Cough, Cancer, PTSD: 20 Years of World Trade Center Research

Jim Brunkati was working for the New Jersey State Police at the time of the 9/11 attack. He is assigned to monitor the mental health of the New Jersey search and rescue team at the Javits Center in New York, allowing him to continue working after a 12-hour shift each day.

“No one was wearing a mask,” Brunkathi recalled. “We are wearing them for COVID, we weren’t wearing them walking in the dust of downtown Manhattan. You weren’t thinking about it, you just got in That’s it. “

Twenty years after September 11, 2001, people in downtown on or shortly after that day are still dealing with fallout. Bruncati and his partner, diagnosed with non-Hodgkin’s lymphoma, faced serious health consequences associated with exposure in downtown.

Extensive research on this group of responders, rescuers, and civilians reveals the health effects of a series of emerging trademarks over time, including respiratory problems, post-traumatic stress disorders, and cancer. I did. However, the findings from these studies strengthened the case for expanding the World Trade Center Health Program to provide medical care to 9/11 respondents and survivors. They have also shaped the way medical and safety professionals work on workplace health in ways that can minimize future health crises after major events.

More than 400,000 people Estimated to be directly affected by environmental hazards, trauma and pollutants of the attack, 81,460 first responders and 30,582 “survivors” (people living or working downtown) are enrolled in the WTC Health Program. Has registered. More than 71,000 people register with the WTC Health Registry, which sends health surveys each year.

Registry registrants participate in dozens of studies published in peer-reviewed journals. Many of these treatises use data from thousands of cohorts to further enhance takeaway health lessons for the future.

Health and Safety Specialist of the New York Occupational Safety and Health Commission (NYCOSH) and WTC Health Program. “It’s not just acute trauma, it’s a chronic condition that this population has to live with, and we as a society have to take care of them.”

Impact on physical health

“cough”

Smoke, ash, and debris eruptions after the tower collapse swallowed Lower Manhattan in Manhattan and extended to Brooklyn, exposing civilians and recovery workers to building material particles and combustion by-products as well. After that, the clouds settled, leaving a thick layer of toxic dust on all surfaces. More than 70 known carcinogens have been identified at the WTC site, and the most exposed carcinogens have developed a variety of acute conditions.

Perhaps the most obvious of these conditions is what has become known as the “WTC cough.” This was the condition first described by Dr. David Pleasant of Medicine and colleagues at the Montefiore Medical Center in New York. Studies published in New England Journal of Medicine In 2002.

Almost all professionals Today’s MedPage He said this was a study that stimulated awareness of health associated with exposure since 9/11.

More than 10,000 New York firefighters who participated in the post-collapse rescue and restoration efforts of the tower received medical attention shortly thereafter. A total of 332 people were diagnosed with WTC cough. It is characterized by a persistent cough after the firefighters have been exposed to the scene, and respiratory symptoms are severe enough to justify sick leave for at least four weeks in a row. Another 102 had bronchial hypersensitivity.

The survey showed clear changes before and after the event, as firefighters underwent regular spirometry tests even before 9/11 and then again.

“They had pre-9.11 data at the New York City Fire Department, so their data survived all sorts of scrutiny,” said Dr. Iris Udasin, MD, Rutgers University School of Public Health and their Environmental and Occupational Health. Scientific Research Institute Clinical Center. “The original cough medicine was groundbreaking.”

Udasin is also a Principal Investigator for Longitudinal Studies in the WTC Medical Monitoring and Treatment Program and a member of the Steering Committee of the same program. She treats patients within the WTC Health Program.

Respiratory disease

Respiratory problems were another common condition that doctors saw in the 9/11 population in the next few years. Another study by Prezant and colleagues Since 2006, of the 12,079 respondents from the New York City Fire Department (FDNY), we have found that an average of 12 years of forced exhalation per second corresponds to an age-related decrease of 12 years.

“These responders had lost years of lung function from site exposure alone,” said Michael Crane, medical director of the WTC Health Program Clinical Center of Excellence at Mount Sinai. Patients of the WTC Health Program. He is also the medical director of the Serikov Occupational Health Center and a professor of environmental medicine and public health at Mount Sinai. “These were really young and healthy firefighters who hurt their lungs, and there was evidence here, so the literature on lung disease then took off.”

The study also found 9/11 survivors Including downtown workers and responders, When Children had a rate of asthma Higher than the general population.

