Copyright © 2003 by the National Environmental Health Association. http://www.neha.org/ E-mail: [email protected] Permission to reproduce or distribute this report is granted when due acknowledgement is given. Please credit the National Environmental Health Association and send a copy of the publication in which information was used to Journal Coordinator, NEHA, 720 S. Colorado Blvd., Suite 970-S, Denver, CO 80246. 1 Background n September 11, 2001, the Chartered Institute of Environmental Health in the United Kingdom was in the middle of its annual conference. Astounded by what had happened in O New York and Washington, the Institute took immediate action to assist environmental health in the U.S. in the aftermath of the terrorist attacks. The Institute donated a sum of money to the National Environmental Health Association to use in ways that NEHA saw fit. NEHA's first idea was to forward the funds to public health agencies affected by these events in the DC, Northern Virginia, and New York City areas. These agencies, however, indicated that they did not need the financial assistance. The NEHA Board of Directors discussed the appropriate use of these funds at length. A decision was made to have a professional writer prepare a "Lessons Learned" report that would examine the response of environmental health professionals to the events of Sept 11, 2001. A committee was formed to develop the request for proposal (RFP) that would be sent to professional writers and reporters, especially those in the impacted areas. The committee would also evaluate the RFP submissions and select the author. This was done in September of 2002. The writer selected was Francesca Lyman, an independent writer and columnist for MSNBC who had written several articles on the health aspects of the events of 9/11. (Her column, “Your Environment,” can be found at http://www.msnbc.com/news/YOURENVIRONMENTH_Front.asp?0dm=C303H.) Ms. Lyman’s articles have appeared in the New York Times, Sierra Magazine, The Los Angeles Times, Seattle Times, San Francisco Examiner and others. She has a Bachelor of Arts from Bennington College, Bennington, Vermont, and she currently lives in Kirkland, Washington. Her report is entitled “Messages in the Dust.” It is NEHA’s intent to see that environmental health professionals throughout the country—and even the world—learn what the lessons from the environmental health response to the attacks were. Hopefully this will help to better prepare this profession so that should anything ever remotely similar happen again, the environmental health response will be the best that it can be. —Nelson Fabian, Executive Director National Environmental Health Association September 2003 2 Preface wo years after September 11, 2001, when a terrorist attack leveled the World Trade Center, killing thousands of people, and hit the Pentagon, killing hundreds more, NEHA is T issuing a report assessing the lessons for environmental health that can be learned from these disasters—widely regarded as the worst and largest international terrorist events in our nation’s history. The images of terror are still vivid to most of us, but not everyone has realized that the nation experienced a new kind of environmental health emergency as well. When the World Trade Center and sections of the Pentagon came crashing down that day, the rubble left for rescuers and cleanup crews was laced with asbestos, heavy metals, diesel fuel, PCBs and dozens of other toxins. New York City was enveloped in a cloud of smoke, soot and toxic ash. Perhaps for the first time, the pivotal role of environmental health in terrorism preparedness was made clear. “Since we’re all on notice to expect some kind of event, NEHA wants to accumulate a base of knowledge to share with those in all areas of environmental health and public health so that they can be better equipped for the future,” Nelson Fabian, NEHA’s executive director, says. The broad outlines of the incidents at the World Trade Center and Pentagon are fairly well known. But the inside story on how environmental health professionals worked behind the scenes to try to make a difference that day and in the months that followed is not well known. These tragic events offer important opportunities to understand how people responded under stress, as well as lasting lessons for emergency and environmental response. In this age of terrorism, environmental health professionals are now on the frontlines defending public safety. As is clear to even the least imaginative among us, environmental health professionals are now on the frontlines in defending public safety in this age of terrorism. That is one of the main reasons NEHA took on the task of this report. At one time the worst hazards they confronted were corrosive acids, asbestos and contaminated medical needles, New York’s Environmental Police Unit told The New York Times. (1) Today it’s dirty bombs and more. People working in the environmental health fields are today being joined by a host of other professionals—EMS and health first responders, public health nurses and doctors, epidemiologists, forensic pathologists, police and fire officials, and others. In fact, the events of 9/11 brought to the fore many issues that have long been simmering—the need for first responders to be more mindful of health and safety, the need for all emergency personnel to be better coordinated and able to communicate with one another, and, of course, the specter of responding to a biological or chemical terrorist attack. A month after September 11, testifying before the Senate, Jeffrey P. Koplan, MD, Director, Centers for Disease Control and Prevention, stated that "Prior to the September 11 attack on the United States, CDC was making substantial progress toward defining, developing, and 3 implementing a nationwide public health response network to increase the capacity of public health officials at all levels—federal, state, and local—to prepare for and respond to deliberate attacks on the health of our citizens. The events of September 11 were a defining moment for all of us." (2) “While not an entirely new issue, 9/11 did bring to the forefront the need to examine how health and safety issues are handled by first responders,” says disaster expert Tricia Wachtendorf. (3) At the World Trade Center, 450 emergency responders—fully one-sixth of the victims of that attack—perished while doing their jobs, while environmental and medical officials, as well as volunteers, stood helpless to save them. Hundreds of others were seriously injured. In the aftermath of the attacks, undoubtedly firefighters now will take greater precautions in rushing into burning buildings and carry in more sophisticated hand-held radios. What should be done when it comes to environmental and occupational health? The mission of this document is to present the facts of responding to a terrorist event as they apply to environmental health professionals of all kinds, be they hazardous waste specialists or sanitarians, air quality technicians or public health department managers. Our considerations in this report cover air and water quality, radiological and bioterrorism threats, hazardous substances and wastes, waste removal, carting and disposal, and public health interventions of all kinds, including food handling, sanitation and vector control. NEHA is interested in describing the important role of assuring environmental health and safety—and hearing the stories of those unsung “heroes” whose stories haven't come out, people at the frontlines who did their regular jobs under rather trying and extraordinary circumstances. These stories emerge as well as healthy debate on such issues as the community’s right to know about environmental hazards in their neighborhoods and the need of public officials to balance the need to weigh top-down control versus community response. What are some of the major issues in addressing a catastrophic health disaster? What were the critical management lessons from the experience? How do public health and environmental health managers need to be better prepared in the future? What was left out last time? What went right and wrong at crucial decision-making junctures? This document describes 1) What environmental professionals of all kinds did (and, to some extent, how they might have worked with first responders) and the pressures on them in response from the public and the community; and 2) what they might have done differently—what they learned from the experience. This report is also written to call forth a variety of new perspectives—including the following types of questions: How soon should the government be able to respond to protect public health and what kind of prior coordination is needed among different agencies? What did the public expect of its public-interest agencies in such dire circumstances? Since the events of 9/11, many state and county health departments have started revamping their emergency response and evacuation plans to prepare for potential acts of terrorism, especially chemical and biological terrorism. And many experts see local public health departments as being central rather than peripheral to preparedness efforts. 4 “All terrorist incidents start as local events and local incident commanders are key agents for protecting the public, and need to be informed,” says Bruce Lippy, an industrial hygienist and occupational health specialist with the National Union of Operating Engineers. “Before 9/11 none of this was really being taken seriously,” says Thomas R. Ward, R.S. Environmental Health Director for the Union County Health Department in Monroe, N.C. “Now we’re getting better prepared, with contingency plans and problem solving along the lines of what is already done in anticipation of nuclear plant hazards or incidents.” More money is now flowing for local training programs through the Centers for Disease Control, says Ward.