September 11 Photo credit: Bryce Edwards

Natural or man-made, disasters can be frightening, chaotic, and tragic events.  In these events, nurses play a fundamental role in response and patient care. In our series, “Nursing and Disasters”, prominent voices in the field give voice to ensure that all nurses are personally and professionally prepared for a disaster.

The  terror attacks on September 11, 2001, resulted in nearly 3,000 immediate deaths at the World Trade Center, near Shanksville, Pa., and at the Pentagon. This represented the largest loss of life caused by a foreign attack on American soil. It also was the greatest single loss of rescue personnel in our nation’s  history.

Where the Twin Towers once stood, there are twin reflecting pools. Each one is nearly an acre in size. They are part of the National September 11 Memorial Museum. Bronze panels that edge the Memorial pools are inscribed with the names of every person who died in the 2001 and the February 1993 attacks.

The tragedy of 9/11 resulted in awareness that our country needed to be prepared for a terrorist attack. Since 2001 there have been significant advances in emergency response for large-scale events. The Hospital Preparedness Program (HPP) was developed in 2002 to improve hospitals’ response capabilities. HPP “provides leadership and funding through grants and cooperative agreements to States, territories, and eligible municipalities to improve surge capacity and enhance community and hospital preparedness for public health emergencies. This funding is used to support programs to help strengthen public health emergency preparedness in several ways” (Public Health Emergency).

Improvements to hospital preparedness since 9/11 include surge capacity, better preparedness for chemical/bioterrorist attack, emergency drills with local agencies and employee training.

Pre-9/11 there was limited or no capability of first responders from different jurisdictions to communicate with each other.  Since fiscal year 2003 the Department of Homeland Security (DHS) has provided approximately $3 billion for communications interoperability initiatives.

Incident Command System was not in place on 9/11. Today DHS requires state and local grant recipients to adopt National Incident Management System (NIMS) and Incident Command System (ICS) at all jurisdictional levels as a condition to receive grant funding.

There were no risk-based security funds pre-9/11. Today 100% of Urban Area Security Initiative (USASI) funds are awarded based on risk and effectiveness. Pre-9/11 no critical infrastructure was in place. Following 9/11 DHS crated the National Infrastructure Plan (NIPP), “a historic and unprecedented public/private partnership to identify and protect the Nation’s critical infrastructure and key resources.”

Today there is private sector preparedness. A Private Sector Office was created. There has been an increase in private sector participation in federal training, exercises and preparedness.  A National Strategy for Transportation Security (NSTS)  did not exist  in 2001. In September 2005 the initial NSTS was delivered to Congress;  a required update to the NSTS was submitted to congress August 2006.  Pre-9/11 airline passenger prescreening entailed airlines collecting passenger information on a voluntary basis only for international flights. There was no single list of suspected terrorists that existed or shared among US agencies.  Now 100% of airline passenger and checked baggage are pre-screened (Department of Homeland Security).

Since 2004, September has been declared as National Preparedness Month.  Sponsored by the Federal Emergency Management Agency,  the focus is on personal and community preparation.  We remember the loss of 9/11 and we share in the responsibility of preparedness.