Marcel Lettre — Observations During the Early Response to the World Trade Center Incident

Observations During the Early Response

Observations During the Early Response

to the World Trade Center Incident

September 11^th, 2001

Marcel Lettre

Manhattan

I began the day normally, leaving the W hotel at 39^th and Lexington to go to the office to spend a focused day preparing for a client presentation on Wednesday morning. I work at a management consulting firm, Booz Allen & Hamilton, with offices at 101 Park Avenue. I was at work by 7:30 a.m.

At about 9:10 a.m. I heard a few words in the hallway at work uttered in anxious voice "World Trade Center". Somehow it became clear that the WTC was on fire. I went to the southwest side of our building where about six others were gathered in an office that viewed the two towers. The two plane crashes had already occurred, and the buildings were burning against a blue clear sky. Once people explained to me that it had been two separate passenger planes, and with the weather being so beautifully clear, it seemed clear that there was no air traffic error. They were also quick to point out at least one of the planes had come from Boston. I thought of my immediate family Simmons, Peter, and Mom and Dad realizing that each of the three knew that I would not have been on that plane. I wondered where Peter was and suspected that he was probably on his subway train from Queens, perhaps still in Queens on the above-ground section. Nevertheless, phone lines were all jammed up and I could not get through to anyone. As I attempted to call, an image of the Pentagon joined the WTC images on the TV screen, and then an announcement that the FAA had grounded all planes across the nation.

This small group of people was watching it also on TV when we saw a huge glitter ball explode out and realized that the building was collapsing which we also could see out the office window. Truly a shocking sight as we realized that one of the WTC's was collapsing. At that point it became clear that there would be hundreds and hundreds of casualties, and that first responders were probably down too. Having been an EMT in the past with the Bethesda-Chevy Chase Rescue Squad, it occurred to me that I should go to a nearby hospital to possibly help out. I shut down my computer and headed downstairs, where in front of 101 Park Avenue people were milling about aimlessly just talking and gesturing, confused. I did not look at my watch but it must have been approximately 10:15 a.m.

I went to the hotel and changed clothes from my suit and tie into other pants and my dress shirt from the day before. I had only the dress shoes I was wearing. I grabbed a large bottle of water, some chocolate, and cell phone, and went to NYU hospital at 27^th and 1^st. Large numbers of people were streaming uptown on the streets and sidewalks, with the uptown avenues bumper to bumper in cars and the downtown ones relatively empty. I saw a sign identifying the city morgue and hospital. Some nurses were standing outside and I asked them where I could talk to somebody about volunteering as an EMT. They said not at NYU but that I should try Bellevue Hospital, about 4 blocks south, which I had not heard of but ended up being one of the main ER trauma centers.

 I walked up the entryway of Bellevue just as people were yelling that all non-employees would have to vacate the building. I approached a security guard and said I was an EMT interested in volunteering. He asked for credentials, and I showed him drivers license and EMT card (the first of many instances of showing identification during the day). I walked down to one entrance to the ER where a uniformed police officer turned me back, saying they were not accepting volunteers. I then walked around the hallway to another entrance to the ER, showed card to another guard, and walked in. I was standing in the hospital's emergency operations command center, which was just getting established and geared up. Most people were in suits, setting up computers and telephones, talking on radios, putting on orange arm bands, writing on clipboards.

No one knew yet what to do with extra people. I was sent into the ER to look for a woman named Brenda, and ended up walking around there, weaving around boxes of supplies that had been brought down. There were dozens of people, perhaps two hundred all together, in the ER area. A few were moving regular patients out, a few were handling at least two serious trauma patients. One of these was a man with chest and head crush wounds, with a very bloody set of blankets and cut-up clothes on his upper body. A medical team of about 10 was working him. They seemed to be the calmest people in the ER. I found Brenda who said she was sending medical people to the 14^th floor to stage. When I got there, there was nothing but a few older nurses in a waiting room, watching spanish language television coverage of the event. It was the only station the TV got and none of them spoke spanish. Two minutes after signing in I went back down to the ER.

