NEW YORK––The sky was a vast painting of yellow-brown smoke: a blizzard of paper, dust and gypsum board sweeping through lower Manhattan. Light dust and burned paper also rained on Brooklyn, prompting even those across the water to wear gauze masks and squint.

In the wake of the Sept. 11 terrorist attack on New York, in which the twin towers of the World Trade Center were felled by hijacked commercial jetliners, the city deployed thousands of health care professionals and mobilized hospitals all over the area, even in New Jersey and Nassau County on Long Island. Emergency workers also ferried the injured by boat, reportedly more than 400, across the Bay of New York to Staten Island and New Jersey.

Jennifer Oldroyd-Snow, a third-year resident medical student at George Washington University Hospital in Washington, went to New York to volunteer just after working on patients from a similar attack on the Pentagon building that morning. She was shuttled aboard an Amtrak train with about 25 other volunteers, she said. What she found when she got to New York was disorganization and chaos.

"They don't know what to do with us," said Oldroyd-Snow, who had gone to St. Vincent's Hospital and Medical Center in Greenwich Village, the closest trauma center to the site of the collapse.

Many medical personnel did not know where they would be staying that night, she said, although a Salvation Army station around the corner on 14th Street had opened a temporary shelter with 40 beds.

A few miles away, across the water in Brooklyn, Maria Rivera, RN, was working as one of the two senior triage nurses at Long Island College Hospital. She described the scene in the emergency room within the first four hours after the collapse.

"It looked like a war zone," Rivera said. "I've never seen anything like this."

The usual number of nurses on staff quickly tripled to about 30 as professionals from other facilities flooded into the university hospital, just a few hundred yards from the water opposite lower Manhattan, the closest hospital across the Brooklyn Bridge from the site of the collision, Rivera said.

The bridge was jammed most of the day with outbound pedestrian traffic and vehicles bringing patients to the hospital-not only ambulances but buses.

The Brooklyn facility received about 187 patients by the next afternoon; most of those patients came within the first four hours of the disaster and then tapered off.

St. Vincent's saw a similar chilling absence of patients after the first eight hours. Between 6:30 and 10:30 p.m., the Manhattan facility received no more than 10 people, Leonard Bakalchek, MD, said.

Doctors and nurses sat outside in bright green scrubs, talking, jumping from foot to foot and waiting for patients who never came, several empty wheelchairs and gurneys lined at the ready. The hospital anticipated about 1,000 patients the first day but received barely half that, a spokesperson said.

The hospital and others eventually began to turn away volunteer doctors and nurses because the patients simply were not coming-an indication that the number of survivors was minimal as the search for a still-unknown number of bodies in the wreckage had begun.

The New York State Nurses Association eventually removed its request for volunteers from its Web site.

Cindy Gurney, director of research and planning, said that the organization submitted a database with more than 700 volunteers and volunteer organizations to the New York State Emergency Management Office. But in the end, the state office told the association that it wouldn't use any of them, Gurney said. (The nurses association itself has offices on the 23rd Floor of 120 Wall St., in the shadow of the World Trade Center towers. The office was evacuated and will have to be inspected before anybody can return.)

Triage centers were set up at the Chelsea Piers Sports and Entertainment Complex on Riverside Highway near the Hudson River, as well as in the Lexington Avenue Armory and the Jacob K. Javits Convention Center on 34th Street. The New York State Emergency Management Office set up headquarters on Pier 92 in Manhattan after its main offices were destroyed in the collapse of the twin towers.

'Smashed everything'
The majority of patients suffered smoke inhalation and eye irritation from the blizzard of debris and dust floating over Manhattan.

"There's a lot of soot and dirt that gets stuck under the eyelids," a St. Vincent's spokesman said. "You start blinking and scratching and you scratch your corneas. It's mostly rescue personnel trying to pull the rubble apart and getting a lot of dust in their eyes. This is not typical dust. This is smashed gypsum board ... smashed everything."

Ophthalmologists arrived in the ER to treat firefighters and other rescue personnel, he said.

"A lot of patients [came in] with chest congestion and difficulty breathing," Rivera said. She added, however, that no one came in with infiltrated or collapsed lungs. One burn victim, a firefighter, died of traumatic arrest. Rivera also noted injuries of people who had been trampled by other pedestrians fleeing the collapsed site.

As much as the bruises and cuts, the nurses said that they saw terror and fatigue in the patients, many of whom acted as if they didn't know what had happened.

Some of them were worried about anthrax poisoning, Rivera said. Many seemed to be in a state of bewilderment, staring into space when Rivera spoke to them.

A St. Vincent's physician said that he was treating a custodian who told him, "I work at the World Trade Center," evidently not realizing that it was gone.

A giant ER
Mark Ackerman, St. Vincent's senior vice president of administration, said all nurses at the hospital are cross-trained. Ironically, this training largely is due to the nursing shortage.

"We implemented this because of the nursing shortage," spokesman William McCann said. "We were looking to get ahead and this was an opportunity. There was a significant amount of cross-training, especially in terms of critical care and trauma care."

The hospital effectively turned into one giant emergency room, he said, with as many patients discharged as possible and elective surgeries canceled.

Long Island College Hospital went on "Code Alert," emptying the emergency room of stabilized patients and bringing in chiefs of different departments and all critical care nurses down to the ER. Elective surgeries were canceled there also.

Rivera said that even though there was a lot of emotion among the staff Tuesday, with families outside waiting to hear word about the number of dead, she was able to function reasonably well and deal with her emotions to get her job done.

"It was very frightening," she said. "Everybody was thinking we were invincible. Aside from the fear, we all functioned. You're frightened and overwhelmed, but you respond."

Oldroyd-Snow eventually did find work. At 3 a.m. Wednesday, she pulled a 12-hour-shift at St. Vincent's. When talking to firefighters, she heard many of the same stories that the world had been hearing all day.

It was Oldroyd-Snow's first trip to New York, she said.

One of the first things she had done before her shift was to buy a disposable camera and ask what many people ask on their first visit, "Where's the World Trade Center?"