On Sept. 11, 2001, the nation recoiled in horror as two planes crashed into the World Trade Center towers in New York City, claiming the lives of thousands of people. After the towers collapsed, firefighters, policemen and other emergency responders and volunteers rushed to ground zero to rescue anyone who still was alive beneath the rubble. Once rescue efforts became recovery and cleanup efforts, workers continued to toil at the site.
But the calamity did not end on that day. From the moment the towers collapsed, a toxic cloud filled with asbestos particles, shards of fiberglass and other toxins shrouded ground zero. Consequently, many of the responders and volunteers – some say as many as 40,000 – who spent days or even months at the World Trade Center site have reported a slew of irreversible and chronic illnesses ranging from upper and lower respiratory ailments to gastro-esophageal reflux disease, post-traumatic stress disorder and cancer.
As more first responders are diagnosed with illnesses related to 9/11 dust, lessons have emerged for occupational and environmental health professionals who might one day face a similar disaster.
Lesson One: Get the Facts Straight
John Feal, an operating engineer contracted to work at the site on Sept. 12, 2001, is a textbook example of how respiratory protection was essential for the workers on site – a lesson learned the hard way, since respirators were scarce commodities in the early days of the cleanup.
In addition to suffering a painful and disabling injury when a 6,000-pound steel beam crushed his left foot as he was working on the site on Sept. 17, Feal also incurred sarcoidosis, a disease that scars lung tissue, and was troubled by acid reflux, a painful form of heartburn. He only worked at the site for 5 and a half days, he said, and was never ordered to wear any type of respiratory protection. Like many other emergency responders, he pointed the finger at EPA for assuring 9/11 responders and the rest of New York the air was safe to breathe, an assurance later revealed to be unfounded.
“I never smoked in my life,” Feal said. “I am an Army veteran. I used to wrestle. For this to happen to me, in my mind ... I thought I was invincible.”
Lesson Two: Provide PPE and Training
One of the lessons both responders and government agencies learned following 9/11 was the importance of not only providing protective equipment, but also training first responders on how to properly use respirators.
Appropriate half- or full-faced air-purifying respirators weren’t made available to workers in adequate numbers until several weeks after the attack, said David Newman, an industrial hygienist from the New York Committee for Occupational Safety and Health (NYCOSH). He pointed out that there already was a short history of people not wearing respirators even though they were available, creating a culture of casualness among the workers. In addition, the nature of the respirators themselves was an impediment, according to Newman. Not only could they be uncomfortable to wear – especially when not fit-tested, as was the case at ground zero – but the design itself didn’t allow responders to communicate with one another.
Lesson Three: Don’t Suspend Enforcement
Joel Shufro, NYCOSH’s executive director, pointed to what he called OSHA’s failure to enforce the respiratory protection standard and other regulations (the agency suspended enforcement of occupational safety and health regulations at the World Trade Center site) as another lapse in worker protections at ground zero. He expressed concerns that if such standards are not enforced during national emergencies, more workers risk getting injured, sick or killed in the future.
Lesson Four: Worry About the Worker, Not Liability
In the years following 9/11, the New York City government was criticized for allegedly failing to address the safety and health risks for workers and volunteers at ground zero. According to Shufro and Newman, the city seemed more interested in protecting itself from liability than protecting public health.
“Rather than deal with the problem, they took the minimal approach and the consequences were that there were large numbers of people who were exposed who could have been protected,” Shufro explained.
Lesson Five: Don’t Allow Politics to Sabotage Response
Newman and Suzanne Mattei, New York City director of the Sierra Club, claimed that while federal agencies and the city of New York carry much of the responsibility for failing to protect emergency response workers, they simply were following orders issued by the White House, which succumbed to tremendous pressure to reopen Wall Street as soon as possible. Mattei said she fears response efforts in the future will continue to be shaped by political influence rather than by public health, medical and scientific considerations. This could put first responders at great risk.
“My concern is emergency responders are a type of people who put other people’s safety in front of their own; therefore if we don’t protect them, who will?” she asked.
Lesson Six: Emergencies Impact More People than First Responders
The people working on the pile at the World Trade Center aren’t the only ones who have developed health problems in the wake of 9/11. Robert Gulack, an attorney working for the Securities and Exchange Commission (SEC), was at World Trade Center Building 7 when the planes hit. He was safely evacuated when the towers came down and had no exposure to the debris. A month later, however, SEC took office space at the Woolworth building, located a block and a half away from ground zero. Within 2 days, Gulack said he fell sick. After several bouts of pneumonia and chronic bronchitis, tests showed he had permanent low-level lung damage.
“The important thing about my story is that it shows that somebody who was in fine health can get permanent lung damage simply by working at an office that was not properly decontaminated,” he said.
Lesson Seven: No Excuses
In addition to theories about government agencies being pressured by the White House to not alarm workers and the rest of the New York population, other failures in protecting first responders and others working in the immediate area stemmed from the absence of an adequate disaster plan.
One of the problems in not having a proper plan when unprecedented disasters emerge is the first responder population is narrowly defined, said Newman. During the World Trade Center rescue and recovery efforts, workers and volunteers responded by the thousands, but most of them had not received any training or had any experience in wearing respiratory protection.
Lesson Eight: The Importance of Site Control
Having a list of responders on site in these types of situations is crucial, both for site management at the time of the crisis and for any public health concerns that might crop up later, said NIOSH Director John Howard.
“In a big disaster, when there are lots of people rushing to help, someone should probably keep a list of who was sent and who was at the site,” he said. “No one can assume that there will be a healthy aftermath and it is important to find these people so that we can offer treatment and care.”
Lesson Nine: Protect Workers
Comparing the management of the World Trade Center site to the Pentagon site management is instructive, Mattei said. The Pentagon site was tightly controlled and workers abided by HAZMAT rules while ground zero in New York was less controlled.
According to Howard, one of the mistakes made at ground zero was to maintain the site as a rescue operation for 9 months. It is paramount, he stressed, to protect the workers who are doing the rescuing and recovering. Otherwise, these workers will have to deal with health issues for the rest of their lives.
Said Howard: “To me, the real take-home lesson is prevention.”