NY B19 Misc FDR - WTC Disaster Response - NYCDOH - 9-12-01
NY B19 Misc FDR - WTC Disaster Response - NYCDOH - 9-12-01
NY B19 Misc FDR - WTC Disaster Response - NYCDOH - 9-12-01
Events ~9am
• Emergency meeting with Dr. Mojica and senior staff.
• Immediate situation analyzed with input from OEM and other
agencies.
• Various teams activated, i.e. environmental response, clinical
response (logistical coordinator^ Dr. Blank), etc.
Team Coordinators
• Susan Blank
• Katherine Kaye
• Tina Mason
Ensuing events-10am
• Lobby of DOH designated as 'medical site'
• Medical personnel obtained at central office not involved with other
emergency activities were asked to assist in care delivery
• Calls placed to all DOH service delivery sites to assist with personnel
and needed supplies
• Immediate support received from all nearby sites and response from
other boroughs
• Areas in DOH lobby designated as 1) initial triage, 2) stable patient
area, 3) unstable patient area
• 'Supply' area established near information desk
• Minimal supplies were available immediately at DOH, i.e. basic First
Aide kits, etc.
• Triage teams developed and areas designated, composed of physician,
nurse, and recorder(time seen at DOH, name, address, phone number
etc.)
• Nonmedical volunteers assigned to assist triage teams with patient
transport or other duties not requiring medical skills.
• 2 triage teams(physicians skilled in emergency care) initially located
near Lafayette entrance with 1 triage team in 'stable area' located
near Centre street entrance and 'unstable' area located near Worth
street entrance.
• 2 additional teams located in vestibule of Lafayette entrance, to assist
the EMS persons located on the street.
• First disaster victim seen -10:10 am, with steady flow until ~2pm
On going Events
• Lack of supplies evident early, i.e. requests for IV solution,
stethoscopes, sphygmomanometers, oxygen tanks etc. needed not only
by DOH site but emergency facilities located in the area. Bellevue and
DOH clinics received requests for supplies.
• DOH staff volunteered en masse.
• Non-DOH staff also volunteered (received assistance from many
medical personnel affiliated with other institutions), many persons
volunteered to dbnate blood. There was no shortage of persons
offering to help. Staff received and were required to wear white DOH
t-shirts for identification.
• EMS and Fire Department requested supplies, similar needs as the
DOH, i.e. IV solutions, etc.
• Supplies arrived in stages beginning at ~1 lam (from DOH clinics).
Supplies continued to arrive throughout the afternoon. Several types
of critical supplies never arrived, i.e. Nebulizers and Albuterol for
respiratory difficulties.
• Document developed to record patient information and vital signs.
Recorder to obtain patient information simultaneous with
physician/nurse team evaluation of physical complaints. If patient
stable > taken to area near Centre entrance for observation and
continued evaluation by team assigned to that area >if patient unstable
> taken to area near Worth street entrance for stabilization of vital
signs, i.e. IV fluids etc. and await EMS transport to medical facility.
• After ~ 30minutes to 1 hour if patient remains stable and wishes to
leave, another set of vital signs are obtained with time recorded and
the patient signature at time of discharge.
• Late afternoon DOH offered transportation to subways, other
boroughs and Staten Island Ferry.
• Inventory of supplies performed and list given to on-call clinical
response team.
Supplies needed but not received
• MD stethoscopes (difficult to assess respiratory and cardiac status
with lower quality stethoscopes)
• Nebulizer equipment
• Albuterol MDI's
• Regular Insulin
• Eye wash solutions (one kit was delivered at 3pm)
• Blankets (insufficient supply received)
• Disposal gowns
• Face masks with eye shields
• 'Red' bags denoting contaminated materials
Lessons Learned
• Volunteers responded promptly.
• Inadequate supplies, BUT many unanswered questions what sort of
supplies should we stock in a site that does not deliver services?
Who will be responsible for supplies, i.e. expiration dates, assuring
appropriate function? Are in-services required? What is the level of
expertise needed for the maintenance?
• Initially only the Lafayette entrance was open, thereby controlling the
flow of patients and staff. But at ~lpm, the Worth and Centre
entrance's were opened with an uncontrolled influx of patients and
staff.
• Many volunteers did not remain in assigned areas, and added to the
appearance of confusion and 'chaos'. Several volunteers
'disappeared' from stations, patients not transported to restrooms or
'stable' area in timely fashion. Information document not collected
as directed by volunteers, we are therefore unable to perform f/u with
patients examined in triage site.
