Injury, Illness Rates High Among Rescue Workers After WTC Attacks

Nearly 11,000 FDNY firefighters and emergency medical service personnel were exposed to physical and mental hazards following the attacks of September 11 and subsequent rescue and cleanup operations. A new study finds a substantial increase in respiratory and stress-related illnesses among those workers.

The collapse of the WTC towers and several adjacent structures resulted in a vast, physically dangerous disaster zone. The height of the WTC towers produced extraordinary forces during their collapse, pulverizing considerable portions of the buildings' structural components and exposing first responders and civilians to substantial amounts of airborne particulate matter. Fires burned continuously under the debris until mid-December 2001.

"Injuries and Illnesses Among New York City Fire Department Rescue Workers After Responding to the World Trade Center Attacks," published in a special edition of the Morbidity and Mortality Weekly Report, describes morbidity and mortality in FDNY rescue workers during the 11-month period after the WTC attacks. The substantial increase in respiratory and stress-related illness compared with the time period before the WTC attacks "demonstrate the need to provide acute and long-term medical monitoring, treatment, and counseling to FDNY rescue workers exposed to this disaster and to solve supply, compliance and supervision problems so that respiratory protection can be rapidly provided at future disasters."

During the collapse, 343 FDNY rescue workers died and, during the next 24 hours, an additional 240 FDNY rescue workers sought emergency medical treatment. The report, which can be found at www.cdc.gov/mmwr/mmwr_wk.html, includes all reported injuries/illnesses during the 24 hours following the attacks. Traumatic injuries are reported for the three months after the attacks because many workers did not report their injuries initially so they could participate in the rescue effort. Respiratory and stress-related illnesses are reported for the 11 months after the attacks because onset might be delayed or influenced by repeated exposures. Stress-related illnesses include post-traumatic stress disorders, depression, anxiety disorders and bereavement issues.

During the first 24 hours after the attacks, most (63 percent) of the rescue workers who sought emergency medical treatment for eye irritation, respiratory tract irritation and exposure (any combination of mild exhaustion, dehydration and eye and respiratory tract irritation) and did not require hospital admission. Of 28 FDNY rescue workers who required hospitalization, 24 had traumatic injuries including 17 with fractures, four with back trauma, two with knee meniscus tears and one with facial burns. Three FDNY rescue workers required hospital admission for life-threatening inhalation injuries. Eight FDNY rescue workers were evaluated for chest pain, and one EMS worker was admitted for suspected myocardial infarction; after evaluation, none was found to have coronary artery disease.

Researchers found the incidence of crush injuries, lacerations and fractures during the month after the attacks increased by 200 percent compared to injury averages before the WTC attacks, but soon returned to levels similar to those observed before the attacks.

During the 48 hours after the attacks, approximately 90 precent of 10,116 FDNY rescue workers evaluated at the WTC site reported an acute cough often accompanied by nasal congestion, chest tightness or chest burning; only three FDNY rescue workers required hospitalization. Compared with numbers of service-connected, respiratory medical leave incidents during the 11 months preceding the attacks, the number of respiratory medical leave incidents increased five-fold during the 11 months after the attacks. During February 2002, the incidence of new respiratory illness requiring either medical leave or light duty began to decrease and during May 2002 began to approach pre-attack incidence.

During the six months after the attacks, 332 firefighters and one EMS worker had WTC-related cough severe enough to require more than four consecutive weeks of medical leave. Despite treatment of upper and lower aero-digestive tract irritation (i.e., sinusitis, gastroesophageal acid reflux or asthma), 173 (52 precent) of the 333 workers show only partial improvement of WTC-related cough and remain either on medical leave or light duty or are pending a disability retirement evaluation.

As of August 28, 2002, a total of 358 firefighters and five EMS workers remained on medical leave or light duty assignment because of respiratory illness that occurred after WTC exposure. On the basis of applications for respiratory disability retirement benefits during the preceding 6 months, an estimated 500 FDNY firefighters (4 percent of the 11,336 total FDNY firefighter workforce) might eventually qualify for disability retirement because of persistent respiratory conditions.

"The high incidence of respiratory problems and related medical leave among FDNY rescue workers demonstrates the need for adequate respiratory protection," commented researchers, who revealed that during the collapse, 52 percent of workers did not wear respirators and 38 percent did not wear respirators for the rest of the first day.

"In addition," they added, "most of those reporting the use of a respirator during the first day used only a disposable paper dust mask that was neither NIOSH-certified nor fit-tested."

During the 11 months after the attacks, 1,277 stress-related incidents were observed among FDNY rescue workers, a 17-fold increase compared with the 75 stress-related incidents reported during the 11 months preceding the attacks. As of August 28, 2002, a total of 250 FDNY rescue workers remain on leave with service-connected, stress-related problems. Of these, 37 also have respiratory problems.

During the three months after the WTC attacks, medical leave incidents increased for eye irritations, fractures, crush injuries and lacerations but decreased for other traumatic injuries.

"These findings probably resulted from 1) lack of adequate eye protection against fine airborne particles, 2) inability of work gloves to reduce injuries while maintaining comfort and dexterity, 3) effective use of thermal personal protective equipment despite an extremely hazardous environment, 4) prevention of major injuries because of safe work practices, and 5) underreporting of minor injuries because of the dedication of this workforce to remain on the job at the WTC site," said researchers.

They added that despite "widespread acknowledgment that rescue workers at future disasters be provided with respiratory protection as soon as possible, such plans will be successful only if barriers to use, such as supply, heat stress and discomfort, communications, training, compliance, and supervision, are resolved."

The researchers concluded that there is a need to provide improved personal protective equipment (especially eye, hand and respiratory protection) and continued medical monitoring, treatment and counseling for all rescue workers exposed to disasters.

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