  A large number of people, perhaps 30, were gathering near the ER entrance in gowns waiting for patients to come in. They had looks of expectation and preparedness on their faces. There were many people and very little to do except continue preparations and continue to organize. People were waiting expectantly for some big wave that we all thought would start coming in. In truth, the pipeline was relatively slim due to field operations seeming to have fallen apart after the towers collapsed. One guy was brought in a firefighter with apparently heavy chest injuries. People were very protective of him, swarming to the backboard to help lift him onto a gurney, giving him words of encouragement.

After wandering all over the hospital looking for the right role, I started seeing more EMTs and cops around. I asked a cop who was carrying his injured colleague's dusty belt and weapon about where the EMTs were staging. He pointed me to three guys who were just walking in. One's blue jumpsuit was turned gray with dust. He had been staging in an initial medical area near the Towers before the collapses and had lost his partner in the collapse. After the initial noise, and in the dust, he said, his partner disappeared. He was dazed and shook. I led the three of them to the operations center, where they reported the loss at this point people were still expecting to initiate normal "man-down" response procedures and we left the one EMT to be examined.

The two EMTs said, definitely, jump on a rig with us, we can use all the help we can get out there. One guy ended up remembering FDNY rules against ride-alongs for non-department personnel and changed his mind. Another guy, Alan, who was loaded down with additional gear including his kevlar vest, had me jump in with him and two others. I again did not look at my watch but it must have been sometime between 11:15 a.m. and 12:00 noon as we left the hospital. There were now four of us in the back of a FDNY ambulance with two FDNY EMTs up front. The two up front were the guys who had brought in the firefighter a few minutes earlier. Alan and the other two were from Brooklyn and other ambulance services. I said that I would just help carry equipment bags until they were comfortable with my skills. They responded that on a day like today they were not at all concerned a helping hand was a helping hand. They also said that today, triage would occur as a "kick test", ie, if you kick someone and they move, you help them, otherwise, you move on. We headed down East River Drive, which was empty except for people walking up it. At one point we were stopped by a cop who pointed out an injured person. The person had some relatively minor cuts and so our team explained we needed to keep going down to get help to the more seriously injured.

In the unit, the four of us in the back prepared ourselves for administering aid without an ambulance. Concerned that I would be misidentified either as a bystander or as someone with different skills than I had, I wrote "EMT" on four pieces of two inch tape which I put on my arms and front and back of my shirt, and put a few pairs of extra gloves in my shirt pocket. We all took 2-3 triangular bandages. We slid a roll of 2" tape on our belts and each took a marker the plan was to do triage primarily by writing any medical information (vital signs, injuries treated, etc.) on tape and sticking it on patients' shirts. We opened up the obstetric kits and took face masks for the dust as well, ripping off the clear plastic eye shield and just keeping the mask.

The ambulance finally stopped. There, the door opened to a scene of quiet and surprising inactivity. We were close to the WTC and the immediate area gave the impression of a quiet, rainy foggy day on a deserted city street. Two or three blocks up, I could see a raised pedestrian bridge through the dust still in the air. Looking at a map later, I still cannot tell if it was the north or south pedestrian bridge, but I believe it was the south bridge about 1-2 blocks south of Towers 1 and 2. On the left the bridge connected with a building, on the right it disappeared into smoke. A dark black jumbled building before the bridge on the right left the impression of being heavily damaged, though it was too hazy to tell, with next to that a smoky space where the tower sat, but it was too smoky to see. Everything was gray. Though I was not seeing cars that were fully burned out and twisted, nearly every car parked had windows blown out, rips down the side or top, and debris on and around them. On the ground were 4-5 inches of soft gray dust, covering my shoes up to my sock as I walked.

We were motioned over to a building which I thought at first was some sort of ground operations center, but rather was serving as a refuge for a few people and rescuers. It first looked like it had been a place under construction but was actually some sort of luxury lobby. The four of us who got off of the ambulance did a quick assessment of a construction worker leaning against a pillar on the dusty carpet. He had multiple abrasions and leg and back pain with radial pulses, and could not move from where he was leaning against the pillar. Though exhausted and in pain, he was not disoriented, so we said we had to leave him for now. He agreed and said go find people hurt more badly than he was. We went back outside.