• Several triage teams did not record the time of examination, therefore
we are unable to document physical status at time of discharge.
• Limited number of medical personnel familiar with acute care
procedures.
• Multiple requests for 'stress' counseling received. Multiple requests
for information regarding persons possibly trapped at the WTC site.
• EMS, Police Department and Fire Department continually requesting
supplies (several occasions, just walking in and taking materials).
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World Trade Center Disaster Response
New York City Department of Health
9/ll/01:8am-8pm
Incident:
Crash of AA into One World Trade Center
Crash of UA into Two World Trade Center
Evacuation of thousands from WTC
Collapse of Two WTC at 9:58
Collapse of One WTC at 10:25
EOC decisions
HOC activated shortly after 9 am
All work groups met, briefed on status and response plan
Immediate response:
Beth Maldin sent to OEM, did not reach 7 WTC, came back before collapse
Commissioner with Mayor at WTC, caught in debris
Managers asked to come to building
OEM schedule set up at OEM, group coverage for next 3 days
All doctors and nurses on standby
Environmental Workgroup
Assess area for radiologic materials
Assist in collecting materials for BT and toxics
By 5 pm, had tested 2 samples
Asbestos
Will be a large issue, there was asbestos in the buildings
Radiation
Not clear if radiologic substances involved
? radioactive substances in planes?
Water
Safety of supply is unknown
Med/Clinical Workgroup
Clinical services put on alert, then clinic was set up on 1st floor
Only a few casualties being seen in the first few hours, Td needed?
Gather medical staff at 125 Worth to assist in providing care to victims
List of medical professionals who can be called to respond to emergencies
By 5 pm, had seen 45 patients, 17 people referred
Sheltering Workgroup
Shelters activated with Red Cross
Activated plan to provide nursing staff at shelters *
set up, some in schools with children /<vit/\
Laboratory
Lab put on alert immediately to provide tests for asbestos, BT agents
Some samples taken today to test for biologicals
No increase in PCC calls today, some treatment calls from hospitals about anthrax
MIS
Operations/Personnel/Staffing
Ft. Greene set up as alternative EOC
All phones at 125 Worth are out, have to use Nextel phones
Vital Records
Will work with OCME to issue burial permits
Funeral directors will be notified about DOH activities
Incident Report
September 11,2001
On Tuesday, September 11, at 8:45 AM, an American Airline passenger plane enroute to LA
crashed into the north tower of the World Trade Center. At 9:00 AM, another passenger plane
enroute to San Francisco crashed into to the south tower of the WTC. At about 9:30 am, the
south tower collapsed, followed shortly by the north tower.
Call all work groups: Surveillance, Medical, Shelter, Environmental, Laboratory, Vital Records,
MIS, Operations met to be briefed on status, and response plan.
Surveillance -
- assess casualties form area hospital;
- assess the risk for the potential release of bioterrorism agents;
Medical -
- gather medical staff at 125 Worth to assist in providing immediate care to individuals/victims
- generate a list of all medical professionals that may be called to respond to emergencies
Shelter -
- activate plan to provide nursing staff in emergency shelters
Environmental -
- assist in collecting samples for bt and other toxic substances
- assess area for radiological materials
Laboratory -
- provide immediate tests for bt agents
- provide immediate tests for asbestos
- provide assistance in housing police/medical examiner operations
Vital Records
- work with medical examiner in issuing burial permits
MIS
- provide technical assistance with the network and other IT issues
Operations
- assist in moving staff
- assist in collecting supplies and setting up emergency clinic
09-11-2001 01:59pm From-INPHO-HAN +7704889300 1-272 P.002/002 F-6S9
This is an official
CDC HEALTH ALERT
DATE: September 11, 2001,13:25
COMMUNICATIONS TOPIC: Initial Health Alert Notice to States and Local Public Health Agencies
Due to current events, CDC is on heightened alert status to monitor for any possible unusual
disease patterns associated with today's events, including chemical and biological agents.^
CDC recommends that you initiate heightened surveillance for any unusual disease occurrence or
Please notify all segments of your emergency response system (including epidemiologists/
laboratories, all local public health units, hospital emergency departments and 911 dispatch
If you require any assistance or become aware of any unusual occurrence, CDC is available at
our emergency number of (770) 488-7100, 24-hours per day, or (770) 488-4819. You may also
www.bt.cdc.gov.
