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World Trade Center Disaster Response

New York City Department of Health


9/13/01:8am-8pm

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

The bureau of Labs will have the following vans available


Two 15-passenger vans.

One cargo van will remain at 125 Worth Street.


The supervisor for this evening is Tommy Yee

His number is (718)


v '
326-7745
I 1 9/11 Personal Privacy
Tommy's Nextel number is;

All drivers will be available on Thursday morning


By 7:00am
NEW YORK CITY EMERGENCY NUMBERS LIST

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

Mental Health Services


English LifeNET 212 995 5824
Spanish LifeNET 2125337007
Chinese LifeNET 2122542731
St. Vincent's Hospital 2126048220
Bellevue Hospital 2125624877/3120
Westchester 914 925 5320
Staten Island 718 354 6300
Red Cross 1 800 367 8788

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

Volunteers/Blood Donation/Monetary Donations


American Red Cross 1800 GIVE LIFE
2128752067/8/9
1 800 801 8092
Red Cross Relief (Monetary Donations) 1 800 HELP NOW (800 257 7575 Spanish)
Doctors/Medical 5184317600
2126043850
NYC Blood Center 212 893 BLOOD; 800 933 Blood
Salvation Army 212 SAL ARMY

Patient/Missing Persons Information


NYPD Missing Persons Information 447 2998/9; 447 8207/10
492 1st Ave (Walk-ins are welcome)

Patients being Treated 2 12 560 2730 (in NYC)


Missing Persons Information 1 800 222 6459 (outside NYC)
1 8003310075
Port Authority Workers Missing Persons Info. 1 973 565 5505
NYPD Families (ONLY) 718 677-8238
FDNY Families (ONLY) 718 999 2541
American Airlines 1 800 245 0999
United Airlines 1 800 932 8555

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

Informational Websites and Phone Numbers


FBI Website www.ifccfbi. gov
Stranded NYC Visitors wvvw. nvcvisit. com
Port Authority Info. Yvww.panvni.com
Court Issues 1 800 COURT NY

BOGUS WEBSITE http://w-wv.nv.com/wtclist.htinl

Wall Street Firms Information Lines


To report a person who 's safe 2127048188
Delloite & Touche 1 888 243 7666
Morgan Stanley 1 888 883 4391
CARR Futures 1 800 755 7620
3 12 762 7677 (Chicago)
AON 1 8662564154
Thatcher, Profitt, Wood 1 800 698 4567
Empire Blue Cross/Blue Shield 18667618265
Kemper Insurance 1 800 622 9966
CIBC World Market 2128566000
Canter Fitzgerald 2129408162
Merrill Lynch 1 877 637 9040

Washington, DC Informational Numbers


Justice Department, Office of victims of 1 800331 0075
crime
Army Pentagon Recruits 1 800 984 8523
Pentagon Information 1 877 663 6772

New York City Department of Health September 13, 2001, 12:00 P.M.
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CASE3
ZW YORK CITY DEPARTMENT OF HEALTH
Active Surveillance Case Form
ame of Facility:
ate of facility visit: / /
EMOGRAPHICS

astName First Name M.I Day Telephone No.

treet Address Apt# Evening Telephone No

ity/Municipality State Zip Code Other Phone/Contact


Name:

'lace of Work Date of Birth Sex


imployer: PMale
/ / P Female
Jity: P Unknown
Hate:
Vhere was patient when injury was sustained?
street Address/Building:
:loor Number: . Room Number:
3oro:

Mode of Transport: D Ambulance D Walk-in P Other_ Patient status: P Stable D Guarded P Critical

Hospitalized P Yes P No P Unknown P ER only Patient Disposition P Alive P Dead P Unknown


Where? P Discharged from ER
Date of admission: / / Date of death: / /
Was patient placed in/on(c/iec/c all that apply): Medical examiner:
P Critical Care Unit P Mechanical ventilation Medical examiner case no:

Type(s) of Injury (check all that apply)

P Eye Trauma/ Foreign Body P Laceration/ contusion D Skin Rash:


P Crush Injury Part of Body: P Neurological Signs:.
P Toxic/ Smoke Inhalation
P Burn Injury P Bone Fracture D Syncope/ pre-Syncope (Fainting).*
P Chest Pain/ Rule Out Ml Part of Body: D Emotional Distress

D Other:'

ADDITIONAL COMMENTS: Completed by:

Date:
wtc4_48 data abstraction form (time range = 0800 9/11 to 0800 9/13)

Case #: Abstractor initials

Facility: Bellevue St. Vincents NYU Beth Israel Other

Date of visit: 9/11 9/12 9/13

Time of visit:

