All hail our second responders

NURSE Pat Crowley has worked at Temple University Hospital long enough to expect certain emotional reactions from patients in the emergency room of the Level One trauma center.

Grimaces, wails of pain, frantic yelling from relatives who've sped to the hospital after learning that a loved one has been shot. Impatience, fright, tears.

But the victims of Tuesday's crash of Amtrak Train 188 were eerily mute, their faces blank, their eyes dry and unblinking.

"That image has stayed with me," says Crowley, who has seen a lot of traumatized people in his medical career - first as a Philadelphia firefighter and paramedic, now as an ER nurse at Temple.

"They had no expression. They could've been in line to buy movie tickets. All the noise was coming from around them.

"We were shouting to each other: Do this! and Do that! But they were silent. I can still see them, in a line that went out the door. Some were standing, or leaning against somebody, or in wheelchairs. They were bloody, dirty, no shoes, their suits half-off, covered in soot, like they'd been in a fire. They were so quiet."

Even when they began to describe their ordeal - they'd crawled over bodies, climbed out broken windows, gagged on the grit that that thickened the air at the Frankford crash site - there was still disbelief:

This isn't supposed to be happening, but it is. I'm supposed to be on a train, but I'm not. I'm bleeding, and I'm in a hospital in a city where I don't know a soul.

"The shock of it was really something to witness," says Crowley. "We see a lot of blood and guts here. We calm a lot of emotion. But I'd never seen something like that before. It tripped me out."

Of the 150 victims treated at Philadelphia hospitals following the derailment that killed eight, 54 were taken to Temple. Near 5 p.m. yesterday, nine remained there - five of them in the ICU with chest and lung injuries and fractures.

Also by yesterday, hospital workers across the city were humbly accepting praise for their work that awful night. The mayor held a news conference to formally thank all emergency workers - first responders, like police and fire/rescue; and second responders, like hospital workers - who calmed the chaos. And U.S. Sen. Bob Casey toured Temple's ER to "listen and learn and be inspired by the really miraculous work that was done here."

"I couldn't do their job for 20 minutes," he said afterward.

I doubt many of us could. I said as much to Temple's ER nurse manager Michele Jones when I visited the hospital yesterday, to ask what it's like to work at a trauma center when catastrophe hits. She says her staffers have been "overwhelmed" by the media attention for something they do routinely, albeit on a much smaller scale.

"It's awesome and amazing," says Jones, who was summoned to work that evening, where she joined those who'd rushed in, unbidden, when they heard about the catastrophe. They joined staffers who, instead of going home when their shifts ended at 11 p.m., stayed through the night to tend to patients - and each other.

"It's awesome to see that everyone has a purpose, they know what to do, they move into place, they're self-directed and it all comes together. It's the result of constant drills and training. And it's amazing because, in the middle of it, you get the sense that, wow, this is what we do every day. You can lose sight of that."

Fortuitously, only three weeks ago Temple opened a spacious, new ambulance area behind the ER to accommodate 12 emergency vehicles at once - a life-saving replacement of the old three-spot drop-off site. The expanse was a godsend on Tuesday as vehicle after vehicle - most of them police squad cars - roared in to deposit the injured. Staffers had set up a triage site outside the ER entrance, where they color-coded patients by condition: red (life-threatening injuries), yellow (serious, but stable) and green (probable discharge after treatment).

Of the new ambulance bays, says Jones, "You sometimes think there's a higher being who puts things in place the way they need to, because that space made all the difference for us."

Temple's ER can accommodate about 48 patients at a time. But the unit was full when the announcement came, via an overhead speaker, that victims from a train accident would soon arrive.

"So your mind immediately starts working," says Crowley. "Mentally, you think, OK, it's a train - so there's a lot of metal, it's moving fast, there's no air bags. So you imagine the kinds of injuries you'll see: You're thinking amputations, lacerations, blunt trauma and, of course, penetrating trauma. You're preparing for the worst before they even come in the door."

But first the staffers had to make room in the ER. They feverishly set about discharging patients who were ready to go home, moving others to inpatient rooms. Transport workers dashed around collecting stretchers and wheelchairs. Thank goodness, no gunshot patients had come in that evening - Temple averages four a day - so the trauma bays were ready.

"And then you just do what you always do," says Crawley. That includes treating noncrash patients who come to the ER and whose conditions can't wait until the crash victims are treated.

Anyone who has seen photos of the mangled Amtrak cars has marveled that more people did not die. I think the fatalities might have been even higher if the crash hadn't occurred so close to Philly's top-notch medical centers. Temple treated the most victims, but praise also is due to Episcopal Hospital (a Temple campus), Einstein Medical Center, Thomas Jefferson University Hospital, Aria Health's Frankford and Torresdale campuses, Hahnemann Hospital and Penn Presbyterian.

Still, what Temple managed to pull off - 54 trauma patients treated in two hours at one place - looks staggering to me. But Robert McNamara, Temple's chief medical officer and chair of emergency medicine, says it's simply what his people have trained for.

"Nothing unusual came in: This wasn't a chemical spill or a radiation emergency," he says modestly. "This was bread-and-butter trauma medicine that we handle all the time, but it was in greater volume."

Temple's emergency-medicine program is huge: 36 residents and more than 40 faculty physicians staff the ERs at Temple's North Broad and Episcopal Hospital campuses. They treat more than 140,000 adults and 15,000 children each year - more than any other Philly medical center.

"When our residents leave here, there is no emergency they can't handle," says McNamara. The day after the crash, he'd told his staff: "I am not surprised you did what you did, because I knew you could. But I am still proud that you did it."

McNamara also was moved Tuesday by how kind some victims were, urging that others be seen before themselves. One man whose arm was seriously mangled insisted that another victim be tended to first.

"They were very altruistic," he says. "This disaster was not just an example of responders going above and beyond for each other and for the patients. The patients themselves did, too. It was extraordinary."

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