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Protecting the lungs of rescue workers

 

Sept 21, 2001—A member of the Public Service Health Disaster Medical Team helps at Ground Zero. Photo: Andrea Booher/FEMA New Photo

Within a day or so after the two towers collapsed, there were already thousands of workers on the scene, battling fumes, dust and constant danger on the five-story-high rubble pile of Ground Zero, signing up for shifts that went on through October. A few workers wore flimsy dust masks that had been collected from around the city. A few wore half-face respirators. But most workers had no respiratory protection at all, although the “pile” was still on fire and emitting clouds of thick smoke. Few tests had been done to characterize what people were being exposed to.

 “We knew that we needed to get a handle on what was in that dust and smoke,” recalls Bruce Lippy, an industrial hygienist working for the International Union of Operating Engineers, representing the construction workers operating the cranes, forklifts, welding and heavy equipment that moved the large pieces of steel and debris.

From the minute he saw those pictures of the enormous dust clouds on his television set, Lippy scrambled to get funding from NIEHS to do safety consulting there. Within a few days, he traveled up to New York from Maryland to help protect the workers from his union, and after some delays in getting past security, made it to the site on September 17.

Upon arrival, he was appalled by the dangers he found and the lack of attention to safety. “People calling the shots at the top were simply not focused on safety,” remembers Lippy, who kept a hawk eye on workers’ compliance with respirator use. “Respirators were worn much like loose neckties, hanging below the neck,” he described it later in a paper published January 2002, which he hoped would direct attention to the widespread occupational hazards at the site.

Yet the scale, duration and hazards at the WTC site were unprecedented, says Lippy, with physical hazards being perhaps worse than the potential respiratory hazards. For the average of industrial hygienist it was treacherous, he said, describing how a colleague fell out of the cab of a piece of equipment, fortunately missing a piece of rebar. “He could easily have been seriously hurt, if not paralyzed.”

Although it was far from a standard construction site, the workers there treated it as though it was. “The heavy equipment was very dangerous,” he says, since workers labored in the tight confines of a cab precariously balanced on a pile that was always shifting. “One worker went off for coffee and found that his equipment had fallen into a pile,” he says, telling a story he repeats in the many presentations he has done since September 11. “I have always been a big fan of coffee and this just reinforced its value.”

 “We had been pushing to have it regarded as a Superfund site,” says Lippy, “so that OSHA hazardous waste standards would be brought to bear, but people in the political structure said ‘we can’t talk about it as hazardous.’ “

Lippy's union, fortunately, with funding from the National Institute of Environmental Health Sciences (NIEHS) filled part of the gap by distributing respirators and training workers on the spot in the safest methods to deal with the potentially hazardous dust, smoke, and other hazards.

Every day for several weeks his team crossed the site and, using binoculars, watched to see every piece of operator of heavy equipment—cranes, earth movers, forklifts, etc.—and whether or not they were wearing the respirators as advised. Regularly less than half of the heavy equipment operators were wearing their respirators while working on the pile, often less than a third, his surveys found.

What was in the thick plumes of smoke that rose up from the tangled shards of steel and rebar had yet to be fully analyzed but there were serious concerns that it contained an assortment of combustion products, many of them carcinogenic, such as benzene, dioxins and furans; EPA had already found asbestos in the dust at levels of concern within the first few days.

By mid-October, Lippy had taken some 60 samples of the air and dust, looking in particular for traces of asbestos and heavy metals such as lead. Many of his samples did not show any surprising hazards, corroborating other readings done by agencies like EPA, but there were enough concerns that he kept prodding workers to keep their respirators on, just in case.

Later, however, his union would document the presence of many hazardous materials besides asbestos, including lead, silica, arsenic and Freon. Just in the first week, between September 14^th and 25^th, workers would suffer 995 injuries, with eye injuries, blisters and headaches topping the list.

Most of all, Lippy led by example, wearing his respiratory all the time. As a result, after weeks and weeks on the site, he never got any “World Trade Center” cough.

A staggering number of respirators were given out by various agencies, says Lippy: “OSHA gave out 130,000; EPA about 22000, and the operating engineers, about 11,000, but it was unclear where they went,” he says.

