It was dark on Sept. 12, 2001, when Christian Strachan, MD, an emergency medicine doctor — and a young father who hastily arranged babysitting for his 2-year-old son — arrived at Ground Zero. As the medical manager for Indiana’s FEMA-sponsored search-and-rescue team, Strachan had traveled through the night with a police-escorted convoy across 700 miles from Indianapolis to Lower Manhattan.
“It was pretty eerie,” he recalled. “One of my first memories is walking through a local graveyard in the middle of New York City, just covered in these mounds of dust.”
Strachan had just graduated from his combined emergency medicine/pediatrics residency at the Indiana University School of Medicine, where he is now an associate professor of clinical emergency medicine while serving as chief medical officer for the Adult Academic Health Center at IU Health. His role on the team at Ground Zero was to keep rescue workers healthy as they searched for victims.
To this day, the sight of picker trucks, the smell of diesel fumes and the sound of construction machinery can trigger haunting memories. Everywhere was the smell of death.
“9/11 is not something that is a fond memory for me; it’s not a fond memory for anybody,” said Strachan. “Twenty-five years later, I can talk about it — a little.”
As the nation marks a milestone anniversary of a day that forever changed the world, Strachan continues the difficult but rewarding work of disaster medicine, a field which, like a phoenix, emerged from the ashes of the Twin Towers.
Nearly 3,000 people were killed in the September 11 terrorist attacks. Since then, more than 2,000 others have died from illnesses related to breathing the toxic dust at Ground Zero, including members of Strachan’s team with Indiana Task Force 1.
“The thing I remember most,” said Strachan, “is that we were searching in a chaotic environment — it’s super loud — but when we found a victim, the chaos diminished to an eerie quiet. Everything stops. All the machines stop out of respect. And we would allow FDNY to bring the victim out because it was their city …
“And then, you know, within several minutes after extracting the victim, then the chaos resumes. The noise resumes. But that quietness is pretty etched in my mind.”
How IU is preparing doctors for disasters
Disaster medicine sits at the intersection of emergency clinical care and public health infrastructure. While the American Board of Emergency Medicine just approved standards for its disaster medicine certification earlier this year, the IU School of Medicine has been training physicians in this emerging subspecialty for over a decade.
The Disaster Medicine Fellowship has seven core faculty members who, collectively, have served on response teams for an array of regional and national disasters — everything from major hurricanes, tornadoes, floods and wildfires to structure collapses, riots and pandemics.
Mark Liao, MD, was in high school on Sept. 11, 2001, and remembers the sense of helplessness he felt, prompting him to enlist in the military. Today he is the medical director for Indianapolis Emergency Medical Services, and he has also served on Indiana’s FEMA task force. At IU School of Medicine, Liao directs the EMS Fellowship and is on core faculty for disaster medicine.
While EMS and disaster medicine often overlap, Liao explained the nuances that make them distinct subspecialities within emergency medicine.
“EMS is a daily rhythm of a city — every day, we see heart attacks, stroke, breathing issues and trauma,” he said. “In a disaster, which by its nature is a low frequency but very high consequence event, it dramatically magnifies health inequities and vastly increases risk to the vulnerable. Being prepared for both the daily heartbeat of the city and the possibility of a major disaster means balancing resources and training.”
Each year, Liao organizes a Disaster Day simulation for emergency medicine residents and fellows at the Indiana National Guard’s Muscatatuk Urban Training Center in Southern Indiana.
“The challenge we have is not to fall into preparing only for the ‘disaster of the week’ — something that is trendy or hot, but otherwise not representative of realistic risks to our community,” Liao said. “Instead, it is better to do an all-hazards approach where we prepare for a wide range of risks.”
While disaster medicine might involve rushing to the scene of chaos, it’s more about preparing, planning and strategy, said Daniel O’Donnell, MD, who serves the community as chief of Indianapolis EMS and is a professor of clinical emergency medicine and EMS division chief at the IU School of Medicine. He’s seen countless disasters, including treating victims of the 2011 Indiana State Fair stage collapse and the deadly 2012 Henryville, Indiana tornadoes, where he deployed with the local FEMA team.
