The World Trade Center Disaster and the Health of Workers: Five-Year Assessment of a Unique Medical Screening Program

Abstract

BackgroundApproximately 40,000 rescue and recovery workers were exposed to caustic dust and toxic pollutants following the 11 September 2001 attacks on the World Trade Center (WTC). These workers included traditional first responders, such as firefighters and police, and a diverse population of construction, utility, and public sector workers.MethodsTo characterize WTC-related health effects, the WTC Worker and Volunteer Medical Screening Program was established. This multicenter clinical program provides free standardized examinations to responders. Examinations include medical, mental health, and exposure assessment questionnaires; physical examinations; spirometry; and chest X rays.ResultsOf 9,442 responders examined between July 2002 and April 2004, 69% reported new or worsened respiratory symptoms while performing WTC work. Symptoms persisted to the time of examination in 59% of these workers. Among those who had been asymptomatic before September 11, 61% developed respiratory symptoms while performing WTC work. Twenty-eight percent had abnormal spirometry; forced vital capacity (FVC) was low in 21%; and obstruction was present in 5%. Among nonsmokers, 27% had abnormal spirometry compared with 13% in the general U.S. population. Prevalence of low FVC among nonsmokers was 5-fold greater than in the U.S. population (20% vs. 4%). Respiratory symptoms and spirometry abnormalities were significantly associated with early arrival at the site.ConclusionWTC responders had exposure-related increases in respiratory symptoms and pulmonary function test abnormalities that persisted up to 2.5 years after the attacks. Long-term medical monitoring is required to track persistence of these abnormalities and identify late effects, including possible malignancies. Lessons learned should guide future responses to civil disasters.

The World Trade Center Aftermath and Its Effects on Health: Understanding and Learning Through Human-Exposure Science

“…Pulmonary functions demonstrated greater reductions than expected in either normal or cigarette-smoking populations. These findings corroborate its initial publication in the Morbidity and Mortality Weekly Report and the studies already published by FDNY and the WTC Health Registry (36).…”

“…In addition, more than half had persistent psychological symptoms, with risks for PTSD 4× the rate in the general male population (30). Recently, Mount Sinai reported its findings in 8000 non-FDNY WTC rescue workers and volunteers (36). Seven out of 10 reported new or worsening respiratory symptoms persisting several years after 9/11.…”

On the Role of Poison Centers in Radiation Emergency Preparedness and Response Activities: Findings of the “Radiation Emergencies Public Health Roundtable” (Atlanta, GA—August 2012)

“…Poison centers also can perform follow-up activities over time and potentially work with allied toxicology clinics that are part of the Association of Occupational and Environmental Clinics (AOEC). A similar procedure involving AOEC was established for follow-up activities of first responders to the 11 September 2001 attacks [11]. As identified by roundtable participants in their next steps, it is critical that PC efforts be integrated with the efforts of other response and public health agencies like state and local health departments through ongoing communication and advance planning.…”

Firefighters: psychopathology and working conditions

“…Therefore, it is not surprising that a significant percentage of firefighters develop mental disorders subsequent to traumatic experiences (Bennett et al, 2005; Centers for Disease Control and Prevention, 2006). Firefighters were studied among the 40,000 professionals who flocked to aid the victims of the World Trade Center disaster, in the United States, on September 11, 2001 (Herbert et al, 2006). These workers were exposed to dust and toxic products, 69% of the respondents developed respiratory difficulties, with symptoms persisting more than 2 ½ years after the attacks.…”