Following the attack on the World Trade Center (WTC), an alarming number of firefighters who responded to the scene and contributed to clean-up efforts began to exhibit consistent signs of respiratory problems. Symptoms ranged from severe distress to a general cough, which became known as the “WTC cough.” Five years later, firefighters and other first responders are still suffering the same respiratory ailments, as well as psychological trauma.
Numerous studies have been conducted and countless articles written about the health problems now affecting hundreds of firefighters, but FireRescue wanted to provide readers with firsthand information from those on the frontline of this issue, those who came to Ground Zero to do their job and are now suffering the consequences.
Note: Some of the firefighters in this article chose to remain anonymous; therefore, their names have been changed.
Early Retirement
The events that occurred on Sept. 11 were heartbreaking in several ways. Despite communications problems and a lack of equipment and supplies, first responders sprung into action that day, doing whatever they could to aid victims within and around the WTC towers. But as a result of their response that day and their basic love for their job, some firefighters and rescuers developed lingering health problems and never returned to work; others tried to work and found they could no longer perform certain tasks-but it wasn’t for lack of trying. “I literally can say every tour, there was never a time when I didn’t want to go to work,” says John, a determined 49-year-old firefighter from a Brooklyn ladder company who responded to the WTC disaster. By the time John arrived at the scene, both towers had already collapsed; he witnessed the collapse of Building 7, the third building that came down that day. “It was chaos,” he recalls.
John worked the scene all day and by nightfall he had climbed onto the rubble pile and began working a hoseline, which he held for several hours until a fire chief told him to take a break. In the months that followed, despite doctors’ warnings, John volunteered for the GPS unit, searching for and recovering the deceased and items of significance.
Admittedly, John wasn’t in perfect health prior to 9/11. “I was put out of the job with a lung disability 15 years ago, but I was able to go back,” he says. “Every time I went to [my doctor to] get tested, I had trouble, but I was always able to work full duty. When 9/11 came, I pretty much knew my career was over.”
Like so many other firefighters and first responders, John underwent medical testing after 9/11, and the news wasn’t good. He tried to avoid further check-ups, but there came a point when he couldn’t put them off any longer. “They finally caught up with me,” he says, “and when I did go, that was it.”
Due to his decreased lung capacity, John was forced into early retirement. “I’m no longer working with the fire department,” he laments. “That was crushing, a huge hit. My kids were scared. It turned my life upside down.”
John is not alone. According to Dr. David Prezant, the deputy chief medical officer and senior pulmonary consultant to the FDNY, prior to Sept. 11, only 30-50 firefighters left the department on disability retirement each year. Since Sept. 11, 650 firefighters have left on disability retirement.
“I have no lung capacity left,” John continues. “I walk up a flight of stairs, and I have to stop to catch my breath. I have a 13-year-old son and I can’t swim with him. I’m holding up the side of the pool. I have sinus sprays, but I try not to use meds every day. I don’t sleep too well either. Some nights the pain in my chest wakes me up.”
Although his prognosis isn’t what anyone would consider ideal, John maintains a positive attitude for the most part and tries to keep his situation in perspective. “There are a lot of things that I can’t do now, but you adjust your lifestyle,” he says. “And compared to some of the other stories I’ve heard, I’m doing OK.”
A Hefty Blow to Health
Unlike John, many responders went to the scene that day in perfect health. Mark, an FDNY company officer, had no prior health concerns. Mark was off duty on Sept. 11, but witnessed the collapse of the second tower. He remained on scene for the rest of the day and for many days that followed, searching the rubble for survivors. It wasn’t long before Mark noticed physiological changes. “I had the cough when I was down there,” he recalls. “I’m not sure if they’re stress related, but I have a lot of problems with vertigo and shortness of breath.”
Like John, Mark is unable to climb a flight of stairs without becoming winded; however, Mark has managed to maintain his job with the FDNY. “A lot of us had good lung capacity before 9/11; now it feels like we have much less, but we don’t have the [medical] records,” he explains. “A lot of people don’t want to ask [for them]. They are sort of biding their time until things get [really] bad or they move.”
Mark understands people’s hesitation to learn the truth and to talk honestly about their problems. For him, one of the biggest changes brought about by the post-9/11 health issue involves the level of consideration he gives to conversations about it. “You don’t know what other people’s feelings are about stuff,” he says. “For a long time people didn’t talk about [it], and they certainly didn’t talk about their own difficulties. Now people talk about how they feel, but you don’t know when you’re going to start tearing up or when someone is going to get upset by what you’re saying. People are in very different places. And it can vary from day to day as to how they are going to think back on that stuff.”
Dan, a 37-year-old firefighter for the city of New York, also arrived at Ground Zero on Sept. 11 with no prior health problems. The towers had already collapsed by the time Dan arrived, but like most firefighters, he remained on scene that night and for the next couple of weeks helping with rescue and recovery efforts. Following sequential work details, his company was assigned to additional rescue and recovery efforts until April 2002. He began treatment for respiratory problems in early 2003. “I have had an annoying cough and constant nasal congestion since the WTC incident,” he explains. “I’ve been treated for this condition by a specialist as well as my personal doctor, who ordered an MRI of my lungs in the spring of 2005 and found several abnormalities on my right lung. As of now, these nodules appear to be large pieces of inhaled debris and scarring lung tissue. Fortunately, these masses presently do not seem to be cancerous.”
