The New York World Trade Center attack on September, 11, 2001 was unprecedented. The rapid response of the police, health care professionals, and firefighters saved countless lives. Because of the urgency of the situation, little attention was paid to the many potential health hazards that these emergency workers faced during the first 24 hours and the days and weeks after the initial event. Many of these first responders, especially firefighters, have been living with significant health conditions directly linked to their exposures at Ground Zero.
Anyone exposed to a dusty environment can have health consequences linked to the irritant dust. However, in the aftermath of 9/11, there was much more than just particles of dust in the air. There were massive amounts of respirable particulate matter, combustion by-products not only from explosives themselves, but also from construction materials including gypsum, calcium, and silicate, metals including chromium and iron, fibrous glass, chrysotile asbestos, and particles of human remains.
Respirable particles are defined by size. Most of the particles at Ground Zero were larger than 10 microns, a size that usually prevents them from reaching the lungs. Unfortunately, there was also an estimated 11 tons of particles that measured 2.5 microns (known as PM2.5 count), a size that can easily be inhaled and reach the lungs. When inhaled, some of these smaller particles can cause more serious damage, inciting scar formation. The particles are then classified as “fibrogenic substances.”
The Fire Department of the City of New York (FDNY) firefighters arrived immediately on site at Ground Zero and incurred high dust exposures. Most of them did not wear the tight-fitting respiratory mask that is typically recommended for hazardous material rescue situations. As a result, they had high exposures to the most toxic particles. A study published by the American College of Chest Physicians in its June 2016 issue of the journal CHEST looked at the results of this exposure, in the follow-up health findings of more than 10,000 World Trade Center (WTC)-exposed FDNY firefighters over a 13-year period. The participants were divided into groups of smokers and non-smokers and by body weight.
The study found that after the first year of exposure, WTC-exposed FDNY firefighters had an average decline in pulmonary function of 10 percent, with little recovery over the following six- year period. These findings suggest that the initial damage to the lungs was permanent in nature, and not a temporary bronchial irritation process, similar to what occurs in asthma. The decline was equivalent to 10 times the normal age-related loss one would see in a typical healthy individual.
The findings were more pronounced in smokers. These individuals also continued experiencing deterioration of lung function in the ensuing seven years.
A second study, also published in CHEST, addressed the effects of exposure to these fibrogenic substances. The researchers found an increase in sarcoidosis, a lung disease resulting in an inflammatory process that ranges from simple enlargement of the lymph nodes to full blown pulmonary fibrosis in the lungs. The cause of sarcoidosis is largely unknown but has been speculated to be related to environmental exposure.
In the second study, the rate of sarcoidosis in WTC-exposed firefighters was increased mostly in the immediate year post-exposure, but persisted in the ensuing four years following the WTC event, with new cases appearing among these firefighters over the years. The finding supports the theory that sarcoidosis is partially induced by environmental causes.
A special FDNY WTC health program was created to track and measure all of this data. It also found higher rates of other non-pulmonary diseases, such as Post Traumatic Stress Disorder (PTSD), among these firefighters.
The rates of earlier retirements and disability and the associated financial burden did not go unnoticed. Compared to 3,261 retirements, with 48 percent due to accidental disability in the seven years prior to the WTC attack, there were 4,501 retirees, with 66 percent due to accidental disability in the seven years following the WTC tragedy. The financial burden on the FDNY pension system has been estimated to have increased by $826 million.
Over the years since 2001, the focus has been on the geo-political implications of this event. On the anniversary of 9/11, it would be fitting to remember the full and lasting health consequences to all of those who bravely served to save lives during the historic attack on New York City and the United States. That is their personal lasting legacy from this tragic event.
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Eli Hendel, M.D., is a board-certified internist/pulmonary specialist with board certification in Sleep Medicine. An Assistant Clinical Professor of Medicine at Keck-University of Southern California School of Medicine, and Qualified Medical Examiner for the State of California Department of Industrial Relations, his areas include asthma, COPD, sleep disorders, obstructive sleep apnea, and occupational lung diseases. Favorite hobby? Playing jazz music. Find him on Twitter @Lung_doctor.