First Reports of Health Effects in World Trade Center Rescue and Recovery Workers Find High Rates of Respiratory and Mental Health Problems

Screening finds half of those examined had upper or lower respiratory symptoms, and more than half had psychological symptoms that persisted after their WTC efforts stopped

Nearly half of more than 1,000 screened rescue and recovery workers and volunteers who responded to the World Trade Center attacks have new and persistent respiratory problems, and more than half have persistent psychological symptoms, according to preliminary data from a medical screening program funded by the Centers for Disease Control and Prevention and administered by the Mount Sinai Medical Center, New York City.

“These findings suggest that specialized medical monitoring programs for rescue and recovery workers that identify potential problems and make appropriate referrals for treatment should be part of all emergency preparedness plans,” said Dr. John Howard, director of the CDC’s National Institute for Occupational Safety and Health (NIOSH). “Early provision of respiratory and other protective equipment is also crucial for preventing physical and mental health effects.”

The findings released today in the CDC’s Morbidity and Mortality Weekly Report are based on evaluation of data from 1,138 participants (91% were men and the median age was 41) who voluntarily enrolled in the World Trade Center Worker and Volunteer Medical Screening Program. Through August 2004, the screening program has provided free standardized medical assessments, clinical referrals and occupational health education to nearly 12,000 workers and volunteers exposed to environmental contaminants, psychological stressors, and physical hazards. Besides respiratory and mental health effects, program participants also eported lower back and upper or lower extremity pain, heartburn, eye irritation, and frequent headache.

“These preliminary findings of the WTC Screening Program demonstrate that large numbers of workers and volunteers suffered persistent, substantial effects on their respiratory and psychological health as a result of their efforts,” said Dr. Stephen Levin, Co-Director of the World Trade Center Worker and Volunteer Medical Screening Program.

Only 21% of the workers and volunteers participating in the screening program, most of whom were police officers and utility and construction workers (Fire Department of New York personnel are covered by other programs), had appropriate respiratory protection September 11-14, 2001. During that period, exposures to dust, diesel exhaust, pulverized cement, glass fibers, asbestos, and other airborne contaminants were considered to be greatest.

Of the 1,138 screened workers and volunteers whose responses were analyzed for these reports, 51% met the pre-determined criteria for risk of mental health problems. The responses also indicated that the participants’ risk for post-traumatic stress disorder (PTSD) was four times the rate of PTSD in the general male population.

CDC has provided $81 million to continue the medical screening for these responders for 5 years. When the screening indicates need for treatment, the WTC Health Effects Treatment Program at Mount Sinai Medical Center, established through philanthropic sources, provides additional clinical evaluation and treatment at no cost to participants.

In Spring 2002, Department of Health and Human Services (HHS) Secretary Tommy G. Thompson announced $10.5 million in funds for research and training to address health concerns related to the September 11, 2001, terrorist attacks and $2 million for mental health and substance abuse services for rescue workers who responded to the disaster. The Substance Abuse and Mental Health Services Administration has funds available for mental health treatment of these workers and volunteers through September 2005. Since September 2001, DHHS has provided more than $126 million to support services for affected communities, including crisis counseling, mental health services, and emergency food and shelter.

CDC's National Institute for Occupational Safety and Health has accelerated efforts to protect emergency responders from health and safety hazards in responding to terrorist incidents. NIOSH issued new criteria for testing and certifying respirators used by emergency responders against chemical, biological, radiological, and nuclear exposures (http://www.cdc.gov/niosh/npptl/standardsdev/cbrn/). NIOSH also is partnering with responders, emergency response agencies, manufacturers, and other federal agencies to improve respirators and other personal protective equipment, improve training and education for responders, and improve safety management at disaster sites (http://www.cdc.gov/niosh/npptl/guidancedocs/rand.html).

The reports on World Trade Center-related physical and mental health effects in rescue and recovery workers and volunteers are available at www.cdc.gov/mmwr. For more information about the Mount Sinai medical screening program, visit: http://www.wtcexams.org.