(See endnotes 36, 37, 38, 39)

September 11, 2001, was the beginning of a new era in the dangerous lives of first responders. A fire or a building collapse may also be a terrorist event and there may be large numbers of unknown hazardous factors that will put the first responders’ lives at great risk. Of the approximately 3000 people who died that day when the World Trade Center was destroyed, 450 were first responders. Construction workers and other tradespeople were put at inordinate risk by the many physical and chemical agents present in the air and in the debris.

Multistory building structural collapse was not understood well. It created a large number of physical, chemical, and biological hazards. The physical hazards included potential electrical shocks from electrical equipment; extreme noise; danger of injury from vehicles and heavy equipment; and potential for injury from sharp objects, falling objects, uneven or unstable working surfaces, floors collapsing, etc. The chemical hazards included: a variety of chemicals stored within the building; byproducts of the fires; and the disintegration of building materials especially concrete, and a large number of building contents. In addition, there were numerous potential chemical hazards from the fuel aboard the jet aircraft that crashed into the buildings. The biological hazards included blood- borne pathogens such as HIV, hepatitis B virus, and hepatitis C virus if individuals came in contact with body fluids; a variety of other infectious diseases which might occur through contact or if airborne; and waterborne organisms from sewage and other contaminated water sources.

Professional first responders included firefighters, emergency medical technicians (EMTs), paramedics, police officers, nurses, and doctors. When a disaster occurs, whether it be weather related, a natural event such as an earthquake, or caused purposely by people such as acts of terrorism, large numbers of people, structures, utilities, etc. may be at risk and this situation would be beyond the capacity of the local professional first responder.

Also, especially in very large disasters, a vast variety of people of all kinds of professions become volunteers and may rapidly enter the disaster area to help save lives, property, and protect people from the consequences of the event. The professional first responders receive training in dealing with the day-today emergencies of the various communities that they serve, whereas the volunteers may have limited or no training. The professionals have equipment and communication systems which may work extremely well for emergencies, but in the event of disasters they may be inefficient or lacking. The volunteers’ equipment and communication systems may be totally inadequate for the response to the disaster.

Search and rescue operations at the destruction of the World Trade Center were hampered by unstable structures, intense fires, unknown hazards, and the slow implementation of command-and- control operations. Because the urgent part lasted for many days and the recovery part lasted for many months, there was a huge amount of stress placed on the rescuers and their equipment. The personal protective equipment was not designed for continuous use and after a while hampered the work of the first responders. The garments became wet and the footwear caused blisters on the feet. The first responders not only faced the usual flames, heat, and byproducts of combustion and smoke, but also air which was heavily contaminated with fine particles of concrete, metals, a variety of chemicals, disintegrated human remains, etc. The firefighters had to perform unaccustomed tasks including the breaking up of concrete, which was very demanding physically. Mentally they were put at extraordinary risk because of the scope of the disaster and the finding and removal of body parts, decayed corpses, the loss of their friends and colleagues, and the sheer enormity of what had happened. Their training had not prepared them for such an event. For many there was a potential for posttraumatic stress disorder. Many of the first responders were without previous experience in this type of disaster and had to improvise as they went along because their supervisors also lacked this type of experience. This increased potential danger to the individuals as they tried to help others.

Search and rescue dogs were put in unusually dangerous situations because of the overwhelming size of the disaster, numerous sharp objects and edges, and unstable environmental situations. Protective booties or other equipment could not be used because they hinder the dogs and can create more problems than they solve. Dogs also can suffer from posttraumatic stress disorder.

Construction workers were immediately put into hazardous situations without appropriate training and in many cases necessary personal protective equipment. They were subjected to the same conditions as the first responders, but without years of experience in emergency situations. They were exposed to untold hazards and severe emotional situations.

