Symptoms, Respirator Use, and Pulmonary Function Changes Among New York City Firefighters Responding to the World Trade Center Disaster

doi:10.1378/chest.125.4.1256

Chest

Volume 125, Issue 4, April 2004, Pages 1256-1264

https://doi.org/10.1378/chest.125.4.1256 Get rights and content

Context

New York City firefighters responding to the World Trade Center (WTC) disaster on September 11, 2001, were exposed to numerous hazards. A medical screening program was conducted 3 weeks after the disaster on a sample of firefighters.

Objectives

To determine whether arrival time at the WTC and other exposure variables (including respirator use) were associated with symptoms and changes in pulmonary function (after exposure − before exposure).

Design

A cross-sectional comparison of firefighters representing the following groups: (1) firefighters who arrived before/during the WTC collapse, (2) firefighters who arrived 1 to 2 days after the collapse, (3) firefighters who arrived 3 to 7 days after the collapse, and (4) unexposed firefighters.

Setting

Fire Department of New York City (FDNY) Bureau of Health Services on October 1 to 5, 2001.

Population

A stratified random sample of 362 of 398 recruited working firefighters (91%). Of these, 149 firefighters (41%) were present at the WTC collapse, 142 firefighters (39%) arrived after the collapse but within 48 h, 28 firefighters (8%) arrived 3 to 7 days after the collapse, and 43 firefighters (12%) were unexposed.

Main outcome measures

New/worsening symptoms involving the eyes, skin, respiratory system, and nose and throat (NT), and changes in spirometry from before to after exposure.

Results

During the first 2 weeks at the WTC site, 19% of study firefighters reported not using a respirator; 50% reported using a respirator but only rarely. Prevalence ratios (PRs) for skin, eye, respiratory, and NT symptoms showed a dose-response pattern between exposure groups based on time of arrival at the WTC site, with PRs between 2.6 and 11.4 with 95% confidence intervals (CIs) excluding 1.0 for all but skin symptoms. For those spending > 7 days at the site, the PR for respiratory symptoms was 1.32 (95% CI, 1.13 to 1.55), compared with those who were exposed for < 7 days. Mean spirometry results before and after exposure were within normal limits. The change in spirometry findings (after exposure − before exposure) showed near-equal reductions for FVC and FEV₁. These reductions were greater than the annual reductions measured in a referent population of incumbent FDNY firefighters prior to September 11 (p ≤ 0.05). There was a 60% increased risk of a decline of ≥ 450 mL in FEV₁ in those arriving during the first 48 h compared to the referent (p ≤ 0.05).

Conclusions

The symptoms and pulmonary function changes following exposure at the WTC demonstrate the need for improvements in respirators and their use, as well as long-term medical monitoring of rescue workers.

Section snippets

Study Design

The study was conducted from October 1 to 5 at FDNY-BHS and included a self-administered questionnaire, medical evaluation by FDNY-BHS staff, chest radiography, spirometry, and blood/urine collection for biomonitoring assays (previously reported³). The questionnaire was self-administered on touch-screen computers with trained personnel available to answer participant questions. The questionnaire addressed arrival time, number of days working at the WTC site, specific work activities at the WTC

Demographics

Our participants were 100% male and 91% white, consistent with FDNY demographics. Mean age and work years were not significantly different between the exposed groups. However, mean age and work years for the unexposed group were slightly higher. Overall, mean years worked was 15 years (range, <1 to 38 years), and mean age was 42 years (range, 24 to 60 years). The rate of current tobacco use was 11% in all exposure groups.

Three hundred sixty-two of 398 firefighters (91% of those recruited)

Discussion

We describe symptoms and pulmonary function changes in a random sample of FDNY rescue workers approximately 3 weeks following their first exposure to airborne particulates and other materials from the WTC collapse. Few firefighters reported the use of respiratory protection in the first 48 h after the collapse; for those who did, most reported use of a dust/paint mask (known to provide inadequate respiratory protection), and only 26% of them reported using the dust mask most of the time.

ACKNOWLEDGMENT

The authors thank Drs. Paul Enright, Thomas Aldrich, and William Rom, and Mr. Charles Mueller for review and comments.

References (8)

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Occupational exposures to air contaminants at the World Trade Center disaster site: New York, September–October 2001
MMRW Morb Mortal Wkly Rep
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LC Chen et al.
World Trade Center cough
Lancet
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P Edelman et al.
Biomonitoring of chemical exposure among New York City fire fighters responding to the World Trade Center fire and collapse
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(2003)
DJ Prezant et al.
Cough and bronchial responsiveness in firefighters at the World Trade Center site
N Engl J Med
(2002)

There are more references available in the full text version of this article.

