Mount Sinai WTC study cites numerous and “persistent’ health problems
Findings from the World Trade Center (WTC) Worker and Volunteer Medical Screening Program, released in September, include the following. The study, which focused on respiratory health, found that a high proportion of workers at the WTC became sick and that the illnesses have remained in many of the workers through the years since 9/11. The number of abnormalities in pulmonary function tests in WTC responders was double that expected in the comparable U.S. populations, and the conditions continued for many months, and even years.
The results of this comprehensive multicenter clinical program were published in the September 7 edition of Environmental Health Perspectives, the journal of the National Institute of Environmental Health Sciences. The report covers 9,500 responders examined between July 2002 and April 2004. They include firefighters; law enforcement officers; building trades, utilities, and telecommunications workers; transit workers; and others. The physical examination included a mental health evaluation, pulmonary function tests, a chest X-ray, blood tests, and urinalysis. Actually, some 12,000 responders were monitored during the study period; only 9,500 agreed to have their results published.
Early-arriving responders suffered the heaviest exposures and had the most frequent respiratory problems; 70 percent arrived at the site between September 11 and 13, 2001.
The World Trade Center Health Effects Treatment Program at Mount Sinai Medical Center has provided medical and social work services for more than 2,000 WTC responders with persistent illnesses, which include upper respiratory conditions such as sinusitis, laryngitis, and vocal cord dysfunction; lower respiratory disorders such as asthma and WTC cough; psychological disorders such as post-traumatic stress disorder and chronic depression; and musculoskeletal problems, often from injuries sustained while working on the pile.
The report recommends long-term medical monitoring of responders, to track the status of the abnormalities and identify later effects, including possible malignancies.
Anyone who worked at Ground Zero, especially early in the incident, who has not yet been screened is urged to go to Mount Sinai for free evaluation and ongoing screening. The monitoring program is supported with federal funding from the National Institute for Occupational Safety and Health and coordinated by the Department of Community and Preventive Medicine of the Mount Sinai School of Medicine.
It was recently reported that retired Fire Department of New York Firefighter Lee Ielpi, who lost his son, Jonathan, 29, an FDNY firefighter, in the towers’ collapse, has been diagnosed with Waldenstrom’s macroglobulinemia, a rare type of non-Hodgkin’s lymphoma that is treatable but not curable. The cancer may be tied to toxins at the WTC site; reportedly, 70 other WTC responders have been diagnosed with blood cancers. Ielpi, a staunch advocate for the WTC victims’ families and a former vice president of the 9/11 Victims and Families Association and cofounder of the WTC Tribute Center at Ground Zero, worked nine months at the WTC site attempting to find the remains of victims, including his son. He underwent medical screening last spring.
Editor’s note: The U.S. Department of Health and Human Services has established the Web site www.hhs.gov/wtc/ as a resource for responders, their families, medical professionals, and others looking for information about the health effects that resulted from the 9/11 WTC attacks. http://www.sciencedaily.com/releases/2006/060906084107.htm; www.nydailynews.com/news/v-pfriendly/story/455370c.html; www.nypostlcom/php/pfriendly/print.phy?url+http://www.nypost.com/news/regionalnews/heroes_a… , Sept. 24, 2006
SSC “appalled” at conditions surrounding proposed Ground Zero Freedom Tower
The Skyscraper Safety Campaign (SSC), chaired by Sally Regenhard, has voiced objection to what it says will be the Port Authority of New York and New Jersey’s (PA) building the new proposed Freedom Tower “just as it built the twin towers-immune from local New York City construction regulations and enforcement.” Regenhard lost her son Christian, who was a firefighter with the Fire Department of New York for only a few months, in the World Trade Center towers’ collapse.
In a release in September, the SSC said it wanted to “call attention to the proposed forced relocation of [federal] government workers to the building- and fire code-exempt Freedom Tower at Ground Zero.” The SSC says it is “appalled that the PA refuses to move its own workers to the Freedom Tower, yet expects other ‘guinea pigs’ to take space in this building.”
According to the SSC: “Today, the PA professes the safety of the Freedom Tower, just as it claimed that the former twin towers met or exceeded all codes, despite the fact that a federal investigation has shown that the towers did NOT meet all regulations.”
The SSC is asking that the governors of New York and New Jersey place safety ahead of financial interests by directing the PA “to give up its code immunities and to turn over all plan reviews, inspections, and code enforcement to the NYC Department of Buildings and the FDNY.” A memorandum of understanding is not acceptable, the SSC says.