The personal protective equipment varied enormously in composition and effective use. Head protection and high visibility vests appeared to work quite well, whereas protective clothing and respirators had considerable problems. The bottles of oxygen ran out quickly and had to be replenished. The respirators reduced the field of vision and the faceplates frequently fogged up. There was a substantial problem with the types of filters that were available for the air-purifying respirators. The protective clothing did not typically protect the individual against biological agents and infectious diseases, the extreme heat of the fires, and the demanding work needed in the unstable rubble. They were neither light nor flexible. The eye protection while usually able to handle impact injuries, did not protect against the dust which was present everywhere. Some people abandoned their personal protective equipment because it hindered them in search and rescue activities. Because of the vast amount of different types of personal protective equipment, it was extremely confusing to determine what replacements were needed and how to obtain them. There was a severe lack of training of personnel in actual on-site health and safety activities to protect themselves.

A report issued by the Office of the Mayor New York City indicated that there were numerous injuries to rescue and recovery workers beyond those who died in the destruction of the World Trade Center. The Fire Department of New York first responders showed poor health effects shortly after the terrorist attack: 99% of the exposed firefighters experienced at least one respiratory symptom within 1 week. The pulmonary function of the exposed firefighters in the first year deteriorated 12 times as rapidly as would be expected for individuals their age. After 8 years, respiratory conditions still continued to be high among these individuals. Other elevated health conditions were noted. Symptoms of posttraumatic stress disorder increased notably in the fire department force, but less in the police responders and other rescue recovery workers. Construction workers involved in the cleanup had increased respiratory problems. Injuries at the site included broken bones or burns and increased risk of chronic disease years later. (See endnote 42.)

Best Practices for Occupational Health and Safety for First Responders, Construction Workers,