On the street approaching the trade center area, there were perhaps a dozen fire vehicles engines, a ladder truck, command suburbans that appeared, at least temporarily, abandoned. Some appeared fully out of commission, with windows blown out, twisted pieces of metal, steal I-beams and large pieces of cement on top of them, everything completely blanketed in gray dust. So much covered the interior of a few police cars that they looked like they were cement sculptures of cars. Some of the doors were left open, and some tires were blown. A city bus, abandoned, had lit up its emergency notice, "emergencycall police" a scrolling banner across the front.

There was little sound quiet; the dust, like snow, muffling all sound. Mixed in with the dust were thousands of full sheets of 8 ý x 11 office paper, littered everywhere so that you were constantly walking on it, my leather-soled shoes alternately kicking up soft dust and then scraping across the dusty paper.

In our minds, we were looking for some command center to report in to, or a triage facility, or some place where people were treating patients. I expected to find some point where casualties would be laying around. We began to pass firefighters dazed, milling about, dazed survivors, recovering. It became clear that an early command structure in place was gone and the personnel in the area had not yet figured out what to do nor had remobilized a second rescue operation in the area. The collapse had been a shocking and operationally-paralyzing event to those initial responders, I realize in retrospect.

As we walked forward toward the pedestrian bridge, one firefighter with dreadlocks in a blue FDNY t-shirt and turn-out pants was standing at the back of a suburban, very subdued. At first I thought he was just taking a break waiting on somebody. But it appeared rather that he had mild shock/disorientation. We told him as we passed by to stay where he was and sit in his vehicle to recover. He agreed, said he had already done it, but his voice was a little vacant.

We arrived at an intersection with more firefighters congregated around a suburban, just below the pedestrian bridge. It was not clear from them what planning was underway. The quiet was shattered as several of their air regulators began chirping the sign that their air supplies were getting low, although by this time they had their masks off. They did not notice the chirping and it did not cease until the last air squeezed out a few minutes later. Thirty yards away was a firefighter that folks said needed help. Alan and I went up to him. Alan had me assess the firefighter while he walked half a block up to two ambulances nearby.

The firefighter had his arm in a sling and was dazed. I assessed the injured firefighter who was sitting with a guy asking him questions. The questioner may have been a young reporter, though he was writing in what looked to be a teacher's grade-marking book. The firefighter had a sling put on by a previous first responder. I reassessed it, assessed his vitals, looked at the broken arm and dislocated shoulder, checked for neck and back and leg pain, and noted some disorientation but no head injuries. We talked with a Lieutenant about getting him into an ambulance. We did not focus on transporting him ourselves because he was not a Priority One patient and we kept expecting there were many other priority ones likely to be strewn about the area.

The two ambulances up the street did not have crews with them so it was thought that we or someone else could take them to deliver patients. The objective became to get the ambulance back in service by getting it to a medical staging area. There was a guy there who was directing things and seemed to be in charge of implementing a plan, and that helped. He was firm and directive but he had a calmness and compassion in his voice. He did not bark orders.

Meanwhile, a huddle of firefighters brought a patient I believe by their urgency that it was another seriously-injured firefighter over to a second ambulance in an emergency basket as we were working to turn around the first unit. Another civilian EMT was backing the unit up. This guy, Jim, was an investment banker with Goldman Sachs and in the past had been a volunteer EMT near Princeton, New Jersey. His building had finally been evacuated after the collapses but since he had training he stuck around to help.