Dr. Dennis Harrison is a clinical director of the WTC Health Program at New York University’s Grossman School of Medicine, treating program patients at the Industrial Environmental Medicine Clinic at Bellevue / New York University. She is different from asthma It took a long time to certify Chronic Obstructive Pulmonary Disease (COPD) For coverage under the program. The FDNY research has spurred that addition.

“”[COPD]Unlike asthma, it is not time sensitive. This is one method and influences decisions about the response to such exposures. “

cancer

Experts also said that many papers linking cancers that appeared in patients years later to their 9/11 exposure were important. “In terms of the seriousness of what’s wrong with people, rising levels of cancer, and pulmonary fibrosis, they file a proceeding in a parliamentary bill that pays for the care of our patients,” Udashin said. rice field.

Udashin James Sadroga BillNamed after a police officer who died of a 9/11 related health problem.The bill will fund the care of Over 100,000 patients Those who qualify if their health problems can be directly related to the 9/11 incident.Cancer was not included in the eligibility requirements until research on responders and survivors assisted the program’s WTC Scientific Advisory Group. Petition the government to include them in 2012..

It appeared From an early study published in Lancet Three types of cancer, thyroid cancer, non-Hodgkin’s lymphoma, and melanoma, were more common in attacked firefighters than in unexposed firefighters.

Recently, Another study linked three vast cohorts –FDNY, WTC Health Registry, and General Responder Cohort–confirmed the same pattern of elevated cancers in all three and clearly added prostate cancer to the cancers of interest.

Currently, Lynch said 68 types of cancer meet coverage criteria if the patient could be shown to have been present in the WTC area in the days and weeks immediately following 9/11.

And the crane, surprisingly Recent research The WTC Health Program’s cancer survival rate has been shown to be superior to that of New York State as a whole. He suspects it is due to early detection and easy access to care within the program.

“It’s free for them and they don’t have to pay for it, you know, they have a good say about where they get their promises,” he said. “By catering to this population in that way, you may reduce the barriers they would normally have.”

Impact on mental health

Post-traumatic stress disorder

Blancati recalled talking to another police officer in the months following the attack. Police officers admitted that they could no longer drive after 9/11.

Blancati asked him, “Do you think you should meet someone about this?” “‘No’,” he remembers the policeman answering. “‘I don’t drive.'”

“Cops are very reluctant to ask for help because they don’t want to be robbed of their guns. They don’t want this kind of thing to affect their promotion,” Bruncati said.

Witnessing and participating in recovery and rescue after the 9/11 attacks had serious mental health consequences. The most common is post-traumatic stress disorder (PTSD). A study evaluating patients in the second largest clinic, which was entrusted with managing care through the WTC Health Program, found that it was monitored out of 3,231 responders. Almost one-fifth developed PTSD After their exposure. Half of them still had it after 11-13 years.

“There is also a very stubborn and anxious subset of individuals who are not only improving, but also appearing to be worsening,” said Dr. Travis Kubare, Associate Director of Research Planning and Care Integration for the WTC Health Program. .. National Institute for Occupational Safety and Health (NIOSH). “This is one of the first publications to document that trend,” he said, and it helped inform research on effective interventions.

Responders with more serious “exposure” also had a higher incidence of PTSD. Severity is assessed based on time to arrival at the scene, being caught in a cloud of dust associated with the collapse of the tower, knowing the injured, looking at a person’s body, and working time. it was done.

Crane mentioned other studies on PTSD. How can the “orbit” of PTSD be different? With WTC Responder. Some “non-traditional” responders, especially construction workers, engineers and volunteers, suffered from chronic or late-onset PTSD.

“These treatises actually laid the foundation for the seriousness of the condition. They also determine that Congress” because these people are seriously ill, it is better to fund this. ” It helped, “said Crane. He also said he encouraged subsequent research into using orbits as a model for what happens after other disasters, such as the trauma seen in soldiers who have been to Afghanistan.

Experienced first responders and survivors High incidence of depression, anxiety, and panic disorder From the general public.

In addition, experts emphasized the importance of research on comorbidities, especially the interaction between physical and mental health. Cranes can disrupt patient and physician treatment with many of the conditions that can occur together, such as asthma and PTSD, asthma and gastroesophageal reflux disease. I pointed out.

Not only this, but together, he said the cost of treatment could rise exponentially.

“In general, I think there are some real questions about how these combinations interact and affect the overall process of someone’s life in medical progress.” Crane said.

The lessons learned from 9/11 continue to emerge decades later. When it comes to that, experts say it’s partly because of our most human impulses during the crisis.

“The disaster scene is very emotional and I want to hurry to rescue everyone at any cost,” Lynch said. “”