United States Government Accountability Office

GAO Testimony

Before the Subcommittee on National Security, 

Emerging Threats, and International Relations,

Committee on Government Reform, House of 

Representatives 

SEPTEMBER 11 

Monitoring of World Trade 

Center Health Effects Has 

Progressed, but Not for 

Federal Responders 

Statement of Cynthia A. Bascetta 

Director, Health Care

For Release on Delivery 

Expected at 9:00 a.m. EDT

in New York, New York 

Saturday, September 10, 2005 

 

GAO-05-1020T
What GAO Found

United States Government Accountability Office

Why GAO Did This Study

Highlights

Accountability Integrity Reliability

September 10, 2005

SEPTEMBER 11

Monitoring of World Trade Center Health

Effects Has Progressed, but Not for 

Federal Responders 

Highlights of GAO-05-1020T, a testimony 

before the Subcommittee on National 

Security, Emerging Threats, and 

International Relations, Committee on 

Government Reform, House of

Representatives

After the 2001 attack on the World

Trade Center (WTC), nearly 3,000 

people died and an estimated 

250,000 to 400,000 people who

lived, worked, or attended school 

in the vicinity were affected. An

estimated 40,000 people who 

responded to the disaster—

including New York City Fire

Department (FDNY) personnel and 

other government and privatesector workers and volunteers—

were exposed to numerous 

physical and mental health hazards. 

Concerns remain about the longterm health effects of the attack

and about the nation’s capacity to

plan for and respond to both shortand long-term health effects in the 

event of a future attack or other

disaster. 

Several federally funded programs 

have monitored the physical and

mental health effects of the WTC

attack. These monitoring programs 

include one-time screening 

programs and programs that also 

conduct follow-up monitoring. 

GAO was asked to assess the 

progress of these programs. GAO 

examined (1) federally funded

programs implemented by state

and local government agencies or

private institutions, (2) federally

administered programs to monitor 

the health of federal workers who 

responded to the disaster in an

official capacity, and (3) lessons

learned from WTC monitoring

programs. GAO reviewed program 

documents and interviewed

federal, state, and local officials 

and others involved in WTC

monitoring programs. 

Three federally funded monitoring programs implemented by state and local

governments or private organizations after the WTC attack have provided

initial medical examinations--and in some cases follow-up examinations--to 

thousands of affected responders to screen for health problems. For 

example, the FDNY medical monitoring program completed initial screening 

for over 15,000 firefighters and emergency medical service personnel, and 

the worker and volunteer program screened over 14,000 other responders. 

The New York State responder screening program screened about 1,700 

state responders before ending its examinations in 2003. Most state 

responders have not been informed that they are now eligible to participate 

in the worker and volunteer program, and New York State responders could 

miss the opportunity for continued monitoring. These monitoring programs 

and the WTC Health Registry have collected information that program 

officials believe researchers could use to help better understand the health 

consequences of the attack and improve treatment. Program officials 

expressed concern, however, that current federal funding arrangements for 

long-term monitoring may be too short to allow for identification of all

future health effects. 

In contrast to the progress made by other federally funded programs, the 

Department of Health and Human Services’ (HHS) program to screen federal 

workers who were sent by their agencies to respond to the WTC disaster has 

accomplished little and is on hold. The program—which started about one 

year later than other WTC monitoring programs—completed screening of 

394 of the estimated 10,000 federal workers who responded in an official

capacity to the disaster, but HHS officials suspended examinations and the 

program has not screened anyone since March 2004. The program’s limited 

activity and the exclusion of federal workers from other monitoring

programs because of the assumption that they could receive screening

examinations through the HHS program may have resulted in many federal

responders losing the opportunity to identify and seek treatment for their 

WTC-related health problems. 

Officials involved in WTC health monitoring programs cited lessons from 

their experiences that could help others who may be responsible for 

designing and implementing health monitoring efforts that follow other 

disasters, such as Hurricane Katrina. These include the need to quickly 

identify and contact people affected by a disaster; to monitor for mental

health effects, as well as physical injuries and illnesses; and to anticipate 

when designing disaster-related monitoring efforts that there will likely be 

many people who require referrals for follow-up care and that handling the 

referral process may require substantial effort. HHS and New York State 

officials provided comments on the facts contained in this testimony and 

GAO made changes as appropriate. 

www.gao.gov/cgi-bin/getrpt?GAO-05-1020T.

To view the full product, including the scope 

and methodology, click on the link above.

For more information, contact Cynthia A.

Bascetta at (202) 512-7101 or 

bascettac@gao.gov.
Mr. Chairman and Members of the Subcommittee:

Thank you for inviting me to participate in today’s hearing to discuss 

issues related to the health effects that people continue to experience in

the aftermath of the September 11, 2001, terrorist attack on the World 

Trade Center (WTC).1

 After the collapse of the WTC buildings, nearly 3,000 

people died, and an estimated 250,000 to 400,000 people who lived, 

worked, or attended school in the vicinity were affected. An estimated 

40,000 people responded to the disaster, including New York City Fire 

Department (FDNY) personnel and other government and private-sector 

workers and volunteers from New York and other locations across the 

nation. These responders,

2

 as they took part in various rescue, recovery, 

and cleanup activities in the days, weeks, and months following the attack,

were exposed to numerous physical hazards and environmental toxins due 

to the destruction caused by the attack. The magnitude and unprecedented 

nature of this event also exposed responders and many other people to

considerable psychological trauma. 

Four years after the destruction of the WTC buildings, concerns remain 

about the long-term physical and mental health effects of the attack. 

Several recent studies of responders report that many of them have high 

rates of physical and mental health symptoms, of which respiratory 

problems are the most persistent physical effects.3

 While the nature and 

severity of a future terrorist attack cannot be predicted, our prior work on 

the health effects of the WTC attack, the 2001 anthrax attacks, and 

bioterrorism preparedness, as well as reports by other organizations, 

highlight the importance of ensuring the nation’s capacity to plan for and 

respond to the short- and long-term health consequences likely to result in

 

it

it

1

A list of abbreviations used in this testimony is in app. I. 

2

In this testimony, the term “responders” refers to anyone involved in rescue, recovery, or

cleanup activities at or near the vicinity of the WTC site and Staten Island Fresh Kills

landfill (the off-site location of the WTC recovery operation). 