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21:34 Tuesday, September 11, 2001
_ u,jnu— unuurxL. i iv *
i
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Obs hospnam ^tpil^ld
t^^4^ Vi'si'^f
&£ ^ 0
1 Brooklyn Hospital Center, Downtown Medical Center 140 0
2 Brooklyn Hospital Center . .
23 Bellevue . • 4jp&$v, »
2*
Beth Israel - Petric Division 100 0
25 Beth Israel - North Division . .
26 Metropolitan Hospital Center . .
27 New York Eye & Ear Infirmary 3 0
28 New York Downtown Hospital • 4 300 0
29 NYU Medical Center - 34th and 1st avenue . .
30 Memorial Hospital . .
Ltsi
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•«i..iB.-: ..-'-.r^;
7 /QJn/L
The SAS System 06:33 Wednesday, September 12, 2001 6
sex(SEX) HOSPNAME
MALE 35 83 52 30 200
FEMALE 16 59 49 15 139
UNKNOWN 3 13 6 6 28
AMBULANCE 22 12 1 35 70
WALK- IN 1 16 0 1 18
Frequency Missing = 5
CRITICAL 1 0 0 0 1
HOSPITALIZED 3 7 2 0 12
DISPOSTN HOSPNAME
DEAD 0 1 0 0 1
YES 15 19 2 16 52
YES 3 5 0 0 8
NO 33 82 73 29 217
YES 21 73 34 22 150
YES 2 1 0 2 5
YES 5 16 2 1 24
lacer(LACERATION/CONTUSION) HOSPNAME
NO 43 111 99 34 287
YES 11 44 8 17 80
YES 4 5 0 1 10
YES 0 1 0 0 1
YES 0 1 0 0 1
faint(SYNCOPE/PRE-SYNCOPE (FAINTING))
HOSPNAME
Frequency BELLEVUE BETH ISR NYU DOWN ST. VINC Total
AEL TOWN ENTS
YES 1 2 0 0 3
YES 4 24 1 7 36
SPRAIN(SPRAIN) HOSPNAME
YES 3 8 0 2 13
NO 38 90 38 42 208
YES 16 65 69 9 159
The Mayor has asked that all non-essential personnel remain at home until further notice.
However, all clinic based and health center personnel should report to their regular
assignmentiif possible; otherwise they should report to a clinic or health center nearest to
their home. All managerial personnel should also make every effort to report to their
nearest DOH facility. All personnel are required to "clock-in" and supervisory personnel
Overnight, the question of asbestos exposure arose, as the World Trade Center (WTC)
was built just prior to stringent regulation about asbestos use in construction,
t
The team, which was now composed of some clinical response staff and some
environmental epi staff focused on coordinating asbestos measurements being made or
about to made by a variety of agencies, including NYC DEP, NYS DEC, NYS DOH,
EPA, culminating in the arrangement of an afternoon (4 P.M.) meeting at 5 Penn Plaza.
Environmental sampling for other potential hazards (e.g. phosgenes - secondary to freon
tanks that were on the roof, or ongoing fires consuming PVC piping -, volatile organics,
acid gases, cyanide) will also be discussed. Additionally, there will be a review of
differences between the state and federal acceptable levels. We also developed a
sampling log system.
The strategy was to consider any environmental recommendations in terms of the levels
of exposure experienced by the following groups of individuals such as:
• transients,
• residents of the immediate vicinity,
• residents at greater distances but downwind,
• clean up crews
• rescue workers
o light exposure
o heavy exposure
We are also trying to work with OEM to determine the numbers of individuals in each of
the above groups.
We have also developed a staffing plan for 12 hour shifts composed of environmental epi
staff with support from medical and clinical response teams through Sunday. Also two
respiratory experts from NIOSH will be arriving this afternoon.
Supplies from yesterdays clinical response at 125 Worth are being redistributed back to
their clinics of origin.
Staff from yesterday's clinical response have not been extensively utilized today, but are
available for other purposes.
