When terrorists flew the planes into the World Trade Center towers three years ago, the nation watched as medical personnel gathered at New York City’s emergency rooms waiting for casualties to stream in. Unfortunately, the catastrophic nature of the attack left little for the doctors, nurses and paramedics to do. But, even before the Sept. 11, 2001, attacks, a nationwide initiative called Project ER One brought together 200 experts to make recommendations on how to make emergency rooms (ERs) better able to prepare for large-scale disasters, such as terrorists attacks.

The federally funded project started in November 2000 and involved MedStar Emergency, Washington D.C., in collaboration with other medical centers, universities, non-governmental organizations and federal agencies. The first of two phases "was to compile design features and specifications that hospitals could use as solutions to ER limitations," says Dr. Michael Pietrzak, director of Project ER One at Washington Hospital Center. The group came up with over 700 suggestions. The individual hospitals did a vulnerability and hazard assessment to choose those features specific to their site and mission, Pietrzak says.