Health Beat – More On The Hazards Of “Responding”

By Mary Jane Dittmar, Senior Associate Editor, Fire Engineering/FireEngineering.com

CDC: Responders to Disasters Need Medical Monitoring and Treatment Programs
Members of disaster response teams should receive comprehensive medical monitoring and access to treatment programs, the Centers for Disease Control and Prevention (CDC) has concluded (Morbidity and Mortality Weekly Report (MMWR), Sept. 10, 2004). The position was based on preliminary findings in a CDC-funded study involving responders to the World Trade Center (WTC) terrorist attacks in 2001. The study, conducted by the Mount Sinai School of Medicine in New York City, monitored rescue and recovery workers, including police and construction and utility crews who took part in the cleanup after the collapse of the two WTC towers.

The researchers found that about 74 percent of the participants had new or worsening upper respiratory problems and that about 60 percent developed new lower respiratory symptoms or suffered a worsening of existing conditions. The study also revealed a high rate of musculoskeletal symptoms. In addition, 51 percent of the study subjects met the conditions for referral to a mental health professional.

The CDC has provided $81 million for medical follow-up screening of responders for an additional five years.

An article in the San Mateo (CA) County Times reports that an ongoing study by Redwood City’s Workforce Medical Center is monitoring health problems experienced by at least 10 members of the California Urban Search and Rescue Task Force 3 team who helped at the WTC site. The team members have experienced medical conditions including bloody noses, coughing up blood, respiratory infections, pneumonia, and what has come to be called “the WTC cough.” According to the article, other team members who are not participants in the Redwood clinic’s study may also be suffering symptoms.

Task Force 3 spent 13 days working in the clean-up operation at ground zero. Seventy percent of them were ill, according to Task Force Leader Capt. Harold Schapelhouman, a division chief with the Menlo Park (CA) Fire Protection District, who has a problem with wheezing and spasms when he coughs or laughs.

Data from the task force members enrolled in the Redwood City study are being forwarded to Mount Sinai Hospital, where a database of symptoms has been established. The task force members will be monitored in conjunction with the Mount Sinai study.

Among the issues to be resolved concerning the WTC event are the following:

  • Contradictions between two reports concerning toxins at the WTC site. A study by the University of California at Davis cited airborne toxins from ground zero that included “silicon matter so fine the respiratory equipment couldn’t protect you.” An Environmental Protection Agency (EPA) study found no major problems. Which survey is to be believed, asks Schapelhouman.
  • To what degree are the medical problems caused by exposures at the WTC site attributable to pre-existing conditions or other factors?

It appears that WTC responders will be under medical surveillance for many years. http://www.sanmateocountytimes.com, art. E2395083,00, Malaika Fraley, Sept 9, 2004; http://www.bigmedicine.ca/americas.htm/, Sept. 11, 2004.

Benzene a Health Risk Even at Low Levels
The study “Hematotoxicity in Workers Exposed to Low Levels of Benzene,” by Qing Lan and colleagues (Science, Vol. 306, Dec. 3, 2004) has found that exposure to benzene, even at levels below the established 1 part-per-million (ppm) occupational standard for exposure in the United States, appears to damage blood cells. Benzene has been associated with blood system damage and leukemia.

Qing Lan and colleagues studied factory workers in Tianjin, China, comparing 250 shoe workers who had been exposed to various levels of benzene above and below the 1-ppm level and 140 controls who had not been exposed to benzene.

The researchers found significant blood defects in the exposed workers, including some exposed to levels below 1 ppm. The defects were greatest among individuals with genetic variations involving an enzyme thought to contribute to blood cell damage.

Although the researchers cite the need for studies to confirm their findings, they say these data “provide evidence that benzene causes hematologic effects at or below 1 ppm, particularly among susceptible subpopulations.”

We generally are not aware of which types of genetic deficiencies or defects we may have in our bodies; therefore, the safest policy is to take the position that a toxic substance such as benzene may cause us some harm or great harm (if we are in one of those “genetic” subpopulations) and to take the precautions needed to protect ourselves from exposure.