The SAS System 06:33 Wednesday, September 12, 2001
£2
The FREQ Procedure
1 WTC 0 1 0 0 1
120 BROADWAY 0 1 0 0 1
280 RECTO ST 0 .1 0 0 1
AMERICAN EXPRESS 0 1 0 0 1
AMERICAN STOCK E 0 1 0 0 1
XCHANGE
ASLAND MGUIT 0 1 0 0 1
BANK OF NY 1 0 0 0 1
BANKERS TRUST 0 0 0 1 1
BOLTONS 0 1 0 0 1
BUS DRIVER 1 0 0 0 1
CHASE MANHATTAN 0 1 0 0 1
BANK
COMMISSION HPD 0 0 1 0 1
DTC - 55 WATER S 0 1 0 0 1
TREET
EMS 0 3 0 0 3
EMT 0 3 0 0 3
FDNY 0 1 0 0 1
FIDELITY INVESTM 0 1 0 0 1
ENTS
FIRE 17 5 3 2 27
GOLDMAN SACHS 0 1 0 0 1
JP MORGAN 0 1 0 0 1
MARRIOTT 1 0 0 0 1
MERRYL LYNCH 0 1 0 0 1
The SAS System 06:33 Wednesday, September 12, 2001 2
METLIFE 1 0 0 0 1
NEAR WTC 0 1 0 0 1
NYFD 0 1 0 0 1
POLICE 0 13 1 6 . . .20
POLICE DEPARTMEN 0 1 0 0 1
T- SCHOOL SAFETY
PORT AUTHORITY 0 1 0 1 2
SCOR REINSURANCE 0 1 0 0 1
SOFTWARE DEVELOP 0 1 0 0 1
ER
STUDENT 0 1 0 0 1
TUMBLEWEED 0 1 0 0 1
WTC 0 2 0 1 3
CROWD 0 2 0 0 2
IN SCHOOL 0 1 0 0 1
NEAR WTC 14 53 0 7 74
PICKED UP BY EMT 0 1 0 0
aw
AT CATHERINE LN i Jt
AND EAST BROADW
AY
STUYVESANT HIGH 0 1 0 0
SCHOOL
SUBWAY 0 4 0 1 5
WALL STREET 0 1 0 0 1
WARREN STREET AT 0 1 0 0 1
IS 89 SCHOOL
WTC 26 39 0 12 77
Moments
Location Variability
Quantiles (Definition 5)
Quantile Estimate
,<'Tt)0"%~'Max 80.2466~^)
99% 74.2521
95% 62.3397
90% 57.5836
75% 0.3 48.0110
{55% Median 40 . 0082")
25% Q1 32.0027
10% 25 . 1 1 78
5% 20.1178
1% -16.3479
(0% Min -17. 8548^>
Extreme Observations
- - Lowest - - --Highest
D Hospital Name Contact Name Area Phone Emergenc EC Phone EC Fax # Patients
Manhattan Hospitals
8 Beth Israel - Petric Division Ruth Hennessey 2~12 420-3887 420-2881 100
3 St. Claire's Hospital Gary Morrison 212 459-8402 Dorothy C 459-8402 459-8127 20
5 Mt. Sinai Dr. Nathan Case or Dr. Gary Rosenerg 212 241-8888 241-7432 722-2543
6 Bellevue Shelley Manzin/Larry Dugen 212 562-4726 562-4726 562-4796
1 0 Beth Israel - North Division Roselyn Weinstein 212 870-9130 Beeper 91 870-9567 870-9404
11 Metropolitan Hospital Center Sara Shahim " 2 1 2 "423-7554 423-7272 423-7974
12 New York Eye & Ear Infirmary Joseph Corcoran/Mr. Minicus 212 "979-0664 228-0664 3
18 New York Downtown Hospital Michael Rollins-head of Command Ctr "212 "312-5148 ask'forlia 312-5148" 312-5794
19 NYU Medical Center - 34th and 1st avenue Susan Bowan - Ferres 212 263-3700 263-1008" "
20 Memorial Hospital 212
21 North General Hospital Mr. Tom Long 212 423-4252 "Dr. Gregoi 423-4252 423-4204
Manhattan Total "". 123
Brooklyn Hospitals
1 Brooklyn Hospital Center, Downtown Medical Ctr Frederick Alley, CEO 718 250-8000 Frank Mac 250-8000 140
2 Brooklyn Hospital Center Frederick Alley, CEO 718 250-8000 Frank Mac 250-8000
4 Lutheran Medical Center Myles Davis 718 630-7300 "Dr. Louis :6"3"6:7 189 745-6092 40
7 Beth Israel Medical Center Kings Highway Div John Byrne - VP Administration 718 951-3000 Nora Fern. 951-2901 951-2728" " 18
9 Long Island College Hospital Linda Vila 718 780-1776 or beeper: 718-780-2 •522-0703" 139
15 New York Community Hospital of Brooklyn Ms. Marcy 718 692-5305 1 692-5360 692-8454 11
16 Woodhull Medical Center Bess Candice 718 963-8000 ask opera- 963-81 05 50
Margo Johnson, Sr. VP 718 240-5212 240-6169
17 Brookdale University Hospital "" : ""~ " " 19
7
22 Interfaith Medical Center (BJ) 718
23 Kings County Hospital Dr.Kathy Roans 718 245-3928 245- 0
24 Interfaith (St. Johns) 718 4
25 Coney Island Hospital William Walsh - Executive Director 718 616-4100 616-4439 0
26 mamonides medical center Pam Briar 718 283-6009 ER: Dr Murphy, 718-283-1416 28
27 Catholic Medical Center-St Mary Mr Baptiste, executive director 718 221-3402 5
28 Wycoff Heights Todd Storm "718 963-7705 15
