Long-Term Health at Issue for Ground Zero Workers

Two new studies suggest thousands of first-responders who toiled at Ground Zero have become victims as well. Farai Chideya talks with Dr. Gisela Banauch, a pulmonary critical-care specialist at Montefiore Medical Center in the Bronx, and Paul Lioy, director and professor of exposure science at the Environmental and Occupational Health Sciences Institute, about the long-term health implications of the Sept. 11 terrorist attacks.

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From NPR News, this is NEWS & NOTES. I'm Ed Gordon.

Since the 9/11 attacks, most of our attention has been focused on the direct victims - those on the planes or inside the Twin Towers and the Pentagon. But two studies suggest thousands of first responders who toiled at Ground Zero have become victims as well. They are the victims of a quiet health crisis.

NPR's Farai Chideya spoke with Dr. Gisela Banauch, a pulmonary critical care specialist at Montefiore Medical Center in the Bronx. She's the lead author of a Montefiore study that looked at the health of more than 12,000 New York firefighters after they worked on Ground Zero.

And Paul Lioy, director and professor of exposure science at the Environmental and Occupational Health Sciences Institute. He described Ground Zero immediately after the collapsed of the towers.

Dr. PAUL LIOY (Director, Environmental and Occupational Health Sciences Institute): You had what I would call a very major surprise to most people, because these two towers collapsed in such a way that they turned to basically dust and smoke. When it did that, you sent out a large number of materials and also large mass of material out in radial directions in southern Manhattan. And the fact that you had a large mixture of a variety of materials that I would just say acted synergistically to cause a lot of the emergency responders first effects like the World Trade Center cough.

You would have materials like pulverized cement, glass fibers from the destruction of 110 stories worth of glass windows. You had fiberglass and other fibers from materials in the building. You had a (unintelligible) incomplete combustion from the burning fires of jet fuel, and you had some asbestos because of the fact that it was used to line one of the building's structures and girders.

And there was some lead because of lead paint. So the one thing we never could learn and will always be a mystery is the fact that there were a lot of gases that were produced during these fires at very intense temperatures, over a thousand degrees Fahrenheit. But there were no measurements so we cannot say how that acted synergistically with the particles.

FARAI CHIDEYA: Dr. Banauch, you are a pulmonary critical care specialist, and we heard this term World Trade Center cough. What does that mean and what sorts of pulmonary problems have you seen?

Dr. GISELA BANAUCH (Pulmonary Critical Care Specialist, Montefiore Medical Center): I think the World Trade Center cough was really the first most severe manifestation of, like, a spectrum of inhalational injury that we've seen in many of the persons who were exposed to the Ground Zero atmosphere. And that involved very intense and long-lasting inflammation of the respiratory tract, both the upper as well as the lower, and the upper digestive tract with reflux being one of the most unusual manifestations that hasn't really been described in inhalational injury before. But it was present in a considerable percentage of the persons who were suffering from World Trade Center cough. The…

CHIDEYA: Maybe you can just describe to us, what is World Trade Center cough? Is it a deep cough? Is it constant coughing? What are we talking about here?

Dr. BANAUCH: It's basically an inflammation, and a main symptom of it was cough. But other symptoms that are usually found in every inflammation, like wheezing, shortness of breath, chest tightness, were also present in a high percentage of persons. And the abnormalities that usually go along with airway inflammation were also found like bronchial hyperresponsiveness and bronchodilator response in pulmonary function testing.

CHIDEYA: So you've done this large-scale study. Do you have any projections of what might happen to people who were first responders who were exposed to all of this pulverized material in the air?

Dr. BANAUCH: A new release from Mt. Sinai has basically complimented the findings that we have previously published in the fire department workforce. And that release describes continued respiratory complaints up to two years after September 11th in workers who were at the site and who were not New York City Fire Department workers. I think we can say at this point that there is a real concern for persistence of respiratory disease in persons who were exposed to the World Trade Center site.

CHIDEYA: Dr. Lioy.

Dr. LIOY: Yes.

CHIDEYA: I just wanted to ask you about health policy. It's clear that these two studies indicate that something bad has happened to the people who were the first responders because of what they inhaled. Is there now a federal policy of providing more respiratory equipment, or what sorts of changes should be made because of what's been happening?

Dr. LIOY: I'll answer that question in a second. I want to add on to what Dr. Banauch said. The Mt. Sinai study and the firefighter study are very consistent in that they - most of the respiratory illnesses that have lingered occurred with people who got to Ground Zero very early on. I mean we see the visualization (unintelligible) for days and months. But the first period of exposure was really highly critical, and I think the first work was done by the fire department and was published - showed that if you got there within the first 48 hours - actually first, within the first few hours - you had the highest probability of having some of these severe acute respiratory responses.