Med rec #:

Name:

Sex: M F

Birthdate:

Zip:

WTC: Y N

Occupational category: NYPD NYFD PA Other

Injury address:

Transport: Ambulance Walk-in Unknown Other

Complaint category: Resp GI Inf Cardiac ObGyn Neurol Psych


(circle one)
Trauma (Open) Trauma (Closed) Burn

Injury Category:
(circle all that apply)
Fracture HN TS UE LE Mult Unsp

Sprain/Strain HN TS UE LE Mult Unsp

Laceration HN TS UE LE Mult Unsp

Contusion HN TS UE LE Mult Unsp

Crush HN TS UE LE Mult Unsp

Burn HN TS UE LE Mult Unsp

Concussion (closed head injury)

Eye injury

Smoke inhalation

Primary Diagnosis:

Disposition: Admitted Discharged home Died


BULLETIN
Greater New York Hospital Association
§ 555 -" 57th Street / New York. N.Y. 10019 / (212)
"~~246-7100 / FAX (212) 262-6350"
Kcnnech E. Raske. President ^

September VIA FACSIMILE


Thirteen
200 1

TO: Chief Executive Officers

FROM: Kenneth E. Raske, Presiden

RE: Needs Assessment

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.

Thank you for your cooperation.

cc: Emergency Department Administrators


Emergency Department Directors
GNYHA / NYSDOH / NYCDOH
NYC Hospitals Needs Assessment
Hospital Name
act Name/Title
Telephone Fax ( ).
Emergency Telephone
Date
Time AM/PM (please circle one)

Total number of patients Seen related to the lacident


Total number of deaths related to the incident
Total ED visits since 9A-M-, September 11th # _
Total admissions since 9A.M., September ll"1 #
Have you admitted or do you have in your ED any unidentified patients? DYcs D No D DK If Ves, bov many?

Number of Beds Filled Adult


Med/Surg ICU/CCU
Bum
Trauma it
Dialysis #
Non Critical Care Beds

Number of Beds Currently Available Adult


Med/Surg ICU/CCU
Bum
Trauma
Dialysis
Non Critical Care Beds

•Emergency Room PcdiatrieAdulc


Number of persons awaiting attention
Number of Beds Available

^"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_

Rcsp. Therapists DYcs D No DDK I f yes, specify #needed_

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

Table of employ by HOSPNAME

employ(PLACE OF EMPLOYMENT) HOSPNAME

Frequency BELLEVUE BETH ISR NYU DOWN ST. VINC Total


AEL TOWN ENTS

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

BANK OF NEW YORK 0 1 0 0 1


m
BANK OF NY 1 0 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

DUR AND BRAD STR 0 0 0 1


EET

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

Total 54 155 107 51 367


The SAS System 06:33 Wednesday, September 12, 2001 2

The FREQ Procedure

Table of employ by HOSPNAME

employ(PLACE OF EMPLOYMENT) HOSPNAME

Frequency BELLEVUE BETH ISR NYU DOWN ST. VINC Total


AEL TOWN ENTS

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

UNKNOWN 33 104 101 39 277

WORLD STREET SYS 0 1 0 0 1


TEMS

WORLD TRADE SECU 0 0 1 0 1


RITY

WTC 0 2 0 1 3

WTC- SYSTEM OPER 0 1 0 0 1


ATION

Total 54 155 107 51 367


The SAS System 06:33 Wednesday, September 12, 2001 3

The FREQ Procedure

Table of injaddr by HOSPNAME

injaddr(WHERE PATIENT WAS LOCATED WHEN INJURY WAS SUSTAINED.)


HOSPNAME
Frequency BELLEVUE BETH ISR NYU DOWN ST. VI NC Total
AEL TOWN ENTS

CROWD 0 2 0 0 2

IN SCHOOL 0 1 0 0 1

NEAR WTC 14 53 0 7 74

NOT NEAR WTC 0 1 0 . 0 1

OUTSIDE WTC DURI 0 1 0 0 1


NG INCIDENT, HOL
LAND TUNNEL @ TI
ME

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

UNKNOWN 14 50 107 31 202

WALL STREET 0 1 0 0 1

WARREN STREET AT 0 1 0 0 1
IS 89 SCHOOL

WTC 26 39 0 12 77

Total 54 155 107 51 367


The SAS System 06:33 Wednesday, September 12, 2001 4

The UNIVARIATE Procedure


Variable: YEARS (AGE IN YEARS)

Moments

N 930 Sum Weights 290


(.Mean 39.805895-T) Sum Observations 11543.7096
Std Deviation 14.34141 Variance 205.676041
Skewness -0.6621121 Kurtosis 2.70514293
Unconnected SS 518948.069 Corrected SS 59440.3759
Coeff Variation ,36.028357 Std Error Mean 0.84215659

Basic Statistical Measures

_. Location Variability

Mean . 39.80590 Std Deviation 14.34141


Median 40.00822 . Variance 205.67604
Mode 34.73151 Range 98.10137
Interquartile Range 16.00822

NOTE: The mode displayed is the smallest of 3 modes with a count of 2.