Dan says there are countless rescue and recovery personnel like him out there, some with similar symptoms and some with cancer. “At this point my cough is nothing but a nuisance,” he says. “Since so many guys have serious problems, I guess I can live with a nuisance.”
It is interesting to note that, given the strong focus on respiratory ailments in medical studies and news articles, one of which pronounced many first responders’ lungs aged 12 years faster than normal1, not all physiological ailments stemming from 9/11 are lung-related. Many people sustained gastrointestinal problems and memory loss, among other things. “You talk to people in my department and a really high percentage have had some kind of memory loss,” Mark says. “[It might happen] for just a while or [it could] continue, but you learn to live with it.”
Watching & Waiting
Many firefighters who responded that day remain in good physical health and can perform their jobs just as easily today as they could before 9/11. But the idea that their health could take a turn for the worse at some point in their future is never far from their minds. Tony Tricarico, a captain with FDNY Special Operations Squad 252, is one such firefighter who doesn’t have any symptoms or ailments at this time and has become proactive about safeguarding his health. “There are many people who have had adverse reactions to the heavy cloud that covered us while working at the Trade Center for the first several hours,” he notes, “and many more who developed health problems from the months of recovery work we did removing the mountains of debris and inhaling who-knows-what.
“I go to the doctor more often for check-ups,” he continues. “I have had full body scans, and I do not ignore anything that is unusual for my body.”
Although he has increased his number of doctor visits, Tony does not live in fear of someday developing a symptom or ailment; instead he believes he will take it in stride. “If I am going to get something, I hope to catch it early while it is treatable,” he explains. “If I get something, that’s what’s supposed to be. Yes, I think about it, but there is really nothing that can be done about the exposure-it’s a done deal. I can only hope to catch it early, if anything happens at all, and try to live my life as normal as possible.”
Psychological Trauma
Although not widely discussed, the psychological effects of the 9/11 tragedy are perhaps just as damaging, if not more so, to first responders’ overall health as physiological problems. Many firefighters are just now beginning to develop and/or recognize signs of psychological distress. “[Some people] have managed to push [those problems] back for all these years, but with the five-year anniversary, there’s something that goes off in people’s heads,” Mark says. “Something happens when they hear five or 10.”
Mark, who has experienced his share of stress-related problems, believes one of the greatest contributors to post-9/11 psychological trauma is the media. “We’re being inundated with articles about the impending health problems we may face and that’s creating a lot of anxiety and frustration,” Mark says. “We’re waiting for another attack-and it’s not so much if, but when. We don’t know what’s going to happen next, and there doesn’t seem to be any answers, just a lot of questions.”
To overcome psychological trauma, John feels counseling is paramount to maintaining members’ health, and he appreciates the effort made by the FDNY to help firefighters cope with stress-related issues. “Counseling is very sorely needed,” he says. “The five-year anniversary is going to make things harder, and I’m glad to see [the FDNY] is aware of that. They’ve expanded their counseling unit, and there are counseling services [provided] to the guys. This was something that was overlooked after Oklahoma City.”
Dan also stresses the need for specialized care after any major incident. “Programs such as critical incident stress debriefing teams must be available and capable of dealing with a large a percentage of members in need of emotional and psychological intervention,” he says. “The very idea of terrorism is to produce large numbers of casualties in a violent, graphic manner. Countless responders may be affected by their experiences long after the incident.”
Fears & Concerns
Five years later, firefighters remain very concerned about and even frightened by their symptoms or the potential harm done by working at Ground Zero. According to a recent study, the air at Ground Zero contained more than 400 chemicals. Approximately 12,000 firefighters worked the scene after the planes hit the two towers; those who were present during the collapse lost the most lung capacity, while responders who showed up later sustained less lung damage2. “Every day you pick up the paper and read about another person who’s sick or the air quality down there,” John says. “I’m not going to lay blame, but it’s hard to get clear answers. And you’re always waiting for the [lung] spots to show up. Knowing what’s waiting for you down the road is pretty disturbing, pretty upsetting. I’m just kind of waiting for the other shoe to fall.”
Mark, who will soon be retiring from the FDNY for reasons not pertaining to 9/11, echoes John’s concern. “[I’m afraid] I’m going to retire and something is going to show up in 5 years,” he says. “But the resources simply won’t be there to take care of the people who are going to need to be taken care of.”
As if in answer to Mark’s concern for adequate resources, the FDNY recently announced that, thanks to $26.8 million it received in federal funding, it will be stepping up its health monitoring of 14,000 firefighters by expanding its medical staff and hiring a research scientist. “A constant barrage of medical monitoring and questionnaires since the tragedy offers dismal insight to what may come,” Dan notes. “[But] perhaps with time and research, the long-term health effects of our toxic exposure while operating at the World Trade Center will become clear. Hopefully, this can be accomplished before the remaining healthy personnel become ill.”
