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DOH Command Center continues at 455 1st Ave, New York City, NY
New phone numbers changed overnight to: 212-213-1694/213-1666
Fax 212-576-4814"?Y/$
New OEM number: 212-477-9610
OEM may be moving tonight to Pier 92
Environmental Workgroup
Field operations
Summary of field operations meeting near restricted site with 30 organizations at 10 am,
including DOH, fire, police, DEC, DEP, army, buildings, coast guard, others
(coordinated by OEM)
- Disaster crew working near debris need to be using masks with cartridges
- Asbestos testing capacity is present, though no coordinated plan for monitoring, most
monitoring has been at periphery, nothing directly at crash site
- 1000 P100 masks with cartridges were delivered and are being used
- 5000 respirators ordered and should arrive tomorrow
- Concern about other major contaminants in area, such as PCBs from burning plastic,
freon, sulfuric acid and hydrochloric acid from batteries from machines in office tower
- Unclear at this time what disaster workers are being exposed to, and who is monitoring
the worksite
- EPA has been asked to monitor phosgene levels at ground zero
- Concern about other contaminants, though lesser priority: x-ray chemicals, diesel fuel,
photocopy fluids, cleaning fluids, etc.
- Cleanup will be massive, large amounts of steel, cement, windows
- DEP hired Bechtel Construction to put together a Disaster Summary Plan, 13 pages
distributed
- Daily Environmental citywide meetings at 4 pm with DEC, DEP, EPA, ConEd
Asbestos - other
- Concern is that acute asbestosis may be experienced by disaster workers who receive a
large dose, and also that cancer risk may be elevated with one-time asbestos exposure
- EPA is continuing testing near restricted area (see map), perimeter, but low levels of
asbestos found
- Concern raised about asbestos exposure in hospitals, namely those closer to site such as
Beekman
- Monitoring plan for disaster workers is not in place at present
- Standards needed for asbestos exposure thresholds for public and surrounding
communities
- Uncertainty continues about exposure levels in restricted area, but hopefully data
collection will be coordinated in more organized fashion
- Sampling strategy needed - protocol, how to distribute results
- Need for hand washing centers as well as decontamination centers voiced
Transportation availability for 9/13/00
Hospitals
St. Vincent's Patient Information Line 2126047285
1 8667618265
New Jersey Medical Center 201 915 2000
Christ Hospital (Jersey City) 2014182710
St. Francis Hospital (Jersey City) 2014182711
St. Mary's Hospital (Hoboken) 2014182712
Transportation/Transit
DOT 2 12/718 CALL DOT
MTA (City) 718 330 3000
MTA (State) 2128787000
Transit Bureau (NYPD) 718 243 3441
FAA 202 267 3484
Port Authority 1 800 221 9903
New York City Department of Health September 13, 2001, 12:00 P.M.
Emergency Health Numbers
NYCDOH Poison Control 2 12 POISONS
NYCDOH Burial Desk 9262150,3686538
135th St/S^Ave Fax: 926 2526
CDC Emergency 770 488 7100
Emergency Preparedness - PHS 3014432401,1167
Medical Examiner ID Line (For NYPD, not Gen. Pub) 2124472713
Medical Examiner Main Office (") 2124472030
New York State Disaster Assistance 1 800 462 9029
FBI Tipline 1 8664835139
FBI Hotline 2123243000
NYPD Tipline 7187654300
New York City Department of Health September 13, 2001, 12:00 P.M.
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ZW YORK CITY DEPARTMENT OF HEALTH
Active Surveillance Case Form
ame of Facility:
ate of facility visit: / /
EMOGRAPHICS
Mode of Transport: D Ambulance D Walk-in P Other_ Patient status: P Stable D Guarded P Critical
D Other:'
Date:
wtc4_48 data abstraction form (time range = 0800 9/11 to 0800 9/13)
Time of visit:
Med rec #:
Name:
Sex: M F
Birthdate:
Zip:
WTC: Y N
Injury address:
Injury Category:
(circle all that apply)
Fracture HN TS UE LE Mult Unsp
Eye injury
Smoke inhalation
Primary Diagnosis:
The New York City Mayor's Office of Emergency Management (OEM) and the New York City
and New York State Departments of Health are requesting information to help assess the effects
(including the cosis) of the disaster at the World Trade Center, This information will be used to
guide allocation of resources in the immediate future.
Therefore, these agencies request that your hospital complete the attached form and fax it ASAP
to the New York City Department of Health at (212) 447-8240, and to GNYHA at (212) 262-
6350. The form should also be updated every eight hours and faxed to these two numbers, so
please make copies of it before filling it out. Please continue this system until you have been
advised otherwise. If you have any questions, please call the New York City Department of
Health at (212) 447-2676. If you have urgent needs, contact GNYHA staff at (212) 246-7100.
^"Staffing Shortages
Do you have a shortage of the following personnel'.'