You can do this by preplanning the industries in your response area: Ask these companies, your state and local regulatory agencies, and the responding haz-mat team for the area what chemicals are used and stored at the sites. Make sure to include hardware stores (see “Update” below), gardening stores, and similar retailers. Then, write policies that ensure the highest level of protection against exposure (including complete, adequate personal protection clothing and respiratory equipment), mandate full documentation of any exposure or possible exposure; and establish a procedure for adequate, periodic medical monitoring of responders to incidents at these facilities.

And, always be alert and vigilant. Products containing benzene and other hazardous chemicals are ordinary “household” items and can be found in many basements, garages, kitchen and bathroom cabinets. Don’t let down your guard because it is a “routine, residential fire.”www.sciencemag.org, AAAS, the Science Society, publisher.

Update: Fire Investigator.
A previous Health Beat column (“Environmental Toxicity: The Fire Investigator Perspective,” Part 2), related the experience of Lt. Doug Ross, CFI, a member of the Arson/Bomb Section of the South Carolina Law Enforcement Division in Greenville, S.C. Ross and three colleagues were exposed to hazardous chemicals while conducting a fire/arson investigation at a hardware store fire in 2001. The event, he said, represented “the beginning of a nightmare for them,” raising concerns about acute and chronic medical conditions. You can reach Ross at FireFuzz@aol.com.
Ross wrote me in October with this update:

The workers compensation doctor has found some disability in my eyes and nose from the chemical exposure in 2001. I will fill you in when I hear more. I have had both eyes surgically repaired in 11 months (extremely quick cataract conditions), and the eye specialists say it is related also.

The sad thing about it is that we’re no safer today than we were in 2001.

Insights on Early Firefighter Death Causes
Jim Sanchez, division chief training division, City of Pembroke Pines (FL) Fire Department Class One, wrote the following relative to the “Early Firefighter Death Causes Sought” Health Beat column. He raises some very pertinent questions and suggests avenues of research that may lead to findings that can be used to help prevent premature firefighter deaths.

Our culture is a tough one to research. Usually, a firefighter will experience all the signs and symptoms of a heart attack and will ignore them until it’s too late.

We have had four cases here at Pembroke Pines Fire Department. Three had favorable outcomes; one did not. The one person who died was off-duty and was recreation diving when he had a heart attack. It is likely that the next time he exerted himself on duty the outcome would have been the same.

The other three firefighters were between 40 and 50 years old. One was extremely fit. He had chest pain occasionally, but only when he felt himself almost pass out did he ask for help. The outcome was a triple bypass.

The second firefighter experienced symptoms but was adamantly against being checked out for a heart attack: “Why check me? I teach this stuff.” The outcome was double stents.

The third firefighter retired early to prevent added stress that eventually could lead to a heart attack. He also had symptoms he ignored.

Yes, I agree that improving health standards will help. But, when a firefighter dies suddenly in his bunk, what steps are taken to truly analyze the causes leading up to this? We think the obvious-heart attack. Have we looked at the blood gases, the history? Does he cut grass on his days off, and [might] his CO level be above normal? Then he goes to work and operates on a salvage team, which further increases his CO saturation level. If I recall correctly, exposure to CO is cumulative, and it takes a long time for CO to leave our system.

It is not unusual for a firefighter to have a pool-cleaning business and breathe In chemicals all day and then go to work and be involved in a structure fire. His SCBA system is asked to deliver a high volume of 02. The outcome is not good.

What must be researched along with the cause of death is, what does the firefighter do before he goes to work?

Here’s another example. Recently a firefighter ran a marathon in the morning and reported to work about six hours after the marathon. Yes, he is fit [but] his workload capability obviously was not as high as it was before the marathon that day. Fortunately, nothing happened on the shift that night to tax his heart again, but the potential was there. Again, HISTORY plays a part in the research.

Do you have comments, information to share, or questions to pose? Send them to maryjd@pennwell.com.

Mary Jane Dittmar is senior associate editor of Fire Engineering magazine and FireEngineering.com. Before joining the magazine in 1991, she served as editor of a trade magazine in the health/nutrition market and held various positions in the educational and medical advertising fields. She has a bachelor’s degree in English/journalism and a master’s degree in communication arts.

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