Quotes from ED nurses on the front lines

Here are accounts from ED nurses who cared for patients injured in the terrorist attack at the World Trade Center towers in New York City:

• "By Wednesday morning, families and friends came in a never-ending stream, carrying fliers with photos of the missing and contact numbers. In the absence of survivors from the rubble, the nursing staff turned their attentions to this group and made every effort to deal with their emotional agony. Many of them were pinning their hopes on rumors of John Does’ or unidentified patients.

"In order to deal with this, we set up a family center’ in a building one block from the ED. It was staffed around the clock by counselors, psychiatric and social work staff, and spiritual care providers. A volunteer phone center was set up, and there were information people stationed at each entrance to the hospital. These measures were an effort to take some of the pressure off the ED staff and largely succeeded.

"There were many cases of false information being placed on the Internet that families cited as being the source for their information on the location of loved ones. In one chilling case, a woman had been called at home and told that her husband was a patient on the second floor of Saint Vincents Hospital, but there are no patient areas on the second floor. When she questioned this, stating that she had already been here and there were no John Does,’ she was told that her husband had been misidentified and that he was now awake and had been able to give correct information. The woman was given a five-digit medical record number (ours is six) and told to report to the information desk in the main lobby. Needless to say, this was a devastating incident to the family as well as the staff."

She continues, "It would have been impossible to include all the different resources made available to us to deal with stress and emotional trauma in a formal disaster plan. I have unscientifically measured this success by noting that there has been no increase in staff sick calls, no increase in confrontations or altercations, no increase in patient and family complaints, and a general feeling that the staff are communicating with each other effectively.

"I believe our ability to deal with emotional stress and trauma effectively is a result of being aware of the potential for it and being adaptable in utilizing whatever resources presented themselves to offer to the staff."

Suzanne Pugh, RN, ED nurse manager, Saint Vincents Hospital, New York City.

• "We have some staff members who are getting very anxious about the threat of hazardous materials and bioterrorism. People are whipping around, asking, Where is the atropine? What is our plan? Where is the shower?’ These are individuals who were never terribly interested in the process before."

Laura Giles, RN, ED nurse manager, Mount Sinai Medical Center, New York City.

• "When the first severely burned patient came in, some of us started to cry. You say to yourself, Is it appropriate for me to do that?’ but at the same time, this was somebody we couldn’t even recognize except that it was a female. I personally felt that I didn’t know if I could handle any burn patients after I saw the first three or four. But no more came in, because most of them were not alive.

"Some of us had families who worked there, so at same time we were taking care of patients, that was in the back of our minds. Emotionally, you are torn in different directions. As an ED nurse, you feel you always have to be tough. We are on the front line of every hospital. We haven’t had the chance here to sit and talk about what happened, to laugh, to cry, or anything. I really don’t know why.

"Even riding to work is difficult. Normally, my eyes would sweep from lower to upper Manhattan, and I would always look at the Twin Towers. Now I look and see nothing but smoke. We lost three of our EMS personnel, and there is a shrine set up at the ambulance bay with their pictures hanging on the wall. To see the faces of all these young people who just started life — I can’t think of anything that could have been worse. But time heals, and I believe it will."

Anna Chin, RN, ED nurse at New York Presbyterian Hospital-Weill Cornell Medical Center, New York City.