9/11 Offers Lessons for Future Crises

One study found health-care workers hesitant to respond to certain emergencies

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By Amanda Gardner
HealthDay Reporter

SUNDAY, Sept. 11, 2005 (HealthDay News) -- Four years after the attacks on the Pentagon and the World Trade Center, researchers are still searching for answers on how disasters such as this affect public health.

One recent study found the ability and willingness of health-care workers to respond to disaster varies, depending on the type of event.

The study, published in the Journal of Urban Health, also identified specific barriers to response and, in so doing, pinpointed areas to be addressed before future calamities occur.

A second study in the same journal found a spike in the number of heart attacks suffered by those living and working in the vicinity of the World Trade Center in the two months following the attack.

"Information like this is very important as we begin to develop an infrastructure that can respond to catastrophic health events," said Dr. Matthew Boulton, an associate professor of epidemiology and director of the bioterrorism preparedness initiative at the University of Michigan's School of Public Health. "We have to think about the very individuals that are core to that response."

"No one has done a systematic study on this previously, where they've attempted to quantify these issues," added Boulton, who was also the chief medical executive for the Michigan department of health, a post he held for about seven years.

Nearly 3,000 people lost their lives in the Sept. 11, 2001, terrorist attacks, including nearly 2,600 killed at New York City's World Trade Center, another 125 who lost their lives at the Pentagon in Washington, D.C., and 265 passengers on four planes (including one flight that crashed in Somerset County, Pa.). For the days and weeks that followed, a cloud of dust and potential toxins filled the area around lower Manhattan as workers toiled round the clock on rescue and clean-up operations.

The risks taken by rescue and health-care workers alike became the subject of a $1 billion lawsuit filed by 800 "Ground Zero" workers almost exactly one year ago against the owners of the World Trade Center. That suit alleges that building owners exposed those workers to toxic conditions.

"By and large, there is a high level of willingness, but these people are just like anybody else. They have concerns about family, especially in the face of large-scale disasters like [hurricane] Katrina," Boulton said.

In the study, more than 6,400 health-care workers from 47 hospitals, community health centers and long-term care facilities in the New York City metropolitan area were asked to fill out 23-item surveys.

The surveys outlined seven hypothetical disaster scenarios including severe weather, a smallpox outbreak, a chemical terrorist attack, an environmental disaster, a mass casualty incident, a "dirty" bomb attack and an outbreak of SARS. For each category, respondents indicated whether they would be "willing," "not willing" or "not sure;" and "able," "not able," or "not sure," when it came to responding to the event.

Health-care workers reported being most able to report for work for a mass casualty incident (83 percent), environmental disaster (81 percent) and chemical event (71 percent). They were least able to report during a smallpox epidemic (69 percent), radiological event (64 percent), SARS outbreak (64 percent) or severe snow storm (49 percent). Various barriers to ability were cited including transportation issues, child care, elder care and pet care.

Health-care workers were most willing to work during a snow storm (80 percent), mass casualty incident (86 percent) and environmental disaster (84 percent), and least willing for a SARS outbreak (48 percent), dirty bomb (57 percent), smallpox epidemic (61 percent) and chemical event (68 percent). Barriers to willingness included fear for personal safety, concern for family and personal health problems.

Boulton saw some of these issues arise during the recent SARS epidemic. "There were workers in the [Canadian] health-care system who were very reluctant to go in because of the risk of contraction of SARS and had concerns less about themselves than transmitting it to their children and families," he said.

But identifying the issues beforehand do give people an opportunity to make advance arrangements for things such as child care, pet care, elder care and even making sure health-care workers have an emergency supply of any medications they are taking at work, the authors stated.

Interestingly, health-care workers marked as first responders were more able and more willing to report to work, perhaps because these households are aware of the need for advance planning.

Health-care workers are also more at risk during outbreaks of infectious diseases such as SARS, monkey pox or influenza. With disasters such as 9/11 or Katrina, search-and-rescue teams tend to make up the front line.

"That is a public health issue from beginning to end," Boulton said. "Pandemic influenza would be a sustained disaster. It would last months and months, so reluctance or resistance on the part of health-care workers could have significant effects in the event of a sustained catastrophe."

At this point, public health issues lingering from 9/11 involve monitoring the health effects of people who have been exposed, including the general public, Boulton said.

In fact, in a second study appearing in the same journal, researchers at Morristown Memorial Hospital in New Jersey found that higher stress associated with the attacks on the World Trade Center may have resulted in more cardiac events in people living closer to the scene. They found a statistically significant increase in heart attacks among patients living within a 50-mile radius of the Twin Towers in the 60 days after 9/11, when compared with the 60 days just prior.

Dr. Robert Gould, president of Physicians for Social Responsibility, feels that more emphasis needs to be put on "what we can do 'upstream' to cut down on the likelihood of facing this."

Such initiatives might include a stronger Bio Weapons Convention to cut down on the chance of a bioterror event, he said, including U.S. abandonment of its nuclear weapons programs and securing of global nuclear stockpiles, to cut down on the chance of nuclear weapon/dirty bomb terrorism.

"No treaties or concerted efforts are guaranteed to be perfect, but cutting down on the 'leakage' possibilities allows us to develop more focused strategies for the downstream threats, and this has been completely lacking from U.S. government/Homeland Security/CDC policies and edicts," Gould said.

More information

For more on the health consequences of the Trade Towers' collapse, visit the National Institutes of Health.

SOURCES: Matthew L. Boulton, M.D., associate professor, epidemiology, and director, bioterrorism preparedness initiative, School of Public Health, University of Michigan, Ann Arbor; Robert Gould, M.D., president, Physicians for Social Responsibility, San Francisco, and pathologist, Kaiser Hospital, San Jose, Calif.; September 2005 Journal of Urban Health

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