Ground-Zero Workers Air Concerns Over Health Impact

Many firefighters who raced to save victims of the Sept. 11 World Trade Center attack now are facing their own health problems because of the contaminated air at the disaster site.

Some have asthma. Others have troubles ranging from a persistent cough to diminished lung capacity that can interfere with their physically demanding jobs. A few hundred are on medical leave or working light duty because of respiratory illness.

It’s too soon to tell how many firefighters will be permanently disabled and forced to retire because of the respiratory problems, said Fire Department spokesman Frank Gribbon. But so far about 30 firefighters have started the retirement process because of respiratory problems after working at the trade-center disaster, which either caused their lung ailments or made prior ones worse, Gribbon said.

Like a Ticking Time Bomb

Apart from those with current symptoms, medical experts say some firefighters and other ground-zero workers may be at risk of developing cancer decades from now.

One attorney said he has filed legal documents on behalf of more than 700 firefighters with respiratory symptoms to preserve their right to sue the city later.

Many firefighters who participated in the rescue effort are easily winded, suffer from chronic cough or have developed symptoms of asthma, said Tom Manley, health and safety officer for the Uniformed Firefighters Assn.

Some on medical leave may not be able to return to their old jobs, he said.

“You can’t be fighting fires with asthma,” said Manley, a firefighter for 19 years. “Smoke irritates asthma severely. And when you climb stairs, you are shot by the time you get up there. You’re going to be out of wind.”

One fourth-generation firefighter, who worked at the trade center site 18 hours a day for the first three days after the disaster and then every other day for about a week, said his first signs of breathing trouble appeared about a month later.

He noticed he became easily winded when exercising or doing job activities like climbing tall ladders. “I knew there was something wrong,” he said. “I was getting tired too quickly.”

The man, who asked not to be identified because he thought his superiors would disapprove of his talking to the media, said he went to a Fire Department doctor for a checkup. The doctor gave him medicine, and the department put him on medical leave and told him to limit his exercise.

A few weeks ago he started getting congested with a gritty phlegm. He said his doctor told him it was a sign his problem is clearing up. “I can live with that for now,” he said.

But there’s also the dry, raspy cough he’s had since the first week after the disaster. “It’s always there,” although the severity comes and goes. Once or twice a week, he said, “your lungs hurt from coughing, you get a pain in your back.”

Manley, who was at the trade center when the towers collapsed, also continues to be nagged by the so-called World Trade Center cough.

“In the mornings it’s heavy,” he said. “It feels like a powder on the back of your throat.”

Apart from the cough, “you can’t take a deep breath sometimes,” he said. He said he has been helped by an inhaler and medication. Gribbon said many firefighters with persistent cough are on the job and improving with treatment.

Michael Barasch, the attorney who has filed the legal notices on behalf of firefighters, said one fireman who used to run marathons now finds he can’t even carry his 3-year-old daughter up the stairs because of lung disease.

“We have guys who are waking up every morning with horrible coughs, spitting up blood,” Barasch said.

The notices he has filed are intended to preserve the firefighters’ right to sue the city under the claim that the city failed to follow federal regulations and provide protective respirators soon after the attack, the attorney said. Besides the 700 firefighters, he said he has also filed on behalf of about 300 police officers, fire marshals and emergency medical technicians.

Researchers who are studying the health effects of Sept. 11 say the failure of many rescue workers to wear respirators is a major factor in their health. The firefighter on medical leave said he didn’t wear one for the first few days because “there were none around.”

Manley said that with so many off-duty firefighters and volunteers pouring in to help, there simply weren’t enough to go around early on. Some used surgical masks, he said, but those can’t keep all the potentially hazardous materials out of the lungs.

Gribbon said that even when respirators were available, some firefighters chose not to wear them. The equipment is uncomfortable, he said, and makes communication difficult.

Respirator use by workers at ground zero improved after the first few days but “could certainly be better,” said Dr. Philip J. Landrigan, chairman of the department of community and preventive medicine at the Mount Sinai School of Medicine in New York.

Noting that the trade-center disaster is “bigger than anything we’ve seen before,” Landrigan said nobody can predict completely what the long-term consequences will be for worker health.

Among the substances that escaped from the 1.2-million tons of debris at ground zero are asbestos, benzene, dioxin, and polychlorinated biphenyls, known as PCBs. These are linked to cancer, although experts said in many cases the exposures were low enough that the risk appears to be small.

Higher Mercury Levels Detected

Recently, four Port Authority police officers who worked at the site were reassigned after they showed elevated levels of mercury in their blood. It wasn’t clear whether the mercury came from ground zero, and the officers were in good health, officials said. Gribbon said no elevated mercury has been detected in firefighters, who are getting special medical evaluations because of their search and rescue roles at the scene.

Landrigan said his top concern is asbestos. Some 20 years or more after exposure, it can cause mesothelioma, a rare cancer affecting the sac lining of the chest or abdomen. Most people with the disease have worked in jobs where they breathed asbestos. Asbestos exposure can also cause lung cancer.

It’s hard to say how big the mesothelioma threat is, Landrigan said, because nobody knows how many workers were exposed to various levels of asbestos.

And the exposure isn’t over yet. Every time a worker picks up a beam that contains asbestos, “that stuff is kicked into the air” and could be inhaled by workers who aren’t wearing proper protection, he said.

Still, Dr. Stephen Levin, medical director of Mount Sinai’s Irving J. Selikoff Center for Occupational and Environmental Medicine, said he believes the risk of asbestos-related disease in ground zero workers is relatively low. While he doesn’t want to trivialize their exposures, he said, they are lower and briefer than the typical lifetime exposures seen in construction workers.

As for dioxins and benzene, Landrigan said, they probably pose much less risk than asbestos. Levin said he suspects the risk from those chemicals and PCBs is small.

A key concern experts cite is dust--a mix of such things as pulverized concrete and fibrous glass, and mineral dust, mixed with irritating gases. Dust can cause respiratory problems that last a lifetime.

Levin said doctors at his medical center have found more than a dozen people who, in the wake of the disaster, experienced a first episode of asthma. The cause isn’t clear, but it could be dust, gases or a combination.

The problem has appeared in rescue workers and people who were just nearby when the disaster happened. The worst cases have shown up in people caught in the dust cloud that spread from the collapse.

When asthma is triggered that way, Levin said, the lungs can become more reactive to other irritants like cigarette smoke and bus exhaust, or just going from a warm room to cold outdoor air. So some of the new asthma cases may end up as lifetime chronic disease, he said.

But with quick treatment, he said, it’s reasonable to hope that won’t happen.

Early Treatment Is Important

Similarly, doctors have also seen workers and others near the site develop sinusitis, an inflammation of the sinus linings that can cause facial pain, stuffy nose and a persistent cough, Levin said. Again, that can turn into a chronic lifelong condition, but the hope is that early treatment can prevent it, he said.

Planned studies of people exposed in the disaster might show whether early treatment--say, within the first two or three months--with inhaled steroids really does lower the risk that newly diagnosed asthma or sinusitis will become lifelong conditions, Levin said. Most rescue workers apparently didn’t get such early treatment, he said.

As for the fourth-generation fireman who served at ground zero and is now on medical leave, he’s taking his medicine.

“I try to relax,” he said, “and I’m hoping it will all go away.”