The World Trade Center Health Program: an introduction to best practices

Abstract

More than 20 years have elapsed since the September 11, 2001 (9/11) terrorist attacks on the World Trade Center (WTC), Pentagon and at Shanksville, PA. Many persons continue to suffer a variety of physical and mental health conditions following their exposures to a mixture of incompletely characterized toxicants and psychological stressors at the terrorist attack sites. Primary care and specialized clinicians should ask patients who may have been present at any of the 9/11 sites about their 9/11 exposures, especially patients with cancer, respiratory symptoms, chronic rhinosinusitis, gastroesophageal reflux disease, psychiatric symptoms, and substance use disorders. Clinicians, especially those in the NY metropolitan area, should know how to evaluate, diagnose, and treat patients with conditions that could be associated with exposure to the 9/11 attacks and its aftermath. As such, this issue of Archives contains a series of updates to clinical best practices relevant to medical conditions whose treatment is covered by the WTC Health Program. This first paper in the 14-part series describes the purpose of this series, defines the WTC Health Program and its beneficiaries, and explains how relevant Clinical Practice Guidelines were identified. This paper also reminds readers that because physical and mental health conditions are often intertwined, a coordinated approach to care usually works best and referral to health centers affiliated with the WTC Health Program may be necessary, since all such Centers offer multidisciplinary care.

Keywords:

• 9/11
• adults
• chemical exposure
• chemical mixtures
• clinical practice guideline
• exposure
• occupational diseases
• quality
• respiratory diseases
• September 11
• workers
• World Trade Center

Acknowledgments

The authors thank the 9/11 rescue, response, recovery and cleanup workers and survivors who participate in the WTC Health Program, and the healthcare professionals dedicated to their care. The authors also sincerely thank Kenneth Rosenman, MD and Nicholas Newman, DO for generously providing technical expertise and review.

Disclosure statement

The authors report there are no competing interests to declare.

Disclaimer

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC). Mention of any company or product does not constitute endorsement by NIOSH/CDC. In addition, citations to websites external to NIOSH do not constitute NIOSH endorsement of the sponsoring organizations or their programs or products. Furthermore, NIOSH is not responsible for the content of these websites. All web addresses referenced in this document were accessible as of the publication date.

Institutional review board (IRB) review

This activity did not involve human subjects and therefore did not require IRB review.

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

Drs. Calvert, Anderson and Lilly are employees of the US federal government and contributed to this paper as part of their official job duties. Work on this paper was also supported by the Centers for Disease Control and Prevention using the following funding mechanisms: contract 200-2017-93327 (Reibman); contract 200-2017-93427 (Reibman, Rosen); contract 200-2017-93430 (Harrison, Haugen, Werth); contract 75D30121C10118 (Cochran); contract 200-2016-88504 (Cochran); contract 200-2017-93428 (Lowe); contract 200-2017-93432 (Luft); contract 200-2017-93429 (Moline); contract 200-2017-93431 (Udasin); cooperative agreement 2U50/OH009739 (Cone); and, cooperative agreement 5U50/OH009739 (Cone).