Sanjey Gupta, MD, is Vice-Chairman of Emergency Medicine at Long Island Jewish Medical Center/Northwell Health in New Hyde Park, NY. He is an assistant professor at Hofstra North Shore-LIJ School of Medicine.
On 9/11/01 Manuel Delgado was a paramedic caring for patients at the base of the south tower. Delgado shares his first hand account of the attack on the building, patient care, survival, and the implications of events of the day on paramedic practice in New York City.
“We waited in the 2nd triage area, and no patients came. We waited for three or four hours and then we moved on,” states Manuel Delgado as he recounts his experience on Sept. 11, 2001, after the collapse of the World Trade Center Towers.
Manuel Delgado is the administrative director of the emergency department at Long Island Jewish Medical Center in New Hyde Park, NY, but that day he was a paramedic with FDNY and responsible for certification and credentialing with the office of medical affairs. On the morning of 9/11 he was treating patients in the forward triage area near the base of the south tower of the World Trade Center when the building collapsed.
In interviewing Delgado about his memories of the events of that day, he speaks a harrowing and detailed recount as if the terrorist attacks had occurred yesterday. He reflects on that day and the implications for paramedic practice.
“I was working in the office at medical affairs and I got a call from a friend in the New York State Department of Health EMS wondering what was going at the World Trade Center (WTC),” he says, “I looked at the CAD (computer aided dispatch) system and the board was lighting up. The first report was a 1040, plane into a building. We heard that it was a small plane that hit the north tower of the WTC. Later, we heard that it was maybe a cargo plane.”
At that point, Delgado grabbed his gear, including his antidote kit for weapons of mass destruction. He jumped into an official FDNY car and drove over the Brooklyn Bridge into lower Manhattan with Dr. Alan Cherson and Dr. Michael Guttenberg, two physicians working in the office of medical affairs.
“We saw a huge a hole and smoke billowing from the building.” At the point, Delgado knew that it was no cargo plane that hit the WTC.
The team from medical affairs went directly to the command post that was set up in the lobby of 1 WTC. They were instructed to go toward the east side of the WTC plaza at Broadway and Vesey Street as most of the injured and evacuees seemed to be moving toward that location. Delgado described the scene as “chaotic,” which was made even worse by the intense and overpowering smell of airplane fuel. The team moved slowly toward Broadway via Vesey Street by car. Near the forward triage area at the corner of Church and Vesey street, Delgado heard “a tremendous” explosion and it was then that the second airliner hit the south tower of the WTC. Delgado abandoned the car and took shelter under scaffolding. He knew at that point that this event was a terrorist attack. He did not know that it was a second plane that hit until hours later.
Delgado remembers seeing a plane engine on Vesey Street. He reports that he had been in that same area just 2 minutes prior to the crash. He remembers seeing debris fall onto a police car, crushing it, which seemed surreal at the time. He recounts seeing shoes and clothing all over Vesey Street, seemingly the personal effects of the airline victims of the attack. He also describes seeing a burned skull and other body parts on the street.
Delgado encountered wounded at this point. He recalls encountering a police officer with a serious head injury and avulsion of the scalp on Vesey Street. Delgado and his team placed the officer in their FDNY car and drove the officer to Beekman Downtown Hospital. The team could not park back on Vesey Street due to the egress of people and street closures. They parked and proceeded to the command center at West and Vesey streets. Delgado reports that they could not walk directly from WTC 1 to WTC 2 due to falling debris, glass, and from people jumping from the north tower. He described the sound of people hitting the ground as “horrific.” Delgado went to the forward triage area near the south tower by the Millennium hotel near Fulton and Church Street. This was estimated to be about 150 yards from the south tower. The report from the command center was that that location was “getting hammered with patients.”
At this forward triage area, any patients with minor injuries, i.e. the walking wounded, were instructed to keep walking. A few ambulances were staging to evacuate the more seriously injured patients. Delgado recalls caring for patients with severe burns and other trauma related injuries. They had more patients than ambulances and were piling 4-5 patients in each ambulance to get the patients to the hospital as fast as possible. In interacting with patients at this time, Delgado understood that evacuation from the buildings was slow. He felt that anyone that anyone on the floors above the fire were likely dead.
At 9:59 am, Delgado heard a rumbling and saw the south tower listing. Time jelled. He said that, “everyone scattered and ran,” and that there was no coordinated egress. He thought that the building was going to tumble. He believes that he ran toward Fulton street while hearing a “boom, boom, boom” as the tower collapsed behind him. At the corner of Fulton and Church Street, Delgado felt a strong pressure at his back and thought that he had been pushed or punched. He fell, losing his glasses and helmet, and tearing ligaments in his ankle which he did not realize until hours later. At this point, the world turned pitch black.
Delgado thought he may have been dead as he could not hear or see anything. After a few minutes, Delgado heard the beeps of the “PASS” system which awaken and vocalize if a firefighter were stationary for over 30 seconds. And he heard many voices stating, “I can’t see.” Delgado was immersed in a thick cloud of hot dust and smoke and stated that it was like having ”cotton balls in your mouth” when one attempted to breath. Delgado sheltered in place in a building for several minutes. When he came back out, he recounts 3-4 inches of ash all over the streets and sidewalks, something that he describes out of a moonscape. As he was walking, Delgado heard the rumble of the north tower collapsing and took shelter in a store with several other people.
Delgado found his way to the ferry terminal and helped to set up a new triage and treatment area. And then he waited. The expectation was that many casualties were going to be taken care of, but the number of casualties were fewer and lower acuity than expected. As Delgado describes it, “no patients came.” As resources and personnel rolled into the site, Delgado left at about 4pm. It is after this time that he discovered his injured ankle. Even worse, this is where he started hearing of the 20 friends and colleagues of his that had passed.
Though not felt at the time, there were operational lessons to be learned from that day.
“Communication needed to be better. The biggest failure was communication. Cell phones didn’t work and there were too many dead spots with our radios. We didn’t know where the resources were,” he says. Of benefit, Delgado noted an increase in paramedic education in disaster management and a better understanding of best practices in dealing with an MCI (mass casualty incident) of that extent. Delgado reveals that he was also a paramedic at the first WTC attack in 1993 and that his forward triage area was actually located in the building itself. He states that models of care and scene safety standards have increased significantly since that time.
He says the biggest changes for the profession that came that day was improved interagency operability and an integrated incident command system. This helped put all New York City agencies, e.g., police, fire, EMS, on the same page with a unified communication and command structure at the scene of any major MCI.
But what sticks with him most from that day is likely shared among many of his colleagues who made it through that day: “Survivor’s guilt.” Delgado recounts losing 20 friends that morning. He attended 20 closed-casket funerals, as only human fragments, were found.
For three of his colleagues, only jackets were founds.
Delgado is also haunted by the patients that he left behind in the triage area when the south tower fell. To this date, he has no way of knowing if any of those patients had survived.
September 11th remains a solemn day of remembrance to Manny Delgado and to the millions of residents of the New York City region who experienced that horrific morning.