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Well-being: September 2011

On Sept. 11, 2001, 343 FDNY firefighters gave their lives in the collapse of the World Trade Center (WTC) towers. These brave firefighters were survived by almost 11,000 members of FDNY. On the morning of the collapse, 1,636 additional members from FDNY’s 11,000 personnel arrived at the WTC site to assist in rescue/recovery efforts. Over the next week, another 1,320 were deployed and several hundred more arrived later. It has been estimated that in the months following the collapse there were as many as 40,000 rescue workers from various agencies operating at Ground Zero, from first responders to construction workers. The tragedy of the WTC collapse is centred not only on the victims who died on 9-11, but also on the fact that many of the rescue workers and contractors who worked at Ground Zero have suffered permanent damage to their health.

From the moment the towers collapsed, a toxic cloud filled with asbestos particles, shards of fibreglass and other toxins shrouded Ground Zero. These pulverized building materials dominated the atmosphere, while pollutants derived from combustion of the ongoing fires increased as rescue, recovery and cleanup progressed. Respirators were not available early on and were not used consistently even when they became available. It has been reported that FDNY had only 600 respirators for more than 11,200 uniformed members when the Twin Towers fell on that fateful day. Consequently, many of the responders who spent days, or even months, at the WTC site, have reported a slew of chronic upper- and lower-respiratory ailments. The WTC cough, as it has commonly been referred to, is a condition that was first described in rescue workers from FDNY. Higher rates of upper- and lower-respiratory irritant symptoms have also been described in at least seven WTC rescue/recovery worker groups including firefighters, police officers and other rescue/recovery and cleanup workers. The WTC incident was the largest acute exposure to high-volume particulate matter in a modern urban environment.

Dr. David Prezant is the chief medical officer and co-director of the World Trade Center medical monitoring and treatment program in the New York City Fire Department, and a professor of medicine at the Albert Einstein College of Medicine. He was at Ground Zero when the towers fell and knows firsthand the impact on rescue workers by the massive plume of particulate matter. “It was as if you were inhaling Drano,” Prezant says of the air quality for rescue workers at Ground Zero. His work has led to a much better understanding of the medical conditions that have resulted from this large-scale exposure.

It’s hard for any agency to prepare for an event on the scale of 9-11. Could things have been done differently? That question is always easy to answer in retrospect. “We cannot undo the past and we cannot prevent exposures that have already occurred,” Prezant said in a presentation to members of the Wellness Fitness Initiative (WFI) task force. “What we can do, however, is to work to restore the health of those that did survive and prepare for the future.” The message from 9-11 that Prezant wants other fire departments to understand is that medical monitoring is absolutely critical for all firefighters.

FDNY had more than 500 workers compensation claims accepted, based solely on discrepancies between post-event medicals and five years of lung function (spirometry) values collected prior to 9-11 through the department’s WFI medicals. Spirometry measures the amount of air exhaled in a single breath. FDNY was one of the 10 founding cities that developed the WFI and had been conducting mandatory annual medicals on all its personnel for five years prior to 9-11. According to Prezant, had the FDNY not had these pre-exposure spirometry values, its members likely would not have been eligible for workers-compensation coverage. The post-exposure chest X-ray and chest CT scans were normal in almost all cases. And the post-exposure spirometry results weren’t much lower than those of the average population, which likely would have resulted in a decline of coverage. Comparing the five years of pre-exposure spirometry values against the post-exposure spirometry told a much different story.  

Prezant had collected spirometry values on 12,079 FDNY rescue workers in the first year post-WTC. He noted that these firefighters had suffered a significantly greater average annual decline in forced expiratory volume in one second (FEV1) of 372 millilitres compared to the normal annual decline of 31 millilitres found in the five years of pre-WTC WFI testing. This test demonstrated a reduction in lung function of 12 times that normally experienced in one year. Spirometry testing shows that most firefighters tend to have higher-than-average lung-function values. Therefore, comparing firefighters to the average population doesn’t reveal much, notes Prezant. “It’s the individual difference from pre to post exposure that truly illustrated the amount of lung damage that each person suffered,” he says. Thanks to the WFI medicals, FDNY had this data to compare.

My intent here is to relate the importance of medical surveillance programs for all firefighters who work in hazardous environments. Canadian cities have suffered some very significant events with large fire losses, such as the Okanagan Mountain fire in Kelowna, B.C., in 2003, which forced the evacuation of more than 27,000 people and destroyed 239 homes. More recently, in Slave Lake, Alta., more than 400 homes and business were destroyed by fire, which incinerated hundreds of vehicles and reduced several neighbourhoods to a blackened wasteland.

Of the departments that responded to Slave Lake, only Calgary and Edmonton have annual medicals and, therefore, are the only departments that have a chance to compare the impact of pre and post exposure for their personnel. As we all know, it doesn’t take a major event for an exposure or injury to occur.

Has the fire service learned from 9-11 or do departments have to suffer through a tragedy before they are motivated enough to change? Prezant sums it up: “The wellness program helps to ensure our obligation that we will always be there when our members come out of the flames.”

Ian Crosby is in his 18th year with the Calgary Fire Department and serves as its wellness and fitness co-ordinator. Crosby developed the department’s wellness centre, which opened February 2005. He is a member of the IAFF/IAFC/ACE peer fitness trainer oversight committee and an instructor for the PFT certification program. E-mail him at Ian.Crosby@calgary.ca