The World Trade Center disaster and the health of workers: five-year assessment of a unique medical screening program.
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.
Herbert
Robin
R
Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA. robin.herbert@mssm.edu
Moline
Jacqueline
J
Skloot
Gwen
G
Metzger
Kristina
K
Baron
Sherry
S
Luft
Benjamin
B
Markowitz
Steven
S
Udasin
Iris
I
Harrison
Denise
D
Stein
Diane
D
Todd
Andrew
A
Enright
Paul
P
Stellman
Jeanne Mager
JM
Landrigan
Philip J
PJ
Levin
Stephen M
SM
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
D004391:Dust