For an index to all NYCOSH in the News articles, click here.

• EPA Report Buries a Revelation - Daily News, December 31, 2002
  
  
• Vaccine Plan Is Full of Holes - Daily News, December 23, 2002
  
  
• Fears Raised About Smallpox Vaccination Plan - OccupationalHazards.com, December 16, 2002
  
  
• Perspective on the Tragedy at the World Trade Center - American Journal of Industrial Medicine, December 2002
  
  
• Union Advocates Call for Safeguards As CDC Readies Smallpox Vaccine Plan - Occupational Safety and Health Reporter, November 28, 2002
  
  
• One Year Later, 9/11 Health Concerns Linger - AFT On Campus, October 18, 2002
  
  
• Congressman: OSHA's 9/11 Response Endangered Workers - Occupational Hazards, September 30, 2002
  
  
• Ready or Nor, Disasters Happen - Online Journal of Issues in Nursing, September 30, 2002
  
  
• Dusting off Manhattan: A year after 9/11, worries about toxic dust plague residents - MSNBC, September 9, 2002
  
  
• The Air Down There: A year after the attacks, concerns linger over the long-term health effects on residents and rescue workers who breathed in contaminated air - Newsweek Web Exclusive,
  September 6, 2002
  

EPA Report Buries a Revelation

By Juan Gonzalez
Daily News
December 31, 2002

http://www.nydailynews.com/news/local/story/47707p-44880c.html

Emission of dioxins in and around Ground Zero in the two months following the World Trade Center collapse were "likely the highest ambient concentrations that have ever been reported," according to a report released last week by the federal Environmental Protection Agency.

This revelation is buried on page 77 of a 160-page report that the agency released last week.

The report is titled "Exposure and Human Health Evaluation of Airborne Pollution from the World Trade Center Disaster" and was authored by the EPA Office of Research and Development in Washington.

It is the most comprehensive study on pollution in and around Ground Zero. The report, dated October 2002, was not released until Friday, between the Christmas and New Year's holidays, when it was unlikely to get much media attention.

Asked about the unusual timing, an EPA spokeswoman in Washington said: "This is a draft report. We really weren't trying to slide it under the door. The sooner the draft is released the more time there will be for public comment."

EPA's press release and the media coverage over the weekend have focused on the report's most comforting conclusion - that most neighborhood people and office workers who returned to their homes and jobs after Sept. 17 were "unlikely to suffer short-term or adverse health effects" from contaminants in the air.

But the report also says that thousands of people who were caught in the huge dust clouds on Sept. 11, or who inhaled the air around Ground Zero in the first few days afterward, were "at risk for immediate acute [and possibly chronic] respiratory and other types of symptoms."

No immediate sampling

Health officials have no way of telling how toxic those initial clouds were, the report says, because major sampling of the Ground Zero environment did not begin for some toxics until Sept. 14 and for others until Sept. 23.

As for dioxin, a product of uncontrolled combustion, unprecedented levels were even found several blocks beyond Ground Zero, in areas that were reopened to the public one week after the attack.

At a monitoring station on Park Row near City Hall Park, for instance, dioxin levels between Oct. 12 and 29 averaged 5.6 parts per trillion/per cubic meter of air, or nearly six times the highest dioxin level ever recorded in the U.S., according to the report.

Dioxin levels at the Ground Zero rubble pile itself were much higher. According to the report, "from the first measurement day of Sept. 23 through Nov. 21, [levels] show unambiguous elevation, with concentrations ranging from about 10 to 170" parts per trillion.

That, says the report, is "between 100 and 1,500 times higher than typically found in urban air."

EPA scientists who wrote the report concluded that there was "minimal concern" for excess cancers because the high levels only lasted about two months and because dioxin exposure is usually associated with ingesting dioxin-contaminated food rather than inhalation.

But not all public health experts agree.

"Those air levels are outrageous," said Dr. David Carpenter one of the nation's top dioxin specialists and former dean of the School of Public Health at State University of New York at Albany. "There's a very significant health danger here."

Others who have reviewed the report criticize its emphasis on sampling for toxics in outdoor air.

"They're assuming that residents would be walking in the general ambient air and never disturbing settled dust," said Carrie Loewenherz of the New York Committee for Occupational Safety and Health, a labor union health group.

According to Lowenherz, a comprehensive study should include data on indoor air tests and on contaminant levels in settled dust.

The EPA report acknowledges that "evaluating the indoor environment in more depth" is one of several future areas of study.

"EPA's Region 2 office is continuing studies of indoor air," said Washington-based EPA spokeswoman Suzanne Ackerman. "It was more a question of priorities, and the outdoor air was what people were most concerned about at first."

© 2002 Daily News, L.P.

Vaccine Plan Is Full of Holes

By Jonathan Bennett
Daily News Oped
December 23, 2002

http://www.nydailynews.com/news/ideas_opinions/story/45707p-42990c.html

President Bush plans to vaccinate 500,000 health care workers against smallpox and then make the vaccine available to the general public. Before the inoculations begin, the government must answer some tough questions about the side effects and the cost.

According to official estimates, roughly one-third of the people receiving the vaccine are likely to be made sick enough to miss one or two days of work. And those estimates may paint a mistakenly rosy picture, because they are based on the pre-1970 experience with a population that was largely immune to smallpox.

Who is going to carry the financial burden of the roughly 250,000 work days that health care workers will lose? As it stands now, the workers will have to take sick days or lose a day's pay or two, a significant burden. The government should agree to cover these losses in advance.

The smallpox vaccine is the most dangerous human vaccine there is. According to the Centers for Disease Control and Prevention, seven to 26 of the health care workers vaccinated in the first wave are likely to develop life-threatening complications. Who will cover their medical expenses, and who will compensate the families of those who die? The federal government has an obligation to shoulder that responsibility now, before the shots begin.

According to the CDC, people with immune systems compromised by medication or disease shouldn't be vaccinated, including people with HIV/AIDS. But what about the estimated 500 health care workers to be vaccinated in the first wave who are HIV-positive but don't know it?

Anyone vaccinated will pose a hazard for two weeks to anyone he or she comes into close contact with, like family members and co-workers. Who will cover the medical expenses and lost time of people with secondary infections? As it stands now, no one.

If there is a possibility that enemies of the U.S. could release smallpox here, the nation needs a vaccination plan that doesn't make the threat worse. The plan should require employers to give confidential counseling about the vaccine's hazards and give employees the option of refusing without that decision being disclosed to anyone and without retaliation against employees who decline.

The federal government's refusal so far to deal with any of these questions might be an act of omission, but there is one indication of actual bad faith: The CDC has flouted a two-year-old federal law that requires the use of safer needles and ordered 50 million needles with no safety device, even though at least one manufacturer produces a smallpox vaccination needle with the device built in.

This contemptuous attitude toward the safety and economic security of health care workers must stop immediately.

Bennett is the public affairs director of the New York Committee for Occupational Safety and Health.

Fears Raised about Smallpox Vaccination Plan

By Sandy Smith
OccupationalHazards.com
December 16, 2002

http://www.occupationalhazards.com/full_story.php?WID=5294

A number of healthcare and worker organizations have questions about the administration's plan to limit the threat of a terrorist attack involving smallpox by vaccinating frontline workers.

The vaccinations, once given to children as a matter of course, have turned into a life-threatening menace, if you listen to some critics and even some cautious fans of the plan.

The plan, announced Saturday by President George W. Bush, involves the formation of smallpox response teams, who, as volunteers will receive the smallpox vaccination. The group will include healthcare workers and other first responders. The Department of Health and Human Services (HHS) will work with state and local governments to form these volunteer teams, who will be expected to provide critical services to the public in the event of a smallpox attack.

Also included in the plan are Department of Defense and State Department personnel. The Department of Defense (DOD) will vaccinate certain military and civilian personnel who are or may be deployed in high threat areas. Some United States personnel assigned to certain overseas embassies will also be offered vaccination.

"The nation needs a smallpox vaccination plan that doesn't make the threat worse. I'm sorry to say that the president's plan doesn't meet that standard," said William F. Henning Jr., chair of the Board of Directors of the New York Committee for Occupational Safety and Health (NYCOSH).

