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PROTECTING THE PROTECTORS: ENSURING THE 

HEALTH AND SAFETY OF OUR FIRST RESPONDERS 

IN THE WAKE OF CATASTROPHIC DISASTERS 

FULL HEARING 

OF THE

COMMITTEE ON HOMELAND SECURITY 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED TENTH CONGRESS 

FIRST SESSION 

SEPTEMBER 20, 2007 

Serial No. 110–71 

Printed for the use of the Committee on Homeland Security 

Available via the World Wide Web: http://www.gpoaccess.go/congress/index.html 


Congress.#13
COMMITTEE ON HOMELAND SECURITY 

BENNIE G. THOMPSON, Mississippi, Chairman 

LORETTA SANCHEZ, California, 

EDWARD J. MARKEY, Massachusetts 

NORMAN D. DICKS, Washington 

JANE HARMAN, California 

PETER A. DEFAZIO, Oregon 

NITA M. LOWEY, New York 

ELEANOR HOLMES NORTON, District of 

Columbia 

ZOE LOFGREN, California 

SHEILA JACKSON-LEE, Texas 

DONNA M. CHRISTENSEN, U.S. Virgin 

Islands 

BOB ETHERIDGE, North Carolina 

JAMES R. LANGEVIN, Rhode Island 

HENRY CUELLAR, Texas 

CHRISTOPHER P. CARNEY, Pennsylvania 

YVETTE D. CLARKE, New York 

AL GREEN, Texas 

ED PERLMUTTER, Colorado 

PETER T. KING, New York 

LAMAR SMITH, Texas 

CHRISTOPHER SHAYS, Connecticut 

MARK E. SOUDER, Indiana 

TOM DAVIS, Virginia 

DANIEL E. LUNGREN, California 

MIKE ROGERS, Alabama 

BOBBY JINDAL, Louisiana 

DAVID G. REICHERT, Washington 

MICHAEL T. MCCAUL, Texas 

CHARLES W. DENT, Pennsylvania 

GINNY BROWN-WAITE, Florida 

MARSHA BLACKBURN, Tennessee 

GUS M. BILIRAKIS, Florida 

DAVID DAVIS, Tennessee 

JESSICA HERRERA-FLANIGAN, Staff Director & General Counsel 

ROSALINE COHEN, Chief Counsel 

MICHAEL TWINCHEK, Chief Clerk 

ROBERT O’CONNOR, Minority Staff Director 

(II) 

(III) 

C O N T E N T S 

Page 

STATEMENTS 

The Honorable Bennie G. Thompson, a Representative in Congress From 

the State of Mississippi, and Chairman, Committee on Homeland Security .. 1 

The Honorable Peter T. King, a Representative in Congress From the State 

of New York, and Ranking Member, Committee on Homeland Security ........ 2 

The Honorable Gus M. Bilirakis, a Representative in Congress From the 

State of Florida ..................................................................................................... 16 

The Honorable Donna M. Christensen, a Delegate in Congress From the 

U.S. Virgin Islands ............................................................................................... 20 

The Honorable Yvette D. Clarke, a Representative in Congress From the 

State of New York ................................................................................................ 24 

The Honorable Henry Cuellar, a Representative in Congress From the State 

of Texas ................................................................................................................. 26 

The Honorable Charles W. Dent, a Representative in Congress From the 

State of Pennsylvania .......................................................................................... 29 

The Honorable Bob Etheridge, a Representative in Congress From the State 

of North Carolina ................................................................................................. 18 

The Honorable Nita M. Lowey, a Representative in Congress From the State 

of New York .......................................................................................................... 61 

The Honorable Eleanor Holmes Norton, a Delegate in Congress From the 

District .................................................................................................................. 30 

The Honorable Mark E. Souder, a Representative in Congress From the 

State of Indiana .................................................................................................... 21 

WITNESSES

PANEL I 

Ms. Cynthia A. Bascetta, Director, Health Care, Government Accountability 

Office ..................................................................................................................... 12 

John Howard, MD, Director, National Institute for Occupational Health and 

Safety, Centers for Disease Control and Prevention, Department of Health 

and Human Services: 

Oral Statement ..................................................................................................... 8 

Prepared Statement ............................................................................................. 8 

Jon R. Krohmer, MD, F.A.C.E.P. Deputy Chief Medical Officer, Department 

of Homeland Security: 

Oral Statement ..................................................................................................... 4 

Prepared Statement ............................................................................................. 6 

PANELL II 

Philip J. Landrigan, MD, MSc, Professor and Chairman, Department of 

Community and Preventive Medicine, Mount Sinai School of Medicine: 

Oral Statement ..................................................................................................... 33 

Prepared Statement ............................................................................................. 35 

Mike D. McDaniel, PhD, Secretary, Louisiana Department of Environmental 

Quality: 

Oral Statement ..................................................................................................... 47 

Prepared Statement ............................................................................................. 50 

Page

IV 

Deputy Chief Nicholas Visconti, International Association of Fire Fighters: 

Oral Statement ..................................................................................................... 39 

Prepared Statement ............................................................................................. 41 

APPENDIX

Additional Questions and Responses: 

Responses from Ms. Cynthia A. Bascetta .......................................................... 71 

Responses from John Howard, MD .................................................................... 72 

Responses from Jon R. Krohmer, MD ................................................................ 74 

Responses from Philip J. Landrigan, MD .......................................................... 78 

Responses from Mike D. McDaniel, PhD ........................................................... 80 

(1) 

PROTECTING THE PROTECTORS: ENSURING 

THE HEALTH AND SAFETY OF OUR FIRST 

RESPONDERS IN THE WAKE OF 

CATASTROPHIC DISASTERS 

Thursday, September 20, 2007 

U.S. HOUSE OF REPRESENTATIVES, 

COMMITTEE ON HOMELAND SECURITY, 

Washington, DC. 

The committee met, pursuant to call, at 10:04 a.m., in Room 311, 

Cannon House Office Building, Hon. Bennie G. Thompson [chairman of the committee] presiding. 

Present: Representatives Thompson, Sanchez, Lowey, Norton, 

Christensen, Etheridge, Cuellar, Clarke, King, Souder, Dent, Bilirakis, McCaul and Lofgren. 

Chairman THOMPSON. The Committee on Homeland Security will 

come to order. 

Good morning. On behalf of the members of the committee, let 

me welcome our witnesses. 

The committee is meeting today to discuss how we can ensure 

the health and safety of our first responders following disasters, 

whether they are manmade or natural. 

Following the collapse of the World Trade Center, approximately 

40,000 responders involved in the rescue, recovery and cleanup 

were exposed to a mixture of dust, debris and smoke-filled lethal 

substances. As time has gone on, firefighters, law enforcement officers, EMTs and workers in the construction trades increasingly 

have gotten sick, most often with respiratory illnesses. 

I look forward to hearing from our witnesses on the status of the 

various medical monitoring and treatment programs that have 

been put into place to address these issues at the site of the World 

Trade Center. 

Subsequently, in August of 2005, Hurricane Katrina devastated 

the Gulf Coast, flooding 80 percent of the city of New Orleans with 

up to 15 feet of water. Millions of gallons of oil were released from 

storage facilities, and tons of wreckage from abandoned cars, 

homes and refrigerators were left in its wake. First responders who 

came from all over the country to help the residents of Louisiana 

and my home State of Mississippi were exposed to filthy flood 

water filled with agricultural and industrial waste and sewage. 

However, there currently is not a system in place to adequately 

track their health, and I worry that the long-term impacts may 

never be completely known. 

2 

In addition, we cannot forget the psychological trauma of our 

first responders, who are exposed to tragedies like 9/11, Katrina 

and Oklahoma City bombings. While working in these situations, 

they see things and have experiences that take a serious toll on 

their mental health being. This often leads to post-traumatic stress 

disorder. Currently, FEMA will fund short-term crisis counseling, 

but Federal assistance does not extend to psychiatric and, often, 

long-term treatment for conditions that stem from disasters. We 

need to examine whether the Federal Government should do more 

in this area. 

Effective health and safety should not be limited to monitoring 

and treating our heroes after they get sick; we should also be focused on preventive measures. No firefighter, law enforcement officer or EMT should go without the personal protective equipment 

or training they need to be safe. The various Federal first responder grant programs are critical in accomplishing this goal, and 

we must reverse the trend of budget cuts we have seen in recent 

years for many of those programs. 

In addition, while the issues of interoperable communication is 

not often considered a health and safety issue, it absolutely is. 

Many firefighters who lost their lives in the World Trade Center 

on 9/11 could have been saved if they had better communications. 

Finally, while I believe it is critical to examine what went wrong 

in past disasters and how we are taking care of our sick emergency 

workers, I hope we can translate the lessons learned from these 

tragedies into positive changes. However, I still have my doubts 

whether there has been sufficient planning and coordination between and among all the relevant Federal agencies. Everyone 

needs to know their respective roles and responsibilities in the 

areas of worker safety and medical monitoring. Unfortunately, this 

country again will have to face another 9/11 or Katrina. We must 

act now to ensure that we protect those who bravely put their lives 

on the line to protect us. 

I want to thank the witnesses again for their testimony. 

And the Chair now recognizes the ranking minority member of 

the full committee, the gentleman from New York, Mr. King, for 

any statement he may have. 

Mr. KING. Thank you, Mr. Chairman. Thank you for recognizing 

me. More importantly, thanks for holding this hearing on an issue 

which is very important and certainly must be addressed. 

My own district in New York lost almost 150 constituents on 

September 11. In addition to those who were lost, there are also 

many who are still suffering and an increasing number who are 

suffering health effects from the recovery effort and the rescue 

work that went on on September 11 and in, literally, the months 

and months that followed that. 

Obviously, there is a significant role for Congress to play. There 

is also a significant role for local and State governments to play, 

and it is important that we recognize and acknowledge the situation that does exist. 

New York was probably as well-prepared as anyone could be for 

a disaster of this type, and yet we saw much more that had to be 

done that wasn’t. The FDNY, the NYPD, were as well-trained as 

any units in the country could be, yet no one was quite ready for 

3 

an attack of this magnitude, of this enormity. And, certainly, what 

was done in the days and weeks after did contribute to lingering 

and, in too many cases, actual fatal effects from what went on during the recovery effort. 

I am supporting legislation, along with Congresswoman Maloney 

and Congressman Fossella, to enable those who do suffer from the 

effects of September 11 to be able to be compensated from the Victim Compensation Fund, because that fund was made available to 

people who were injured or wounded on September 11, and many 

of the illnesses we are finding now were not known as of the time 

the deadline for filing claims expired. I think it is important we go 

forward with that. 

I want to commend Mount Sinai Hospital in New York for the 

program that they have. They really have stepped up on this and 

are doing an extraordinary job of monitoring and analyzing the effects of September 11. 

Also, fortunately, the FDNY had a program in place which 

makes it easier—I don’t know if ‘‘easier’’ is the right word or not, 

but I will say easier—to notice effects of September 11, since they 

have a backdrop against which they can base their current analysis, current health conditions, because of the history of examinations that are being held by the FDNY. 

But this is a very significant hearing. We have to, in planning 

for the future of September 11—as tragic as it was, it could have 

been worse—it could be worse in the future. We have to, when we 

are preparing for catastrophes, use September 11 as an example of 

just how bad it can be and even worse. And we have to be better 

prepared for all contingencies: to stop the attack or the natural disaster, as happened in Katrina; to prevent it to the extent that it 

can be done; to address it at the time it is happening; and then to 

be ready in the immediate and subsequent aftermath to address 

the first responders who put their lives and health on the line to 

protect so many people, to rescue so many people and to recover 

the remains of those who do not survive the attack or the natural 

disaster. 

So I look forward to the hearing. Unfortunately, I will not be able 

to stay throughout the hearing, but if Congressman Bilirakis will 

fill in for a while, I would certainly appreciate it. My staff will be 

updating me, and I will certainly study all the testimony and the 

transcript. 

Mr. Chairman, I yield back. Thank you for holding this hearing. 

Chairman THOMPSON. Thank you very much, Ranking Member 

King. 

Other members of the committee are reminded that, under committee rules, opening statements may be submitted for the record. 

I welcome the panel of witnesses. 

Our first witness, Dr. Jon Krohmer is the Deputy Assistant Secretary for Health Affairs and Deputy Chief Medical Officer for the 

Office of Health Affairs in the Department of Homeland Security. 

Dr. Krohmer is a physician trained in emergency medicine and has 

been a real leader in this field. He has held a variety of leadership 

positions, including president of the National Association of EMS 

Physicians. His work in setting standards for EMS providers of all 

types is well-recognized. 

4 

Our second witness, Dr. John Howard, is Director of the National 

Institute for Occupational Safety and Health and a fellow coordinator for the World Trade Center health issues. Dr. Howard is an 

occupational physician who has emphasized both occupational 

health and public safety during his career. 

Our third witness is Ms. Cynthia Bascetta, Director of the 

Health Care Division of the Government Accountability Office, at 

the GAO. Ms. Bascetta has addressed a number of issues, including 

bioterrorism preparedness, veteran affairs, military health care, as 

well as health-related issues generated by the situations of concern 

to us today, Hurricane Katrina and the WTC. 

We thank all three of our witnesses for their service to the Nation and for being here today. 

Without objection, the witnesses’ full statements will be inserted 

in the record. 

I now ask each witness to summarize his or her statement for 

5 minutes, beginning with Dr. Krohmer. 

STATEMENT OF JON R. KROHMER, MD, F.A.C.E.P, DEPUTY 

CHIEF MEDICAL OFFICER, DEPARTMENT OF HOMELAND 

SECURITY 

Dr. KROHMER. Mr. Chairman, Ranking Member King and members of the committee, as you noted, I am the Deputy Assistant 

Secretary of Health Affairs and the Deputy Chief Medical Officer 

in the Department of Homeland Security. Thank you for the opportunity to testify before the committee on this critical issue of first 

responder health and safety. 

On behalf of Secretary Chertoff, Dr. Runge, the Acting Assistant 

Secretary and Chief Medical Officer, and the Department, thank 

you for your continued leadership and willingness to work with the 

Department to address the issues facing our Nation’s health care 

security. 

The Office of Health Affairs serves as the Department’s principal 

agent for all medical and public health issues and is responsible for 

ensuring a unified program for medical support of the Department’s missions, to include the integration of occupational medicine 

and workforce protection principles whenever DHS personnel are 

deployed during a critical incident. 

Our goal in the Office of Health Affairs is to work closely with 

our safety and environmental sciences colleagues to have a comprehensive approach to health and safety for all employees of the 

Department, regardless of their work setting. My role today is not 

to discuss the overall approach to health and safety of first responders nationally, but to focus on that of DHS employees. 

Within the emergency response community, there is an axiom 

that we must care for those who care for others. Ensuring scientifically sound, compassionate and comprehensive health and safety 

support for emergency responders is a priority for all government 

agencies. 

In the aftermath of the attacks of September 11 and the Gulf 

Coast hurricanes, emergency personnel were exposed to a number 

of environmental contaminants and irritants. We have learned a 

great deal from those events, but we still have progress to make. 

5 

Our DHS first responder role is actually fairly minimal. In general, the first people on site in any incident will be the local and 

State emergency services personnel. However, once Federal assistance is requested, DHS will deploy early responder personnel while 

incidents are still in flux and do not have a typical safety and support system in place. Consequently, we must have the same concerns for our early responders that we do for the local communities’ 

first responders. 

At the Department level, we now have two offices that work together to provide policies, requirements, standards and metrics to 

support safety and health functions. In addition to the Office of 

Health Affairs, the Office of Safety and Environmental Programs, 

or OSEP, provides guidance, oversight and advocacy for the safety 

and health needs of the components. Collectively, our role is to facilitate and coordinate occupational health issues and the expanding functions to improve specific responder safety across components. 

Within the Office of Health Affairs, we have recently established 

the Office of Component Services to focus on optimizing health-related services and consultations in DHS. This program will partner 

with OSEP to ensure that occupational medicine principles are incorporated throughout the Department. This partnership, with 

each office bringing specific complementary skill sets to the program, increases program benefits. Additionally, by placing the head 

of the Component Services Office, a physician, as a direct report to 

the Assistant Secretary for Health Affairs, we are ensuring that 

these critical issues have high visibility and a well-positioned advocate within DHS. 

The first new position we have filled within Component Services 

is the Director for Workforce Health Promotion and Wellness. This 

position will address such issues as medical and physical recommendations for deployment to critical incidents and the health 

and safety training requirements for those responders. 

With OSEP, this branch will also develop standards and policies 

for environmental and safety assessments of areas to which DHS 

personnel are deployed and the resulting requirements for appropriate personal protective equipment. Soon, we will also be hiring 

an occupational medicine physician, who will work to provide medical guidelines and recommendations for the physical and medical 

preparations of responders and to develop plans for medical and 

psychological assistance for personnel during and after deployments. 

Direct medical support for DHS personnel responding to critical 

situations is also a primary consideration of our office. We recognize that there will be certain intensive operations which are 

unique to these responders. We are in the process of hiring a physician director for emergency medical services, who will have a specific goal of ensuring that the operational personnel of the Department have the appropriate medical support services in place, to 

give them the confidence that DHS will do everything in our power 

to take care of them medically. 

We also recognize the need for horizontal and vertical integration 

and will strive to work across the Federal Government and through 

our State, territorial, tribal and local partners to ensure that there 

6 

is a integrated approach to the health and safety issues of all first 

responders. 

Mr. Chairman, I appreciate the opportunity to outline for the 

committee the importance that DHS puts on ensuring the health 

and safety of our responders, and we will look forward to answering any questions you might have. 

[The statement of Dr. Krohmer follows:] 

PREPARED STATEMENT OF JON R. KROHMER, MD, F.A.C.E.P. 

Mr. Chairman, Ranking Member King, and Members of the Committee: 

I am Dr. Jon Krohmer, the Deputy Assistant Secretary for Health Affairs and 

Deputy Chief Medical Officer within the Department of Homeland Security. Let me 

begin by thanking you for the opportunity to testify before the Committee on these 

critical issues related to ensuring the health and safety of our nation’s first responders. In addition, on behalf of Secretary Chertoff, Dr. Runge—the Acting Assistant 

Secretary and the Chief Medical Officer—and the rest of the Department, thank you 

for your continued leadership and willingness to work with the Department to address many of the issues facing our nation’s security. 

My office, the Office of Health Affairs, serves as the Department’s principal agent 

for all medical and public health matters and is responsible for ensuring a unified 

program for medical support of the Department’s missions, including the integration 

of occupational medicine and workforce protection principles into the occupational 

health and safety programs of DHS and its components. Importantly, this includes 

ensuring that these principles are applied whenever DHS personnel are deployed in 

a response role during any critical incident. 

One point that I would like to make at the outset is that while today’s hearing 

is focused on ‘‘first responders,’’ our goal in the Office of Health Affairs is to work 

hand-in-hand with our safety and environmental sciences colleagues to have a comprehensive approach to health and safety for employees of the Department, from 

those who are working in a climate controlled office, to those protecting our borders 

and airports, to those who are deploying on no-notice to the worst imaginable disasters, both natural and man-made. Importantly, my role here today is not to discuss 

the overall approach to health and safety of first responders nationally, but to focus 

on how the Department of Homeland Security is working to ensure the health and 

safety of early responders from the component agencies of DHS, including TSA, 

CBP, Coast Guard, FEMA and others. 

Within the emergency response community, it is an axiom that we must ‘‘care for 

those who care for others.’’ Ensuring scientifically sound, compassionate, and comprehensive health and safety support for emergency responders is a priority for all 

government agencies involved in emergency response. In the aftermath of the attacks of September 11th and Hurricane Katrina, emergency personnel and others 

involved in the response effort were exposed to a number of environmental contaminants and irritants. These were, obviously, large scale events for the responder community, and even for the greater public health community, but, as you know, today 

we must think about the unthinkable. Initial safety assessments and the safety 

measures applied to incident management of those events were not what they would 

be today, based on the lessons we have learned from those events. We have learned 

a great deal from those events, both in terms of how we protect our first responders 

and in the long-term management of those involved, but we still have progress to 

make. My colleagues testifying today will detail many of the lessons learned and 

actions that have been taken in response to those events. I have been asked to discuss how DHS has taken those lessons-learned and what is being done now to ensure that responder health and safety advances are moving forward. 

Let me also add that our DHS ‘‘first responder’’ role is actually fairly minimal, 

as we know that, in general, the first people on site in any incident will be the local 

and state emergency services personnel. However, once assistance from the Federal 

Government is requested DHS will deploy ‘‘early responder’’ personnel to respond 

to incidents that are still in flux and do not have the usual safety and support systems in place. Consequently, we must have the same concerns for these ‘‘early responders’’ that we do for the local community’s first responders. 

DHS occupational safety and health programs, including those supporting personnel who respond to major disasters and other catastrophies, have historically 

been a function of management because they directly affect the efficiency and productivity of the workforce and because they are often seen primarily as responsive 

to laws and regulations related to the Occupational Safety and Health Act. These 

7 

functions are managed primarily by the safety offices within the individual operating components. At the Department level, we have two offices that work in close 

coordination to provide policies, requirements, standards and metrics to support the 

safety and health functions at the component level. In addition to the Office of 

Health Affairs, the Office of Safety and Environmental Programs, or ‘‘OSEP,’’ provides guidance, oversight and, importantly, advocacy for the safety and health needs 

of the components. Collectively, our role is to facilitate and coordinate the occupational health issues across components. It is a combination of oversight management 

(e.g. ensuring OSHA rules are applied in all situations) and the more recently expanding functions to improve specific first responder safety across all components. 

Within the Office of Health Affairs, we have recently established the Office of 

Component Services to focus on optimizing health related services and consultations 

for component agencies of DHS. I would like to take a few moments to outline the 

objectives of the office that bear on the health and safety of our response personnel. 

The Office of Component Services will partner with OSEP to ensure that occupational medicine principles are incorporated. This partnership, with each office bringing specific complimentary skill-sets to the program, increases program benefits 

throughout the Department. Additionally, by placing the head of the Component 

Services office as a direct report to the Assistant Secretary for Health Affairs, we 

are ensuring that these critical safety and health issues have high visibility and 

have a well positioned advocate within DHS. 

The first new position we have filled within Component Services is a Director for 

Workforce Health Promotion and Wellness, who will directly address the concerns 

of our response personnel. Staffed with an Industrial Hygienist and supported by 

the physician staff of the Office, this position will address such issues as medical 

and physical recommendations for deployments to critical incidents, including vaccination and preventive medicine services, as well as the health and safety training 

requirements for responders. Additionally, in conjunction with OSEP, this branch 

will be well-positioned to develop standards and policies for environmental and safety assessments of areas to which DHS personnel are deployed, and the resulting requirements for personal protective equipment, or PPE, for our personnel. 

Over the coming weeks, we will also be bringing on board an Occupational Medicine Physician who will work with the Human Capital Office and the individual 

DHS components to provide medical guidance and recommendations for the physical 

and medical preparation of responders and to develop plans for medical and psychological assistance for personnel during and after deployments. 

Direct medical support for DHS personnel, particularly those responding to critical situations, is also a primary consideration in the event that prevention efforts 

are overwhelmed in a disaster situation. In general, medical systems established in 

a disaster setting will take care of both victims and responders. At the same time, 

however, we recognize that there will be certain intensive operations which are 

unique to responders, including aviation response, wilderness rescue, toxic environments, and so on. We are in the process of hiring a Director for Emergency Medical 

Services who will have the specific goal of ensuring that the operational personnel 

of the department, in either a law enforcement role, or a responder role, have the 

right medical support services in place to give them the confidence that DHS will 

do everything in our power to take care of them medically. 

Finally, I would like to note that we also recognize the need for horizontal and 

vertical integration of response to early responder health and safety issues. This response is not just a local issue, nor a state issue, nor an HHS issue, nor a DHS 

issue. Instead, ensuring the safety of our first responders is a shared obligation that 

the entire response community has to those who put themselves in harm’s way for 

the betterment and safety of others. We will always strive to work across the federal 

government and through our state, territorial, tribal, and local partners to ensure 

that there is an integrated approach to ensuring the health and safety of all first 

responders. 

Mr. Chairman, I appreciate the opportunity to have outlined for you today the importance that the Department of Homeland Security places on ensuring the health 

and safety of our response personnel and look forward to answering any questions 

you may have on these matters. 

Chairman THOMPSON. Thank you for your testimony. 

I now recognize Dr. Howard to summarize his statement for 5 

minutes. 

Dr. Howard? 

8 

STATEMENT OF JOHN HOWARD, MD, M.P.H., DIRECTOR, 

NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND 

HEALTH, DEPARTMENT HEALTH AND HUMAN SERVICES 

Dr. HOWARD. Thank you, Mr. Chairman and members of the subcommittee. I am from the National Institute for Occupational Safety and Health, NIOSH, in the Centers for Disease Control and Prevention, of the Department of Health and Human Services. 

I am pleased to be here today to share with you some on observations about ensuring responder safety and health based on my experience in coordinating programs of the Department for World 

Trade Center volunteers. 

Over 36,000 World Trade Center responders and volunteers from 

across the country are currently enrolled in a federally funded 

medical monitoring and treatment program. Just over 7,000 of 

these responders are being treated for physical health ailments and 

nearly 5,000 for mental health conditions associated with their heroic response to the World Trade Center attacks. 

