by Elizabeth Grossman

It’s now ten years since the streets of lower Manhattan roiled with clouds of toxic dust and debris from the horrific events of September 11, 2001, but it was clear from discussions and presentations at the September 16 conference hosted by the New York Coalition for Occupational Safety and Health (NYCOSH) that the dust has not yet settled when it comes to issues of protecting worker and community health from environmental hazards of a disaster – nor from the ongoing impacts of 9/11. In the course of the day-long meeting held on lower Broadway a few blocks from the World Trade Center site, it was at times painfully evident that despite the huge efforts made toward providing help to those injured and sickened by exposure to World Trade Center dust and improving systems for protecting those responding to and affected by such a catastrophic disaster, many gaps remain in the current regulatory framework that must be addressed to ensure that policies at any level of government do not prevent people in a disaster zone from being fully – and effectively – informed about and protected from environmental health hazards.

Looming large over the day’s discussions was the declaration made on September 14, 2001 by the Environmental Protection Agency (EPA) and Occupational Safety and Health Administration (OSHA) that the air in New York’s financial district was “not a cause for public concern” and that indoor air quality in downtown buildings would meet safety standards. “Our tests show that it is safe for New Yorkers to go back to work in New York’s Financial District,” said John L. Henshaw, Assistant Secretary of Labor for OSHA in a press statement. “The good news,” said EPA administrator Christine Whitman in the same press release, “continues to be that the air samples have all been at levels that cause us no concern.” These too-rosy reassurances from federal officials – along with the directions from the New York City Department of Health for residents to use wet mops and rags to clean World Trade Center dust, without any mention of precautionary respiratory protection – in many ways set the stage for how the response unfolded. Both are also emblematic of what many speaking during the day characterized as the “failure of the regulatory framework” that plagued worker and community health protection during the 9/11 response.

Embodied in those September 2001 statements are all the issues stemming from the 9/11 response that have played out over the past ten years: Political expediency; the challenges of assessing health hazards of chemical mixtures; the issues related to health hazard monitoring, including where and when measurements should be taken; enforcement of safety precautions; the medical implications, both short and long term, of hazard exposure, including who is considered at risk; and who’s responsible for personal health safety measures and for the safety assessment and clean up of hazard-contaminated private property.

These were the themes addressed by the five panels of speakers assembled by NYCOSH, among them key medical, public and occupational health experts, labor, and community group leaders, along with senior staff from the Environmental Protection Agency (EPA), Occupational Health and Safety Administration (OSHA), National Institute of Occupational Safety and Health (NIOSH), and National Institute of Environmental Health Sciences (NIEHS), and Representatives Carolyn Maloney (D-NY) and Jerrold Nadler (D-NY) lead sponsors of the James Zadroga 9/11 Health and Compensation Act. NYCOSH asked the speakers to address the following: How the extent of harm from 9/11 exposures has been documented; how and why this harm occurred; and what changes have been made to include the government’s response to any future disasters.

Protecting responders with imperfect knowledge
In the wake of 9/11 and the BP/Deepwater Horizon disaster, the federal government has initiated various efforts aimed at addressing some of the shortcomings of the 9/11 response. Among these is NIOSH’s Emergency Responder Health Monitoring and Surveillance guidance, which is designed to improve health (including psychological) and safety of all workers involved in a complex emergency response. There are extensive long-term follow-up health studies underway on the Gulf Coast, and much talk of improved communications. Yet by the end of the day it seemed clear that some of the most fundamental problems that arose during 9/11 response and their root causes have yet to be resolved.

The list of “lessons learned” NIOSH director John Howard presented pin-pointed many of these outstanding issues. Among these is “the need to know who was involved,” whether as professional responders, volunteers, or as members of affected communities. Not yet fully addressed was the question of “Who is an emergency responder?” raised by Micki Siegel de Hernandez, Health and Safety Director for Communications Workers of America, District 1, whose members include cable and phone company workers. Another is the need to monitor exposure during the response. “Piecing that together after is craziness,” said Howard. But as evidenced during the BP/Deepwater Horizon disaster, despite extensive efforts to compile responder rosters and to conduct meaningful environmental and personal exposure monitoring, there remain many gaps in both these areas.

