The attacks on New York and Washington in 2001 changed American life in so many ways.
And that includes how big emergencies are handled.
"As soon as I heard the second tower was hit, I knew it was terrorism," remembers Dr. David Jaslow, an emergency physician at Einstein Medical Center.
Minutes after the attacks in New York, Dr. Jaslow packed his emergency gear, kissed then 3-year-old Josh and 5-month-old Sarah goodbye, and left with the Pennsylvania Urban Search & Rescue team.
Even those seasoned rescuers were stunned by what they saw -
"We saw the plume of smoke, and no buildings. The bus was dead quiet."
Over the next 8 days, Dr. Jaslow says, "I saw a lot of horrible things, did a lot of crying while I was there. But I tried to focus on the future."
And 9/11, and the unrelated anthrax attacks that fall indeed became a turning point in emergency medicine.
Doctors of all specialties had to learn about chemical and biologic threats they never expected, and there is now a certified "disaster medicine" specialty.
Hospital and community disaster drills are larger, and incorporate healthcare workers from new areas, such as housekeeping and food preparation. The drills take their lessons from real-life disasters, such as the bombing of a train station in Madrid, the multiple terrorist strikes in Mumbai, and the devastation of Hurricane Katrina.
Hospitals no longer exist, or train by themselves.
"We work together as a team to respond to these things now," say Tom Grace, who heads up emergency preparedness for the Delaware Valley Healthcare Council - the area's hospital association.
One major element of that preparedness is the SMART team - the Surge Medical Assistance Response Team.
With the equipment in these trucks, the 200-member volunteer team can answer any large-scale emergency, even one needing a 50-person field hospital.
"We can do emergency department level care, we can do general care of patients, or we can go into the full ICU level care with ventilators, cardiac monitors, suction, oxygen," and more, says Grace.
The SMART team isn't waiting for a national emergency to use their skills.
Parts have already seen action - providing emergency power for a hospital which lost its electricity AND its backup, and sheltering elderly residents of a rainstorm-damaged nursing home.
On a smaller scale, Dr. Jaslow has created an E-R in an SU. It has everything from ultrasound to antidotes for hazardous materials.
"We're completely self-reliant," he says. "We have all our own protective equipment, we have a computer with wireless access. We even carry our own prescription pads - we can actually write prescriptions to replace people's drugs right on the scene."
Units like the SMART team have put this area far ahead of others in the U-S in emergency response. But both Grace and Dr. Jaslow says we can't afford to wait for the next 9/11.
"The whole emergency response community is prepared totally differently than it was 10 years ago," says Grace.
Dr. Jaslow note, "We're all kind of in this together as a country."