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Environmental Features

Respirators Protect Health in WTC Emergency Response

Firefighter uses a full-face respirator.

Firefighter uses a full-face respirator.

On September 11, 2001, people around the world watched as the two towers of the New York City World Trade Center (WTC) fell to the ground.  Dense clouds of smoke and dust rose into the air. The streets filled with people escaping the burning buildings. Meanwhile, emergency responders charged into the darkness with little thought for their own safety.

In the following days, Americans mourned for those who lost their lives. Police, firefighters, and emergency medical technicians (EMTs) continued to search for survivors. Construction and sanitation workers joined them to clean up the six-story pile of debris that burned for more than 3 months.

The events of 9/11 created an environmental disaster that still affects the health of people present in lower Manhattan on that day and in the weeks following. The burning jet fuel and falling towers released soot, metals, acid, cement dust, glass fibers, asbestos, and lead into the air.

Respiratory protective equipment (RPE) protects people from exposure to dust, fumes, smoke, and gases. RPE ranges from simple surgical or dust masks to respirators that cover the face and help workers breathe.  Because the 9/11 attack was unexpected, many rescue and recovery workers had no time to find RPE. Even in the months following the disaster, many workers did not protect themselves from toxic substances coming from the debris pile.

FEMA Urban Search and Rescue Teams work to clean rubble and search for survivors at World Trade Center. 9.17.2001. (Photo courtesy of FEMA/Andrea Booher)

FEMA Urban Search and Rescue Teams work to clean rubble and search for survivors at World Trade Center. 9.17.2001. (Photo courtesy of FEMA/Andrea Booher)

Vinicius Antao, MD, MSc, PhD, a senior scientist at the Agency for Toxic Substances and Disease Registry (ATSDR), became interested in the health of rescue and recovery workers on and after 9/11. He wanted to see if using dust masks and respirators protected them from breathing problems.  And he wanted to find out which devices worked best.

Together with colleagues from the New York City Department of Health and Mental Hygiene (NYC DHMH) and Columbia University, ATSDR’s Dr. Antao, Dr. Laszlo Pallos, Dr. Youn Shim, and Jay Sapp had an excellent resource to help them study the health of 9/11 rescue and recovery workers. The World Trade Center Health Registry, created in 2002 by ATSDR and NYC DHMH, gathered information from people who were in lower Manhattan on 9/11/2001.

“It is common sense that respirators will generally protect workers from respiratory diseases. The availability of WTC Health Registry data proved to be a unique opportunity to quantify, for the first time, the amount of protection against specific respiratory symptoms and diseases provided by each type of device,” said Antao.

New York firefighters use a half-face respirator at WTC 10.31.2001 (Photo courtesy of FEMA/Andrea Booher)

New York firefighters use a half-face respirator at WTC 10.31.2001 (Photo courtesy of FEMA/Andrea Booher)

The study by Antao and his colleagues, published in the American Journal of Industrial Medicine, is the first to look at the use and fit of different types of respiratory protection for those who worked on the WTC debris pile. The study shows that during the first day of response, half of the workers wore no respiratory protection at all, and about a third wore only disposable masks. Beginning in 2002, however, half of responders wore protective respirators most of the time.

Of the 71,437 people in the Registry, 30,665 (43%) were rescue and recovery workers. Registry members answered questions about their exposure to the cloud of dust and about breathing and mental health problems. Results showed that workers suffered a number of breathing problems and illnesses after the WTC disaster. Many developed a chronic cough, known as “WTC Cough,” nose and sinus problems, or asthma.

Responses to a second survey in 2006-2007 showed that almost 80% of responders who worked on the debris pile had at least one breathing problem that began or got worse after 9/11. Among the workers, twice as many developed asthma after 9/11 than would have been expected compared to the rest of the country.

However, in general, survey results showed that workers who used respirators had a lower chance of developing breathing problems and disease, and that workers who were trained were the most likely to use them.

The study also showed that surgical or nuisance dust masks gave workers very little protection. Although they did protect some workers from chronic cough, upper respiratory symptoms and asthma, the study shows that surgical or dust masks were only slightly better than no protection at all. They should be used only as a last resort in disaster response.

This study clearly shows that using half or full facepiece respirators during the WTC response protected workers against later breathing problems and illness. If respirators protected rescue and recovery workers in the extreme conditions of the WTC disaster, then they can protect emergency responders from breathing the smoke, gas, fumes, and dust common in other emergencies.

“Although we hope that a disaster like the WTC will not happen again, no one can predict when an emergency will occur. This study advises local, state, and national emergency programs to keep a supply of respirators on hand and to train responders to fit, use, and care for them.

The study also recommends that emergency managers require workers to use them in all disaster responses,” Antao said.

”Being ready to protect the health of the emergency responders who risk their lives safeguarding the health and safety of others is an essential part of preparedness. Using well-fitted respirators is one of the best ways to do this,” he said.

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