Also, in collaboration with the New York City Department of 

Health and Mental Hygiene, the Department funds the World 

Trade Center Health Registry. The registry tracks the health of 

71,000 responders, residents, office workers, students, school staff 

and those present in the area of the World Trade Center on September 11, 2001. The registry’s findings provide an important picture of the long-term physical and mental health consequences of 

September 11. 

These programs, as well as NIOSH-funded studies since 2001, 

have generated a body of knowledge that indicates the importance 

of ensuring the safety and the health of disaster responders before 

they are deployed, while they are deployed and after deployment. 

Before deployment, it is critical to provide pre-event training 

about likely hazards and hands-on instruction in the use of personal protective equipment. 

While responders are deployed, it is critical, at a minimum, to: 

one, compile a list of responders and their daily, individual disaster 

site exposure profiles; two, reinforce training with on-scene training, especially for spontaneous or unaffiliated responders who volunteer their services; three, establish integrated safety management among all responding agencies; four, set up tight disaster site 

perimeter control; five, rigorously track responder entry and exit 

from that site; six, employ shift rotation to enable shorter duration 

of service at the site; and, seven, engage in real-time exposure assessment and hazard control. 

After deployment, it is critical to screen responders for health effects based on exposure assessment findings or the occurrence of 

symptoms. Positive findings would then lead to long-term medical 

monitoring and treatment, as necessary. 

Thank you, Mr. Chairman. I would be pleased to answer any 

questions you might have. 

[The statement of Dr. Howard follows:] 

PREPARED STATEMENT OF JOHN HOWARD, MD, M.P.H. 

Good morning, Chairman Thompson and other distinguished Members of the 

Committee. My name is John Howard, and I am the Director of the National Institute for Occupational Safety and Health (NIOSH), which is part of the Centers for 

9 

Disease Control and Prevention (CDC) within the Department of Health and 

Human Services (HHS). CDC’s mission is to promote health and quality of life by 

preventing and controlling disease, injury and disability. NIOSH is a research institute within CDC that is responsible for conducting research and making recommendations to identify and prevent work-related illness and injury. 

Mr. Chairman, I would like to express my appreciation to you and to the members 

of the subcommittee for holding this hearing and for addressing the critical need 

of ensuring the health and safety of our first responders. I am pleased to appear 

before you today to report on the progress we have made in addressing the health 

needs of those who served in the response effort after the World Trade Center 

(WTC) attack on 9/11 and NIOSH’s ongoing activities to protect responders in general. 

Since February 2006, I have served as the HHS WTC Programs Coordinator. Secretary of Health and Human Services Michael O. Leavitt determined that there was 

a ‘‘critical need to ensure that programs addressing the health of WTC responders 

and nearby residents are well-coordinated,’’ and charged me with this important 

task. Since receiving this assignment I have traveled to New York City (NYC) and 

Albany, New York, to assess the status of the existing HHS programs addressing 

WTC health effects, and meet with those we serve. Participating in these dialogues 

has enabled me to better understand the needs of those affected, and the steps we 

can take to meet those needs. As the HHS WTC Programs Coordinator, I work to 

coordinate the existing programs and ensure scientific reporting to provide a better 

understanding of the health effects arising from the WTC attack. Today, I will focus 

my remarks on the progress we’ve made towards these tasks, lessons learned, and 

NIOSH’s efforts to address responders’ needs for future disasters. 

WTC Responder Health Program—Monitoring and Treatment 

Since 2002, agencies and offices within HHS have been dedicated to tracking and 

screening WTC rescue, recovery and clean up workers and volunteers (responders). 

In 2004, NIOSH established the national WTC Worker and Volunteer Medical 

Monitoring Program to continue baseline screening (initiated in 2002), and provide 

long-term medical monitoring for WTC responders. In fiscal year 2006, Congress appropriated $75 million to CDC to further support existing HHS WTC programs and 

provide screening, monitoring, and medical treatment for responders. Since these 

funds were appropriated, NIOSH has established a coordinated WTC Responder 

Health Program to provide annual screenings, as well as diagnosis and treatment 

for WTC-related conditions (e.g. aerodigestive, musculoskeletal, and mental health) 

identified during monitoring exams. The WTC Responder Health Program consists 

of a consortium of clinical centers and data and coordination centers that provide 

patient tracking, standardized clinical and mental health screening, treatment, and 

patient data management. 

To date, the WTC Responder Health Program has screened approximately 36,000 

responders. The New York City Fire Department (FDNY) manages the clinical center that serves FDNY firefighters who worked at Ground Zero. As of July 31, 2007, 

FDNY had conducted 29,203 screenings, including 14,429 initial examinations and 

14,774 follow-up examinations. The Mt. Sinai School of Medicine?s Center for Occupational and Environmental Medicine coordinates a consortium of clinics that serve 

other response workers and volunteers who were active in the WTC rescue and recovery efforts. These clinics have conducted 21,088 initial examinations and 9,101 

follow up examinations. Of the 36,000 responders in the WTC Responder Health 

Program, 7,603 have received treatment for aerodigestive conditions, such as asthma, interstitial lung disease, chronic cough, and gastro-esophageal reflux, and 4,868 

have been treated for mental health conditions. 

The availability of treatment for both physical and mental WTC-related health 

conditions has encouraged more responders to enroll and continue participating in 

the WTC Responder Health Program, which will enable us to better understand and 

treat the long-term effects of their WTC exposures. 

WTC Federal Responder Screening Program 

In fiscal year 2002, the HHS Office of Public Health Emergency Preparedness— 

which is now the Office of the Assistant Secretary for Preparedness and Response 

(ASPR)—received $3.74 million through Federal Emergency Management Agency 

(FEMA) to establish the WTC Federal Responder Screening Program to provide 

medical screening for all Federal employees who were involved in the rescue, recovery or clean up efforts. Current Federal employees in this program are screened by 

the HHS Federal Occupational Health (FOH), a service unit within HHS. FOH has 

clinics located in areas where large numbers of Federal workers are employed. As 

of August 31, 2007, FOH had screened 1,331 Federal responders. In February 2006, 

CDC–NIOSH and OPHEP (now ASPR) signed a Memorandum of Understanding to 

10 

monitor former Federal workers via the WTC Responder Health Program. Since 

then, former Federal workers have been enrolled in the WTC Responder Health Program and served by the Mt. Sinai Data and Coordination Center and national clinic 

partners. 

Nationwide Scope 

HHS is working with its partners to ensure that the benefits of all federally-funded programs are available to all responders, across the nation. Those responders 

who selflessly came to the rescue of NYC from throughout the country to assist in 

rescue efforts at the time of the WTC disaster should receive the same high quality 

monitoring and treatment as those who reside in the NYC Metropolitan Area. Enrollees in the WTC Responder Health Program who are not located in the NYC Metropolitan Area, receive monitoring and treatment via a national network of clinics 

managed by QTC, Inc. and the Association of Occupational and Environmental Clinics (AOEC), respectively. To date, 698 responders outside of the NY Metropolitan 

Area have been screened by the WTC Responder Health Program. 

Achieving such nationwide coverage for WTC responders is challenging; however, 

we are committed to serving all responders, regardless of their location or employment status. I am actively working with the medical directors of the WTC Health 

Program, the WTC Federal Responder Screening Program, QTC, Inc. and AOEC to 

ensure that the services available to responders are uniform across programs. 

WTC Health Registry 

In addition to the WTC Responder Health Program, the Agency for Toxic Substances and Disease Registry (ATSDR) maintains the World Trade Center Health 

Registry. In 2003, ATSDR, in collaboration with the New York City Department of 

Health and Mental Hygiene (NYCDOHMH), established the WTC Health Registry 

to identify and track the long-term health effects of tens of thousands of residents, 

school children and workers (located in the vicinity of the WTC collapse, as well as 

those participating in the response effort) who were the most directly exposed to 

smoke, dust, and debris resulting from the WTC collapse. 

WTC Health Registry registrants will be interviewed periodically through the use 

of a comprehensive and confidential health survey to assess their physical and mental health. At the conclusion of baseline data collection in November 2004, 71,437 

interviews had been completed, establishing the WTC Health Registry as the largest 

health registry of its kind in the United States. The Registry findings provide an 

important picture of the long-term health consequences of the events of September 

11th. Registry data are used to identify trends in physical and mental health resulting from the exposure of nearby residents, school children and workers to WTC 

dust, smoke and debris. 

The WTC Health Registry also serves as a resource for future investigations, including epidemiological, population specific, and other research studies, concerning 

the health consequences of exposed persons. These studies can assist those working 

in disaster planning who are proposing monitoring and treatment programs by focusing their attention on the adverse health effects of airborne exposures and the 

short- and long-term needs of those who are exposed. The findings will permit us 

to develop and disseminate important prevention and public policy information for 

use in the unfortunate event of future disasters. 

Since 9/11, HHS has worked diligently with our partners to best serve those who 

served their country, as well as those in nearby communities affected by the tragic 

attack. While we have made much progress, we must continue to gather and analyze data that will enable us to better understand the health effects we have observed. 

Funding 

I want to reaffirm the Department’s commitment to work with the Congress to 

provide compassionate and appropriate help to responders affected by the World 

Trade Center exposures following the attacks. 

As you know, the Department of Defense, Emergency Supplemental Appropriations to Address Hurricanes in the Gulf of Mexico, and Pandemic Influenza Act of 

2006 (P.L. 109–148) provided $75 million for the treatment, screening, and monitoring of the responders. With less than one month remaining in the fiscal year (FY) 

we are confident this funding will last at least until the end of fiscal year 2007. 

The President’s fiscal year 2008 budget requests $25 million for World Trade Center responders and in May 2007, the President signed the U.S. Troop Readiness, 

Veterans’ Care, Katrina Recovery, and Iraq Accountability Appropriations Act of 

2007 (P.L. 110–128), which included an additional $50 million to support continued 

treatment and monitoring for World Trade Center responders. This funding will be 

11 

awarded, as needed, to support continued monitoring, care, and treatment of responders through fiscal year 2008. 

From July 1, 2006, through June 30, 2007, the Federal grantees have reported to NIOSH spending approximately $15 million total for treatment for World Trade 

Center related illnesses. This includes $6 million from American Red Cross funds 

and $9 million from the $42 million total Federal grants awarded in October 2006. 

Of this $9 million, the grantees have actually ?drawn down? only $2 million in payments on the Federal grants. Over $90 million in appropriated funds remains available—including the balance of the treatment funds appropriated in fiscal year 2006 and the $50 million appropriated in fiscal year 2007—before adding the $25 million included in the President’s fiscal year 2008 budget request. HHS is gathering additional financial data 

from the Federal grantees in order to better understand the healthcare cost issues 

of the responders. Additional data will help inform our policies, ensure that the current program operates efficiently and effectively, and maximize the available resources to meet responders’ medical needs. HHS will continue to monitor the work 

of the grantees as part of the fiscal year 2009 budget process. 

Lessons Learned 

In December 2001, NIOSH convened a conference to explore lessons about preserving the safety and health of emergency responders in the context of terrorist attacks, organized and led by the RAND Science and Technology Policy Institute in 

New York City. This conference and subsequent evaluations of response efforts to 

large-scale disasters concluded that there is a critical need for: • Accessibility to protective and practical personal protective equipment (PPE) 

and hazard monitoring technologies; 

• Interagency training to aid in the effective implementation of health and safety measures and PPE enforcement; 

• Quick and effective establishment of a command authority over the disaster 

site and perimeter control; and 

• Tracking of responders. 

In my experience as WTC Health Coordinator, I have learned that we must address responder safety and health in three stages: pre-deployment, deployment and 

post-deployment. During the pre-deployment stage, prior to the initiation of a response, all responders need to be adequately trained to recognize and protect themselves from health and safety hazards. Adequate preparation is especially important 

for spontaneous or unaffiliated responders who volunteer their services. As reported 

in findings based on WTC Health Registry data, these responders are often more 

adversely affected, possibly due to a lack of health and safety training (American 

Journal of Psychiatry, 2007; 164; 1385—1394). During the deployment stage, when 

responders are actively engaged in the response effort, it is critical to track responders’ access to the disaster site and conduct real-time exposure assessment. Knowing 

where responders have gone and their potential exposures will enable us to more 

accurately assess their health effects and determine their post-deployment needs. 

During post-deployment, once the response effort is completed, responders should be 

screened for health (physical and emotional) effects, if exposure assessment or the 

occurrence of symptoms indicates. These findings could then be used to determine 

if long-term monitoring and treatment are necessary. To ensure responder safety 

and health during future disaster events, we must address each of these stages. 

Additional NIOSH Programs 

In addition to WTC-related programs, NIOSH continues to conduct research and 

make recommendations to protect the health and safety of first responders and recovery workers through various program activities. 

In the aftermath of disasters, NIOSH actively participates in the response effort 

and identifies staff to provide technical expertise to meet immediate worker protection needs. As outlined by the Worker Safety and Health Annex of the National Response Plan, NIOSH provides assistance on occupational exposure assessments, provides guidance on personal protective equipment, and develops and disseminates 

guidelines to integrate worker safety and health into site operations. NIOSH works 

with multidisciplinary occupational safety and health teams to develop procedures 

for follow-up evaluations of worker injuries, conduct health hazard evaluations 

(HHEs) and provide technical assistance to local, state, and Federal governmental 

agencies to assess potential health effects from workers’ exposures in the recovery 

zone. 

NIOSH also conducts research to address the critical need for effective personal 

protective technologies, such as respirators, chemical-resistant clothing, hearing protectors, and safety goggles and glasses that provide a barrier between the worker 

and an occupational safety or health risk. Building upon NIOSH’s longstanding resVerDate Nov 24 2008 12:49 Nov 17, 2009 Jkt 000000 PO 00000 Frm 00015 Fmt 6633 Sfmt 6621 H:\DOCS\110-HRGS\110-71\48966.TXT HSEC PsN: DIANE
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piratory certification and evaluation program for respirators used in traditional 

work settings, NIOSH scientists test and approve respirators for use by responders 

against chemical, biological, radiological, and nuclear (CBRN) agents. Since 9/11, 

NIOSH has approved 77 different models of CBRN respirators. Our work has led 

to an increase in the national inventory of respiratory protection equipment and 

supports the long-term development of standards and technologies for protecting the 

health and safety of workers, especially first responders. 

NIOSH addresses hazards specific to fire fighters through the Fire Fighter Fatality Investigation and Prevention Program. Through this program NIOSH conducts 

in-depth evaluations of fire fighter line-of-duty deaths to formulate recommendations for preventing future deaths and injuries. The goals of the program are to: better define the characteristics of line-of-duty deaths among fire fighters, develop recommendations for the prevention of deaths and injuries, and disseminate prevention 

strategies to the fire service. 

Additionally, NIOSH has developed an aggressive Research Portfolio to address 

a wide range of research needs in the emergency response community. Examples of 

proposed research include developing tools to improve safety climate, advances in 

personal protective equipment, enhanced medical surveillance methods for responders and recovery workers, and advancing environmental sampling strategies. 

NIOSH is committed to protecting the health and safety of workers, and is actively working to address the critical needs of first responders. I appreciate your 

support of our efforts and look forward to working with you in the future as we continue to serve this deserving population. Thank you for the opportunity to testify. 

I would be happy to answer any questions you may have. 

Chairman THOMPSON. Thank you very much, Dr. Howard, for 

your testimony. 

I now recognize Ms. Cynthia Bascetta to summarize your statement for 5 minutes. 

STATEMENT OF CYNTHIA A. BASCETTA, DIRECTOR, HEALTH 

CARE, GOVERNMENT ACCOUNTABILITY OFFICE 

Ms. BASCETTA. Thank you, Mr. Chairman and members of the 

committee. I am happy to be here to participate in your hearing 

today on protecting the protecters. 

As you know, the 9/11 responders were exposed to numerous 

physical hazards, environmental toxins and psychological trauma, 

which continue to exact a heavy toll for many of them 6 years after 

the World Trade Center attack. 

My testimony is based primarily on our July 2007 report and our 

prior work, which found that the screening program for Federal responders had accomplished little and lagged behind programs for 

other responders, and highlighted similar problems with the provision of services for non-Federal responders residing outside the 

New York metro area. We also identified lessons learned from the 

World Trade Center health programs that could be helpful in responding to future disasters. 

My remarks today focus on the status of services for Federal responders and non-Federal responders who came from across the 

Nation in the aftermath of the attack. I will also highlight three 

lessons learned that were common to the World Trade Center and 

the Hurricane Katrina disaster. 

Regarding 9/11 Federal responders, we reported, this July, that 

HHS has had continuing difficulties ensuring the uninterrupted 

service for them. 

First, the availability of screening examinations has been intermittent. HHS suspended screening exams from March 2004 to December 2005, resumed them for about a year, then placed the program on hold and suspended scheduling exams from January to 

13 

May 2007. The last interruption occurred because interagency 

agreements were not arranged in time to keep the program fully 

operational. 

Second, the provision of specialty diagnostic services often needed for ear, nose, throat, heart and lung problems has also been 

intermittent. The program had referred responders and paid for 

these diagnostic services. However, because the contract with the 

new provider network did not cover these services, they were unavailable from April 2006 until the contract was modified in March 

2007. 

NIOSH has considered expanding services for Federal responders 

to include monitoring exams, the same follow-up physical and mental health exams provided to other categories of responders. Unlike 

other responders, whose programs were designed to monitor their 

health over time, Federal responders are only entitled to a one-time 

screening examination. Without monitoring, their health conditions 

may not be diagnosed and treated, and knowledge of the health effects caused by the World Trade Center disaster may be incomplete. 

We also found that NIOSH has not ensured the availability of 

screening and monitoring services for non-Federal responders outside the New York City area, although it recently took steps to expand their availability. Similar to the intermittent service patterns 

for Federal responders, NIOSH’s arrangements for a network of occupational health clinics to provide services nationwide were onagain, off-again. This May, NIOSH renewed its efforts to expand a 

provider network and has completed about 20 exams. 

The start-and-stop history of HHS’s efforts to serve these groups 

does not provide assurance that the latest efforts to extend screening and monitoring services to these responders will be successful 

and sustained over time. As a result, we recommended in July that 

the Secretary take expeditious action to ensure the availability of 

health screening and monitoring services for all people who responded to the attack on the World Trade Center, regardless of 

their employer or their residence. To date, HHS has not responded 

to this recommendation. 

Mr. Chairman, our testimony also highlights three lessons 

learned from the World Trade Center health programs that could 

improve future responses to disasters. 

First, having a roster of who responded is key to identifying and 

monitoring health effects that they may have experienced. This 

seems obvious, yet 4 years after 9/11, no one was assigned the responsibility for collecting data on the total numbers of response 

and recovery workers deployed to the Gulf in the aftermath of Hurricane Katrina. 

Second, health monitoring could benefit from centrally coordinated planning to facilitate compatible data collection among monitoring efforts. Our work on Hurricane Katrina noted that, in general, no systemic health monitoring for responders occurred, and 

we recommended that Federal agencies resolve their disagreement 

over who should fund medical monitoring of responders. 

And finally, efforts to address health effects should include both 

physical and mental health. The New York/New Jersey World 

Trade Center consortium officials told us that initial Federal fundVerDate Nov 24 2008 12:49 Nov 17, 2009 Jkt 000000 PO 00000 Frm 00017 Fmt 6633 Sfmt 6601 H:\DOCS\110-HRGS\110-71\48966.TXT HSEC PsN: DIANE
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1See GAO, ‘‘SEPTEMBER 11: Problems Remain in Planning for and Providing Health Screening and Monitoring Services for Responders’’, GAO–07–1253T, Thursday, September 20, 2007. 

ing was not sufficient to cover mental health needs, but they were 

able to obtain philanthropic funds to address psychiatric screening 

and more extensive evaluations when necessary. 

This concludes my remarks, and I would be happy to answer any 

questions you or the other committee members might have. 

[The statement of Ms. Bascetta follows:] 1

Chairman THOMPSON. Thank you very much. 

I want to again thank the witnesses for their testimony. 

I will remind each member that he or she will have 5 minutes 

to question the panel. 

I will now recognize myself for the first questions. 

Dr. Krohmer, what has the Office of Health Affairs done, to date, 

to address the needs of people who respond to disasters like 9/11 

or Katrina? 

Dr. KROHMER. Well, you are aware, Mr. Chairman, the Office of 

Health Affairs really stood up and started to address some of the 

issues just in March of this year, and through some supplemental 

funding and reprogramming that was provided to us by the Congress just a couple months ago, are really in the process of building 

up to address those issues. 

As I mentioned, the Office of Component Services that we have, 

headed by Dr. Bill Lang, has some very aggressive plans that we 

hope to start implementing this fall, looking at some of the issues 

that have been identified, finding out how those specifically apply 

to our employees within DHS. 

Chairman THOMPSON. So before, say, March, who had that responsibility? 

Dr. KROHMER. Within DHS? 

Chairman THOMPSON. Yes. 

Dr. KROHMER. I think it was addressed somewhat peripherally 

by the Office of the Chief Medical Officer regarding input into some 

of the DHS programs. But other than that, there was not any direct involvement. 

Chairman THOMPSON. Okay. 

Dr. Howard, you talked about some experiences in things as coordinator of the World Trade Center health issues. Have you found 

the long-term monitoring and resources necessary to do that to be 

a problem? 

Dr. HOWARD. Mr. Chairman, at this time, no. 

Chairman THOMPSON. Well, at this time. Before this time? 

Dr. HOWARD. Beginning in 2001, very early, when the defense 

authorization bill for 2002 was being worked on in the Congress, 

money was provided to FEMA, which allowed us to begin a medical 

screening program within months of the disaster, which we began 

at Mount Sinai Medical Center. 

Chairman THOMPSON. Thanks. So you are saying that there were 

no problems associated with monitoring of first responders to the 

World Trade Center, it was not a resource, everything was done in 

a timely manner? 

15 

Dr. HOWARD. In terms of resources, yes. We have had no shortage of resources to provide monitoring, and now adding treatment 

services in 2006. 

Chairman THOMPSON. Well, then I guess I need you to respond 

to what the GAO person said, which was kind of contradictory to 

your answer to me. 

Dr. HOWARD. Right. We have had difficulties, as GAO has pointed out, in interagency arrangements with regard to starting and 

stopping of the Federal program as well as the national program. 

There is no doubt of that, sir. 

I think, right now, we are on a good trajectory to screen all Federal responders. We are also working on a plan to, as Ms. Bascetta 

mentioned, get the Federal responders into the monitoring program 

that we run with our grantees, because one screening appointment, 

we do not feel, is enough. 

The national program—we now have a national contractor. Before, one of our issues was the geographical distribution of the responders that came from all 50 States, Puerto Rico and many U.S. 

territories, and the location of the services that they could avail 

themselves of. We now have a national contractor for that. 

Chairman THOMPSON. All right. 

Ms. Bascetta, can you shed a little light on that same issue? 

Ms. BASCETTA. I don’t disagree with what Dr. Howard said, regarding the resources. For monitoring in particular, there has been 

adequate funding. Ninety million dollars was provided by FEMA 

shortly after the attack, and that money was used to do the monitoring that he discussed. 

The problem, as he said, has been in the interruptions in services 

because of administrative failures to assure that provider networks 

and the like were put in place to spend that money. 

Chairman THOMPSON. So maybe I asked the wrong question. So 

why have we heard from a number of people involved in both situations that they were not getting the services? So, now, is your testimony that the Federal Government failed to provide the monitoring 

services because certain agencies weren’t talking to each other, or 

that Congress provided the resources but the agencies didn’t talk 

to each other to get it done? 

Dr. HOWARD. I am not sure that either one of those explanations—I think it is a matter of administrative capability. 

What we have never done in NIOSH is establish a nationwide 

monitoring program. So individuals, wherever they are in the country, can travel just a small distance to be able to get a monitoring 

exam. 

That has been a real challenge, but it hasn’t been a lack of financial resources. It is infrastructure implementation and coordination 

with a network of providers, because we have to have the physician 

network in order to see the monitoring exam patients. 

Chairman THOMPSON. So your testimony now, that if a 9/11 or 

Katrina—type event occurred today, all those necessary building 

blocks to monitor and follow the Federal responders are in place, 

and that would not be an interruption of any of the monitoring? 

Dr. HOWARD. Yes, sir, that is what I am saying. 

Ms. BASCETTA. I am not as convinced. It seems to us, on our 

reading of the annex in the National Response Framework, that 

16 

there are still questions about HHS and OSHA getting together to 

figure out when long-term monitoring needs to occur and who will 

pay for that and how that will be set up. We have concerns because 

the operational details of the annex aren’t in place. 

So while I think that the situation at the World Trade Center actually worked pretty well for the people who could get services in 

New York, our work has shown that it has not worked well at all 

for those outside the New York City area or for Federal workers. 

And I am not convinced that future disasters will be much better. 

We know that, for a fact, in Katrina, there hasn’t been long-term 

monitoring. 

Chairman THOMPSON. At all? 

Ms. BASCETTA. Systematic, long-term monitoring. I believe one or 

two agencies may have done some monitoring on their own, including the Coast Guard. 

Chairman THOMPSON. Are you prepared to respond to GAO’s 

comment with respect to that, Dr. Howard? 