Alan climbed in the driver's seat, Jim hopped in the back. The passenger side window glass had been broken out, so I swept the glass chards off of the passenger side seat and climbed in. We had to drive over an abandoned but fully-charged fire hose slowly so as not to rip it, then head down a road with dust kicking up very heavy from the unit with the seriously injured firefighter in front of us so that we could not see more than a few feet ahead. We drove three or four blocks to next to a park. I did not know where it was but I believe it may have been Battery park. As we pulled up, a uniformed EMT through his arms up in the air and said "My bus!". We had returned his ambulance, which had been abandoned during the collapse, and he was happy to have it back. There, about twenty ambulances began gathering. Some people were checking in with and giving their names to an officer, but it still was not clear what we were doing or supposed to be doing. Jim began to tape EMT on his shirt, and a third civilian came up to do the same. This third civilian guy was a young Customs officer who had been in the Customs offices of the WTC and had evacuated before the collapse. He had found a helmet and medical bags in an abandoned ambulance closer to the scene and was carrying them.

After about ten minutes, someone passed word that we were to move a few blocks over to a staging area at the Staten Island ferry. Along with Jim, I jumped into a new unit for the move, where after our arrival about 30-40 or more ambulances quickly stacked up and parked. Again, everyone here was standing by ready to act, but with no idea of where to go to best help. No one indicated they were in charge, no one enunciated plans, no one was taking initiative, and no new information was coming in over the radios, although over an hour or so these began to change. The EMTs driving the new unit I was in got a bunch of bottled water and medical supplies (bandages, gauze, cotton balls, sheets) from a nearby drug store that had been abandoned, carrying everything in hand shopping baskets, and began handing it all out. We stacked a lot of these supplies in back of the unit I was sticking with.

A few casualties trickled through. A team of us helped transfer two patients from one unit that got out of the WTC area to another fresh unit in our lineup. One was a very large 300+ pound man, chest bared and pants cut away, semi-conscious, cyanotic, with trouble breathing. He had been found under a bridge, presumably one of the pedestrian bridges. A second patient was an unconscious man covered in dust who needed intubation by a medic. These were moved to a paramedic unit and immediately transported to a hospital. We helped two police officers flush their eyes from concrete dust. Their car was coated gray. They had abandoned it during the collapse and then came back for it. The full interior looked like it had gray dryer lint caked on everything in the keys of their computer keyboard, all over their uniforms, covering the instrument panel.

Throughout this time, most rescuers were wearing face masks. The smell was like that of burning nylon or burning plastic, the smoke and dust began to sting your skin after half an hour or so, and eyelids began to feel scratchy.

  And a waiting period began. Sitting, sitting, sitting, through a feeling of frustration. After a first wave of several hundreds of casualties made it out (probably by 12:30 or so), things seemed to grind to a halt as a revised set of afternoon operations began slowly, slowly to get set up.

  I was surprised by the length of time that several hundred EMTs and firefighters had no choice but to stand around. This was mostly a function of the minimal number of patients, which in turn was a function of the inability to access them. After all initial victims were found or walked out on their own, it became clearer that the rest probably were buried under the rubble. The difficulty in accessing the rubble was an especially limiting factor as it became clearer that buildings were unstable. A triage area on another side of the area had to be moved.

  The EMTs I was with were anxious to do more. One of the two was the son of an EMS chief (a guy named McCracken) and was concerned about his dad's whereabouts as there had been a radio report that a number of chiefs had been injured or were missing. They attempted to move their vehicle to move back closer in but were talked out of it by a lieutenant. Ultimately, we moved over to the main triage facility in the Staten Island ferry building, driving up the ramp to the building where we unloaded all of the supplies from the drug store. The main ferry ticketing and waiting room was under transformation into a triage facility, with fifty or so cots set up, piles of supplies, and officers digging out quarters to use the pay phones to coordinate activities or call their families.  

As it began to be clear that the initial crisis stage was becoming more controlled, it also became clear that operations would shift to a slower, more deliberate approach. On the medical side, field teams of physicians, anesthesiologists, nurses had arrived at the triage area prepared to deliver advanced medical care. EMTs and firefighters were shifting to stockpiling supplies. With so many trained personnel getting the system going, and with far more resources than required, I figured it was time for me to back off. I took leave of the teams I was with around 5 pm and walked uptown. On the way, another building collapsed near the WTC. As I got further up Manhattan, through China town and past Canal Street, more and more people were out in the streets. But the traffic was nearly only emergency vehicles.