3

See, for example, Centers for Disease Control and Prevention, “Mental Health Status of

World Trade Center Rescue and Recovery Workers and Volunteers—New York City, July

2002-August 2004,” Morbidity and Mortality Weekly Report, vol. 53 (2004); Centers for

Disease Control and Prevention, “Physical Health Status of World Trade Center Rescue and 

Recovery Workers and Volunteers—New York City, July 2002-August 2004,” Morbidity and 

Mortal y Weekly Report, vol. 53 (2004); and Gisela I. Banauch and others, “Bronchial

Hyperreactivity and Other Inhalation Lung Injuries in Rescue/Recovery Workers after the 

World Trade Center Collapse,” Cr ical Care Medicine, vol. 33, no. 1 (2005). 

Page 1 GAO-05-1020T
the event of a future attack or other disaster, such as the destruction 

recently caused by Hurricane Katrina.4

As we testified in September 2004, in the aftermath of the WTC attack, five 

key federally funded programs were implemented to assess the short-term,

and in some cases long-term, effects on people’s physical and mental

health. These programs include the FDNY WTC Medical Monitoring 

Program, WTC Medical Monitoring Program (worker and volunteer 

program),

5

 New York State responder screening program, WTC Health

Registry, and the Department of Health and Human Services’ (HHS) WTC 

Federal Responder Screening Program. You asked us to provide 

information on the progress of these monitoring programs.

6

 My testimony 

today will focus on (1) progress made by federally funded programs that

are implemented by state and local government agencies or private 

organizations and were established to monitor the health of people in the

aftermath of the attack, (2) progress made by federally administered 

programs established to monitor the health of federal workers who 

responded to the disaster in an official capacity, and (3) lessons from WTC 

monitoring programs that could assist those who may be responsible for 

future disaster-related health monitoring efforts. 

To conduct this work, we obtained and reviewed program documents

dating from the beginning of the programs, including grantee progress 

reports, budget documents, clinical protocols, health screening and other 

assessment tools, and selected peer-reviewed articles based on 

information collected by WTC monitoring programs. We also interviewed 

federal, state, and local officials and others involved in administering WTC 

monitoring programs, including officials from HHS and the Department of

 t

t li

i

i

i i i t

4

See, for example, GAO, September 11: Health Effec s in the Aftermath of the World Trade

Center Attack, GAO-04-1068T (Washington, D.C.: Sept. 8, 2004); GAO, Bio errorism: Pub c

Health Response to Anthrax Inc dents of 2001, GAO-04-152 (Washington, D.C.: Oct. 15, 

2003); GAO, Public Health Preparedness: Response Capac ty Improving, but Much Remains

to Be Accomplished, GAO-04-458T (Washington, D.C.: Feb. 12, 2004); and Institute of 

Medicine, Prepar ng for the Psychological Consequences of Terror sm: A Publ c Heal h

Strategy (Washington, D.C.: 2003). 

5

This program was formerly known as the WTC Worker and Volunteer Medical Screening 

Program. In this testimony, we refer to the program as the worker and volunteer program.

6

In this testimony, we use the term monitoring program to refer to both one-time screening 

programs and programs that include initial screening and periodic follow-up monitoring. 

Page 2 GAO-05-1020T
Homeland Security (DHS);

 7 New York State Department of Health; New

York City Department of Health and Mental Hygiene; and FDNY. Within

HHS, we interviewed officials from the Agency for Toxic Substances and 

Disease Registry (ATSDR); the Centers for Disease Control and 

Prevention’s (CDC) National Center for Environmental Health and 

National Institute for Occupational Safety and Health (NIOSH); Federal

Occupational Health Services (FOH);8 and the Office of Public Health

Emergency Preparedness (OPHEP). We also obtained information from

the Department of Defense (DOD) and the Department of Justice (DOJ).

We interviewed medical professionals affiliated with the New York 

University School of Medicine, FDNY’s Bureau of Health Services, Long

Island Occupational and Environmental Health Center, Mount Sinai-Irving 

J. Selikoff Center for Occupational and Environmental Medicine, Mount

Sinai School of Medicine Department of Psychiatry, and the University of

Medicine and Dentistry of New Jersey’s Robert Wood Johnson Medical

School. We relied on data provided by agency officials and contained in 

government publications and did not independently verify the data we 

obtained. In our judgment the reliability of the information we obtained 

was adequate for our purposes. HHS and New York State officials 

provided comments on the facts contained in this statement, and we made 

changes as appropriate. We conducted our work from July 2005 through 

September 2005 in accordance with generally accepted government 

auditing standards. 

In summary, three federally funded programs implemented by state and 

local governments or private organizations in the aftermath of the WTC

attack have provided initial medical examinations—and in some cases

follow-up examinations—to thousands of affected responders to screen 

for health problems. For example, the FDNY program completed initial 

screening for over 15,000 firefighters and emergency medical service

personnel, and the worker and volunteer program has screened over

14,000 other responders. The New York State program screened about 

1,700 state responders before ending its screening examinations; in 

general, it has not informed state responders that they are now eligible to

receive continued monitoring from the worker and volunteer program. 

These three programs and the WTC Health Registry have collected 

information that monitoring program officials believe could be used by

 7

The DHS officials we spoke with were from the Federal Emergency Management Agency,

which became part of DHS in March 2003. 

8

FOH is a part of HHS’s Program Support Center. 

Page 3 GAO-05-1020T
researchers to help better understand the health consequences of the 

attack and improve treatment, such as by identifying which types of

treatment are effective for specific conditions. Officials of programs that

plan to conduct long-term health monitoring are concerned that current

federal funding arrangements may be too short to allow for identification 

of all the health effects that participants may eventually experience. 

In contrast to the progress made by federally funded programs

implemented by state and local governments or private organizations, the 

program that HHS implemented to screen federal workers who were sent

by their agencies to respond to the WTC disaster has accomplished little. 

The program—which started later than other WTC monitoring programs—

completed screening of 394 of the estimated 10,000 federal workers who 

responded in an official capacity to the disaster and were not eligible for 

any other WTC health monitoring program. HHS placed the program on 

hold in January 2004, when it stopped scheduling new examinations. It has 

not screened anyone since March 2004. We identified two federal agencies 

that, in the aftermath of the WTC attack, have implemented programs to 

assess the health of their own employees who responded to the disaster. 

Officials involved in WTC health monitoring programs cited lessons from

their experiences that could help others who may be responsible for 

designing and implementing disaster-related health monitoring efforts in 

the future. These include the need to quickly identify and contact people 

affected by a disaster; to monitor for mental health effects, as well as the 

more obvious physical injuries and illnesses; and, when developing health

monitoring efforts in the wake of disasters, to anticipate that there will 

likely be many people who require referrals for further diagnostic and 

treatment services and that handling the referral process may require a 

substantial level of effort. 