Dr. HOWARD. I think GAO is talking about a larger global issue. 

I was talking about the narrow issue of just World Trade Center 

responders right now, in terms of Federal and nationwide responders being able to access monitoring services. 

I think what Ms. Bascetta was talking about is a very large 

issue, which I am not as well-versed in, in terms of the overall national plan. I know that, from our agency’s viewpoint, at CDC and 

NIOSH, we work cooperatively with OSHA, who works cooperatively with DHS, to look at some of these long-term issues. We are 

primarily a research agency supplying our research findings to any 

Federal department that is interested in responder safety and 

health. 

Chairman THOMPSON. So is your testimony, Ms. Bascetta, that 

presently there is no Federal operational manual for the long-term 

care and monitoring of Federal first responders? 

Ms. BASCETTA. That is correct. We haven’t seen the operational 

details for that plan, as Dr. Howard said, on a global scale. I would 

agree that they are on a better trajectory, with regard to the World 

Trade Center, but, again, you know, because of the past history, we 

really need to see a track record of following through with uninterrupted services for the Federal responders and for the non-Federal 

responders who don’t live in the New York City area. 

Chairman THOMPSON. Thank you. 

I yield to the ranking member. 

Mr. BILIRAKIS. Mr. Chairman, I appreciate it very much. 

To follow up on your comments, Mr. Chairman, this is for all 

three panelists. 

In your view, does the National Response Plan, soon to be known 

as the National Response Framework, adequately assign roles and 

responsibilities, with respect to protecting the health and safety of 

first responders in the wake of a disaster? 

Dr. KROHMER. I guess I will take a stab at that one first. 

As you are aware, ESF–8, the Emergency Support Function 8 

that addresses public health and medical services as that annex, 

does include provisions for worker safety and health. Within the 

framework and the annex itself, there are general guidelines and 

17 

observations of issues that need to be addressed, but it doesn’t get 

down into the very specific operational issues. 

We would look forward to the opportunity of working both with 

HHS, NIOSH and ASPR, as well as the Department of Labor, to 

try and address some of those specific things. But I don’t think it 

is the intent specifically of the National Response Framework to 

get down into the operational issues. 

Dr. HOWARD. From my perspective—and I have to give you a disclaimer: I am an occupational safety and health physician by profession, so I care very much about responder safety and health. 

And I would prefer to see that responder safety and health issue 

elevated a bit within the larger structure of the national response 

network. 

I can’t speak for OSHA, who we partner with as technical support to OSHA, as they implement the safety and health support 

annex. But elevating the support annex to an essential support 

function is something that we at NIOSH would like to see, because 

we want to make sure that responder safety and health is put on 

par with victim safety and health and rescue. 

Mr. BILIRAKIS. Ms. Bascetta? 

Ms. BASCETTA. I would say that, without the operational details 

that Dr. Krohmer said are not in place yet, we can’t evaluate the 

adequacy of the framework. But we would certainly have concerns 

about the ability to protect first responders, or responders, without 

some assurance that those kinds of details are in place and that 

they would work well. 

Mr. BILIRAKIS. Thank you. 

Dr. Krohmer, in your written testimony, you said that DHS is 

working across the Federal Government and through State, territorial, tribal and local partners to ensure that there is an integrated approach to ensuring the health and safety of all first responders. 

How does the Office of Health Affairs coordinate with other Federal, State and local agencies to ensure that first responders receive adequate training and guidance to protect their health and 

safety? 

Dr. KROHMER. Well, this is a process and an activity that we are 

just now becoming involved with. As I mentioned earlier, a lot of 

the work that has been done in the Office of Health Affairs since 

we stood up in March has really been done at the senior management level. 

With the reorganization that we have undergone, we now have 

the Office of Medical Readiness, which is starting to ramp up. Up 

until very recently, it had a small staff with the associate chief 

medical officer, a couple of public health officers and a couple of 

Federal employees. 

But as we move into these activities, we will be working, really, 

in two areas. The first is as the subject matter experts for the various Homeland Security grant programs—the MMRS program, the 

U.S. Fire Administration grants and the general Homeland Security grants—to ensure that there are components within those 

grants that address issues of training, personnel protective equipment and the like for first responders, to make sure that their 

health and safety issues are addressed. 

18 

In addition, within this Office of Medical Readiness, we are 

standing up a Division of First Response, that will work specifically 

through the FEMA regions with State and local first responder representatives to make sure that the health and safety issues of the 

first responders are addressed both at the State and local levels. 

So this is very much a program in evolution based on our ability 

to start to move forward in those areas. 

Mr. BILIRAKIS. Thank you, Mr. Chairman. I would like to take 

another round after, if that is okay. Thank you. 

Chairman THOMPSON. Thank you. 

We now yield 5 minutes to the gentleman from North Carolina, 

Mr. Etheridge. 

Mr. ETHERIDGE. Thank you, Mr. Chairman. 

And let me thank you for being here today. 

A recent Harvard University study found that a significant link 

between firefighters and coronary heart disease was significant in 

the study. They pointed out that firefighters face up to 100 times 

their normal risk of heart attacks while working on a fire, and that 

accounts for roughly 45 percent of all the deaths of firefighters, volunteer and full-time paid professionals. Clearly, this is a concern 

with firefighters or anyone else who is considering a career or volunteer position in a local fire department. 

Congress has taken action to deal with that issue. Unfortunately, 

we can’t seem to get the administration to seem to understand and 

read the language that Congress has passed. I think they have now 

paid about four of the 200-and-some claims that are still outstanding. So I would encourage you in the health area to work with 

the Department of Justice to see if we can’t get this rock moved, 

to move it. 

If it just was last week, I wouldn’t be as concerned. It was passed 

in 2003 and the President signed it, and it is still lounging around, 

and we can’t seem to get anything done. 

My question to you is a little bit broader than that, as important 

as that is, because we have added emergency funding, fire grants, 

et cetera. What advice would you give the firefighters and other 

first responders through the rest of the country as they prepare to 

be volunteers? Because ultimately the bulk of our first responders 

are volunteers. 

And I believe, in your testimony, you said the Federal first responders. Well, if you look at the people who respond across America, they aren’t Federal first responders. They are a very small part 

of it. 

Now, granted that is our first step, but a broader issue is, if we 

are going to ask people to respond along the interstate highways 

of this country and the airports, et cetera, et cetera, my guess is 

they aren’t Federal folks; they are local first responders. What do 

we say to these folks and what is our obligation to them to help? 

So let me ask you first, Dr. Krohmer, what else should the Federal Government do to be prepared to address the health needs of 

first responders when they respond to the next catastrophe, if we 

aren’t keeping a good list of those who responded in the past? 

When I just heard you testify that across the country, we don’t 

have that list. What do we say to them? 

19 

Dr. KROHMER. Well, I think your point about the responders in 

the country being first responders from the local communities is 

right on, I think, sir. I spent 20 years as an EMS physician and 

worked very closely with folks in the fire service and emergency 

medical services. I think that we have to continue to be very sensitive to their needs. We need to continue to work very closely with 

them—— 

Mr. ETHERIDGE. What does that mean, when you say ‘‘being sensitive’’? 

Dr. KROHMER. I think we need to work very closely with them 

to identify the issues that are of concern to them, figure out ways 

that we, at the Federal level, can support those. 

I mean, I don’t know that it is any of the Federal agencies’ responsibilities to dictate to a local police department, fire department or EMS agency that they need to do particular things. I think 

that we can establish standards and metrics to identify and highlight best practices and provide them with potential resources to do 

that. 

Mr. ETHERIDGE. Well, let me ask the question a different way 

then. 

There are Federal highways, Federal aviation, there are Federal 

arteries in this country. And since 9/11, we have asked the local 

responders to respond. Now, they go, they get injured, they have 

long, lingering consequences. Do we not have an obligation, in some 

way, to help there, to their families? In most cases, these are single 

wage earners; they don’t have a lot of money; they are volunteers. 

Dr. KROHMER. Well, I think probably more importantly than 

working with the individual first responders is working with the 

agencies that employ them, and identify ways that we can help 

agencies. 

Mr. ETHERIDGE. A lot of these folks come from small, independent businesses. 

Dr. KROHMER. Well, but they are part of an organized response 

structure, whether that be a local fire department or volunteer fire 

department or local EMS—— 

Mr. ETHERIDGE. Are we doing anything to do that now? 

Dr. KROHMER. I am not familiar with programs—— 

Mr. ETHERIDGE. Would you get back to me on anything in that 

regard? It seems to me that is what the Department ought to be 

doing, if we are depending on them as our backbone, which, seems 

to me, that is how we are going to get there. Otherwise, because 

we can put all the people we want to in big buildings and we can 

do all the paperwork we want, but unless they respond to the call, 

the job doesn’t get done. 

Dr. KROHMER. Correct. 

Mr. ETHERIDGE. And they are doing a marvelous job. I mean, 

let’s face it. 

Dr. KROHMER. They are. 

Mr. ETHERIDGE. But I think, in a lot of cases, we don’t really follow through. We finish up and talk about the last disaster, and 

then we start talking about getting ready for the next one. And unfortunately, we aren’t always ready, and that bothers me greatly. 

I think that is what the chairman was getting to. 

20 

And I have some other questions, Mr. Chairman, if we get to a 

second round. 

Chairman THOMPSON. Thank you very much. 

We have about 4 minutes left for votes. We have four votes. We 

will adjourn the hearing and reconvene in about 20 minutes. 

Thank you. 

[Recess.] 

Chairman THOMPSON. We would like to reconvene the hearing. 

Our next questioner is Dr. Christensen from the Virgin Islands, 

for 5 minutes. 

Mrs. CHRISTENSEN. Thank you, Mr. Chairman, and thank you for 

having this hearing. This is a very important issue. 

Let me try to get in about three questions, if I could. 

Doctors Howard and Krohmer, I am not sure that—I do not 

think we quite answered this question. During the World Trade 

Center disaster and Hurricane Katrina, there was not an agency 

directed to coordinate and identify a greater roster of all of the respondents. In the future, which agency is responsible for this, for 

creating that roster, the list of all of the responders? 

Dr. KROHMER. Of all of the responders who were taking part in 

the response or who were—— 

Mrs. CHRISTENSEN. Who were on the ground, taking—— 

Dr. KROHMER. That is an interesting idea, and I do not know 

that that has occurred to us. 

Mrs. CHRISTENSEN. How do you keep track of who came and who 

responded so that we can do the exams and the monitoring and so 

forth? Which agency keeps track? 

Dr. HOWARD. One of the issues from the World Trade Center experience is that many governmental agencies, both on the city, 

State and Federal levels, did keep track. We have some good census data from those agencies. Where we really do not have good 

data is in the affiliated and unaffiliated volunteers. The Red Cross 

and the Salvation Army did a pretty good job, but a lot of folks in 

New York and for any disaster, they just come to help, and they 

are not affiliated with a particular agency. So, a lot of times, we 

do not capture those individuals. 

But my answer to that question would be the incident commander of the disaster really is the census-taker, in my view. 

Mrs. CHRISTENSEN. Is that worked into exercises now? We have 

one coming up in October. Is there something in the National Response Framework that speaks to coordinating a list of responders 

so that we can follow them? 

Dr. KROHMER. As Dr. Howard mentioned, it is the responsibility 

of the incident commander of the event. I do not know if there is 

a Federal agency that has assumed responsibility for that. 

Mrs. CHRISTENSEN. Do I understand that we still do not have 

any way of reaching those who came from outside of New York City 

and who are not Federal responders, to have them examined and 

monitored? If that is true, what is going to be done about that? 

I know I had responders. I am sure just about everybody on this 

committee had people going to New York, for example, to help, and 

to Katrina as well. 

Dr. HOWARD. Well, certainly, you make an excellent point. If we 

do not have a total census, then you cannot really know afterwards 

21 

who was there at the time. So what you have to do is use alternative mechanisms. You have to look into the search and rescue 

logs of responders, who are by State, and see if any of them came. 

You have to reach out to them. You have to do a lot of outreach. 

For instance, in the Virgin Islands and in Puerto Rico, we have had 

to reach out to individuals who were part of that response structure and say, ‘‘Were you there in New York? We want to make you 

aware——’’ 

Mrs. CHRISTENSEN. So you have done that? 

Dr. HOWARD. We have tried very hard to make sure that everyone who we think might have shown up at least is aware of our 

monitoring program. But it is after the fact. 

Mrs. CHRISTENSEN. Okay. Well, we realize that there was not 

what needed to be in place at the time, so that it had to be after 

the fact. 

I am concerned. I do not think I heard much about mental health 

today, and during both of those events and probably many others 

the mental health needs of the responders have not been, I think, 

adequately addressed. 

So what steps are being taken to better coordinate mental health 

needs during a response? Given that we still do not have mental 

health parity, what about those who are affected for the long term? 

What is in place for that? 

Dr. HOWARD. I think the mental health effects, the emotional 

health effects, of being a disaster responder are the real frontier in 

the area of responder safety and health. 

As an example, in the Annals of Psychiatry this month, the New 

York City World Trade Center Health Registry did a paper showing that the average post-traumatic stress disorder in responders 

went from about 6 percent in police officers up to 21.2 percent in 

unaffiliated volunteers, and this speaks to the issue. For an unaffiliated volunteer, someone whose profession is not disaster response, we have to be very careful with those individuals in making sure that they have some pretraining and that, at the time, 

they are not exposed to some of the stressors, the mental health 

stressors, at any disaster. And at the World Trade Center, they 

were quite severe over prolonged periods of time. Because, then, 

what will happen is that we will get a higher prevalence of PTSD 

afterwards. 

So that is, to me, one of the most central lessons learned, in 

terms of folding in mental health both at the time of the deployment and then afterwards to assess a responder about what symptoms he or she might be feeling in terms of mental health issues. 

Mrs. CHRISTENSEN. Thank you. 

Thank you, Mr. Chairman. 

Chairman THOMPSON. Thank you very much. 

I will now yield 5 minutes to the gentleman from Indiana, Mr. 

Souder. 

Mr. SOUDER. Thank you, Mr. Chairman. 

I am sorry I missed the opening statements. I did my best to 

catch up there as I came back. 

I am interested a little bit in the differences—obviously, when 

you are doing rescue, you are at higher risk than when you are 

doing recovery. Could you discuss that briefly? 

22 

Then, in the Katrina situation, obviously, people pour in, and 

they start seeing the needs. I would like you to expound a little bit 

more on how you deal with the people both in rescue and recovery 

and how it might differ. 

Also, in Katrina, when our first group of Members were allowed 

in, they took us to a site in Mississippi, showed how the government was dealing with all of these things. And what we quickly 

learned on the ground, which, to my understanding, what is typical 

is that the nonprofit religious organizations were there roughly 7 

days before the first government people were really getting involved. And I had people pour in from my churches down in there. 

How in the world—I mean, you talked a lot about what we do 

with government employees, and then you have State and local employees. But what about even the nonprofit sector, which, in recovery, almost anybody who looks at it—and when I challenged FEMA 

as to why they represented this as the model FEMA recovery effort, they said, ‘‘Well, of course the religious groups are usually 

there as much as a week before we are all set up.’’ I even visited 

a Buddhist organization that is often among the first there at these 

sites. And the government does not even necessarily know they are 

there, but clearly, they are facing all kinds of health risks in these 

kinds of situations. 

Do you view, as part of your mission, to deal with the nonprofits, 

as well as the State and local responders and the Federal? Then, 

if you can separate that, your answers, a little bit into rescue response in the nature of risks. 

Thank you. 

It is to any of you who want to take parts of that. 

Dr. KROHMER. Well, I think, certainly, from a techniques perspective, there are issues in terms of activities we would employ for 

rescue versus recovery. I think, in terms of the overall health and 

safety issues, they are probably fairly similar based on the environment that the folks are working in. I think one of the things—— 

Mr. SOUDER. Let me see if I have a layman’s understanding. If 

you think somebody is trapped in a house and they are going to 

die if you do not enter, you are likely to take more risks of whether 

that water is dangerous to your life, whether it is dangerous to 

your health, in order to save another life in a matter of minutes 

as opposed to recovery afterwards. 

Dr. KROHMER. Oh, certainly, from that perspective, that is very 

true. I was looking at the environment as being not terribly different from a rescue phase versus a recovery phase. You are still 

faced with the same environmental and potential health and safety 

risks. 

The issue of—— 

Mr. SOUDER. Well, I am still confused. This is kind of a fundamental thing, but wouldn’t the health and safety risks be substantially higher in the initial rescue than the recovery? Because, partly, you would have more time, you would have more time to calculate your decision. The place may be on fire. The intensity has 

not been dispersed as much in the pollutants that enter the water. 

Why would you say the risks are roughly the same, health risks? 

Dr. KROHMER. The risks are the same. How the rescuers respond 

to them, I think, is different in those two scenarios. You are corVerDate Nov 24 2008 12:49 Nov 17, 2009 Jkt 000000 PO 00000 Frm 00026 Fmt 6633 Sfmt 6601 H:\DOCS\110-HRGS\110-71\48966.TXT HSEC PsN: DIANE
23 

rect. In a rescue scenario, there are a lot of situations where folks 

may not take the time to put on all of the personal protective 

equipment that they may have available to them during a recovery 

operation. We need to look at all of the environmental factors and 

make sure that the first responders have the appropriate PPE 

available during the rescue phase that they would likely also have 

available during the recovery phase. So, from a rescuer perspective, 

I think that there are some issues that we need to address. 

I think, in many situations, the environmental threats that they 

are faced with are very similar, okay? You may have a fire in a rescue situation and not have a fire in a recovery situation, but a lot 

of the other environmental issues are very typical. 

Mr. SOUDER. Would it be a different case, then, with smoke and 

chemicals, as to whether it is a water scene or it is the ashes that 

came out of 9/11? You are going to have dissipation over days that 

you do not have in the intensity of the first. 

Dr. KROHMER. Correct, but there may also be other environmental issues that would develop over a period of days that do not 

occur during—these are all things—— 

Mr. SOUDER. Briefly, because I know I am out of time, and I cut 

into the answer: Could somebody address nonprofits briefly? Because they are not going to have as much equipment when they are 

there, but they play such a critical role, particularly in the earliest 

days. 

Dr. HOWARD. Yes, sir. I think your question is extremely complex. The way that I would break it down is between trained responders and untrained responders. 

For an emergent situation, trained responders obviously can 

evaluate the risk and take the proper precautions, but if you have 

an emergent situation or even a less-than-emergent situation, 

when you have untrained responders, good-thinking people from 

churches, nonprofits, et cetera, who want to do their best, they 

need to know that they may not be aware of all of the risks that 

that rescue or recovery that they are involved in present. And that 

is why it is critically important that all individuals/entities, whether they are nonprofit or governmental or whatever, have the proper 

training. 

One of the things that we are trying to do at NIOSH is to bring 

all of that experience together. We have a four-volume set of information that we provide to local fire departments, volunteer and 

otherwise, and to local response agencies so that they can then cascade that down to all types of volunteers, including churches, private sectors, et cetera. 

Mr. SOUDER. The government had no water. You can sit there 

and say they were not trained, but bringing water was essential in 

those first days, and it was not there from the government. Hopefully, we will improve those kinds of things. 

But particularly, I am interested in follow-up on what you are 

doing with the faith-based groups, which is clearly the big element 

of the first responders that has not really been officially acknowledged as much. 

Dr. HOWARD. Right, and I agree with that. I think the key is educating any kind of responder about the risks of response. 

Dr. KROHMER. Agreed. 

24 

Chairman THOMPSON. Thank you. 

I will now yield 5 minutes to the gentlelady from New York, Ms. 

Clarke. 

Ms. CLARKE. Thank you very much, Mr. Chairman. 

As you are aware, being a New Yorker from New York City, this 

is a matter of deep concern to me and to my constituents. 

Many tens of thousands of first responders who heroically came 

to the scene and helped New York and the entire country recover 

from the worst attack in U.S. history are now either getting sick 

or are in danger of doing so because the Federal Government 

failed—and I emphasize ‘‘failed‘‘—in its duty to protect first responders who worked at the World Trade Center. Part of the Government’s failure was due to the fact that the Occupational Safety 

and Health Administration, which possesses the expertise to help 

keep workers safe, was not used immediately, and when it was 

brought in, its role was not clearly defined. 

Now, DHS has the NRF, a new plan for coordinating responses 

to disasters, which I hope would improve the role of an agency that 

is designed to keep first responders safe. However, last week, I attended a hearing in another committee where OSHA testified that 

their response role remained minimized and that they have minimal input in planning. 

Dr. Krohmer, I would like to direct this question to you. Can you 

tell me exactly what is the role of OSHA in the new National Response Framework? Has its role been modified at all, and has it 

been granted a stronger voice in this process? 

Dr. KROHMER. It is my understanding that its role had not been 

modified at all, but I will check with you and make sure. I have 

not looked specifically into that, but I will find out and get back 

with you. 

Ms. CLARKE. Mr. Chairman, I would ask that we make sure that 

that material is given to us, because, as a member of the Education 

and Labor Committee, it was testified that their role has been 

modified. 

Chairman THOMPSON. Well, maybe the GAO can help with 

OSHA’s role as they saw in their review. 

Ms. BASCETTA. I only have current information as of what occurred at Hurricane Katrina, and I do not have current information 

about the most recent articulation of their role in the National Response Framework. But it is a very important question, and it 

needs to be resolved. 

Chairman THOMPSON. We will make sure the question is answered. 

Ms. CLARKE. Thank you very much, Mr. Chairman. 

Ms. Bascetta, I understand that the GAO was told that FEMA 

assigns and funds specific responsibilities for many agencies only 

after a disaster. Does this grant agencies enough time to mobilize 

after FEMA calls? 

And how capable is FEMA of assigning these responsibilities and 

in coordinating a response quickly after a disaster? After all, we all 

recall how poorly FEMA coordinated the responses to the hurricanes 2 years ago. 

Ms. BASCETTA. That is a good question. 

25 

I think there has been a mixed experience with that. I can say 

that, in the work that we did, looking at long-term monitoring, that 

there was a delay that caused problems in terms of setting up monitoring programs and that, in fact, in New Orleans, monitoring did 

not happen at all. And one of the disagreements was between 

OSHA and FEMA about who was responsible for doing this, whether it should be done and how it would be funded. 

Ms. CLARKE. Dr. Krohmer, the response of the Federal Government to the health concerns faced by many of the first responders 

impacted by the debris of the World Trade Center is to provide 

screening but nearly nothing in the way of providing actual care 

for the maladies many of them face. This has led many people to 

question whether they could respond in the same way in the future, putting their health and their families at risk. 

Do you feel that the Government must be able to guarantee that 

we will help first responders with related health problems if we are 

to get a full response to disasters in the future? 

Dr. KROHMER. I think we need to look very closely at the issue 

of being able to include treatment as part of the response that is 

offered to folks. Yes, I agree with you. 

Ms. CLARKE. Has that conversation begun, as of yet? I mean, this 

is clearly something that we must be prepared for. We do not know 

what happens, day to day, in our Nation. We hope that we can put 

all kinds of prohibitive actions in place to make sure that we are 

safe in the homeland, but you know, at any given moment, given 

the world we live in today, I think these are issues that have to 

really be in the forefront of our minds, given what we know and 

what we have experienced already. 

Has there been the type of conversation that you feel comfortable 

with that would address what we know will be a challenge for 

those who respond to the call of duty, that is, that we can guarantee that their health concerns will be addressed in a timely fashion and that we will not see the type of hesitancy that seems to 

be a part of our culture right now that needs to be addressed? 

Dr. KROHMER. As I mentioned in an earlier part of the testimony, 

many of the activities that the Office of Health Affairs has been involved with and is in the process of developing have just started 

over the last couple of months. We have had some internal discussions about those, but they are extremely complicated, in terms of 

private insurance and public insurance and who all is going to 

cover what. 

We have had those internal discussions and fully plan to continue having those discussions, but they have been very preliminary on the part of our office. 

Ms. CLARKE. I would like to suggest to you, Doctor, that this 

should be a priority. You know, we want to get ahead of the curve, 

with respect to this matter. Again, we are not determinants of 

what can happen in our Nation, be it a natural disaster, be it a 

terrorist attack, but we can learn from, you know, the experiences 

we have had and be prepared to address it. 

I would hate to be in a situation where my life is in jeopardy and 

there are individuals who have the expertise and the know-how to 

be there at my aid, and they are thinking, you know, ‘‘Do I enter 

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26 

being will be at risk and there will be no one there to support me 

at the end of the day?’’ This has to become a part of our culture. 

Dr. KROHMER. Oh, I agree with you completely. I have been 

there, yes. 

Ms. CLARKE. Thank you very much, Mr. Chair. 

Chairman THOMPSON. Thank you very much. 

I will now yield 5 minutes to the gentleman from Texas, Mr. 

Cuellar. 

Mr. CUELLAR. Thank you, Mr. Chairman. 

One question for all three of you: If I were to have one of my constituents ask me this question, how would you answer this without 

going into specifics? As you know, I did not have the opportunity 

to be here and to listen to the details and get copies of the testimonies in advance, but if I asked you—as you know, the title of 

this hearing is ‘‘Protecting the Protectors’’ and ‘‘Ensuring the 

Health and Safety of our First Responders’’ in the wake of, you 

know, these types of disasters. 

