NYTimes.com Article: Lung Ailments May Force 500 Firefighters Off Job
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Lung Ailments May Force 500 Firefighters Off Job
September 10, 2002
By DENISE GRADY and ANDREW C. REVKIN
As many as 500 New York City firefighters may have to
retire early as a result of "respiratory disability,"
chronic breathing problems caused by their exposure to
dense clouds of dust, smoke and fumes at the World Trade
Center, health officials said yesterday.
The potential departure of the firefighters comes as the
department is still struggling to deal with the loss of 341
firefighters and 2 paramedics, who were among the 2,801
people killed in the collapse of the twin towers after the
attack on Sept. 11.
As of Aug. 28, 358 firefighters and 5 emergency medical
workers were still on medical leave or light duty because
of respiratory disorders that began after they worked at
the site. Symptoms include persistent cough, wheezing,
shortness of breath and other asthma-like symptoms, sinus
inflammation and heartburn.
David J. Prezant, deputy chief medical officer of the New
York Fire Department, said doctors did not know exactly
what the affected workers had been exposed to, or whether
they would get better or worse. Many, he said, worried
about whether they would develop more serious lung diseases
Their current problems are thought to have been caused by
the inhalation and swallowing of fine particles created by
the fires and building collapse. Workers who had the
heaviest exposure - those who were there when the buildings
collapsed and in the first few days and weeks after - had
the highest incidence of respiratory trouble. Very few
firefighters used respirators or other types of breathing
protection in the early days after the attack, when the air
was at its worst.
In addition to the 363 firefighters and rescue workers with
respiratory disability, 213 others were on leave with
emotional stress resulting from their work at the site and
from their grief over the deaths of so many friends and
co-workers. The number of stress-related incidents observed
among the workers during the 11 months after the attack was
17 times the number that occurred in 11 months before the
Reports on the firefighters' injuries and illnesses are to
be published tomorrow by the Centers for Disease Control
and Prevention, and another, to be published on Thursday in
the New England Journal of Medicine, has already been
published on the journal's Web site, www.nejm.com.
Over all, the surviving firefighters have fared both better
and worse than doctors expected. Considering that nearly
all of the city's more than 11,000 firefighters worked at
the site, and that 90 percent developed a cough, the
proportion with chronic problems is relatively small.
"Some might have thought the percentage would be higher,"
said Dr. Prezant, who is also a professor at Albert
Einstein College of Medicine and an author of both reports.
In the firefighters who do have lingering symptoms,
however, the problems have been more severe and persistent
than doctors would have expected, Dr. Prezant said. In the
past, among firefighters who had respiratory problems from
smoke inhalation, 90 percent recovered. But among the 332
firefighters who had a severe case of "World Trade Center
cough," only 48 percent have fully recovered and returned
to work. Severe cases were defined as those needing four or
more consecutive weeks of medical leave.
Dr. Prezant said the reason that the symptoms were so
severe was probably that the concentration of particles was
very high, and the exposures prolonged and repeated.
"We're never going to know the full scale of what the
firefighters were exposed to on that day," Dr. Prezant
said. He said that air quality testing did not begin until
several days after the attack. But he said everyone at the
site was clearly exposed to "a massive dust cloud" full of
tiny particles that could be inhaled into the airways and
"Even if that respirable airborne particulate matter does
not include a single chemical, it is incredibly toxic at
that level of exposure," Dr. Prezant said, adding that
there was a great deal of evidence that exposure to such
material can cause increased rates of chronic lung disease
like emphysema and heart disease.
The very finest particles can make their way into the
depths of the lung and persist there for a long time, he
said. Some particles, like asbestos fibers, stay in the
lung forever. Other particles can be digested and removed.
But in some cases, Dr. Prezant said, "the enzymes used to
digest them can lead to lung inflammation and destruction,
and that's why, in some people, the healing response can be
part of the illness."
Dr. Prezant said that one of the most important findings of
the study was that many of the firefighters with persistent
cough and other respiratory problems also had heartburn, or
gastroesophageal reflux, a condition in which stomach acid
backs up into the esophagus and throat. He said swallowing
the particles may irritate the stomach and esophagus, and
that in the firefighters, the condition may have been
aggravated by stress, long hours and irregular meal times.
He said doctors had not realized before these cases that
heavy inhalation or swallowing of particulates could bring
on reflux. The reflux may cause the respiratory problems or
make them worse, he said.
"This is critically important for physicians to know," he
said, because the cough does not improve unless the reflux
The report by the disease centers also includes a summary
of a survey, taken 6 weeks after the attack, of people who
lived near the trade center. About 75 percent were
initially evacuated from their homes. Many reported that
they had had health problems: 66 percent had nose or throat
irritations; 50 percent had eye irritations or infections;
47 percent had coughs. About 39 percent had signs of
People who worked in the area also had health concerns and
stress-related problems. Sherry Baron, an official with the
National Institute for Occupational Safety and Health, said
that at the time, health officials did not realize how
deeply those people were affected. "Perhaps one of the
lessons we can learn," Dr. Baron said, "is to have adequate
outreach programs and other kinds of services ready and
available to a much wider group of people than we might
have thought about at the time."
The new reports also address questions about the
firefighters' use - or failure to use - respirators. In the
first hours after the attack, most of the thousands of
rescuers and workers converging on the site rushed into the
swirling clouds of dust and smoke without much regard for
their lungs, the reports say, based on surveys of the
Among those who had severe cases of the cough, 93 percent
said they used respirators "rarely or not at all" on the
first day and only a little more in subsequent days.
Reviews of the emergency response concluded that this was
partly the result of the urgency of the task and also
because New York City officials and federal officials
simply did not have the right gear on hand.
A week elapsed before most workers were wearing the device
that federal worker-health officials decided was best
suited to the conditions: a half-face respirator, a rubbery
mask that seals around the nose and mouth and can be fitted
with different filters.
During their first hours at the site, firefighters often
had inappropriate protection, Dr. Baron and other health
officials found. Most either had no lung protection or used
paper masks. Others relied on the heavy backpack-style
pressurized breathing systems they use to fight
conventional fires. But these were cumbersome, and provided
air for only about 8 to 15 minutes, Dr. Prezant said.
At the trade center, Dr. Baron said, "It took just about a
week before the normal systems and supplies kicked into
"The lesson here is how to move that process up three or
four days," she said.
Dr. Prezant said that ironworkers at the site also had
increased rates of respiratory problems, but were being
studied by other researchers who had not yet published
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