“When you get that call, you have to slow down for a second,” O’Donnell said. “Because you have to start thinking from the physician side, ‘What’s the plan I need to make to be able to provide medical in this situation?’ Especially with search and rescue, you’re going down to areas that have been devastated, so a lot of times, their medical infrastructure is also taking a major hit.”
Roxanna Lefort, MD, MPH, a 2020 graduate of the Disaster Medicine Fellowship, now directs the program. She and the current fellows serve as medical advisors for the Indiana District 5 Healthcare Coalition, a collaborative network that coordinates emergency preparedness, response and recovery efforts for central Indiana.
“We are experts in determining and coordinating best practices for resource-poor situations,” Lefort said, “whether that be a short-term shortage of operating rooms, surgeons or blood during a mass shooting, or a prolonged shortage of pediatric or other specialized nurses or ventilators in a pandemic.”
The fellows also design projects for medical students in the Disaster Medicine Elective, and they frequently participate in simulations with local disaster management agencies including Indianapolis EMS, county health departments, fire departments, trauma hospitals and TSA at the Indianapolis International Airport.
During a recent training event, Disaster Medicine Fellow Eshwar Kishore, MD, climbed into an isolation pod for an infectious disease simulation with the IU Health Methodist Hospital Special Pathogens Unit. He also serves as a disaster action team specialist with the American Red Cross and has helped with house fires, floods and other severe weather events.
“My training with Indiana University at the local, community, regional, state and federal levels has culminated in my growing expertise as a leader in healthcare resilience, public health-informed mitigation and preparedness, and Midwestern disaster operations,” said Kishore.
He is completing the two-year fellowship pathway that includes earning a master’s in public health through the IU Fairbanks School of Public Health.
“With disaster medicine, we really start thinking about medicine for the greatest good, and that very much ties into public health,” noted Lefort.
Calling the courageous: ‘They run toward disaster’
Practicing disaster medicine means rushing to chaotic scenes to deliver medical care under extreme conditions.
“I tell people when they come in: There’s a little risk associated with this,” said Strachan, who has struggled with his own health challenges related to his service at 9/11. “We’re trained to go into the ‘pile,’ into a void, to go and assess patients in that austere environment. That’s our job.”
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Along with 9/11, Strachan has deployed to about 20 disaster zones over the course of his 30-year affiliation with Indiana Task Force 1. One of the harshest environments was the aftermath of Hurricane Katrina, centered in New Orleans in 2005, a natural disaster that claimed the lives of more than 1,800 people.
On that mission, Stachan’s team “slept in sweat on asphalt” in a parking lot tent after working 12-hour days. It took a toll on morale. Strachan focused on “feet, heat and what not to eat” in his attempt to keep his team healthy.
“You learn something every time you go out,” he noted of the progressive advancements in the field.
Before 9/11, there was little awareness of post-traumatic stress disorder and other mental health impacts that can come from compartmentalizing emotions while sifting through a scene of mass destruction and death in search of survivors. Now critical incident stress management is a standard practice for all disaster rescue teams.
September 11 also exposed the need to assess environmental hazards and take actions to mitigate their long-term health impacts. Breathing in the dust cocktail of crushed concrete, asbestos, heavy metals and other toxins has led to thousands of deaths and chronic health conditions for first responders.
When Strachan was called to the Surfside Condominium collapse in Miami 20 years later, a hazmat team was deployed, and rescue workers took his directives to wear respirators much more seriously, he said.
Along with its inherent risks, the field of disaster medicine also comes with a great reward: witnessing communities come together.
“I am always impressed about the resiliency of communities — neighbors helping neighbors,” said Liao, who deployed to the deadly Lahaina wildfires on the Hawaiian island of Maui in 2023. “It reminds me the power of humanity, because deep down, people care for people.”
The type of people who choose a career in disaster medicine are passionate about helping, said O’Donnell.
“I think those are people who really want to challenge themselves, stepping out of their comfort zones and wanting to have a bigger impact than they would in their normal clinical lives,” he said.
Lefort said she is inspired daily by her trainees in disaster medicine: “I see learners who are courageous, fearless, strong leaders, advocates for vulnerable populations, and the type of people that run into the fire and not away from it.”
For Strachan, racing off to Ground Zero — and to all the other disasters that have followed — comes down to this: “It’s a mission to serve our community and our nation.”