What would be the top three things that we have done to ensure 

their safety and their protection, number one? 

The second part is: What are the three deficiencies? Where do we 

need to go? 

I need a one, two and three outline on each of them, the 

strengths where we have done well and where the deficiencies are. 

And it is the same question to each of you. 

Dr. Krohmer, do you want to go first? 

Dr. KROHMER. I think there are three issues that we have done 

to ensure their safety. We have improved the incident management 

system, which is very critical to coordinating the overall response, 

and it addresses some of the other issues that you had identified 

earlier. We have identified what additional issues there are, in 

terms of some of the environmental things. 

Mr. CUELLAR. You are now on number two—— 

Dr. KROHMER. Correct, number two. 

Mr. CUELLAR. —for the strengths? Okay. 

Dr. KROHMER. We have much closer coordination now among the 

medical aspects, among the medical components—public health and 

health care. 

In terms of deficiencies, I think that there is still a large part 

of the response community, some of the unsolicited volunteers who 

Dr. Howard has referred to, who are still not well-incorporated into 

that. And we need to address that. 

Mr. CUELLAR. That is number one? 

Dr. KROHMER. That is number one. 

Mr. CUELLAR. Okay. So what do you call that, ‘‘better integration’’? 

Dr. KROHMER. Better integration of unsolicited volunteers. 

Mr. CUELLAR. Okay. 

Dr. KROHMER. I think probably one of the other deficiencies—and 

I am not sure I can come up with three. A second one is, although 

our surveillance programs are better now than they were previously, I think we still have room to improve them from a pre-exposure assessment to continued monitoring throughout the event 

and post-event. 

Mr. CUELLAR. So how do you summarize number two? 

27 

Dr. KROHMER. More coordinated in structured surveillance programs throughout the continuity of the event. 

Mr. CUELLAR. All right. 

Dr. Howard? 

Dr. HOWARD. My turn for the pop quiz. Okay. 

So, number one, I would put the emphasis that we now have on 

responder safety and health through the Worker Safety and Health 

Annex in the National Response Plan. I think that is a positive 

step. 

The second I would put is our own work at NIOSH to emphasize 

that integrated safety management, bringing all of the responder 

agencies—private, public, whoever shows up—into the same safety 

management structure is a very important advantage that we have 

discovered, and we have incorporated that. DHS has incorporated 

it into their targeted capabilities list. 

Three, at NIOSH, we have done a lot of work in ensuring that 

respirators are suitable for the kind of work that long-duration disasters require. We were not prepared for that before the World 

Trade Center. We are better prepared. 

I think the things that we still have to do, and on the flip side, 

are, number one, that I do not think we have elevated worker safety and health within the National Response Plan high enough. 

Even though we have an annex for it, I think it needs to even move 

higher. 

I think the second issue is the same one that—— 

Mr. CUELLAR. Let me ask you, how do we elevate that? 

Dr. HOWARD. Well, you can make it an emergency support function. You can make it an ESF, as opposed to an annex to an ESF. 

That would be very—that is what I am talking about. 

Mr. CUELLAR. Can I interrupt you for a second? 

Dr. HOWARD. Sure. 

Mr. CUELLAR. Homeland, how do you respond to that? 

Dr. KROHMER. I think there are a little bit of semantics there. 

We can very easily elevate the importance of it, the focus on it, and 

still allow it to be a support function, a support annex. Well, actually, I would have to look at it, because it applies to enough of 

the—— 

Dr. HOWARD. The issue of the annex is only triggered by the 

keeper of the ESF, and that is FEMA. So OSHA has to wait until 

FEMA activates their ESF. If it is an ESF, OSHA does not have 

to wait for FEMA to do it. That is the important distinction here. 

Mr. CUELLAR. Do you agree with that distinction, Dr. Krohmer? 

Dr. KROHMER. Well, it would be. Then we would need to identify 

who the lead agency for that particular ESF would be. From my 

perspective, there is enough overlap. That may be a little bit difficult, but we could work on that. 

Mr. CUELLAR. Could I ask, maybe, Mr. Chairman, to follow up 

on that and then follow up with the committee on that conversation? 

Chairman THOMPSON. Okay. Sure. Absolutely. 

Are you prepared, Dr. Krohmer, to follow up with the committee 

on that? 

Dr. KROHMER. Yes. 

28 

Dr. HOWARD. Let me point out that it has to be followed up with 

OSHA, not NIOSH. This is an OSHA issue. 

Mr. CUELLAR. I am sure you all have good working relationships 

with them. 

Dr. HOWARD. We do. 

Now, I think I was just getting over number two, and number 

two is the same issue Dr. Krohmer mentioned. Unaffiliated volunteers, spontaneous volunteers, people who show up at a site, they 

may not be associated with any particular entity. We need to grab 

those people as soon as their hearts lead them in the right direction. These are heroes in waiting. They are doing wonderful things. 

They think they are indestructible. They may not be aware of the 

hazards associated with responding. Somehow, we have to have a 

structure where we can grab those people, and if they are untrained—and many of them are—we have to grab them before they 

actually go on the site and train them. And that is a real tough 

one, and I am not sure I have the answer to that. 

Then the third one, I think, is the mental health issue, which we 

have talked about this morning here. People imagine themselves 

capable of doing things emotionally and mentally that, once they 

get into a situation, they find out they are not indestructible from 

a mental health perspective. And that is a part of training that we 

need to do, both for trained volunteers, people who do this for a living, whether you are police or fire or Red Cross or whatever, as 

well as and especially for people who do not do this for a living but 

decide to respond. This is an area that we really need to spend 

some time on, too. 

Mr. CUELLAR. Gentlemen, I am out of time. 

Chairman THOMPSON. Thank you. We have been very liberal 

with the time, so do you want to ask another question or—— 

Mr. CUELLAR. No. I just wanted her to finish the question. I am 

not going to ask any more questions. I would just like to give her 

the courtesy to finish that question. 

Chairman THOMPSON. Thank you. 

Ms. BASCETTA. I would be happy to answer. 

I think that positives are that we know how to do monitoring, 

both during the response and we know how to do long-term monitoring. We know how to do good research to monitor what the longterm health effects might be. 

And I think we are making more progress as a society in acknowledging the importance of mental health. We see this with our 

Armed Forces. We see this with our firefighters and police officers. 

So, while there is a lot of work to do, I think there is a growing 

acknowledgment of the importance of mental health. 

I think the biggest problems are operationalizing what we know 

how to do and making sure that it, in fact, gets done and that some 

of the most basics, like keeping track of who has responded, are accomplished. Because if we do not know the denominator, it is going 

to be very hard to track these people and to figure out what kinds 

of health effects they truly did experience in a scientifically valid 

way. 

I also think that handling the treatment issue in advance is very 

important. People need to know how they are going to be cared for 

and where the financial responsibility is going to lie, whether it is 

29 

going to be with Workers’ Comp or with their own health insurance 

or some mix of payers. 

Mr. CUELLAR. Thank you, Mr. Chairman. 

Chairman THOMPSON. Thank you very much. 

I will yield 5 minutes to the gentleman from Pennsylvania, Mr. 

Dent. 

Mr. DENT. Thank you, Mr. Chairman. 

Good morning. 

I guess my question is really to all three of you. In your view, 

what do you think are the most important lessons learned from the 

response to the World Trade Center site regarding first responders’ 

health and safety? I thought, maybe, we would just go right down 

the list there. 

Dr. Krohmer? 

Dr. KROHMER. This is probably a personal perspective. 

The issue of—we have touched on it several times already—identifying who all of the rescuers are. The unsolicited volunteer was 

a very critical issue. And then the surveillance programs, as we 

have talked about. 

Dr. HOWARD. Similarly, I would also emphasize those. 

Very tight perimeter control, central safety management, and a 

responsible party who determines total responder census so that 

we can identify these individuals after they leave the site if we 

need to medically monitor them. 

Ms. BASCETTA. We have noted three in our work so far, and those 

include quickly identifying and contacting responders and others, 

centrally coordinating an approach for assessing the individuals’ 

health effects, and addressing the importance of both physical and 

mental health. 

Mr. DENT. Based on what you just said, do you believe that steps 

have been taken to address those lessons? Do you think we are 

where we need to be in the event of a future disaster? 

Ms. BASCETTA. No, we do not think so. 

Mr. DENT. Okay. That is true of all three, that we are not where 

we need to be? 

Dr. KROHMER. Correct. I think we have made some very nice 

progress, but we are not where we need to be. 

Mr. DENT. Okay. 

Then, I guess, my next question would be to Dr. Krohmer: What 

guidance does the Department of Homeland Security provide to its 

State and local partners to help them protect the health and safety 

of our first responders? 

Dr. KROHMER. Most of the guidance that we have provided historically has been based on the guidances that have been provided 

in the grants. As resources become available—and it is probably 

going to be in the next year or 2 and in the outyears—through the 

Office of Health Affairs, we are looking at developing a program of 

specific outreach to the State and local folks that will be working 

through the FEMA regions, working in coordination with the HHS 

regional preparedness coordinators but, much more specifically, 

making sure that the State and local folks, from a health care and 

a public health perspective, are much more integrated into the 

emergency management community and in the planning activities 

that occur. 

30 

Mr. DENT. Okay. Thank you. 

My final question is this: The SAFE Port Act of 2006 contains 

a provision requiring the Secretaries of HHS and DHS and, I think, 

the EPA Administrator to jointly enter into a contract with the National Academy of Sciences to conduct a study and to prepare a report on disaster area health and environment protection and monitoring. 

What is the status of this initiative? 

I guess we should again start with you, Dr. Krohmer. 

Dr. KROHMER. Quite honestly, sir, I was not aware of the provisions of that act until we started to do some of the background information for this hearing. And we are in the process of trying to 

identify the current status, so I will have to get back with you on 

that. 

Mr. DENT. Dr. Howard? 

Dr. HOWARD. My understanding is it was authorized, not appropriated. But I would like to point out that it is really a remarkably 

excellent roadmap for a medical monitoring program post-disaster. 

Mr. DENT. Ms. Bascetta? 

Ms. BASCETTA. I do not have current information on the SAFE 

Port Act. 

Mr. DENT. Thanks, Mr. Chairman. I yield back. 

Chairman THOMPSON. Thank you very much. 

I will now yield 5 minutes to the gentlelady from the District of 

Columbia, Ms. Norton. 

Ms. NORTON. Thank you very much, Mr. Chairman. 

This is an important hearing. I think it is important to have, 

particularly here in the District of Columbia, where we have already had incidents where it is its own version of Ground Zero for, 

particularly, first responders who rush to the scene, often without—almost always without—any thought of their own health. 

I am wondering if you know of any health officials who were contacted when the first issues involving formaldehyde in trailers in 

Louisiana were raised. Do you know of any health officials who 

were contacted before the Government responded on that issue? 

Dr. KROHMER. We were contacted by folks at FEMA, I believe, 

in May of this year. We did not have any prior contact. 

Ms. NORTON. I ask because, on the day the story broke, I was 

having a hearing with FEMA on another issue, and I, of course, inquired about this formaldehyde that was hitting the news, and 

they told me that they were sure that the formaldehyde had absolutely no negative effects. 

Subsequently, in another hearing, the oversight hearing, very 

harmful, harmful testimony came out about the suppression of the 

possibility of harm in formaldehyde in those trailers. And evidence 

was brought forward in which it was said that lawyers said that 

it was best to move ahead and not to make inquiries because of liabilities that might arise. Well, the liability is going to arise now 

because it is clear that people knew or should have known that 

there was harmful formaldehyde in those trailers, so they really 

made it worse. 

My question to you is: Before anybody opines or makes a policy 

judgment when there is a health issue related to a natural event 

or to a terrorist event, shouldn’t there be a link to some health proVerDate Nov 24 2008 12:49 Nov 17, 2009 Jkt 000000 PO 00000 Frm 00034 Fmt 6633 Sfmt 6601 H:\DOCS\110-HRGS\110-71\48966.TXT HSEC PsN: DIANE
31 

fessionals before any administration decides what to do? Is there 

any link that you know of? Or are policymakers free to just move 

forward without contacting anyone to get an expert medical or 

health opinion on whether there is a danger to public health? 

Dr. KROHMER. I think the concerns that you bring up are very 

important concerns, and at least based on my understanding, they 

are one of the issues that led to the formation of the Office of 

Health Affairs within Homeland Security. Within our office, our Office of Component Services is going to be specifically looking at 

workforce protection and occupational health issues. 

I would note that, since we brought on board the Associate Medical Officer in January of this year, the Associate Medical Officer 

for Component Services, he has been working very closely with 

FEMA and with other DHS components. And I think, much to his 

credit, he is being called very frequently within the Department for 

public health and health care issues. 

So it is a critical issue, from our perspective, and that is why we 

are moving forward with this office. 

Ms. NORTON. It was clear to me that the policymakers did not 

know what to do and saw an issue foaming up, and when you do 

not know what to do and you do not know where to turn, there are 

people who just suppress it. 

And of course, there were hundreds of people in these trailers. 

I was very concerned, not only for that reason but because, when 

the trailer issue came before us in another circumstance, what we 

wanted to know was why they were stockpiling all of these trailers 

and not trying to offload some of them and sell some of them. Now 

we come to find out that they are really not trailers that probably 

should be sold to anybody. 

It does seem to me that the implications here are certainly for 

the workforce, but here, where FEMA has to take personal responsibility for people it puts into such trailers and then, in a panic, 

suppresses or is told to suppress, that is where the evidence was 

just as clear. They had the memos where the lawyers said, ‘‘Do not 

press this. If you press this, you might expose us to liability.’’ 

First of all, you need to get another lawyer, because the question 

of liability does not go to suppression; it goes to no one should have 

known. And so, the notion that it would never come out is very 

poor legal advice, but it is the kind of advice you give first when 

you are not entirely honest but also when you do not have any resource to go to. Because the first instinct should have been to say, 

‘‘Get somebody in there who knows something about health issues 

and formaldehyde to see if we have any liability and to do something about it quickly so as to mitigate any liability.’’ 

Dr. KROHMER. If I may, Mr. Chair, it is my understanding that, 

when the issue first came up, representatives from FEMA did contact representatives from the CDC. In the information that we 

have been able to identify, there is some conflicting information in 

the scientific literature about the significance of sensitivities. A lot 

of it has the potential of being very individualized. 

Having said that, we are in the process now of working very 

closely—FEMA, with some consultation from us, is in the process 

of working very closely with the CDC, some consultation with 

NIOSH, to do some specific environmental monitoring and environVerDate Nov 24 2008 12:49 Nov 17, 2009 Jkt 000000 PO 00000 Frm 00035 Fmt 6633 Sfmt 6601 H:\DOCS\110-HRGS\110-71\48966.TXT HSEC PsN: DIANE
32 

mental sampling to try and get a better handle specifically on these 

trailers, what the levels are and what the issues may be. 

Ms. NORTON. Thank you. 

Thank you, Mr. Chairman. 

Chairman THOMPSON. Thank you very much. 

We would like to thank the first panel of witnesses for their valuable testimony and members for their questions. 

The members of the committee have additional questions for the 

witnesses, and we ask that you respond expeditiously in writing to 

any of those questions. 

Thank you again. 

Let me, before you leave, say that, as Chair, I am concerned that 

we do not keep a roster of Federal responders to natural disasters. 

That is absolutely critical. Now, that is what I heard from the testimony today. I stand to be corrected if we do not. 

Dr. Krohmer? 

Dr. KROHMER. I would just observe that I do believe we keep a 

roster of Federal responders. What becomes difficult is when there 

are additional citizens and unsolicited volunteers who respond. It 

is more difficult to catalog those. 

Chairman THOMPSON. So we keep Federal, but State and locals 

is left to State and locals? 

Dr. KROHMER. Correct. 

Chairman THOMPSON. No one keeps the other roster of other volunteers who respond to disasters; is that correct? 

Dr. KROHMER. As the volunteers become incorporated into the response structure, they are cataloged—it is my understanding that 

they are cataloged. But if they are not a part of the response structure, if they do not identify themselves to folks on scene, they may 

not be included. Correct. 

Chairman THOMPSON. Thank you. 

GAO, I am going to give you the last response on that. 

Ms. BASCETTA. Thank you. 

I am not aware of a requirement for the keeping of a roster of 

the Federal employees who responded. It is true that some agencies 

kept track on their own, but it was not through a centralized process. It needs to be explicit that that be done. It is absolutely fundamental. 

Chairman THOMPSON. So there is no uniformed process to keep 

up with the Federal responders to any disaster, be it 9/11, Katrina, 

the Pentagon situation—— 

Ms. BASCETTA. Right. That is correct. 

Chairman THOMPSON. —to your knowledge? 

Ms. BASCETTA. That is correct. That responsibility has not been 

assigned. That is correct. 

Chairman THOMPSON. I yield to the gentleman from North Carolina for the last comment. 

Mr. ETHERIDGE. Very, very quickly. Wouldn’t it be just as easy, 

in working with these local folks and in working with State and 

local officials, to ask them if they have people at these major catastrophes to submit that to the Federal and have a place where we 

could keep that, along with our Federal folks, as to who has responded to these natural disasters? 

33 

Dr. KROHMER. Well, I think that is something we could easily 

pursue, yes. 

Chairman THOMPSON. Thank you. 

Again, we thank the panel. 

And we call up the second panel of witnesses. 

I welcome the second panel of witnesses, and I appreciate your 

indulgence for the questions, but as you can see, there were some 

things we needed, I think, to get on the record in anticipation of 

this panel, because I think your testimony flows right into some of 

the overall reasons for having this hearing. 

I welcome you, as I said. 

Our first witness will be Dr. Philip Landrigan, who is the professor and chair of Community Preventative Medicine at the Mount 

Sinai School of Medicine, who you heard referred to by our ranking 

member in his opening statement. Mount Sinai runs one of the centers in the World Trade Center Worker and Volunteer Medical 

Screening Program that provides medical screening exams for first 

responders, workers and other volunteers who worked at Ground 

Zero. In addition to this work, Dr. Landrigan spent time at the 

CDC, where he directed research for the global smallpox eradication program, among other efforts. 

Our second witness is Nicholas Visconti, Deputy Fire Chief, Fire 

Department, City of New York. Chief Visconti, who I see Representative Clarke knows very well, was there on September 11, responding after the attacks on the World Trade Center. Chief 

Visconti has also worked extensively with the Uniformed Fire Officers Association in New York. He has been a New York firefighter 

for nearly 39 years. 

Congratulations. 

Our third witness is Dr. Mike McDaniel, Secretary of the Louisiana Department of Environmental Quality. Dr. McDaniel is an 

environmental scientist who has worked for more than 35 years 

doing environmental investigations and ensuring regulatory compliance. Prior to his current position, he served as executive director of the Baton Rouge’s Clean Air Coalition and as president of 

DOE, the Greater Baton Rouge Clean Cities Coalition. 

We thank all three of you for being our witnesses here today and 

for your service to the cities and States you represent, as well as 

the Nation. 

Without objection, the witnesses’ full statements will be inserted 

into the record. 

I now ask each witness to summarize his statement for 5 minutes, beginning with Dr. Landrigan. 

STATEMENT OF DR. PHILIP J. LANDRIGAN, MD, PROFESSOR 

AND CHAIRMAN, DEPARTMENT OF COMMUNITY AND 

PREVENTIVE MEDICINE, MOUNT SINAI SCHOOL OF 

MEDICINE 

Dr. LANDRIGAN. Good morning, Mr. Chairman. Thank you for 

having convened this hearing and for having invited me. And my 

thanks also to the other representatives from New York who have 

been present here this morning, Ms. Clarke and, earlier, Mr. King. 

And I also wish to thank those members of the Congress under the 

leadership of—— 

34 

Chairman THOMPSON. Excuse me. Is your mike on? 

Dr. LANDRIGAN. Now it is, sir. 

Chairman THOMPSON. Thank you very much. 

Dr. LANDRIGAN. I wish to thank those members of the Congress, 

under the leadership of Congresswoman Maloney, Congressman 

Jerry Nadler, Congressman Fossella and the whole New York delegation, who have introduced legislation supporting medical care for 

the 9/11 responders. 

Well, as you mentioned, I am the chairman of Community and 

Preventative Medicine at Mount Sinai, and the World Trade Center 

medical responder programs are based in the department that I 

chair. 

Let me speak first about the nature of the workforce who converged at Ground Zero after 9/11. The witnesses on the previous 

panel touched on this same point. The key point here is that it was 

a very diverse workforce. It included the uniformed services, such 

as the firefighters, the police and the National Guard, who came 

with a structure and with a high degree of organization. But in addition to those trained responders, there was a wide array of uncounted volunteers. Indeed, we only know within an order of magnitude the total number of people who were there. Estimates range 

from a low of 40,000 to a high of 90,000, with no clear way of deciding precisely what the number is. And they obviously varied greatly in their training. 

Secondly, I would like to say a word about the exposures to 

which these people were exposed. It changed over the course of the 

days following the attacks on the World Trade Center. The exposures were most intense, not surprisingly, in the first 24μhours. We 

all saw the dense cloud on TV, and we now know that 65 percent 

of the material that was in that cloud consisted of very alkaline 

pulverized cement from the destruction of the concrete in the towers. 

The reason we believe that the dust was so toxic is that that alkaline dust had a pH of 10 or 11. My colleague Dr. David Prezant, 

who is the chairman of the medical program at the fire department, has described this as pulverized lye, and on another occasion, he described it as pulverized Drano. And it was extremely irritating to the upper and lower respiratory tracts of the men and 

women who responded. The toxicity of the dust was further magnified by virtue of the fact that it contained millions of microscopic 

shards of glass from all of the windows, and those are clearly evident on the microscope, and they further led to the irritation in the 

respiratory tracts. 

Our group at Mount Sinai began to stand up the medical response to 9/11 on the 13th of September, 2001. Two days after the 

attack, our doctors gathered; they plotted a course and began seeing patients within weeks. We first received funding from the Federal Government through the National Institute for Occupational 

Safety and Health in June/July 2002, and that funding, initially for 

screening and now, today, for monitoring of the workers, continues. 

We have seen close to 22,000 workers total, and we have seen more 

than 7,000 for a second time. And the plan is to continue to see 

each and every eligible worker and volunteer every 18 months for 

as long as funding continues. 

35 

Also, since 2006, since approximately 1 year ago, we have had 

Federal funding for the treatment of these workers and volunteers. 

Prior to that, treatment had to be done using philanthropic money. 

And we have treated approximately 7,000 of the men and women 

for a range of conditions that include upper and lower respiratory, 

GI and mental health. 

Briefly, let me summarize the principal medical findings. Fortysix percent of the workers whom we have examined, or the first 

9,700 whom we have examined, were documented to have symptoms of their lower respiratory tract. Sixty-two percent had symptoms involving their upper respiratory tract. In the aggregate, 69 

percent had one, the other or both. 

Dr. LANDRIGAN. A high percentage have had gastroesophageal 

reflux disease, and a high percentage have had continuing mental 

health problems, depression, post traumatic stress disorder. In a 

number of these workers, those symptoms continue to the present. 

There are, in my mind, two major unanswered questions. The 

first is how long and with what degree of severity will these conditions that I have just described continue. We don’t know the answer to that on this day, and the only way we can come to know 

that is to continue to follow them at regular intervals and track 

and monitor and record the data. 

Then the second medical question concerns the issue of what new 

diseases might emerge in these brave men and women in the years 

ahead, diseases of long latency such as chronic lung diseases, such 

as malignancies. We know that there was asbestos in the dust. We 

know that there was dioxin in the dust. The question is what may 

or may not be the long-term consequences of those exposures. 

I think a couple of lessons learned that I would like to summarize in closing are, first of all, it was incredibly important that we 

had some pretty good monitoring of exposures, beginning shortly 

after 9/11. It could have been better, but it was nonetheless good, 

and I am able to talk with a high degree of confidence about the 

nature of the exposures, because records were kept. 

Secondly, it is a lesson learned is that we can expect that responders who rush into these disasters are going to become sick 

and plans have to be put in place in advance for monitoring and 

for treatment, can’t be left to chance, it can’t be reinvented with 

each new disaster. 

Thank you very much. 

[The statement of Dr. Landrigan follows:] 

PREPARED STATEMENT OF PHILIP J. LANDRIGAN, MD, M.SC. 

Good morning. 

Mr. Chairman and Members of the Committee, I thank you for having invited me 

to present testimony before you today on the issue of ‘‘Protecting the Protectors: Ensuring the Health and Safety of our First Responders in the Wake of Catastrophic 

Disasters’’ 

My name is Philip J. Landrigan, MD. I am Professor and Chairman of the Department of Community and Preventive Medicine of the Mount Sinai School of Medicine 

in New York City. I am a board certified specialist in Occupational Medicine as well 

in Preventive Medicine and Pediatrics. My curriculum vitae is attached to this testimony. 

In my capacity as Chairman of Community and Preventive Medicine at Mount 

Sinai, I oversee the World Trade Center (WTC) Medical Monitoring and Treatment 

Program as well as the World Trade Center Data and Coordination Center, two 

closely linked programs that are based in my Department and supported by grants 

36 

from the National Institute for Occupational Safety and Health (NIOSH). It has 

been the responsibility of our programs at Mount Sinai and of WTC Centers of Excellence in New York, New Jersey and across the United States, with which we collaborate closely, to diagnose, treat and document the illnesses that have developed 

in the workers and the volunteers who responded to 9/11. 

