Health Care and Social Issues of Immigrant Rescue and Recovery Workers at the World Trade Center Site

WTC Health Effects Treatment Program, and the Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.
Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine (Impact Factor: 1.63). 01/2009; 50(12):1329-34. DOI: 10.1097/JOM.0b013e31818ff6fd
Source: PubMed


This article reviews the experience of a unique occupational group of World Trade Center (WTC) workers: immigrant workers. This group is comprised largely of men, laborers, who are first-generation immigrants. The majority of these workers are from Latin America (predominantly from Ecuador and Colombia) or from Eastern Europe (predominantly from Poland). Our data shows that the disease profile observed in these workers was what we have previously reported for WTC working population as a whole. Recent reports have begun to document the disproportionate burden of occupational hazards, injuries, and illnesses experienced by immigrant workers in the United States. The WTC experience of immigrants exemplified this burden but, additionally, highlighted that this burden is exacerbated by limitations in access to appropriate health care, disability and compensation benefits, and vocational rehabilitation services. A clinical program that was designed to address the complex medical and psychosocial needs of these workers in a comprehensive manner was successfully established. Full justice for these workers depends on larger societal changes.

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    • "Additional variable factors include local air currents related to the explosion and collapse, wind eddies, reentrainment (re-suspension in air) of dust during the rescue and recovery phases, release of trapped gases and dust in confined or poorly ventilated spaces during the rescue, recovery, and cleaning efforts. There were also differences in an individual's minute ventilation depending on the nature and the location [de la Hoz et al., 2008c] of the assigned duties. "
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    ABSTRACT: On September 11, 2001, events at the World Trade Center (WTC) exposed residents of New York City to WTC dust and products of combustion and pyrolysis. The majority of WTC-exposed fire department rescue workers experienced a substantial decline in airflow over the first 12 months post-9/11, in addition to the normal age-related decline that affected all responders, followed by a persistent plateau in pulmonary function in the 6 years thereafter. The spectrum of the resulting pulmonary diseases consists of chronic inflammation, characterized by airflow obstruction, and expressing itself in different ways in large and small airways. These conditions include irritant induced asthma, non-specific chronic bronchitis, aggravated pre-existing obstructive lung disease (asthma or COPD), and bronchiolitis. Conditions concomitant with airways obstruction, particularly chronic rhinosinusitis and upper airway disease, and gastroesophageal reflux, have been prominent in this population. Less common have been reports of sarcoidosis or interstitial pulmonary fibrosis. Pulmonary fibrosis and bronchiolitis are generally characterized by long latency, relatively slow progression, and a silent period with respect to pulmonary function during its evolution. For these reasons, the incidence of these outcomes may be underestimated and may increase over time. The spectrum of chronic obstructive airways disease is broad in this population and may importantly include involvement at the bronchiolar level, manifested as small airways disease. Protocols that go beyond conventional screening pulmonary function testing and imaging may be necessary to identify these diseases in order to understand the underlying pathologic processes so that treatment can be most effective. Am. J. Ind. Med. 54:649–660, 2011. © 2011 Wiley-Liss, Inc.
    American Journal of Industrial Medicine 09/2011; 54(9):649 - 660. DOI:10.1002/ajim.20987 · 1.74 Impact Factor
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    ABSTRACT: Since the Sept. 11, 2001, attack on the World Trade Center (WTC), the health status of survivors, rescue and cleanup workers, and residents of Lower Manhattan has been monitored. Exposure to dust and particulate matter resulted in numerous complaints of both upper and lower aerodigestive tract irritation. The symptoms, diagnoses, and management of affected persons have previously been described in the literature. However, evidence establishing causation is scarce, especially with regard to the purported long-term effects of such exposure. Many persons who were exposed to the Ground Zero site have otolaryngologic conditions that are common in persons who were not so exposed. Therefore, otolaryngologists involved in the care of such patients should be cautious about assigning a diagnosis of "WTC syndrome" without a comprehensive examination to look for other possible etiologies. A diagnosis of a treatable, potentially serious health problem should not be missed simply because a patient who was exposed to WTC irritants was presumed to have WTC syndrome. In this review, we discuss the reported otolaryngologic manifestations of exposure to the WTC site, and we describe the specific cases of 2 workers there who continue to have otolaryngologic complaints. Considerable research is needed to establish the existence and nature of any long-term sequelae of exposure to WTC fallout.
    Ear, nose, & throat journal 09/2009; 88(8):1067-73. · 1.00 Impact Factor

  • American Journal of Respiratory and Critical Care Medicine 01/2010; 181(1):95-6. DOI:10.1164/ajrccm.181.1.95a · 13.00 Impact Factor
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