The governors should direct the PA to place all its executive offices in the topmost office floors at the Freedom Tower to demonstrate the safety of the building, the SSC suggests.
Study cites need for “technical guidelines” for managing mass fatalities in large natural disasters
“Emergency response should not add to the distress of affected communities by inappropriately disposing of the victims. The rights of survivors to see their dead treated with dignity and respect requires practical guidelines and technical support. Mass fatality management following natural disasters needs to be informed by further field research and supported by a network of regional and international forensic institutes and agencies,” conclude the authors (Oliver W. Morgan, et al.) of “Mass Fatality Management following the South Asian Tsunami Disaster: Case Studies in Thailand, Indonesia, and Sri Lanka” (PLoS Med. 2006;3(6):809-815).
The authors found that existing methods of managing mass-fatality disasters are designed for transport accidents and acts of terrorism and are not “directly transferable” to natural disasters. They cited also the lack of information about post-disaster management of the dead following previous large natural disasters.
Following the tsunami disaster of December 26, 2004, the authors undertook three case studies to systematically document how the dead were managed in Thailand, Indonesia, and Sri Lanka. They focused on body recovery and storage, identification, disposal of human remains, and health risks from dead bodies.
The authors found that the efficiency of handling bodies after the tsunami varied widely across and even within countries. They attribute many of these differences to a lack of national or local plans for mass fatalities and a lack of practical field guidelines. There was little coordination of the organizations involved. The authors suggest guidelines for managing large numbers of bodies and suggest that additional research be done. They found that the large numbers of bodies did not cause problems for the survivors, a finding the researchers said “should encourage survivors to systematically identify the dead instead of rushing to bury them because of fear of disease.”
Among their specific recommendations for managing the dead after natural disasters include the following:
- Drinking water must be tested to avoid diseases.
- Body handlers should follow universal precautions for blood and body fluids, wear gloves, and wash their hands.
- Visual recognition or photographs of fresh bodies are the simplest forms of nonforensic identification and should be attempted after all natural disasters.
If resources and comparative data are available, simpler methods can be supplemented by forensic techniques (dental, fingerprint, and DNA analysis).
Communal graves may be necessary. Bodies should be buried in one layer to facilitate future exhumation. Graves should be clearly marked.
- A named person/organization should have an agreed mandate to coordinate the management of dead bodies.
- Mass fatality plans should be included in national and local disaster preparedness activities. Systematic documentation about how the dead are managed in future disasters is needed to learn from them.
- Close working with the media is needed to avoid misinformation and to promote the rights of the survivors to see their dead treated with dignity and respect.
An online summary of the study is at http://dx.doi.org/10.1371/journal.pmed.0030195. A reprint of the study summary may be requested by e-mail: omorgan@Bigfoot.com
NIST posts fact sheet on WTC investigation on Web site
The National Institute of Standards and Technology (NIST) has posted on its Web site (http://wtc.nist.gov) a fact sheet explaining that NIST found no corroborating evidence to support “alternative theories” that the towers were brought down by factors other than those described in NIST’s October 2005 final report.
In a release, Michael E. Newman, NIST’s director of media relations, Public and Business Affairs Office, noted that there is no evidence for the suggestion that the towers were destroyed by controlled demolition using explosives planted before 9/11 or by missiles fired at the towers. “The fact sheet describes how photographs and videos from several angles clearly showed that the collapse initiated at the fire and impact floors and that the collapse progressed from the initiating floors downward until the dust clouds obscured the view,” Newman says.
The WTC investigation team, Newman says, “stands solidly behind the collapse mechanisms for each tower and the sequences of events (from aircraft impact to collapse) as described in the report.” Newman can be reached at Michael.newman@nist.gov or by phone at (301) 975-3025.
USFA-NWCG wildland fire training available for structural firefighters
The Department of Homeland Security’s U.S. Fire Administration (USFA), in conjunction with the National Wildfire Coordinating Group (NWCG), will make available for structural firefighters several projects that will help develop their competencies for safely fighting wildland urban interface fires. These resources will be sent to the states.
A component of the program, “Wildland Fire Training for Rural Fire Departments,” was broadcast over the National Preparedness Network (PREPnet) on Wednesday, October 4, at 2 pm and 7 pm EDT. It may be viewed through satellite and the Internet and will be available for viewing for 90 days at www.prepnet10-4webcast.com.
The information contained in the one-hour program is consistent with National Fire Protection Association (NFPA) 1001, Standard for Fire Fighter Professional Qualifications, and 1021, Standard for Fire Officer Professional Qualifications. It assists local, rural, and volunteer fire organizations to assess their readiness to safely engage in wildland fire suppression. After the testing phase is completed, additional information will be sent to all state fire training organizations. Additional broadcast information can be obtained by calling (800) 500-5164 or at prepnet@dhs.gov.