"Under the president's plan, half a million civilians are going to be in the first wave of people vaccinated," continued Henning. "Every one of them is a worker, and they must get at least as much protection from the vaccination process as they get from any other on-the-job hazard."

None of those essential protections is included in the president's plan, said Henning, adding that before the inoculations begin, the government needs to answer some tough questions about the vaccine's side-effects and their costs.

Critics of the plan note that by the government's estimates, one-third of the people vaccinated are likely to be made sick enough to miss a day or two of work. Employers, and in some cases, the workers themselves will be expected to shoulder the cost of the lost work time.

Also by the government's estimates, between seven and 26 of the healthcare workers vaccinated in the first wave are likely to develop life-threatening side effects. One of them is likely to die. Henning and other suggest the federal government should agree, in advance, to cover the cost of medical care for side effects and lost work-time.

The government acknowledges that the vaccine is so dangerous that people with compromised immune systems should not take it at all. That includes people with HIV/AIDS, because the vaccine could kill them. How is the federal government going to protect the estimated 500 healthcare workers in the first wave who are scheduled for the inoculation and who are HIV-positive, but don't know it?

People who are vaccinated will "shed" the live virus that is used for the vaccine for two weeks, exposing anyone they come into close contact with, such as a housemate or a co-worker, to a virus that could kill anyone with a compromised immune system. Critics question how they are going to be protected, and who will cover their medical expenses.

Critics question who is going to insure that the screening process that employers use to avoid vaccinating people who should not, or don't want to be vaccinated is confidential and does not result in employees suffering retaliation or discrimination?

Critics point out the federal government just purchased 50 million vaccination needles that lack any device to protect a healthcare worker from getting stuck with a used needle, even though safer needles are on the market. A federal law urging health care organization to use safer needles has been on the books for two years.

The federal government is not recommending vaccination for the general public at this time, but acknowledges there may be some members of the general public who insist on being vaccinated. In fact, anyone knowingly exposed to smallpox has two to three days to be vaccinated to prevent an outbreak and the Centers for Disease Control and Prevention has pledged to make vaccine available anywhere in the United States within 12 hours.

Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, participated in a press conference announcing the plan on Dec. 14. She said, in part, "By offering smallpox vaccine to the first people who have to step up to the plate and respond, we know that we can strengthen the ability of our states and our communities to protect the public in that kind of a situation."

As the government moves forward to implement the president's plan, it's important to note several things, said Gerberding. "First of all, we know how to fight smallpox…. Second, the smallpox vaccine is the best protection we have against smallpox, but it is not the only protection. Infection control measures, and especially isolation of infected people, also help prevent transmission. And these measures can help protect when people cannot or choose not to be vaccinated. Finally, but most importantly, as this program unfolds vaccine safety is a top priority. We intend to do everything that we can to minimize the risk and reduce the number of serious adverse reactions to the vaccine."

Soon after the Sept. 11 attacks, HHS began working to expand the national stockpile of smallpox vaccine. The United States currently has sufficient quantities of the vaccine to vaccinate every single person in the country in an emergency.

While voicing support for the president's plan, the American Medical Association (AMA), though trustee Timothy T. Flaherty, M.D., did say the association plans to "closely monitor the data on issues such as adverse reactions to the vaccine, inadvertent transmission to others, and the question of medical furlough. We are also working with the Department of Health and Human Services to ensure that vital federal liability protections are in place prior to the initiation of any smallpox vaccination program."

According to Flaherty, "The need for further voluntary vaccination beyond front-line health care workers and military personnel is a very complex issue. Any future plans for voluntary vaccination beyond the current ACIP recommendations will need to be reassessed using the information and scientific data available at that time."

The AMA voted Dec. 4 to take a cautious approach to any national smallpox vaccination program, urging the federal government to wait for good science before ordering vaccinations for all U.S. citizens. The group estimated vaccinating every American could result in as many as 300 deaths.

The American Nurses Association (ANA), which represents many of the frontline healthcare workers slated to be given the vaccine, has some concerns about the plan.

"We are well aware that there is a pressing need to be prepared against the possibility of a bio-terrorist attack," said ANA President Barbara A. Blakeney, MS, APRN,BC, ANP.

"Since 1998, the ANA has been involved in developing strategies for educating the nation's 2.7 million registered nurses to respond in the event of such an attack. ANA also is working closely with the U.S. Department of Health and Human Services (DHHS), to develop the National Nurse Response Teams for just such an event," she added.

"However, we want people to be able to make an informed decision about whether or not they should get vaccinated against smallpox, and I do not believe we have the answers we need to make that informed decision," she said.

The smallpox vaccine, which was routinely administered to Americans until 1972, is a highly effective protection against the disease when given before or shortly after exposure to the virus.

Perspective on the Tragedy at the World Trade Center

By Joel Shufro
American Journal of Industrial Medicine 42:557-559 (2002)
December 2002

PDF version

No one was prepared for the tragedy that occurred on September 11th. The loss of life, the collapse of two enormous buildings were overwhelming. No one could have been fully prepared. Agencies with responsibility for protecting the public health did the best they could, working day and night under the most difficult conditions. They triaged; dealing with what they thought were the worst risks first.

Our government has rarely invested enough money in building the infrastructure for environmental health and occupational health. In fact, we have dis-invested over the last two decades in those agencies that have responsibility for public health. We were not only unprepared and overwhelmed, agencies with responsibility to respond to such crises were, and still are, underfunded and understaffed.

The extraordinary circumstances of the collapse demanded an extraordinary response from our government. The Environmental Protection Agency (EPA), Occupational Safety and Health Administration (OSHA), Public Employees Safety and Health (PESH),the New York Department of Health (NYDOH), New York City Environmental Protection Agency (NYCEPA) all attempted to use regulatory frameworks of rules and regulations that are inadequate to protect the health and safety of workers and community residents in good times. In the context of the collapse of the Twin Towers it was apparent that they were ill-prepared to adequately protect the health of workers and community members.

The New York Coalition for Occupational Safety and Health (NYCOSH) has concerns relating to the failure of government agencies to utilize their own rules and regulations to protect and educate the public.

Let me list some of our concerns:

1. There is a need for a new regulatory framework regarding potentially toxic exposures:

Despite reassuring comments by these agencies (e.g., Christine Todd Whitman, www.epa.gov/wtc/stories/ headline), workers in and around Ground Zero and office workers and community residents whose apartments and offices were contaminated by dust were exposed to toxic substances that posed a threat to their health and safety. In each case, the applicable standards were outdated or non-existent. Whether we are talking about EPA's definition of asbestos containing material (1%) or OSHA's asbestos standard, the standards do not protect workers or community residents. Government standards are a compromise between the scientists and industry; they are not based solely on the science.

The crisis did reveal significant gaps in these regulations. First, for office workers returning to contaminated offices, there was no re-occupancy protocol. Workers who returned to work had no recourse but to rely on their employer's assertions that their offices were cleaned appropriately. We are aware that some offices were properly abated, but we also know that many offices were not (Wall Street Journal, citations here). Second, residents, including those with young children, were left to their own devices; they were given minimal guidance on what constituted a "safe environment." The EPA, disclaiming any responsibility for indoor contamination, deferred to the New York City Department of Health, which advised apartment dwellers to clean up by using a mop and wet rags.
2. Rather than use their position as a bully pulpit to provide the public with information they could use to make informed decisions, the agencies saw their role as reassuring the public or said little.

From the outset, government agencies, including EPA, OSHA, PESH and the New York City Department of Health, made reassuring statements about the safety of the environment without adequate data. These statements, as one official bluntly told me off the record, were designed to "reduce hysteria," they were designed for ‘‘crowd control.'' Although some agency staff tried their best to qualify, clarify and disavow the statements of their agency heads, the agencies themselves never retracted their initial reassuring statements. The discrepancy between these official statements and the illnesses experienced by workers and community residents created a serious credibility gap that has not been closed—and in our estimation has bred contempt and cynicism, if not derision, among the public and in important segments of the public health communities.

