Expert Commentary

Acute and Long-Term Medical Response to the 911 Disaster in New York City and the Role of Occupational Medicine in Similar Catastrophic Situations

Phillip Landrigan, MD, MSci

Dean for Global Health, Chairman, Dept. Preventive Medicine, Professor of Pediatrics
Mount Sinai School of Medicine
New York, NY

 

The response that a medical team mounts to deal with a disaster must, from the outset, include occupational medicine (OM) considerations; that is, caring for first-responders. Given the exposure of first responders to dust, smoke, toxins, airborne pollutants and disrupted environments, OM assessments and interventions are critical. One of the most important initial steps is to inform first responders that an OM team has been assembled to care for their needs secondary to their disaster work. From lessons learned from disaster survivors, as well as from veterans returning from the Gulf, Iraq and Afghanistan wars, OM becomes especially important when PTSD is a component of the post-exposure burden. In these cases, psychometric screening is essential. One caveat is that such assessments and approaches should be non-stigmatizing and ideally integrated with direct medical intervention. Another critically-important consideration is that ALL disaster workers, not just traditional first-responders, require attention. These may include persons with tasks as diverse as heavy crane operation and sanitation work. Finally, OM professionals at a disaster site should be sensitive to demographic groups such as pregnant women and small children. In both cases, children and fetuses are always more heavily exposed because of a greater surface-to-volume ratio. Also, developing organ systems are considerably more susceptible to toxins. The clear importance of OM at a disaster site is signaled by the significant increase in disease and disability encountered in 911 responders. Data indicates over 15% of first-responders followed have presented with new onset asthma and over 40% have presented with impaired pulmonary function likely due to high-alkaline cement dust. Thus, OM teams should include respiratory specialists to help clinicians know what to look for in their patients. State of the art k knowledge of industrial hygiene and biochemistry will help patients be treated most effectively.

References

  1. Crowley, FE et al (2010) "Sarcoid like" granulomatous pulmonary disease in World Trade Center disaster responders. Am J Ind Med. 2010 Dec 22 http://31337videos.com/youtube/911_site_workers_hearing_philip_landrigan_testimony.php
  2. Wisnivesky JP, et al (2011) Persistence of multiple illnesses in World Trade Center rescue and recovery workers: a cohort study. Lancet. 2011 Sep 3;378(9794):888-97.
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