Today, I shall present a summary of our medical findings in the 9/11 responders. 

I shall comment also on the critical need for continuing support for Centers of Excellence that have the expertise and the hard-won experience that is essential to sustain high-quality medical follow-up and treatment for these brave men and women. 

The Diverse Population of 9/11 Responders. In the days, weeks, and months that 

followed September 11, 2001, more than 50,000 hard-working Americans from 

across the United States responded selflessly—without concern for their health or 

well-being—when this nation called upon them to serve. They worked at Ground 

Zero, the former site of the World Trade Center, and at the Staten Island landfill, 

the principal depository for WTC wreckage. They worked in the Office of the Chief 

Medical Examiner. They worked beneath the streets of lower Manhattan to search 

for bodies, to stabilize buildings, to open tunnels, to turn off gas, and to restore essential services. 

These workers and volunteers included traditional first responders such as firefighters, law enforcement officers, paramedics and the National Guard. They also 

included a large and highly diverse population of operating engineers, laborers, ironworkers, building cleaners, telecommunications workers, sanitation workers, and 

transit workers. These men and women carried out rescue-and-recovery operations, 

they sorted through the remains of the dead, they restored water and electricity, 

they cleaned up massive amounts of debris, and in a time period far shorter than 

anticipated, they deconstructed and removed the remains of broken buildings. Many 

had no training in response to civil disaster. The highly diverse nature of this workforce, and the absence in most of the groups who responded of any rosters to document who had been present at the site, posed unprecedented challenges for worker 

protection and medical follow-up. 

The 9/11 workforce came from across America. In addition to tens of thousands 

of men and women from New York, New Jersey, and Connecticut, responders from 

every state in the nation stepped forward after this attack on the United States and 

are currently registered in the WTC Medical Monitoring Programs. Particularly 

large numbers came from California, Massachusetts, Ohio, Illinois, North Carolina, 

Georgia, and Florida. 

The Exposures of 9/11 Responders. The workers and volunteers at Ground Zero 

were exposed to an intense, complex and unprecedented mix of toxic chemicals. In 

the hours immediately after the attacks, the combustion of 90,000 liters of jet fuel 

created a dense plume of black smoke containing volatile organic compounds—including benzene, metals, and polycyclic aromatic hydrocarbons. The collapse of the 

twin towers (WTC 1 and WTC 2) and then of a third building (WTC 7) produced 

an enormous dust cloud. This dust contained pulverized cement (60–65% of the total 

dust mass), uncounted trillions of microscopic glass fibers and glass shards, asbestos, lead, polycyclic aromatic hydrocarbons, hydrochloric acid, polychlorinated 

biphenyls (PCBs), organochlorine pesticides, furans and dioxins. Levels of airborne 

dust were highest immediately after the attack, attaining estimated levels of 1,000 

to > 100,000 μg/m3, according to the US Environmental Protection Agency. Firefighters described walking through dense clouds of dust and smoke in those first 

hours, in which ‘‘the air was thick as soup’’. The high content of pulverized cement 

made the dust highly caustic (pH 10–11). 

The dust and debris gradually settled, and rains on September 14 further diminished the intensity of outdoor dust exposure in lower Manhattan. However, rubbleremoval operations repeatedly reaerosolized the dust, leading to continuing intermittent exposures for many months. Fires burned both above and below ground 

until December 2001. 

Workers and volunteers were exposed also to great psychological trauma. Many 

had already lost friends and family in the attack. In their work at Ground Zero they 

commonly came unexpectedly upon human remains. Their stress was compounded 

further by fatigue. Most seriously affected by this psychological trauma were those 

not previously trained as responders. 

The World Trade Center Medical Monitoring and Treatment Program. Although 

New York has an extensive hospital network and strong public health system, no 

existing infrastructure was sufficient to provide unified and appropriate occupational health screening and treatment in the aftermath of September 11. Local labor 

unions, who made up the majority of responders, became increasingly aware that 

their members were developing respiratory and psychological problems; they initiated a campaign to educate local elected officials about the importance of estabVerDate Nov 24 2008 12:49 Nov 17, 2009 Jkt 000000 PO 00000 Frm 00040 Fmt 6633 Sfmt 6621 H:\DOCS\110-HRGS\110-71\48966.TXT HSEC PsN: DIANE
37 

lishing an occupational health screening program. In early 2002, Congress directed 

the Centers for Disease Control and Prevention (CDC) to fund the WTC Worker and 

Volunteer Medical Screening Program. 

In April 2002, the Irving J. Selikoff Center for Occupational and Environmental 

Medicine of the Mount Sinai School of Medicine was awarded a contract by the National Institute for Occupational Safety and Health (NIOSH), a component of the 

CDC, to establish and coordinate the WTC medical program. The Bellevue/New 

York University Occupational and Environmental Medicine Clinic, the State University of New York Stony Brook/Long Island Occupational and Environmental Health 

Center, the Center for the Biology of Natural Systems at Queens College in New 

York, and the Clinical Center of the Environmental & 

Occupational Health Sciences Institute at UMDNJ–Robert Wood Johnson Medical 

School in New Jersey were designated as the other members of the regional consortium based at Mount Sinai. The Association of Occupational and Environmental 

Clinics was designated to coordinate a national examination program for responders 

who did not live in the New York/New Jersey metropolitan area 

In addition to this consortium, there is a parallel program based at the Fire Department of New York (FDNY) Bureau of Health Services, also supported by the 

federal government through NIOSH. This program has provided medical examinations to over 15,000 New York City firefighters and paramedics. The FDNY and 

Mount Sinai programs collaborate closely and use closely similar protocols for monitoring the health of 9/11 responders. A great strength of the FDNY program is that 

it had collected extensive baseline data on the health of each firefighter and paramedic through a periodic medical examination program that long predated September, 2001. 

Nearly all of what we know today about the health effects of the attacks on the 

WTC has been learned through these medical programs that were developed in Centers of Excellence funded by the federal government. 

The Centers that comprise the consortium based at Mount Sinai provide free comprehensive medical and mental health examinations for each responder every 18 

months. Examinations are undertaken according to a carefully developed uniform 

protocol, and all of the data obtained on each responder are entered into a computerized database. The goals of the program are two: 

1. To document diseases possibly related to exposures sustained at the World 

Trade Center; 

2. To provide medical and mental health treatment for all responders with WTC 

related illnesses, regardless of ability to pay. 

To date, thanks to federal support, over 21,000 WTC responders have received initial comprehensive medical and mental health monitoring evaluations in the Centers of Excellence that comprise this consortium. More than 7,250 of these responders have also received at least one follow-up examination. Demand for the program 

remains strong. Even now, six years after 9/11, approximately 400 new workers and 

volunteers register for the program each month. In August 2007, 771 new participants, persons whom we had never previously seen, registered for the program 

through our telephone bank. 

Our WTC Medical Treatment Program has also been active. We launched this 

program in 2003 with support from philanthropic gifts. Philanthropic support provided the sole financial base for the treatment program from 2003 to 2006. Since 

September, 2006, we have begun to receive support for this program from the federal government. To date over 6,300 responders have received 47,000 medical and 

mental treatment services through this program. 

Health Effects Among WTC Responders. Documentation of medical and mental 

health findings in 9/11 responders followed by timely dissemination of this information through the peer-reviewed medical literature are essential components of our 

work. Documentation of our findings enables us to examine trends and patterns of 

disease and to assess the efficacy of proposed treatments. Dissemination of our findings and our recommendations for diagnosis and treatment to physicians across the 

United States permits us to share our knowledge and to optimize medical care. Such 

documentation and dissemination would be well nigh impossible in the absence of 

federally funded Centers of Excellence. 

In September 2006, the Centers of Excellence that comprise our consortium published a paper in the highly respected, peer-reviewed medical journal Environmental 

Health Perspectives, a journal published by the National Institutes of Health. This 

report detailed our medical findings from examinations of 9,442 WTC responders 

whom we and our partner institutions had assessed between July 2002 and April 

2004. I have appended this report to my testimony for your review, and I would like 

to direct your attention to a few key findings: 

38 

1See Environmental Health Perspectives The World Trade Center Disaster and the Health of 

Workers: Five-Year Assessment of a Unique Medical Secreening Program Volume 113 / Number 

12 / December 2006 

• Among these 9,442 responders, 46.5% reported experiencing new or worsened 

lower respiratory symptoms during or after their work at Ground Zero; 62.5% 

reported new or worsened upper respiratory symptoms; and overall 68.8% reported new or worsened symptoms of either the lower and/or the upper respiratory tract. 

• At the time of examination, up to 2 ° years after the start of the rescue and 

recovery effort, 59% of the responders whom we saw were still experiencing a 

new or worsened lower or upper respiratory symptom, a finding which suggests 

that these conditions may be chronic and that they will require ongoing treatment. 

• One third of responders had abnormal pulmonary function test results. One 

particular breathing test abnormality—decreased forced vital capacity ? was 

found 5 times more frequently in WTC responders than in the general, nonsmoking population of the United States. 

• We found that the frequency and severity of respiratory symptoms was greatest in responders who had been trapped in the dust cloud on 9/11; that frequency and severity were next greatest in those who had been at Ground Zero 

in the first week after 9/11, but who had not been caught in the dust cloud; 

and that frequency and severity were lower yet in those who had arrived at 

Ground Zero after the first week. These findings fit well with our understanding 

of exposures at the site and thus lend internal credibility to our data. 

• Findings from our program released in 2004 have attested to the fact that in 

addition to respiratory problems, there also exist significant mental health consequences among WTC responders. 

External Corroboration of our Findings. The peer-reviewed article that we published one year ago in Environmental Health Perspectives1 gains further credibility 

by virtue of the fact that the findings we report in it are consistent with findings 

on 9/11 responders that have been reported by highly credible medical investigators 

outside of our consortium. The FDNY has published extensively on the burden of 

respiratory disease among New York firefighters. They have seen a pattern of symptoms that closely resembles what we observed. Forty percent of FDNY firefighter 

responders had persistent lower respiratory symptoms, and 50% had persistent 

upper respiratory symptoms more than one year after 9/11. FDNY noted that rates 

of cough, upper respiratory irritation and gastroesophageal reflux were highest in 

those firefighters who had been most heavily exposed on 9/11. FDNY physicians 

have also noted reactive airways disease, and highly accelerated decline in lung 

function in firefighters as well as in other responders in the year following 9/11. 

Our findings receive further corroboration from reports released recently by the 

New York City Department of Mental Health and Hygiene from the WTC Registry 

that the health department has established with support from CDC. These reports 

noted increased rates of asthma and of post-traumatic stress disorder. 

Future Health Risks and Unanswered Questions. Two major unanswered questions confront us as we consider the future health outlook for the brave men and 

women who responded to 9/11: 

1. Will the respiratory, gastrointestinal and mental health problems that we are 

currently observing in responders continue to persist? For how long? And with 

what degree of severity and associated disability? These questions are especially 

important in the case of those responders who sustained very heavy exposures 

in the dust cloud on 9/11, in those who served in the first days after 9/11 when 

exposures were most intense, and in those who had prolonged exposures in the 

weeks and months after 9/11? 

2. Will new health problems emerge in future years in responders as a consequence of their exposures to the uniquely complex mix of chemical compounds 

that contaminated the air, soil and dust of New York City in the aftermath of 

9/11? Responders were exposed to carcinogens, neurotoxins, and chemicals toxic 

to the respiratory tract in concentrations and in combinations that never before 

have been encountered. The long-term consequences of these unique exposures 

are not yet known. 

Concluding Comments. Six years following the attacks on the World Trade Center, thousands of the brave men and women who stood up for America and who 

worked on rescue, recovery, and clean up at Ground Zero are still suffering. Respiratory illness, psychological distress and financial devastation have become a new 

way of life for many. 

39 

The future health outlook for these responders is uncertain. The possibility is real 

that illnesses will persist, at least in some, and that new conditions—diseases 

marked by long latency—will emerge in others. 

Only continuing, federally supported medical follow-up of the 9/11 responders 

through Centers of Excellence that are equipped to comprehensively evaluate responders, to document their medical findings, and to provide compassionate stateof the-art treatment will resolve these unanswered questions. 

Thank you. I shall be pleased to take your questions. 

Chairman THOMPSON. Thank you very much. I am sure you can 

expect some questions based on your testimony once we have completed. 

Chief Visconti, please. 

STATEMENT OF DEPUTY CHIEF NICHOLAS VISCONTI, 

INTERNATIONAL ASSOCIATION OF FIREFIGHTERS 

Deputy Chief Visconti. I thank you, Chairman Thompson and 

distinguished members of the committee for the opportunity to testify before you today. 

My name is Nick Visconti, and I serve as the Deputy Chief of the 

New York City Fire Department. I am pleased to appear before you 

today on behalf of the International Association of Firefighters and 

the more than quarter million full-time emergency response personnel who comprise our organization. 

Like virtually every other member of the FDNY, I responded to 

the World Trade Center on September 11, 2001. Initially, it was my 

job to establish a staging area for first responders at Shea Stadium. Having nothing on hand, we borrowed supplies that we could 

from the NYPD detail at the stadium. 

As hundreds of firefighters began assembling at the stadium, we 

recorded their names and then dispatched them to the World Trade 

Center on buses provided by the Department. 

I assigned other officers to my duties, and I made my way to 

Ground Zero. I arrived shortly after the second tower fell. The 

scene was pure chaos. Everywhere I turned I saw firefighters with 

debris, our radios were screeching with urgent calls and May Days, 

an operations command post had not been set up, and I was immediately assigned to find and rescue the men of Ladder Company 6. 

The men of Ladder Company 6, including one of my best friends, 

had been on the fourth floor of Tower 2 when it collapsed. 

I pulled together people I knew personally, and we began the 

search. Somehow, I was able to quiet the chatter on the radio long 

enough to contact the missing company, and amazingly, I received 

an answer. 

Thinking they had only experienced a localized stairwell collapse, 

and not realizing that the entire building had crumbled down upon 

them, the captain asked that someone respond to a May Day that 

had been received from firefighters on the 12 floor. I couldn’t bring 

myself to tell them that there was no longer a 12th floor. 

As we conducted a futile search for the stairwell, which no longer 

existed, the men of Ladder 6, who were miraculously able to dig 

themselves out of rubble, I can only imagine what they felt when 

they realized the full extent of what had happened. That was first 

and last miracle I experienced that day. 

As we continued to search for victims and survivors, a firefighter, 

who is just off to my side, spotted some well-shined shoes in the 

40 

debris. This discovery led to the removal of the body of the Chief 

of the department, Peter Ganci. Almost at the same time, the 

search for another pile of debris uncovered the body of William 

Feehan, the First Deputy Fire Commissioner. Two of the highest 

members of the fire department were found no more than 25 feet 

apart. 

For the rest of the day and into the night, my team and I 

searched for victims, hindered by the chaos and the complete lack 

of unit integrity. We had nothing to work with. We had no water, 

no trucks, no stretchers or body bags in which to place the victims 

we expected to find. 

We also expected to find survivors. Sadly, there were none. Only 

on the following day was a woman rescued from what was left of 

the north tower, and, to the best of my knowledge, she was the 

last. 

At about 11:00, I took my first break. I found the phone to call 

my wife and family to tell them that I was okay. Then I went back 

to the pile. For 3 days I did little else, occasionally catching a couple of hours of sleep at a firehouse before returning. 

On that day we lost 343 brother firefighters. As hard as it is to 

acknowledge, I know that illness and disease from hazardous exposures to Ground Zero will take yet more from us. It is from the perspective of one man who responded to that awful day that I wish 

to address the health and safety risks faced by first responders 

during major disasters. 

On September 11, there was nothing we could have done to have 

saved the towers from falling, but we could have and should have 

saved 121 firefighters who couldn’t hear evacuation orders because 

their radios weren’t working. 

We could have and should have provided responders with proper 

respiratory gear. We could have and should have an operated 

under a unified command system that effectively used well— 

trained and well-prepared emergency response professionals. 

The failure of the New York Fire Department to provide its firefighters with radios that worked in that environment is the greatest. The study of the FDNY response to the 1993 World Trade Center bombing included several recommendations, but none more important than replacing the antiquated radios we were using. 

Eight years later, we were using the exact same radios. Four 

years later our responders and the citizens of the gulf coast suffered many of the same problems during the response to the 

Katrina. There is, unfortunately, no quick fix. If Congress wishes 

national safety to be a national priority, it will require a concerted, 

long-term effort to ensure responders health and safety before, during and after a disaster. 

The best way to ensure responders’ health and safety during a 

disaster is to ensure that they have the right personnel, tools and 

training they need before the response even begins. 

Unfortunately, far too many fire departments lack sufficient personnel to perform their duties safely, and far too many firefighters 

lack the training, equipment and preparation they need to safely 

participate in large-scale response. The Federal Government must 

provide both financial and programmatic support to address these 

shortcomings. Grant programs that provide resources to our fire deVerDate Nov 24 2008 12:49 Nov 17, 2009 Jkt 000000 PO 00000 Frm 00044 Fmt 6633 Sfmt 6601 H:\DOCS\110-HRGS\110-71\48966.TXT HSEC PsN: DIANE
41 

partments must be fully funded. Research to improve personal protective gear and equipment, such as the work currently under way 

at the NIOSH lab must be expanded, and we must assure that the 

communications failures we witness on September 11 and during 

Katrina never happen again. 

The Federal Government also has an important role to play in 

assuring the health and safety of responders during the response. 

The National Incident Management System reflects a fundamental 

understanding by establishing a common framework to enable all 

government private sector and nongovernmental organizations to 

work together during disasters. In order for NIMS to work effectively, all firefighters must have certain minimum levels of training 

and capabilities. Just because someone calls himself a firefighter 

does not mean he or she is capable of doing what a firefighter 

should be able to do. 

In New York, we already have mandated minimum standards for 

mutual aid responses, and we believe this concept should be implemented nationwide. We therefore urge prompt and full implementation of the NIMS Integration Center National Credentialing System. 

Lastly, we must insure that on scene emergency commanders 

have the training and that they comply with standard operating 

procedures. There is no excuse for firefighters to operate in an unsafe manner when we know how to keep them safe. Every firefighter knows that the work of first responders does not end when 

the fire is out. 

Recovery after the fact is just as important as preparation and 

response. This is especially true in major disasters such as 9/11 

and Katrina where the health needs of responders continue to be 

far beyond the initial response and illustrate the importance of 

management of disasters’ aftermath. Medical monitoring and treatment programs addressing both the physical and mental health 

needs of the responders must be implemented following any largescale event. 

In conclusion, I want to thank you for the opportunity to share 

a firefighter’s perspective on protecting the health and safety of individuals who respond to major disasters. The issues and recommendations outlined in my testimony today only skim the surface of the matter at hand. 

Ensuring the health and safety of our first responders will require a comprehensive, long-term effort to align our Nation’s policies and priorities with this goal. 

I want to thank the chairman once again and the committee for 

its attention. I would be happy to answer any questions. 

[The statement of Mr. Visconti follows:] 

PREPARED STATEMENT OF NICHOLAS VISCONTI

Thank you Chairman Thompson, Ranking Member King, and distinguished members of the Committee for the opportunity to testify before you today. My name is 

Nick Visconti, and I currently serve as Deputy Chief of the New York City Fire Department. I am pleased to appear before you today on behalf of the International 

Association of Fire Fighters (IAFF) and the more than quarter million full-time 

emergency response personnel who comprise our organization. 

Whenever and wherever disaster strikes, America’s professional fire fighters and 

emergency medical personnel are on the front lines working tirelessly and heroically 

to save lives and protect the public safety. As we have witnessed, whether respondVerDate Nov 24 2008 12:49 Nov 17, 2009 Jkt 000000 PO 00000 Frm 00045 Fmt 6633 Sfmt 6621 H:\DOCS\110-HRGS\110-71\48966.TXT HSEC PsN: DIANE
42 

ing to a bomb in Oklahoma City, an earthquake in San Francisco, massive flooding 

in the Gulf Coast or terrorist attacks on the World Trade Center, the men and 

women of the IAFF are the first to arrive on the scene and the last to leave. 

Like virtually every other member of the New York City Fire Department, I responded to the World Trade Center on September 11, 2001. Although I was not 

scheduled to be on-duty that day, when the planes hit, every New York City fire 

fighter was mobilized. Initially, it was my job to establish a staging area for first 

responders at Shea Stadium. When I arrived, we had no equipment or material to 

set up a staging area. We rushed to collect needed supplies, record the names and 

units of the Fire Officers and fire fighters who responded, and began to delegate 

responsibilities. Having nothing on hand, we borrowed what we could from the 

NYPD detail at the stadium. As hundreds of fire fighters began assembling at the 

stadium and after five bus loads were dispatched to the World Trade Center, I assigned my duties to a Battalion Chief and made my way to Ground Zero. 

I arrived somewhere around thirty minutes after the second Tower fell. The scene 

was pure chaos. Everywhere I turned, I saw fire fighters covered with debris. Our 

radios were screeching with urgent calls and ‘‘May–Days.’’ An Operations Command 

Post had been set up, and I was immediately assigned to find the members of Ladder 6. The men of Ladder 6, including one of my best friends, had been on the fourth 

floor of Tower Two when it collapsed. 

We began to assemble our own search and rescue teams. At that time there were 

no ‘‘units’’ available. There were only groups of Fire Officers and fire fighters from 

different units and different areas of the City. I pulled together people I knew personally—people I knew how to work with—and began my search. Somehow, I was 

able to quiet the chatter on the radio long enough to contact the missing company— 

amazingly—I received an answer. They didn’t know the entire building had crumbled around them. Thinking that they had only experienced a localized stairwell collapse, they asked that someone respond to a mayday they had received from fire 

fighters on the twelfth floor. I couldn’t bring myself to tell them that there was no 

twelfth floor—there was only the mound that was once the North Tower. As we conducted a futile search for a stairwell which no longer existed, the men of Ladder 

6 were miraculously able to dig themselves out from the rubble. I can only imagine 

what they felt when they realized what had happened. 

That was the first and last miracle I experienced that day. 

During this time fire officers were establishing command posts around the perimeter of the pile, but it was difficult to keep track of all personnel on scene. I must 

repeat that there was little to no unit integrity. The mainstay of Fire Department 

operations is organization. People know who is in command; they know their immediate supervisor and they know their role in the work at hand. Fire Department 

radio communications, despite the fact that the Towers had collapsed, were intermittent and jammed with individual messages. Furthermore, we lacked even the 

most basic of necessities. There was no water. There was no hose, there were no 

trucks. There were no stretchers or body bags in which to place the bodies we expected to find. We also expected to find survivors. Sadly, there were none. Only on 

the following day was a women rescued from what was left of the North Tower. To 

the best of my knowledge she was the last. 

I was assigned to set up an operations post on the south side of the collapsed 

North Pedestrian Walkway. We accessed the collapse field through a window of a 

World Financial Center building. The first priority was to organize the group and 

the others flowing into the debris field. Everyone was trying to do something; to accomplish anything we had to work together. As my group and I made our way 

around our assigned area, I looked down and found myself walking on the roof of 

a fire engine. When we searched the remains of that Engine we found the bodies 

of two members of the FDNY. A short time later, as the group that I commanded 

searched the debris field, a fire fighter, who was just off to my side, yelled out that 

he had spotted some well-shined shoes in the debris. This discovery led to the removal of the body of Chief of Department Peter Ganci. Almost at the same time the 

search of another pile of debris uncovered the body of William Feehan, the First 

Deputy Fire Commissioner. The two highest ranking members of the Fire Department were found no more than twenty-five feet apart. 

And so it went for the next several hours: digging through debris, trying to bring 

some order to unimaginable chaos, finding the bodies of not only our friends, our 

brothers, but also the civilian victims of the attack. I’d like to add that when a body 

was discovered and removed, it was done with the utmost respect and care, regardless of the identity or affiliation of the individual. At no time were we only seeking 

our Brothers; we wanted to find each and every victim. 

At about 4:30 PM the Operations Chief notified all Sector Commanders to evacuate the entire area of the debris field. The Chief had enough evidence to suspect 

43 

that WTC 7 would collapse. Under normal circumstances, an evacuation order would 

have been transmitted over the handheld radios that are carried by officers and fire 

fighters. At this horrific landscape, successful radio communications were intermittent, most fire personnel did not have radios, we had no radio communication with 

other agencies that were working in the debris field, and there were many construction workers and others with whom we had no communications at all. To evacuate 

the area as rapidly as possible, the order to evacuate was transmitted repeatedly; 

Fire Department members were ordered to evacuate and to notify anyone with 

whom they had contact to leave the area. It was necessary to send individual ‘‘runners’’ to groups of people working throughout the area who did not receive the order. 

WTC 7 collapsed around 5:30 PM without further injury or death. 

At 11:00 PM I took my first break of the day. I found a phone and called my wife 

and family to tell them that I was OK. Then I went back to the pile. For three days, 

I did little else, occasionally catching a couple of hours of sleep at a firehouse before 

returning to the nightmare of that pile. 

On that darkest day, we lost 343 brother fire fighters. And as hard as it is to acknowledge, I know that illness and disease from hazardous exposures at Ground 

Zero will take yet more from us. 