Doctors D Yes O No D DK
If yes, specify # needed u Specify typc_
Nurses a Yes D No D DK
If yes, specify # needed> Specify type_
Orher O Yes D No D DK
If yes, specify # needed Specify iype_
^Supplies Needed
Blood D Yes DNo DDK (f Yes, describe _Spccify amount_
Antibiotics UYes a NO DDK If Yes, describe _Specify amount_
IV equipment a YCS DNo DDK If Yes. describe _Spccify amount_
IV solution D Yes a NO DDK If Yes, describe _Specify amouru_
Bandages D Yes DNo ODK If Yes. describe _Specify amount^
Surgical Supplies D Yes a NO DDK If Yes, describe _Spcci fy amount_
Ventilators D Yes DNo DDK If Yes, describe _Specifyamount_
Dialysis Machines a Yes a NO DDK If Yes, describe Specify amoum_
TD Vaccine a YCS D N o DDK If Yes, describe _Spccify arnoura_
Oxygen a Yes a NO DDK If Yes, describe ^Specify amoum_
Other O Yes DNo DDK If Yes, describe _Specify amount_
">rgue
Total Capacity Specify ft Current Capacity Available Specify #
Please fax this form back to (212)447-8240. For any questions call the New York City Department of Health at (212) 441-2616 .
version 5.0
The SAS System 06:33 Wednesday, September 12, 2001 1
ve
The FREQ Procedure
1 WTC 0 1 0 0 1
120 BROADWAY 0 1 0 0 1
280 RECTO ST 0 .1 0 0 1
AMERICAN EXPRESS 0 1 0 0 1
AMERICAN STOCK E 0 1 0 0 1
XCHANGE
ASLAND MGUIT 0 1 0 0 1
BANKERS TRUST 0 0 0 1 1
BOLTONS 0 1 0 0 1
BUS DRIVER 1 0 0 0 1
CHASE MANHATTAN 0 1 0 0 1
BANK
COMMISSION HPD 0 0 1 0 1
DTC - 55 WATER S 0 1 0 0 1
TREET
EMS 0 3 0 0 3
EMT 0 3 0 0 3
FDNY 0 1 0 0 1
FIDELITY INVESTM 0 1 0 0 1
ENTS
FIRE 17 5 3 2 27
GOLDMAN SACHS 0 1 0 0 1
JP MORGAN 0 1 0 0 1
MARRIOTT 1 0 0 0 1
MERRYL LYNCH 0 1 0 0 1
METLIFE 1 0 0 0 1
NEAR WTC 0 1 0 0 1
NYFD 0 1 0 0 1
POLICE 0 13 1 6 20
POLICE DEPARTMEN 0 1 0 0 1
T- SCHOOL SAFETY
PORT AUTHORITY 0 1 0 1 2
SCOR REINSURANCE 0 1 0 0 1
SOFTWARE DEVELOP 0 1 0 0 1
ER
STUDENT 0 1 0 0 1
TUMBLEWEED 0 1 0 0 1
WTC 0 2 0 1 3
CROWD 0 2 0 0 2
IN SCHOOL 0 1 0 0 1
NEAR WTC 14 53 0 7 74
PICKED UP BY EMT 0 1 0 0
AT CATHERINE LN
AND EAST BROADW
AY
STUYVESANT HIGH 0 1 0 0 1
SCHOOL
SUBWAY 0 4 0 1 5
WALL STREET 0 1 0 0 1
WARREN STREET AT 0 1 0 0 1
IS 89 SCHOOL
WTC 26 39 0 12 77
Moments
_. Location Variability
Quantiles (Definition 5)
Quantile Estimate
r--ro~0%'~Max 80.2466^
99% 74.2521
95% 62.3397
90% 57.5836
75% 03 48.0110
(55% Median 40 . 008T)
25% 01 32.0027
10% 25.1178
5% 20.1178
1% -16.3479
(6%~Min -17.8548^>
Extreme Observations
--Lowest - — Highest
sex(SEX) HOSPNAME
MALE 35 83 52 30 200
FEMALE 16 59 49 15 139
UNKNOWN 3 13 6 6 28
AMBULANCE 22 12 1 35 70
WALK- IN 1 16 0 1 18
Frequency Missing = 5
CRITICAL 1 0 0 0 1
HOSPITALIZED 3 7 2 0 12
DISPOSTN HOSPNAME
DEAD 0 1 0 0 1
YES 15 19 2 16 52
YES 3 5 0 0 8
NO 33 82 73 29 217
YES 21 73 34 22 150
YES 2 1 0 2 5
YES 5 16 2 1 24
lacer(LACERATION/CONTUSION) HOSPNAME
NO 43 111 99 34 287
YES 11 44 8 17 80
YES 4 5 0 1 10
YES 0 1 0 0 1
YES 0 1 0 0 1
faint(SYNCOPE/PRE-SYNCOPE (FAINTING))
HOSPNAME
Frequency BELLEVUE BETH ISR NYU DOWN ST. VINC Total
AEL TOWN ENTS
YES 1 2 0 0 3
YES 4 24 1 7 36
SPRAIN(SPRAIN) HOSPNAME
YES 3 8 0 2 13
NO 38 90 38 42 208
YES 16 65 69 9 159
All DOH Staff should report to their normal work locations, EXCEPT those who
work below 14th street in Manhattan. A DOH Staff Hotline has been established
to address employee questions. That number is 1 -800-527-6900.