Tests for Location: MuO=0

Test -Statistic- p Value-

Student's t 47.26662 Pr > |t| <.0001


Sign 141 Pr >= |M| <.0001
Signed Rank 21066.5 Pr >= |S| <.0001

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

Value Obs Value Obs

-17.8547945 188 71.4603 300


-17.1534247 245 73.1178 240
•16.3479452 273 74.2521 53
•14.9369863 2 75.7151 243
0.0931507 73 80.2466 225
The SAS System 06:33 Wednesday, September 12, 2001 6

The FREQ Procedure

Table of sex by HOSPNAME

sex(SEX) HOSPNAME

Frequency BELLEVUE BETH ISR NYU DOWN ST. VINC Total


AEL TOWN ENTS

MALE 35 83 52 30 200

FEMALE 16 59 49 15 139

UNKNOWN 3 13 6 6 28

Total 54 155 107 51 367


The SAS System 06:33 Wednesday, September 12, 2001 7

The FREQ Procedure

Table of trans by HOSPNAME

transfMODE OF TRANSPORT TO HOSPITAL FACILITY)


HOSPNAME
Frequency BELLEVUE BETH ISR NYU DOWN ST. VI NC Total
AEL TOWN ENTS

AMBULANCE 22 12 1 35 70

WALK- IN 1 16 0 1 18

UNKNOWN 30 125 106 13 274

Total 53 153 107 49 362

Frequency Missing = 5

Table of status by HOSPNAME

status(PATIENT STATUS) HOSPNAME

Frequency BELLEVUE BETH ISR NYU DOWN ST. VINC Total


AEL TOWN ENTS

STABLE 41 121 1 33 196

CRITICAL 1 0 0 0 1

UNKNOWN 11 34 105 18 lea-


Total 53 155 106 51 ses
Frequency Missing = 2

Table of hosp by HOSPNAME

hosp(WAS PATIENT HOSPITALIZED) HOSPNAME

Frequency BELLEVUE BETH ISR NYU DOWN ST. VINC Total


AEL TOWN ENTS

HOSPITALIZED 3 7 2 0 12

ER ADMISSION 39 127 1 48 215

UNKNOWN 12 21 104 3 140

Total 54 155 107 51 367


The SAS System 06:33 Wednesday, September 12, 2001 8

The FREQ Procedure

Table of DISPOSTN by HOSPNAME

DISPOSTN HOSPNAME

Frequency BELLEVUE BETH ISR NYU DOWN ST. VI NC Total


AEL TOWN ENTS

ALIVE 40 123 2 1 166

DEAD 0 1 0 0 1

Total 40 124 2 167

Frequency Missing = 200

For dodeath * HOSPNAME


all data are missing since all
the levels of variable dodeath are missing.
The SAS System 06:33 Wednesday, September 12, 2001 9

