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NIOSH Respiratory Diseases Research Program

Evidence Package for the National Academies' Review 2006-2007

NIOSH Programs > Respiratory Diseases > Evidence Package > 10. Emergency Response and Disaster Preparedness

10.1 World Trade Center Terror Attacks of 2001

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The terrorist attacks of September 11, 2001 exposed rescue and recovery workers in New York City to high levels of risk for job-related injury and illness. Workers included firefighters, police, emergency medical staff, demolition workers and drivers hauling away rubble, sniffer-dog handlers, and volunteer workers. Thousands of people, both workers and the public, were exposed to a huge dust cloud when the World Trade Center towers collapsed. In subsequent weeks, large dust exposures also occurred among those disturbing settled dust created by the disaster. Reports of adverse health effects from these exposures have been growing steadily over the years since, and reports of respiratory tract-related deaths due to dust exposure are growing.


NIOSH responded swiftly and addressed workers' immediate protection needs in the aftermath of the attacks. RDRP was an important part of this response, given the prominence of respiratory hazards caused by the WTC collapse. Approximately 30 RDRP staff members were deployed to the site, many of them experts in respiratory toxins or respirator use. NIOSH and RDRP performed the following activities:

  • Assessed individual jobs and work locations to identify potential hazards, including risk of eye injuries from blowing debris and potential exposures to silica dust, asbestos, and other hazardous materials
  • Helped site managers’ select appropriate equipment for sampling hazards, use the equipment properly, and Institute procedures for analyzing samples quickly
  • Helped managers and workers select appropriate personal protective equipment and coordinated the deployment of respirators to rescue and recovery workers
  • Developed cost-effective procedures for cleaning and sanitizing respirators on-site
  • Worked with medical assistance teams to ensure they were prepared to meet specific emergencies on-site and to help them develop procedures for follow-up evaluations of worker injuries
  • Helped build safety and health capacity by developing and disseminating written guidelines to help supervisors integrate worker safety and health into site operations
NIOSH and RDRP have also played a key role in long term follow up of the estimated 40,000 workers who responded to the disaster. Strong extramural support has been provided to conduct organized health monitoring programs.183 (Please note that the large funding allocations targeted specifically to victims of the WTC disaster as detailed in this section are not included in the financial data reported in chapters 1 and 2). The Fire Department of New York (FDNY) received $4.8 million beginning in October 2001 for an initial program and subsequently was awarded additional funding in March 2004 (as detailed below). In addition to the FDNY WTC Medical Monitoring Program, funding was provided to establish a WTC Medical Monitoring Program to provide medical screening for rescue and recovery workers other than federal workers or New York City Firefighters (the firefighters are eligible for the FDNY program). Initially, this effort was funded via a contract of $11.4 million to the Mt. Sinai Medical School of Medicine.  Under the contract, Mt. Sinai School of Medicine and a consortium of occupational health clinics in New York, New Jersey and other locations provided medical examinations to eligible workers and volunteers.

In March, 2004, FDNY, Mt. Sinai and a group of other institutions (the Long Island Occupational and Environmental Health Center, the Mt. Sinai School of Medicine, the New York University School of Medicine, the City University of New York’s Queens College, and the University of Medicine and Dentistry of New Jersey’s Robert Wood Johnson Medical School) were awarded eight grants totaling $81 million to support an additional five years of medical monitoring. Funding was also provided to create a WTC Responder Health Consortium to promote coordination and data sharing between programs. The medical monitoring programs based at FDNY and Mount Sinai have played an extremely important role both in providing both service to sick workers and in doing research to better understand their health problems, including frequent and difficult respiratory problems.

Outputs and Transfer

RDRP was part of the NIOSH effort to distribute information to on-site workers and supervisors concerning respiratory hazards and exposure prevention through two documents:

  • Fact Sheet: Workers in Secondary Response and Other Supporting Roles: Frequently Asked Questions About Exposure to Dusts and Gases (A10-2).
  • Fact Sheet: Protecting Workers at the WTC Site. Response from NIOSH. (A10-3).

In addition, RDRP assisted with the preparation of a topic page on the disaster and other electronic resources for emergency workers on the NIOSH Web page: (A10-4).

 In 2004, NIOSH sponsored a report by RAND's Science and Technology Policy Institute (External Link: on emergency responders’ personal protective equipment needs, “Protecting Emergency Responders Volume 2: Community Views of Health and Safety Risks and Personal Protection Needs” (A10-5). The report helps define technology needs and research priorities for personal protection for emergency responders, including respiratory protection. It presents what members of the emergency response community believe to be the most important hazards that they face and their personal protection needs for those situations. The findings presented were derived from feedback obtained from 190 representatives from 83 organizations in the emergency response community nationwide. Volume 1 in this series was “Lessons Learned from Terrorist Attacks” and Volumes 3 and 4 concerned safety management and structural collapse respectively.