Staff who work below 14th Street may be assigned to other locations. Such
personnel should make every effort to contact their direct supervisor. It is
important that persons report to the nearest DOH health center.
PAYCHECKS
Employees who work below 14th Street can be directed to pick up their checks
at 295 Flatbush Ave Extension in Brooklyn at 9 AM.
If you have any questions about your paychecks, please call (718) 643-3048.
9/11 P e r s o n a l P r i v a c y
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9/11 Personal P r i v a c
Office Program Building Number need relocation Location to Relocate EKpraye* Liaison
E:H '• ' .'•, '•.
Surveillance and £pi Surv & Epi Admin 125 Worth 1 clerical, 1 MD. 1PHD Polly will call to come to 455 First Ave E:: :: ', '. '•, \i H I \. \ £: : •. •. \r
some are field but availabe to help-
HIV AIDS Surveillance 346Bdwy 100 staff supervisor will call wrth instructions
will be called by supervisor for
AIDS Research 346Bdwy 12 staff instructions- 1
445 First
Integrated Surveillance aTreemont Clinic 20 report to normal work location 11: \
will be called by supervisor for :;,;:•. :.~ ; '. '. '.
City Immunization
Registry 2 Lafayette 30 instructkxis- Affiy MfelroteJ
Jack RedriBuesJ |
Immunization 2 Lafayette 100? 7?
Office of Staff Training JaraEg;;.Srriith.i 1
inMPET
Goto clinics closest DOH health cente Si:; =;;;: ;
HIV Training Institute 225 Broadway 14 (8 educators. 6 clerical) John Egan B:;;:'. "/::'": ';
liv;. ;;?; '.
Research and 5 (1 RS- tRB, 2 Clerical-
=••!:: =•::• •
Publications 346 Broadway Publications. 2 HRTP- JRB) Go to clinics closest DOH health cente
Medical and
Professional Education 346 Broadway
6 (3 Clerical. 1 RN. 2
HRTP) nearest clinic
liii 11 ;,
do not report to work, lawyers contact
Roz Winholtz if you have questions, 71
846-0256. clerical contact. Theresa
^;::::' ':::;':•
Legal Lawyers & Clerical 25 Worth Street 20 Clark, 718-789-5572
itnployment Law Unit 2 Lafayette Street 4 do not report to work, contact ?o«;»ssrerl •
jjjjjel (SofeaK
*\
Administrative Tribunal 66 John Street I full time. 30 per diem do not report to wonV contact ::;1: :•. ::: ::^
possible relocation to Jamaica Hearth .arrir-Wblf.l::::.' 1
Contracts Office Contracts 25 Worth Street 16 Clinic. (pmjji:;:;; i^
Ban»:Owver{^. 1
Procurement 25 Worth Street 20 possible Jamaica Health Center;
Business & Tech
Strategy Policy & Planning 25 Worth 2 Clerical. 4 Professional come to Bureau of Labs Marfo Merlinb,
Business Systems ^jajtesi Troqb,
mprovement 346 Bway Clerical. 5 Professional contact supervisor :•.:
7*"1"°"?"
Grants 25 Worth Cterica. 4 Professional contact supervisor
contact;^ C^rubjjJ
^ '
60 Technical Staff. 4 jorilian LJU.V __
MIS/New Media 25 Worth Clerical contact supervisor e^eT ; i = ^ ; • ^T
Michelle Robinsonl " 1
ureau of Inspections nspections 53 Bway 20 Employees eport to SOL Auditorium, at 9:OOpm —Tit^; !; '' '
Govt Affairs. Press. CR.