The FREQ Procedure

Table of eye by HOSPNAME

eye(EYE TRAUMA/FOREIGN BODY) HOSPNAME

Frequency BELLEVUE BETH ISR NYU DOWN ST. VI NC Total


AEL TOWN ENTS

NO 39 136 105 35 315

YES 15 19 2 16 52

Total 54 155 107 51 367

Table of crush by HOSPNAME

crush(CRUSH INJURY) HOSPNAME

Frequency BELLEVUE BETH ISR NYU DOWN ST. VI NC Total


AEL TOWN ENTS

NO 51 150 107 51 359

YES 3 5 0 0 8

Total 54 155 107 51 367

Table of toxic by HOSPNAME

toxic(TOXIC/SMOKE INHALATION) HOSPNAME

Frequency BELLEVUE BETH ISR NYU DOWN ST. VI NC Total


AEL TOWN ENTS

NO 33 82 73 29 217

YES 21 73 34 22 150

Total 54 155 107 51 367

Table of burn by HOSPNAME

burn(BURN INJURY) HOSPNAME

Frequency BELLEVUE BETH ISR NYU DOWN ST. VI NC Total


AEL TOWN ENTS

NO 52 154 107 49 362

YES 2 1 0 2 5

Total 54 155 107 51 367


The SAS System 06:33 Wednesday, September 12, 2001 10

The FREQ Procedure

Table of chest by HOSPNAME

chest(CHEST PAIN/RULE OUT MI) HOSPNAME

Frequency BELLEVUE BETH ISR NYU DOWN ST. VI NC Total


AEL TOWN ENTS

NO 49 139 105 50 343

YES 5 16 2 1 24

Total 54 155 107 51 367

Table of lacer by HOSPNAME

lacer(LACERATION/CONTUSION) HOSPNAME

Frequency BELLEVUE BETH ISR NYU DOWN ST. VI NC Total


AEL TOWN ENTS

NO 43 111 99 34 287

YES 11 44 8 17 80

Total 54 155 107 51 367

Table of bone by HOSPNAME

bone(BONE FRACTURE) HOSPNAME

Frequency BELLEVUE BETH ISR NYU DOWN ST. VINC Total


AEL TOWN ENTS

NO 50 150 107 50 357

YES 4 5 0 1 10

Total 54 155 107 51 367

Table of skin by HOSPNAME

skin(SKIN RASH) HOSPNAME

Frequency BELLEVUE BETH ISR NYU DOWN ST. VINC Total


AEL TOWN ENTS

NO 54 154 107 51 366

YES 0 1 0 0 1

Total 54 155 107 51 367


The SAS System 06:33 Wednesday, September 12, 2001 11

The FREQ Procedure

Table of neuro by HOSPNAME

neuro(NEUROLOGICAL SIGNS) HOSPNAME

Frequency BELLEVUE BETH ISR NYU DOWN ST. VINC Total


AEL TOWN ENTS

NO 54 154 107 51 366

YES 0 1 0 0 1

Total 54 155 107 51 367

Table of faint by HOSPNAME

faint(SYNCOPE/PRE-SYNCOPE (FAINTING))
HOSPNAME
Frequency BELLEVUE BETH ISR NYU DOWN ST. VINC Total
AEL TOWN ENTS

NO 53 153 107 51 364

YES 1 2 0 0 3

Total 54 155 107 51 367

Table of emotion by HOSPNAME

emotion(EMOTIONAL STRESS) HOSPNAME

Frequency BELLEVUE BETH ISR NYU DOWN ST. VINC Total-


AEL TOWN ENTS

NO 50 131 106 44 331

YES 4 24 1 7 36

Total 54 155 107 51 367

Table of SPRAIN by HOSPNAME

SPRAIN(SPRAIN) HOSPNAME

Frequency BELLEVUE BETH ISR NYU DOWN ST. VINC Total


AEL TOWN ENTS

NO 51 147 107 49 354

YES 3 8 0 2 13

Total 54 155 107 51 367


The SAS System 06:33 Wednesday, September 12, 2001 12

The FREQ Procedure

Table of other by HOSPNAME

other(OTHER TYPES OF INJURY) HOSPNAME

Frequency BELLEVUE BETH ISR NYU DOWN ST. VINC Total


AEL TOWN ENTS

NO 38 90 38 42 208

YES 16 65 69 9 159

Total 54 155 107 51 367


FOR DOH PERSONEL

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

Direct deposit is expected to proceed normally. Staff paychecks will be


distributed on Friday. Checks bundled by program will be available for pick-up
by program representatives at 295 Flatbush Ave Extension in Brooklyn at 9 AM.

Employees who work below 14th Street can be directed to pick up their checks
at 295 Flatbush Ave Extension in Brooklyn at 9 AM.

Other staff will receive checks at their usual location.

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

)
G^ J_
/3_e><? . .

J.
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Plo,ijLter~
d
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

Curtis HS, SI ~+ 100 kids 2 0

Westinghouse 2 0 0
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FOR IMMEDIATE RELEASE CONTACT: SANDRA MULLIN
September 13,2001 (212) 447-8232,
(212) 447-8233

NEW YORK CITY DEPARTMENT OF HEALTH HEADQUARTERS


TEMPORARILY RELOCATES; HEALTH DEPARTMENT OPERATIONS CONTINUE

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.

Please note the following emergency telephone numbers:

DOH Press Office: (212) 447-2981 or (917578-6208


DOH Poison Control Center: (212) POISONS or (212) 764-7667
other numbers?