Cited by (119)

A 15-year follow-up study of mortality in a pooled cohort of World Trade Center rescue and recovery workers
2023, Environmental Research
Hazardous exposures from the World Trade Center (WTC) terrorist attacks have been linked to increased incidence of adverse health conditions, often associated with increased mortality. We assessed mortality in a pooled cohort of WTC rescue/recovery workers over 15 years of follow-up.
We analyzed mortality through 2016 in a pooled and deduplicated cohort of WTC rescue/recovery workers from three WTC-exposed cohorts (N = 60,631): the Fire Department of the City of New York (FDNY); the WTC Health Registry (WTCHR); and the General Responder Cohort (GRC). Standardized mortality ratios (SMRs) were estimated to assess mortality vs. the US and NY state populations. Multivariable Cox proportional hazards models were used to examine associations of WTC exposures (date of first arrival, working on the WTC debris pile) with mortality risk.
There were 1912 deaths over 697,943.33 person-years of follow-up. The SMR for all-cause mortality was significantly lower-than-expected, both when using US (SMR 0.43, 95% confidence interval [CI] 0.42–0.45) and NYS (SMR 0.51, 95% CI 0.49–0.53) as reference populations. SMRs were not elevated for any of the 28 major causes of death. Arriving at the WTC site on 9/11-9/17/2001 vs. 9/18/2001-6/30/2002 was associated with 30–50% higher risk of all-cause, heart disease and smoking-related mortality in non-FDNY/non-GRC members. Conversely, arriving on 9/11/2001 vs. 9/18/2001-6/30/2002 was associated with 40% lower all-cause and smoking-related mortality risk in FDNY members. Working on vs. off the WTC pile was associated with an increased risk of all-cause mortality in non-FDNY/non-GRC members (adjusted hazard ratio [aHR] 1.25, 95% CI 1.04–1.50), and cancer-specific mortality in GRC members (aHR 1.39, 95% CI 1.05–1.84), but lower mortality risks were found in FDNY members.
We did not observe excess mortality among WTC rescue/recovery workers compared with general populations. However, significantly increased mortality risks among some sub-groups with high WTC exposure warrant further investigation.
Health effects following exposure to dust from the World Trade Center disaster: An update
2022, Life Sciences
Citation Excerpt :
Among these FR and recovery workers, there were also reported increases in the incidence of irritant-induced asthma, bronchitis, chronic obstructive pulmonary disease (COPD), pulmonary fibrosis (PF) and chronic inflammation in the upper and lower airways [16,18,20–23]. As with the other above-noted health effects, the incidence of many of these disorders also strongly correlated with respirator use/non-use and arrival time and/or time spent at Ground Zero [24]. Histological studies of FR lung samples also confirmed a high incidence of sarcoid-like granulomatous lung disease (SGLD) or sarcoidosis [16,66].
Exposure to dust, smoke, and fumes containing volatile chemicals and particulate matter (PM) from the World Trade Center (WTC) towers' collapse impacted thousands of citizens and first responders (FR; firefighters, medicals staff, police officers) of New York City. Surviving FR and recovery workers are increasingly prone to age-related diseases that their prior WTC dust exposures might expedite or make worse. This review provides an overview of published WTC studies concerning FR/recovery workers' exposure and causal mechanisms of age-related disease susceptibility, specifically those involving the cardiopulmonary and neurological systems. This review also highlights the recent findings of the major health effects of cardiovascular, pulmonary, and neurological health sequelae from WTC dust exposure. To better treat those that risked their lives during and after the disaster of September 11, 2001, the deleterious mechanisms that WTC dust exposure exerted and continue to exert on the heart, lungs, and brain of FR must be better understood.
The September 11, 2001, terrorist attacks from a dermatology perspective: A remembrance
2021, Clinics in Dermatology
Citation Excerpt :
At five New York hospitals, 18% of survivors hospitalized for injuries had lacerations.5 Among surveyed firefighters who were at the scene, 3% endured cuts or abrasions.4 Although many of these injuries may not have left a permanent mark, the injured still required medical attention for their cuts and lacerations.
The terrorist attacks on September 11, 2001, caused a significant loss of life and resulted in injuries, plus other health issues that continue to plague many survivors and responders to this day. With the 20th anniversary of this tragedy approaching, this contribution looks at the dermatologic injuries suffered on the day of the attacks, including burns and lacerations, along with the chronic skin conditions that have afflicted survivors and responders during the nearly two decades since. These chronic illnesses include sarcoidosis, autoimmune disease, ill-defined skin lesions and irritation, nonmelanoma skin cancer, and melanoma. We also recognize the heroism of first responders who struggled to save the lives of those injured at the World Trade Center and the Pentagon, many of whom have suffered health consequences that continue to have lasting effects on them and on the people they treated.
Quantifying asbestos fibers in post-disaster situations: Preventive strategies for damage control
2020, International Journal of Disaster Risk Reduction
