It's been a tough week with all the 911 memorial activities. I wanted to acknowledge the 10th anniversary of what was a life changing experience for me, but it soon became an all-consuming task. My e-mailbox, as well as my Facebook page, was flooded with 911 related videos, tributes and pictures from well meaning friends. I appreciated the contributions that paid tribute to those that were lost that day, but not the ones that showed the worst of the event. I didn't really need to see pictures and videos of bodies falling from the windows. I have enough visual memories, scents, and sounds permanently etched in my mind.

Well, it's all over now, and for most Americans, 911 will slide back into the recesses of their minds.

Sunday I was invited by my old friend, Jane, who is a Deputy Chief with the Livermore-Pleasanton Fire Department, to co-write and present a piece on USARS and DMATs at Ground Zero. It was an honor. As a federal government employee with the National Disaster Medical System, it's forbidden to wear the uniform for anything but official trainings and deployments, but they made an exception in the case of 911 10th anniversary tributes. The event itself was amazing. It was in a huge theatre (almost filled to capacity) and included all branches of the military with police and fire honor guards. There were speakers, bagpipes, videos, the flag folding, and the tolling of the bell. Quite impressive. Afterward there was a very nice reception where the folks could meet the participants and the Search and Rescue dogs which included Orion, the only Ground Zero dog still alive in Northern California.
I had written this piece for another purpose, but decided to use it here instead. I looked back at the things I learned while deployed at Ground Zero - the things can still impact me today. I wanted to share them with you.

Twenty-Five Lessons from Ground Zero

Sam Bradley, BS, EMT-P

“I think the essence of life is laying down your life for others. If you’ve ever felt that no one loves you, just look at a fire truck going by. Then you’ll know that somebody does.”

Regina Wilson, firefighter, Fire Department of New York.

Quoted from the book, “Women at Ground Zero – Stories of Courage and Compassion”

by Susan Hagen and Mary Carouba.

I received a gift last year. It was one of those large patches that honors the World Trade Center disaster. Embroidered within it are the patches of FDNY, NYPD and the Port Authority. If was left for me at our county EMS agency by someone in Public Health. It was to show her appreciation for a lecture I did for the County Medical Reserve Corp on my Ground Zero experience. The focus of the discussion was on critical incident stress in disaster. I spoke to a packed house. It was nice to know that, even after 9 years, people still cared.

In thirty-two years as a paramedic, I learned how each patient interaction, no matter how mundane or redundant, creates a certain level of stress. Some reach you on a very personal level - others will change you forever. A major airline crash and responding to the traumatic arrest of one of my fellow paramedics did it for me.  Unfortunately, I discovered the meaning of post traumatic stress disorder by experiencing it.

By the time I joined a federal disaster medical assistance team in 1997, I had taken a significant amount of training in critical incident stress management (CISM). I felt prepared - better than most, I thought. It was that training that qualified me to be put in charge of CISM for the sixteen of us that responded to New York City to provide medical support for people working on the “Pile” at Ground Zero. Saying it was a life-changing experience is like saying Hurricane Katrina was a squall.

Lesson #1: It’s hard to manage someone else’s stress when you’re in the thick of it yourself.

Lesson #2: You can’t effectively defuse people (or yourself) when you’re in a “work” mode.”

Lesson #3: Everyone will react differently to events based on their individual experiences and coping skills.

Lesson #4: Going to a memorial service to honor one of the fallen firefighters was difficult, but gratifying.

Lesson #5: Meeting his family, learning more about him as a person, and making him one of our own was even better.

Lesson 6: Three horn blasts meant a body was found. Heavy equipment would be silenced and all work would stop as everyone honored the fallen. The same ceremony was repeated several times a day as firefighters walked along side a flag draped body on a gurney which would be loaded into an FDNY ambulance and taken to the morgue for processing. It was painful to watch, until I realized that one more family had closure. Most never would.

Lesson #7: Wearing steel toed boots on ground that was still 800 degrees below the surface was painful.

Lesson #8: Disconcerting can be defined by opening the back door of a treatment tent to see the headstones of a church graveyard covered in 6” of dust and the trees above decorated with brightly colored and torn clothing.

Lesson #9: It was gratifying to know how much the world cared based on the donated supplies from boots to teddy bears, and well wishes from people on the streets, for helping New York by being “out there”. We appreciated the ever-present hot meals made available to us by local restaurants and served up by local volunteer agencies. The largest pot of jambalaya I’ve ever seen was transported and cooked up by a contingent from New Orleans.