Burial Desk: (212) 447-2981


2238 Fifth Avenue (at 135th Street)
Department of Mental Health Hotline for mental health services: (212) 995-5824

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

Effective Monday September 17, 2001, all Department of Health


Employees should make every effort to report to their regularly assigned
work location. If your work location is below 14th Street and is currently
closed, you will need to report to the nearest DOH health center, unless you
have been otherwise directed by your program manager to another work
location.
Each employee reporting to an alternate work location will be
expected to sign in on a daily basis. In addition, regular procedures with
regard to timely submissions of timecards must be adhered to.
f fa

Operational

Each program must identify a responsible liaison to coordinate with the


health center personnel in order to appropriately direct where staff need to be
deployed and staff assigned.
Every effort should be made to provide meaningful work assignments to
each staff member.
Finally, please be reminded that all appropriate time records must be
submitted in a timely fashion to your timekeeper.
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Patient Imprint Card or Label If imprint card is unavailable:

Last Name:

First Name:

Med Rec #:
D Female D Male

NEW YORK CITY DEPARTMENT OF HEALTH


ENHANCED EMERGENCY ROOM SURVEILLANCE
Instructions: FOR EACH PATIENT SEEN AT THE EMERGENCY DEPARTMENT
1. Stamp form at top left with patient imprint card
2. Triage/registration and health care provider fill out respective sections
3. Place in drop box Hospital Code
Triage/Registration Complete This Section

Date of visit:
For age less than one year please use "1"
A9e:

Home Zip Code: | _ J^_ | Work Zip Code:

Was patient in southern Manhattan (below Canal St) on Tuesday, September llth
after the attack? (circle one) YES NO Don't Know

Health Care Provider Complete This Section

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.

Two sampling plans will be developed

1. Sampling of Worker Hazards


Personal air monitoring plan to be developed. Dan Hewitt of NIOSH is at site today to review
types of workers in the field, types of work being performed, etc. in order to characterize numbers
and amounts of samples needed. Tomorrow we will review data with Dan to finalize personal air
monitoring plan.

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.

2. Ambient Sampling Plan


This plan will include regular sampling at specified sites and sampling sites determined based on
daily needs:

Predetermined Sampling Sites

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

c. Other Sites where there is egress from WTC including:


-Church and Canal
-Worth and Hudson

d. Other Possible Sites- decision to be made after the following is determined:


-Route of debris to Freshkills and Transport sites
-Sentinel sites in Brooklyn, Staten Island, Queens, Bronx

Daily Need Sampling Sites:


These sites will be determined based on information from the daily meeting.

Other Sampling Issues:


Periodic phosgene monitoring will continue.

Agenda Items for Friday


1. Review sampling results from 9/13/01
2. Worker Sampling Plan
3. Determine if there are other sites that need to be added to predetermined list.
4. Other recommendations
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Exit

TOifiL P.04
THE CITY OF NEW YORK
DEPARTMENT OF HEALTH
Rudolph W. Giuliani Neal L. Cohen, M.D.
Mayor Commissioner

September 13, 2001

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

FROM: Marcelle Layton, MD, Assistant Commissioner


New York City Department of Health

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:

Communicable Disease Issues: 212-447-2676 or 212-578-0823


FAX: 212-532-5241 or 212-447-2678
Environmental Issues: 212-684-1710 or 212-684-1896
For other Urgent Public Health Issues, or if above numbers do not answer:
212-684-1628

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.

B) Environmental Risks Posed by Asbestos and Dust


Asbestos was used in the construction of the World Trade Center. Tests performed indicate
that asbestos may be present in an area marked by Worth St. to the North, Centre and Nassau
Sts. to the East, and Exchange and Thames Sts. to the South. The health risk posed by a
single exposure of short duration is very low. The risk to persons who have not been present
in the affected area following the disaster is also thought to be extremely low. There are no
tests that can be done, including chest radiographs, to tell if exposure has occurred, nor to
predict if pulmonary disease will occur in the future.
1 z
At a minimum, anyone who needs to enter the affected area should wear a disposable cup-
type (i.e., not fan- folded or duck-bill) N100 or PI 00 respirator and goggles. Workers in
contact with debris or surface dust in the affected area should contact their employers or the
NYCDOH (212-684-1710 or 212-684-1896) for specific recommendations regarding needed
protective equipment.

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.

Environmental testing is continuing to better characterize levels of asbestos and other


potentially hazardous materials within the affected site and in other off-site locations.

C) There is Currently No Evidence of a Biologic, Radiologic or Chemical Attack: The


NYCDOH has received no information suggesting that a biologic, chemical or radiologic
terrorist attack has occurred in New York City. There is currently NO evidence — including
laboratory tests on environmental samples taken from the affected area - that any chemical or
biologic agents were released. Moreover, biologic agents would likely not have survived an
explosion of that magnitude. We are not currently recommending antibiotic prophylaxis for
NYC residents.