The EPA, OSHA, and PESH now presume that the dust released by the collapse of the Twin Towers including asbestos-containing material. However, it was not until early February that OSHA, for example, made this presumption public and then only in a letter responding to an inquiry from the Laborers International Union of North America. There was no public warning and the agency took no step to publicize this critical information. Why didn't OSHA, EPA or the New York City Department of Health hold a press conference and put out best practice protocols for cleaning up offices that would, at a minimum, give office workers and residents a standard to which they could have held their employers? A public announcement about the asbestos-containing character of the dust—in English and Spanish—might have had dramatic impact on the day laborers who were hired to clean up lower Manhattan office buildings without appropriate equipment and no training.

3. The absence of strong enforcement and leadership on the part of EPA, OSHA, PESH, the New York City Department of Health and New York City Department of Environmental Protection resulted in unnecessary exposure of workers and community residents to toxic substances. We also believe that such action has set a bad precedent.

I will give one example. OSHA claimed it lacked jurisdiction in a rescue operation under the National Response Plan which prevented them from enforcing their standards—a position we believe is legally incorrect. During the entire cleanup operation, no OSHA standards were enforced on the site. We are concerned about the precedent OSHA set by failing to enforce the law and its standards on the World Trade Center site. Our understanding of the law requires the agency not to interfere with a rescue operation. However, it does not require the agency to suspend enforcement of its regulations as OSHA did. While the agency devoted considerable resources to insure that work at this dangerous site proceeded safely—and it is truly an achievement that no one was killed on this job—we are greatly concerned that this model returns us to the pre-OSHA days of voluntary compliance. We understand that extraordinary times require extraordinary measures. But extraordinary circumstances are not an excuse for a government agency to violate the law and weaken worker protections.

We are also concerned that the partnership that OSHA entered into with the unions on the site does not follow its own criteria and compromises worker protections. We fully trust that the unions on the site are representing the interests of their members, but again, we believe this is a bad legal precedent and OSHA does not have the authority to enter into agreements that violate its own directives.

Congressman Jerrold Nadler and the EPA Ombudsman, Robert Martin have detailed during hearings, the EPA's failure to fulfill its legal mandate. New York City's Department of Environmental Protection, which claims that dust from the Trade Center must be presumed to be asbestos-containing material and must be treated as asbestos has received approximately 35 filings for asbestos abatement jobs in lower Manhattan. Yet the Department has not issued one, not one, violation.

4. A need for uniform sampling protocols and a centralized collection of all testing results.

From the outset, there was confusion about appropriate testing protocols. We do not believe that the sampling strategy was adequate or test results were fully reported to the public. For example, the EPA relied almost exclusively on the results of outdoor sampling to characterize risk—a method which does not provide an adequate characterization of indoor risk levels. Currently, testing is being done in buildings throughout the area by private companies, but there is no central repository to which the data is being reported or being mapped. We have learned that there is mercury contamination at 90 Church Street and that there is dioxin contamination in buildings owned by Manhattan Borough Community College, but there is not a systematic gathering of data of private testing so we can understand the patterns of exposure or contamination. The public is entitled to all of the data in real time and presented in an understandable manner so that people can make informed decisions.

5. Government agencies appear to have ignored their own precedents.

Twelve years ago, when asbestos-containing material contaminated buildings in Gramercy Park as a result of a steam pipe explosion, the New York City Department of Health declared a public health emergency, evacuated buildings, wrapped the buildings in plastic to prevent the dust from contaminating the area, sent in professional asbestos abatement cleaning companies and took five months to clean the apartments. The percentage of asbestos in the mud which was sprayed into buildings from the explosion was the same as that found in samples from the World Trade Center—only in Gramercy Park it is estimated that 200 pounds of asbestos was released whereas it is estimated that approximately 5,000 tons of asbestos was released at the World Trade Center.

EPA intervention in Libby, Montana provides a dramatic contrast to its posture here in New York City. While conditions are qualitatively different than in the area surrounding the World Trade Center—the difference between the protocols followed in the two cities raises important questions. For example, in Libby, the EPA has spent more than $30 million in the last 2 years to decontaminate the outdoor environment in Libby, Montana. The EPA is expected to shortly declare a public health emergency in Libby in order to gain the authority to decontaminate private homes. In lower Manhattan, by contrast, EPA has only recently, after intense pressure, established an indoor air task force to examine the contamination of indoor air.

A driving force and priority in this crisis was to re-open the downtown area especially Wall Street. Public health was not government's main priority when the Mayor announced that Wall Street would be open the following Monday—only six days after the collapse. These decisions were made at the highest levels—probably at the White House. Politics, not public health, was in command.

The AFL-CIO's poster for Worker Memorial Day for 2002 is a photograph of workers at Ground Zero. We do not know when the shot was taken. Not one worker is wearing appropriate protective equipment. The workers who have worked at Ground Zero were on a mission to save their brothers and sisters in one of our nation's most horrible tragedies. These workers were heroes. But like workers who rush into confined spaces to save their brothers or sisters and are overpowered by toxic substances—we hope that they do not become martyrs— 6 months, next year or 10 years from now.

Of the many lessons learned we need to reiterate the dynamic that public health and worker safety are based upon stringent government standards, strong enforcement, and an educated, informed, active, organized workforce and public. We need to go back to basics.

Infectious Diseases
Union Advocates Call for Safeguards As CDC Readies Smallpox Vaccine Plan

By John Herzfeld
Occupational Safety and Health Reporter
November 28, 2002

NEW YORK--With the announcement of a Centers for Disease Control and Prevention plan for voluntary smallpox vaccinations expected imminently, two union safety and health directors Nov. 25 called for safeguards to ensure that the anti-bioterrorism effort does not bring more harm than good to health care and emergency response workers.

Speaking at a forum on smallpox sponsored by the New York Committee for Occupational Safety and Health, safety advocates Bill Borwegen of the Service Employees International Union and James August of the American Federation of State, County, and Municipal Employees argued that many unanswered questions must be addressed before the vaccination plan moves forward.

CDC announced in early October that it intends to launch a preventive vaccination program, prior to any reports of a smallpox incident, for some 500,000 health care workers, to be expanded in later waves to 10 million emergency response workers and then the general U.S. public (32 OSHR 997, 10/24/02).

Borwegen said that he had been told at a meeting with federal health officials that the final CDC plan could be announced as early as the first week in December. Stephanie Factor, a CDC medical epidemiologist assigned to the New York City Department of Health who also appeared at the event, said that she had heard that the plan was being reviewed by officials at the Department of Health and Human Services and the White House and that an HHS announcement on the final shape of the policy was expected "any time."

Worker Protections Needed

Borwegen maintained that the plan would be incomplete without adequate worker protections. "We need to ensure that our members are protected in this process," he said. "A lot of I's need to be dotted and T's need to be crossed, and we hope they will be when the final plan comes out." August similarly warned that tough unresolved economic and political issues come along with the vaccination plan, adding, "We need to think these things through together and ask these questions now, before it's too late."

Among the issues raised by the union officials were:

• education and training to ensure that workers understand the nature of the smallpox risk and the risks of the vaccine itself;
  
• screening for conditions for which the vaccine is counterindicated, including HIV, chemotherapy treatment and other sources of immune deficiency, pregnancy, history of eczema, or any active skin rash;
  
• discrimination against workers who decline the vaccine and may thus face job transfers with accompanying seniority and pay issues;
  
• compensation for lost time and medical expenses for workers made ill by the vaccine or quarantined because of the risk of contagion;
  
• the role of the workers' compensation system for vaccine-related illness or death; and
  
• the cost of the effort and other resource-allocation issues.

"If health care workers are going to be the foot soldiers in the war on terrorism, how are they going to be protected?" Borwegen asked. "We need a safety net to be provided, either by the employer or by the federal, state, or local government."

Unsafe Needles

The union officials also protested against what they said was a CDC purchase of millions of the bifurcated needles used for smallpox vaccine without insisting on obtaining a needle type equipped with integrated safety features, which is available. Borwegen said that CDC was "flouting" the Needlestick Prevention and Safety Act of 2000 with the purchase.

