title: Evacuating damaged and destroyed buildings on 9/11: behavioral and structural barriers.
abstract: BACKGROUND
  Evacuation of the World Trade Center (WTC) twin towers and surrounding buildings damaged in the September 11, 2001 attacks provides a unique opportunity to study factors that affect emergency evacuation of high rise buildings. Problem The goal of this study is to understand the extent to which structural and behavioral barriers and limitations of personal mobility affected evacuation by occupants of affected buildings on September 11, 2001.
  
  
  METHODS
  This analysis included 5,023 civilian, adult enrollees within the World Trade Center Health Registry who evacuated the two World Trade Center towers and over 30 other Lower Manhattan buildings that were damaged or destroyed on September 11, 2001. Multinomial logistic regression was used to predict total evacuation time (<30 to ≤60 minutes, >1 hour to <2 hours relative to ≤30 minutes) in relation to number of infrastructure barriers and number of behavioral barriers, adjusted for demographic and other factors.
  
  
  RESULTS
  A higher percentage of evacuees reported encountering at least one behavioral barrier (84.9%) than reported at least one infrastructure barrier (51.9%). This pattern was consistent in all buildings except WTC 1, the first building attacked, where >90% of evacuees reported encountering both types of barriers. Smoke and poor lighting were the most frequently-reported structural barriers. Extreme crowding, lack of communication with officials, and being surrounded by panicked crowds were the most frequently-reported behavioral barriers. Multivariate analyses showed evacuation time to be independently associated with the number of each type of barrier as well as gender (longer times for women), but not with the floor from which evacuation began. After adjustment, personal mobility impairment was not associated with increased evacuation time.
  
  
  CONCLUSIONS
  Because most high-rise buildings have unique designs, infrastructure factors tend to be less predictable than behavioral factors, but both need to be considered in developing emergency evacuation plans in order to decrease evacuation time and, consequently, risk of injury and death during an emergency evacuation.
authors.affiliation: 1 New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York USA.
authors.forename: Justina L
authors.initials: JL
authors.lastname: Groeger
authors.forename: Steven D
authors.initials: SD
authors.lastname: Stellman
authors.forename: Alexandra
authors.initials: A
authors.lastname: Kravitt
authors.forename: Robert M
authors.initials: RM
authors.lastname: Brackbill
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003142:Communication; D003441:Crowding; D004189:Disaster Planning; D060447:Emergency Shelter; D005160:Facility Design and Construction; D005260:Female; D049674:History, 21st Century; D006801:Humans; D008029:Lighting; D008297:Male; D008875:Middle Aged; D018635:Rescue Work / Q000266:history* / Q000458:organization & administration; D047851:September 11 Terrorist Attacks / Q000523:psychology; D055815:Young Adult