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Remain Calm

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There was a proposal put forward to use letter carriers to deliver antibiotics as a kind of stopgap measure. But the union balked, citing issues of protection and security. In a life-or-death situation, when who lives and who dies may depend on access to pills, the social order can quickly break down.

No matter how many drills you run, it is impossible to predict what will actually take place in the frenzy of a real disaster. In Baton Rouge, 6,000 beds were successfully set up in Pete Maravich Arena, and the national stockpile of medicine did arrive. As it turned out, however, it contained the wrong drugs for the situation. There were plenty of medications for bio- and chemical terrorism, but what was needed were drugs like insulin for chronic illnesses.

Several years ago, I interviewed the head of emergency medicine at NYU Downtown Hospital, which, only a few blocks from the World Trade Center, treated more than 1,200 people in the first couple of hours after the attack.

“We learned that nothing works the way it works in theory,” he told me. On 9/11, as ambulances were screaming into the hospital’s receiving bay filled with ten and twelve people each, even the simplest things became difficult. It was impossible to handle the standard triage tags that have a place to write a patient’s name and a colored tear-off strip to identify the patient’s condition (from green, which is not urgent, to black, which is dead or beyond saving).

The tags have a little string that is used to tie it around a toe or a finger. “It doesn’t get any more basic than this,” the doctor said. “But when we were outside triaging patients, we just didn’t have the time to do it. And some of the strings were tearing as we fumbled in a rush to get them on.”

It may even be too much to count on health-care workers—not to mention other critical public-service employees like cops, firemen, and the people who keep public transportation running—to show up for work during a crisis. According to a study just released by the Mailman School of Public Health at Columbia, only 48 percent of the more than 6,000 health-care workers surveyed said they would go to work during a SARS outbreak, 57 percent during a radiological event, and 61 percent during a smallpox epidemic.

“Staffing during a crisis is a concern,” says the Health Department’s Weisfuse. “We’ve created a little institute at NYU Bellevue to educate hospital staff and help remove their fears. We’ve also worked to make sure hospitals provide staff with personal protective equipment. And emergencies do bring out the best in people sometimes.”

Though it is true that firemen and cops and health-care workers rushed to the scene downtown on 9/11 without regard for their own safety, there is no reason to assume this would happen again. As devastating as the 9/11 attacks were, it was still what experts refer to as a traditional explosive event. It was localized, it was visible. Everyone thought they knew what they were dealing with.

Today, people have a better idea of what there is to fear. “The truth is,” says Redlener, “in a major disaster, we just don’t know who will and who won’t show up for work.”

On a hot August afternoon two summers ago, when the Northeast power grid failed, plunging New York and much of the East Coast into a blackout, Phil Pulaski, the NYPD’s assistant chief in charge of preparedness, was driving on Ocean Parkway in Brooklyn. Pulaski, who may be the most credentialed cop in the history of the department (next to Commissioner Ray Kelly)—he has run the Counter Terrorism Bureau, the Joint Terrorism Task Force, the Bomb Squad, and the police lab, and he has two engineering degrees and a law degree—was on his way back to One Police Plaza from the Counter Terrorism Bureau.

When he saw the traffic signals go out, he radioed headquarters and was told the problem was citywide. Pulaski knew immediately where to go. “We have a continuity-of-command plan,” he says, “that tells everyone where they need to be and what their function is in a crisis.”

During any crisis in the city, from a terrorist attack to a severe storm, the Police Department has what it calls five centers of gravity: the police commissioner, the chief of department, the emergency operations center, the backup operations center (everyone learned on 9/11 that redundancy is critical), and the Patrol Borough Stand Alone Plan.

The emergency operations center, located at One Police Plaza (the backup center is at another location), is designed to coordinate the response to an emergency through a single clearinghouse for all information. Every commander in every corner of the city reports into the operations center.


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