It is from this perspective, the perspective of one man who responded on that 

awful day, that I wish to address the health and safety risks faced by first responders during major disasters. 

The terrorist attacks of September 11 and the devastation wrought by Hurricane 

Katrina fundamentally changed the way our nation views emergency response. Prior 

to these seminal events, public safety was viewed almost exclusively as a local government function. No more. Americans now fully understand that homeland security 

is a vital federal government responsibility, and Congress has rightly acted to improve the manner by which our nation responds to major disasters. But while the 

federal government has focused on how to better protect our nation’s communities, 

citizens, and property, we have yet to focus on how to better protect the individuals 

who respond to major disasters in any comprehensive way. 

The fact of the matter is that, in today’s post–9/11 world, local first responders 

play the most significant role in the federal response to large-scale disasters. As the 

federal government continues to ask more of its first responders, we owe it to them 

to ensure that our nation’s policies and priorities enable their safe and effective response. 

The Response to the World Trade Center and Hurricane Katrina: Lessons 

Learned 

On September 11, there was nothing we could have done to have saved the Towers from falling, or to have saved the lives of those on the Towers’ highest floors. 

But we could have, and we should have, saved 121 fire fighters who couldn’t hear 

evacuation orders because their radios weren’t working. We could have, and should 

have, lessened the health impact on responders by providing them with proper respirators and protective gear from day one. We could have, and should have, operated under a unified command system staffed by well-trained and well-prepared 

emergency response professionals. 

The tragic reality is that these failures were avoidable. Workers were allowed on 

the pile without respirators, even though the air had not yet been determined safe 

to breathe. The City’s command center, whose staff had never prepared for a highrise fire, much less a major incident at the World Trade Center, collapsed at 7 

World Trade Center, while fire fighters struggled to keep order on the ground. 

Perhaps most egregious was the failure of the New York Fire Department to provide its fire fighters with radios that worked in that environment. The exhaustive 

study of the FDNY response to the 1993 World Trade Center bombing included several recommendations, but none more important than replacing the antiquated radios we were using. Yet, eight years later we were using the exact same radios. 

Following the cataclysmic events of 9/11, our nation rightly decided it needed a 

better way to respond to major disasters. Congress and the Administration moved 

quickly and forcefully to develop new systems so that we would be better prepared 

for the next disaster. We created the Department of Homeland Security, the largest 

reorganization of the federal government in half a century. The President of the 

United States issued a series of Directives that were meant to change not only procedures, but the way in which we thought about emergency response, leading to the 

creation of the National Incident Management System (NIMS) and the National Response Plan (NRP). Money flowed to establish interoperable communications systems. 

Yet, four years, billions of dollars, and countless man-hours later, our nation’s 

new preparedness and response system failed the citizens of the Gulf Coast, and our 

44 

responders, yet again. The response to Hurricane Katrina was plagued by the delayed deployment of people and resources, a lack of basic supplies, and a failed communications system. 

There is, unfortunately, no quick fix to safeguard those who put their lives on the 

line to protect the public. If Congress wishes first responder safety to be a national 

priority, it will require a concerted, long-term effort to ensure responders’ health 

and safety before, during, and after a disaster. 

Before a Disaster: Preparation 

The very best way to ensure responders’ health and safety during a disaster is 

to ensure you have the right personnel, tools, and training you need before the response even begins. Every Boy Scout knows the mantra ‘‘Be Prepared.’’ Yet, far too 

often, we as a nation forget that simple lesson from our childhood. Unfortunately, 

far too many fire fighters today lack the training, equipment and preparation they 

need to safely participate in a large-scale response. 

The single most effective thing the federal government can do to protect fire fighter safety is assure that every fire department in the nation has a sufficient number 

of adequately trained and equipped fire fighters. Currently, two-thirds of all fire departments are understaffed and operating below safe minimum staffing guidelines 

issued by the National Fire Protection Association (NFPA). The results are tragic 

and harrowing. 

Since 1998, the National Institute for Occupational Safety and Health (NIOSH) 

has investigated every fire fighter line of duty fatality. From January 1, 1998 

through 2005, there were 174 fatalities from trauma, such as burns, crushing, falls 

and inhalation of toxic gases, at a fire scene. In almost all of these incidents, NIOSH 

found a lack of incident command, accountability, and most importantly, staffing as 

a primary cause of these line of duty deaths. 

That said, having sufficient personnel on the ground would make little difference 

if they are not properly equipped or properly trained for the job at hand. New resources must be dedicated to develop and test new protective gear and equipment. 

Currently, NIOSH’s National Personal Protective Technology Laboratory is developing new technologies to better protect fire fighters from all hazards, including a 

terrorist attack using deadly chemicals or biological agents. 

Based on the innovations that emerged from NIOSH’s lab and other research centers, all fire fighter respirators now protect fire fighters against chemical, biological, 

radiological and nuclear (CBRN) agents. And NIOSH is continuing its efforts to improve turnout gear and other personal protective gear to protect fire fighters against 

the dangers of the 21st Century. 

Training levels must also ensure fire fighters are able to function in even the most 

hazardous scenarios. NFPA has recently revised its standard for hazmat training 

to fully incorporate response to weapons of mass destruction. We believe it should 

be a minimal requirement for all fire fighters to receive this hazmat/WMD training 

as a matter of course. 

As the failures on September 11 and during the response to Katrina illustrate, 

emergency communications challenges during major disasters continue to endanger 

first responders. However, despite the common belief that communications issues on 

9/11 and on the Gulf Coast were failures of interoperability, they were, in actuality, 

failures of basic operability. The fact of the matter is that, before emergency response departments can grapple with the issue of interoperability, they must ensure 

that basic communications needs are fulfilled. Too many emergency departments 

lack effective and reliable communications equipment. Additionally, in a major disaster basic communications systems may be destroyed. 

Once departments overcome any weaknesses in their own internal communications systems, they may then face additional technical and operational challenges 

in achieving interoperability. Equipment purchases alone will not ensure interoperable communications. Communities must also ensure appropriate planning, design, 

exercises, modeling and training. 

The Office of Management and Budget conservatively estimates that $15 billion 

is needed to address communications interoperability issues in the United States. 

Billions more will also be needed to assist local emergency response agencies meet 

their own communications needs. Congress should take steps to provide additional 

funds for emergency responder operability and interoperability needs as expeditiously as possible, and ensure that interoperability grants are made available for 

a wide variety of activities. 

Equally as important as ensuring that personnel have proper equipment and 

training is ensuring that such personnel are physically fit to carry out their duties. 

To this end, all fire fighters should be required to undergo an annual physical evaluation to identify and address any health issues a responder might have. FurtherVerDate Nov 24 2008 12:49 Nov 17, 2009 Jkt 000000 PO 00000 Frm 00048 Fmt 6633 Sfmt 6621 H:\DOCS\110-HRGS\110-71\48966.TXT HSEC PsN: DIANE
45 

more, fitness facilities should be made readily available, and incentives should be 

provided for fire fighters to undertake regular fitness programs. 

The IAFF has made achieving and maintaining fire fighter wellness and fitness 

one of its top priorities. Working in conjunction with the International Association 

of Fire Chiefs, the IAFF has developed a Wellness-Fitness Initiative designed to 

help maintain fire fighters’ physical and mental capabilities throughout their careers. One way to better protect fire fighters in responding to major disasters would 

be to implement this initiative in every fire department in America. 

During a Disaster: On-the-Scene 

The federal government also has an important role to play in assuring the health 

and safety of responders during an actual response. As I mentioned previously, the 

mainstay of fire department operations is organization. The National Incident Management System (NIMS) reflects this fundamental understanding by establishing a 

common framework to enable all government, private-sector, and nongovernmental 

organizations to work together during disasters. By establishing a common language, a unified approach, and standard command structures, NIMS enables first 

responders and those with whom they work to operate more efficiently, and thus, 

more safely. As the federal government continues to update and refine NIMS, it 

must ensure continued compliance with its principles among all levels of government, and proactively provide continuing educational opportunities to first responders and government officials to achieve such compliance. 

Additionally, the safety of responders and citizens during a major disaster, as well 

as mission effectiveness, can be greatly increased by the efficient and appropriate 

management of response personnel. Although their impact on disaster response has 

always been overwhelmingly positive, the arrival of fire fighters on the scene has 

often been chaotic and less than 100% effective. There are several reasons for this. 

First and foremost, too many well-meaning fire fighters self-dispatch rather than 

waiting to be officially mobilized. Second, the qualifications of fire fighters currently 

vary across and within departments. Just because someone calls himself a fire fighter does not mean he is capable of doing what a fire fighter should be able to do. 

Current difficulties tracking on-scene personnel and their capabilities prevents onscene commanders from making the best use of their most valuable resources. This 

was certainly my experience on 9/11. 

The NIMS Integration Center (NIC) within the Department of Homeland Security 

is currently developing a national credentialing system to help verify the identity 

and qualifications of emergency personnel responding to a major disaster. The System, requiring minimum national qualifications for specific emergency response 

functions, will help on-scene commanders identify who is on-scene and make the 

best possible use of their capabilities. Had such a system been in place on 9/11, the 

issues we experienced tracking and utilizing personnel may have been avoided. Congress should do all it can to ensure that States and localities only credential personnel who fully comply with the minimum national standards established by the 

NIC, and that the National Credentialing System is quickly and thoroughly implemented. 

Lastly, we must ensure that on-scene commanders fully comply with standard operating procedures. Unfortunately, far too often, fire fighter deaths and injuries result not from failures of equipment or unexpected dangers, but from a failure to 

comply with widely accepted rules and procedures for operating safely. This is completely unacceptable; there is no excuse for fire fighters to operate in an unsafe 

manner when we know how to keep them safe on-scene. 

After a Disaster: Follow-Up and Follow-Through 

Every fire fighter knows that the work of first responders does not end when the 

fire is out. Recovery after the fact is just as important as preparation and response. 

This is especially true in major disasters such as 9/11 and Katrina. In these two 

cases, the health needs of responders, in particular, have continued far beyond the 

initial response and provided an illustration of the importance of managing a disaster’s aftermath. 

Because any major disaster is bound to pose significant physical dangers and 

mental health challenges, the establishment of a comprehensive health monitoring 

program is essential. Following the 9/11 response, the New York Fire Department 

established a medical monitoring program to identify and treat any new health 

problems in responders. The situation facing responders and their physicians was 

extremely serious. The Ground Zero dust cloud was the largest acute exposure to 

high-volume particulate matter in a modern urban environment—ever. Within the 

first week following 9/11, the FDNY found that 99% of exposed New York City fire 

fighters reported at least one new respiratory symptom while working at Ground 

Zero. Fortunately, FDNY’s annual physical requirement established a baseline medVerDate Nov 24 2008 12:49 Nov 17, 2009 Jkt 000000 PO 00000 Frm 00049 Fmt 6633 Sfmt 6621 H:\DOCS\110-HRGS\110-71\48966.TXT HSEC PsN: DIANE
46 

ical picture from which monitoring physicians could judge a fire fighter’s relative 

health. 

The Department also provided mental health treatment through its Counseling 

Service Unit, providing treatment for post traumatic stress disorder, substance 

abuse counseling and grief counseling. Due in large part to the program, FDNY experienced only one post–9/11 suicide. 

There is no doubt in my mind that hundreds of additional fire fighters would have 

experienced serious physical and mental health issues were it not for the FDNY programs. Their success makes them an excellent model for comprehensive physical 

and mental health monitoring programs established in the wake of future disasters. 

We must also ensure that lessons learned from future response efforts are retained and applied in preparation for the next catastrophe. The 9/11 Commission 

report and the Katrina report enabled organizations and persons at all levels of society to identify and remedy broken response components and missed opportunities. 

In response to these reports, Congress, for example, established the Department of 

Homeland Security, provided homeland security funding to the states and passed 

a comprehensive FEMA reform bill. After-action reports such as these should be de 

rigueur for any major disaster so that lessons learned can be incorporated into our 

future training, exercises, and response plans. 

Lastly, it should go without saying that when the public safety department of a 

community is completely devastated by a disaster, the federal government should 

step up to the plate and help that community rebuild that department. On 9/11, 

FDNY lost 343 fire fighters, and 100 pieces of apparatus—equivalent to losing an 

entire fire department the size of San Diego. Similarly, when Katrina hit the Gulf 

Coast, New Orleans lost two-thirds of their fire stations, while the St. Bernard Parish Fire Department lost five of six stations. When a community takes such a devastating blow, the federal government must intervene to protect the safety of the 

homeland as well as its citizens. And it should do so without adding the burden of 

dealing with red tape and bureaucracy on a community already facing an overwhelming burden. 

Progress Made: Recent Congressional Action 

While there is still much work do be done to align our nation’s policies and priorities with the goal of protecting the protectors, I am encouraged by the spotlight this 

Committee and the Congress has shone on the issue as of late. I would be remiss 

if I did not mention a number of recent reforms instituted by the Congress which 

I believe will help better ensure the health and safety of fire fighters and others 

who respond to future disasters. 

One of the most important recent reforms implemented by the Congress was the 

enactment of the Emergency Management Reform Act of 2007, popularly known as 

the FEMA reform bill. The leadership of this Committee was early to recognize 

many of the problems facing FEMA, and actively engaged the IAFF as you crafted 

your bill, which we were proud to support. 

Many of the provisions included in the FEMA reform bill will significantly contribute to assuring the health and safety of responders in an emergency. By reuniting emergency preparedness with emergency response under FEMA, the bill will 

help ensure that tomorrow’s emergency response efforts are in sync with today’s 

preparedness efforts. Authorizing the National Integration Center to promote compliance with the National Incident Management System (NIMS) and the National 

Response Framework (NRF) will help assure that responders are operating under 

common procedures. And involving first responder organizations through the National Advisory Council will ensure that the plans made by governmental officials 

make real-world sense to those who must carry them out. 

Congress has also consistently supported grant programs to ensure that fire departments nationwide are safely staffed by properly equipped and trained personnel. 

This year, the House of Representatives has provided $235 million for the SAFER 

grant program as well as $570 million for the FIRE grant programs. Although these 

funds will provide a down-payment on fire fighter safety, I urge the Congress to 

fully fund these vital and life-saving grant programs so that they may achieve their 

full potential. 

I am also appreciative of legislation passed by the Congress and signed into law 

authorizing the President to establish medical monitoring programs following disasters. We at FDNY benefited from a truly comprehensive monitoring and treatment 

program that, I have no doubt, saved countless lives. Likewise, future monitoring 

programs will permit the treatment of potential diseases and other health conditions 

in responders that might not otherwise be detected. 

I am also pleased that Congress has made significant strides to improve emergency communications during disasters. By doubling the current spectrum available 

47 

to public safety and establishing two new grant programs to help public safety agencies achieve interoperability as well as basic communications operability, you have 

made great strides towards ensuring that the communications failures of 9/11 and 

Katrina are not repeated. 

Furthermore, provisions in the recently enacted 9/11 Commission Act help ensure 

that federal homeland security assistance be distributed to state and local governments based on risk and vulnerability. A key recommendation of the 9/11 Commission, this reform will help ensure that the lion’s share of resources are used to provide equipment and training to protect those responders at highest risk for disaster, 

whether natural or man-made. 

Conclusion 

On behalf of myself and the IAFF, I appreciate the opportunity to offer our perspective on protecting the health and safety of individuals who respond to major disasters. But the reality is that the issues and recommendations outlined in my testimony today only manage to skim the surface of the matter at hand. Ensuring the 

health and safety of our first responders will require the dogged will of legislators, 

such as yourselves, to undertake a comprehensive, long-term effort to align our nation’s policies and priorities with this goal. We look forward to working and 

partnering with your committee to this end, so that we may better safeguard our 

first responders as they put their lives on the line every day to protect our communities and their citizens from emergency situations both large and small. 

Again, I would like to thank the Committee for its attention and I would be happy 

to answer any questions you may have. 

Ms. CLARKE. [Presiding] Thank you for your testimony. 

I now recognize Dr. Mike McDaniel to summarize his statement 

for 5 minutes. 

STATEMENT OF MIKE MCDANIEL, SECRETARY, LOUISIANA 

DEPARTMENT OF ENVIRONMENTAL QUALITY 

Mr. MCDANIEL. Thank you, Representative Clark, the committee 

members. 

I am Mike McDaniel of the Louisiana Department of Environmental Quality. 

My testimony will address DQ’s response to Hurricanes Katrina 

and Rita. LDEQ’s responsibility under Louisiana’s emergency operating plan are limited primarily to environmental support function 

10, and that is oil spill, hazardous materials and radiation. 

However, as detailed in my written testimony, the Department 

conducted many activities that yielded critical information to assist 

and protect first responders. This information was provided 

through the unified command center. These activities included 

search and rescue, reconnaissance, damage and environmental 

threats assessment, environmental sampling and assessment and 

hazardous radioactive materials management. 

In the area of search and rescue, teaming with the Louisiana 

Sheriff’s Association, the LDEQ employees aided in the rescue of 

approximately 480 people from the area impacted by Hurricane 

Katrina. 

In the area of reconnaissance damage and environmental threats 

assessment, our immediate concerns relevant to responders included industrial sites, oil spills, waste water treatment plants, rail 

cars, barges, radioactive material locations, drinking water sources 

and intakes, underground storage tanks, ruptured pipelines, Superfund tanks and then access routes and photo documentation. 

Air reconnaissance was used to provide an initial evaluation of 

status of these sites of concern. In addition to high resolution aerial 

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tectors, the EPA’s mobile air monitoring units and a helicoptermounted HAWK camera. 

The EPA ASPECT aircraft has capabilities for air quality and radiation monitoring, as well as aerial photography. The HAWK camera is an infrared gas-imaging technology that captures images of 

volatile gases that are visible to the naked eye. This information 

obtained during these assessments was shared with the unified 

command center, including assisting first responders. 

In addition, hazards such as oil spills, gas releases were photo 

documented, and potential access routes were evaluated to assist 

first responders and for followup ground assessments. As facilities 

and sites became assessable, ground assessments were made of all 

potential sources and all potential releases of hazardous materials. 

Drinking water sources were evaluated for contamination, and 

operational status of water and waste water treatment plants were 

determined. In many cases, multiple visits were made to sites in 

order to ascertain that potential hazards had been secured. For example, 383 visits were made to 258 radiation source licensees in 

order to verify that all radiation sources had been secured. 

In the area of environmental sampling and assessment, with 

EPA and other partners, thousands of environmental samples were 

collected, including floodwaters, waters of Lake Pontchartrain, adjacent coastal areas in the Mississippi River, sediment and soils, 

seafood and air quality. These efforts are detailed in our written 

testimony. 

In all over 1 million individual analyses were performed, and 

data and health risk assessments were presented to the public and 

LDEQ and EPA Web sites, through press releases, press conferences, presentations, media interviews and calls to live radio. 

Effectively communicating the environmental sampling results to 

first responders and the public was recognized as critical, and great 

effort was extended in this area. The various means of communicating and environmental results to the first responders and the 

public, along with some examples, are described in our written testimony. 

In the area of hazardous and radioactive materials management, 

with valuable assistance and resources provided by EPA, over 22.4 

million pounds of hazardous material were collected and removed 

from waste streams for proper treatment and disposal. Over 1 million white goods such as refrigerators, 956,000 electronic goods and 

250,000 small engines were collected and sent to be recycled. 

Over 4 million orphan containers, many containing hazardous 

materials were collected and reprocessed for recycling disposal. 

Over 110 school laboratories were cleared of hazardous material. 

Our radiological response efforts included issues relating to the security of the State’s nuclear facility and radioactive materials held 

by our licensees. 

In the area of protecting our first responders, throughout our 

emergency response efforts, great care was taken to protect all first 

responders working from our unified command center. The LDEQ 

attended many briefings on a daily basis to share information from 

its assessments and other activities that was used to assist and 

protect first responders. 

49 

1 All exhibits referenced in this written testimony may be found at www.deg.louisiana.gov. 

Specifically, environmental conditions, as well as health and 

safety procedures were discussed and briefings held every morning 

before our field crews left for their various responsibilities. An example of the types of communication and information provided to 

the responders are provided in our written testimony. 

In closing, I would like to note that at the request of the Senate 

Committee on the Environment and Public Works, the LDEQ put 

together a report entitled Some Observations and Recommendations for those Planning for or Responding to Environmental Challenges presented by Major Disasters. This report addresses issues 

relevant to this hearing and can be found on LDEQ’s Web site. 

That concludes my statement. I would be happy to take any 

questions at this time.1

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Ms. CLARKE. I thank all of the witnesses for their testimony. I 

will remind each member that he or she will have 5 minutes to 

question the panel. 

I will now recognize myself for questions. 

Let me start by just thanking Chief Visconti for coming and testifying today, for his service to our Nation, the State of New York, 

the City of New York, for the past 39 years. You must have started 

when you were about 8, right, chief? 

Deputy Chief Visconti. Five. 

Ms. CLARKE. Five. But you raised some very important questions, 

just based on your personal experience and through the wealth of 

knowledge that you have gained throughout your career as a firefighter and as a ranking member of the FDNY. 

Chief Visconti, having interoperability with communications, 

proper staffing levels, solid leadership and proper personnel protective equipment are critical health and safety issues. 

You stated in your testimony that you felt that we weren’t, or the 

City of New York and Nation was not equipped on September 11. 

Do you feel that the New York City fire department have all 

these things currently and what would you recommend to make 

sure that fire departments around this Nation are prepared for 

emergency events such as a terrorist attack or a natural disaster? 

Deputy Chief Visconti. Well, I will begin with interoperability. I 

don’t believe that the city is up and running yet with the interoperVerDate Nov 24 2008 12:49 Nov 17, 2009 Jkt 000000 PO 00000 Frm 00064 Fmt 6633 Sfmt 6601 H:\DOCS\110-HRGS\110-71\48966.TXT HSEC PsN: DIANE

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ability portion of communications. I know they are working very 

hard, and there is a center that is being created. They are spending 

a lot of man-hours and money into getting that up and running. 

But the bedrock of communications, of any emergency scene, is 

that if each agency can talk to themselves. That was the problem 

at the World Trade Center. 

At the World Trade Center, we couldn’t communicate effectively 

with our own people. Even after the towers were down, and there 

was no line-of-sight problems, we could not talk to somebody 60 

yards away when somebody 100 yards away could hear them from 

a different location. The communications were really terrible. 

If we had been able to communicate with our people effectively, 

we could have probably lost fewer people in Tower 2. Tower 1 collapsed without anybody realizing that it was going to collapse. But 

Tower 2, when Chief Cowan gave the order to evacuate, the vast 

majority of people in that tower did not receive the message. 

Going up one level, if the fire department had been aware that 

a police officer in a helicopter saw signs or suspected that Tower 

1 was going to collapse, we certainly could have notified some people in Tower 1 and obviously in Tower 2. So that is an issue that 

starts at the bedrock of communications within your own agency, 

and then communicating with other agencies will definitely be of 

benefit to us. 

Staffing, I really can’t argue with the staffing of the New York 

City Fire Department. We have the best staffing in the entire country, from what I understand. We have also at a minimum, four firefighters on every engine and also a minimum of five firefighters on 

every ladder. That is excellent staffing. 

The third issue that you mentioned? 

Ms. CLARKE. Is personal protective equipment. 

Deputy Chief Visconti. On September 11, I don’t know where 

they came from, but ultimately we would see people walking 

around with filter masks. Now filter masks were inappropriate for 

that atmosphere. Everybody was talking around covered in dust. 

Firefighters, when they arrived at the scene, had the self-contained 

breathing apparatus, but that is a 1-hour bottle. You work with a 

face piece. 

In that environment, especially after the air cleared, nobody was 

aware that they would need respiratory protection. But the first 

that I can recall, and it is a pretty hazy period of time, the best 

that I can recall is that about a week later, a concerted effort was 

made to provide everybody with HEPA masks, dual-canister respirators. Before that, it was disjointed. People would have filter 

masks, people would have other protection. Firefighters did not 

walk around after the collapses the next days with their masks on, 

because it didn’t appear that we needed any. 

Ms. CLARKE. Why didn’t it appear so? Was there something that 

indicated was their message or, you know, we are all aware of what 

the EPA said, but what do you think precipitated that? 

Deputy Chief Visconti. Well, I am not sure what precipitated 

that, but I know that after the collapses, and the dust cloud moved 

away, and all that was left was the smoking debris, that most people felt confident that they were breathing clean air. 

62 

It was only once the fire department actually established a second fire department just to deal with the World Trade Center, that 

every single individual down there was mandated to wear the 

HEPA dual-canister mask. If you didn’t have it on, you were removed from the site. We had site safety people walking around 

making sure you had that respirator on. But that was not until 

sometime later. 

Ms. CLARKE. The gentlelady from New York, Mrs. Lowey. 

Mrs. LOWEY. I thank the distinguished Chair, a fellow New Yorker, and I am very pleased to welcome the panel, Dr. Landrigan, 

Chief Visconti, and the gentleman from Louisiana, who I haven’t 

had the pleasure of meeting. Thank you very much for being with 

us today. 

Since September 11, the issue of first responder health has been 

one of my top priorities. As someone who had hundreds of first responders from my district were the pilots, and really tragic seeing 

the health problems faced by many of our heroes. 