When the WTC buildings collapsed on September 11, 2001, an estimated

250,000 to 400,000 people were immediately exposed to a noxious mixture 

of dust, debris, smoke, and potentially toxic contaminants in the air and on

the ground, such as pulverized concrete, fibrous glass, particulate matter, 

and asbestos. Those affected included people residing, working, or 

attending school in the vicinity of the WTC and thousands of emergency

response workers. Also affected were the estimated 40,000 responders 

who were involved in some capacity in the days, weeks, and months that

Background 

Page 4 GAO-05-1020T
followed, including personnel from many government agencies and private 

organizations as well as other workers and volunteers.9

A wide variety of physical and mental health effects have been observed 

and reported among people who were involved in rescue, recovery, and 

cleanup operations and among those who lived and worked in the vicinity

of the WTC.10 Physical health effects included injuries and respiratory 

conditions, such as sinusitis, asthma, and a new syndrome called WTC 

cough, which consists of persistent coughing accompanied by severe 

respiratory symptoms. Almost all firefighters who responded to the attack 

experienced respiratory effects, including WTC cough, and hundreds had 

to end their firefighting careers due to WTC-related respiratory illnesses. 

The most commonly reported mental health effects among responders and

others were symptoms associated with posttraumatic stress disorder—an

often debilitating disorder that can develop after a person experiences or

witnesses a traumatic event, and which may not develop for months or 

years after the event. Behavioral effects such as alcohol and tobacco use 

and difficulty coping with daily responsibilities were also reported. 

Several federally funded programs monitor the health of people who were 

exposed to the WTC attack and its aftermath. The monitoring programs

vary in such aspects as eligibility requirements, methods used for 

collecting information about people’s health, and approaches for offering

referrals. Of the four programs that offer medical examinations to WTC

responders, the only one that is open to federal workers who responded to

the disaster in an official capacity is the one implemented by HHS. (See 

table 1.) None of the monitoring programs receives federal funds to

provide clinical treatment for health problems that are identified. 

 9

The responders included firefighters, law enforcement officers, emergency medical

technicians and paramedics, morticians, health care professionals, and other workers and 

volunteers, including those in the construction and ironwork trades, heavy equipment 

operators, mechanics, engineers, truck drivers, carpenters, day laborers, and 

telecommunications workers. Numerous federal, state, and New York City agencies sent

personnel to respond to the WTC disaster (see app. II). 

10GAO-04-1068T. 

Page 5 GAO-05-1020T
Table 1: Key Federally Funded WTC Health Monitoring Programs 

Implementing

agency or

organization 

Federal 

administering 

agency

Eligible 

populations 

Monitoring 

methods Treatment referral

FDNY WTC Medical

Monitoring 

Programa

FDNY Bureau of 

Health Services

(FDNY-BHS) 

National Institute for 

Occupational Safety

and Health (NIOSH) 

Firefighters and 

emergency medical 

service technicians 

Medical

questionnaire and 

examination 

Refers to FDNYBHS 

WTC Medical 

Monitoring 

Program (worker

and volunteer

program)a

Five clinical centers,

one of which, the 

Mount Sinai-Irving J.

Selikoff Center for 

Occupational and 

Environmental

Medicine, also 

serves as a data and 

coordination centerb

 

NIOSH Rescue and

recovery workers

and volunteers, 

except for federal

workers who were

official responders

and New York City

(NYC) firefighters

c

 

Medical

questionnaire and 

examination 

Refers to privately 

funded programs

available to

responders; some

privately funded 

treatment provided 

at the clinical centers

New York State 

responder

screening 

programd

New York State 

Department of 

Health 

National Center for 

Environmental

Health 

New York State 

employees and

National Guard 

personnel who 

responded to the 

WTC attack in an

official capacity 

Medical

questionnaire and 

examination 

Instructed

participants to see 

their primary care

physician or a 

specialist 

WTC Health 

Registry

NYC Department of

Health and Mental 

Hygiene 

Agency for Toxic

Substances and 

Disease Registry

(ATSDR) 

Responders and 

people living or 

attending school in

the area of the WTC,

or working or 

present in the vicinity 

on September 11, 

2001e

Telephone-based 

health and exposure

interview

Provides information

on where treatment 

can be sought;f

refers participants to

LIFENETg

 for mental

health services

WTC Federal 

Responder

Screening Program 

Department of 

Health and Human 

Services’ (HHS) 

Office of Public

Health Emergency 

Preparedness 

HHS Federal workers who 

responded to the 

WTC attack in an

official capacity 

Medical

questionnaire and 

examination 

Instructs participants 

to see their primary 

care physician; in

future, may refer 

participants with 

mental health 

symptoms to a 

Federal

Occupational Health 

Services employee

assistance program

Source: GAO analysis of information from ATSDR, FDNY, Mount Sinai, National Center for Environmental Health, New York City 

Department of Health and Mental Hygiene, New York State Department of Health, and NIOSH.

a

The FDNY WTC Medical Monitoring Program and the WTC Medical Monitoring Program constitute

the WTC Responder Health Consortium. NIOSH established the consortium in March 2004 to

coordinate the health monitoring of the two programs and to facilitate data sharing.

Page 6 GAO-05-1020T
b

The other clinical centers are located at the Long Island Occupational and Environmental Health

Center, the New York University School of Medicine, the City University of New York’s Queens 

College, and the University of Medicine and Dentistry of New Jersey’s Robert Wood Johnson Medical 

School. The responsibilities of the Mount Sinai data and coordination center include coordination of

the clinical centers, outreach and education, quality assurance, and data management.

c

The worker and volunteer program excludes responders who were paid as federal workers or as

NYC firefighters for their WTC work; these employees are eligible for other programs. The program

initially excluded responders who were paid as New York State employees for their WTC work and

were eligible for the New York State responder screening program. That program ended its screening 

examinations in November 2003, and as of February 2005, New York State responders became 

eligible for the worker and volunteer program.

d

The New York State program ended its screening examinations in November 2003.

e

Participants in the other WTC monitoring programs may also participate in the registry program.

f

The registry program provides enrollees with a resource guide of occupational, respiratory,

environmental, and mental health facilities where they could seek treatment. Some of the services

provided by these facilities require payment, while others are free of charge.

g

LIFENET is a 24-hour mental health information and referral service provided by the New York State 

Office of Mental Health. In cases where WTC Health Registry interviewers think a person is 

experiencing moderate distress, they can immediately transfer the call so the person can speak to a 

LIFENET counselor.

The majority of federal funding for these monitoring programs was

provided by DHS’s Federal Emergency Management Agency (FEMA),11 as 

part of the approximately $8.8 billion in federal assistance that the 

Congress appropriated to FEMA for response and recovery activities after 

the WTC disaster.