When buildings that contain asbestos collapse, harmful asbestos fibers can spread in large quantities. It is critical to control this scattering as quickly as possible to protect residents and workers. Rescue and recovery operations in post-disaster situations usually take a lot of time. Therefore, experiments were conducted to evaluate and control the scattering of asbestos fibers. First, the concentration of asbestos fibers released from broken pieces of asbestos cement roofing sheet (ACRS) was measured over time. Next, the broken pieces were classified into three groups (A: no coating, B: water coating; C: asbestos stabilizer coating) and the amount of asbestos fiber released over time was measured to determine the efficiency of asbestos fiber control using water and asbestos stabilizer. The concentration of asbestos fibers generated from broken ACRS was 0.162 f/cc on average. The asbestos fiber control efficiencies of water and asbestos stabilizer showed similar patterns in the early stage. However, the efficiency of the water coating rapidly decreased after 9 h, whereas the asbestos stabilizer coating showed high efficiency even after 36 h. The results of this study will contribute to the establishment of plans for protecting workers and survivors more safely in disaster sites while controlling asbestos fibers.
Prolonged occupational exposure leads to allergic airway sensitization and chronic airway and systemic inflammation in professional firefighters
2016, Respiratory Medicine
Little data exist on short- and long-term effects of occupational exposure on airway and systemic inflammation in professional firefighters. We aimed to characterize airway and systemic inflammation in training firefighters with a maximum occupational exposure of 1 year compared to the long-term exposure of professional firefighters.
A questionnaire for symptoms and exposure, pulmonary function, atopy, bronchial hyper-responsiveness, and markers of inflammation in induced sputum, serum, bronchoalveolar lavage (BAL) fluid and bronchial biopsies were assessed in a total of 92 firefighters (63 full-time professionals and 29 trainees).
Professional firefighters showed allergic bronchial sensitization documented by the presence of atopy, and eosinophilia in induced sputum, BAL and bronchial biopsies. IL-8, ECP, VEGF, and TNF-α levels were statistically significantly higher in the sputum supernatants of professional firefighters compared to the trainees (p = 0.04, p = 0.02, p = 0.04, and p = 0.02, respectively). Serum IL-8 and TNF-α levels were also statistically significantly higher in the group of professional firefighters (p = 0.04, p = 0.03, respectively). Finally, there was a linear correlation between the duration of the occupation in Service and the degree of airway and systemic inflammation.
These results indicate a “dose-response” effect of chronic exposure to a polluted environment on bronchial and systemic inflammation in professional firefighters.
Lung Function Trajectories in World Trade Center-Exposed New York City Firefighters over 13 Years the Roles of Smoking and Smoking Cessation
2016, Chest
World Trade Center (WTC)-exposed Fire Department of the City of New York firefighters lost, on average, 10% of lung function after September 11, 2011, and >10% developed new obstructive airways disease. There was little recovery (on average) over the first 6 years. Follow-up into the next decade allowed us to determine the longer-term exposure effects and the roles of cigarette smoking and cessation on lung function trajectories.
We examined serial measurements of FEV₁ from March 11, 2000, to September 10, 2014, among 10,641 WTC-exposed Fire Department of the City of New York firefighters with known smoking and body weight histories.
The median number of FEV₁ measurements during follow-up was 9; 15% of firefighters arrived at the WTC during the morning of September 11, 2001; and 65% never smoked. Firefighters arriving the morning of September 11, 2001 averaged lower lung function than did lesser exposed firefighters; this difference remained significant during most of follow-up (P < .05). Never smokers had significantly better lung function than current smokers; former smokers fell in between, depending upon their cessation date. Those arriving the morning of September 11, 2001 were more likely to have an FEV₁ < lower limits of normal compared with those arriving between September 13, 2001, and September 24, 2001 (OR = 1.70, P < .01). Current smokers were more likely to have an FEV₁ < lower limits of normal compared with never smokers (OR = 2.06, P < .01), former smokers who quit before September 11, 2001 (OR = 1.96, P < .01), or those who quit between September 11, 2001 and March 10, 2008 (OR = 1.49, P < .01).
Thirteen years after September 11, 2001, most firefighters continued to show a lack of lung function recovery, with the trajectory of decline differing by WTC exposure and smoking status. Unlike the immutable effect of WTC exposure, we demonstrated the benefit on lung function of smoking cessation in this unique occupational/environmental cohort.

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: Supported by grants from CDC U1Q/CCU221158 and NIOSH RO1-OH07350.

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Chest

Clinical InvestigationsWORLD TRADE CENTERSymptoms, Respirator Use, and Pulmonary Function Changes Among New York City Firefighters Responding to the World Trade Center Disaster

Context

Objectives

Design

Setting

Population

Main outcome measures

Results

Conclusions

Section snippets

Study Design

Demographics

Discussion

ACKNOWLEDGMENT

Occupational exposures to air contaminants at the World Trade Center disaster site: New York, September–October 2001

MMRW Morb Mortal Wkly Rep

World Trade Center cough

Lancet

Biomonitoring of chemical exposure among New York City fire fighters responding to the World Trade Center fire and collapse

Environ Health Perspect

Cough and bronchial responsiveness in firefighters at the World Trade Center site

N Engl J Med

Clinical Investigations
WORLD TRADE CENTER
Symptoms, Respirator Use, and Pulmonary Function Changes Among New York City Firefighters Responding to the World Trade Center Disaster