While New Yorkers faced the biggest impact, the issue certainly 

goes beyond New York. The World Trade Center health registry 

has collected information from 71,400 out of the 410,000 individuals who were exposed to serious health hazards. Those exposed, 

many of whom are first responders, as we know too well, who 

worked the pile, came from every congressional district in the country. 

For instance, 57 of the registry’s participants are from the chairman’s State of Mississippi, and we should keep in mind that the 

registry has only collected information of one-sixth of the total 

number of individuals who are likely exposed. So I encourage everyone who is here before and now to support the efforts that are 

being led by the New York delegation to ensure that everyone exposed to Ground Zero toxins is medically monitored and treated. 

I have several questions, but, Chief, I just want to respond to 

something that you just said. No one was aware that they needed 

a mask. 

Now, there has been a lot of discussion about this, from the 

mayor, from the former head of the EPA, if you could elaborate on 

that, you said about a week later? 

Deputy Chief Visconti. Yes. 

Mrs. LOWEY. The masks were delivered. 

Deputy Chief Visconti. Yes to the best of my recollection. The 

first few days on the pile, seeing somebody with a filter mask on 

was not uncommon, but it wasn’t widespread. I saw several people, 

firefighters, police officers and construction workers with the little 

filter masks on. Where they got them, how they got them, what 

made them think about getting them, I don’t know. 

But then it was later on, after that first week, that the HEPA 

masks were brought in. Now, initially, it was just handed it out, 

and then it was realized that they must be fitted. You had to have 

a fit test. Otherwise, you would do more damage by using the mask 

than not using it. So then they got into the program of you had to 

have one of those masks, you had to be fitted for it and you had 

to use it. 

Mrs. LOWEY. After the first week. 

63 

Deputy Chief Visconti. I am guessing, I am going to say the first 

4 days, I don’t think anybody had the capability of realizing or capability of gathering enough respiratory protection to bring it into 

the site. 

Mrs. LOWEY. Dr. Landrigan, nice to see you again. We know sustained Federal funding is critical to continue to provide monitoring 

and treatment to 9/11 workers who are ill, and I was pleased that 

the supplemental funding bill enacted earlier this year in the fiscal 

year 2008 House Labor-HHS appropriations bill, each contained 

$50 million for health monitoring and treatment. As you know, 

many of us worked hard to get that. 

Unfortunately, estimates for the 9/11 health problems would be 

as high as $393 million per year. The Federal Government just has 

to be prepared to invest significantly more funds. The annual figure is substantially more than the $227 million total figure that 

has gone to 9/11 health programs. 

If funding was not an issue, Dr. Landrigan, how would you expand the program at Mount Sinai. How much would it cost to do 

this, and how does a lack of adequate funding impair your ability 

to provide the services and care that these individuals need? 

Dr. LANDRIGAN. Thank you for that question, Mrs. Lowey, and 

thank you for being with us throughout this issue. There have been 

two issues about the funding that have been problematic. One is 

that it has been limited over the past 6 years, and the second is 

that the flow has been intermittent. There hasn’t been the assurance from one year to the next that there would be funding, nor 

has there been any assurance as to the level of funding from one 

year to the next, which has made the planning very difficult, the 

space, personnel, and the rest of it. 

If funding were not an issue, then we would continue to work in 

two areas, and we would expand both of them. 

First of all, we would continue the aggressive monitoring that we 

are doing. We have now seen more than 22,000 of the responders 

who were down there, and our colleagues at FDNY have seen another about 15 or 16,000 or so between us. We have seen 36—or 

37,000, but we know that there were somewhere between 40,000 

and 90,000 responders down on the pile. 

Therefore, we still have many tens of thousands that we haven’t 

seen, and we would, if we had full funding, we would reach out 

even more aggressively than we are already reaching. 

The second issue is treatment. Federal funding for treatment 

began only 1 year ago in September of 2006. Prior to that time, all 

of our treatment activities were funded solely by philanthropy, by 

local foundations, plus the American Red Cross. It is clear that we 

are only scratching the surface on treatment. There are lots of persistent respiratory diseases, I mentioned in my testimony, there 

are mental health problems, and there is the possibility, it is not 

a certainty, but there is the possibility that we will see additional 

disease in the year ahead, and some well locked-in funding for 

medical treatment that extended over the years would be a great 

source of security for the responders themselves, as well as for 

those of us who are providing their care. 

64 

Mrs. LOWEY. Thank you very much. Madam Chairman, do you 

want to ask a question, and then we can just go back and forth, 

since it is the two of us. 

Ms. CLARKE. Very well. 

Mrs. LOWEY. We have another guest. 

Ms. CLARKE. We have Mr. Etheridge joining us from North Carolina. The gentleman from North Carolina has 5 minutes to ask his 

questions. 

Mr. ETHERIDGE. Thank you, Madam Chairman. I apologize for 

having to duck out. I am involved in two hearings this morning, 

and both of them at the same time. 

You probably heard me earlier raise the question with our previous panel about the number of firefighters who lose their lives of 

a heart attack or stroke. 

But let me, Chief, ask you a question, if I may, and thank you 

for your service and all of you folks for what you are doing. 

Prior to the 9/11 attack, the Fire Department of New York had 

systematically collected and updated, really had developed a baseline of medical data for all of your firemen, which had to have a 

significant impact on assisting the clinical ability to detect the subsequent health problems that came as a result of the World Trade 

Center. 

My question is to what extent can professional responder groups, 

not just firefighters but all the responders that we with call, upon 

benefit from that? What would you share with this committee that 

we ought to be doing at the Federal level, if anything, as I raised 

the issue a while ago? What can we do. 

Deputy Chief Visconti. In The New York Fire Department, there 

are physical standards to become a firefighter as in every other fire 

department. The New York City Fire Department has kept a 

record. I know I can do go down and find x-rays from when I was 

appointed to the Department in 1968. They keep their records. 

They maintain a baseline on you. The Department, after 9/11, 

Dr. Kelly and Dr. Prezant, instituted a program of giving a World 

Trade Center physical to each and every member of the department. That data is now available for the yearly checkup that each 

firefighter or fire officer gets. They are able to determine if there 

are some changes going on. They are able to see whatever and 

what other illnesses are becoming apparent. 

I don’t think that in this day and age that any department or 

any agency should be without that capability. It is essential to have 

that so that in the future, in a situation like this, we have some 

place to start. 

Mr. ETHERIDGE. Let me follow up with you, because just in conversation, I like to have, I realize the system is as large as New 

York, and maybe Washington alone, but I guess I want to probe 

it just a little farther because across the country we have a lot of 

first responders who are volunteers, probably, 70 or 80 percent I 

would have to check that, and I don’t know how many of them do 

what you are talking about. Now, the probability is less, but I do 

know in a number of instances across, even in rural departments 

now, we have had firemen, by and large firemen, police officers too, 

for that matter. 

65 

Some EMS have responded to meth labs not recognizing houses 

on fire, they go in not recognizing what they have had, and all of 

a sudden you have a problem. I know of one situation where we 

had a volunteer who lost his life, did not know what it was till it 

was over. 

I would be interested in your thoughts, and either of the medical 

officers, how we can encourage that, because I think there is a 

whole group of first responders out there, that we don’t have that 

data on and are responding. 

Deputy Chief Visconti. I don’t know what the requirement would 

be. I don’t know who would institute it. But in 2007, that would 

not be—that would be an excellent goal to achieve, that every 

member of that volunteer fire department has the training he 

needs to recognize hazards and to deal with hazards, but also to 

make sure they are able to physically able to do the job. 

I don’t see how you can get around that. If an entrance physical 

and a medical examination is required, and this doctor said this 

person is capable, you have right there and then as soon as they 

enter the department a baseline on the physical condition when 

they entered. As far as the training goes, it is absolutely essential 

to have the training. 

Mr. ETHERIDGE. Yes, that is required, I think, in most jurisdictions. 

Deputy Chief Visconti. But I don’t know what the standard is 

across the country. 

Mr. ETHERIDGE. Sure. 

Deputy Chief Visconti. All I know is the volunteers of my town, 

because I live outside of New York, they train, they have New York 

City fire officers who are members of their volunteer fire company. 

I give them classes on commander control and other things. I know 

they are interested in training, not only in what comes out of books 

but hands-on training. I know they are well prepared. I don’t know 

if there is a standard of level of training across the country for that 

expertise. 

Mr. ETHERIDGE. Madam Chairman, I know my time has expired. 

I do from State to State you do have this. I think it would be a 

great issue that ought to be developed simply because of the mobility of people today, the movement of transportation, the hazardous 

things that move across our borders and the interstates and the 

probability that it could happen today. 

Thank you, Madam Chairman, I yield back. 

Ms. CLARKE. Dr. McDaniel, I understand that the Louisiana Department of Environmental Quality, LDEQ, started gathering data, 

monitoring the environment and putting out information to everyone in Louisiana very soon after Hurricane Katrina made landfall. 

What challenges did you face in obtaining this data, getting lab 

analysis done and et cetera? 

Mr. MCDANIEL. I would say the greatest challenge and the thing 

that we are working on with EPA is getting the samples taken, the 

analysis time and turning the information around to the public as 

rapidly as possible. Sometime there is a delay of the time you take 

the sample, you deliver it to the lab and get the analysis. 

So emphasis should be placed, and we are looking at this, on instrumentation in the field that gives you quick, at least surrogate 

66 

information that helps in protecting first responders. We got better 

and better as time went, but having prepositioned assets for remote 

sensing, for taking samples, whatever media it might come from, 

to be able to provide that information as rapidly as possible. 

Ms. CLARKE. What additional support would you have liked to 

have seen from your Federal partners in the aftermath of Hurricane Katrina, acknowledging that there was some support provided 

by the National Center For Environmental Health and the EPA 

and others? 

Mr. MCDANIEL. I would say that we enjoyed a pretty good working relationship, particularly with EPA region 6, and they were actually housed in our conference room in a unified command center, 

so we had a very close working relationship. I think that was very 

helpful to have that communication up front, very efficient, effective in responding. 

I would say, again, going back to my first point, having them 

have the equipment or the assets, preposition or readily available 

that give us quick turn around on information on environmental 

sampling would be very helpful in any instance, of course. 

We had the advantage of having a little time. Knowing that a 

problem was approaching, you don’t always have that luxury. 

Ms. CLARKE. In the aftermath of this storm, were there predictions about the types of toxins that would hit the area and how 

to mitigate that, and were you able to follow through on that? 

Mr. MCDANIEL. Yes. One of the problems we had, quite frankly, 

was a lot of false information that was being put out. We were collecting information, you probably saw some of the press releases on 

toxic soup, toxic sludge, toxic air killing lake Lake Pontchartain 

and on and on. We spent a lot of time trying to get information out, 

trying to quell the anxiety that was out there. 

We found the floodwaters certainly were unsanitary. There was 

some fuel components in it. But this information was provided to 

the responders. We have a very good preventive program and training and briefings every morning so they know how to deal with 

those kinds of conditions when they get to the field. 

Ms. CLARKE. Thank you very much, Doctor. 

I want to turn to you, Dr. Landrigan. I understand that approximately 1,000 folks sign up every week for the Mount Sinai World 

Trade Center screening program. How has the screening program 

expanded since its inception, and are there issues that are not 

being addressed due to research or funding limitations? 

Dr. LANDRIGAN. Yes, madam, the number of new responders who 

are coming in for the first time, even now 6 years and some after 

the attacks, fluctuates between 400 and 500 a month, new people, 

multiply that by 12, that is about close to 5,000 new people every 

year at the current rate. That has been holding steady for the last 

year and a half, 2 years. 

At the present time, we are funded in the monitoring program 

through 2009, and it is moving along well. We have a very efficient 

system. The wait time for new visits for somebody who comes along 

is just a few weeks. We are in the process of attempting to set up 

a satellite out in Staten Island to take care of people in that borough and in areas of New Jersey. 

67 

Of course, we continue to work closely with Belleview Hospital, 

Queens College, UMDNJ and State University of New York at 

Stony Brook. So I would say the monitoring program is doing well, 

but I am still saddened, as I said to Mrs. Lowey several moments 

ago, that there are probably 35—, 40,000 people who even now we 

have not yet now seen. We will continue to hope that they will 

come forward. 

Ms. CLARKE. You didn’t speak to any funding limitations or research challenges. Could you just give us a sense of the status of 

that? 

Dr. LANDRIGAN. Well, clearly we will need continued funding. 

The funding sunsets in 2009. Indeed, we may run out sooner if the 

number of patients continues to come in at the rate they are coming, 4 to 500 a month. We will continue to keep you informed as 

to the status of that. Anything that you can and Congress can do 

to extend the funding beyond 2009 will be critically important. 

Ms. CLARKE. The gentlelady from New York. 

Mrs. LOWEY. Thank you, Madam Chair. 

I wanted to follow up on one of my good friend from New York’s 

questions concerning the equipment. 

Chief Visconti, is the Federal Government doing enough to test 

equipment to ensure that it is truly safe? If you can comment on 

that. 

Deputy Chief Visconti. Mrs. Lowey, you are referring to the personal protective equipment, the bunker gear that we are talking 

about? 

Mrs. LOWEY. In other words, are there a lot of salespeople coming around trying to sell equipment, and do you feel that the Federal Government is taking response—I see people smiling. Maybe 

they are the salespeople in back of you. 

Do you feel the Federal Government is testing the equipment to 

ensure that it is safe? Those of us who sit on appropriations as well 

work very hard to get the money for first responders and equipment. I just want to get a handle on whether it is being tested adequately. 

Deputy Chief Visconti. I know for a fact that the National Fire 

Protection Association has standards for firefighter gear. I know 

that the Federal Government has standards for the gear. 

The vendors, when they come in, no matter what the organization, they have to comply with an RFP. We have it tested. We run 

pilot programs which may appear, in some cases, to be too extensive, but we want to make sure that the equipment is good. 

The equipment, bunker gear that firefighters have now is being 

constantly upgraded to include levels of protection from different 

contaminants, and not only from fire. These are not garments— 

they are meant to protect you for a limited amount of time, but 

they are putting barriers in them, which does create problems because of heat and exhaustion. But they are putting barriers in the 

garments so you can be protected from heat and elements. 

Mrs. LOWEY. Thank you. I will have to come back to you for another question. I am sorry, Dr. McDaniel. 

We all agree that those who are made ill deserve special care and 

attention. However, there are some people who disagree that care 

68 

needs to be provided by Mount Sinai and other centers of excellence and Federal resources. I strongly disagree. 

I am pleased you are here to make the case that there needs to 

be more Federal support and some more medical monitoring and 

treatment. 

If you could explain to us, number one, why isn’t it sufficient for 

many of these individuals to obtain care from their primary care 

physicians? 

And, what do you know, what do we know about the long-term 

health consequences of exposure to toxins at Ground Zero? 

And what would happen if the funding for the centers did not 

continue, how important is it to have experience with a knowledge 

of World Trade Center-related illnesses, and truly helping these individuals obtain the diagnoses and care that they need? Tell us 

how important it is. 

Dr. LANDRIGAN. Thank you, Mrs. Lowey. There are several reasons why these centers of excellence are critically important. First 

of all, lies in the high quality of the medical care that they can provide. 

The people that went through 9/11, and I suspect in the future, 

people that might go through any future disaster that befalls this 

country, suffered a complex mix of exposures, cement, shards of 

glass, a unique soup of toxic chemicals. It is only at a major medical center that has experience in occupational medicine, as we do 

at Sinai and as our colleagues in the other institutions that I mentioned in the greater New York area—it is only—you need to have 

that expertise, you knew he had to be able to combine that expertise in occupational medicine with expertise in pulmonary medicine, gastroenterology, psychiatry, very important. Many of those 

folks have multisystem problems. 

If they were to go to a general practitioner in a town or a suburb 

who was not in a position to call upon these other medical disciplines, then the care of the responder who put his or her life on 

the line is going to be compromised, possibly seriously compromised. 

The second advantage of centers of excellence is that after a time 

of disaster, we gain experience. We have seen in the neighborhood 

of 22,000 patients. That is a great deal of experience. Out of that 

experience we have distilled recommendations for the provisions of 

optimal care. We worked with the New York City Department of 

Health to issue guidelines for the care of people. 

If the care of these 22,000 people were scattered out among 

15,000 practitioners who saw a few responders each, there would 

be no opportunity to accumulate that body of experience. 

Thirdly and finally, an enormously important advantage that results from the existence of these centers of excellence is that we are 

in a position to keep records, track patterns of disease, recognize 

new diseases as they emerge. In the absence of some kind of centralized recordkeeping, that sort of medical surveillance would not 

be possible. 

You ask, what does if future hold for these people? I don’t know. 

None of us do. 

But what I do know is that we will be able to spot the future 

as it begins to arrive if we have these centralized record systems 

69 

in hand that serve as what used to be called a distant early warning system. 

Mrs. LOWEY. Thank you very much. Thank you, Madam Chairman. Thank you, Chair of the full committee. Thank you, Dr. 

Landrigan, Chief Visconti, Dr. McDaniel. Thank you very much. 

Ms. CLARKE. I now call on our chairman, the gentleman from 

Mississippi. 

Chairman THOMPSON. Thank you very much, Madam Chairman. 

I appreciate you stepping in while I stepped away for a few minutes. 

Let me thank the panel. 

A couple of questions come to mind. 

Dr. Landrigan, to what extent do you, with the Mount Sinai 

project, relate to the Federal partners are you exchanging data? 

Explain a little bit of the relationship? 

Dr. LANDRIGAN. First of all, we have a very close relationship 

with the other programs in New York City. Our group of firefighters, the FDNY, have aligned our medical programs very closely. We use pretty much the same protocols for doing the examinations on the two groupers of workers and recording the data. We 

also stay in very close touch with the health department and their 

registry that now encompasses 71,000 people. 

With regard to the Federal partners, we work very closely. We 

are probably on our phone to our funding principal agency, NIOSH, 

at, least twice a day. It is almost constant communication. Folks 

from NIOSH are up to visit us, I would say on average, every 2 

or 3 weeks. We exchange a great deal of information with them. 

The other thing we do with their encouragement and support is 

we take the scientific analyses that we have conducted, based on 

our medical findings, and we write these up. We publish them in 

the peer-reviewed medical journals. We have done it several times 

in the past already. One of those articles is appended to my testimony. 

The reason that we disseminate this information out in the peerreviewed medical literature is to alert doctors across the country 

about our findings so that they will be educated, and they will be 

intellectually prepared in the future should there be further disasters. 

Chairman THOMPSON. Thank you very much. One of my reasons 

for asking is, from a lessons-learned standpoint, the previous panel 

kind of said, well, it is our overall responsibility, but we haven’t 

quite done it. So if that happened in Detroit or Chicago, would we 

have the 9/11 experience there starting, or have we put together 

a system that can now be incorporated into the broader picture? 

I guess I am saying that what we are grappling with is based 

on the testimony of the last panel, we have not gotten to that point. 

I hope we have your participation in moving that part of the response puzzle, so that we follow people from the incident forward, 

and not have to pick it up along the way, and then try to catch up. 

We feel that the Katrina situation is equally as troubling because 

when people come to help, there is very little regard for personal 

safety. 

I think what we have to do, as Members of Congress, anticipate 

that certain things will happen when people offer themselves for 

70 

help, whether they have Federal, State, locals or just volunteers. 

But we want the system to work as fast as it can and not play 

catch up. So we are going to have to identify the people through 

some system, and that is a real challenge. 

Chief, I hope over time we can provide the departments with the 

necessary equipment. People ought to be able to communicate with 

each other. 

In most instances, the public already thinks that everybody can 

talk to each other any way, but that is not the case. 

So that is a real issue for us. We are trying to get through the 

bureaucracies. You heard GAO say that those agencies who are responsible for it, we put the money there, but they can’t work out 

the logistics of coordinating and cooperating with each other. So 

that remains a real challenge for us. 

Let me thank you for your testimony. It is absolutely essential 

to helping us define legislatively what we can do. But it is people 

like you who are on the front line who ultimately have responsibility for not only carrying it out but helping us get it right. 

So I appreciate you in that respect, as well as your service to 

your city or State and the Nation. 

I yield back. 

Ms. CLARKE. Mr. Chairman, you took my closing. 

I thank the witnesses for their valuable testimony, and the Members for their questions. 

The Members of the committee may have additional questions for 

the witnesses, and we ask that you respond expeditiously in writing to those questions. 

Hearing no further business, the committee stands adjourned. 

[Whereupon, at 1:20 p.m., the committee was adjourned.] 

(71) 

Appendix: Questions and Responses 


11071-12.eps
72 

QUESTIONS FROM THE HONORABLE BENNIE G. THOMPSON, CHAIRMAN, COMMITTEE

ON HOMELAND SECURITY

RESPONSES FROM JOHN HOWARD, MD 

Question 1.: As the Federal Coordinator for World Trade Center (WTC) 

Health Issues, can you please describe for the Committee how you coordinate the activities among the various Federal agencies and non-governmental organizations involved in this effort and what challenges you have 

faced in coordination these different efforts? 

(a) What research and health monitoring is the Federal government undertaking Gulf Coast? 

(b) In your opinion, are first responders who were in the Gulf in the aftermath 

of Hurricane Katrina at risk for developing health problems? 

As the WTC Coordinator for the U.S. Department of Health and Services (HHS), 

I coordinate existing HHS programs addressing WTC health effects. These programs 

include the WTC Responder Health Program (New York City Fire Department and 

Mt. Sinai School of Medicine), the WTC Federal Responder Screening Program, the 

Police Organization Providing Peer Assistance (POPPA), Project COPE, and the 

WTC Health Registry. I coordinate these programs by meeting regularly with the 

leadership of each to discuss program status and ongoing activities. I also host WTC 

Programs Coordination meetings to bring together program leadership and key representatives from federal, state and city government, community and labor organiVerDate Nov 24 2008 12:49 Nov 17, 2009 Jkt 000000 PO 00000 Frm 00076 Fmt 6601 Sfmt 6621 H:\DOCS\110-HRGS\110-71\48966.TXT HSEC PsN: DIANE

11071-13.eps
73 

zations to share program updates and explore opportunities for collaboration to better serve the affected population. 

The National Institute for Occupational Safety and Health (NIOSH), in consultation with the Occupational Safety and Administration (OSHA), developed and 

broadly guidance for pre-and post-exposure medical screening programs for workers 

in hurricane disaster recovery areas soon after Hurricane These recommendations 

are available at: http://www.cdc.gov/niosh/topics/flood/preexposure.html; http:// 

www.cdc.gov/niosh/topics/flood/MedScreenWork.html. NIOSH has also conducted research to assess potential health effects associated 

Hurricane Katrina response effort. is currently funding a study at University to examine exposure to post-Katrina flood cleanup and restoration work and the risk of 

respiratory illness, symptoms, and decline in lung function in workers. Study participants (approximately 1,000 New Orleans area workers performing demolition 

work, trash and debris removal and disposal, sewerage and water line repair, construction work. tree cutting, and landscape restoration) will complete questionnaires 

and undergo standardized clinical testing annually over a five year period. The findings this study will provide valuable information on the respiratory impact of exposures, including the level or respiratory protection required in similar flood recovery 

operations. 

As requested by the New Orleans Fire Department (NOFD), in October 2005 

NIOSH conducted a health hazard evaluation of the NOFD. NIOSH investigators 

conducted a survey to evaluate physical and psychological consequences in NOFD 

personnel following work after Hurricane Katrina. The results showed that fire 

fighters who reported floodwater contact for longer than a few hours reported significantly more upper respiratory systems than those who reported no contact with 

the floodwater. Fire fighters experiencing these physical symptoms, as well as those 

involved in gun shot incidents and body retrieval more often reported systems consistent with depression and post traumatic stress disorder (PTSD). NIOSH recommended that New Orleans Fire Department management provide clinical followup of affected fire fighters for physical and psychological conditions should be implemented. Results of this and NIOSH recommendations were distributed widely 

through the International Association of Fire Fighters (IAFF) and through scientific 

publications. The full report is available at: http://www.cdc.gov/niosh/hhe/reports/ 

pdfs/2006–0023–3003.pdf 

Also in October 2005, NIOSI-I conducted a similar study at the New Orleans Police Department (NOPD) to assess the impact of the Hurricane Katrina disaster on 

employee physical and mental health. NIOSH conducted a survey and found that 

NOPD personnel frequently reported experiencing head and sinus congestion, nose 

and throat irritation, as well as symptoms consistent with PTSD and depression. 

Factors including contact with floodwater and isolation from family were associated 

with the physical and mental outcomes. NIOSH made a number of recommendations, such as suggesting NOPD management encourage personnel to seek follow up 

care for clinical and mental health symptoms, develop a disaster preparedness plan, 

and improve the incident reporting system. As a result the NOPD has implemented 

a disaster preparedness that has a contingency plan for evacuation and relief of personnel during disaster events. The NOPD continues to explore programs that provide guidance for crisis management and debriefing, to further to support officers. 

