Most Americans can recall how following the September 11^th attacks, the nation changed overnight. The attacks impacted everything from how we navigated airports, to how Americans conceptualized national security, shaping the 21^st century for the two decades to come.

As Americans reimagined their lives in the face of these new threats, leaders at Nantucket Cottage Hospital were reimagining their role in Nantucket’s emergency preparedness.

“Before 9/11, hospitals used to be isolated organizations, when we thought about emergency management, we planned solely for ourselves, there was no interagency coordination, no system-level thinking for how to respond to a crisis,” said Martha Lake-Greenfield, NCH’s Emergency Department Manager from 1996 to 2020. “In the wake of 9/11 it became evident that we all had a role to play in emergency management, from your government agencies, to local hospitals and even individuals.”

In the years following the attacks, the Department of Homeland Security developed the National Incident Management System (NIMS), a comprehensive approach to coordinating government and private sector partners during disasters and emergencies.

“We had been working to develop a common emergency management language amongst our government partners before 9/11, but after the attacks, as more incidents happened, we began to develop that common language and common mission by using NIMS,” said Lake-Greenfield.

Today, every staff member at NCH undergoes NIMS training through the Federal Emergency Management Agency (FEMA), to ensure that in the case of an emergency, all staff members understand their role and responsibilities during a worst-case scenario.

“We always build our plans off a worst-case scenario because that’s when we can identify issues like staffing, stress and resource constraints,” said Georges Beckford, a New York firefighting veteran and Nurse Educator at NCH. “During a disaster, some people naturally respond well, and some collapse, that’s why its so important to train and prepare your team so they have that experience to fall back when a disaster strikes.”

In the decades following the September 11^th attacks, NCH has consistently worked with public and private partners to ensure a high degree of preparedness should a disaster ever strike Nantucket.

“When I first came to NCH, the largest emergency incident we had was a porch collapse, after 9/11 we went from preparing for porch collapses to preparing for plane crashes,” said Lake-Greenfield. “We started to run more and more drills, when there was a major event on Nantucket, we would physically take out the supplies we would need and run through how we would use them during a crisis.”

One of the most significant changes since the attacks, according to Beckford, is the level of interest the public has in playing their part during disasters.

“All the knowledge we were developing as first responders or clinicians we would turn around and give it to the public,” said Beckford. “The public began making emergency kits, learning first aid and had an enormous appetite to learn about what they can do to prepare themselves and their families for an emergency. This preparedness meant that patients could be stabilized well before they arrived in our emergency room.”

Two decades after the September 11^th attacks, Americans are more prepared than ever to respond to a disaster, both through individual desires to stay safe during an emergency, but also through the lessons learned over decades of training and responding complex emergencies. Nowhere is this refined preparedness more evident, than in today’s hospitals, as we emerge from one of the most complex crises demanding interagency support, and public understanding.

“COVID-19 has reiterated this need for preparedness, today, everyone from our housekeepers to our labor and delivery nurses are trained in emergency management, because as we’ve seen during these last 18-months, we expect everyone to play their role during a crisis,” said Lake-Greenfield.