And then, as time went on and you were - came to Ground Zero farther, farther time away, it's reduced. That's the same thing that was observed with the Mt. Sinai work. So it's the intense period of time during the initial exposures that were really critical. And obviously from my vantage point, and to answer your question, we have to really recognize that these people were true victims also of the attack on the World Trade Center and that their problems have been generated by the fact that we rushed in, but I don't think we made an adequate enough statement. I know people said it many times including myself: Wear your respirators.

Well I think people really have to understand that you go into these situations, you need respirators and they have to be appropriate for the situation in hand; because one situation and another situation will lead to very, very different consequences if you wear the wrong respirators.

But I think one of the things that's very, very important, which as I've known for years has been a problem that has been identified and I haven't seen it yet solved, is that these respirators, especially for ones where you go on acute situations, need good communication within the respirators so somebody doesn't have to rip their respirators off and say, hey, watch out for that beam coming, which one firefighter had to do for me when I was in Ground Zero. This should not be the case.

CHIDEYA: Okay. Tell me a little bit more about that experience on a personal level. When did you go? What were you doing? What did you see?

Dr. LIOY: Well, I was there to - at the request of one of the agencies to observe what was going on and see what was happening in terms of, you know, what was being done on the site and get a feel for what the environmental impacts were going to be in the future. And it was clear to me that being at Ground Zero that you had a fire that was - at that time was still burning, but it was burning in isolated cases. It was about the sixth day after the event.

But there was plenty of dust still around, especially inside buildings, which still remains as a lingering issue is that how well were the cleanups done. And in most cases, I would assume things went back to normal. But there're still issues like Deutsche Bank, which is being taken down brick by brick, which still has some of the World Trade Center dusts in it. Issues like that were identified almost early on by folks like myself who were down there.

CHIDEYA: I'm going to end…

Dr. LIOY: It was a very tragic experience. How would you might say, I was moved very, very greatly. I was angry, I was unhappy, but I was very proud of these firefighters and workers who were doing what they were doing. The unfortunate thing is I did see a lot of people who were not wearing their respirators.

Dr. BANAUCH: I can add to that that I also remember seeing people going to rest and going to sleep in the dust there. And nobody was, I think very few people were wearing respirators. This was the first night down there. And it was like pictures that you will never forget. I mean we all know the photographs and, like, really otherworldly because of all the suspended particles.

CHIDEYA: And you saw the first responders going to sleep in this environment, this toxic...

Dr. BANAUCH: Yes. I remember being a little surprised about that. But they were really, they were resting and there were like other, like, buddies coming around saying, what are you doing? And they were saying, oh, we're taking a break. And I can remember thinking, you know, this is not the best place to take a break.

Dr. LIOY: These are the kinds of lessons that were observed and have to be learned by our country so that in future types of events we are able to respond. Because we do not want firefighters, policemen and other volunteers not to respond to get people out of very difficult challenging and life-threatening situations.

But we also want to make sure that they are properly protected. And I think we need to have a series of protocols developed to help people understand what to do when nature, when an event like this occurs. Because I think as of this point and time, we are still learning, because obviously we are learning about the effects of the second wave of victims from 911 attack.

CHIDEYA: Dr. Banauch, I just wanted to end with you and ask you the same question I asked Dr. Lioy earlier. What can we expect in terms of long-term effects for people who went down there and who really put their lives on the line?

Dr. BANAUCH: Looking into the future, I think the surprising thing medically was that the acute irritation persisted in many persons. And from my personal experience with some of the firefighters who I've continued to examine up to four years after, some of the problems have gotten worse.

So I'm think we're looking at having long-term inflammatory airway disease with all its consequences, like severe asthma or chronic obstructive pulmonary disease, that can develop. And in addition, we of course have concerns that are now getting bigger because time is progressing off cancers, and those are yet to come for the most part but they're very real.

CHIDEYA: Thank you both so much for joining us.

Dr. BANAUCH: Thanks for your interest.

Dr. LIOY: You're welcome.

GORDON: That was NPR's Farai Chideya speaking with Paul Lioy, director and professor of exposure science at the Environmental and Occupational Health Science Institute, and Dr. Gisela Banauch, a pulmonary critical care specialist at Montefiore Medical Center in New York City.

Coming up, President Bush says the war on terror must go on, and another attack on a U.S. embassy. We'll discuss these topics and more on our Roundtable.

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