Workers at the site resisted wearing respirators for a number of reasons, Lippy feels. For one thing, as construction workers, they were not used to wearing respirators, since they typically build things, rather than doing demolition work, and usually in an environment absent these hazards, not a blast zone following a terrorist attack.

Plus, this disaster zone called for extraordinary endurance. Firefighters who wear their standard gear are typically in and out of a fire scene within minutes, in contrast to this scenario, which would last months upon months. “Firefighters, with their self-contained breathing apparatus – (SCBA, nicknamed SCUBA) typically get a half-hour bottle of air, and they’re out long before that,” adds Lippy. “When they switched to the half-face respirator, they hadn’t been properly trained in it.”

Secondly, the respirators were difficult to wear while working. “A lot of workers didn’t wear the respirators,” says Lippy, “because it was very hard to talk in them.” In a dangerous environment, hearing and talking can be a necessity. Also, many of the cartridges that came with the respirators didn’t work well because they weren’t compatible, or they didn’t last long enough to be effective.

Photo: EPA

Workers at the site needed to be properly fit-tested, and trained—yet they weren’t for months, Lippy charges. While workers labored around the clock, they got little if any protection. As an example of how little attention went to health and safety, Lippy notes: “The first personal samples weren’t given until September 19 (a week after the attacks); fit tests weren’t required until October 17^th; a safety plan wasn’t issued until October 29; and first formal training wasn’t given until November 29^th.

Had this been a typical workplace regulated by OSHA, there would have been standards requiring that all respirator users be properly trained, fit-tested, and medically certified for wearing such devices. But OSHA was serving only in a “consulting” role rather than an enforcement role, because the Fire Department, and later the Department of Design and Construction had command over the site—so such standards didn’t apply as they should have.

Lastly, says Lippy, one of the tragedies of the September 11^th attack at the World Trade Center was the loss of New York’s “crack HAZMAT team.” The New York Fire Departments Hazardous Material (HAZ-MAT) companies suffered about 75 percent casualties—and their loss struck a blow for health and safety.

“With their loss, we lost that expertise, and we lost the ‘haz-mat’ culture,” says Lippy. “Had they been at the table, there would have been a different dynamic at work, valuing health and safety.”

Lippy and others felt that OSHA’s hazardous waste standards ought to have been brought to bear. But, he says, there were disagreements among the agencies about the necessity of protection against organic vapors and acid gases because the levels measured have been generally low.

“The position of the IUOE team is that the potential exposure to dioxin in the smoke warrants organic vapor protection. Additionally, the cartridges will protect against odors from bodies. The presence of large quantities of Freon means that hydrochloric and hydrofluoric acid can be generated in the presence of heat. Consequently, workers need to be protected from acid gases, too.”

Lippy feels that there were misunderstandings behind the decision to ignore the OSHA HAZWOPER standard. New York city officials felt that lower Manhattan might have been in danger of being declared a Superfund site if that standard were enforced.

Yet there were occasions when that standards was used, as when there had to be clean up of underground tanks, covered under HAZWOPER, rather than under the Comprehensive Environmental Response, Compensation and Liability Act (CERCLA, or Superfund).

WTC wash station. Photo: EPA

At the same time, too, OSHA considered the recent cleanup of anthrax contamination as covered by HAZWOPER, even though the Brentwood Post Office could hardly be regarded as a Superfund site. Another concern expressed at the site was that HAZWOPER would force workers into overly protective garments and respirators, slowing down the work and jacking up the price.

But Lippy points out that enforcing HAZWOPER only requires that the level of protection “be commensurate with the level of hazard,” as determined by assessing risks.

Most of these key practices of HAZWOPER—such as creating a site-specific health and safety plan, establishing zones of control, training workers, and decontaminating personnel and equipment – eventually became part of the procedures at Ground Zero. But according to Lippy and Carson, they arrived slowly and too late. Unlike the HAZWOPER requirements, personal decontamination was never mandatory at Ground Zero. Medical screening was not required and as a result not widely performed during the entire rescue, recovery, and cleanup.