The Day That the START Triage System Came to a STOP: Observations from the World Trade Center Disaster

The Fire Department of the City of New York--Emergency Medical Services (EMS) Operations is one of the largest EMS systems in the country. On a daily basis, this system responds to approximately 3,000 to 3,500 calls for ambulance requests. This equates to 1.2 to 1.5 million calls annually. As part of its response, EMS deals on a daily basis with multiple casualty and disaster-type situations. The magnitude of the attacks on the World Trade Center, however, was on a scale not previously seen by any system. This article is a case report of the September 11, 2001, incident.