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:

1 - Any unusual increase or clustering in patients presenting with clinical symptoms


that suggest an infectious disease outbreak (e.g., >_ 2 patients presenting with
unexplained pneumonia, respiratory failure or sepsis - especially if occurring in persons
who are otherwise healthy. In addition, please notify us regarding a sudden increase in
flu-like symptoms).

2 - A suspected case of any of the following diseases:

Anthrax Brucellosis Q Fever Tularemia


Botulism Plague Smallpox Hemorrhagic fevers

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.

D) Reporting Fatal Cases and Information on Mortuary Issues, Including Death


Certificate Registration for Deaths Related to this Incident

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:

NYC Health Department Burial Desk


Central Harlem Health Center
2238 Fifth Avenue (at 135th Street)
New York, NY 10035

Telephone: 212-926-2150 or 212-368-6538


FAX: 212-926-2526

E) Mental Health Needs


Clearly, many patients may present with emotional distress or grief reactions in the aftermath of
this enormous tragedy. Patients and their families may be referred to the Department of Mental
Health Services Hotline at 212-995-5824 for counseling.
F) Hospital Material or Personnel Needs
In the event that you require acute assistance, please contact the Greater New York Hospital
Association (212-246-7100 or 212-506-5405).

G) Rescue Worker Exposures to Potentially Contaminated Body Fluids


During rescue operations, some rescue workers may come in contact with potentially
contaminated body fluids. If such exposures occur percutaneously, to non-intact skin, or to
mucous membranes, we suggest that facilities refer to their institutional protocols for managing
potential exposures to blood-borne pathogens, or that they consult the infectious disease experts
who routinely manage these situations in their hospitals.

H) West Nile Testing


Laboratory testing for West Nile virus is still available at the Public Health Laboratories.
However, we are unable to offer transportation pick-up service at this time due to other pressing
transportation needs. We request that hospitals arrange their own transportation of clinical
specimens (Monday-Thursday, during regular business hours) to:

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

^ Cover all body surfaces. This includes wearing:


• Coveralls
• Gloves
• Goggles
• Water-impermeable footwear

^ 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.

•S Leave the site immediately and go to first aid station if you:


• develop signs and symptoms of heat exhaustion or heat stroke:
if you feel cold and sweaty, are overheated, have an irregular or fast heart rate, are nauseous, or
become confused
• have chest pain
• are short of breath or have difficulty breathing
• become physically or emotionally exhausted
• are bleeding or if someone bleeds on you
• if blood, body fluids or tissues contact your eyes, mouth, nose, or any non-intact skin
• and when you need to change clothing

•/ 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:

Human immunodeficiency virus (HTV)


Recommended HIV post-exposure prophylaxis is a 4-week regimen with 3 antiretroviral agents that should be
initiated immediately-as soon as possible and not longer than 36 hours after exposure. Testing for HIV antibody
(which may be done after antiretroviral treatment is started) should be performed within 72 hours and repeated at 6,
12, 24 weeks, and 1 year. The person should be referred for follow-up by an experienced HIV clinician within 72
hours.

HIV Post-Exposure Prophylaxis Regimens


4 weeks
Preferred Alternate
zidovudine 300mg PO BID* Consult with an infectious diseases
PLUS specialist on substitutions of any drugs
lamivudine 150mg PO BID* in the preferred regimen.
(*one Combivir PO BID) Consideration may be given to
PLUS substituting stavudine 40 mg PO
indinavir SOOmg PO q8h on empty stomach q!2 h if zidovudine is contraindicated
OR or not tolerated
nelfinavir 1250mg PO BID with food

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.

Hepatitis B virus (HBV)


Emergency & medical personnel who have completed the HBV vaccination series and are known to have
seroconverted require no further evaluation. For personnel with unknown antibody status or those who are not
fully vaccinated, obtain HTV serology and administer Hepatitis B Immune Globulin and first dose of HBV
vaccination series within 72 hours of exposure; the administration of Hepatitis B Immune Globulin may be
considered up to one week after the injury. Make arrangements for the exposed person to complete the HBV series;
receipt of the complete HBV vaccination series and subsequent seroconversion will offer protection against future
exposures. A second dose of Hepatitis B Immune Globulin one month after the first is indicated in the following
two scenarios: a) an exposed person who has not previously been vaccinated against hepatitis B receives only
Hepatitis B Immune Globulin or b) an exposed person who has not seroconverted after two complete HBV
vaccination series, and for whom therefore further vaccine is not indicated. Hepatitis B Immune Globulin alone will
not offer long-term protection against future exposures.