29 Kings County Hospital Dr. Rowes 718 245-3131 245-3928 245-5500 17
30 University Hospital Brooklyn Brenda """718 270-630 1 Dan Grave 270-2401 270-1628
31 Kingsbrook Jewish-Medical Center Dr. Coonan or Dr. Farragano 718 604-5455 604-6517
32 Victory Memorial Hospital Mary Conlon - Associate Administrater 718 "567-1411 Director a 567-1260 "567- 1286 12
33 NY Methodist Hospital Marilyn Hill 718 780-3301 "Lauren Ye 780-3301 780"-3770 "" 30
Brooklyn Total 535
Page 1
Hospital Needs ^ummary
Hospital Name # Deaths Total beds filled Total beds available # Persons in ER Waiting Room # of Beds Available in ER
Manhattan Hospitals
Beth Israel - Petric Division "o " o 48 0 0
St. Claire's Hospital 27.'.. "I o o " o 0
Mt. Sinai '962 100 o 40
3ellevue 0 0 0 0
Beth Israel - North Division 0 21 " o 0
Metropolitan Hospital Center
0 ""
0 o " "" o 0
New York Eye & Ear Infirmary o 36' • o 0
" 4'_'_" o
New York Downtown Hospital
"
20' ""
8" " o:" 0
\IYU Medical Center - 34th and 1st avenue 38 0 0
Memorial Hospital 0 0 o 0
North General Hospital 4 45 0 0
Manhattan Total "'...^.."731.... "„ 1004 '" 278 ' ' "_' ' 0 40
-' -
Brooklyn Hospitals
58""""
Brooklyn Hospital Center, Downtown Medical Ctr 0 26 o" 6
Brooklyn Hospital Center " o ~19 o " 2
"o ~ "" 6 ""40""
Lutheran Medical Center 115 10
2
Beth Israel Medical Center Kings Highway Div 196 15 8
Long Island College Hospital r 100 '240 "b" 0
New York Community Hospital of Brooklyn o 115 14" 0 0
Woodhull Medical Center 0 0 0
"'"":
"o
13' 0
Brookdale University Hospital 0 337 64 5
" '6
Interfaith Medical Center (BJ) 0 140 10 0
o o ""39""
Kings County Hospital " o 0
Interfaith (St. Johns) b' ~ " 140 3 17" 0
Coney Island Hospital 0 0 38 0 0
mamonides medical center 0 60 20 0 0
Catholic Medical Center- St Mary 0 0 0 o 0
Wycoff Heights 0 0 67 9 0
Kings County Hospital 0 0 33 0 0
University Hospital Brooklyn 60 8 4 8
Kingsbrook Jewish Medical Center 275 '30 0 15
Victory Memorial Hospital 0 150 > 38 0 20
NY Methodist Hospital 0 490 60" "o 0
Brooklyn Total 1 2095 867 101 68
Page 2
Hospital_Needs_ jmmary
Hospital Name Plan in place Total Morgue Capacity Current Morgue Capacity
Manhattan Hospitals
Beth Israel - Petric Division Unknown o ,. °
St. Claire's Hospital Yes ~ 6
Mt. Sinai Unknown ' " ' "]'"'_ " " 15 " 35
Bellevue .Yes
Beth Israel - North Division Unknown " 4
Metropolitan Hospital Center Unknown
New York Eye & Ear Infirmary Unknown
New York Downtown Hospital Unknown
NYU Medical Center - 34th and 1st avenue Unknown 7
Memorial Hospital Yes 15 14
North General Hospital Unknown 6 3
Manhattan Total 49 56
Brooklyn Hospitals
Brooklyn Hospital Center, Downtown Medical Ctr Yes 58 54
Brooklyn Hospital Center Yes 4 2
Lutheran Medical Center Yes 10 10
Beth Israel Medical Center Kings Highway Div Unknown 4 3
Long Island College Hospital Unknown o 0
New York Community Hospital of Brooklyn Yes 4 2
Woodhull Medical Center Unknown 15 0
Brookdale University Hospital Yes 20 8
Interfaith Medical Center (BJ) Yes 14 10
Kings County Hospital Unknown 60 60
Interfaith (St. Johns) Unknown 14 10
Coney Island Hospital Unknown 34
mamonides medical center Unknown 6 6
Catholic Medical Center-St Mary "Yes " 15 15
Wycoff Heights Unknown 8 _ _ _ 8
Kings County Hospital Unknown
University Hospital Brooklyn Yes 10 8
Kingsbrook Jewish Medical Center Unknown 12 4
Victory Memorial Hospital ""Yes 6 6
" " " 9
NY Methodist Hospital Yes " 10
Brooklyn Total 270 249
All Hospitals " " " '' ' J' 7J" 31 sT _! I 305
Page 3
Medical Advisory: Asbestos and Dust
Asbestos was used in the constaiction of the World Trade Center. Measurements of asbestos fiber
levels are being monitored to determine if there is any risk of exposure. To prevent exposure to