The walk to 39^th and Lexington took about an hour. I linked up with my brother and brother-in-law by cell phone. Throughout the day until then, my phone had not been able to make calls. I showered, and met them for a burger. Back in the hotel, TV coverage helped bring the various parts of the day into coherence. I saw that rumors among emergency personnel earlier that the Sears Tower had been hit, that LA had been hit, and that car bombs were going off all over the city were unfounded. I caught up with where the nation's leadership had been and what they had been doing, found that neither Secretary of Defense Rumsfeld nor the Pentagon leadership had been injured, which I felt would have caused more difficulty.

After the President's speech at 8:30 pm, my mind went back over the day's events. Could I have done more? Couldn't I have gone further back in? Should I have stayed to experience it all and help where I could. People are still in there alive. The country is riveted on those 20 square blocks, and it seems that more can be done than just to sit in my hotel and watch this "Pearl Harbor" on TV when it is so close by. It seems important to soak in all of it what works, what does not, why responses occur one way or the other.

So at around 10:15 or so, I went back out. I walked out of the W hotel down Lexington to 27^th and 1^st, back to the NYU medical center. Police road blocks, but as long as you know where you are headed and have a credential, they will let you through. I taped EMT back on my shirt again, too, which helped. At NYU they were basically setting up for a large influx of people into the city morgue, with bright lights and Salvation Army food trucks and refrigerator trucks. The morgue guys said "the people coming in here don't need EMTs" though there was not much happening there yet either way. I could not get past the police at the entrance to Bellevue. I asked some medical students who were also returning to work and finally found out that there was a medical staging area at Chelsea Piers, 23^rd and 9^th, a 30-40 minute walk across to the West side. The walk was through eerily silent streets. Near Broadway and 24^th, I ran across a lineup of humvees, where the national guard was assembling. I passed my brother's old apartment building in Chelsea and the well-lit up Chelsea Hotel. Every couple of minutes, an emergency vehicle passed, or another pedestrian several of whom were medical personnel returning from the staging area which they said was too quiet.

Outside of Chelsea Piers, which normally is a large sports and games complex, a long line of perhaps more than 40 ambulances was stretched southward, and police vehicles were stationed in all directions. Nevertheless, I walked right in to the Piers, where I signed in at a table for medical personnel. I walked into a large set of warehouse spaces, with hundreds of medical personnel milling about. At the entrance to a large warehouse room, "trauma" had been spray-painted in orange paint like graffiti above the door. Inside, about fifty emergency stations were set up in a rather sophisticated setting. Many of the stations were stocked to perform emergency surgery by the looks of it, with floodlights set up and surgical teams including surgeons and anesthesiologists standing at the ready, again just waiting expectantly for an eventual flood of patients. Red zone, green zone, food, signs posted, whiteboards with a room diagram and color-coded areas. A floor hockey rink had been filled with mattresses as a place for people to sleep if they wanted. Overall, a really impressive setup. Emergency crews from New Canaan, CT and other outlying communities were arriving ready to help.

However, there were no patients coming in. Over two hours, about half a dozen police officers and firefighters with dust inhalation reactions, scratches to the cornea, and general exhaustion. I, like others, wandered back and forth, listening for news of any patients coming in. Finally, as it became clear yet again that any people trickling out of the rubble were likely to be adequately handled by hospitals, the command announced that the center would be downsized from dozens of teams to just four. The walk home was on even quieter streets. I went to bed quite tired and on Wednesday went into the office to attempt to return to work.

I spent the day Wednesday at work. Many people around the city and the nation wanted to help. Hard to concentrate on getting any work done. Instead, I felt like I had to write it all down so as not to forget, and hopefully, to learn something useful for the future. Still just a trickle of people coming out of the rubble. Varying reports of numbers of living at one point people were saying authoritatively that 9 survivors had been pulled out, but it seems the real number was 5 or 6. A full day and night of rescuers working and only 100 or so bodies pulled out. Now more than 1,500 rescue workers involved in the effort, and the city receiving more offers of help and supplies than can be put to use.