The officials also argued that protections against smallpox transmission could be built into health care facilities as part of a general airborne pathogens standard similar to the unreleased Occupational Safety and Health Administration tuberculosis standard they said was set to be "killed" by the Bush administration. "If we had a TB standard in place, we would already be miles down the road for preventive measures other than vaccination," August said.

Suggesting that more information is needed to assess the relative risk of a smallpox outbreak, August said it was hard to judge what the proper response should be to a "theoretical" threat. Borwegen questioned the launching of protections against such exotic threats as smallpox, plague, or anthrax "when we're not doing what we can" to counter the larger existing threat of TB.

Calling for more efforts at discussion and education with workers and the public, August said that AFSCME members "are the folks on the front lines of every disaster, and they know what can happen to the best-laid plans." He added, "The key is informed consent, with the emphasis on informed."

Impositions From Both Sides

Faced with the criticisms at the meeting, Joseph R. Masci, director of medicine at Mount Sinai Services/Elmhurst Hospital, acknowledged that many issues had yet to be worked out. "This is being imposed on us as it's being imposed on you," he said. In his general remarks, he laid out the medical background on smallpox, underscoring its potency but seeking to balance those dangers with the absence of risk from casual contact and the relative effectiveness of available defenses.

Factor, who gave a presentation on preliminary versions of the CDC plan, sought to assure union safety and health professionals that confidentiality, discrimination, compensation, and other issues could be resolved. "Our role is to give people as much information as possible to make an informed decision," she said during a question-and-answer session. "We hope this is part of a continuing dialogue. Nobody will agree to go forward with this unless these issues are worked out."

Copyright © 2002 by The Bureau of National Affairs, Inc., Washington D.C.

One Year Later, 9/11 Health Concerns Linger

By Barbara McKenna
AFT On Campus
October 18, 2002

http://www.aft.org/higher_ed/Health_Concerns.html

The effects of Sept. 11 will remain forever in the minds and hearts of Americans. But for many New Yorkers, the disaster continues to pose daily physical and psychological challenges as well. No one knows this better than the people who live and work in the community near Ground Zero--including members of the Professional Staff Congress/AFT who work at the Borough of Manhattan Community College. Last September, the 17,000-student institution lost a large classroom building--Fiterman Hall--located next to the World Trade Center.

The PSC received many inquiries from members who were worried about their health in the days following the terrorist attacks. A full year later, questions remain about the long-term effects of exposures to toxins in the aftermath of the incident.

The PSC is concerned about elevated lead levels in the air-handling units and the deadly mix of asbestos, dioxin and mold, says Joan Greenbaum, a health and safety officer for the union. PSC has yet to be given an exact date for toxic waste clean-up, Greenbaum adds.

A more visible problem is overcrowded classrooms. When the community college's 17,000 students returned to campus last month, they were crammed into the main campus building, which was designed to hold only 8,000 students. "The air is terrible," says Jane Young, president of the PSC chapter at BMCC. "Many of the [temporary] classrooms don't have windows. Every day, there are escalators that don't work. We have lots of quality-of-life issues."

The administration brought in portable classrooms, but they were located too close to the trucks and barges used during the clean-up of the site; the noise and dust kept students from using them, notes Greenbaum.

Fiterman Hall will be razed and rebuilt, but it may take three to five years before the new building is completed. In the meantime, the BMCC administration is looking for rental space in the area to ease overcrowding.

Last year the PSC, with the cooperation of the college administration, asked the National Institute for Occupational Safety and Health (NIOSH) to examine the extent of the physical and mental health problems of college staff following Sept 11. NIOSH surveyed the faculty and professional, clerical, maintenance and security employees at the college. The agency's report is pending.

In June, NIOSH released results of a similar survey of faculty and staff conducted at Stuyvesant High School, located several blocks from BMCC. A significant number of Stuyvesant staff showed symptoms of depression and posttraumatic stress disorder syndrome as well as other physical symptoms.

The findings are important to the PSC because "BMCC has used Stuyvesant as a barometer," Greenbaum says. The PSC has been following the lead of the high school's parent association and its efforts because the BMCC has all of the same health and safety issues as the school, she adds.

The PSC also has been active in the New York Committee for Occupational Safety and Health (NYCOSH), a coalition of unions, environmental activists and city residents. Earlier this year, NYCOSH experts testified on behalf of its members about the impact of the attacks on public health at hearings held by the City Council, the New York State Department of Environmental Conservation and the U.S. Environmental Protection Agency.

The successful effort to hold hearings on the community health and safety issues that resulted from the Sept. 11 attacks was a collaboration between labor and city residents, notes Greenbaum. The parties came together because "the residents were not getting anywhere by themselves, and neither was labor," she says.

Copyright by the American Federation of Teachers, AFL•CIO

Congressman: OSHA's 9/11 Response Endangered Workers

By James Nash
Occupational Hazards
September 30, 2002

In the face of mounting evidence of long-term illness among those who did rescue and recovery work at the former World Trade Center (WTC), the congressman representing Lower Manhattan has criticized the response of OSHA and EPA to last year's terrorist attacks.

In a June 3 letter to OSHA Administrator John Henshaw, Rep. Jerrold Nadler, D-NY, requested detailed information explaining why OSHA suspended its enforcement authority at the WTC disaster site.

Henshaw's Aug. 9 reply appears not to have resolved the issue. In addition, the OSHA administrator's letter provoked new charges of EPA duplicity from Nadler's office.

Henshaw explained that "the urgency of the task" at the WTC "did not allow time to invoke OSHA's ordinary enforcement procedures to assure the safety of these workers."

OSHA officials have defended the decision not to enforce safety and health rules by noting that contested citations can take years to settle, whereas the partnership agreements used at Ground Zero led to immediate resolutions of safety issues. They also point to the low injury rate at the site as proof the emphasis on consultation and compliance assistance worked.

"I am sure there is no suggestion on your part," Henshaw wrote in his reply to Nadler, "that the decision to place an emphasis on assistance somehow added to the danger those heroic workers encountered."

That is precisely what Nadler is suggesting, according to spokesperson Eric Schmeltzer.

"The Congressman's contention is that there should have been enforcement," Schmeltzer explained. "He believes the suspension of OSHA enforcement authority in favor of the contractors did put America's heroes in unnecessary danger."

Schmeltzer emphasized that Nadler was placing no blame on the contractors, as they can only operate with the information given them by the government. Recent studies by Johns Hopkins University's School of Public Health, the Center for Disease Control and other institutions have documented persistent respiratory symptoms among rescue and recovery workers, many of whom did not use proper respiratory equipment while working at Ground Zero.

Jonathan Bennett, public affairs director at the New York Committee for Occupational Safety and Health said his organization was troubled by a number of features of Henshaw's response to Nadler.

"The Nadler letter asks for some very specific information, to document and explain why OSHA suspended its enforcement authority," Bennett said. "Henshaw didn't answer the question - what he wrote was a bunch of generalities."

Nadler has been even more critical of EPA's reaction to the terrorist attacks, specifically statements that the air in Lower Manhattan was safe and EPA's refusal to take charge of cleaning up the interior of Lower Manhattan buildings contaminated with a variety of contaminants.

EPA has defended its decision by arguing that it had no legal responsibility to clean up interior environments because the National Contingency Plan (NCP) was not in effect.

In his letter, Henshaw defended OSHA's consultation role at the WTC be referring to OSHA's membership in the NCP.

"OSHA is now saying NCP is in effect, a point Rep. Nadler has been contending all along in the face of EPA denials," said Schmeltzer.

EPA declined to respond to numerous requests for comment on whether NCP was in effect.

by James L Nash (jnash@penton.com)

Ready or Not, Disasters Happen

By Martha L. Orr, MN, RN, CAE
Online Journal of Issues in Nursing
September 30, 2002

http://www.nursingworld.org/ojin/topic19/tpc19_2.htm

ABSTRACT
The New York State Nurses Association was – as was the entire country – plunged into disaster response mode by 9:30 am on the morning of Tuesday, September 11, 2001. Although the association had engaged in limited disaster planning prior to this event, that planning was in terms of an internal disaster such as a fire in our headquarters building. There was no plan for responding to a community catastrophe of the magnitude being experienced. The association faced unique challenges – including the fact that our New York City offices are located near ground zero - but was fortunate in having expert resource persons on staff and available to organize a response. Since September, the association has applied the lessons learned from this experience and developed a comprehensive disaster plan for the future. The purpose of this article is to share those lessons learned with the community of nursing associations in the hope that others can use the information to build effective disaster plans of their own.

