Health Care Lessons Learned in the Aftermath of September 11, 2001

New case study in the Annals of Global Health assesses the immediate andongoing response to the 9/11 disaster and explores the implications for futuredisasters

New York, NY, December 9, 2014

Fourteenyears after the attack on the World Trade Center (WTC),  a case study in the current issue of Annals of Global Health identifiesseveral elements that have had a critical impact on the evolution of the WTCresponse and, directly or indirectly, on the health of the WTC-exposedpopulation. The case study also recounts and assesses post-disastermonitoring efforts, recent scientific findings from the World Trade Center Health Program (WTCHP), andexplores the implications of these experiences for ongoing and futureenvironmental disaster response.

Short-term9/11 rescue and recovery actions have been followed by a long-term monitoringand treatment program, the World Trade Center Health Program (WTCHP), whichincludes more than 60,000 WTC disaster responders and community members and isnow funded by the Zadroga Act of 2010. This program has provided a frameworkfor understanding the variable consequences of the WTC disaster, ensuring thatlessons learned can be identified and incorporated into improved long-termprograms.

Reauthorizationof the Zadroga Act by Congress will ensure that these observations will have anopportunity to translate into a meaningful and sustainable clinical andresearch impact. Reauthorization is also crucial to ensuring  that all responders and survivors of theWorld Trade Center disaster have continued access to World Trade CenterClinical Centers of Excellence, where the needs of responders and survivors areunderstood and necessary expertise and healthcare are available to all thoseexposed to the disaster.

"Wehave identified key elements of the WTC response that have affected the healthof the exposed population and ongoing population monitoring and treatment,"comments lead author Michael Crane, MD, MPH, of the Icahn School ofMedicine at Mount Sinai.He and his co-authors call attention to the failure of government agencies toaddress widespread contamination of the local community. Residents wereconsequently exposed to the risks of toxic exposure. Responders also were putat risk by the failure of responsible agencies to enact and coordinate strictsite health and safety policies during recovery and cleanup operations.

Thecase study provides insights into the many interconnected elements thatdetermine the effectiveness of any public health disaster response. Among theseare:

  • Clinical Expertise and Data Collection – Putting experts on the scene who can recognize ongoing threats to health, record critical data, and institute essential monitoring programs.
  • Site Safety and Worker Training – Lack of these measures caused lasting effects on the health of untrained responders in the WTC environment.
  • Attention to Vulnerable Populations – Certain groups, such as schoolchildren from the area and children indirectly exposed through their own exposed parents, can be overlooked in the chaos of a large-scale disaster.
  • Developing Trust and Transparency – The value of trust and transparency between the exposed populations and the public health authority in environmental disasters is well established and critical, but often not achieved.

Accordingto the authors, operationalizing these ideals amidst the initial chaos andlonger-term bureaucratic challenges that are an integral part of any disasterremains a daunting but essential mandate. They conclude that "Even in arelatively well-resourced environment, challenges regarding allocation ofappropriate attention to vulnerable populations and integration of treatmentresponse to significant medical and mental health comorbidities remain areas ofongoing programmatic development."


Notes for editors
"TheResponse to September 11: A Disaster Case Study," by Michael A. Crane, MD, MPH,Nomi C. Levy-Carrick, MD, MPhil, Laura Crowley, MD, Stephanie Barnhart, MD,MPH, Melissa Dudas, DO, Uchechukwu Onuoha, MD, MPH, Yelena Globina, MD, MPH,Winta Haile, BA, Gauri Shukla, MPH, and Fatih Ozbay, MD. DOI: It appears in Annals of Global Health,Volume 80, Issue 4 (2014) published by Elsevier. 

Full text of this article is available to credentialedjournalists upon request; contact Eileen Leahy at +1 732 238 3628 or hmsmedia@elsevier.comto obtain copies or you may access the article directly at wishing to interview theauthors should contact Sid Dinsay, Associate Director, Media Relations, MountSinai Press Office, at +1 212 241 9200, +1 646 413 3493 (cell) or

Research reported in this articlewas supported by a contract with the National Institutes of Occupational Safetyand Health (NIOSH). Contract number: +1 200 2011 39356.

About Annals of Global Health
Annalsof Global Health, formerly published as TheMount Sinai Journal of Medicine, is an open-access, peer-reviewed Journalfocused on global health. The Journal's mission is to advance and disseminateknowledge of global health, promote research and foster the prevention andtreatment of disease worldwide by supporting open dissemination and livelydiscourse about a wide range of the most important topics in global health andmedicine.

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