The attacks on September 11, 2001, created an occupational health and safety challenge for New York City (NYC) firefighters and rescue workers responding to the disaster. Following the initial collapse and fires, ongoing risks included lingering particulate matter in the air and intermittent combustion products from initial and persistent fires beneath the rubble pile.
During the weeks after September 11, the NYC Fire Department's Bureau of Health Services (FDNY-BHS) and the National Institute for Occupational Safety and Health (NIOSH) organized a collaborative study to evaluate occupational hazards and exposures for these workers, including their use of respiratory protection. They also offered the workers the opportunity to make suggestions to increase use of respiratory protection at future emergencies.
"Because the nature and extent of exposures in disaster situations are complex and difficult to characterize, the use of adequate personal protective equipment (PPE), including respiratory protection, is essential in protecting the health of firefighters and other rescue workers," said researchers in the report, published in a special, September 11 edition of the Morbidity and Mortality Report Weekly.
The study population consisted of the approximately 11,000 FDNY firefighters present at the WTC site during the first week of the disaster. The study included a questionnaire (self-administered through touch-screen computer), medical evaluation, spirometry and blood/urine collection for biomonitoring assays. The 53 questions elicited arrival time, number of days worked at the WTC, work activities and use of PPE (including respiratory protection) during each day worked at the WTC during the first two weeks. The medical evaluation was mandatory, but participation in the research study was voluntary and required informed consent.
Of those firefighters who reported being present during the WTC collapse, 67 (52 percent) admitted wearing no respiratory protection, and 41 (38 percent) of those arriving later that day wore no respirator. The respirator most commonly used during the first day was the disposable mask; of the 130 firefighters present on the first day (either during or following the collapse) who reported wearing a respirator, 76 (58 percent) used the disposable mask. During the initial two-week period, use of half-face respirators increased, and use of the disposable masks decreased.
"Adequate planning, preparation and training are key to protecting the safety and health of emergency responders," noted researchers. "Anticipating the nature and magnitude of exposures during the initial stages of a disaster situation is difficult; however, plans should be in place to provide a rapid emergency response and protect the health of the responders. The findings in this report indicate that many firefighters responding to the WTC disaster were not protected adequately during the initial stages of the emergency response."
Study participants developed recommendations about technologies and procedures that could help protect the health and safety of emergency workers as they respond to acts of terrorism. The final recommendations included the following:
- Develop guidelines for appropriate PPE ensembles for long-duration disaster responses involving rubble, human remains and different respiratory threats. If appropriate equipment is not available, address barriers to its development. Such equipment could be applicable to other major disasters (e.g., earthquakes or tornadoes) and to terrorist attacks.
- Define the appropriate ensembles of PPE needed to respond safely and efficiently to biologic incidents, threats, and false alarms. Key considerations include providing comparable levels of protection for all responders and addressing the logistical and decontamination concerns associated with large numbers of responses in short time periods.
- Explore effective ways to outfit all responders at large incident sites with appropriate PPE as rapidly as possible.
- Examine barriers to equipment standardization or interoperability among emergency-responder organizations. Strategies could include coordinating equipment procurement among organizations or working with equipment manufacturers to promote broader interoperability within classes of equipment.
- Define mechanisms to provide responders at incident sites rapidly and effectively with useful information about potential hazards and the equipment they need for protection. Approaches could include more effective coordination among relevant organizations and development of technologies that provide responders with individual, real-time information about their environment.
- Ensure that responders at large-scale disaster sites are trained appropriately to use PPE. All responders must be trained, and mechanisms that provide training and experience with the equipment before a disaster occurs should be investigated.
- Consider logistical requirements of extended-response activities during disaster drills and training. Such activities provide response commanders with information on logistical constraints to response capabilities.
- Provide guidelines and define organizational responsibilities for enforcing PPE use at major disaster sites. Although such guidelines must address the risks responders are willing to take when the potential exists to save lives, they also should reflect the principle that the health and safety of responders should be a primary concern during long-term responses.
- Develop mechanisms to allow rapid and efficient scene control at disaster sites as early as possible during a response.