25 Years later: Lessons in emergency preparedness

"Nurses came. Surgeons came. Anesthesiologists came. Everybody came. It was all hands on deck."

Christine Wade, vice president of Surgical and Procedural Services at The University of Texas Medical Branch (UTMB Health), remembers staff members showing up at the New Jersey hospital where she was working as an emergency department nurse on Sept. 11, 2001.

"Everyone wanted to help. I just remember us all standing there, waiting."

They gathered in the ambulance bay, expecting patients from New York City. The hospital had activated its mass-casualty response and was preparing for an overwhelming number of injured people.

But the patients never came. As the hours passed, the reason became clear.

"People just weren't coming," Wade said. "Nobody ever came. There was no one to save."

What happened that day shaped how she has approached emergency preparedness throughout her career.

Lessons from 9/11

Wade had started graduate school in New York City the day before the attacks. When the scope of what had happened became clear, her hospital activated its mass-casualty response. Staff came in and prepared for patients who never arrived.

"The feeling of being attacked on your own soil is something I'll never forget," she said.

She also remembers the people who responded that day.

Firefighters entered the World Trade Center as others were trying to escape. Healthcare workers showed up at hospitals throughout the region, ready to help.

Emergency departments can be chaotic by nature. Wade said nurses and physicians often become calmer as situations become more serious because experience helps them recognize what needs attention and where to focus.

Learning to lead in uncertainty

Wade spent about a decade working in emergency departments in New Jersey, including at a major trauma center near New York City. Emergency nursing required her to make decisions quickly and adapt as situations changed, often while caring for patients with complex, life-threatening injuries.

Those experiences helped shape the way Wade approaches leadership. In emergency care, preparation matters, but so does the ability to respond when circumstances don't go according to plan.

Preparedness at UTMB Health

Wade joined UTMB in 2012 after spending much of her career in emergency and trauma care. Since then, she has held leadership roles in clinical operations and emergency services, including overseeing the Galveston and League City emergency departments and helping develop the UTMB Health infectious disease biocontainment program.

The UTMB Health Galveston Campus is home to a Level I Trauma Center that serves as the lead trauma facility for a nine-county region of Southeast Texas and provides around-the-clock access to trauma specialists and emergency resources. It is also the only Level I trauma center in the region that is an American Burn Association-verified burn center.

The emergencies that reach UTMB Health take many forms. Hurricanes require planning for ride-out operations while maintaining emergency services. Fires may require rapid evacuation of patients. Other incidents, including active shooter situations and mass-casualty events, require a coordinated response across the institution.

UTMB Health prepares for a broad range of threats, including hurricanes and other severe weather, industrial incidents, and cyberattacks.

"Our location presents a complex risk profile, and we face a diverse range of potential emergencies," said Dylan Lancaster, associate vice president of Institutional Preparedness at UTMB. "Beyond planning and drills, that gives us valuable real-world experience responding to many different types of incidents and helps us continually test and refine our preparedness efforts."

The UTMB emergency management program takes an all-hazards approach that includes risk assessments, emergency operations planning, training, exercises, continuity planning, and disaster recovery.

Much of that work takes place before an emergency begins. Teams need to understand their roles, leaders must be prepared to make decisions, and communication systems must function under pressure.

For Wade, that is the enduring lesson of 9/11. No organization can know exactly what the next emergency will look like. It can, however, build the experience and systems needed to respond.

Passing the experience forward

The 25th anniversary of 9/11 has made Wade think about the nurses entering the profession today.

Some were not yet born when the attacks happened.

She compares that distance to the way her generation learned about Pearl Harbor.

"We know it was terrible. We know what happened," she said. "But it's different from having lived through it."

For Wade, remembering 9/11 means remembering the people who responded.

She remembers the firefighters who ran into the towers and the healthcare workers who showed up at their hospitals. She also remembers standing in that ambulance bay with people who were ready to help, even though none of them knew what the next few hours would bring.

That memory continues to inform how Wade approaches preparedness at UTMB Health.

Today, teams across the health system regularly train and participate in emergency exercises for scenarios ranging from severe weather and mass-casualty incidents to threats that may be harder to anticipate. The preparation gives teams an opportunity to practice their roles, test response plans, and identify areas for improvement before a real emergency occurs.

Twenty-five years after standing in that New Jersey ambulance bay, Wade still carries the lesson with her.

"I truly believe the only thing that saves you in those times is how much you've practiced and prepared," she said.