Lesson 10: The cards from children that decorated our “respite” spoke of anger, patriotism and the kind of fear that kids in this country should never have had to experience. Firefighters were their new heroes, but they also acknowledged the ironworkers, trash truck drivers and volunteers. The cards had messages of, “I hope you’re not dead or I’ll be sad”; “remember your family”; and “relax and take some time for yourself”; We didn’t.

Lesson #11: Children are smarter than adults.

Lesson #12: We were told the air we breathed probably contained the DNA of 1000 people. If so, I carry them with pride.

Lesson #13: Taking a special mission onto the Pile itself during a caving operation was the singular most intense experience I have ever had. In the deepest part of the most infamous place on the planet, it became very clear that myself, my partner Andy, and the firefighters were not alone. All I could do was tell them, “I’m sorry” ….

Lesson #14: Talking to firefighters who were already psychologically (and, most likely physiologically) crippled tore my heart out.

Lesson #15: Hot french fries and cold martinis (with three olives) after a shift at 0100 was the best part of the day. We could share experiences with the other half of the team and make peace with the events of the day ... as much as that was possible.

Lesson #16: We wrote a message to the firefighters on a plywood board the day we demobilized. We learned later that teams that came after us followed our lead (and the team before us). That board was secured, sealed in Plexiglas and was transported to Atlanta for our annual conference the next year. My handwriting is now in a museum somewhere.

Lesson #17: Trying to assimilate back into “real” life was extremely difficult.

Lesson #18: I was really pissed then.

Lesson #19: I still am.

Lesson #20: When it comes to Ground Zero, emotions still sit very close to the surface.

Lesson #21: The person that left Northern California in October of 2001, isn’t the same person that returned two weeks later. My temper is shorter, I’m much more skeptical, and I have way less tolerance for stupidity.

Lesson #22: Disaster workers aren’t easily discouraged, even in the worst of times. A few of those that deployed with me have left the team and disaster work. Others went on to experience other deployments like Hurricane Katrina and the Haiti Earthquake. Disaster work is what they live for.

Lesson #23: Each disaster takes a piece of our sanity, yet we’re driven to go back for more.

Lesson #24: I’d do it again in a heartbeat.

Lesson #25: Memories of feelings, sounds, and odors from Ground Zero live in the far reaches of my mind, but, comparatively, I’m lucky. I met a pastor from Iowa several years ago. He had also been at Ground Zero. At the time I met him he would become incapacitated whenever he heard heavy earthmoving equipment, music he associated with a movie about Ground Zero, or three blasts of a horn. He has recovered, although not completely.

Am I still angry? Yes. Why? Because 343 firefighters, police and EMS people died along with thousands of civilians? That responders still need to have government physicals every year to see if the poisonous air we breathed has turned our cells to cancer? That too many Americans have forgotten that day like it was just another bad “B” movie? That we hear more about a pop star’s latest addiction or infidelity more often than the ongoing suffering of those firefighters and their families? Because there are radical extremists that still focus their lives on destroying ours because they don’t agree with our way of life? That good Muslims are chastised for the acts of a few radicals? Yeah ... all of the above.

It mattered to me that people came to the meeting that night to listen to my story.  To know that firefighters, law enforcement, EMTs, paramedics, nurses and docs are willing to go out there every day and brave those dangers, face their demons, and fight the good fight tells me that the bad guys will never win. They can take our lives, but not our spirits. They sought to weaken us with fear, but initial shock turned to resolve and a level of patriotism this country hasn’t seen in a long time. I am proud to have had the honor to take care of those heroes at Ground Zero and form a posthumous friendship with a young firefighter that died way too soon on September 11, 2001. We’re still in touch with his family. Christian, you will always be in my heart.

This brings home the importance of being physically and mentally prepared for what we face, not just in disaster work, but every day on the streets and in our ERs. Situational awareness can’t be taken for granted. The bad guys are still out there and first responders are their targets. That’s why I believe in the efforts of all the experienced professionals who strive to make sure that every cop, firefighter, disaster worker and medical practitioner is aware, well-trained, and safe. It’s a new world … a much more dangerous one, and we need to prepare each other for 21^st century threats.

Stay safe out there!