12 One fiscal year 2003 appropriation specifically 

authorized FEMA to use a portion of its WTC-related funding for screening

and long-term monitoring of emergency services and rescue and recovery 

personnel.

13 Generally, however, FEMA may fund only short-term care 

 11FEMA is the agency responsible for coordinating federal disaster response efforts under

the National Response Plan. 

12FEMA provided funds to HHS to support screening and long-term monitoring efforts from

funds appropriated for disaster relief and emergency response to the September 11, 2001, 

terrorist attacks. See Consolidated Appropriations Resolution, 2003, Pub. L. No. 108-7, 117 

Stat. 11, 517; 2002 Supplemental Appropriations Act for Further Recovery from and

Response to Terrorist Attacks on the United States, Pub. L. No. 107-206, 116 Stat. 820, 894; 

Department of Defense and Emergency Supplemental Appropriations for Recovery from

and Response to Terrorist Attacks on the United States Act, 2002, Pub. L. No. 107-117, 115 

Stat. 2230, 2338; and 2001 Emergency Supplemental Appropriations Act for Recovery from

and Response to Terrorist Attacks on the United States, Pub. L. No. 107-38, 115 Stat. 220-

221. 

13Pub. L. No. 108-7. 

Page 7 GAO-05-1020T
after a disaster, such as emergency medical services, and not ongoing

clinical treatment.

14

FEMA entered into interagency agreements with HHS to fund most of

these health monitoring programs. HHS is the designated lead agency for 

the public health and medical support function under the National

Response Plan and is responsible for coordinating the medical resources 

of all federal departments and agencies. HHS’s Office of Public Health 

Emergency Preparedness (OPHEP) coordinates and directs HHS’s 

emergency preparedness and response program. 

Three federally funded programs implemented by state and local

governments or private organizations—the FDNY WTC Medical 

Monitoring Program, WTC Medical Monitoring Program (worker and 

volunteer program), and New York State responder screening program—

have made progress in monitoring the physical and mental health of 

people affected by the WTC attack. Federal employees who responded to 

the WTC disaster in an official capacity were not eligible for these 

programs because it was expected that another program would be 

developed for them. The New York State program stopped providing 

examinations in November 2003, and state workers are now eligible for

initial or continued monitoring through the worker and volunteer program.

In general, the state program has not informed state responders that they

are eligible for the worker and volunteer program. All three programs and 

the WTC Health Registry have collected information that could contribute

to better understanding of the health consequences of the attack and

improve health care for affected individuals. Officials from the FDNY, 

worker and volunteer, and WTC Health Registry programs are concerned 

that federal funding for their programs could end before sufficient

monitoring occurs to identify all long-term health problems related to the 

WTC disaster. 

Health Monitoring 

Programs 

Implemented by State 

and Local 

Governments or

Private Organizations 

Have Made Progress 

 14The Robert T. Stafford Disaster Relief and Emergency Assistance Act, as amended, 

authorizes FEMA to, among other things, make appropriated funds available for disaster

relief and emergency assistance. Pub. L. No. 93-288, 88 Stat. 143 (1974), as amended. The 

Stafford Act does not specifically authorize ongoing clinical treatment. 

Page 8 GAO-05-1020T
Three WTC Monitoring 

Programs Provided 

Medical Examinations to 

Identify Responders’ 

Health Problems 

Three federally funded programs implemented by state and local

governments or private organizations have provided medical examinations

to identify physical and mental health problems after the WTC attack. (See

table 2.) Two of these programs—the FDNY WTC Medical Monitoring 

Program and the worker and volunteer program—are tracking the health 

of WTC rescue, recovery, and cleanup workers and volunteers over time. 

The third program, the New York State responder screening program,

offered one-time screening examinations to state employees, including 

National Guard personnel, who participated in WTC rescue, recovery, and 

cleanup work. Federal employees who responded to the WTC disaster in

an official capacity were not eligible for any of these programs because it

was expected that another program would be developed for them. 

Table 2: Monitoring Activities and Associated Federal Funding for WTC Monitoring Programs Implemented by State and Local 

Governments or Private Organizations 

Completed monitoring activities Planned monitoring activities Federal fundinga

FDNY WTC Medical

Monitoring Program 

Through June 2005, 15,284

firefighters and emergency medical

service technicians received 

screening examinations, and 522 of 

these participants completed a

follow-up examination. 

By June 2009, conduct three 

follow-up examinations of each

participant. 

$4.8 million was provided 

beginning in October 2001 for initial 

program; additional $25 million is 

available through June 2009. 

WTC Medical 

Monitoring Program 

(worker and 

volunteer program) 

Through June 2005, 14,110 people 

received screening examinations, 

and 1,699 of these participants 

completed a follow-up examination.

By July 2009, conduct three followup examinations of each 

participant. 

$15.9 million was provided for initial 

program;

b

 additional $56 million is 

available through July 2009. 

New York State 

responder screening 

program 

As of November 2003, 1,677 of

approximately 9,800 eligible

employees and National Guard 

personnel received screening

examinations. 

No further examinations are 

planned. Participants are now

eligible to participate in the worker 

and volunteer program.

$2.4 million was provided in 

January 2002 and is available 

through January 2006.

c

WTC Health Registry As of November 2004, the program

completed baseline data collection

through interviews with the 71,437 

people who enrolled in the registry;d

registry officials estimate that about 

385,000 people had been eligible 

to enroll. In 2005, the program

updated contact information

obtained at the time of enrollment. 

In 2006, conduct follow-up survey 

of participants. 

Registry officials are developing 

plans to track participants’ health 

through 2023. 

$20 million was provided beginning 

in July 2002,e

 and additional 

funding of about $3 million has

since been provided.f

Source: GAO analysis of information from ATSDR, FDNY, Mount Sinai, National Center for Environmental Health, New York City 

Department of Health and Mental Hygiene, New York State Department of Health, and NIOSH.

a

Except as noted, FEMA provided these funds to the federal administering agency for each

monitoring program.

b

$11.8 million of this amount was provided beginning in July 2002 through funds appropriated to CDC.

An additional $4.1 million was provided in fiscal year 2003 through an interagency agreement with

FEMA. 

Page 9 GAO-05-1020T
c

The primary program activity since November 2003 has been data analysis.

d

Registry officials told us that final enrollment numbers may be revised pending internal verification of

data.

e

The grant agreement is between ATSDR and the New York City Department of Health and Mental

Hygiene. However, ATSDR contracted directly with Research Triangle Institute (RTI), a private notfor-profit organization, for most of the work to establish the registry, and about $16 million of the $20

million went directly from ATSDR to RTI. 

f

The Environmental Protection Agency provided $2 million of these funds. In addition, CDC and 

ATSDR provided $500,000 each.

