A report issued by the Mt. Sinai School of Medicine, Department of Community and Preventive Medicine, discusses irritative and respiratory problems in relation to environmental exposures from the World Trade Center (WTC) disaster.
The purpose of the report is to provide guidance for clinicians on evaluation and management of the irritant and respiratory health effects being seen among adults that appear to be related to environmental and/or occupational exposures at or near the WTC site.
The report was prepared by an ad hoc working group that included: Jaime Szeinuk, MD, Robin Herbert, MD, Nancy Clark, CIH, Debra Milek, MD, and Stephen Levin, MD, from the Mount Sinai-Irving J. Selikoff Center for Occupational and Environmental Medicine; David Prezant, MD, from the New York Fire Department Medical Department; Robert Gillio, MD, Chief Medical Officer, InnerLink
The report notes that since the Sept. 11 terrorist attacks on the WTC, there has been concern about the impact of environmental contaminants generated by the fires and building collapses on the health of workers at and near the site as well as of residents of the surrounding area and workers returning to work at or near the site.
On Sept. 11th, when the fire, explosion and collapse of the towers occurred, irritating materials such as concrete, silica, gypsum, plastics and fiberglass dusts, as well as soot were released. Asbestos, used in the WTC buildings as an insulation and fireproofing material, has been found in the dust and debris. Other hazardous contaminants include polyaromatic hydrocarbons (PAHs), lead, polychlorinated biphenyls (PCBs) and other combustion products that could include dioxin-like components.
Toxic and irritating gases, along with acid mists, were also released when plastics and other materials burned. More hazardous gases like carbon monoxide were also released from combustion at lower temperatures and in enclosed spaces.
"Given the extremely high temperatures of the fires generated in the combustion of jet fuel, combined with the tremendous range of contents of the towers, it is likely that we will never fully know the precise nature of exposures sustained immediately after the explosions, fires, and building collapses on September 11th," the report notes.
While concern has been primarily about inhalational exposures, there have been a number of reports of dermal irritation and rashes on exposed areas of the skin. In addition, those escaping the area on Sept. 11th and those working without appropriate respiratory early after the disaster, experienced ingestional exposures.
Primary short-term health effects of exposure to airborne contaminants may include asthma/reactive airways disease (RADS), chemical irritation of the eyes, nasal passages, throat, and upper airways, sinusitis, and persistent cough, and pneumonitis. Ingestional exposures can result in digestive symptoms such as irritation of the upper gastrointestinal tract with gastro-esophageal reflux (GERD).
The report notes that while measured levels of exposure to individual airborne contaminants have been relatively low, there is a lack of environmental and personal sampling data for the first days after the disaster. It also points out that there have been occasional elevations of levels of some contaminants in air and bulk dust samples depending on conditions at the site. "Exposures can vary widely depending on the ambient weather conditions, types of activities and whether or not fires are burning at the site on a particular day. Finally, workers at and near the site as well as residents report that outdoor air is highly irritating at certain days and times," according to the Mt. Sinai report.
Adults who have been at or near the site for as little as 24 to 36 hours are reporting a variety of symptoms and illnesses, including reactive airways disease, new onset or exacerbation of pre-existing asthma, RADS, sinusitis, irritant rhinitis, persistent cough, and diffuse irritation of nasal mucosal surfaces, note the members of the Mt. Sinai committee. There has also been an increase in GERD symptoms, especially among first-responders or people fleeing the area who where hit by the cloud of dust and debris released from the collapse of the towers.
People who worked primarily at Ground Zero, either during or after the disaster, including New York firefighters and firefighters from outside New York City, police officers from New York City and surrounding communities, emergency rescue workers from a variety of organizations (including emergency medical technicians and paramedics), building trades workers, members of the press/news media, health care workers, food service workers, structural and other engineers and a variety of other public and private sector workers have all potentially been exposed to hazards, according to the report.
Others at risk are people who worked in the immediate vicinity of Ground Zero restoring essential services such as telephone service, electricity, and transportation, or performing services vital to reopening buildings in the area, including cleaning and assessing the structural integrity of buildings. People who worked in the WTC vicinity prior to the disaster and who sustained exposures either on Sept. 11 or upon their return to work in the area around the WTC, as well as residents in the area are also reporting symptoms related to exposure to WTC contaminants.
The report is available at www.mssm.edu/cpm/wtc_health/respiratory.shtml.
(Tomorrow: How to distinguish between WTC exposure-related conditions and unrelated symptoms and treatment of WTC exposure-related conditions.)
by Sandy Smith ([email protected])