asbestos and to reduce any risk that might exist, the following protective measures are
recommended:
1 - Based on currently available information, persons working at the site should use N95
respiratory masks (TB masks) to prevent inhalation of asbestos fibers and goggles to prevent eye
irritation. Persons who will be going into the building or working in confined spaces should use at
least an N100 mask for respiratory protection. To the extent possible, gloves and coveralls
should be worn and removed before going home. Boots or shoes should be covered, if possible,
and rinsed prior to returning home.
2 - Other risks may include exposure to cyanide and acid gases; levels will be monitored at the site
to determine if any risk exists.
3 - Emergency personnel (firefighters, EMS staff) should remove outer garments and shower
immediately when returning to their firehouse/garage. Uniforms should be separated from other
clothing and washed twice in ordinary detergent.
4 - Persons who were exposed to ash and soot should shower and wash their hair. Clothing
should be washed twice in ordinary detergent, separated from other clothing.
WHAT
• Used for building insulation
• It is generally white and fibrous
• The dryer it is, the more dangerous it becomes
HAZARDS
• Causes types of respiratory cancer
• Long lead time before an illness occurs
• Smoking while exposed increases the risk of cancer by
twenty times.
• The asbestos fibers on your clothes can be carried to
your home.
CONTROLS
• The wetter the better.
• Respirators should be worn at all times within the
contaminated area.
• Your last line of defense - Tvek suits with hood, gloves,
respirators, disposable boots, goggles ... should be
worn at all times.
• Where decontamination stations are present, use them!
THE CITY OF NEW YORK
DEPARTMENT OF HEALTH
Rudolph W. Giuliani Neal L Cohen, M.D.
Mayor Commissioner
ALERT: Terrorist Attack at the World Trade Center in New York City:
/ Medical and Public Health Issues of Urgent Concern
Please Share this Alert with the Following Key Staff at Your Hospital:
1 - Hospital Administration
2 - All Medical and Nursing Staff
3 - Emergency Departments
4 - Hospital Safety Director
5 - Hospital Pharmacy and Laboratories
TO: Emergency Medicine Directors, Infection Control Practitioners and Infectious Disease
Physicians, and Other Persons on the NYCDOH Broadcast Facsimile Alert
We are sending this broadcast alert in response to the tragic terrorist attack at the World Trade
Center yesterday morning. We want to alert you to the following issues:
However, we do request that you be especially alert to ANY unusual disease issues over
the next three weeks. Urgent health issues for which we would want to be notified
immediately include:
Please report immediately to the Communicable Disease Program at the NYC Department of
Health if you evaluate patients with any of these suspected illnesses or conditions. The
Emergency Operations Center for the NYCDOH has been relocated to the Public Health
Laboratories at First Avenue and 27th Street. Please contact us at the following numbers:
or if unable to get through, please call the Poison Control Center at 212-764-7667 or the
Office of Emergency Management at the contact number listed at the end of this alert.
The NYC Department of Health will be establishing an active surveillance program with
sentinel hospitals throughout the city over the next two weeks to monitor for an increase in
patients presenting with unusual disease syndromes. Surveillance staff will be contacting
emergency room directors at these sites to request their participation in this program.