The FDNY program completed initial screening for over 15,000 firefighters 

and emergency medical service personnel, and the worker and volunteer 

program completed initial screening for over 14,000 other responders. In

both programs, screenings include physical examinations, pulmonary

function tests, blood and urine analysis, a chest X-ray, and questionnaires 

on exposures and mental health issues. Both programs have begun to

conduct follow-up examinations of participants and continue to accept 

new enrollees who desire initial screening. Current plans are to conduct a 

total of three follow-up examinations for each participant by 2009. As part

of their federally funded activities, both programs provide referrals for 

participants who require treatment. FDNY employees and retirees can 

obtain treatment and counseling services from the FDNY Bureau of Health

Services and the FDNY Counseling Services Unit, or they can use their 

health insurance to obtain treatment and counseling services elsewhere. 

The worker and volunteer program also provides referrals for its 

participants, including referrals to programs funded by the American Red 

Cross and other nonprofit organizations. 

The New York State program screened about 1,700 of the estimated 9,800 

state workers and National Guard personnel who responded to the WTC 

disaster. Officials sent letters to these responders to inform them about

the program and their eligibility for it.

15 For each participant, the screening

included a health and exposure questionnaire and physical and pulmonary 

examinations. Participants who required further evaluation or treatment

after screening were told to follow up with their personal physician or a 

specialist. The program stopped screening participants in November 2003, 

in part because the number of responders requesting examinations was 

dwindling, and no follow-up examinations are planned. 

 15When state officials contacted the estimated 9,800 state responders, some of them

informed the program that they were not interested in participating. Officials sent followup letters to state employees who did not respond to the initial mailing. National Guard 

personnel were sent only an initial letter. 

Page 10 GAO-05-1020T
In February 2005, worker and volunteer program officials began to allow

New York State responders to participate in that monitoring program. The 

officials determined that the worker and volunteer program would have 

sufficient funding to accommodate state workers who want to join the 

program.

16 The state program has not notified the approximately 1,700 

workers it has screened that they are now eligible for continued 

monitoring from the worker and volunteer program. Program officials 

relayed this development only to those state responders who inquired 

about screening or monitoring examinations following the decision to

permit state responders to participate in the worker and volunteer 

program. Worker and volunteer program officials told us that, through

August 2005, no state workers who responded to the WTC disaster in an 

official capacity had received examinations from the worker and volunteer 

program. According to worker and volunteer program officials, any state 

worker screened by the state program would need a new baseline 

examination through the worker and volunteer program because the 

screening data collected by the state program differ from the data 

collected in the worker and volunteer program. For example, the worker

and volunteer program offers a breathing test not provided by the state 

program.

Programs Provide Data for

WTC-Related Health 

Research 

In addition to providing medical examinations, these three programs—the 

FDNY program, the worker and volunteer program, and the New York 

State program—have collected information for use in scientific research to 

better understand the health consequences of the WTC attack and other 

disasters. A fourth program, the WTC Health Registry, includes health and 

exposure information obtained through interviews with participants; it is

designed to track participants’ health for 20 years and to provide data on 

the long-term health consequences of the disaster (see table 2). Physicians 

who evaluate and treat WTC responders told us they expect that research 

on health effects from the disaster will not only help researchers 

understand the health consequences, but also provide information on 

appropriate treatment options for affected individuals. 

 16As of September 1, 2005, the worker and volunteer program was in the process of 

establishing a network of providers to serve responders outside the New York City

metropolitan area. State responders had been eligible for monitoring at existing New York

City area clinics since February 2005, but they will not be able to visit providers in Albany

and other areas of New York until the network is established.

Page 11 GAO-05-1020T
Both the FDNY program and the worker and volunteer program have been

the basis for published research articles on the health of WTC responders. 

For example, the FDNY program reported on the injuries and illnesses 

experienced by firefighters and emergency medical service workers after 

responding to the attack.

17 In addition, the worker and volunteer program

published information on the physical and mental health of responders in

2004.18 Officials from both programs plan to publish additional findings as 

they track participants’ health over time. Although the New York State 

program has stopped offering examinations, program officials are 

continuing to analyze data from the program with plans for eventual

publication.

The WTC Health Registry program has collected health information 

through interviews with responders, people living or attending school in

the vicinity of the WTC site, and people working or present in the vicinity 

on September 11, 2001. The registry completed enrollment and conducted 

interviews with over 71,000 participants by November 2004. Officials 

updated contact information for all participants in 2005, and they plan to 

conduct a follow-up health survey of participants in early 2006. Registry 

officials would like to conduct subsequent follow-up surveys periodically 

through about 2023—20 years after the program began in 2003—but have 

not yet secured funding for long-term monitoring.19

The registry is designed to provide a basis for research to evaluate the 

long-term health consequences of the disaster. It includes contact 

information for people affected by the WTC attack, information on 

individuals’ experiences and exposures during the disaster, and 

information on their health. In November 2004, registry officials published 

preliminary results on the health status of registry participants, and 

officials expect to submit several research papers for publication within 

the next year. In addition, in May 2005, registry officials published 

 

it

t l

it

17See, for example, CDC, “Injuries and Illnesses among New York City Fire Department 

Rescue Workers after Responding to the World Trade Center Attacks,” Morbidity and 

Mortal y Weekly Report, vol. 51 (2002), and Elizabeth M. Fireman and others, “Induced 

Sputum Assessment in NYC Firefighters Exposed to World Trade Center Dust,”

Environmen a Health Perspectives, vol. 112 (2004).

18CDC, Morbidity and Mortality Weekly Report, vol. 53, p. 807, and CDC, Morbidity and 

Mortal y Weekly Report, vol. 53, p. 812.

19Program officials told us that the registry was designed as a 20-year program because

most long-term health effects that might result from the WTC disaster would likely begin to

appear in the population within that period of time. 

Page 12 GAO-05-1020T
guidelines for allowing registry information to be used in scientific

research,20 and they have since approved three proposals for external 

research projects that use registry information. These proposals include 

two studies of building evacuations and a study of psychological

responses to terrorism. 

Officials from the FDNY, worker and volunteer, and WTC Health Registry 

programs are concerned that current federal funding arrangements for 

programs designed to track participants’ health over time may be too short

to allow for identification of all the health effects that may eventually 

develop. ATSDR plans to fund the WTC Health Registry through April 

2008, and NIOSH plans to fund the FDNY program and the worker and 

volunteer program through mid-2009. ATSDR’s 5-year cooperative 

agreement with the New York City Department of Health and Mental

Hygiene to support the WTC Health Registry went into effect April 30, 

2003, and extends through April 29, 2008. Similarly, NIOSH awarded 5-year 

grants in July 2004 to continue the FDNY and worker and volunteer 

programs, which had begun in 2001 and 2002, respectively. Health experts 

involved in these monitoring programs, however, cite the need for longterm monitoring of affected groups because some possible health effects, 

such as cancer, may not appear until decades after a person has been 

exposed to a harmful agent. They also told us that monitoring is important

for identifying and assessing the occurrence of newly identified 

conditions, such as WTC cough, and chronic conditions, such as asthma. 

