Emergency services bring medical expertise straight to the scene.

On the sunny morning of September 11, 2001, the corner of Seventh and Greenwich avenues in downtown Manhattan was a scene of chaos and panic. Doctors, nurses and paramedics were frantically running in and out of the emergency entrance of St. Vincent's hospital, outfitting stretchers and hooking up medical equipment.

On the opposite corner, a group of onlookers gazed down Seventh Avenue, transfixed by the horror before their eyes. History had been made minutes before as two planes crashed into the World Trade Center.

Within minutes of the first plane careening into the Twin Towers that morning, New York City firefighters, the police department and other members of the city's rapid response team were traveling downtown at breakneck speed. Nobody knew what was happening, just that there would be casualties. The EMTs and paramedics at St. Vincent's and other area hospitals knew nothing of how horrific that day would be or how much their resources would be tested. Like the city's firefighters and police officers, the Emergency Medical Service personnel would end up being some of New York's finest and bravest.

John Peruggia Jr. knows the importance of emergency medical technicians. He oversees more than 3,500 EMTs, paramedics and officers every day as the chief of planning for the Fire Department of New York. Peruggia and his team responded just minutes after the second jumbo jet hit the World Trade Center. He and other members of Mayor Rudolph Giuliani's Office of Emergency Management immediately convened at headquarters at 7 World Trade to oversee the various agency operations. While they were coordinating rescue efforts, the first tower collapsed and Peruggia, the mayor and others were trapped near Ground Zero, not knowing if they would survive.

"The front of the building had collapsed in and when the debris cleared, some of us evacuated people in the lobby and myself and another fire chief went up on the promenade of the World Trade Center plaza and evacuated a couple of hundred people from there," Peruggia says. "Then we went back to our command post and were on the corner of West and Vesey streets when the second building came down. We started to run, a firefighter grabbed me and threw me underneath a fire truck, and I was trapped under there for a few minutes and then I got out."

Seven World Trade was burning and by 5:30 p.m. had collapsed completely. Peruggia stayed near the site to help set up the EMS operations. That was when he discovered he had lost a number of his comrades, including the chief of the department and his immediate boss, Peter Ganci Jr. (Ganci was one of the two highest-ranking department officials who died while trying to save lives at the site.)

Today, Peruggia is back at Fire Department headquarters planning for other events, coordinating drills and trying to get back to business. But it hasn't been easy.

Getting back to business hasn't been easy for EMT Brad Mann, either.

Mann, a 15-year veteran EMT and a lieutenant for the last six years, worked tirelessly at Ground Zero from September 11 till the end of the year. On that fateful day, Mann was at fire department headquarters in Brooklyn. He had heard that a plane had hit one of the Twin Towers and immediately traveled with his commander across the Brooklyn Bridge. They had originally thought the crash was an accident, but once they were traveling across the bridge and saw the damage to the tower, they realized it couldn't be.

"We arrived shortly after the first plane hit the tower and began setting up EMS operations," says Mann. "By the time we realized what happened, we looked up and saw the second plane hit the second tower, and within a few minutes we were just running for our lives. It was like nothing I have ever seen in 15 years."

Like Peruggia, Mann also lost comrades. "The two paramedics that were killed, Ricardo Quinn and Carlos Lillo, both worked for me when I was a supervisor in the field. It was a terrible thing," Mann says. "But they were doing what they do, and unfortunately they paid the price." Six other paramedics and EMTs lost their lives trying to save others.

After September 11, Mann went to work at Ground Zero, helping to sift through the wreckage and trying to bring closure to the victims' families and the city. "It's eerie. Now it's starting to look like a construction site," he said in December. "But you never know what you're walking through, you don't know what's where, and you don't know if you could be stepping on a person. It's very difficult but it has to be done."


Although Napoleon's surgeons treated and transported wounded soldiers during the Corsican's many military campaigns in the early nineteenth century, the ambulance, as we know it, is a modern phenomenon.

For most of the twentieth century, Americans didn't fully realize the importance of pre-hospital care. While there had been ambulance drivers since the late nineteenth century (Bellevue Hospital in New York City, using horse-drawn carriages, became, in 1870, the first metropolitan health-care facility to have staff answer emergencies), many of the personnel in such vehicles were poorly trained or ill-equipped to answer life-threatening situations. Thus, many who might have been saved died.

In the 1920s, New York City hospitals saw that they would need better-trained staff to respond to the rapid increase in automobile casualties and other accidents arising from modernization. Area ambulances were staffed with "ambulance surgeons." These hospital personnel -- usually doctors but sometimes nurses or even orderlies -- treated patients at the scene of an accident, then transported them to a health-care facility if they needed additional care. But the system still had its faults. The care remained inadequate and the response time was long.

When the National Research Council published "Accidental Death & Disability -- The Neglected Disease of Modern Society" in 1966, it brought attention to the need for modernizing Emergency Medical Services. The government finally concluded that proper pre-hospital care was necessary. So later that year, Congress created the National Highway Traffic Safety Administration to set guidelines and requirements for EMT training programs. At last, ambulances carried people who could properly respond to medical emergencies.

But it wasn't until 1972, when the television show "Emergency!" aired, that public opinion swung in favor of on-the-spot emergency medical care. In 1973, Congress realized the importance of paramedics and passed the EMS Systems Act, which funded regional EMS programs. In 1974, EMTs in Pittsburgh became some of the first in the nation trained in advanced life support techniques. By 1975, half of the U.S. population lived within a 10-mile radius of an emergency medical unit, and the American Medical Association formally acknowledged the importance of trained emergency medical personnel.

"Pre-hospital care is night-and-day different than it was 20 years ago," says Steve Haracznak, the executive vice president of the American Ambulance Association, an 800-member Washington trade association that promotes the importance of pre-hospital care. "Back in the early days, all [ambulance personnel] could do was contact the hospital and tell them what kind of patient they had and that they were bringing them in and when they would be arriving at the hospital. Now they are actually doing the treatment. Paramedics are able to use alternate external defibrillators to bring people back who have heart attacks and give them medication and IVs, and they can even do tracheotomies. Some of the patients are being saved now by paramedics that would have never been made it to the hospital 20 years ago."

Today, the roles of paramedics and EMTs are as vital as those of doctors and nurses. And at places such as Ground Zero, as important as that of firefighters and police officers.

"When the disaster hit in New York City, the fire department of New York called on 24 hospital ambulance services, 18 commercial services and 40 volunteer services that were part of a mutual aid agreement," Haracznak says. "The ambulance crews worked shoulder to shoulder; it didn't matter if they were private or public or for hire or volunteer. They just did what needed to be done. They did their job and they were there for several weeks after in terms of taking care of the people that were on the scene doing rescue and recovery operations. It was an across-the-board effort that the Fire Department of New York wouldn't have done alone without the support of the private ambulance providers and the hospital-based providers and the volunteer ambulance services."

It's an effort that many are thankful for. Most of all, the residents of New York City.

Photo by A. Perry Heller