Cardinal halts production of Alaris SE infusion pump line; FDA cites risks
U.S. marshals, in response to a request from the U.S. Food and Drug Administration (FDA), seized about 1,300 Alaris Signature Edition Gold infusion pumps (models 7130, 7131, 7230, and 7231) from Cardinal Health Inc.’s manufacturing facility in San Diego, California, in August. The FDA said the pumps, used to deliver intravenous solutions or medications, could be hazardous to patients.
The manufacturer said there was a risk of overdose of the IV drugs because of a sensitive keypad on the systems. The FDA refers to the problem as “key bounce”-the number on the key registers twice when pressed only once. The FDA said should key bounce occur during programming verification and not be detected, the infusion rate could be at least 10 times the intended rate. The company sent letters and warning labels to customers on August 15.
Cardinal reportedly is testing a modification of the device that reduces keypad sensitivity; the modification will have to be validated on the product and approved by the FDA. www.medscape.com/viewarticle/543823_print
NVFC Volunteer Firefighter Support Fund will be ongoing
Originally established by the National Volunteer Fire Council (NVFC) to help individual volunteer firefighters, rescue workers, and emergency medical personnel who lost their homes and other possessions during Hurricanes Katrina and Rita, the Volunteer Firefighter Support Fund, in April, was relegated permanent status by the NVFC Board of Directors. “We have now expanded the Support Fund in order to continue to provide assistance to volunteer firefighters in the wake of any disaster they might face,” explains Chairman Philip C. Stittleburg.
The NVFC reported that it raised nearly $550,000 for the Hurricane Katrina/Rita disaster fund. It awarded stipends of $250 to all who requested assistance: 392 firefighters and EMS personnel in Louisiana, 209 in Mississippi, and 14 in Alabama, for a total of $153,750.
When the Northeast suffered severe flooding resulting from the overflowing of major rivers and tributaries as a result of heavy rains the end of June, the NVFC received 83 requests from firefighters and EMS personnel in New York for support. The awards totaled $20,750.
The NVFC donates all administrative costs associated with the Fund.
NGA creates task force and advisory council
The National Governors Association (NGA) has created a Public Safety Task Force to “consolidate safety- and security-related issues in a comprehensive and strategic approach to coordinating governors’ planning and actions in the areas of homeland security, protection of critical infrastructure, emergency response, pandemic preparedness, National Guard readiness, and traditional law enforcement activities.” The objective of the task force is “to provide a forum that will promote state-federal partnerships to ensure the safety of our citizens,” according to NGA Chair Arizona Governor Janet Napolitano.
The NGA also created, in June 2006, a Homeland Security Advisors Council to establish an agenda for the approaching year, which includes as top priorities intelligence and information sharing, protection of critical infrastructure, border security, interoperability of public safety communications, catastrophic planning, and grants and funding. Additional information is at www.nga.org. http://www.medscape.com/viewarticle/543945_print, Sept. 7, 2006
FDA reviews regulation covering unapproved emergency treatments
The U.S. Food and Drug Administration (FDA) said in August it was reevaluating regulation 21 CFR 50,24, which allows research studies to test emergency treatments on patients with specific life-threatening medical conditions (head trauma, cardiac arrest, stroke) when patients are unable to give informed consent because of their conditions and family members are not available to provide consent. This type of emergency research has been allowed since 1996, when the FDA regulation went into effect, under “very restricted circumstances,” according to the FDA.
The regulation review is one of the projects under the FDA’s Human Subject Protections and Bioresearch Monitoring Program, designed to strengthen the FDA’s oversight and protection of patients in clinical trials and the integrity of resulting data.
Dr. Janet Woodcock, the FDA’s deputy commissioner for operations, said the regulation review will include “getting the perspectives of those who participated in such studies to make sure that emergency research is being carried out in a scientifically sound and ethical manner.” Conducting studies in life-threatening emergency situations helps advance the practice of emergency medicine,” Dr. Woodcock explained.
One such study involved the testing of Northfield Laboratories Inc.’s experimental blood substitute PolyHeme in trauma patients.
