Following the September 11, 2001, terrorist attacks on the World Trade Center, rescue workers, volunteers, and residents of lower Manhattan were exposed to a dense, persistent dust cloud of pulverized building materials and chemical by-products of combustion or pyrolysis, known as “World Trade Center dust.” Studies have shown that those present during the collapse or during the 10-month rescue-and-recovery operations had substantial loss of pulmonary function.
Aldrich et al. investigated the longer-term consequences of exposure in 12,781 FDNY workers who arrived at the World Trade Center within the first two weeks following the attacks. They analyzed lung function as measured by the forced expiratory volume in 1 second (FEV1) of firefighters and EMS workers who had undergone spirometry at least once before September 11, 2001, and were routinely tested at intervals of 12 to 18 months until 7 years after the attacks. Workers had a large loss in lung function within the first year of exposure and these losses persisted, leaving a substantial proportion of workers with abnormal lung function.
“We weren’t certain that the loss of lung function would be permanent,” says Jeff Drazen, M.D., editor-in-chief at NEJM. “This study shows that exposure to World Trade Center dust was associated with an irreversible loss of lung function. It is possible that these workers are at risk for developing early symptomatic respiratory disease. We can only wonder if the use of protective respiratory equipment could have mitigated this risk.”
In the first year, the mean FEV1 decreased substantially for all workers. Firefighters who never smoked saw a mean reduction of 439 ml, and EMS workers who had never smoked saw a mean reduction of 267 ml. After the first year, FEV1 values continued to decline, but remained within the range of normal loss of lung function, 25 to 56 ml per year for healthy, non-smoking men between the ages of 24 and 65 years.
The authors cite other studies of firefighters not involved in 9/11 rescue efforts that suggested short-term declines in lung function related to smoke exposure are generally followed by full recovery.
They conclude, “In a group of FDNY workers who had immediate and sustained exposure to dust from the collapse of the World Trade Center, we observed a large decline in FEV1 values…followed by an overall lack of substantial recovery…a pattern that contrasts with reports of recovery in pulmonary function among firefighters before the 9/11 attack.”
Do we have an obligation to provide rescue workers with easily available and functional respiratory protective equipment? Should providing the proper gear and training for rescuers be a priority to prepare for future disasters?