Soon after the first plane struck the north tower (1 World Trade Center) at 08:46, New York City OEM began directing resources to the area. This role was short lived. Its building was heavily damaged at 10:29 by the fall of the north tower and was evacuated. Command and control was re-established elsewhere. Damage by falling debris and fire caused 7 World Trade Center to collapse less than 9 hours after the initial strike. The coordination of the response of the Emergency Medical Systems (EMS), the New York Police Department, and the FDNY was significantly impaired by the loss of its center of communications and many key personnel.
By 09:00, before the second attack had even occurred, our hospital went into a state of disaster preparedness. Patients in the Emergency Department were quickly moved to our urgent care area adjacent to the main Emergency Department. Plans were made to transfer subsequent acute patients (those unrelated to the World Trade Center incident) to North Central Bronx Hospital, our sister hospital approximately 4 miles (6.4 km) away. Within3 hours, 20 intensive care unit beds were available. All elective surgery was halted and six operating rooms were fully staffed and open. Within 4 hours, almost 100 critical and acute beds were created and large areas for the minimally injured were prepared. No physicians, nurses or support staff were allowed to go home. All area hospitals, including New York, New Jersey, and Connecticut, whether 911 call receiving or not, prepared in various ways to accept the expected hordes of patients.
In the first 2 hours, over 350 patients walked or were taken to New York University Downtown Hospital, a nontrauma center, which is 0.2 miles (0.32 km) from the World Trade Center. St Vincent's Hospital is about 1 mile (1.6 km) from the scene. As the closest trauma center, it was quickly swamped with over 300 walking wounded and critical patients. Bellevue Hospital, a trauma center approximately 2.5 miles (4.0 km) northeast of the World Trade Center, also received some of the early injured patients both directly and in transfer. Nineteen burn patients were taken to New York Hospital-Cornell Medical Center, the only burn center in Manhattan.
Scene management was especially complex during this attack because of the diversity in the EMS response. Communication between most hospitals and coordinators at the scene was almost nonexistent due to the early disruption of its communications tower and, later, the office of the OEM itself. Telephone communication either via landline or cell phone did not exist in lower Manhattan. Helicopter transport did not occur because the skies over New York were closed except for military aircraft. Triage from the scene of more stable patients to hospitals outside the immediate area did not occur due to the loss of OEM coordination. Only FDNY ambulances were in communication with central dispatch in Maspeth, Queens. NonFDNY ambulances took patients to the nearest hospital without any knowledge of available resources, or back to nontrauma centers in Brooklyn and New Jersey where they originated. Physicians, nurses, and ancillary professionals at St Lukes-Roosevelt Hospital, a trauma center only 3 miles (4.8 km) north, sat idle and frustrated, while staff at St Vincent's and New York University Downtown Hospital worked under extreme conditions.