The results of this evaluation and subsequent recommendations will have implications for all police officers involved in disaster response. The full report is available 

at: http://www.cdc.gov/niosh/hhe/reports/pdfs/2006–0027–3001.pdf 

Other important health and safety research conducted the Gulf Coast involved the 

use of respirators by the public in post-Katrina New Orleans, where respirators 

were recommended for mold remediation. This research indicated that only 24% of 

participants donned respirators properly. The resulting publication has received 

much attention because of its implications for use of respirators by the public in settings, such as during an outbreak of pandemic influenza. [Cummings KJ, CoxGanser J, Riggs MA, Edwards N, Kreiss K. Respirator donning in post-hurricane 

New Orleans. Emerg Infect Dis. 2007 May; 13(5):700–7. http://www.cdc.gov/eid/ 

content/13/5/7000.htm] 

In the aftermath of Hurricane Katrina, thousands of responders worked in a complex, uncontrolled environment; one that involved mixed chemical exposures, hazardous substances, microbial agents, and psychological stress. Most of the hazards 

have poorly characterized due to the changing nature of the site and the receding 

waters. Given the complexity of the Gulf Coast response, uncertainty regarding the 

extent of exposure, lack of regarding the use of personal protective equipment and 

follow-up treatment, it is not possible to generalize the risk of health effects to all 

Hurricane Katrina responders. However, based on available evidence, such as the 

NOPD and NOFD studies discussed above, some responders worked in environVerDate Nov 24 2008 12:49 Nov 17, 2009 Jkt 000000 PO 00000 Frm 00077 Fmt 6601 Sfmt 6621 H:\DOCS\110-HRGS\110-71\48966.TXT HSEC PsN: DIANE
74 

ments with exposures that may have resulted in short—or longer-term health effects, including eye and respiratory respiratory illness, hearing loss and psychological stress. 

Question 2.: Section 709 of the Safe Port Act of 2006 refers to research 

and a report to be conducted by the National Academies of Science on Disaster Area Health. 

(a) What is the status of this research? 

I am not aware of any research or reports being developed in response to the Safe 

Port Act of 2006. Section 709 of the statute has never received congressional funding 

and, therefore: has not been implemented. 

QUESTIONS FROM THE HONORABLE BENNIE G. THOMPSON, CHAIRMAN, COMMITTEE ON

HOMELAND SECURITY

RESPONSES FROM JON R. KROHMER, MD 

Question 1: What are we doing to help local first responders that respond 

to emergencies at federal sites? They do not necessarily have all of the information regarding what is in those locations (e.g. locations of hazardous 

materials, military weapons caches, and scientific research on dangerous 

organisms). 

Response: The universe of first responders includes law enforcement, fire, emergency medical services, and other public safety officials. Each facility and agency is 

responsible for identifying and marking potentially hazardous or dangerous situations, developing emergency action plans, coordinating those plans with local resources, and briefing any responders on current conditions when they arrive at any 

federally managed site. The Office of Health Affairs will work in the near future 

through the Federal Interagency Committee on Emergency Medical Services 

(FICEMS) to bring forward the issue of identification of best practices for addressing 

hazardous materials and other unique situations at federal sites for communication 

with local medical responders during an event, and when applicable, before an 

event. This type of initiative will also require coordination across interagency partners that work directly with other first responder groups. As funding and staff enable our office to establish our planned outreach program to state, local and regional 

partners, we will work with our partners to develop a model for identifying specific 

needs of local responders. 

Question 2.: Has the OSHA role been modified in the National Response 

Framework versus the National Response Plan? 

Response: The Department of Labor/Occupational Safety and Health Administration (OSHA) has been, and continues to be, a vital partner in Federal response activities under the National Response Framework (NRF). OSHA’s primary intended 

purpose under the NRF is to provide resources, policies, and structures (e.g. technical assistance, safety monitoring, etc.) to other Federal agencies, States or other 

jurisdictions and entities during response and recovery activities of major incidents. 

OSHA’s key role as the coordinating agency for the Worker Safety and Health 

Support Annex remains unchanged from the National Response Plan (NRP) to the 

NRF. The purpose of the Worker Safety and Health Support Annex is to coordinate 

the management of worker safety and health among all responders (Federal, state, 

local, private sector, etc.) and provide worker safety and health resources to response organizations that are overwhelmed by the incident. 

In addition to its role as coordinating agency for the Worker Safety and Health 

Support Annex, OSHA continues to serve as a support agency to various Emergency 

Support Functions and as a cooperating agency to certain Support Annexes and Incident Annexes. In addition to roles carried forward from the NRP, OSHA has been 

added as a cooperating agency to the new Critical Infrastructure/Key Resources 

Support Annex to the NRF. 

Question 3.: What is the status of the Component Services Directorate of 

the Department of Homeland Security Office of Health Affairs? When was 

this Directorate established? How does it interact specifically with relevant 

entities in the Department’s Management Directorate? 

How is the Component Services Directorate ensuring the Department’s 

‘‘early responder’’ workforce is provided with scientifically-based and regulatory-compliant occupational health and safety standards and practices? 

As part of its goal to create a culture of wellness throughout the Department, what work has the Components Services Directorate done in the way 

of developing policies, standards, requirements and metrics for fitness-forduty, drug testing, health screening and monitoring, health promotion and 

75 

management, pre-placement evaluations, and immunizations and deployment physicals—especially for the Departments ‘‘early responders?’’ 

Response: The Office of Component Services within OHA was established concurrently with the Office of Health Affairs in April of this year. Until this month, the 

office has been staffed by one full-time detailee, one detailee divided between Component Services and pandemic influenza planning, and one part-time contractor focused on workforce protection issues related to pandemic influenza (which is being 

extended to ‘‘all hazards’’ workforce education to the extent possible). Funding, including any funding for personnel, was not available until a reprogramming was authorized late this summer. Consequently, the efforts to this point have focused on 

strategic planning and hiring actions for the initial staff to carry out the important 

functions of the office. The initial hiring actions are underway currently, with the 

first new staff member scheduled to report this month. 

Having said that, the Associate Chief Medical Officer for Component Services has 

been extremely active in supporting specific incidents / activities—including the incorporation of the Division of Immigration Health Services into DHS/ICE; the DHS 

response to the Speaker TB incident and supporting the FEMA investigation into 

the trailer formaldehyde issues. 

From the outset, a major philosophy in the operation of the Office of Component 

Services has been to establish a close working relationship between the Occupational Safety and Environmental Programs (OSEP) within the Office of the Under 

Secretary for Management and the Office of Health Affairs (OHA). DHS Management Directive 5200.2, which is currently in final vetting, provides that ‘‘It is DHS 

Policy to establish and maintain an effective and comprehensive safety and occupational health program which is consistent with the standards promulgated under 

the Occupational Safety and Health Act of 1970, E.O. 12196, and 29 CFR Part 

1960.’’ Under this Directive, the role of the Assistant Secretary for Health Affairs 

is to serve as the primary policy advisor to the Secretary, Under Secretary for Management, and the Designated Agency Safety and Health Official (DASHO) on occupational medicine aspects of the safety and occupational health program. Backed by 

the seniority of an Assistant Secretary and with the subject matter expertise of physician staff, including an Occupational Medicine physician, the Office of Component 

Services will be well positioned to establish scientifically and medically valid policy, 

requirements, standards, and metrics that will serve to drive synchronization, 

standardization, and unification of occupational safety and health (OSH) policies 

and regulations across the department. Over the next fiscal year, we will catalog 

existing OSH programs within the Department and benchmark these against best 

practices in industry. Our goal is to complete this process over the fiscal year and, 

in conjunction with OSEP, reach 50% development of unified DHS OSH policies and 

regulations this year, laying the ground work for a complete program by the conclusion of the next fiscal year. The major challenge in accomplishing this goal will be 

the varied missions of the Department’s Components. This will require establishing 

a firm scientific and ‘‘best practices’’ basis in order to allow Component leadership 

to adopt common policies and procedures except in those areas where mission dictates unique approaches. 

Specifically in regard to support for DHS employees during response to disasters, 

there are three major Components that OHA, specifically the Office of Component 

Services, will address: Ensuring medical readiness for response duties, ensuring 

availability of medical response for DHS employees during contingency missions, 

and minimizing safety risks during those missions. 

OHA has a significant role, in conjunction with OSEP and the Components’ safety 

offices for the first two portions of this, while OSEP has the lead for the third. A 

significant role of the Office of Component Services within OHA is establishment 

of an emergency medical services (EMS) section with 2 primary roles: medical supervision of EMS services provided by or on behalf of the Department in support 

of its own deployed personnel, and establishment of policies, requirements, standards and metrics for EMS support of DHS operations. The EMS section will work 

closely with the Department of Health and Human Services (HHS) regarding those 

aspects of EMS that fall within HHS’s purview. Hiring of staff was started in late 

fiscal year 07 with the first personnel arriving in October 2007. In the interim, we 

are coordinating with the Components to catalog existing services and map gaps in 

medical supervisory support for EMS. The first employee, who is reporting later this 

month as noted above, is an EMS coordinator and OHA is in the process of hiring 

an EMS Physician Medical Director. Their role will be to ensure that appropriate 

emergency response systems, either directly provided or established through local 

services, are in place and that they have the required medical supervisory structures, including protocols and back-up, to enable their efficient operation during 

both day-to-day and contingency operations. 

76 

In addition, with the availability of funds, the Office of Component Services has 

converted the part-time detailee noted previously, into a full-time Director of Force 

Health Protection and Wellness, and is in the hiring process for a Director of Occupational Medicine. Their closely linked roles will be to coordinate with the Components to ensure that occupational health principles are incorporated into the job 

‘‘life-cycle’’ of all appropriate DHS personnel, especially responders, to ensure coordinated policies and standards for issues such as duty-based physical standards, preplacement physical evaluations, periodic physical evaluations, pre-response medical 

preparation, etc. 

Finally, OSEP has the lead for all safety programs, including those related to response operations. Through an MOA with OSEP, OHA will function as a major partner in these safety operations through adding medical/scientific basis to recommendations and providing a senior-level, ‘‘third party’’ voice for safety controls in 

operational environments. 

Question 4.: What is the Medical Readiness Directorate of the Office of 

Health Affairs doing specifically to coordinate medical readiness of first responders? 

Response: The Office of Medical Readiness is currently in the process of hiring 

a Medical First Responder Coordinator, based on funding that has recently become 

available through a reprogramming that was authorized late this summer. This position will be responsible for serving as the DHS point of contact for all medical first 

responders. Even though this personnel action is currently pending, the Office is actively engaged with the medical first responder community through representation 

on the Federal Interagency Committee on Emergency Medical Services (FICEMS), 

and through growing coordination of activities, including grants, with DHS and 

DHHS. It is the goal of the Office to better incorporate issues related to medical 

first responders into initiatives related to planning, training, exercises, and funding 

throughout relevant parts of the federal government and to ensure that medical first 

responders are more fully integrated into local emergency management communities 

through the country. 

Question 5.: We understand that federal first responders were turned 

away from screening programs offered to non-federal first responders, and 

that many have a cap on how much mental health counseling their health 

insurance will pay for, before they have to pay for these services out of 

their own pockets. 

Since we know that post-traumatic stress disorder and other responses to these 

sorts of incidents can go on for decades, affecting productivity now and in the future. 

How will the Office of Health Affairs address these sorts of mental health 

issues for the Federal ‘‘early responders’’ working in the Department? 

Response: The Office of Health Affairs has worked closely with our occupational 

safety and health colleagues on issues related to World Trade Center response 

issues, and recognize that there are problems with ensuring all employees have 

taken advantage of resources that are available to them. Because every agency determines independently how it will comply with Federal Occupational Safety and 

Health Guidelines (as required by Executive Order 12196, ‘‘Occupational Safety and 

Health Programs for Federal Employees’’ and 29 CFR Part 1960, ‘‘Basic Program 

Elements for Federal Employee Occupational Safety and Health Programs and Related Matters’’) and because agencies use various occupational health services providers, there is no consistent occupational screening program across the government. Therefore, even for our federal responders, there is no structured mechanism, 

at present, to get good information beyond the voluntary enrollment mechanisms. 

Current Federal workers, who were exposed to environmental hazards at the 

World Trade Center site and choose to register for tracking, are screened through 

Federal Occupational Health (FOH) clinics and other clinics that have contracts 

with FOH throughout the country. Retired Federal workers and intermittent Federal employees hired during the post-9/11 period to work in Manhattan have access 

to screening through the NIOSH Medical Monitoring program. Because these programs are voluntary they will not provide useful epidemiologic data, but they will 

ensure that Federal Employees have a safety net to see that their needs are addressed. 

The exposures to environmental hazards in the aftermath of Hurricane Katrina 

were much less homogenous and also spread across many more agencies. This would 

likely contribute to an inability for some federal employees to access common support for post event screening and care. We appreciate the Committee alerting us to 

this issue and will actively engage with the components to provide assistance and 

guidance in ensuring all DHS employees have appropriate access to screening and 

treatment. 

77 

Question 5.: We understand that a decision was made we understand that the 

Office of Health Affairs recently declined to include the CONTOMs program 

(Counter Narcotics and Terrorism Operational Medical Support Program) in the Office of Health Affairs. The program is expressly designed to ‘‘protect the protectors,’’ 

by providing advanced training (beyond EMT–B) to medics who’s job it is to provide 

emergency medicine under difficult conditions to our tactical first and early responders. It is the only program of its kind for which faculty are both sworn law enforcement officers and medical practitioners, with extremely current real-world experience (such as with the shootings at Virginia Tech, combat operations in Iraq, Ruby 

Ridge, Waco, and Hurricane Katrina). Participation in this specific program has 

been mandated by state and local tactical and special operations law enforcement 

units (such as SWAT) throughout the country, and that requirement continues 

today. 

How did the Office of Health Affairs arrive at this decision? 

How will the Office of Health Affairs ensure that this training will be provided to the component agencies within the Department that need and 

would clearly benefit from this training, without contracting out to academic programs at greater cost to the government? 

How will the Office of Health Affairs ensure that this training is obtained 

by those state and local units that have mandated its completion, without 

increasing the costs at the state and local level? 

What does the Office of Health Affairs believe should be offered in its 

stead? 

Response: The Office of Health Affairs shares the Committee’s concerns regarding the medical support of tactical law enforcement officers and all early responders. 

The DHS Office of Health Affairs agrees that the Counter–Narcotics/Terrorism 

Operational Medical Support (‘‘CONTOMS’’) has been a valuable contributor to the 

development and ongoing support of the field of tactical medicine. The decision of 

the Office of Health Affairs not to absorb the existing program from Immigration 

and Customs Enforcement (ICE) is in no way abandonment of the principles embodied in CONTOMS, but a recognition that the ‘‘playing field’’ has changed in the 

nearly 20 years since CONTOMS was established. OHA believes that the approach 

we are taking, based on establishment of requirements, policies, protocols, standards, and metrics, enhances DHS support of tactical medicine throughout the country. 

As you are aware, ICE’s Federal Protective Service (FPS), of which the Protective 

Medical Branch is a component, recently completed a restructuring in order to more 

efficiently ensure the protection of Federal offices throughout the country. As part 

of this restructuring, the Protective Medical Branch was discontinued in order to 

better focus available FPS resources on facility protection. 

Recognizing the importance of federal leadership in tactical medicine programs, 

OHA has established, within the Office of Component Services, an Operational Medical Services branch. The focus of this branch is to ensure that operational personnel 

of DHS, many, but not all of whom would be considered ‘‘tactical law enforcement’’ 

personnel, have appropriate medical support in whatever environment to which they 

are assigned. In accomplishing this function, it is important to note that OHA was 

not established to be an operational component of DHS. While OHA may in the future develop very limited operational medical capabilities for support of DHS personnel and missions , OHA’s primary focus is and will be to provide operational 

components with medical guidance (requirements, policies, protocols, standards, and 

metrics, as noted previously), to include the medical supervisory chain to Chief Medical Officer. As a part of this medical guidance OHA will continue research into tactical medicine and support of tactical medicine protocols and training which will be 

of significant benefit not only to the Department, but to law enforcement officers 

throughout the country. In fact, by shifting tactical medicine issues from an operational branch of a small segment (FPS) in one of the Department’s operating components (ICE), to an office only one level removed from the Assistant Secretary for 

Health Affairs and Chief Medical Officer, these issues will get the attention and 

resourcing they deserve. It should also be noted that the Deputy Assistant Secretary 

/ Deputy Chief Medical Officer is extremely supportive of tactical medical activities, 

having served for over 10 years as a tactical physician and the medical director for 

several TEMS programs. 

Additionally, in the 18 years since CONTOMS was initiated at the Uniformed 

Services University of the Health Sciences, a number of similar programs focused 

on tactical emergency medical support have developed throughout the country. 

Chairman Thompson’s home state of Mississippi is home to one of oldest such organizations in the country, the Tactical Medical Operators Group (TMOG) of Mississippi (www.tmog.org), which is dedicated to training, support, and medical direcVerDate Nov 24 2008 12:49 Nov 17, 2009 Jkt 000000 PO 00000 Frm 00081 Fmt 6601 Sfmt 6621 H:\DOCS\110-HRGS\110-71\48966.TXT HSEC PsN: DIANE
78 

tion to tactical medics and SWAT operators within the state of Mississippi. OHA 

management approach to this issue is to focus on the internal DHS requirements, 

while using our own needs to act as a catalyst to effectively synchronize activities 

and findings of groups like TMOG. Consequently, the role of DHS will not primarily 

be as a service provider, as was the focus of CONTOMS and PMB, but as a scientifically-based standards-setting organization (in conjunction with national groups 

such as such as the National Tactical Officers Association, the Tactical Emergency 

Medical Services Association, the American College of Emergency Physicians, the 

National Association of EMS Physicians, the National Association of EMS Directors, 

and the National Registry of Emergency Medical Technicians). It is also important 

to note that there are, in fact, several TEMS training programs throughout the 

country in which faculty are both sworn law enforcement officers and medical practitioners. 

The initial funding for the OHA mission is part of the pending fiscal year 2008 

DHS appropriation. In the interim, available funds have been used to hire the first 

member of the operational services staff who will be the coordinator for programs 

and protocols for the office. Over the next several weeks, OHA will be hiring the 

first OHA Director of Emergency Medical Services who will head that branch within 

the Office of Component Services. 

QUESTIONS FROM THE HONORABLE BENNIE G. THOMPSON, CHAIRMAN, COMMITTEE ON

HOMELAND SECURITY

RESPONSES FROM PHILIP J. LANDRIGAN, MD, MSC

I would like to thank you and the Committee on Homeland Security for your continuing vigorous investigation into the question of how this nation can best protect 

the health and safety of our first responders in the aftermath of catastrophic disasters. 

To assist you in this important work, my colleagues and I are pleased to share 

with you the lessons that we have learned through the World Trade Center Monitoring and Treatment Program that is supported at the Mount Sinai School of Medicine in New York City by the National Institute for Occupational Safety and Health 

(NIOSH), and to respond to the questions that you have asked in follow-up to your 

recent hearing: 

Question 1.: We understand that 1,000 approximately sign up every week 

for the Mt. Sinai World Trade Center Screening Program. 

a. How has the screening program expanded since its inception? 

The World Trade Center Medical Monitoring and Treatment Program at Mount 

Sinai has received federal funding from since April 2002. The focus of the program 

from its inception has been on workers and volunteers who served at Ground Zero, 

at the Staten Island landfill, and at other locations where there was potential for 

occupational exposure to World Trade Center dust. The program has expanded and 

transformed several times since 2002. 

Initially, the program was called the World Trade Center Worker and Volunteer 

Medical Screening Program. At that time, it was funded to see 9,000 responders for 

a single medical screening examination for the purpose of assessing health problems 

post 911 the target number was expanded a few months later to 12,000. It was intended initially that the program would continue only until spring 2004. 

By 2004, however, it was becoming clear that there were substantial continuing 

health problems in responders and that a larger number of responders than anticipated had become ill as a consequence their work. Also by 2002, we had identified 

groups of workers not previously included in the initial criteria for eligibility. These 

included mechanics who had worked on vehicles contaminated by debris as well as 

PATH (Port Authority Trans-Hudson) workers who labored in WTC-dust-contaminated PATH tunnels. Initially, eligibility covered only a narrow geographic area, as 

the program wanted to make sure people who were exposed came in for an examination. Once the capacity of the program was established and we had demonstrated 

our capacity to reach this initial population, the program was able to expand parameters for eligibility. To date, there have been 7—8 alterations/expansions to the eligibility criteria. With the identification of new groups, eligibility criteria also, expanded geographically. 

In July 2004 the program was reconstructed and renamed the World Trade Center Medical Monitoring Program. This change in name reflected the fact that the 

program was now expected to see workers and volunteers periodically—every 12 to 

18 months—rather than merely once for screening. To date, the program has performed 22,224 initial examinations, has seen approximately 8,000 of these workers 

79 

and volunteers for a second examination, and approximately 1200 for a third examination. All data from all examinations are stored in a computerized database. 

A further major transformation of the program occurred in the fall of 2006. At 

that time, treatment for covered World Trade Center conditions began to be provided with federal support and at no cost to WTC responders who were enrolled in 

the Screening or Monitoring Program. Provision of treatment without charge was 

necessary because many responders had little or no health insurance before 911 or 

subsequently lost their insurance as a consequence of their work-related illness. 

Many new responders still continue to contact the program for initial examinations at this time—six years the attacks of September 11, 2001. These are persons 

whom we have never previously seen. Some come to our program because they have 

symptoms, while others are free of symptoms, but have come to appreciate the wisdom of obtaining a baseline examination. Thus approximately 500—600 new eligible 

participants have registered with our program each month over the past two years. 

Three major lessons that we have learned from this experience are: 

(1) It is important to anticipate that the number of first responders who will become ill as a consequence of their heroic work will be large; 

(2) It is important to anticipate that illnesses in at least some responders will be 

severe and persistent; and 

(3) It is important to anticipate that treatment as well as diagnostic services will 

be needed for responders 

b. Are there issues that are not being addressed due to research or funding limitations? 

An impediment to the World Trade Center Medical Monitoring and Treatment 

Program is that the program has received no funding for research. This has hindered our ability to conduct detailed investigation into causes of illnesses in responders and into treatments. Despite this limitation, we have collected data on 

over 22,000 individuals who have received over 31,000 cumulative standardized examinations and we have published descriptions of our findings. 

Research funding would provide a vitally needed opportunity to further explore 

these findings in greater depth so that physicians who will care for future responders will better understand the full spectrum of World Trade Center related health 

effects. Such research could be instrumental in identifying new treatment modalities. 

The lesson here is that provision funding for research into health effects in responders should be an integral component of planning for future disaster response. 

An additional impediment is that funding for the Medical Monitoring Program 

was allocated for only four and one-half years, According to this timetable, examinations will cease in FY 09. We see this as a major unresolved problem, because illnesses in many responders and their prognosisis is unclear. Funding for the treatment program is also time-limited and will soon end if not renewed. If the program 

ceases, we will not be able to answer questions related to the long-term implications 

of exposures sustained at the WTC site. This is very important since many diseases 

related to dust exposure may take years to manifest. Similarly, we will not be able 

to answer questions about the possible persistence of disease. A further consequence 

of program cessation will be that the collective expertise of the WTC Centers of Excellence, particularly in terms of the care of the WTC responders, will be lost. 

The less for the future here is that there must be established a stable, multi-year 

source of funding to sustain the provision of medical care of first responders. 

Question 2.: What does the data generated by Mt Sinai indicate about the 

impact of the World Trade Center events on the ability of first responders 

to breathe? 

Of 9,442 responders examined between July 2002 and April 2004, 69% reported 

new or worsened respiratory symptoms while performing WTC work. Of these, 46% 

had lower respiratory symptoms, and 62% had upper respiratory symptoms. Symptoms persisted to the time of examination in 59% of these workers. 

On pulmonary function testing, 28% had abnormal spirometry forced vital capacity (FVC) was low in 21%; and obstruction was present in 5%. Among nonsmokers, 

27% had abnormal spirometry compared with 13% in the general population. Prevalence of low FVC among nonsmokers was 5-fold greater than in the population (20% 

vs. 4%). Respiratory symptoms and spirometry abnormalities were significantly associated with early arrival at the site. 

2.1. Would you recommend additional research to improve personal protective equipment, including respirators? 

Many of the respirators available to responders were unsuitable, and responders 

did not receive adequate training in their use. Additional research to develop better 

respirators is certainly warranted. 

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The failure of federal Occupational Safety and Health Administration (OSHA) to 

require respirator use at Ground Zero was in my opinion a serious dereliction of 

duty. OSHA’s failure to act is not justified by the fact that average levels of exposure to dust were below OSHA’s standards, because OSHA’s reliance on average levels of exposure fails to protect workers against the intermittent high-dose exposure 

to toxic substances that are common in urban demolition work. OSHA’s failure to 

act to require respirators at Ground Zero contrasts painfully with their aggressive 

insistence on the use of respirators at Staten Island landfill and at the Pentagon. 

The lesson here is that insistence on proper personal gear is essential for the protection of worker health, OSHA must enforce the law. 

My colleagues and I deeply appreciate your continued support and work on behalf 

of those heroic responders whose health was affected by the World Trade Disaster. 

We agree with you that it is essential to extract all possible lessons from this tragedy so that responders to future disasters may be optimally protected. 

Please do not hesitate to contact me with any additional questions. 


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1See committee file. 

Attachment 2—Title 33 Environmental Quality Part V.1

Attachment 3—Hazardous Materials and Hazardous Waste Reporting Requirements under Emergency Conditions 1


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Æ 


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