A public input hearing was scheduled for October 11 in Rockville, Maryland (after press time). Written comment on the guidance may be submitted at www.fda.gov/dockets/ecomments/. www.fda.gov/bbs/topics/NEWS/2006/NEW01439.htm/, Aug. 29, 2006; www.medscape.com/viewarticle/543972_print, Aug. 30, 2006
Tick paralysis reported in CO
The Colorado Department of Public Health and Environment received reports of four cases of tick paralysis (a six-year-old girl, a 78-year-old female, and a 58-year-old and an 86-year-old male over a six-day period last May), according to the Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report (September 1). All the individuals live or recently visited within 20 miles of each other in the mountains of north central Colorado.
Initial symptoms included difficulty walking because of bilateral lower extremity weakness and tingling sensations. The tick was embedded in the skin on the patients’ neck or back and was removed within a day or two of the patients’ admission to the hospital. Symptoms improved within a few days after removal of the tick; the adults reported residual weakness several weeks after.
Tick paralysis should be included in the differential diagnosis of ascending paralysis, authors of the report say, and patients with these symptoms should be checked for the presence of a tick. To remove the tick, grasp it close to the patient’s skin with forceps and pull with a steady, even pressure, recommends Dr. W. J. Pape and associates, the study’s authors. CDC Surevill Summ 2006;55:933-93
Line-of-Duty Deaths
August 27. Lieutenant Howard Carpluk, 43, Fire Department of New York: injuries suffered in a floor collapse while working at the scene of a commercial structure fire.
August 27. Firefighter Michael Reilly, 25, Fire Department of New York: injuries suffered in a floor collapse while working at the scene of a commercial structure fire.
August 28. Fire Police Officer Wilbur Ritter, 78, Sayville (NY) Fire Department: apparent heart attack.
September 4. Assistant Fire Chief Errett W. Miller, 43, Posey Township Clay County Volunteer Fire Department, Staunton, IN: injuries sustained when the tanker he was driving en route to a fire call left the roadway.
September 6. Battalion Chief Robert Paul Stone, 36, California Department of Forestry and Fire Protection, Sacramento: aircraft crash while working a wildland fire.
September 6. Pilot George Willett, 52, California Department of Forestry and Fire Protection, Sacramento: aircraft crash while working a wildland fire.
September 9. Acting Captain Vincent R. Neglia, 45, North Hudson Regional Fire & Rescue Department, West New York, NJ: trapped by flames while searching for victims in a three-story residential structure fire.
September 16. Firefighter John Paul Memory II, 19, Carrollton (VA) Volunteer Fire Department: collapsed while performing an extrication demonstration; cause of death was not yet determined at press time.
Source: USFA Firefighters Memorial Database
News Glimpses
American Red Cross fined for violating blood-safety laws. The U.S. Food and Drug Administration (FDA) fined the American Red Cross $4.2 million for violations related to the safety of the blood supply, including failure to ask potential donors appropriate questions and follow test procedures. The fines are related to the Red Cross recalls between 2003 and 2005, which the FDA said could have been prevented. www.msnbc.msn.com/id/14736375/print/1/displaymode/1098, Sept. 8, 2006
Candle suspected in fire that killed six children in Chicago. Fire department officials say candles used to light an apartment without electricity probably ignited a fire that killed six children-ages 14, 12, 10, 6, and 3 (two girls, cousins)-in the three-bedroom apartment on Chicago’s North Side in September. Police, investigating the fire because of the fatalities, said there was no evidence of smoke detectors; however, the landlord told the police smoke detectors were in the unit when the family moved in. http://www.foxnews.com/printer_friendly_story/0,3566,212099,00.html.
WI fire departments carry oxygen masks for pets. Appleton’s six trucks and 13 ambulances will carry masks for use on dogs, cats, and other small animals. A town alderman initiated the program after he saw a photograph in the newspaper showing a firefighter in a nearby community giving mouth-to-mouth resuscitation to a cat rescued from a house fire. The money for the masks ($49 each) was donated by citizens and community groups, who voluntarily offered to contribute after they heard about the fire incident and the mask program. The masks, available in three sizes, will also be carried by Appleton’s Police Department K-9 unit. The Madison Fire Department carries masks on its seven ambulances, and several neighboring communities were given mask kits by the Madison department, which was able to purchase them with monies voluntarily contributed by its community members. www.sbbc,nsb,cin.ud.14665929/print/1/displaymode/1098
MA boy dies from eastern equine encephalitis. The boy, from Middleborough, died in August. His community had undergone two rounds of aerial spraying to destroy the mosquitoes that carry the virus. Two other people, a 52-year-old woman (Lakeville) and a 23-year-old man (Acushnet) contracted the virus this year. Four people died from the virus in the state in the past four years. http://www.msnbc.msn.com/id/14624756
