Health consequences of the 11 September 2001 attacks.

community in the aftermath of the terrorist attacks on the World Trade Center and the Pentagon is to determine whether these hor-rific events on 11 September 2001 will have continuing consequences for the health of the public. Workers, community residents, policy makers, and the press are asking us daily about the possible short-and long-term health threats of asbestos, silica, airborne dust, heavy metals, and the products of combustion. They are asking about risks to rescue, recovery, and construction workers as well as to office workers and residents of nearby communities. Our responsibility is to undertake the studies that will answer these questions and to convey the results of our work on a timely and ongoing basis to public health authorities, clinical colleagues, and the public. The ultimate goal is to guide the prevention of disease. Asbestos is a major threat to the health of workers at the World Trade Center site. Asbestos was used as fireproofing in construction of the north tower up to approximately the fortieth floor, and it was used also in the north tower elevator shafts (1). Some of this asbestos had been removed from the building in the years since its construction , but much still remained on 11 September. That asbestos was blasted free during the attacks. Much of it fell into the dust and debris at Ground Zero. Air samples obtained by the U.S. Environmental Protection Agency (U.S. EPA) and the Occupational Safety and Health Administration (OSHA) in the weeks since the attacks have shown that 8-hr time-weighted average (TWA) levels of airborne asbestos fibers are generally below OSHA standards (2). However, bulk samples of dust at the site show concentrations of asbestos ranging as high as 20%. This material is unevenly distributed at the site, but the potential for exposure is constant. Whenever workers pick up a steel beam or overturn a piece of rubble, the threat exists that a puff of asbestos can be thrown into the air and then inhaled. The long-term health risks of those exposures include lung cancer and malignant mesothelioma. Risks will be greatest for those with the most intense and prolonged exposures. Protection against these risks requires the provision of proper respirators to workers and the undertaking of health and safety training programs that emphasize the need for constant wearing of respirators, for proper fit testing, and for frequent changing and cleaning of filters. Workers at the …