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Closing Reflections on Lessons Learned

During some of the down time of Tuesday, a number of thoughts came to mind about what I was seeing.

Regarding what the nation's leaders would do to respond, I saw several probable sets of activities. I was keenly interested to see what would happen on these dimensions. These are unedited as jotted down around 7:00 pm on Tuesday.

Priorities and Objectives

• Control the situation
• Responding to emergencies/mobilizing resources
• Mitigating other immediate likely attacks
• Thinking about what the perpetrators tactical followup moves might be
• Keep everyone calm, focus nervousness in right places, keep government functioning, demonstrate control of situation (periodic public communications)
• Tracking the perpetrators

Respond to the situation

• Determine perpetrator's objectives how do they want us to act, and do we want to try not to react the way they want us to
• Immediate response to the incident options Get justice on our side get world consensus that this is shared problem
• Longer-term response our objectives Show America's benevolence not rash response but a principled, calculated, proportional one, based in criminal investigations and fairness but also resolute

What are the opportunities created by this incident

• New consensus and definition of era
• New and better governmental institutional consolidation and coherence
• New and more effective coalitions of moderation of people and allies to thwart this stuff

Political response

• What causes the deep-seated hatred that drives such an act? Is it widespread?
• How, in addition to countering it, do we lessen it at its source?

Military response

Consequence management response

In addition, I thought about a number of operational-level things I had seen and learned about.

Organization took a while.
People in the ER were primed and ready to go but you otherwise could really see the control of the situation only evolving piece by piece, bit by bit, hour by hour. Asking people who was in charge rarely gave you a uniform answer or a confident one.

Doing work during this confusion requires assertiveness and persistence.
People tell you different things. One channel is blocked (e.g., by one police officer barring an entrance) but there is another way and another place to get involved. In crisis, amazingly easy to get into areas where you are not normally supposed to be. Ask, but realize that won't get you far. Better to just do. There just was not a person I could report to and say, "place me somewhere to work", and have it happen. You just needed to find it yourself. I should have done more of that when sitting at the ambulances later in the afternoon perhaps getting back down to the crisis area rather than staying with the ambulances since I was not tied to them. But, it seemed like being with the ambulances would be a good way to be likely to help. The problem was that command and control was not deploying them necessarily to areas for work both because there was no work and because for a while there was no connection to command and control. Lesson learned in future crises, there is likely not to be someone in charge. Assess this first, and if not, think of the top 2 or 3 things that need to be done and get those started.

Sometimes something is important despite deadlines or other obligations.
It took at least an hour to realize that it was more important to be out helping than to work on client work.

Keep looking for the most value-added role.
There were far more people than jobs. It took some creativity to figure out where to help, and also some initiative to realize when I was being led down a path of being sidelined (e.g., side trip to the hospital's 14^th floor). Had I not kept looking for the right role, I would have been sitting in a room for hours with nothing to do.

The people that were leading were effective because they were calm and compassionate.
Urgency in voice, "let's go! let's go! let's go!" does not seem to help as it conveys some panic and loss of control. Also, when there are too many people, even in crisis need to stop and force everyone into coordination. For example, at hospital or at staging area, when an ambulance arrived, 10-12 people would rush over to it to lend a hand. Everyone means well, but what happens is that the job is not done well. In this case, too many people meant that the stretcher was almost dropped, further injuring a patient.

A few minutes during a unique event can determine your satisfaction with how you've handled a job. A few minutes can determine what kind of person you are. All these rescue workers and leaders know right now that the next two days will be the big moment of their professional lives. Those who handle it with resolve, conviction, and professionalism (which I expect will be all of them) can look back and know they performed up to their best when they were most needed. How they handle it defines them. It is a great personal/professional satisfaction. But it is important to know that such small but important events happen in every line of work. You work and train hard so that you can perform well in those rare but crucial moments.