B) Assessment of Acute Care Hospital Needs: Greater New York Hospital Association
(GNYHA) is continuing to monitor hospital needs by regular telephone contact. Additionally,
the NYCDOH has sent surveillance teams to hospitals with higher numbers of casualties, to
better assess morbidity and mortality related to this attack. A GYNHA representative is at the
Mayor's Office of Emergency Management if you have any urgent health care resource needs.
C) Reporting Fatal Cases and Information on Mortuary Issues, Including Death Certificate
Registration for Deaths Related to this Incident
a. ALL deaths directly or secondarily related to this terrorist incident should be reported
to the Office of the Chief Medical Examiner at 212-447-2030.
b. The NYCDOH Burial Desk for registration of death certificates has been temporarily
moved to the Central Harlem Health Center. Please notify all Funeral Directors
regarding the relocation of this office:
There are no acute symptoms with asbestos exposure. The risk of disease in this type of
setting is deemed to be low. There are no tests that can be done, including chest radiographs,
to tell if exposure has occurred, nor to predict if pulmonary disease will occur in the future. A
medical advisory regarding issues related to asbestosis is attached.
F) Td Vaccine Availability
Standard recommendations for use of Td vaccine should be followed for wound management.
If additional vaccine supplies are needed by your hospital, please contact the Mayor's Office
of Emergency Management Command Center at the number listed below.
The Mayor's Office of Emergency Management has been temporarily relocated. In the event
that you require acute assistance, please contact the city's command center at 212-477-
9610. Representatives from the New York City and State Departments of Health, as well as the
Health and Hospital Corporation and the Greater New York Hospital Association have
representatives on site. As telephone lines are limited, only emergency calls should be made to
the numbers listed above.
CDC EMERGENCY RESPONSE 770 499-7107 QS^lS/01 04-:lGP P . 004
SBM2-2001WED) 11:24 HtlAB
CDC was asked on Day 5 to visit the Federal Building and immediate environs to advise on
Biological and Chemical haswds, appropriate use of personal protective equipment, and related
safety issues. The site visit was made on Day 6.
General Observations:
1. Oil-site personnel have established excellent procedures for all aspects of health and
safely.
2. The personal protective equipment/clothing used during rescue operations ore certainly
adequate for the minima] biohazardous risk associated with this operation.
1 , There are no known biohozards thai pose o public health concern or individual Cttntetvs
10 rescue workers.
2. Bodies in this. collapsed building do not pose specific infectious disease risk TO
workers. Bodies will begin lo decompose, and in that process any Infectious diseases that my have
been in the living person will also decompose. Although the decomposition process will begin to
smell bad, no infectious agents arc associated with that process.
3 . Rescue personnel who handle bodi«? (or/ body parts) are wearing disposable Tyvekjump-
suits, rubber gloves, respirators and hard hats. Disposable covers may be wprr\« boots.
4. Rescue personnel who are involved with activities like rubble removal arc cither wearing
fire-fighter's bunker gear or military fatigues. Both groups are wearing hard bats, respirators, boots,
and leather work gloves.
5._ Personnel who have been involved with rescue operations have been out-processing
through decon, stations. Respirator cartridges and gloves are discarded, boots are sprayed with tysol
(1 :50 dilution with water), and appropriate uniform parts are also decontaminated',
There have beta staffing difficulties at the dccon station?; these difficulties arc being
addressed and control will remain with the Oklahoma City Fire Department.
CDC EMERGENCV RESPONSE 770 *E»-7107 ^'^(iS) 5*3841 4488 P. 01 8/821
SfP-12-2001 (WED) 11=25 HETAB
Affected Area Definition: Based on available asbestos test results and distribution of dust
& debris, the site is defined by the Hudson River on the west and the following street
boundaries:
Site Control: Site control is needed to assure that all workers and visitors are aware of
these recommended precautions and possess recommended personal protective
equipment. In addition, site control is needed to assure decontamination and dust
suppression of debris coming off site.
Visitor Protection: It is recommended that anyone entering the site, but not scheduled to
actively work in debris or to disturb dust wear at a minimum a disposable cup-type (i.e.,
not fan-folded or duck bill) N100 or PI00 respirator and goggles. Upon exiting the site,
the respirator should be disposed of by being placed in a plastic bag.
Decontamination: All vehicles leaving the site, should be hosed down with water.
Anyone performing decontamination should wear a half-face, reusable respirator with a
replaceable PI00 filter, goggles, and either fire-fighting (turnout) gear or disposable
Tyvek coveralls.
Hauling and Storage of Debris: All debris leaving site and stored off-site should be
wetted and covered with a tarp.
