CorrectCare

Driven by Duty and Goodwill, INS Clinicians Lend a Hand
by Jaime Shimkus

The shelves of the deli on Church St. used to be lined with salads and sodas. Now they hold bandages, ointments, painkillers and myriad other medical supplies.

One of four “clinics” on the perimeter of the massive pile of smoking debris that was New York’s World Trade Center, the deli now receives a steady stream of injured heroes, seemingly tireless men and women who put themselves in danger as they labor to clear wreckage and recover victims.

Tending to their cuts, fractures and burns are equally committed teams of U.S. Public Health Service employees, including a group of 21 clinicians from INS detention facilities in the New York City area. In fact, the entire health care staff of the INS Service Processing Center in Manhattan was pitching in. The facility, on Varick St., evacuated its detainees Sept. 11 and remained closed for business at press time.

The INS Queens Detention Center lent the team its clinical director, Capt. Neal Collins, MD. He’s been working long night shifts, staying at a hotel and checking in with the Queens facility by cell phone and e-mail. He wouldn’t have it any other way.

“As horrible as we all feel about what happened, we feel very glad and privileged to be able to help those who have been working so hard on rescue and recovery,” says Collins. “Health care workers came from across the country to participate. And for those of us who live in New York, we have a sense that this is our home. The mood here is incredibly positive.”

LIBERTY AND CHURCH
Each of the four clinics serving the site has been given a one-word designation, Collins explains. Church, in the deli, is right on the edge of the pile. The West clinic is in what was formerly an American Express building. The remaining two clinics have been set up in tents and are named for the streets they’re closest to: Liberty and Vesey.

A team from the Federal Emergency Management Agency runs the whole clinical operation from a command center in a college just north of the site. “FEMA is doing a fantastic job,” says Collins. “They’re taking care of everything we need.”

The clinicians who staff the INS detention facilities are not actually INS employees. In brief, INS is part of the Department of Justice, while the chain of command for the clinicians leads to another Cabinet-level department, Health and Human Services. Deep within HHS is the Public Health Service’s Division of Immigration Health Services. Through a long-standing agreement, DIHS medical staff—PHS commissioned officers, civil servants and contract employees—are assigned to 11 INS facilities nationwide.

Collins was deployed as part of the Commissioned Corps Readiness Force, another PHS entity. “Our mission, along with supporting INS correctional health care, is to stand ready for whatever comes up,” explains Capt. Geralyn Johnson, DDS, chief of staff at DIHS. Still, CCRF participation is not mandatory, she says. “Commissioned public health officers volunteer and receive training. Then, when the Surgeon General determines that the CCRF needs to be activated, they’re ready to go.”

Another team, headed by an INS health services administrator, is doing logistical work, moving personnel and medical supplies to where they’re most needed. Medical teams don’t stay at the same clinic but are rotated. That’s to give people a break from the Church St. clinic, which gets the heaviest caseloads, says Collins.

Yet another group is assigned to computer work, entering into a huge database information supplied by families seeking missing relatives.

Collins’ group will be on duty at the site for two weeks, after which it will be relieved by another CCRF team. Johnson says PHS hasn’t set a date for discontinuing CCRF participation, although some at the agency estimate that it will be at least several weeks.

HELPING THEIR ‘BROTHERS’
After the attack, the crash site was swamped with all manner of “civilian” volunteers eager to help. A week or so later, only federal or other official personnel were allowed on the scene.

“When there’s no chance of finding anybody alive, then you settle into the grind of recovery,” Johnson says. That’s a job best left to the pro-fessionals: Untrained volunteers are more likely to degrade the investigation site and to get injured.

But the pros are getting hurt, too, and that’s where Collins comes in. “The debris is inherently unstable and it’s extremely hot—the core temperature is still 1000 degrees Centigrade—so we’re seeing lots of crush injuries and burns,” he says. Even so, the workers keep going. “They are desperate to go back to work, so we’re doing what we can to provide definitive care on site.”

If necessary, patients are sent to hospitals, but Collins has some interesting statistics on that. “Emergency room transfers were very high at first. We saw 70 when we first began to track it, and only 50 on-site treatments. But the latest numbers show only 3 transfers and 400 on-site treatments.”

Why? “On-site care is very important to the firefighters and police. They want to stay in rescue mode and find their ‘brothers.’”

That’s a poignant testament to their courage. But Johnson says that what Collins and his team do is special, too. “People who work in correctional health care already serve a very special population, but our people have rewards that extend way beyond that. They’re able to respond and help out during disasters. It’s a great thing.”

[Note: This article first appeared in the Fall 2001 issue of CorrectCare.]