:ublic Affaire Media 25 Worth Street 30 Employees eport to BOL Auditorium, at 9.00pm ranpan'sji 1 i 1
do not report to work at present;
25 Worth Essential personnel will be notified by arios Fprtuno
Human Resources Street/346 Bway 90/3 upervisor
nnrnane ;Fraschitlaj |
STD 25 Worth Street 60 il personel has been reassigned
School Health Lafayette Street 40
Physicslly Handicaped
Children
elocation to Health Center, contact oyce: Weinslein.1 . f
Health Care Access 25 Bway 35 upervisor
im Capizelloj"
eaith Promotion Lafayette 23 b-«^
Community Health \sthma/Health all East Harlem sitd i
Works eighborhoods 0 Worth St 0? etocatiofi to East Harlem
Shelter Client Usage
Shelter 9/11-12 9/12 9/12-13 9/13 9/13-14 9/14 9/14-15 9/15 9/15-16
9P-9A 9A-9P 9P-9A 9A-9P 9P-9A 9A-9P 9P-9A 9A-9P 9P-9A
# clients # clients # clients # clients # clients # clients # clients # clients # clients
Seward Park 3 11 6
HS
Washington 2 75 20
Irving HS
Fashion 5 4 20
Industry HS (+8 tourists)
Chelsea HS 3 9 1
Norma Thomas 7 20
HS
City School HS 3-5 6 7 6
JHS22 0 2
IS 131 10 8 6
Comprehensive 0 0
Day&Night HS
Bayard Rustin 6 Closed
HS
Westinghouse 2 0 0
HS.BK
FOR IMMEDIATE RELEASE CONTACT: SANDRA MULLIN
September 13,2001 (212) 447-8232,
(212) 447-8233
The headquarters of the New York City Department of Health has been temporarily relocated to
the Department's Bureau of Laboratories at 455 First Avenue. The Department continues to
operate clinics and health centers in areas above 14th Street and in the other boroughs. The
Department is continuing most of its public health operations and is working closely with City,
State and Federal agencies in a coordinated emergency response to the World Trade Center
Disaster.
In addition to clinic services, school nurses are dispatched throughout schools in New York City,
day care centers are operating and surveillance and laboratory services are ongoing.
it 11 n
###
Policy Statement
Operational
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Patient Imprint Card or Label If imprint card is unavailable:
Last Name:
First Name:
Med Rec #:
D Female D Male
Date of visit:
For age less than one year please use "1"
A9e:
Was patient in southern Manhattan (below Canal St) on Tuesday, September llth
after the attack? (circle one) YES NO Don't Know
Please check the ONE PREDOMINANT syndrome from the following list that best
represents the PRIMARY condition of the patient
D iNone of the following
D Trauma
D Smoke or dust inhalation
1 Exacerbation of underlying respiratory condition (Asthma/ COPD)
D Anxiety reaction (including somatic complaints, insomnia)
D Diarrhea / gastroenteritis (including vomiting or abdominal cramps)
D Upper or lower respiratory infection WITH fever
D Sepsis or non-traumatic shock
D ;Rash WITH fever (do NOT check unless both are present)
D Meningitis, encephalitis, or unexplained acute encephalopathy
D iBotulism-like syndrome (cranial nerve impairment and weakness)
Q Unexplained death with a history of fever
IF YOU HAVE ANY QUESTIONS OR NEED TO REACH THE NYC DEPARTMENT OF HEALTH, PLEASE CALL
212-447-2676 AND ASK FOR THE DOCTOR ON DUTY. IF NO ONE IS AVAILABLE AT THAT NUMBER, CALL
THE POISON CONTROL CENTER AT 212-764-7667.
Environmental Coordination Meeting
September 13, 2001 4pm-6:30pm
Present: DEC, EPA, Bechtel Corp, CDC, Port Authority, NYCDOH
Daily meeting will be held at 9am at the West Street Command Center to inform field staff on decisions of
the Environmental Coordination Group.
24 hour sampling was recommended due to the different types of work being performed at
different times of the day.
Contractors are also working at Freshkills and transfer stations and it was recommended that they
be included in sampling frame as well.
a. Locations immediately East, West, North and South of WTC (see locations 1, 6, 3 on attached
map; location West of WTC to be determined). EPA to more clearly identify locations by
street name.
b. Decontamination Sites @:
-West and Harrison Streets
-Church and Franklin Streets
-Water and Old Slip
Mag 16.00
ThuSep 1311:43 2CO-: Local Road Point of Interest
Scale 1:7,812 (at •?•"— Major Corftettw Pa-K/Keservaticn
500 Feet Primary Stale Route Mega City
• - Ferry Land
200 Meters
— Walkway/Stairway Water
5>lrtersta!eA-imited Actcs* Clt/Park
Toll Highway
Exit
TOifiL P.04
THE CITY OF NEW YORK
DEPARTMENT OF HEALTH
Rudolph W. Giuliani Neal L. Cohen, M.D.
Mayor Commissioner
UPDATE #2: Terrorist Attack at the World Trade Center in New York City:
Medical and Public Health Issues of Urgent Concern
Please Share this Alert with the Following Key Staff at Your Hospital:
1 - Hospital Administration
2 - All Medical and Nursing Staff
3 - Emergency Departments
4 - Hospital Safety Director
5 - Hospital Pharmacy and Laboratories
TO: Emergency Medicine Directors, Infection Control Practitioners and Infectious Disease
Physicians, and Other Persons on the NYCDOH Broadcast Facsimile Alert
We are sending this broadcast alert to update you on urgent public health issues following the
terrorist attack at the World Trade Center on Tuesday, September 11, 2001.
