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9/14/2001

Hospital Pharmacy Near World Trade Center Helps Treat Disaster Victims

Cheryl A. Thompson

Pharmacy director Curtis Jay Kellner, M.S., had decided Tuesday morning to take the train that would drop him off about three blocks from work, St. Vincents Hospital and Medical Center on Manhattan Island in New York City. He got off the train about 8:55, looked up, and could "see the skyscraper burning."

Ten minutes earlier, an American Airlines jetliner had crashed into the north tower of the World Trade Center.

"I didn’t have time to gawk because I knew the [hospital’s] disaster plan would go into effect," Kellner said.

On reaching the pharmacy department, Kellner sent Laura M. Clemente, supervisor of the sterile products preparation area, to assist health care workers in the emergency department, an area not routinely staffed by a pharmacist.

The hospital expected to receive many of the people injured at the World Trade Center, about two miles away.

At about the same time that Clemente arrived in the emergency department, one floor above the pharmacy, a United Airlines jetliner slammed into the south tower of the trade center. Within an hour, the south tower collapsed. By 10:30 a.m., the north tower also had collapsed.

"I think we had the first few patients" rescued from the buildings, Clemente said.

"There was no plan for what my job was going to be once I got up there," she said. "You just do what you’re best at, which for me was handling drugs."

Having been a supervisor for only the past few months, Clemente had not participated in the hospital's disaster-preparedness training.

For the next five hours, Clemente used the emergency department's medication room, near the area set aside for trauma patients, as her home base. She prepared doses of tetanus toxoid, morphine, lorazepam, and other drugs in ready-to-use syringes, documented the use of controlled substances, and ensured the speedy delivery of pharmaceuticals not stocked in the emergency department.

"Everything flowed nicely," Clemente said. "No one was missing anything that day."

Clemente said her preparation of the syringes, in the seclusion of the medication room, helped to prevent the needle-stick injuries that otherwise would likely have occurred in the crowded emergency department as workers hurried to treat patients and extra security personnel entered an already crowded area. Afterward, many of the nurses thanked her for helping.

In anticipation of receiving large numbers of injured patients, the hospital had rearranged the emergency department. Clemente said there were "stretchers everywhere," awaiting or carrying the injured who had been sent inside from the outdoor triage area.

She said she did not know what was happening outside. "It took a few hours to deal with the first patients," she said. Initially, the situation was "pretty hectic."

While Clemente worked in her new surroundings, Kellner concentrated on the pharmaceutical inventory and the staffing of upcoming shifts.

Silver sulfadiazine cream "was one of the items we knew we’d run out of" if supplies were not replenished soon, Kellner said. He asked his wholesaler, AmeriSource Corp. of Valley Forge, Pa., for emergency deliveries of the cream, plus narcotic analgesics, crystalloid intravenous solutions, hetastarch and other plasma expanders, tetanus toxoid, fluorescein eye-test strips, albuterol solution for inhalation, corticosteroid inhalers, povidone–iodine topical solution, and injectable norepinephrine and nitroglycerin.

"There was no way we could have anticipated this type of thing in advance," Kellner said. "I can’t say enough about [AmeriSource’s] cooperation."

His calls to one of the city’s emergency command centers made it possible for the wholesaler’s trucks to travel onto Manhattan. Because of the disaster, the island had been cut off to traffic.

Patrol cars from the New York City Police Department brought members of the hospital’s Tuesday evening staff from their homes to the facility, Kellner said.

By mid-afternoon, Kellner sent a pharmacist to the emergency department to take Clemente’s place. He called the pharmacist back to the pharmacy by early evening, however.

"After we had the initial influx to the emergency department, we had very few thereafter," Kellner said. "The people we saw were the ones who were injured before the building collapsed." Afterward, the only disaster-related patients seen in St. Vincents’ emergency department were injured firefighters, he said.

Kellner said the hospital may not need many of the emergency items that his wholesaler sent and the U.S. Department of Health and Human Services provided from its national pharmaceutical stockpile.

"I have stuff in the hallways that I don’t know where it came from," he said.

Tuesday evening, Clemente, who lives in New Jersey, walked 15 blocks to spend the night at her mother's house.

Kellner stayed at the hospital Tuesday until he confirmed that his department would have adequate staffing for the overnight and morning shifts. Although it was 10:30 p.m. by the time he was ready to leave the hospital, and the trip home to New Jersey would take a long time, Kellner said he wanted to sleep in his own bed, if only for a couple of hours.

Clemente returned Wednesday morning to the pharmacy department, where she resumed her role as supervisor. "Everyone was still tense," she said.

Kellner said yesterday that all of his personnel are working overtime despite not knowing for certain how they will get home. Many of the pharmacy personnel did not know whether relatives or friends were alive or dead.

Although three hospitals had offered to send staff members to St. Vincents to help out, Kellner said his department has resumed normal operations.