World Trade Center and Occupational Health/ALS among Veterans Flashcards
Public health role in disasters
-Contain or remove sources of contamination, or
evacuate the populace to prevent exposures.
-Conduct appropriate environmental sampling and
analysis to quantify risk and monitor progress of
remediation.
-Protect worker health and safety by ensuring
availability and use of protective measures, and by
monitoring illnesses and injuries to inform
modifications in the use of protective measures.
-Provide regular advisories to the public and the
medical community.
Fine dust hazards
-Dusts were found to consist primarily of calcium sulfate
(gypsum) and calcium carbonate (calcite) from crushed
building materials such as cement, concrete aggregate,
ceiling tiles, and wallboard.
-PM2.5 dusts induced lung inflammation and hyper-
responsiveness when high doses were given to mice
directly into their airways.
-It was estimated that healthy people exposed to ~425
µg PM2.5/m3 air for 8 hr would receive a dose
comparable to the high dose in mice, and could
experience lung inflammation and hyper-
responsiveness.
-It was also determined that larger dust particles (PM
2.5-10µm) could have contributed to respiratory
problems reported in persons working and living near
Ground Zero.
-Analysis showed the dust to be a mixture of building
debris and combustion products.
-In addition to gypsum, calcite, and concrete dust, it
included asbestos, crystalline silica, glass fiber, lead,
and toxic organics such as PAHs, PCBs, dioxins, and
furans.
-WTC dust presented exposure hazards for workers
and the public immediately after the disaster, and for
weeks later as settled dusts were resuspended by
work activities or weather.
Health effects (acute, chronic)
-Gypsum and calcite irritate the mucus membranes of
the eye, nose, throat, and upper airways.
CaCO3 dust causes coughing, sneezing, and nasal
irritation.
-The high concentrations of gypsum and calcite
suggest that potentially toxic effects may extend to the
lower airways.
-Respiratory Illness
-The major health effect from acute exposures to fine
particulate WTC dust appears to be a type of asthma
termed “reactive airways dysfunction syndrome”
(RADS).
-In addition to RADS, some developed persistent
cough and gastric reflux.
-Long-term health effects have been reported:
-Of 74 emergency responders from Ohio Task Force
-One working at Ground Zero, 37 became ill: 3 were
hospitalized with pneumonia, 8 showed extreme
weight loss, 2 were diagnosed with asthma and 1
with bronchitis, with the remainder experiencing a
variety of other respiratory disorders and rashes.
-In California, of 395 emergency responders who
volunteered to work at Ground Zero for the first three
weeks after 9/11, at least 100 filed workers’
compensation claims because of illness.
-Many of the 500 NY City firefighters have qualified
for disability retirement because of persistent
respiratory conditions due to WTC dust.
-Long-term epidemiology studies of exposed workers
will investigate increased risk for a variety of cancers.
-City and federal officials downplayed any potential
hazards from the dust.
-An NIEHS report detailed the lack of any organized
safety and health protection plans, noting that of 1350
construction workers at Ground Zero, probably fewer
than 20% were medically certified to wear respiratory
protection.
Federal response to World Trade Center disaster
-With environmental data showing a lack of “immediate
health risks” EPA announced a cleanup plan in
conjunction with NYC, FEMA, OSHA, and NY State.
-Lower Manhattan residents had option of having their
units:
-Tested for asbestos
-Cleaned & then re-tested by professional cleaners on
contract with the government
-Residents could also request a free HEPA vacuum
cleaner through the program.
-In February 2002, EPA set health-based benchmarks
(concentrations) for contaminants of potential concern
(COPC) for indoor air and settled dust.
-Identified as COPC were: PAHs, dioxin, lead, asbestos,
fibrous glass, crystalline silica.
-Long-term, on-going epidemiological studies will help
determine chronic health effects on workers and the
public.
9/11 Health and Compensation Act
-In 2010, Congress passed the 9/11 Health and
Compensation Act to provide medical monitoring and
treatment benefits to eligible WTC responders and city
residents (claimants not to exceed 25,000).
-In March 2011, NY City agreed to pay up to $657
million to some 10,000 rescue and recovery workers
with health claims from dust exposures.
-Current epidemiological data show that 15 years after
the 9/11 WTC attacks, rescue and recovery workers
continue to have a substantial burden of physical and
mental health problems. These findings emphasize the
need for continued monitoring and treatment of the
WTC rescue and recovery population.
Definition of occupational health
Occupational health is the multidisciplinary approach to the anticipation, recognition, evaluation, and prevention and control of work-related illnesses and injuries.
U.S. government agencies, and their responsibilities, that are focused on occupational health and safety
-The National Institute for Occupational Safety and
Health (NIOSH) is the federal agency responsible for:
Conducting workplace health & safety research
Making recommendations for the prevention of work-
related injury and illness.
-NIOSH is part of the Centers for Disease Control and
Prevention (CDC) in the Department of Health and
Human Services. WWW.CDC.GOV/NIOSH/
-The Occupational Safety and Health Administration
(OSHA) is the federal regulatory agency within the US
Department of Labor responsible for the oversight of
health and safety in America’s workplaces.
-OSHA provides enforcement of workplace health and
safety regulations, wherein its mission is to save lives,
prevent injuries, and protect the health of America’s
workers. www.osha.gov/
-To accomplish this, federal and state governments
work in partnership with the more than 100 million
working men and women and their six and a half million
employers who are covered by the Occupational Safety
and Health Act of 1970.
Things to which coalition troops were exposed during deployment to the 1990-1991 Persian Gulf War
Oil Well Fire Smoke, Dust, Sand
Scud Missiles, Depleted Uranium
Nerve Agents, PB Pills
Permethrin, Vaccinations
Amyotrophic lateral sclerosis (type of neurons affected, symptoms)
- Neurofilament buildup
- Diseased nerve fiber
- Wasted skeletal muscle
Steps of cluster investigation (and how to complete each step)
- Team
- Industrial hygienists
- Epidemiologists
- Neurologists/physicians
- Health promotion specialists
- Medical geographers
- Engineers
- Objectives
- Is this a cluster?
- What is the cause?
- Study Design
- Cohort
- Need a huge sample size
- Sometimes limited exposure data
- Case-control
- Good for rare outcomes
- Often very detailed exposure data
- Cohort
- Assessment of ALS
- In-person neurological exam
- Preferred
- Medical record review and abstraction
- For deceased patients
- In-person neurological exam
- Exposure Assessment
- Personal monitoring difficult
- Biomarkers difficult
- Military records
- Time and location, branch, deployment
- Virtually nothing on exposures
- Questionnaires/interviews
- Data Collection and Analysis
- Depleted uranium
- Oil well fire smoke
- PB pills
- Scud missiles
- Recommendations
- Hierarchy of controls
- Elimination
- Substitution
- Engineering controls
- Administrative controls
- Personal protective equipment
- Surveillance/registries
- Exposure
- Medical
- Hierarchy of controls
Hierarchy of (exposure) controls
- Elimination
- Substitution
- Engineering controls
- Administrative controls
- Personal protective equipment