Key words: disaster, planning, response

The tragic events of September 11, 2001 affected the entire nation and the world. To those of us who live and work in New York, the shock of watching the World Trade Center’s skyscrapers collapse into millions of tons of rubble and the fear of possibly 10,000 victims were initially paralyzing. In the headquarters building of the New York State Nurses Association (NYSNA) in upstate New York – 150 miles away, approximately 80 nurses – many from the metropolitan area - were gathered for a meeting. They and the staff of the association congregated around our television sets and wept, or sat at telephones urgently, and usually in vain, trying to reach family and friends in the immediate area. Most telephone service and electronic communications systems in lower Manhattan were disrupted, and all intact communication lines were immediately flooded with calls. The NYSNA offices on Wall Street, within a few blocks of the World Trade Center, could not be reached, so we had the additional stress of concern for the staff’s safety in that area.

It was initially feared that as many as 10,000 persons might have lost their lives in the disaster. However, through the heroic evacuation efforts of the police, fire departments and thousands of employees, visitors, and bystanders, fewer than 3000 individuals died in the tragedy. The property and business damages have been estimated at over 100 billion dollars. Indirect costs related to the lost wages and benefits of employees, and the continuing medical and mental health treatment of survivors, their families, and others affected by the disaster are incalculable.

The association had never contemplated a disaster on this scale.
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We were clearly not prepared to respond to a major community disaster in which the health care system – and nurses – would be a vital resource to be mobilized.

We had planned for fire or other natural disaster involving our headquarters, but we were clearly not prepared to respond to a major community disaster in which the health care system – and nurses – would be a vital resource to be mobilized. Although many nurses receive basic education in first aid, epidemiology and outbreaks of infectious disease, and perhaps some facility- based training on disaster plans related to fires, multiple vehicle accidents or train/plane crases, few (if any) educational institutions or health care facilities provide any courses or electives on mass casualties or disasters of this scale.

As the professional association for registered nurses in New York, the association’s mission includes services to members and the profession at large. We have more than 150 staff in three offices, including experts in communications, the regulation of practice in the state, and information management. When the disaster occurred, senior NYSNA staff were uncertain of what role the association could serve in the recovery efforts. However, it seemed apparent that we had the resources to assist in the disaster by being a channel for information concerning the possible need for nurse volunteers. Nurses across the United States, as well as within the state, soon utilized our web site as a first point of information. Additional disaster response continued throughout the course of the disaster recovery efforts, thus showing the appropriate role of the association in this situation. The purpose of this article is to share those lessons learned, lessons about what professional associations can do in response to such disasters, in the hope that other associations can use this information to build effective disaster plans of their own.

Immediate Responses
Within an hour of the disaster, executive staff of the association organized an Emergency Response Team to assess the situation, determine priorities, and organize our work. These activities included arranging transportation; obtaining proof of licensure; establishing communications; and managing volunteers, operations and public relations.

Arrange Transportation

The most pressing requirement was to arrange for transportation back to New York City for the nurses attending our meeting in our headquarters in upstate New York.
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A complicating factor was that many of the members in the building had no available documentation of their licensure status as RNs...

These nurses were experiencing a profound and urgent need to return to New York City, both to check on the safety of their families and to report to their places of employment in the City. Public transportation had ceased and private transportation was restricted from entering Manhattan. Since airlines were grounded, several members had to rent automobiles to drive back to other cities around the state. A complicating factor was that many of the members in the building had no available documentation of their licensure status as RNs or their employment in New York City, both of which were required to arrange clearance by the National Guard to travel into the affected area.

Initially, the State Police, the Fire Department, the Red Cross, and the National Guard turned down NYSNA’s request to provide transportation back to New York City for the stranded nurses. Ultimately, an official from the State’s Emergency Medical Services Bureau commandeered a bus and coordinated entry into the city. By this time the Borough of Manhattan and all approaches to New York City had been "locked down" and were under the control of local police, the military, or National Guard.

Obtain Proof of Identity and Professional Licensure

Members needed proof that they were registered nurses to gain access into New York City. NYSNA staff accessed the State Education Department Office of the Professions’ licensure verification web site and printed a copy of each nurse’s on-line licensure information. This proof of status, in conjunction with photo identification, facilitated the successful return of these nurses into New York City.

Establish Communications

The disruption of telephone, fax, and computer communications into lower Manhattan was particularly stressful. Fortunately, many staff and visitors present in our headquarters had cell phones and were eventually able to make connections to their families and employers in New York City. NYSNA staff were evacuated from the New York City office, located within blocks of "ground zero" and soon arranged a network of cellular communications among themselves and with our headquarters. Since the Executive level staff work at headquarters, it was important to establish regular communication with the New York City staff, most of whom work as field service representatives in the health care facilities of the New York City area.

Communications with disaster response agencies were very difficult since we did not have a current list of contact numbers or staff names. These agencies were inundated with their own requirements and we had to go through "back channels" to establish contact. Our headquarters staff who had working relationships with agency staff were able to contact those persons instead of the agency officials, and then to relay offers of assistance or ask urgent questions.

Manage volunteers

Within two hours of the disaster, NYSNA headquarters (upstate) was overwhelmed with calls and e-mail from nurses across the country who wanted to volunteer their services. It was necessary to assign three full-time staff to answer the telephones and e-mail and record the information. Potential volunteers (over 1000 contacts) were eager to be called on and wanted immediate and frequent follow-up telephone or e-mail contact from NYSNA.

NYSNA’s Emergency Response Team contacted the State Emergency Management Office (SEMO), and NYSNA was designated as the official repository for information from nurses who could volunteer during the disaster. A system was established to respond to telephone calls and e-mails, and a database was created that included name, state of licensure, address, contact numbers, e-mail address, specialty and availability.

This information was sent to SEMO. In addition, NYSNA notified the Healthcare Association of New York State, the Greater New York Hospital Association, the New York Organization of Nurse Executives, and the nursing executives in the New York City area that a searchable list of over 1000 nurses and other healthcare workers was available. This list was also shared with the American Red Cross. State nurses associations and other groups offered to send busloads of nurse volunteers. A medical center in Vermont sent a list of all of their healthcare workers. All potential volunteers were informed that the New York State Nurse Practice Act contains an exemption for federal, state and civil emergencies. During such emergencies, RNs need not be licensed in New York State, but must bring with them evidence of current licensure in another state.

Manage operations

Not the least of our concerns was the fact that no business could be conducted from our New York City office for two weeks. Mail delivery was completely disrupted and when the office was reopened, there was an enormous backlog of work for the administrative and professional staff. Although the professional staff were able to establish contacts working from home, in many cases field service staff could not reach their facilities because of transportation disruption. It was necessary to shift all possible activity to our headquarters. Alternative office space had to be found in the event that the city office could not be reopened.

The impact of the disaster on staff was tremendous, especially among those who volunteered at the disaster site or who were evacuated from the NYC office. Nearly every staff person has experienced some form of post-traumatic stress disorder. Our Employee Assistance Program provider could not meet the need for service on this scale, so it was necessary to find additional assistance among our members and staff. Peer support meetings were organized and provided for staff for about three months.

Manage information and public relations

Many members, the press, and others called for information about the disaster and NYSNA’s response. We had no communications plan for an event of this magnitude that required near constant internal and external communications with the press, agencies, members, and volunteers. Fortunately, NYSNA has an experienced communications staff, and as quickly as messages could be crafted, they were placed on our web site. Broadcast e-mail was used to keep the board of directors, other state nurses associations and ANA informed of our activities and needs.

