Long-Awaited 9/11 Health Guidelines Released by NYC

Five years after the World Trade Center attacks, the New York City Health Department has released updated clinical guidelines to help instruct doctors how to treat first responders and other adults working on and around the World Trade Center site.

Such guidelines were considered crucial for 9/11 workers such as firefighters, police officers, constructions workers and other volunteers who have complained of respiratory illnesses ranging from asthma to sarcoidosis, a disease that scars lung tissue.

The Health Department and city of New York were criticized by politicians and labor leaders who say the guidelines should have been issued in 2001, when the first health problems started to arise. Four emergency responders who work at the site allegedly have died as a result of World Trade Center dust exposure.

"These guidelines paint a bleak picture about the health effects of 9/11, but are an meaningful step forward in helping doctors to better treat patients exposed to the toxins of Ground Zero,' said Rep. Carolyn Maloney, D-N.Y. "My only question is why has it taken New York City 5 years to release this information to doctors? I just hope that it was not liability concerns that have held it up all these years."

Rep. Jerrold Nadler, D-N.Y., said the release of the guidelines was a good step forward, but added they were too limiting in their scope. "I am particularly troubled at the inadequate attention given to the issues of contaminated indoor spaces and chronic exposure populations."

Guideline Components

In addition to recommending screening approaches to improve detection of illness associated with WTC exposures, the guidelines also will incorporate the latest available published information on physical health effects as well as new national guidelines on general treatment of respiratory disorders released earlier this year.

The guidelines also will provide information to help assess exposures, assist in diagnosis and treatment, provide preventive services and refer for consultation or specialty care.

The guidelines singled out tobacco use, stating, "The risk and severity of many WTC-related diseases are heightened by tobacco use. Exposure to secondhand smoke may also exacerbate WTC-related diseases."

The New York City Department of Health and Mental Hygiene said that it previously provided guidelines on treatment of depression, post-traumatic stress disorder and chemical dependency to clinicians in New York City. The new guidelines will update these previous guidelines, as well as previously released medical guidelines prepared by Mt. Sinai Hospital and New York Fire Department physicians, and provide physical and mental health information in one document.

"We are releasing an important document to help doctors better recognize and treat these illnesses," said Health Commissioner Dr. Thomas R. Frieden. "Doctors should ask their patients about WTC exposure, especially patients who are experiencing respiratory symptoms, reflux disease, mental health problems or substance use disorders."

"We anticipate that the updated guidelines will help health professionals diagnose and treat prevalent World Trade Center associated conditions," said Dr. John Howard, coordinator of WTC health response programs for the U.S. Department of Health and Human Services and director of the National Institute for Occupational Safety and Health. "We will help distribute the guidelines to physicians and others who are assisting individuals exposed to the WTC disaster."

Registry Survey Results

Currently, the World Trade Center Health Registry is keeping track of the long-term physical and mental effects of more than 71,000 registry participants, which include first responders (fire fighters, police officers), other city agency and private recovery workers, individuals who were working in office buildings on the morning of the attacks, school children in lower Manhattan and others who were highly exposed to the toxins resulting from the WTC disaster.

Results of the first survey conducted by the registry show that:

  • Nearly half of adult enrollees reported new or worsened sinus or nasal problems after 9/11.
  • There are high levels of psychological distress among registrants compared to the citywide average two to three years after the event.
  • More than half of 8,000 registrants who survived the collapse and/or escaped from damaged buildings on 9/11 reported new or worsening respiratory symptoms and almost all witnessed events with a strong potential for causing psychological trauma. More than one in ten (11 percent) screened positive for serious psychological distress.
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