HHS’s OPHEP established the WTC Federal Responder Screening Program

to provide medical screening examinations for an estimated 10,000 federal 

workers who responded to the WTC disaster in an official capacity and 

were not eligible for any other medical monitoring program. OPHEP did 

not develop a comprehensive list of federal responders who were eligible 

for the program. The program began in June 2003—about a year later than 

other monitoring programs—and completed screenings for 394 workers. 

No examinations have occurred since March 2004, because officials placed

the program on hold, temporarily suspending new examinations. The 

program is still on hold, and OPHEP officials are taking actions intended 

Program Officials Are 

Concerned That Current 

Federal Funding 

Arrangements Will End 

before Needed Monitoring 

Is Complete 

HHS’s Program for 

Screening Federal 

Responders Has

Accomplished Little 

and Is on Hold 

 20Under the guidelines, a review committee consisting of public health scientists and

stakeholder representatives evaluates each proposed research project based on criteria

such as the proposal’s scientific and technical merit, funding, and contribution to a 

community or individuals. 

Page 13 GAO-05-1020T
to lead to restarting the program. We identified two federal agencies that

established screening programs for their own personnel who responded to

the disaster. 

HHS Program Screened 

Few Federal Workers and 

Has Been on Hold for over

1 Year

HHS’s WTC Federal Responder Screening Program was established to

provide free voluntary medical screening examinations for an estimated

10,000 federal workers21 whom their agencies sent to respond to the WTC 

disaster from September 11, 2001, through September 10, 2002, and who 

were not eligible for any other monitoring program.

22 FEMA provided $3.74 

million through an interagency agreement with HHS’s OPHEP for the 

purpose of developing and implementing the program. OPHEP entered 

into an agreement with HHS’s FOH to schedule and conduct the screening 

examinations. 

The launching of the federal responder screening program lagged behind 

the implementation of other federally funded monitoring programs for 

WTC responders. For example, the medical screening program for New

York State employees and the worker and volunteer program started 

conducting screening examinations in May 2002 and July 2002, 

respectively. However, OPHEP did not launch its program until June 2003. 

(Figure 1 highlights key actions in developing and implementing the 

program.) 

 21For this program, a federal worker is defined as being either a permanent, temporary, or

intermittent federal employee. 

22According to a FEMA official, federal workers who did not receive official orders from

their agencies to respond to the WTC disaster are not eligible for this program. According

to an official of the worker and volunteer program, federal workers who volunteered on 

their own in the aftermath of the disaster were eligible to participate in that screening

program.

Page 14 GAO-05-1020T
Figure 1: Timeline of Key Actions Related to WTC Federal Responder Screening Program 

Source: GAO analysis of information from HHS’s OPHEP and FOH, and FEMA.

Period during which program was conducting examinations

April 2005: 

OPHEP and ATSDR enter interagency 

agreement to identify and contact 

federal responders and establish a 

database of names

January 2004: 

HHS places program on hold

June 2003: 

FOH begins screening examinations

September 11, 2001:

WTC attack

July 2005:

OPHEP and FOH revise 

agreement to expand clinical 

services and provide referrals for 

follow-up care

March 2004: 

FOH conducts last 

screening examination

December 2003: 

FEMA approves no-cost extension 

of program to December 2005

March 2003:

FEMA and OPHEP enter interagency agreement to fund 

and implement WTC Federal Responder Screening Program

2001 2002 2003 2004 2005

April 2003:

OPHEP and FOH enter agreement for 

conducting screening examinations

September 2005:

OPHEP initiates action to 

identify federal responders 

and to schedule examinations 

for people on waiting list

Decision on how to provide 

examinations to former federal 

workers is still pending

OPHEP did not develop a plan for identifying all federal agencies and their 

personnel that responded to the WTC disaster or for contacting all federal

personnel eligible for the screening program. Although OPHEP and FEMA

developed a partial list of federal responders—consisting primarily of HHS 

and FEMA personnel—OPHEP did not have a comprehensive list of

agencies and personnel, and so could not inform all eligible federal 

responders about the WTC screening program. The program’s principal

action to communicate with the federal responders was to place program

Page 15 GAO-05-1020T
information and registration forms on FEMA’s National Disaster Medical

System (NDMS) Web site.

23

The screening program had operated for about 6 months when OPHEP 

officials decided in January 2004 to place it on hold by temporarily 

suspending examinations. FOH officials told us that they completed 394 

screening examinations24 from June 2003 through March 2004,

25 with most

completed by the end of September 2003. According to FOH, a total of 

$177,967 was spent on examinations.26 As of September 7, 2005, the

program remained on hold, with 37 people on the waiting list for 

examinations,27 and OPHEP has not set a date for resuming the

examination process. 

OPHEP officials told us that three operational issues contributed to the 

decision to suspend the program. First, OPHEP could not inform all

eligible federal responders about the program because it lacked a 

comprehensive list of eligible federal responders. Second, there were 

concerns about what actions FOH clinicians could take when screening 

examinations identified problems. Based on the examinations that had 

been completed before the program was placed on hold, FOH clinicians

determined that many participants needed additional diagnostic testing 

and follow-up care, primarily in the areas of respiratory functioning and 

mental health. However, under the existing interagency agreement there 

was no provision for providing follow-up care and no direction for 

 23NDMS provides medical care to victims and responders to domestic disaster, including

acts of terrorism and natural disasters. According to HHS officials, when NDMS was 

transferred to FEMA in 2003 as part of the formation of DHS, key NDMS staff involved in 

the initial planning of the screening program were also transferred. During the transition

period, these NDMS staff continued to carry out some tasks related to the screening 

program, including working to identify agencies that had sent employees to the WTC

disaster, developing a list of federal responders, and placing information about the program

on the NDMS Web site. Officials said that overall program management responsibility and 

funding remained with HHS. 

24FOH officials told us that although FOH clinicians had seen approximately 460 federal

personnel, not all of them completed the entire examination process.

25FOH continued to schedule and conduct examinations for those people who had 

requested an examination before the program was placed on hold in January 2004. 

26FOH officials told us that this amount includes spending on the 394 completed 

examinations and on examinations that were not completed.

27FOH officials told us that these 37 applications were received after the screening program

was placed on hold in January 2004. 