Hepatitis C virus (HCV)


Baseline HCV serology and serum ALT should be obtained. Refer to usual health care provider for follow-up
evaluation. No post-exposure prophylaxis is available.

These recommendations do NOT authorize HIV testing


without the individual's informed consent.
Public Health Advisory for New York City Residents:
Asbestos, Dusts, Air Quality and Health Concerns

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.

What is asbestos, and -what are the health effects of asbestos?

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.

How much asbestos is present in the affected area?

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.

Can I be tested to see if I inhaled asbestos?

There is no way to determine whether someone has recently inhaled asbestos, or how much has been
inhaled after an exposure.

Public Health Advisory: Vicinity of WTC: 9/14/2001 d-tn A*/r


Other than asbestos, what else might be present in the dust and air following the collapse?

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.

What health effects can result from breathing these dusts?

Dusts can cause eye and respiratory irritation, such as a sore and scratchy throat. Heavy exposures
may result in difficulty breathing'.

Who is most likely to be affected by these dusts?

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.

If I experience any of these symptoms, what should I do?

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.

How do I avoid these health problems?

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:

• Avoid unnecessary outdoor strenuous activity;


• Keep dust from entering the home;
• Keep windows closed;
• If an air conditioner will be used, it should first be cleaned before turning it on with a wet rag
(the external surfaces, inside and out (if possible), as well as the filter) . Set the air conditioner
to re-circulate air (closed vents), and clean or change the filter frequently.
• Remove shoes before entering the home.

Public Health Advisory: Vicinity of WTC: 9/14/2001, 4:30 AM


I see people wearing dust masks. Do they help?

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.

How can I clean up dusts in or near my home or office?

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.

Do pregnant women and young children need to take additional precautions?

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.

Public Health Advisory: Vicinity of WTC: 9/14/2001,4:30 AM


CDC EMERGENCV RESPONSE 770 4-88-7107 09/15/01 04-: 16P P. 002

U.S. Department of Health and Human Services


Centers for Disease Control and Prevention
Agency for Toxic Substances and Disease Registry
Agency Fact Sheet - September 13, 2001

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

U.S. Department of Health and Human Services


Centers for Disease Control and Prevention
Agency for Toxic Substances and Disease Registry
Agency Fact Sheet - September 13,2001

Management of human remains for rescue personnel


Mass fatality management may evoke strong emotions by responders and other medical
personnel. Inaccurate information may promote rumors about disease outbreaks.

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:

* Heavy-duty gloves to protect against injury from sharp objects.


* Eye protection and mask to protect face from splash exposure
* Protective clothing to protect skin
* Immediately wash hands with soap and wafer after removing gloves
o Alcohol based hygiene products are a useful substitute only when hands
are not visibly soiled
* Report injuries or splashes with blood or body fluids to the appropriate supervisor
immediately.

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.

Additional precautions may be warranted in situations where a biological ot chemical


threat is known or suspected. Information about these special precautions can be
obtained from CDC at 770-4&8-7100.
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Observations from WTC Walkthrough and Command Center
NIOSH / CDC
As of 9/13/01

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.

September 14, 2001


4:15 AM/ L. Moskin
Shelters remain open.

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.

September 14, 2001


4: 1 5 AM/ E. Marcus
1
7,500 masks have been received at/ Center St:J<000 have been delivered to the
Command Center at West St. /

2 decontamination sites have been erected: Harrison and West; Battery Tunnel entrance.

E. Marcus will attend the 6:00 AM meeting at the Command Center.


Issues/Tasks
- radiation monitoring of trucks leaving the area, using Army personnel and
equipment, has been requested through OEM;
uncertain whether the DOE plan to conduct aerial monitoring was carried out;
still uncertain about the identity, the permit, or the work done by the industrial
radiological company;
- area clean up operation; SCA has been requested to provide resources, personnel,
equipment, and general assistance in the process of cleaning up buildings in the
periphery of the affected area;
garbage accumulating in the area will be conducive to rodent harborage;
- potential problems with food handling procedures and distribution to personnel and
clean up crew remain; food from unidentified sources are being distributed to rescue
crew;
- absence of eye wash station; hand washing station in the site; request was made
through OEM;
uncertain about the current operations at the South Street Seaport Fish Market;

4:15 AM /J. Zucker/F. Laraque/M. Perrin/P. Kellner


Health and safety of rescue crew
health and safety advisory has been developed and ready for distribution to the
rescue workers
Army medical unit will conduct the medical assessment and the fit testing of rescue
crew;
- health advisory on asbestos has been developed and ready for distribution

Surveillance
Friday, September 14, 2001
12:15AM/M.Layton

Update #2 advisory to hospitals was sent by broadcast telefacsimile.