Continuing and Long-Range Issues

By Thursday, September 13th , the response to NYSNA and SEMO was so overwhelming that the call for nurse volunteers had to be withdrawn. It was clear there would be few survivors and that the emphasis would be on recovery, not rescue.

NYSNA members helped treat thousands of survivors who arrived at NYC hospitals. Many were admitted, but most were triaged and treated for minor injuries. While the initial onslaught of patients seemed overwhelming, hospitals never lost their ability to deliver services, largely because their own staffs instantly mobilized. Few facilities had to call any staff persons to come in – all off duty staff mobilized themselves!

By Tuesday afternoon, September 18th, the focus shifted to helping rescue workers, as there were no more survivors expected. NYSNA members helped at the staging and family center areas, providing mental health counseling and assistance with the shelters. NYSNA staff members contacted their military reserve units, volunteered with the American Red Cross at a World Trade Center triage center, assisted with the rescue and recovery, provided emergency nursing care, donated blood, and volunteered with the Red Cross’s Family Services Division.

Our web site described how nurses were responding to the terrorist attack and how to volunteer. Information was also supplied about hotlines, grief-counseling services, and suggested charities for donations. On a daily basis the need for supplies or opportunities for volunteering were identified. NYSNA shared stories from nurses providing care near the World Trade Center and provided an online opportunity for nurses to comment on the national crisis. Also on the web site were recommendations from the New York Committee for Occupational Safety and Health (NYCOSH) about air and environmental hazards that might affect those involved in rescue, recovery and clean-up operations.

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The association utilized staff of our Statewide Peer Assistance Network to provide individual and group opportunities to discuss the feelings of grief and anger that were so prevalent.

For months following the disaster, the primary needs for nurses were for specialists in mental health care (children and adults) and burn care. NYSNA facilitated access to lists of qualified providers in these areas. Post-Traumatic Stress Syndrome was evident in many volunteers and staff of the association. The association utilized staff of our Statewide Peer Assistance Network to provide individual and group opportunities to discuss the feelings of grief and anger that were so prevalent. First-hand accounts of conditions at "Ground Zero" were shared by staff who volunteered at the site. Through our communications department, the association also collected nurses’ stories of their experience. Some of these stories were printed in a special issue of The Journal of the New York State Nurses Association (The Journal of NYSNA,2002).

One very special concern was the fact that the Association’s centennial convention and celebration was scheduled in less than six weeks – in a New York City hotel.
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...the decision to proceed with the convention (and to deny terrorism that acknowledgement) was quickly made.

Questions about our intent to hold the convention – and members’ willingness to attend – surfaced almost immediately. With enormous cancellation penalties looming, the decision to proceed with the convention (and to deny terrorism that acknowledgement) was quickly made. By action of our Voting Body at convention, a special task force was created to examine our preparedness to meet the disaster-related needs of our communities, especially for provision of mental health care.

The Future – Getting Ready For Any Disaster
NYSNA held an "after-action" review of the entire experience and formulated plans for future work. These were our goals:

Establish a comprehensive disaster plan. The plan should, at a minimum, include internal policies for responding to various levels of emergencies and disasters; policies for interaction of the association with federal, state and local authorities; alternate communications channels; evacuation plans; plans for maintenance and restoration of business operations.

Develop guidelines for communication and information that should be provided for members and the public through various communication vehicles. Designate a specific spokesperson to respond to the press.

Develop and maintain a master list of contact numbers and staff names for SEMO, FEMA, American Red Cross (state and city offices), Salvation Army, and mental health providers. Establish and develop relationships with these resource persons. Update the list every 3-6 months.

Develop an understanding of the functions (and coordination) of FEMA and SEMO, and relief agencies. (Some Directors of Nursing told us that they were required to get nurses from FEMA in order for the federal government to reimburse for the costs of these nurses.) Determine the best way to integrate assistance from the association into these other groups’ activities.

Address the educational needs of members regarding disaster preparedness, training for volunteer work in disasters, bioterroism, and employee rights when absent due to a federal, state, or local emergency.

Explore the possibility/advisability of establishing permanent photo identification cards for health personnel.

Keep in mind that history is occurring during a disaster and keep a record for historical purposes. First hand accounts of nurses’ involvement in disaster relief should be invited and recorded.

Understand that SNA staff are experiencing the disaster even while having to respond. Plan for provision of staff support.

A "permanent" staff team was created to develop the disaster plan and make recommendations for implementation activities. The plan is nearing completion and includes sections on life safety, property protection, staff communications, administration and logistics, community outreach and disaster response, recovery and restoration of operations, policies regarding interruption of mail and telecommunications, and handling of suspicious mail.

Alternate office space has been identified.
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Offsite storage of the association’s critical databases has been arranged, with electronic backup every evening.

Offsite storage of the association’s critical databases has been arranged, with electronic backup every evening. American Red Cross pamphlets and checklists for personal/home disaster preparation have been distributed to all staff. Primary and alternate communications "trees" (including telephone, e-mail, and cell phone numbers) have been developed and will be distributed to all management staff.

NYSNA has received a grant from the Department of Health to provide disaster preparedness training for nurses. We hope to receive some additional funding to create and maintain a statewide database of nurses who are trained and ready to provide disaster related services. NYSNA has developed and posted an on-line continuing education course on exposure to biological agents (bioterrorism) and plans to offer additional courses on disaster preparedness. (http://www.nysna.org/PROGRAMS/NED/HOME.htm)

Organized Nursing’s Response

NYSNA believes that a national, coordinated plan and mechanism for mobilizing the profession’s large resource pool should be developed. It is important to ensure the availability and involvement of volunteer professional nurses for the emergency organizations and agencies that respond to emergencies and disasters such as earthquakes, hurricanes, fires, storms, tornadoes, epidemics, nuclear reactor accidents, biological hazards, and acts of violence and terrorism.

For this reason, NYSNA, in collaboration with several other state nurses associations, submitted a resolution to the 2002 House of Delegates of The American Nurses Association (ANA) to urge ANA to provide ongoing leadership for the profession on the need to develop and maintain an adequate number of nurse volunteers available to the organizations and agencies that provide emergency, rescue and disaster services. We believe ANA must also provide direction to individual volunteer professional nurses in order that these nurses may proactively plan their own responses in a coordinated way that enhances the necessary relief and rescue efforts.

The specific recommendations submitted to ANA were as follows:

Provide leadership for the profession on the need for nurses to volunteer their services to assist in the activities of the agencies and organizations that offer rescue, relief, and disaster services.

Promote workplace initiatives that support nurses volunteering during periods of local, state, and federal emergencies and disasters.

Provide leadership for the constituent member associations in planning for state, regional and national disaster services.

The resolution was passed nearly unanimously by the House of Delegates in 2002.

Several state nurses associations have already begun their own work in planning for disasters. The Georgia Nurses Association, for example, in collaboration with the American Red Cross, the Georgia Board of Nursing, the Georgia Department of Human Resources, and the Georgia Nurses Foundation, has established a network of volunteer nurses who will make up part of a statewide emergency response team(Robinson, 2002). Work on disaster preparedness has also been done by the Florida, Oklahoma. Virginia, and Washington Nurses Associations.

Clearly, professional associations should be prepared to respond to even unimaginable disasters - to mobilize resources, maintain their vital business operations, facilitate communications, and support nurses in the exercise of their professional responsibility. One excellent resource to assist associations in planning is a special publication of the Federal Emergency Management Agency’s "Emergency Management Guide for Business and Industry"(Wahle & Beatty, n.d.). This publication contains sections on plan development and suggestions for communications, community outreach, life safety, and other business recovery information. The Guide is available in both HTML and as a PDF file from the Preparedness, Training and Exercises Room of the FEMA online library (www.fema.gov/library/).

Another excellent resource is a special issue of a Joint Commission on Accreditation of Healthcare Organizations (JCAHO) publication, "Emergency Management in the New Millenium." (JCAHO, 2001). Although framed in terms of emergency management within health care facilities, several of the articles contain recommendations for emergency management that are applicable to associations. Subscribers can obtain this issue online at www.jcrinc.com/.