A) The New York City Department of Health (NYCDOH) has relocated its headquarters to
the Department's Public Health Laboratories at 455 First Avenue. NYCDOH is working
closely with other City, State and Federal agencies, including the Centers for Disease Control
and Prevention in a coordinated response to the World Trade Center disaster. Until further
notice, please report only urgent communicable and environmental health issues to the
following telephone numbers:
If you experience difficulty getting through to any of these numbers, please call the NYC
Poison Control Center at 212-764-7667 (212-POISONS).
Routine communicable disease reports (i.e., paper reports) should be sent by mail, as they will
be forwarded to us.
Increased particulate matter and dust released during recent days may cause eye and/or
respiratory irritation, particularly for persons with underlying pulmonary disease, including
asthma or COPD. Individuals who have a history of heart and lung conditions and who are in
areas where smoke or dust is visible are advised to remain indoors with the windows shut. It
is advised that air conditioners be operated on the "recirculate" mode, so that outside air is
not pumped inside, or if this is not possible, that they be turned off. Persons who experience
difficulty breathing or chest pain are advised to seek medical care immediately.
However, we do request that you be especially alert to ANY unusual disease issues over
the next three weeks. Urgent health issues for which we would want to be notified
immediately include:
Please report immediately to the Surveillance Office at the NYC Department of Health
(interim telephone number: 212-447-2676 or 212-578-0823) if you evaluate patients with
any of these suspected illnesses or conditions. If you cannot get through to these
numbers, please call the NYC Poison Control Center at 212-764-7667.
The NYC Department of Health also has established an active surveillance program with
sentinel hospitals throughout the city. Collaborating with emergency department staff, we
will be monitoring for increases in patients presenting with certain disease syndromes (e.g.,
respiratory disease with fevers, gastrointestinal illness, neurological syndromes, and fever
with rash), and other illnesses (e.g., asthma exacerbations) that may be associated with this
attack. We anticipate that this surveillance will continue for 2-3 weeks.
a. ALL deaths directly or secondarily related to this terrorist incident should be reported
to the Office of the Chief Medical Examiner at 212-447-2030.
b. The NYCDOH Burial Desk for registration of death certificates has been temporarily
moved to the Central Harlem Health Center. Please notify all Funeral Directors
regarding the relocation of this office:
Immunology Laboratory
Public Health Laboratories
455 First Avenue (between 26 and 28th St)
212-447-2660
Serum specimens should be kept refrigerated; cerebrospinal fluid specimens should be kept
frozen at "70 °C. The West Nile case report form should be completed and a copy included with
each clinical sample. A copy of the case report form should also be faxed to 212-532-5241.
Please call the laboratory at the number listed above if you have any questions regarding proper
specimen transport.
I) Td Vaccine Availability
Standard recommendations for use of Td vaccine should be followed for wound management. If
additional vaccine supplies are needed by your hospital, please contact the NYCDOH at 212-
447-2676 or 212-578-0823.
We appreciate your cooperation and understanding as we all work together to deal with the
ongoing consequences of this tremendous tragedy.
THE CITY OF NEW YORK
DEPARTMENT OF HEALTH
Rudolph W. Giuliani Neal L. Cohen, M.D.
Mayor Commissioner
nyc .gov/health
Health «& Safety Precautions for Rescue Workers
^ Use respiratory protection and make sure someone checks the fit of the mask. A respirator that does not fit
correctly provides no protection (* see footnote below).
• Do not eat, drink, or smoke before properly removing respirator and gloves AND washing your
hands.
^ Avoid dehydration: Drink enough fluids so that you are urinating every 4 hours. Don't wait until you are
thirsty.
S Follow decontamination instructions AND wash your hands before eating or smoking.
•/ Follow decontamination instructions AND wash your hands before (and after) using the toilet.
•/ Before going home, remove contaminated clothing and wipe your footwear. Don't bring your
contamination home with you!
*/ When you get home, remove clothes immediately and place in a plastic bag until washing. Launder twice—
separately from other laundry. Wash off shoes and other items, then throw the sponge away in a plastic bag.
* Checking the fit requires, at a minimum, a negative pressure test and a positive pressure test. For a cartridge respirator,
check the negative pressure by covering the cartridges fully with your bare hands. Suck air in using your lungs. You should
feel a tight suction around the seal of the respirator. For a positive pressure test, cover the exhalation valve fully and blow
out. You should feel the respirator puff out without air escaping from the seal. If either test fails, try adjusting the tightness of
the strap or select a different size respirator.
WHAT TO DO FOR POSSIBLE EXPOSURES TO BLOOD-BORNE PATHOGENS
Jiven the hazardous setting, the blood, tissues, and body fluids from injured persons or corpses may come in direct
contact with rescue workers' bloodstream, mucous membranes, or non-intact skin. This contact may present an
exposure to blood-borne pathogens.
If there is no information on whether or not the source case was infected with HIV, hepatitis B or hepatitis C,
contacts to such source cases should be handled as exposure incidents:
If source patient is known to be HIV-positive and has received antiretroviral therapy, determine the post-exposure
prophylaxis regimen in consultation with an infectious disease specialist.