Page 16 GAO-05-1020T
clinicians on how to handle the provision of further diagnostic tests, 

treatment, or referrals. FOH officials told us that they were concerned

about continuing to provide screening examinations without the ability to

provide participants with additional needed services. Third, although the 

screening program had been established to provide examinations to all

federal responders regardless of their current federal employment status, 

HHS officials told us that the department determined that FOH does not

have the authority to provide examinations to people who are no longer in 

federal service. OPHEP officials told us in September 2005 that they were 

exploring avenues for providing examinations to federal responders who 

were no longer federal employees. 

OPHEP has begun to take action to prepare for offering examinations 

again. In April 2005, program officials enlisted the assistance of ATSDR—

which had successfully developed the WTC Health Registry—to help 

develop the needed lists of federal agencies and personnel for the federal 

responder program. OPHEP executed an agreement with ATSDR that

allocated about $491,000 from the program’s remaining allocation from

FEMA to ATSDR.28 Under this agreement, which is scheduled to run

through April 2006, ATSDR is working with the contractor it used to 

develop the WTC Health Registry to develop a new registration Web site, 

develop and implement a comprehensive recruitment and enrollment plan 

for current and former federal workers, and establish a database

containing the names of federal responders. On September 1, 2005, 

OPHEP sent a letter to 51 federal agencies requesting them to provide 

ATSDR’s contractor with contact information on the employees they sent 

to respond to the WTC disaster. 

In July 2005, OPHEP and FOH executed a new agreement so that when the 

program begins examining responders again, FOH clinicians will be able to

make referrals for follow-up care. For example, they will be able to refer 

participants with mental health symptoms to an FOH employee assistance 

program for a telephone assessment. If appropriate, the participant will be

referred to an employee assistance program counselor for up to six inperson sessions. If the assessment indicates that longer treatment is

necessary, the participant instead will be advised to use health insurance 

to obtain care or to contact a local Department of Labor Office of Workers’ 

Compensation to file a claim, receive further evaluation, and possibly 

 28According to OPHEP, as of August 22, 2005, about $3 million of the original $3.74 million 

allocated by FEMA for this screening program remained. 

Page 17 GAO-05-1020T
obtain compensation for mental health services. The new agreement

between OPHEP and FOH also will allow FOH clinicians to order

additional clinical tests, such as special pulmonary and breathing tests. 

Two Federal Agencies 

Established Their Own 

Screening Programs 

We identified two federal agencies that established medical screening 

programs to assess the health of the personnel they had sent to respond to

the WTC disaster. One agency, the Army, established two screening 

programs—one specifically for Army Corps of Engineers personnel and 

one that also included other Army responders. The Army Corps of

Engineers established a voluntary program to assess the health of 356 

employees it had sent to respond to the disaster.

29 The program, initiated in

November 2001, consists of sending employees an initial medical 

screening questionnaire covering physical health issues.30 If questionnaire 

results indicate symptoms or concerns that need further evaluation, the 

employee is offered a medical examination.31 As of August 2004, 92 Corps 

of Engineers employees had participated in the program, with 40 receiving 

follow-up examinations. The Army’s Center for Health Promotion and 

Preventive Medicine initiated a program—the World Trade Center Support

Health Assessment Survey—in January 2002. It was designed as a 

voluntary medical screening for Army military and civilian personnel,

including contractors. From January 2002 through September 2003, 

questionnaires were sent to 256 employees.32 According to DOD, 162

employees completed and returned their questionnaires. In addition, the 

U.S. Marshals Service, within the Department of Justice, modified an

existing agreement with FOH in 2003 for FOH to screen approximately 200 

U.S. Marshals Service employees assigned to the WTC or Pentagon 

recovery sites. The one-time assessment includes a screening 

 29The screening program has no closing date, and employees can request a screening 

examination at any time. 

30The questionnaire collects information on prior and WTC-related occupational exposures

and prior and current physical health status. 

31The medical examination includes a comprehensive history and physical examination, 

chest X-ray, and pulmonary function, blood, and urine tests.

32The Army’s questionnaire was distributed to active-duty service members, activated 

members of the Reserves and National Guard, civilian employees, and civilian contractors.

These included 125 New Jersey Army National Guard members. The 474 active-duty

members of the New York Army National Guard who responded to the WTC disaster were

not included due to their eligibility to participate in the medical screening program

established for New York State workers. 

Page 18 GAO-05-1020T
questionnaire and a medical examination.33 FOH officials said that as of

August 2005, 88 of the 200 U.S. Marshals Service employees had requested 

and obtained examinations.34

Officials involved in the WTC health monitoring programs implemented by 

state and local governments or private organizations—including officials 

from the federal administering agencies—derived lessons from their 

experiences that could help officials design such programs in the future. 

They include the need to quickly identify and contact people affected by a 

disaster, the value of a centrally coordinated approach for assessing

individuals’ health, the importance of monitoring both physical and mental

health, and the need to plan for providing referrals for treatment when

screening examinations identify health problems.

Lessons from WTC

Health Monitoring 

Programs Could

Assist Future 

Monitoring Efforts 

Officials involved in the monitoring programs emphasized the importance 

of quickly identifying and contacting people affected by a disaster. They

said that potential monitoring program participants can become more 

difficult to locate as time passes.35 In addition, potential participants’ 

ability to recall the events of a disaster may decrease over time, making it 

more difficult to collect accurate information about their experiences and 

health. However, the time it takes to design, fund, approve, and implement

monitoring programs can lead to delays in contacting the people who were 

affected. For example, the WTC Health Registry received funding in July

2002 but did not begin collecting data until September 2003—2 years after 

the disaster. From July 2002 through September 2003, the program’s 

activities included developing the registry protocol, testing the 

questionnaire, and obtaining approval from institutional review boards and 

 33The medical examination includes an occupational exposure history and physical

examination, chest X-ray, blood and urine tests, pulmonary function test, audiogram, and 

electrocardiogram. 

34FOH officials told us that under the terms of the agreement, eligible employees can still 

request a screening examination. 

35The extent of the challenge of locating potential participants varied among WTC

monitoring programs, depending on the population involved. For example, FDNY had 

contact information for all potential participants in its monitoring program because they 

were employed by FDNY during or after the disaster. In contrast, the worker and volunteer

program and the WTC Health Registry had to expend considerable effort to identify people 

who were eligible to participate and inform them about the programs. 

Page 19 GAO-05-1020T
the federal Office of Management and Budget.

