AK: I think you do wind up downgrading them just because in the emergency department it’s a much more controlled situation. You have better light, you get the patients fully undressed, you can have a conversation with them, and you can see them in the context of everybody else as well. They may have had interventions already that had stabilized them to the point that they were able to be downgraded a little bit.

KK: So with more resources, a more controlled environment, and perhaps even more extensive training, it is reasonable to say, “We can slow this down a little bit and take a more detailed look.” How has this affected you personally?

AK: I don’t want disasters to happen, but when they do, I want to be able to help. A large part of me really wanted to be in the field rather than in the emergency department, but I recognized that I was really able to facilitate things. The deployments that I’ve been on so far with Pennsylvania Task Force 1 have been natural disasters where we’ve deployed to pre-stage for hurricanes, and then I responded and deployed for Superstorm Sandy. What I saw was a lot of property damage but not a lot of injured patients. Then there’s the issue of why this even happened. Everyone knows why a hurricane happens. It’s a natural disaster. An earthquake or a tornado, it’s nobody’s fault, but this disaster had a very human factor in it, and we still don’t know exactly what caused the incident. Nobody knew if it was an intentional act of terrorism, if it was accidental, or if there was someone or something that would ultimately be shouldering the blame. This gives the disaster an additional emotional component that I hadn’t experienced in my natural disaster responses.

On a side note, I’ve used the term “so-and-so is a train wreck” throughout my career; I will never say that again without thinking of this incident. This really gave meaning to the term.

KK: What kind of emotional support did you provide for the patients? Were social services available?

AK: I pointed out to our emergency managers that all of the people who were now in the department from the accident were actually in transit. They weren’t from Philadelphia. They didn’t know the area, and they certainly didn’t intend to stay there that night. So we set up a hospitality center. We talked about helping them get cell phone chargers and making arrangements for housing or for other means of transportation for those who were discharged from the emergency department. There were a lot of people from European countries and East Asia who use rail travel as their means of transportation probably more than your average American. We used our translation language line and other resources.