The NYC Department of Health (DOH) is closely monitoring and analyzing air quality data that is
being collected by the US Environmental Protection Agency (EPA), the NYC Department of
Environmental Protection (DEP) and other agencies. Dust, debris, and at times smoke have been
concentrated in a section of lower Manhattan. Additionally, other neighborhoods in the greater
metropolitan area may experience increased air pollution. Of primary concern is that
environmental testing has shown evidence of asbestos contamination in lower Manhattan. The
DOH recommends that people in the immediate vicinity of the World Trade Center take a few
simple precautions to protect their health. The DOH also offers recommendations for residents
throughout New York City to minimize their exposure to potential air pollutants.
What is the area where precautions are required in the vicinity of the World Trade Center?
Of concern is the area bounded by Worth Street to the North, Centre and Nassau Streets to the
East, the Hudson River to the West, and Exchange and Thames Streets to the South. Beyond this
area, exposure to asbestos is unlikely.
Asbestos, a naturally occurring mineral, was used in the construction of the World Trade Center. The
destruction of the World Trade Center buildings released large amounts of dust and ash, some of
which contained asbestos.
Exposure to inhaled asbestos primarily affects the lungs. The risk of lung disease from the inhalation
of asbestos fibers depends on the intensity and duration of exposure. In general, lung disease has
resulted from intense asbestos exposure experienced over a period of many years, primarily in
occupational settings. The risk of developing an asbestos-related illness following an exposure of
short duration is very low.
Asbestos has been found in both dust and debris. In addition, air tests taken on Tuesday, September
12th found very small concentrations of asbestos in air in the vicinity of the World Trade Center.
However, tests performed the next day found no airborne asbestos. To the extent that dust and debris
are disturbed in the clean up effort, asbestos could enter the air once more. Precautions are being
instituted to keep dust levels as low as possible.
There is no way to determine whether someone has recently inhaled asbestos, or how much has been
inhaled after an exposure.
Dust and fine particles continue to be released into the air. A complete analysis has not yet been
conducted. It is likely that the plume of smoke and dust contains ash, silica, soot and chemicals from
burning plastics and other materials present at the site. These pollutants are collectively known as
"particulates". A very large amount of dust is present throughout lower Manhattan; the highest levels
of particulates are likely to occur in the areas closest to the World Trade Center site.
Dusts can cause eye and respiratory irritation, such as a sore and scratchy throat. Heavy exposures
may result in difficulty breathing'.
Persons with asthma and other respiratory problems are most susceptible to the effects of air
pollution. They may experience chest tightness, wheezing and shortness of breath after inhaling the
dusts resulting from the fire and collapse. Those with the greatest exposure are most at risk of
experiencing these symptoms. Residents are urged to stay away from the World Trade Center
cleanup site.
Tap water or ocular saline solutions may be used to rinse eyes irritated by dust. All persons should
avoid wearing contact lenses while in lower Manhattan. Anyone who has difficulty breathing should
consult their physicians or seek medical help. People with asthma may need to step up their usual
medical treatment with more frequent use of bronchodilators, and should consult their physicians if
necessary. People with other respiratory diseases, such as chronic pulmonary obstructive disease and
emphysema should avoid all possible exposure.
Residents of lower Manhattan — especially those living in the vicinity of the World Trade Center ~
can reduce their exposure and the risks associated with increased air pollution by taking the following
steps:
Inexpensive disposable masks, such as surgical masks, may modestly reduce dust exposure. In
general, people with respiratory problems should not use masks or respirators without medical
guidance. People with asthma or other respiratory problems should focus on reducing exposure by
staying indoors with windows closed when air quality is poor, when odors become apparent, or if
they feel they are in the path of the smoke plume.
The best way to remove dust is to use a wet rag or wet mop. Sweeping with a dry broom is not
recommended because it can make dust airborne again. Dirty rags should be put in plastic bags while
they are still wet and bags should be sealed and discarded (cloth rags can be washed, see instructions
below). Rags should not be allowed to dry out. People with asthma and respiratory disease should not
vacuum. Because the dust particles are so small, standard vacuuming is not an efficient way to
remove the dust and may put dust back into the air where it can be inhaled. Only HEPA vacuums
capable of trapping very fine particles should be used. HEPA vacuums are now widely available in
stores, and can be shared by more than one family. Carpets and upholstery can be shampooed, then
vacuumed.
Persons should shower to rinse off any dust. Clothes should be washed separately from other
.clothing. Pets can be washed with running water from a hose or faucet; their paws should be
wiped to avoid tracking dust inside the home. To clean plants, rinse leaves with water. Throw
away any food that may have been contaminated with dust, except for food in cans, jars or
containers with tight-fitting lids. Just wash the can or jar with water and wipe it clean. If in
doubt, throw it out.