and Volunteers

  • • Develop a command-and-control center to immediately go into operation in the event of a major disaster and test the system frequently to determine if there are shortcomings that need to be corrected.
  • • Develop for each community and region, a community-based disaster plan based on recent experience for different potential disasters and different degrees of devastation by involving all organizations, governmental bodies, business and industry, and other interested parties in the planning process.
  • • Utilize professionals who can quickly recognize health and safety hazards and report them immediately to the command-and-control center.
  • • Recognize the symptoms of chemical, biological, and/or radiological substances that can be used by terrorists and immediately report them to the command-and-control center.
  • • Constantly assess the content and concentration of hazardous substances in the air that can impact first responders and the type of air filters that they use, and advise them immediately about the findings.
  • • Ensure that there is a constant stream of equipment and materiel that is needed by personnel at the scene of the disaster.
  • • Determine if the personal protective equipment to be used at the scene of the disaster is appropriate for the situation.
  • • Emergency medical service personnel must be made aware of the potential for the spread of a variety of diseases from the individuals who are being rescued and therefore use appropriate infection control techniques and protective clothing in these situations.
  • • Develop new personal protective equipment including respirators that can be used in a disaster where there are multiple hazardous situations.
  • • Utilize where possible supplied-air respirators since they require less effort by the individual to use them.
  • • Position substantial quantities of personal protective equipment in a variety of sizes in areas which are subject to potential disasters and make the equipment available to various groups of professionals and volunteers as needed.
  • • Develop specialized training programs for all first responders and the types of volunteers who come to the scene of the disaster for the use of personal protective equipment.
  • • Provide hazard information on a routine basis to first responders and teach them how to deal with the hazards.
  • • Develop specialized emergency response training programs and require that all first responders take them and refresher programs on a periodic basis.
  • • Utilize barcode identification cards for all individuals working on the site of the disaster to be able to keep track of them.
  • • Recognize that all terrorists’ acts are considered to be crime scenes and utilize the techniques that are required by the appropriate police authorities when gathering evidence.
  • • Develop back-up communication systems if the original systems in use are disabled or destroyed.
  • • Provide alternate sources of electricity when the normal sources are disabled or destroyed.
  • • Be aware of the potential for secondary explosive devices to disable or kill first responders.
  • • Map out the community and determine where there are hazardous or explosive chemicals or devices and alert first responders to the problems before they enter the disaster area.
  • • Use extreme caution in the event of downed power lines.
  • • Use extreme caution in working around piles of rubble and debris because of unstable surfaces, sharp objects such as rebars and glass, and collapsing surfaces.
  • • Develop a uniform set of tested scientifically valid guidelines for lightweight comfortable personal protective equipment for individuals involved in specific types of disaster responses that last for a considerable period of time.
  • • Develop a uniform set of tested scientifically valid guidelines for lightweight easily used personal protective equipment for biological hazards, chemical hazards, radiological hazards, and physical hazards (such as disintegration of concrete).
  • • Equip first responders with National Fire Protection Association approved personal protective equipment when dealing with blood-borne pathogens.
  • • Utilize the equipment above and take extra precautions such as wearing gloves that are resistant to viral pathogens under more durable gloves, goggles, or face shields when treating victims or working with human remains.
  • • Use water-resistant clothing and boots when working in areas that have contaminated water or dust contaminated with waterborne pathogens. Decontaminate the clothing and boots as soon as possible.
  • • Monitor frequently the air in the environment that the firefighters will be working in to determine the appropriate type of respirators which should be worn by the individuals to avoid serious health consequences.
  • • Do not allow anyone to enter collapsed building areas without proper respiratory, head, eye, and skin protective clothing and equipment.
  • • Use lightweight helmets and protective clothing which is not cumbersome to prevent exhaustion and injuries, where fires are not occurring and individuals are part of search and rescue teams.
  • • Use supplied-air breathing equipment in oxygen-deficient environments.
  • • Use self-contained breathing equipment when working around active fires and where there is a potential for carbon monoxide, organic chemicals, and hazardous byproducts of combustion.
  • • Use close supervision for all individuals involved in active fires where there is a potential for carbon monoxide, organic chemicals, and hazardous byproducts of combustion.
  • • Develop lightweight, comfortable air-purifying equipment for various major hazards and make sure they are not used beyond their capacity without changing the equipment and/ or air filters.
  • • Do not allow anyone to enter the disaster area without appropriate air-purifying equipment that can be used as needed.
  • • Do not use an air-purifying respirator in an oxygen-depleted environment.
  • • Recognize that the heat intensity may be so great that it will destroy the personal protective equipment.
  • • Have safety supervisors do ongoing risk analysis at each of the rescue scenes to determine if the workers need to be moved to a safer location and communicate this information immediately.
  • • Have first responders take appropriate breaks from various tasks to avoid severe heat- related conditions.
  • • Have supervisors recognize extreme stress in the workers and remove them from the site in order to avoid bad judgment and injuries.
  • • Be aware of the potential for building collapse and provide immediate information to all emergency personnel.
  • • Determine and carry out effective means of issuing more uniform personal protective equipment to all individuals working at the scene of a disaster and provide back-up supplies when additional equipment is needed.
  • • Develop a means of rapidly communicating information and eliciting responses from the individuals concerning hazards to people working at the site of a major disaster.
  • • Use hearing protection devices when heavy equipment is needed to remove parts of the structure and debris.
  • • Ensure that all first responders are trained in the use of their personal protective equipment before allowing them to work within the primary disaster area.
  • • Train first responders how to avoid excessive risk-taking behavior.
  • • Conduct drills of first responders to determine their ability to respond to various types of disasters and correct shortcomings.
  • • Establish medical screening programs to evaluate the personal fitness of individuals to perform extremely hazardous and stressful work prior to the time of their use in disasters. Evaluate physical fitness and mental stability and establish a baseline of various health parameters and health concerns including preexisting conditions and familial problems. Determine pregnancy status if it applies. Make sure that individuals take with them an appropriate amount of pharmaceuticals that they typically use. Collect personal identifying information and appropriate contacts in the event of an emergency. Determine the previous amount, time, and level of exposure to a variety of situations such as chemicals, biological agents, radiological agents, heat and cold stress, repetitive motion, air contaminants, etc., to decide if the individual can be stressed further by these various agents. (See endnote 46.)
  • • Require all individuals to have received tetanus vaccinations within the past 10 years and a hepatitis B vaccine series.
  • • Establish medical postexposure screening programs to evaluate workers’ health after working at a disaster site which was physically demanding, very dirty, unstable, and where there was exposure to numerous contaminants. Determine if the various stresses caused injury or illness in the short term, either mental or physical, related to the work exposure. Follow-up at a later date to determine if chronic conditions have been established and longterm problems created. (See endnote 47.)
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