ABSTRACT
BACKGROUND: The response to 9/11 continues into its 14th year. The World Trade Center Health Program (WTCHP), a long-term monitoring and treatment program now funded by the Zadroga Act of 2010, includes >60,000 World Trade Center (WTC) disaster responders and community members ("survivors"). The aim of this review is to identify several elements that have had a critical impact on the evolution of the WTC response and, directly or indirectly, the health of the WTC-exposed population. It further explores post-disaster monitoring efforts, recent scientific findings from the WTCHP, and some implications of this experience for ongoing and future environmental disaster response. FINDINGS: Transparency and responsiveness, site safety and worker training, assessment of acute and chronic exposure, and development of clinical expertise are interconnected elements determining efficacy of disaster response. CONCLUSION: Even in a relatively well-resourced environment, challenges regarding allocation of appropriate attention to vulnerable populations and integration of treatment response to significant medical and mental health comorbidities remain areas of ongoing programmatic development.
Subject(s)
Inhalation Exposure/adverse effects , Mental Disorders/epidemiology , Occupational Exposure/adverse effects , Population Surveillance , Rescue Work , Respiratory Tract Diseases/epidemiology , September 11 Terrorist Attacks , Disasters , Firefighters/psychology , Government Programs/legislation & jurisprudence , Health Impact Assessment , Humans , Inhalation Exposure/analysis , Mental Disorders/etiology , Occupational Exposure/analysis , Occupational Health , Police , Registries , Respiratory Tract Diseases/etiology , Safety , September 11 Terrorist Attacks/psychology , Survivors/psychologyABSTRACT
OBJECTIVE: Disasters are complex events making epidemiologic studies and determination of accurate denominators difficult due to the poor nature of available records. However, these data are essential to perform useful calculations and accurate descriptions of disaster medical impacts. This study was undertaken to identify the availability and utility of various information sources in the analysis of a mass casualty disaster. In addition, characteristics of cases presenting for care are described. DESIGN: This is a retrospective cohort study abstracting medical records and other documents relating to an explosion and fire. Public domain documents are obtained by written request or by filing a Freedom of Information Act (FOIA) request. SETTING: A rural EMS and tertiary hospital. CASES: Individuals directly exposed to the forces of the explosion. OUTCOME MEASURES: The number of cases detected by various information sources. In addition, the demographics, dispositions, and nature of the physical injuries of the cases are reported. RESULTS: Seven sources of case information were identified. The most cases were identified by investigative agencies (33) and the fewest by medical records (18). Rates include; injury 0.68, admission 0.20, and operative 0.14, with no deaths. Case locations during the explosion were determined for all cases. No association was noted between admission and location in the building. CONCLUSIONS: This study demonstrates the availability and usefulness of data in the public domain. Using FOIA requests or partnerships with public or private agencies may more clearly define denominator data in epidemiologic evaluations of disasters.