Air purifiers may help reduce indoor dust levels. HEPA air purifiers are superior to other models in
filtering the smallest particles. Air purifiers are only useful for removing dust from the air. They will
not remove dust already deposited on floors, shelves, upholstery or rugs. Keep windows closed when
using an air purifier.
The recommendations above are sufficient, except that children should be kept away from the area
while it is being cleaned to prevent them from putting contaminated hands in their mouth.
What are the threats to public safety from decomposing human remains
over the next 30-60 days?
There is no threat to the health of the general public from decomposing human remains.
Given the added time for recovery efforts, human remains may begin to decompose.
Bad odors may come from decomposing human remains; although unpleasant, these odors are
not harmful.
Family members and others brought to mortuary areas for identification should avoid direct
unprotected contact with blood or body fluids.
Images of human remains may evoke strong responses of grief, anger, or self-destructive
behavior. People who feel emotionally overwhelmed should seek help from family and
friends, clergy, mental health professionals, or disaster service organizations such as the
American Red Cross.
For other questions or further information, you may contact the CDC at 770-488-7100.
CDC EMERGENCY RESPONSE 770 483-7107 09/15/01 04:16P P. 003
It is important to remember that human remains from explosions and building collapse do
not pose a risk of disease epidemics.
However, responders should use standard precautions when handling human remains.
Your priority is to maintain the dignity of the deceased and respect family wishes as well
as religious and social customs.
Rescue workers who will have direct contact with the bodies should use universal
precautions including:
Blood-borre pathogens pose a risk to unprotected rescuers and others in contact with
remains. Blood, bloody fluids, body fluids, and moist tissues are potential sources of
blood-borne pathogens Universal precautions should be strictly observed regardless of
time since death.
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Front end loader operators, truck drivers, and claw loader operators were generating
significant dust, exposing themselves and surrounding workers. Recommendation: Wet
debris piles, and debris before shoveling and if wetting is not possible, inform workers of
dust hazard and encourage wearing of respirators and use of re-usable, tight-fitting half-
mask respirators over the dust/mist variety.
Oxy-acetylene torch cutting was performed with respiratory protection ranging from no
protection to use of dust/mist or half-mask respirators. Recommendation: use re-usable,
tight-fitting, half-mask respirators with combination PlOO/OVC/Acid Gas cartridges (if
available). At a minimum, use a half-mask with PI00 filters.
Street and sidewalk shoveling and sweeping generates a large amount of dust for the
workers and those in the vicinity. Recommendation: avoid this activity.
A very large number of workers appear to have no purpose other than rest and staging as
replacements. These workers are susceptible to falling debris and dust/smoke exposures.
Workers not actively participating in the rescue effort should be moved as far away as
practical from the site to a staging area where occupational safety and health personnel
can take advantage of this "down time" by attending, to worker protection.
A staging area at a second perimeter is greatly needed to remove idle workers from areas
where dust/smoke generation occurs. Two zones are needed; an inner zone where active
work is being performed and a staging zone with (ideally) a fenced perimeter where
workers can be staged to enter the inner zone. This zone could be taped or marked with a
painted line if necessary.
Perimeter safety and health stations are needed at the four compass points. Four stations
should be located within the inner zone and four at the staging zone perimeter next to
access points. Inner zone stations should have first aid equipment, and include eye wash
stations. Staging stations should have personal protective equipment, provide fit testing,
respirator cleaning and exchange, and replacement filters. The respirators of fit-tested
workers should be marked in some way, perhaps with an 'X' by a highly visible marker,
such as metallic gold or silver. At these stations, respirators should be checked, cleaned
and returned or re-issued to a different individual. Cleaning respirators should utilize
three buckets; one each for washing, sanitizing, and rinsing. In addition, a table is needed
to distribute personal protective equipment. These stations should be manned 24/7.
Break areas were observed in dusty conditions, which has led to inhalation as well as
food/drink contamination issues. Break areas should be moved to a staging perimeter.
Many oxygen and acetylene tanks are not tethered in any way, and some are uncapped
and untethered. These tanks can become missies as well as fire hazards. Tanks need to
be secured and isolated from high traffic areas. We observed over 100 untethered tanks.
A central on-site safety and health coordinator is needed with the authority from the
mayors' office to make on-the spot recommendations, coordinate occupational safety and
health activities among various organizations, and serve as a point of contact to authorize
occupational and environmental health professionals' access to all areas of the site.
Stop unnecessary rooftop or other demolition work not directly related to the rescue
effort. Sending debris to the street level generates dust exposures to rescue workers as
well as a falling material hazard.
Only one eye wash station was observed in the 20 block radius. Recommendation: Install
and clearly label at least one wash station at each of the four compass points.
Falling glass hazards exist all over the site. Glass should controlled using a ladder truck
or some other means of reaching and taping the window glass, and removing broken
panes by breaking loose glass to the interior of the buildings in a controlled manner.
All types of personal protective equipment were not used consistently. Individuals with
minimal gear worked next to workers using all available gear, or no gear. This problem
could be resolved by using a staging perimeter to control worker access for those without
the proper gear.
