March 8, 2002

MGH physicians, researchers, nurses and other health and scientific professionals frequently publish articles in journals about studies or clinical experiences. But the article written by Ronald Gaudette, BS, MBA, MGH pharmacist, for the March issue of Pharmacotherapy was unusual because it was about a unique event: the Sept. 11 disaster in New York City and the subsequent response of MGH-based disaster teams.

Having served as pharmacy team leader for the MGH-based disaster team, Gaudette describes the challenging — and sometimes harrowing — situations facing the specially trained health care workers after their arrival at Ground Zero. He notes that the New York site was "one of the first disaster areas where we could not even place search and rescue teams because of the twisted steel barrier created by the collapse." Gaudette describes how what originally was planned as an effort to care for those injured in the attacks instead became a mission to support and care for the rescue workers.

The National Disaster Medical System of the U.S. Department of Public Health, Gaudette writes, is comprised of state-based Disaster Medical Assistance Teams (DMATs). The DMATs are staffed by volunteers from a variety of medical fields. Four DMATs are based in Boston and consist of health care workers from the MGH and other area hospitals: one general medical DMAT; a pediatric DMAT; a burn DMAT, directed by Robert Sheridan, MD, of the MGH and Shriners Burns Institute; and the International Medical and Surgical Response Team (IMSuRT), directed by Susan Briggs, MD, of MGH Surgery and Shriners. Briggs also is overall commander of the four Boston DMAT teams.

Some members of the Boston DMAT before leaving the MGH en route to Ground Zero Sept. 11.

The MGH-based IMSuRT arrived at Ground Zero on the evening of Sept. 13, not long after a collapsing building had fallen on the site initially chosen to serve as the medical station. An alternative site was designated and, as Gaudette describes, the team set up the first of five medical stations that would be erected throughout that cold and rainy night. By 7 am the following morning, the team had treated its first patient, surpassing the readiness goal it had established for itself. Among the medical needs the team met was providing medications to rescue workers suffering from chronic conditions such as asthma, diabetes and hypertension. Team members also treated a wide variety of injuries. In all, the MGH IMSuRT and the other Boston disaster teams cared for more than 5,000 workers during the first 11 days following the disaster.

Gaudette notes that of all the clinical and personal skills the team members brought to Ground Zero, creativity, flexibility and true teamwork were the most valuable. Among the nonmedical challenges met by the team: getting themselves to New York when all air transport in the country was suspended; using sandbags to support the tents because stakes could not be pounded into the city concrete; and adapting a delicatessen's shelves and counter to serve as a supply depot and examination table. He describes combining antibacterial and anesthetic creams to treat the blistered feet of a firefighter who refused to stop working, and treating another rescuer with a history of heart disease who insisted upon returning to work after his chest pains subsided.

"We thought we knew what we were going to find until we got there, and then our worst nightmare didn't even come close to reality," Gaudette writes. "What was particularly frustrating is that we, as a country, have the best medical care available and yet at Ground Zero, we could not save people. What also is important to realize is the strength that a disaster like this gave to us, and the fact that the MGH team, like the other teams and our federal system, really worked."

Gaudette's co-authors on the paper are Jay Schnitzer, MD, PhD, of MassGeneral Hospital for Children; Edward George, MD, PhD, of MGH Anesthesia and Critical Care; and Briggs.