listening to a book on tape when her cell phone rang. It was a co-worker calling to tell her about the disaster. Turning her car around, she sped back to Newark, lights flashing and sirens blaring. Whatever the cause of the crash, she knew she had an enormous job ahead of her.
"When we established the mutual aid plan, nobody ever thought New Jersey would be responding to a disaster in New York, a big city with so many hospitals," says Hamstra. "We always thought it would be the other way around – that someday they’d have to come to help us in the event of an airport disaster or other mass casualty situation." Parts of UMDNJ’s Newark campus overlook panoramic views of New York City, usually a beautiful sight. Today the scene was grim. Hamstra and other EMT staffers watched in shock and disbelief as the first tower burned, and then collapsed. Allen Maniker, MD, an assistant professor of neurosurgery at UMDNJ-New Jersey Medical School, could also see the fire and smoke from his office window. He is on the seventh floor of the Doctors Office Center with a view of the New York skyline. Maniker’s group operates at UH and Jersey City Medical Center, across the river from the Wall Street area. In mid-morning, Maniker left Newark to attend a clinic in Jersey City, but traffic forced him to turn back. By now, UH was being readied to receive casualties, as was Jersey City Medical Center. Both hospitals were designated triage centers. "We were concerned that there would not be anyone at Jersey City to treat the expected neurological injuries," he said. So Maniker headed back to Jersey City, this time in a police car. He brought with him a senior resident, Raj Raab, MD, so there would be two neurosurgeons available to operate independently if necessary. At this point, massive numbers of casualties were expected. Every hospital in the area was on full alert.
In a disaster, the "all hands on deck" mentality doesn’t work. Emergency resources need to be organized and deployed efficiently, or chaos can result. "Everyone wants to help. They rush to the site to see what they can do," explains Hamstra. "Though they mean well, they can complicate things and prevent the people who are really trained to help from getting in." The job of organizing the state’s EMS efforts was coordinated by Hamstra and her staff. Within 15 minutes of the disaster, New Jersey’s EMS response was underway. Communication and chains of command were established by sending EMS managers to ground zero, NYPD headquarters at 1 Police Plaza in New York, the Holland Tunnel, Jersey City and other key areas of the New Jersey waterfront, and additional locations. Hamstra stayed in Newark at the Emergency Operations Center, along with police, fire, FBI, and other agencies. Ambulances and numerous other rescue vehicles from communities across New Jersey were dispatched to ground zero to provide assistance and transport any injured victims to hospitals. In addition, the state’s two medevac helicopters, NorthSTAR and SouthSTAR, were sent to Teterboro Airport, along with two other helicopters that were similarly equipped to transport the most seriously injured to trauma centers. There they would wait in vain, since the government quickly closed the sky to air traffic. Rescue efforts were not restricted to ground zero. Thousands of people had evacuated lower Manhattan by ferry, arriving in Jersey City, Hoboken, Weehawken, and Liberty State Park. Some were injured, while others were covered in dust and ash. On the New Jersey waterfront, approximately 20,000 people were seen, triaged, transported to hospitals, and/or decontaminated by UH-EMS and other emergency medical personnel. Decontamination involves spraying people with water from hoses to wash off debris. The majority of these people were the "walking wounded," those who had escaped with injuries that were not life-threatening.
Not only was the New Jersey response quick and efficient, it was also sustained. Many communities rely on volunteer EMTs, firefighters, and other emergency support staff to handle local emergency calls. These volunteers hold jobs; some are students; others are mothers and fathers; all have busy lives. "In some emergency situations, you have a huge response from volunteers the first day, but then it tapers off," explains Hamstra. "Not in this case. People kept coming back, day after day." The New Jersey team stayed on-site at ground zero until September 22, when New York’s city and state resources took over. By now, days had gone by with no survivors pulled from the wreckage, and "rescue" was starting to become "recovery." Many workers left the site with mixed feelings. They’d trained for a disaster for years, staging "table-top" drills at their desks and "real-life" exercises at Newark Airport, using Boy Scouts to simulate the injured. They were prepared to handle a massive number of survivors. "Unfortunately, despite the readiness of all the assembled groups, the patients never came," says Maniker. THE LUCKY SURVIVORS Here and there, amid the horror and destruction, are a few bright spots: the stories of a small number of survivors and the heroes who saved them. One of those heroes was John Chovanes. He arrived at the Holland Tunnel late that morning, so unfamiliar with the area that he’d had to buy a New York road map at a New Jersey rest stop. After identifying himself to police as a physician, he was waved through the tunnel and directed to an aid station near ground zero. Full-scale rescue efforts were underway, and the scene was chaos. Massive piles of rubble and twisted metal were everywhere, and the air was filled with smoke and fire. Chovanes was not out of place at a disaster site. As a teenager, he’d lied about his age, claiming to be 16 when he was only 13 so he could join a volunteer ambulance company. He’d been an emergency room nurse and then head of a helicopter medical evacuation crew in northern