When it comes to exposure assessment, said Howard, “we need to think about mixtures.” Chemical safety assessments and standards are now set for one substance at a time, but in reality exposures always occur in combination, so the issue of addressing mixtures is vital. NIEHS, said deputy director Richard Woychik, has made this a research priority. But the question remains how to protect people in advance of any study results.

The need to deploy of the precautionary principle was another theme of the day – as was the tug-of-war between politics, science, and common sense. “Science, which requires evidence, will lag behind social need,” said David Prezant, Chief Medical Officer of the New York City Fire Department Office of Medical Affairs and one of the responders at the World Trade Center site on 9/11. But he said, we also “need some flexibility to be able to treat while studying.”

Balancing the demands of an emergency rescue situation with responder health and safety and how decisions are made to move into recovery mode when haste is no longer imperative, were also key topics. “The prolonged rescue phase hampered health and safety at the World Trade Center,” said NYCOSH industrial hygienist Dave Newman.

Agency roles and jurisdictions
One particularly contentious issue is that of OSHA’s role as an enforcement agency during a disaster response. As OSHA head David Michaels recounted on the 16th, during the BP/Deepwater Horizon response, when it came to exposure standards, OSHA was able to say that “meeting existing OSHA standards was not adequate.” But he explained OSHA’s policy of operating in compliance rather than enforcement mode during an emergency response by saying that issuing citations under such circumstances is not the most effective way to achieve immediate abatement.

Also still to be resolved is how environmental hazards are to be assessed in privately owned indoor spaces and how they are to be safely cleaned of toxic contamination. A combination of inadequate safety standards and “jurisdictional issues between EPA and OSHA” resulted in there never being any comprehensive systematic assessment of indoor contamination nor any comprehensive guidelines for clean-up or remediation – whether of residential or commercial space, explained Micki Siegel de Hernandez in an interview before the conference. “It’s not just a question of looking back and saying ‘You did this wrong,'” she said, “but so many things were predicated by those initial decisions and set in motion ongoing exposures.” Determining the geographic extent of affected areas is also an issue to be resolved. John Howard cited the need for improved hazard mapping, while representatives of community groups highlighted the inadequacy of boundaries drawn during the 9/11 response. The upshot is the concern that indoor areas continue to be contaminated with World Trade Center dust.

Ten years later, emotions are still raw. As NIEHS Worker Education Program director Chip Hughes said, “The view from the ground is not good. All the issues you’re talking about are still palpable and real.” People exposed to World Trade Center dust with its treacherous mix of toxic particulates and invisible chemicals are sick, and some have died. A number of those directly affected shared personal testimony during the conference. “The health effects and sickness experienced today is a result of lies,” said Congressman Jerry Nadler. “Those lies undoubtedly compounded the damage caused by 9/11,” he said. “It’s our moral duty to address the unfinished clean-up.”

In her politically charged closing remarks, Linda Rae Murray, president of the American Public Health Association also emphasized morality. “If someone’s sick, it shouldn’t matter how much time they spent on the pile and what block they live on,” she said. “If they’re sick, if they’re human beings, they deserve the best care we can give them.”

“Are we ready for the next 9/11?” asked NYCOSH in its title for the day’s meeting. At the end of the day Murray offered her assessment, a resounding, “No,” and cited years of policymaking that have eroded support for a broad array of educational, health and social service programs needed to answer the specific questions raised by the 9/11 response and enable Americans to truly safeguard worker and community health. The challenges are enormous but as they day’s speakers made clear – we know what needs to be done.

Elizabeth Grossman is the author of Chasing Molecules: Poisonous Products, Human Health, and the Promise of Green Chemistry, High Tech Trash: Digital Devices, Hidden Toxics, and Human Health, and other books. Her work has appeared in a variety of publications including Scientific American, Salon, The Washington Post, The Nation, Mother Jones, Grist, and the Huffington Post. Chasing Molecules was chosen by Booklist as one of the Top 10 Science & Technology Books of 2009 and won a 2010 Gold Nautilus Award for investigative journalism.