““9/11 has influenced public health on a number of dimensions. I believe the importance of that impacts cannot be overstated.” – Dr. Elizabeth Montesi, Director of Harvard T.H. Chan School of Public Health, May 2010 “Public health is inextricably tied to the social and political decisions made by communities.” – President Barack Obama, President’s Commission on the Prevention of Future Terrorist Attacks on the United States, December 2010 ““The ongoing effort to protect the safety of America remains as it was on 9/11.” – President Barack Obama, February 2011 “This is the first time the World Trade Center sites are considered a health hazard. It is the responsibility of government to ensure that the health risks are well understood and communicated to the public.” – Elizabeth Montesi, Director of Harvard T.H. Chan School of Public Health, August 2011 “These findings, published today in the New England Journal of Medicine, shed additional light on the long-term impact of this catastrophe on the health of first responders, and may have implications for decisions about public health policies to reduce health risks at other sites.” – Efraim Ben-Ishai, Director of the Office of Public Health Preparedness and Response, August 2011
President’s Commission on Preventing Future Terrorist Attacks on the United States, chaired by Dr. Samuel Berger, President’s Assistant for Homeland Security and Counterterrorism, issued a report in December of 2010 with recommendations for defining and managing risk as well as improving public health preparedness and response.
Exposure to 9/11 toxins
The investigation by the forensic sciences team at the National Institute of Environmental Health Sciences (NIEHS) revealed the underlying causes of fatigue and muscle damage at the World Trade Center sites. Chronic exposure to radiation and dust exposures at the trade center sites resulted in a neurochemical imbalance known as persistent oxidative stress, caused by free radicals that were produced from free radicals produced by the process of combustion. Free radicals are compounds that release energy and are characteristic of biological systems, such as the brain and lungs.
The 13 principal actors in the emergency operations at the time of the 9/11 attacks were identified as: The World Trade Center Commission (WTC Commission), Federal Emergency Management Agency (FEMA), the U.S. Department of Labor (DOL), New York State Department of Health, New York City Department of Health and Mental Hygiene (DOHMH), the Port Authority of New York and New Jersey (PA), the New York City Police Department (NYPD), New York City Fire Department (FDNY), the New York City Department of Environmental Protection (DEP), and Federal Protective Services.
The investigations produced a large amount of information. However, it was not until August 2011 that the investigation teams met together to discuss their findings. NIEHS scientists, who were involved in the investigations at the World Trade Center site, focused their investigations on the people who were directly exposed to WTC dust and first responders.
From 2001 until 2002, a total of 4,641 individuals, including 3,011 people who had applied for or received compensation under the WTC compensation program, conducted more than 5,500 initial evaluation interviews, 51,400 walk-through examinations, and 844,238 screening interviews. The investigators also collected more than 14,000 physical examinations. They focused their investigations on the people who were directly exposed, meaning they had access to WTC dust, people who had provided support to WTC responders, and people who had directly participated in or viewed WTC events, such as rescue workers and emergency management personnel. For the analyses, scientists used medical records to determine which participants had lived in New York City between August 28, 2001 and September 11, 2001. The researchers also reviewed administrative records for these people. The team used data from the FBI’s National Instant Criminal Background Check System to determine whether the applicants or witnesses who participated in the interviews or physical examinations had any criminal convictions.
Analysis of the records found that individuals who were selected from the pool of individuals selected as potential first responders, as well as people who had personal contact with these individuals, were most vulnerable to persistent oxidative stress. The data also demonstrated that exposure to WTC dust and first responders was a public health risk.
The findings suggest that recent efforts to establish clean-up standards for cleaning up the residues of soot, fumes, water, sand, and debris on buildings will need to be reviewed to incorporate the adverse effects of persistent oxidative stress as part of the remediation process. For example, OSHA’s Residential Dust Impacts (RDIT) standard applies only to residential buildings, such as that on the site of the 9/11 attacks.
It is also important to consider the long-term effects of the