Pennsylvania before going to medical school. At first, there wasn’t much for him to do. True to his paramedic roots, he listened in on the conversations coming over the emergency workers’ radios. At 7:00 p.m., he heard that two Port Authority officers had been found alive, buried in the rubble. One had been freed, but the other would have to be dug out. Chovanes was asked if he could help. As he began assembling medical supplies, he realized he did not have enough morphine to treat a trauma patient. "I saw a line of guys marching into the rubble like ants," Chovanes says. "So I got in line with them, and we went into a huge crater." A police officer pointed to the mouth of a tunnel where the officer was trapped. Looking at the piles of broken concrete underfoot, he suddenly spotted three boxes of morphine. "To find the one thing I desperately needed was incredible," he says. "It was a good omen." Inside the tunnel, there was barely enough room to move. He and rescue workers crawled along a fallen girder to reach the officer, who was pinned face-down and buried up to his arms. All night long, Chovanes and a NYPD paramedic crawled in and out of the hole, administering intravenous fluids, anti-nausea and pain medication, and oxygen to the trapped officer, who had severe crushing injuries to both legs. At one point, there seemed a very real chance that he would have to amputate the officer’s lower legs to get him out of the wreckage. "He said he had four kids, and begged me not to," said Chovanes, who had even obtained a battery-powered saw, but hoped he wouldn’t have to use it. At 7 a.m., nearly 12 hours later, the rescue efforts began to yield results. A cheer went up when diggers called for "spoons," the smallest shovels used for rescues. A half hour later, the seriously wounded officer was pulled from the wreckage and transported to New York’s Bellevue Hospital. (Ed. Note: As Healthstate went to press, Chovanes learned the officer was still in intensive care, but improving.)
Shea was admitted to the hospital, but it was not until Wednesday that he was found to have a serious neck injury: a fracture of the fifth cervical vertebral body. He was immediately transported to University Hospital by NorthSTAR, the medevac helicopter. Shea’s fracture went completely through the vertebra, so he would need surgery. On Thursday, Maniker repaired the fracture with bone grafting and application of a titanium plate. The plate is attached to the bone with screws, and holds the pieces of the vertebra together while the bone fuses. Shea, who comes from a family of firefighters, has made an excellent recovery. "Despite his serious injuries, he will be fine, with all his spinal functions intact," says Maniker. "But somehow he had been put on a missing persons list. On Friday morning, six New York City firefighters who thought Kevin had not survived showed up at our intensive care unit and when they saw he was okay, they all burst into tears. We all cried together, this time tears of joy." LESSONS LEARNED In October, the Mutual Aid Task Force met to assess how their plan had worked. Overall, everyone agreed the response had been efficient and well-organized. "Had there been a large volume of patients, we would have been able to treat them," says Hamstra. "All the parts were in place: The trauma centers were prepared, the equipment was there and the EMTs were ready."
"With the help of many New Jersey communities, we were able to send a lot of resources over the bridges and through the tunnels," says Hamstra. "We learned some important things from this operation: primarily, that our mutual aid agreement works and our systems are in place for organizing a major EMS response. If there had been a lot of patients, we would have been able to help them get the medical treatment they needed."
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In
1993, following the bombing of the World Trade Center, a mutual aid disaster
plan was enacted by New York and New Jersey. "In essence, it is an
agreement that we will help each other in the event of a disaster,"
says Hamstra. The plan established a Mutual Aid Task Force comprised of
all emergency support services in New Jersey, New York City, and Nassau,
Suffolk and Westchester counties in the state of New York. UMDNJ is in
charge of implementing the plan in New Jersey, and her department is responsible
for coordinating the emergency medical services response across the entire
state. 
NEW
JERSEY’S EMS RESPONSE
Another
remarkable story of survival is that of Kevin Shea, a 34 year old New
York City firefighter. He was transported to Jersey City Medical Center
with numerous injuries, including some slight bleeding on the brain. Shea
had just entered one of the towers when it collapsed. Fortunately, he
was near enough to the edge of destruction to be rescued. He doesn’t
recall much about what happened to him. He says his last recollection
of that day is running out of one of the towers as it was collapsing.
"The next thing I knew, people were looking over me in the hospital,"
he says. He was one of three patients Maniker treated at Jersey City,
and the most seriously injured. 
A
few aspects of the mutual aid disaster plan will need updating. The original
plan called for survivors to be transported by vehicles over tunnels and
bridges, not by water. In 1993, there were only two ferries making the
run from New York to New Jersey, so ferries weren’t considered viable
transportation. However, in 2001, there are 14 ferries, including a few
that are capable of traveling at high speeds. A few patients were transported
by ferries to hospitals that weren’t expecting them. Another minor
problem involved radio communication. Not all the ambulances that responded
used the same radio frequency. So a few were unable to communicate with
dispatchers. Hamstra says the disaster plan will be fine-tuned to avoid
these problems in the future.