Summary

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Nursing’s organizations have an opportunity and obligation, as part of the profession’s social contract, to identify our appropriate roles in the event of natural or manmade disasters.

Sadly, it appears that continued threats of terrorism and mass destruction will be a presence in our society for the foreseeable future. Nursing’s organizations have an opportunity and obligation, as part of the profession’s social contract, to identify our appropriate roles in the event of natural or manmade disasters. It is a given that such disasters will be disruptive of the normal systems needed to respond to large-scale disasters, including communications, transportation, supply lines, and decision-making systems. Strategic planning must be utilized to identify alternate scenarios for response. Finally, the impact of disasters upon the emergency response personnel and their families must be understood and provision made to care for the caregivers. Ready or not, disasters happen. Registered nurses – and their professional organizations – can be leaders in recovery efforts.

AUTHORS
Martha L. Orr, MN, RN, CAE
e-mail: martha.orr@nysna.org

Martha Orr received both her bachelor and master’s of nursing degrees from Emory University in Atlanta, GA. She is certified by the American Society of Association Executives (Certified Association Executive). Ms. Orr has been Executive Director of NYSNA for 17 years. NYSNA is the oldest and largest of the ANA constituent member associations. With a staff of more than 160 persons located in three offices, Ms. Orr has had numerous experiences managing organizational crises, though none involving a community disaster of these proportions. When asked to comment on experiences that might have assisted her in responding, Ms. Orr credits her training in nursing assessment, care planning, and evaluation. Multi-tasking skills are highly developed in professional nurses and association executives!

REFERENCES
Joint Commission on Accreditation of Health Care Organizations. (2001). Mobilizing America’s health care reservoir. Perspectives, 21, 12.

The Journal of the New York State Nurses Association. (2002). The New York city disaster [Special Issue]. The Journal of the New York State Nurses Association, 33,1.

Robinson, C.C. (2002). Introducing the Georgia nurse alert system. Georgia Nursing, 62 (1), 1,3.

Wahle, T.& Beatty, G. (n.d.). Emergency management guide for business and industry. Jessup, MD: Federal Emergency Management Agency.

© 2002 Online Journal of Issues in Nursing

Dusting off Manhattan: A year after 9/11, worries about toxic dust plague residents

By Francesca Lyman
MSNBC
September 9, 2002

http://www.msnbc.com/news/803400.asp

Sept. 9 — A year since the twin towers collapsed, spewing a million tons of dust and ash over the city and triggering long-smoldering fires, New Yorkers say they're finally breathing cleaner air. Even so, as schools reopen and the city continues testing and cleaning thousands of apartments for lingering dust, residents are voicing unsettling health concerns about the fallout from the city's worst environmental disaster.

On the morning of Sept. 11, just after the first jetliner hit, actress Kim Todd got a call from a friend who worked in the World Trade Center asking for help evacuating people. Living just two blocks away, Todd rushed to his aid. But she was caught in thick smoke and the throngs of people escaping the building, and narrowly missed being hit by a falling piece of the jetliner.

"Then the second tower came down, and everyone around me was dead. And while I was taking a breath and thinking, ‘I'm OK — don't move,' a passing fireman stopped and, seeing me alive, slapped me across the face and said, ‘Run! Run for your life!'"

After intensive therapy and an easing of her "survivor's guilt," the loyal resident of lower Manhattan, an acting coach, is beginning to recover psychologically. Now she worries about her physical ailments. She still suffers from a chronic cough and headaches, like many of her neighbors who inhaled the dust and fumes of downtown Manhattan over the course of the past year. "But I am happy to be alive, and my doctors have helped tremendously, even with my bills," Todd says.

Today most New Yorkers, including clean-air advocates, say New York's air quality is back to normal — "at least normal for New York," says Louise Leavitt of the American Lung Association's state chapter.

But some anxieties remain. Downtown residents who were promised help in getting rid of lingering ash and dust that made its way indoors through windows, vents and ducts worry that the testing and cleanup may not be enough. Fire trucks and cars still turn up with asbestos-tainted dust.


ONGOING CLEANUP EFFORTS

In May, the Environmental Protection Agency announced it would clean up and test the apartments of any downtown residents who wanted it. So far, the agency has received more than 3,100 requests for for cleaning and 900 for testing only.

The EPA hopes its efforts will allay any lingering health concerns. "We're talking about very low, long-term health risks here," says Bonnie Bellow, an EPA spokeswoman, "but there's no question that some people are more sensitive than others and that residues of asbestos could be problematic."

Many residents have been mistrustful of health officials because they feel they didn't warn them enough of potential hazards early on or take necessary steps to protect them from dust mixed with hazardous materials such as asbestos and heavy metals.

The agency was widely criticized after EPA chief Christie Whitman told New Yorkers that there was nothing in the air to worry about in the weeks after the attacks.

In June, a poll by an independent health research group found that more than half of lower Manhattan residents reported some sort of ailment. "In an interesting twist," wrote the Mellman Group, "the Manhattanites expressed more concern about air quality than they did about another terrorist attack."

"We all have been exposed to a host of toxic chemicals," says Todd, adding that tests of dust in her apartment turned up everything from asbestos to mercury to kaolin, a clay that causes skin irritation.

Many residents worry about what was in the dust they breathed or still breathe. Jared Cook, president of a tenants group for one of Battery Park City's buildings, two blocks south of Ground Zero, says many tenants wish the EPA would test indoor spaces for other contaminants besides asbestos, since mercury, lead and other heavy metals, PCBs and dioxins have turned up in independent tests.

Rather than protest, however, Cook says his group advocates that tenants take advantage of what the EPA is now offering. "We hope that letting EPA send in its certified contractors to test and clean for asbestos will most likely take care of most other contaminants as well," says Cook. Nevertheless he finds it unsettling that of the five or six residents who had themselves tested for exposure to heavy metals, all tested positive.

Rep. Jerrold Nadler, D-N.Y., an outspoken critic of the EPA's handling of the situation, puts it more strongly. "One year later, it's outrageous that people are still living in contaminated spaces," says the congressman. "People are still anguishing over the known hazards and possible hazards of what they're breathing in their homes."

Other critics say the EPA ought to be protecting workplaces as well. "There are thousands of offices and stores where asbestos-tainted dust fell and where cleanups were insufficient," says Jonathan Bennett of the New York Committee for Occupational Safety and Health. "It still lingers in boiler rooms, crevices and carpets."


CONCERNS ABOUT NEARBY SCHOOL

Then there are worries over Stuyvesant High School, the center of a heated controversy since last June, when its ductwork and ventilation system were found to be contaminated with lead. The school, which sits across from a site where toxic debris was loaded onto a garbage barge, also served as a triage center for Ground Zero rescue workers.

The New York City Department of Education assured parents that the school was thoroughly cleaned when it reopened last week, and Parents Association President Judy Moore is satisfied with the department's standards. "It's better that they should get back to their old school than worry about possible hazards," she says. "Any problematic areas could be sealed off and cleaned while school is in session."

But on opening day, several dozen parents stood outside protesting the school's handling of the issue. Paul Edwards, parent of a 17-year-old Stuyvesant student, wasn't planning on sending his son back until the school could answer his lingering safety questions. He and others worried that vents had not been retested and that carpeting and upholstery were still contaminated with asbestos. As a result of their protest, however, Edwards was happy that the department "agreed to remove and replace all carpeting in the building, replace the theatrical curtain in the auditorium and continue discussions."

Despite the concerns, many residents say they wouldn't want to leave downtown. "I just want to get through the anniversary, and find the fireman that saved my life," says Todd.

Francesca Lyman is a Seattle area-based freelance writer.

