Respiratory Diseases and the Fire Service

For example at the WTC site, FDNY has reported that respirators were not
available early on and were not used “most of the time” even when available. 3,46
The WTC registry recently reported that for rescue/recovery workers who arrived
on 9/11 and worked in all subsequent time periods, use of masks or respirators
did not eliminate the risk for newly diagnosed asthma; but that delays in the
initial use of a mask or respirator were associated with an increased incidence
of newly diagnosed asthma. 55
To better prepare for the next disaster a multi-pronged effort is needed that
begins with an understanding that the immediacy of the event will lead to
acute exposures, but that this time period should be limited by a dedicated,
system-wide approach to provide (as rapidly as possible) and to wear (as
frequently as possible) respiratory protection. A thorough understanding of
user difficulties in wearing respirators should prompt a re-design of respirators
for this environment and if this is not possible then work protocols, especially
during the recovery phase should be adjusted to minimize unprotected
exposures. Workers and volunteers, untrained for this environment should
not be allowed on-site but instead should used off-site as support personnel.
Exposures can be reduced but can never be prevented and therefore a robust
health program for pre-screening, monitoring, disease surveillance and
early treatment should be planned for in advance and then rapidly instituted
beginning with on-site registration of all workers and volunteers.
REFERENCES
1. Lioy PJ, Weisel CP, Millette JR, et al. Characterization of the dust/smoke
aerosol that settled east of the World Trade Center (WTC) in lower Manhattan
after the collapse of the WTC 11 September 2001. Environ Health Perspect.
2002, 110(7):703-14.
2. McGee JK, Chen LC, Cohen MD, et al. Chemical analysis of World Trade
Center fine particulate matter for use in toxicologic assessment. Environ
Health Perspect. 2003, 111: 972-80.
3. Centers for Disease Control and Prevention: Use of respiratory protection
among responders at the World Trade Center site--New York City, September
2001. Morb Mortal Wkly Rep. 2002; 51, Spec No: 6-8.
4. Weiden M, Banauch G, Kelly KJ, and Prezant DJ. Firefighters Health and
Health Effects of the World Trade Center Collapse. In: Environmental and
Occupational Medicine. Pgs 477-490. 4th Edition, Edited by Rom WN and
Markowitz S. Lippincott-Raven Inc. Philadelphia, 2007.
5. Prezant DJ. World Trade Center Cough Syndrome and its Treatment. Lung.
2008 ; 186 :94S-102S.
6. Prezant DJ, Levin S, Kelly KJ, and Aldrich TK. Pulmonary and Airway
Complications Related to September 11th. In: Interstitial Pulmonary and
Bronchiolar Disorders, Pgs 573-590. Edited by Lynch JP; Lung Biology in
Health and Disease Vol 227 Ex Editor Lenfant C. Informa Healthcare USA
Inc., New York, 2008
270
Chapter 3-5 • World Trade Center Respiratory Diseases