title: The World Trade Center disaster and the health of workers: five-year assessment of a unique medical screening program.
abstract: BACKGROUND
  Approximately 40,000 rescue and recovery workers were exposed to caustic dust and toxic pollutants following the 11 September 2001 attacks on the World Trade Center (WTC). These workers included traditional first responders, such as firefighters and police, and a diverse population of construction, utility, and public sector workers.
  
  
  METHODS
  To characterize WTCrelated health effects, the WTC Worker and Volunteer Medical Screening Program was established. This multicenter clinical program provides free standardized examinations to responders. Examinations include medical, mental health, and exposure assessment questionnaires; physical examinations; spirometry; and chest X rays.
  
  
  RESULTS
  Of 9,442 responders examined between July 2002 and April 2004, 69% reported new or worsened respiratory symptoms while performing WTC work. Symptoms persisted to the time of examination in 59% of these workers. Among those who had been asymptomatic before September 11, 61% developed respiratory symptoms while performing WTC work. Twenty-eight percent had abnormal spirometry; forced vital capacity (FVC) was low in 21%; and obstruction was present in 5%. Among nonsmokers, 27% had abnormal spirometry compared with 13% in the general U.S. population. Prevalence of low FVC among nonsmokers was 5-fold greater than in the U.S. population (20% vs. 4%). Respiratory symptoms and spirometry abnormalities were significantly associated with early arrival at the site.
  
  
  CONCLUSIONS
  WTC responders had exposure-related increases in respiratory symptoms and pulmonary function test abnormalities that persisted up to 2.5 years after the attacks. Longterm medical monitoring is required to track persistence of these abnormalities and identify late effects, including possible malignancies. Lessons learned should guide future responses to civil disasters.
authors.affiliation: Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA. robin.herbert@mssm.edu
authors.forename: Robin
authors.initials: R
authors.lastname: Herbert
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Moline
authors.forename: Gwen
authors.initials: G
authors.lastname: Skloot
authors.forename: Kristina
authors.initials: K
authors.lastname: Metzger
authors.forename: Sherry
authors.initials: S
authors.lastname: Baron
authors.forename: Benjamin
authors.initials: B
authors.lastname: Luft
authors.forename: Steven
authors.initials: S
authors.lastname: Markowitz
authors.forename: Iris
authors.initials: I
authors.lastname: Udasin
authors.forename: Denise
authors.initials: D
authors.lastname: Harrison
authors.forename: Diane
authors.initials: D
authors.lastname: Stein
authors.forename: Andrew
authors.initials: A
authors.lastname: Todd
authors.forename: Paul
authors.initials: P
authors.lastname: Enright
authors.forename: Jeanne Mager
authors.initials: JM
authors.lastname: Stellman
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Landrigan
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Levin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000397:Air Pollution / Q000009:adverse effects / Q000032:analysis; D004391:Dust / Q000032:analysis; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009784:Occupational Diseases / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D016273:Occupational Exposure / Q000009:adverse effects*; D012140:Respiratory Tract Diseases / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D047851:September 11 Terrorist Attacks; D013147:Spirometry; D013997:Time Factors
chemical_list: D004391:Dust