Best practices for the care of those exposed after a disaster

September 11, 2001 is a day of infamy in the United States, and in reality, in the world. The terrorist attacks on the World Trade Center (WTC), located in downtown New York City, USA toppled two iconic skyscrapers from the skyline. In the attack and collapse of the WTC twin towers, 2,606 people working in those buildings or who were nearby on the ground lost their lives. A coordinated attack on another plane led to the Pentagon, located in metropolitan Washington, D.C., being struck and killing 125 people who worked there. A fourth plane, rumored on course to attack the US Capitol crashed into a field in Shanksville, PA and all passengers aboard the plane perished. A total of 246 civilians, flight crew, and law enforcement officers on the four planes died in the attacks.

In New York City, everything stopped after the planes hit the two WTC towers and those buildings collapsed, generating an enormous dust cloud that spewed a toxic brew of compounds to the adjacent neighborhoods and eastward across the East River to Brooklyn, NY. First responders from the metropolitan New York region were mobilized for a rescue and recovery effort at the WTC site, known as Ground Zero. Thousands of construction workers rushed to the site to lend their expertise. Volunteers came and lent a hand. Search and rescue teams from across the US came to NYC. Approximately 91,469 individuals worked or volunteered at Ground Zero in the days, weeks, and months after 9/11.¹ An estimated 400,000 people were exposed to the toxicants unleashed by two jumbo jets colliding into massive office buildings and then collapse.¹ Fires raged at the 16-acre site for approximately three months. And human remains continued to be recovered from the site for months. The horrors of the aftermath of the WTC disaster continue even now, 21 years later.

Health concerns from toxicants known to be at the site, such as asbestos, were immediate in the public health community. Workers and volunteers spent countless hours at Ground Zero, and nearby residents and school children evacuated that day amidst the dust, debris, and trauma. When they returned to their homes and community, it was often to very dusty conditions. Many office workers also came back to lower Manhattan, some of them as early as a week after the event.

Within days, it was clear that individuals with WTC exposures were at risk for developing symptoms and illnesses. Early health effects from the WTC disaster have been well described.^2–5 This awareness led to an early partnership between the US government, first responders, medical professionals, and organized labor, culminating in a medical surveillance program that began in 2002 and continues this date, and is federally authorized to keep going until the year 2090. It is now known as the World Trade Center Health Program, and is administered through the National Institute for Occupational Safety and Health and authorized through the Zadroga Act (42 United States Code [U.S.C.] §§ 300 mm − 300 mm-61).

In this special issue, clinical best practices for conditions covered by the WTC Health Program are presented. Along with a Work Group consisting of clinicians affiliated with the WTC Health Program, guest editors, Drs. Rafael de la Hoz and Evangelia Nina, have amassed fourteen manuscripts covering best practices for the care of individuals with WTC exposure. The articles follow the coverage guidelines required by the federal program. Calvert et al. provides an introduction to this special issue, with an overview of the WTC Health Program and an understanding of who is eligible for the Program.⁶ The goal of the fourteen articles is to provide evidence-based best practices for the recognition and treatment of conditions found in those exposed to WTC dust and debris. Clinical guidelines were last published in 2008⁷; the articles in this issue of Archives seek to update current knowledge and provide a resource for clinicians caring for those affected by the attacks of 9/11. Using published best practices for seven physical health conditions and four mental health conditions, along with articles on how to identify 9/11-related conditions and on tracking the magnitude of those diseases, these articles provide a primer for the care of individuals with complex exposures, both physical and psychological. Information in these articles can provide data that can be helpful in other disasters, whether man-made or national, as a framework for evaluation and treatment.

A comprehensive website exists for the WTCHP – www.cdc.gov/WTC. Additional background as well as a comprehensive array of the hundreds of papers published after 9/11/01 can be found at that Website. It is an invaluable resource, as I hope the contents of this special issue will be for clinicians caring for individuals throughout the USA with 9/11 exposures, and for anyone with disaster-related exposures.

Again, my gratitude to our guest editors, Drs. De la Hoz and Nena, for their dedicated work on the special issue.

Disclaimer

The contents of this article are the sole responsibility of the author and do not necessarily represent the official views of, nor an endorsement, by the National Institute for Occupational Safety and Health (NIOSH), the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (CDC/HHS), or the U.S. Government.

Jacqueline Moline, MD, MSc
Editor in Chief
[email protected]

Additional information

Funding

This work was supported by the Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health using the following funding: contract 200-2017-93429.