Deployment of CDC epidemiologists to area hospitals for syndromic surveillance


continues; initiate hospital needs assessment, and surveillance for injury and trauma;
develop protocol for surveillance of occupational health in rescue crew and other
workers.

4:15 AM
No calls from hospitals were received.
Environmental/Clinical Group: 9/13 8 PM to 9/14 8 AM

1) Safety of Rescue Workers


Health and Safety Guidelines for Rescue Personnel completed and cleared.
Copies ready for distribution .

2) Availability of Half-face Respirators


300 half-face respirators were received at the command center this
evening (source not clear).
The ordered half-face respirators (7,500) were received at 1 Centre St. An
additional 1000 of various sizes went sent to the command center.
Need to check needs of Fire Department
- Need to check if other ordered supplies arrived (goggles). There were
sufficient goggles available but one particular model was requested (MSA,
model #791072). Hard hats also needed (not DOH item).

3) Distribution of Half-face Respirators


will be done by the Army in the am
MD scheduled was prepared but they will not be needed.
** these MDs need to be told that they will not be needed (and thanked!)

4) Public concern about Dust and Asbestos Exposure


- Asbestos Q and A revised and cleared.

5) Need to address concerns re: health issues related to removing remains being
found

6) Handwashing facilities requested. Need to sort out feasibility/availability of using


waterless antibacterial solutions and/or wipes.

7) Command Center will move to Pier 96 at 6pm.


(e-Memo #0 1-24G) STILL waiting for information (5:20 PM) Page 1 of 1

•& X

From: Hamilton, Douglas H.


Hamilton, Douglas H.; Alexander, Tim; Bellamy, Patsy; CDC EISO Officers 2000; CDC EISO Officers 2001;
CDC EISO Supervisors; Armstrong, Lori; Buehler, Jim; Chu, Susan; Dannenberg, Andrew; Drotman, Peter;
Ehrenberg, Rick; Fleming, David; Holloway, Barbara R.; Horan, John; Madans, Jennifer H.; Martin, Robert
o: Dr. (DLS); Rowley, Diane; Sinks, Tom; Thacker, Stephen B.; Dicker, Richard C.; Karpati, Adam; Fehrs, Laura
J.; Moolenaar, Ronald L.; Torok, Thomas; Winquist, Andrea; All - EPO/DAPHT PMR 2001; All -
EPO/DAPHT MPH 2001
Cc: Bruce, Sherrie
Subject: (e-Memo #01-24G) STILL waiting for information (5:20 PM)
Sent: 9713/01 5:35 Importance: Normal

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.

5. You should expect to work 12-hour shifts, day and night.

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 * ^ ?

From: Hamilton, Douglas H.


Hamilton, Douglas H.; Alexander, Jim; Bellamy, Patsy; CDC EISO Officers 2000; CDC EISO Officers 2001;
CDC EISO Supervisors; Armstrong, Lori; Buehler, Jim; Chu, Susan; Dannenberg, Andrew; Drotman, Peter;
__ Ehrenberg, Rick; Fleming, David; Holloway, Barbara R_; Koran, John; Madans, Jennifer H.; Martin, Robert
To: Dr. (DLS); Rowley, Diane; Sinks, Tom; Thacker, Stephen B.; Dicker, Richard C.; Karpati, Adam; Fehrs, Laura
J.; Moolenaar, Ronald L.; Torok, Thomas; Winquist, Andrea; All - EPO/DAPHT PMR 2001; All -
EPO/DAPHT MPH 2001
Cc: Bruce, Sherrie
Subject: (e-Memo #01-24F) Still waiting for information (4:20 PM)
Sent: 9/13/014:25 PM Importance: Normal
We are still waiting for details about transport to NYC. Again, hopefully this will happen this
afternoon/evening.. .but don't be surprised if it doesn't come about until tomorrow (Remember.. ."Hurry up
and wait!")

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).

The following people will be going in this first wave.

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

25. McKenzie Andre


26. Peter Dull
27. James Sevjar
28. Michael Martin
29. Anil Panackal
30. Michael Bales (informatics)
31. Brent Lee

The following people will need to get to NYC on their own

32. Kevin Griffith (Hartford)


33. Julia Rhodes (Rockville)
34. Susan Lukcas

In NYC you will need to report to Tracee Traeadwell

Department of Health Laboratories

455 1st Avenue NY

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

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