Symptoms, respirator use, and pulmonary function changes among New York City firelighters responding to the World Trade Center disaster

Debra M. Feldman, Sherry L. Baron, Bruce P. Bernard, Boris D. Lushniak, Gisela Banauch, Nicole Arcentales, Kerry J. Kelly, David J. Prezant

Research output: Contribution to journalArticlepeer-review

119 Scopus citations


Context: New York City firefighters responding to the World Trade Center (WTC) disaster on September 11, 2001, were exposed to numerous hazards. A medical screening program was conducted 3 weeks after the disaster on a sample of firefighters. Objectives: To determine whether arrival time at the WTC and other exposure variables (including respirator use) were associated with symptoms and changes in pulmonary function (after exposure - before exposure). Design: A cross-sectional comparison of firefighters representing the following groups: (1) firefighters who arrived before/during the WTC collapse, (2) firefighters who arrived 1 to 2 days after the collapse, (3) firefighters who arrived 3 to 7 days after the collapse, and (4) unexposed firefighters. Setting: Fire Department of New York City (FDNY) Bureau of Health Services on October 1 to 5, 2001. Population: A stratified random sample of 362 of 398 recruited working firefighters (91%). Of these, 149 firefighters (41%) were present at the WTC collapse, 142 firefighters (39%) arrived after the collapse but within 48 h, 28 firefighters (8%) arrived 3 to 7 days after the collapse, and 43 firefighters (12%) were unexposed. Main outcome measures: New/worsening symptoms involving the eyes, skin, respiratory system, and nose and throat (NT), and changes in spirometry from before to after exposure. Results: During the first 2 weeks at the WTC site, 19% of study firefighters reported not using a respirator; 50% reported using a respirator but only rarely. Prevalence ratios (PRs) for skin, eye, respiratory, and NT symptoms showed a dose-response pattern between exposure groups based on time of arrival at the WTC site, with PRs between 2.6 and 11.4 with 95% confidence intervals (CIs) excluding 1.0 for all but skin symptoms. For those spending > 7 days at the site, the PR for respiratory symptoms was 1.32 (95% CI, 1.13 to 1.55), compared with those who were exposed for < 7 days. Mean spirometry results before and after exposure were within normal limits. The change in spirometry findings (after exposure - before exposure) showed near-equal reductions for FVC and FEV1. These reductions were greater than the annual reductions measured in a referent population of incumbent FDNY firefighters prior to September 11 (p ≤ 0.05). There was a 60% increased risk of a decline of ≥ 450 mL in FEV1 in those arriving during the first 48 h compared to the referent (p ≤ 0.05). Conclusions: The symptoms and pulmonary function changes following exposure at the WTC demonstrate the need for improvements in respirators and their use, as well as long-term medical monitoring of rescue workers.

Original languageEnglish (US)
Pages (from-to)1256-1264
Number of pages9
Issue number4
StatePublished - Apr 2004


  • Disaster
  • Firefighters
  • Occupational exposure
  • Pulmonary function
  • World Trade Center

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine


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