36 This delayed the collection 

of information from participants. To prevent similar delays during the 

response to future disasters, ATSDR officials are developing a 

questionnaire, known as the Rapid Response Registry, to allow officials to

identify and locate potentially affected individuals immediately after a 

disaster and collect basic preliminary information, such as their current 

contact information and their location during the disaster.37 ATSDR 

officials expect that using this instrument would reduce delays in 

collecting time-sensitive information while officials take the time 

necessary to develop a monitoring program for disaster-related health 

effects. 

Furthermore, officials told us that health monitoring for future disasters 

could benefit from additional centrally coordinated planning. Such 

planning could facilitate the collection of compatible data among 

monitoring efforts, to the extent that this is appropriate. Collecting

compatible data could allow information from different programs to be 

integrated and contribute to improved data analysis and more useful

research. In addition, centrally coordinated planning could help officials 

determine whether separate programs are necessary to serve different 

groups of people. For example, worker and volunteer program officials 

indicated that it might have been possible for that program to serve federal

workers who responded to the disaster in an official capacity, which might

have eliminated the need to organize and administer a separate program 

for them. 

Officials also stated that screening and monitoring programs should be

comprehensive, encompassing both physical and mental health

evaluations. Worker and volunteer medical monitoring program officials 

told us that the initial planning for the program had focused primarily on 

screening participants’ physical health, and that they did not originally

budget for extensive mental health screening. Subsequently, they 

recognized a need for more extensive mental health screening, including 

greater participation of mental health professionals, but the program’s 

 36Institutional review boards are groups that have been formally designated to review and 

monitor biomedical research involving human subjects. Under the Paperwork Reduction 

Act, agencies are required to submit proposed information collections to the Office of

Management and Budget for approval. See, 44 U.S.C. § 3507.

37The Rapid Response Registry has been approved by CDC’s Institutional Review Board 

and has undergone initial review by the Office of Management and Budget. 

Page 20 GAO-05-1020T
federal funding was not sufficient to cover such screening. By 

collaborating with the Mount Sinai School of Medicine Department of

Psychiatry, program officials were able to obtain philanthropic funding to

develop a more comprehensive mental health questionnaire, provide onsite psychiatric screening, and, when necessary, provide more extensive 

evaluations. 

Many participants in the monitoring programs required additional testing 

or needed treatment for health problems that were identified during 

screening examinations. Officials told us that finding treatment sources for

such participants is an important, but challenging, part of the programs’ 

responsibility. For example, officials from the worker and volunteer 

program stated that identifying providers available to treat participants

became a major part of their operations, and was especially difficult when 

participants lacked health insurance. The officials said that planning for 

future monitoring programs should include a determination of how best to

help participants obtain needed treatment. 

Federally funded programs implemented by state and local governments 

or private organizations to monitor the health effects of the WTC attack on 

thousands of people who responded to the disaster have made progress. 

However, the program HHS established to screen the federal employees 

whose agencies sent them to the WTC after the attack has accomplished 

little, completing screenings of fewer than 400 of the thousands of federal 

responders. Moreover, no examinations have occurred for over a year. 

Because of this program’s limited activity, and the inability of federal 

workers to participate in other monitoring programs because of the 

assumption that they would have the opportunity to receive screening 

examinations through the HHS program, many federal responders may not

have had an opportunity to identify and seek treatment for health 

problems related to the WTC disaster. For state responders, the 

opportunity for continued monitoring could be lost if they are not

informed that they are now eligible to participate in the worker and 

volunteer program.

Concluding

Observations 

Based on their experiences, officials involved in the monitoring programs

have made a number of useful observations that will apply to future 

terrorist attacks and natural disasters such as Hurricane Katrina. For 

example, screening for mental as well as physical health problems in New

Orleans and along the Gulf Coast will be critical to the recovery of

survivors of Hurricane Katrina and the responders to the disaster. The 

federal, state, and local government officials who are responsible for 

Page 21 GAO-05-1020T
planning and implementing health monitoring activities in the aftermath of 

disasters could improve their effectiveness by incorporating the lessons

learned from the World Trade Center experience. 

Mr. Chairman, this completes my prepared remarks. I would be happy to

respond to any questions you or other Members of the Subcommittee may 

have at this time. 

For further information about this testimony, please contact Cynthia A. 

Bascetta at (202) 512-7101 or bascettac@gao.gov. Contact points for our 

Offices of Congressional Relations and Public Affairs may be found on the 

last page of this statement. Helene F. Toiv, Assistant Director; George H. 

Bogart; Alice L. London; Roseanne Price; and William R. Simerl made key 

contributions to this statement.

Contact and

Acknowledgments 

Page 22 GAO-05-1020T
Page 23 GAO-05-1020T

Appendix I: Abbreviations 

ATSDR Agency for Toxic Substances and Disease Registry

CDC Centers for Disease Control and Prevention 

DHS Department of Homeland Security

DOD Department of Defense 

DOJ Department of Justice 

FDNY New York City Fire Department

FDNY-BHS New York City Fire Department Bureau of Health Services

FEMA Federal Emergency Management Agency 

FOH Federal Occupational Health Services 

HHS Department of Health and Human Services

NDMS National Disaster Medical System

NIOSH National Institute for Occupational Safety and Health

NYC New York City

OPHEP Office of Public Health Emergency Preparedness

RTI Research Triangle Institute 

WTC World Trade Center 
Page 24 GAO-05-1020T

Appendix II: Government Agencies That Sent 

Responders Following the World Trade 

Center Attack 

Through our work, we identified the following agencies that sent

employees to respond to the World Trade Center attack of September 11,

2001. 

Department of Defense 

Department of Energy 

Department of Health and Human Services

 Agency for Toxic Substances and Disease Registry

 Centers for Disease Control and Prevention 

 National Institutes of Health

 Substance Abuse and Mental Health Services Administration 

Department of Homeland Security

 Federal Emergency Management Agency1

 U.S. Coast Guard2

Department of the Interior

 National Park Service 

Department of Justice 

 Federal Bureau of Investigation 

 U.S. Marshals Service 

Department of Labor 

 Occupational Safety and Health Administration 

Environmental Protection Agency 

Department of Environmental Conservation

Department of Health

Division of Military and Naval Affairs 

Emergency Management Office

Office of Mental Health

Federal Agencies

New York State

Agencies 

 1

At the time of the World Trade Center attack, the Federal Emergency Management Agency 

was an independent agency.

2

At the time of the World Trade Center attack, the U.S. Coast Guard was in the Department

of Transportation. 
New York City

Agencies 

Department of Design and Construction 

Department of Environmental Protection 

Department of Health and Mental Hygiene 

Department of Sanitation

Fire Department 

Metropolitan Transportation Authority 

Office of Emergency Management 

Police Department

(290482) Page 25 GAO-05-1020T
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