MSNBC © 2002

The Air Down There
A year after the attacks, concerns linger over the long-term health effects on residents and rescue workers who breathed in contaminated air

By Julie Scelfo and Suzanne Smalley
NEWSWEEK WEB EXCLUSIVE
September 6, 2002

http://www.msnbc.com/news/802911.asp#BODY

One Year Later — When the World Trade Center exploded in a cloud of dust and fire last year, LaVerna Bradley, 71, watched in horror from her apartment on Madison Street, just ten blocks away. But within minutes, she—along with her husband, Arthur, who suffers from Parkinson's disease and has difficulty walking—were unable to see much of anything. A cloud of thick, gray dust blew through their open windows before Arthur was able to close them. LaVerna, who was bedridden after having minor surgery the day before, was too weak to get up or prevent the contaminated dust from overtaking the apartment. A fine powder quickly coated everything in their home, including the kitchen counter, the velvet sofa, and the bed the couple had bought when they got married in 1984. "It was like being in England during the blitz," says LaVerna. "Everything was confused."

A YEAR AFTER THE September 11 attack on New York, the Ground Zero clean-up is officially over. But the health impact on workers at the site and on lower Manhattan residents remains largely unknown. Tens of thousands of people live in the surrounding area. Thousands of others spent months working at the recovery site, often directly atop the smoky ruins. In the days following the attacks, the Environmental Protection Agency's Christie Whitman proclaimed that there was no reason to worry. "[T]he public in these areas is not being exposed to excessive levels of asbestos or other harmful substances," Whitman said in a September 18 press release. New Yorkers "need not be concerned about environmental issues as they return to their homes and workplaces," she added three days later.

But as information about toxins in the dust began to make headline news, critics questioned whether Whitman had spoken too quickly. Tests soon revealed, among other findings, that some of the downtown dust samples contained significant amounts of asbestos. Federal law requires that materials containing more than one percent asbestos must be cleaned and disposed of by professionally licensed workers wearing proper masks. Yet many of the rescue workers spent days or weeks at the disaster site with nothing covering their faces.

Residents who remained in lower Manhattan also resumed life without masks, choosing to believe the government's assurances. The EPA says it has no regulations or standards regarding indoor air quality and deferred decisions about cleaning indoor spaces to New York City. The city, in turn, delegated those cleaning duties to tenants and building owners who could decide for themselves how much, or even whether, to clean. While some residents hired professionals, others like the Bradleys couldn't afford the costly effort and instead cleaned sporadically cleaned using mops or vacuums in the months following the attacks. "You can't sweep this stuff," says the grandmother of 17. "It's hidden in corners and underneath furniture. I had to buy a cover for the couch because every time my grandkids sit down a light dust rises up."

Meanwhile, hundreds of the firefighters and other rescue workers began having respiratory problems. Bobby Stanlewicz, who had rushed to Ground Zero after the Towers collapsed on September 11, spent days fighting the fires that still spewed from beneath the wreckage and helping his coworkers search for signs of life—often working 16-hour shifts, even though the smoke was irritating his throat and lungs. It wasn't until weeks after he'd stopped working at the site that the 13-year veteran firefighter began to notice a tightness in his chest. "I had a couple of nights where I couldn't breathe at all," says Stanlewicz, 35. "I felt like I was suffocating."

Within six months of the tragedy, an estimated 332 of the 10,000 firefighters who reported to the site, including Stanlewicz, required medical leave of one month or longer. Even some who did not take medical leave still complain about shortness of breath, persistent coughs and tightness in the chest. "It is very probable that some proportion of the firefighters who worked at Ground Zero have sustained permanent damage to their lungs," says Dr. Jaime Szeinuk, a doctor who works at Mt. Sinai Hospital's occupational and environmental health clinic. "Some of them may not have sustained permanent damage, but if they continue to work as firefighters and become exposed to more smoke, their condition will be aggravated. For some of these men, the damage could be career ending."

As news of the firefighters' heath problems spread, lower Manhattan residents who believed they might still be living in contaminated apartments began demanding more tests of the dust in their homes and workplaces. Other groups formed to challenge authorities to do a better job cleaning up the lower Manhattan schools. Jenna Orkin, who has become an environmental activist in the wake of the September 11 attacks, pulled her 17-year-old son out of Stuyvesant High School in February. He didn't speak to her for months but began to cheerlead her efforts when independent test results became available two weeks ago showing alarming asbestos levels throughout the school. In the auditorium, asbestos levels were 250 times the safety limit, according to independent tests performed by Howard Bader, an environmental engineer hired by a parents' association. Yet Stuyvesant High School waited until July to clean its ventilation system, after assuring parents that it had been cleaned in October, Orkin says.

The New York City board of education says testing was done in October, though spokesman Tom Antonen concedes that it consisted mainly of blowing air through the vents. The decision to clean out the vents with soap and water this summer came after low levels of lead were found in the system. Still, Antonen says that the board has spent $1.7 million so far on cleaning and testing at Stuyvesant High School. "There have literally been thousands of air quality tests done and all of them have come back normal," he adds.

Orkin remains skeptical. "The testing done during the school year was grossly inadequate," she says. "I think the consequences of this are going to be vast and I worry about increased cancer rates and birth defects."

Concerns like these reached a fever pitch this summer. Although most lower-Manhattan residents don't think they had the same level of exposure as the firefighters who worked directly on the pile of rubble, they are worried about the long-term implications of breathing the fine, particular dust. Under increasing pressure from local residents and officials, the federal government finally stepped in. On May 8, the EPA announced it would provide clean-up and testing to any downtown residents who wanted it. In August, the EPA announced that it would extend the deadline for registration by a month, until October 2, but the news never reached some families like the Bradleys, who, despite multiple calls to FEMA, never heard about the EPA's offer to clean. At press time, only 3,185 residents had requested cleaning and testing, with another 902 asking for testing alone.

The EPA and some experts say most of those tests should yield normal (or near normal) results. In fact, the EPA has maintained all along that the test results conducted so far have not shown dangerous levels of contaminants and that the heightened concern among downtown residents over pollution problems has more to do with fear of the unknown than with specific scientific data. "We're on the cutting edge of science here. There's not a textbook that we could pull off a shelf that says ‘This is what you do when huge buildings collapse'," says Mary Mears, a spokeswoman for the EPA's office in New York. "I recognize that we do have our critics right now, but, sadly, I'm afraid that all of the good work we have done has gone unnoticed." The EPA began testing outdoor air in lower Manhattan immediately after the tragedy, and didn't stop until the week after recovery work officially ended at the site in June. The agency also sent a dozen trucks to vacuum dust from the street and erected a 31,000-square-foot cleaning station to prevent workers from carrying the dust outside the World Trade Center area.

Still, many health and safety advocates insist that the EPA has been minimizing the risks of air pollution in the area. "From our perspective...we're coming up on the anniversary date and the EPA is just now seriously addressing residents' problems," says Carrie Loewenherz, a certified industrial hygienist with the New York Committee for Occupational Safety and Health. "And the EPA is still not acknowledging that there's a health risk problem, even though there are documented cases of asthma, bronchitis and other respiratory disease." The New York City Department of Health is making plans to register 200,000 people for a longitudinal study to monitor unusual symptoms among people who were heavily impacted by the debris. "No one can say with absolute certainty until time has passed whether there will be any longer term health impacts than the ones that we saw in the immediate aftermath," says Sandra Mullin, a spokesperson for the New York City Department of Health. "It's something we can't know and won't know until over time."

While downtown residents and firefighters are encouraged by the federal government's recent agreement to help with clean-up and testing, many grumble that it's too little, too late. ""The damage has been done to my throat," says LaVerna Bradley, who began to cry as she described how she has been unable to swallow and has trouble breathing. "I know it's related to the dust that remains in my apartment," she adds. "I've never had problems like this before."

Though firefighters have finished their work at Ground Zero, they also remain at risk. Scores of firefighters found out in July that they'd been driving contaminated trucks all year. The non-profit New York Environmental Law and Justice Project (NYELJP) conducted independent tests of debris taken from some fire trucks still in service after September 11. The results showed asbestos levels of 5 percent in the debris found inside at least one truck, five times the widely recognized threshold for material that civilians can safely handle. Several other trucks tested by NYELJP also showed elevated asbestos rates. Philip McArdle, the health and safety director of the Uniformed Firefighters Association, said he is saddened by the way the government has forgotten the men it once heralded as heroes. "We did a very good job of taking care of the dead after September 11," he said. "But we're doing a very bad job of taking care of the living." Hopefully, it's not too late to take care of both.