Through June 2005, the FDNY WTC Medical Monitoring Program had provided screening examinations to 15,284 firefighters and emergency medical service technicians. The WTC Medical Monitoring Program had provided screening examinations to 14,110 people. These programs have documented high rates of respiratory conditions including sinusitis, asthma, and a new syndrome termed “World Trade Center Cough.” These programs have published numerous peer-reviewed publications documenting the extent and severity of these problems.184

RDRP has provided consultation and help to both the FNDY WTC Medical Monitoring Program and the WTC Medical Monitoring Program in assessing longitudinal spirometry collected by the programs. Representatives of both programs participated in the RDRP-organized a workshop on “Interpretation of Longitudinal Spirometry Data in an Individual” previously described in chapter 4.2c.

An RDRP investigator with expertise in management of lung function data has worked with the Mt. Sinai group since the early stages of the medical monitoring program and was co-author of a recent publication describing high rates of respiratory symptoms and abnormal lung function in exposed workers.

Intermediate Outcomes

Early after the disaster, NIOSH/RDRP personnel played an important role in helping New York City and other responding organizations implement procedures for occupational safety and health. Key areas were promoting use of respirators; and helping others, including OSHA, to do exposure assessment.

An internet search using Google showed that the Fact Sheets, “Workers in Secondary Response and Other Supporting Roles: Frequently Asked Questions About Exposure to Dusts and Gases” (A10-2) and “Protecting Workers at the World Trade Center Site and Response from NIOSH” (A10-3) have been cited by OSHA and a variety of other state and private organizations (A6-72).

NIOSH/RDRP extramural funding has played a major role in enabling a range of groups, including FDNY, Mount Sinai School of Medicine, and many others to provide medical screening to tens of thousands of people. Documentation that so many were sick from respiratory conditions has, in turn, motivated DHHS to commit $55 million to provide treatment services (see below).

What’s Ahead

CDC/RDRP will continue to fund the FDNY WTC Medical Monitoring Program and the WTC Medical Monitoring Program to provide medical monitoring services to the 40,000 responders exposed to the WTC collapse. This will allow continued follow up and detection of long term health effects.

CDC/RDRP will soon be funding a $55 million World Trade Center Treatment Program to provide medical treatment to those responders who suffer from diseases related to the WTC Collapse.

RDRP will continue to provide help and consultation to both the FDNY WTC Medical Monitoring Program and the World Trade Center Medical Monitoring Program in evaluating longitudinal lung function data of participants. RDRP will also remain engaged with these programs to help as needed with the long term problems of people exposed to the WTC Collapse.


183. Bascetta CA. GAO testimony before the Subcommittee on National Security, Emerging Threats, and International Relations, Committee on Government Reform, House of Representatives.  September 11 – Monitoring of World Trade Center Health Effects has progressed, but program for federal responders lags behind. GAO-06-481T, February 28, 2006.

184. Examples of peer-reviewed publications include the following: CDC. Injuries and illnesses among New York City Fire Department rescue workers after responding to the World Trade Center attacks. Morbid Mortal Wkly Rep 2002;51:1-5; Herbert R, Moline J, Skloot G, Metzger K, Baron S, Luft B, Markowitz S, Udasin I, Harrison D, Stein D, Todd R, Enright P, Stellman J, Landrigan P, Levin S . The World Trade Center disaster and the health of workers: five-year assessment of a unique medical screening program.  Environ Health Perspect doi:10.1289/ehp.9592 available via [Online 6 September 2006]; Landrigan PJ, Lioy PJ, Thurston G, Berkowitz G, Chen LC, Chillrud SN, Gavett SH, Georgopoulos PG, Geyh AS, Levin S, Perera F, Rappaport SM, Small C; NIEHS World Trade Center Working Group.  Health and Environmental Consequences of the World trade Center Disaster.  Environ Health Perspect. 2004 May;112(6):731-9.; Prezant DJ, Weiden M, Banauch GI, McGuinness G, Rom WN, Aldrich TK, Kelly KJ. Cough and bronchial responsiveness in firefighters at the World Trade Center site. N Eng J Med. 2002; 347:806-815; Skloot G, Goldman M, Fischler D, Goldman C, Schechter C, Levin S, Teirstein A. Respiratory symptoms and physiologic assessment of ironworkers at the World Trade Center disaster site. Chest. 2004; 125:1248-1255