Health officials warn that it may take 20 years before doctors know the full effect Sept. 11 has on first responders’ health; therefore, it is important to note that in addition to the FDNY’s federal funding, the state of New York is making changes to help those affected by 9/11. Governor George Pataki recently signed legislation that will expand benefits for those who have died or become sick as a result of working at the World Trade Center site.
What Should Other Departments Know?
One major concern faced by fire departments today: another terrorist attack. To safeguard firefighters’ health in the event of another disaster, fire departments around the country are urged to take what has been learned so far from 9/11 and implement it into their training regimen. “You’ve got to preplan and train on these things like it’s going to happen to you,” Mark says. “You always have to keep in your head ‘I gotta protect myself and my family as I perform my responsibilities.’ Don’t take protective gear and SOPs lightly.”
Dan also believes family should play a major part when considering personal safety. “Your safety and the safety of your family is at stake and must be considered while operating,” he says. “All first-responding agencies should have an ample supply of respiratory protection devices, either SCBAs or air-purifying respirators, with the appropriate filters. The agency should provide training to its members and ensure their proficiency with the device. It is [your] responsibility to wear and use respiratory protection.”
Many firefighters admit the Sept. 11 attack caught our country and our first responders completely off guard. As a result, the city’s health and safety professionals were without vital resources and supplies for several days. “We didn’t have a lot of options,” Mark recalls. “All of our equipment was gone; we didn’t have SCBAs for a long time; and we didn’t have respirators or the proper kind of decon procedures. The rigs weren’t decontaminated for years, and we lost our command structure. No one can assume they wouldn’t be faced with devastating things like that. So you have to be aware of what happens if half your workforce is contaminated. How are you going to deal with that?”
John also acknowledges certain shortcomings of the operations that occurred at Ground Zero. “Paper masks were useless,” he says. “They had eyewash stations set up that night, but they actually made [your eyes feel] worse.”
In the same breath, John commends the efforts currently being made by the FDNY to assist firefighters suffering negative health effects. “No one is sitting back. Everyone is working hard to protect the guys should this happen again,” he says. “We were like crash test dummies. [If this were to happen again,] take whatever precautions you can, use your head and use what’s available to you.”
Sources: Some information for this article was taken from the New York Post online and the Associated Press.
References
1,2 Banauch, Gisela I., et al. (2006.) Pulmonary Function after Exposure to the World Trade Center Collapse in the New York City Fire Department. The American Journal of Respiratory and Critical Care Medicine, 174, 312-319.
For More Information
If you would like to know more about the health issues surrounding Sept. 11, the Centers for Disease Control Web site (www.cdc.gov) offers numerous articles. Listings include:
Psychological and Emotional Effects of the September 11 Attacks on the World Trade Center-Connecticut, New Jersey, and New York, 2001, Volume 51, No. MM35; 784 (dated Sept. 6, 2002)
Surveillance for World Trade Center Disaster Health Effects Among Survivors of Collapsed and Damaged Buildings, Volume 55, No. SS2; 1 (dated April 7, 2006)
CDC Press Release/First Reports of Health Effects in World Trade Center Rescue and Recovery Workers Find High Rates of Respiratory and Mental Health Problems (dated Aug. 15, 2006)
Self-Reported Increase in Asthma Severity After the September 11 Attacks on the World Trade Center-Manhattan, New York, 2001, Volume 51, No. MM35; 781 (dated Sept. 6, 2002)
Impact of September 11 Attacks on Workers in the Vicinity of the World Trade Center-New York City, Volume 51, No. MM0; 0 (dated Sept. 11, 2002)
Follow-up Survey
Last June, New York City Health and Mental Hygiene Commissioner Dr. Thomas R. Frieden and Dr. John Howard, director of the National Institute for Occupational Safety and Health (NIOSH), and coordinator for federal World Trade Center health response programs, urged all 71,000 people enrolled in the World Trade Center Health Registry to participate in the first of several follow-up surveys since the registry was launched in 2003. The more enrollees who participate in follow-up surveys, the better the registry will be at assessing the health impacts of 9/11 and determining how to help enrollees and others directly affected by 9/11. Results will be used to improve the recognition and treatment of conditions potentially associated with exposure to WTC, both for registrants and others.
How to Participate
If you enrolled with the registry in 2003 and gave your e-mail address, you should have already received an e-mail with a link to the online version of the survey. Those who did not provide an e-mail address will receive a paper copy via regular mail; a pediatric survey will be sent to parents and guardians of enrollees under 18 years of age.
Please allow 15-30 minutes to complete the survey, and remember to update your contact information. Note: Your answers will be kept completely confidential.
The registry maintains a comprehensive directory of available resources and treatment options to benefit participants and others affected by the disaster at www.nyc.gov/html/doh/html/wtc/wtc-resource.pdf.
Visit www.wtcregistry.org for more information on the registry.