Fire hoses under water pressure have the potential to fail and move under pressure
causing injury. Hoses should be relieved of pressure if not in use.
Commonly used roadways should be wetted if dust generation is still observed after the
recent rains.
World Trade Center Disaster Response
New York City Department of Health
September 13-14, 2001
Shelter
September 13, 2001
9:00 PM/L. Moskin
A shelter supervisor from the American Red Cross is threatening to close a shelter in the
absence of a reliever. Problem resolved through OEM.
Issues
determine the need to keep underused shelters open
- coordinate shift changes with the American Red Cross
- resolve the communications issue; most of the shelters in schools have phones that
go through the switchboard which does not allow them to call out at night.
Environmental/Medical Team
10:50PM/J.Leighton
1 1 :30 PM/ K. McKinney
The Environmental Coordination Group met to plan for the environmental monitoring
and addressing environmental health risk to rescue crew and the community. The group
developed and implemented the protocol for personal air monitoring; 25 battalion
chiefs/supervisors were given personal air monitoring equipment to determine air quality
in breathing zone; stationary air monitoring sites have been established and air sampling
is being done; additional sites will be determined based on status of the work being done
in the affected areas.
Air sampling results will be provided by EPA daily; advisory will be provided to prevent
exposure should that be necessary. Results from last sampling do not present any health
risk.
2 decontamination sites have been erected: Harrison and West; Battery Tunnel entrance.
Surveillance
Friday, September 14, 2001
12:15AM/M.Layton
4:15 AM
No calls from hospitals were received.
Environmental/Clinical Group: 9/13 8 PM to 9/14 8 AM
5) Need to address concerns re: health issues related to removing remains being
found
•& X
The BPRP group is still working on travel arrangements. Looks like a plane donated by Lockheed will be used
(How many EIS officers will fit into the bomb bay of a B-1??) Specific details are still pending.
In the meantime, I have been given a few more details about the assignment in NYC. The BPRP folks have
made the following points.
1. BE FLEXIBLE (this should be brutally obvious by now). You are moving into a disaster situation and
things may not always run as smoothly as we would wish.
2. You are going to ASSIST NYC with their investigation and management of the situation. Remember at
all times, this is New York's show, we are there to help them. They are in charge.
3. Your primary job will be to conduct surveillance in Emergency Rooms. This will be syndromic
surveillance (always thinking BT) and injury surveillance.. However, you may be asked to do other duties as
assigned (i.e. members of the team may be asked to help conduct routine outbreak unrelated to the crash).
4. The exact length of the assignment has not yet been determined. Your travel orders will read "Until
30 September" (end of the fiscal year) "with the possibility for extension". It is likely to be much shorter, but no
one knows for sure.
6. Please bring any personal Medical supplies with you that you might need ("comfort meds") as you
won't be guaranteed access to a pharmacy (I'm just repeating what I was told to say).
7. If possible, try and bring some basic office supplies (you can't count on getting any support from the
hospitals). These should include: pens, pencils, notebooks, paper, clips, tape, push pins, sticky notes etc.
8. BRING A LAPTOP (if you don't have access to one let me know and I'll see if there are any available
here). Also bring some diskettes and, if you have it, a zip drive and disks.
9.
Doug
https://webmail.cdc.gov/exchange/forms/IPM/NOTE/read.asp?command=::open&obj===<)000(... 9/13/2001
(e-Memo #01-24F) Still waiting for information (4:20 PM) Page 1 of 2
& X * ^ ?
It is important that we try and get as many laptops as possible into the field. Therefore, if you have a laptop,
please plan on bringing it into the field.
The following revised list contains the names of people who have been slated to go and have responded that
they are ready for immediate departure (we should be so lucky).
1. Melanie Myers
2. Reuben Varghese
3. Puneet Dewan
4. Jina Shah
5. Scott Harper
6. Jill Morris
7. Lorna Thorpe
8. Lisa Nelson
9. MaryDott
10. Gabriella Paz-Bailey
11. Rachel Avchen
12. Charon Gwinn
13. Brad Winterton
14. Mick Ballesteros
15. Regina Tan
16. Ilin Chuang
17. Pauline Terebuh
18. Reina Turcios
19. Nicole Smith
20. Toya Russell
21. Carolyn Green
22. Vincent Hsu
23. Robin Curtis
24. Teshale Eyasu
https://webmail.cdc.gov/exchange/form^ 9/13/2001
(e-Memo #01-24F) Still waiting for information (4:20 PM) Page 2 of 2
Tracee is the CDC BPRP rep on the scene. She can be reached by beeper at 888-374-1765
More details to follow as soon as I get them. Remember, please e-mail a short
acknowledgement, otherwise I'll need to try and find a replacement
Doug
https://webmail.cdc.gov/exchange/forms/IPM/NOTE/read.asp?command=open&obj===0000(... 9/13/2001