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Advances in the Screening and Treatment for WTC Responders and Survivors—WD2813

Jacqueline Moline, MD, MSc
CME / CE Released: 3/1/2019; Valid for credit through 9/01/2021

Practice Test

JS resided in lower Manhattan at the time of the WTC disaster. On the morning of 9/11 she was out shopping and witnessed people falling from the twin towers after the attacks. When the towers collapsed, she became engulfed in the dust cloud and was totally covered in debris. JS has had a chronic, nonproductive cough for 8 years, and has been treated for rhinitis, sinusitis, and cough-variant asthma. She has also been diagnosed with irritable bowel syndrome and PTSD. She tells you today that she has noticed that her heartburn and indigestion are getting harder to live with.

Question 1: Which of JS’s symptoms is least likely to be a result of exposure to dust and debris from the WTC on 9/11?

Explanation: Common physical illnesses and complaints among responders and survivors exposed to the dust and debris from the WTC attack include respiratory problems, such as asthma, rhinitis, shortness of breath, and chronic cough. Of note, 67% of the adult enrollees in the World Trade Center Health Registry reported new or worsening respiratory symptoms after 9/11, and 3% had newly-diagnosed asthma by a physician. Common digestive disorders include gastroesophageal reflux disease (GERD) as well as both acid and non-acid reflux. The 9-year cumulative incidence of GERD in WTC rescue and recovery workers was 39.3%. In addition, patients frequently present with allergies, skin problems, and select cancers.

PH is an emergency medical worker living in New Jersey who volunteered with rescue and recovery after the attack on the WTC. Within the first 7 weeks following the attack, he estimates spending about 50 hours at ground zero. After presenting with pulmonary symptoms including chronic cough and possible GERD, he admits to difficulty getting to sleep at night and having frequent nightmares, feelings of guilt, as well as concerns about memory and attention.

Question 2: Based on PH’s exposure to the devastation at ground zero as well as the symptoms he mentions at his visit, which mental health disorder should you screen for?

Explanation: Exposure to the WTC devastation has been associated with mental health disorders including PTSD, anxiety, depression, and substance abuse, particularly with tobacco, alcohol, cannabis, and opiates. Other mental health symptoms that are common include insomnia, headaches, memory attention problems, interpersonal difficulties, and chronic pain syndromes. Of note, results of the WTC registry have shown that PTSD has been seen in various responders at different rates. Among general responders, the following rates were seen for mental health disorders: PTSD, 32%; panic disorder, 21%; and depression, 27.5%.

Question 3: Dust from the WTC attack included numerous air pollution constituents that have been associated with a variety of health effects. Which air pollutants have been associated with the development of cancer?

Explanation: Dust from the WTC attack included several constituents that may have led to serious health effects among responders and survivors. A variety of compounds originated from with the structural collapse, including from the cement, ceiling tiles, dry wall, and windows, which has been associated with airway and pulmonary irritation. Other pollutants associated with increased cancer risk include asbestos from fire retardants, organic hydrocarbons and furans/dioxins from the incomplete combustion of plastics, and diesel exhaust resulting from the use of diesel-powered rescue equipment. Of note, ongoing assessment of WTC responders and survivors has demonstrated the need for earlier testing of ambient exposures at disaster sites and nearby, with a focus on toxicants.

Question 4: Which one of the following registries helps local, state, and federal public health and disaster response agencies quickly establish registries of persons who are exposed or potentially exposed to chemicals or other harmful agents during catastrophic events?

Explanation: The Agency for Toxic Substances and Disease Registry (ATSDR) manages several databases of information focused on select groups of individuals with environmental exposures, disease characteristics, and risk factors. The aim of the ATSDR’s Rapid Response Registry is to help local, state, and federal public health and disaster response agencies rapidly establish registries of persons who are exposed or potentially exposed to chemicals or other harmful agents during catastrophic events. The KARE Registry is a survey of individuals who lived or stayed in trailers furnished by the Federal Emergency Management Agency (FEMA) after Hurricanes Katrina and Rita. The ALS Registry was congressionally mandated for persons in the U.S. with ALS, and is the only population-based registry in the country that collects information to help scientists learn more about who gets ALS and its causes. The World Trade Center Health Registry is a comprehensive and confidential health survey of those most directly exposed to the events of 9/11/01.

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Page Last Reviewed: October 23, 2023 | Page Last Updated: June 21, 2022