Equipment To Be Ordered:
Transportation/Transit
DOT 2 12/7 18 CALL DOT
MTA (City) 718 330 3000
MTA (State) 2128787000
Transit Bureau (NYPD) 7182433441
FAA 202 267 3484
'<}
SEP-12-2001 17:32 NYS Warning Point 518 457 9930 P.01/13
FACSIMILE TRANSMISSIOH
ACTION INFO
IMMEDIATE
PRIORITY
MR STD -(
° M-»-
\,
MO ALL
3-< \o
TOTAL-
bEP-12-2001 10:02 NYCDhP DERTft 71 y 595 4690 P.01
S
WORLD T RADE CENTER INCIDENT?- 9/1 1/01 j
SAMPLE RESULTS -~ —--"
SAMPLE # LOCATION RESULT
1 23 Barclay Street 1 % chrysotile
2 217 Broadway 4% chrysotile
3 Church St & Vesey St negative
4 North east Church St & Vese 1.3% chrysotile
5 Across 90 Church Street negative
6 Barclay St & Church St 4.8% chrystotile
7 Warren St & Church St trace
8 Church St & Murray St less than 1%
9 Park Place & Church St 4% chrystotile
10 Church St & Dey St less than 1%
11 Church St & Cortland less than 1% chrysotile
Response Summary Tab?e-1
9/11 «M
Sample # Location Matrix Lead Cone Asbeslos • Total VQCs. ppbv
111978 Corner of West Broadway & Warren Dust 170 mg/Kg None Delected NA
NYC
307/561 ftemsen St @ Promenade Air ND 0.004S fiber/cc ChrysolUe 42'
Brooklyn
562 Reinsert St @ Promenade Air ND O.flCMB ftber/cc Chrysolile NA
Brooklyn
308/563 Cranbe;ry St @ Columbia Air ND None Detected ND
Brooklyn
309/564 Congress St @ Columbia Air NO O.OQ4B iiber/cc Chrysolile ND
Biooktyn
310/665 Coufi S( @ Montague Air NO None Delected 5
Brooklyn
116/667/666 near Command Center Air ND None Detected Q.6J
Liberty ParK
117/665/668 near Command Center Air ND None Detected D.6J
Liberty Park
if8/66f/664 looking al Elf is island Air NO None Delected O.6J
Liberty Park
19/664/663 looking al World Trade Center Air ND None Delected ND
Liberty Park
3 ppb toluene, 7 ppb benzene, 1 ppb elhylbenzene, 3 ppb styfene, 1 ppb m & p xylene, 3 ppb chtoromelhane
ppb trichloroffLJoromelhane. 19 ppb non large! freon compouncfs
111978 Corner of West Broadway & Warren Dust 170 mg/Kg None Detected NA
NYC
307/561 Remsen St @ Promenade Air ND ' 0.0048 S/cc Chrysotile 42*
Brooklyn
I 562 Remsen St @ Promenade Air ND 0.0048 S/cc Chrysotile NA
Brooklyn
308/563 Cranberry St @ Columbia Air ND None Detected ND
Brooklyn
309/564 Congress St @ Columbia Air. ND 0.0048 S/cc Chrysotile ND
Brooklyn
310/565 Court St @ Montague Air ND None Detected 10
Brooklyn
416/667/668 near Command Center Air ND None Detected 0.6J
Liberty Park
417/665/666 near Command Center Air ND None Detected 0.6J
I
Liberty Park
418/661/664 looking at Ellis Island Air ND None Detected 0.6J
Liberty Park
419/664/663 looking at World Trade Center
Liberty Park
Air ND None Detected ND
ff
* 3 ppb toluene, 7 ppb benzene, 1 ppb ethylbenzene, 3 ppb styrene, 1 ppb m & p xylene, 3 ppb chloromethane
5 ppb trichlorofluoromethane, 19 ppb non target freon compounds
SEP-12-20B1 17:33 NVS U,rnln3 Polnt
513 457
DATE:
HOTES^COMMiNTS:
SEP-12-2001 17:33 NYS Warning Point 518 457 9930 P.06/13
_SEP-12-2001 17:33
NYS Warning Point
518 457 9930
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SEP-12-2001 17=33 NYS Warning Point 518 457 9930 P.08/13
ATC ASSOCIATES-INC r«OC
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SEP-12-2001 17:34
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TOTfiU P.01
TOTQL P.14
Department of Public Health Disaster Response
World Trade Center Attack
9/12/2001 8:15PM
Offices of DOH have been temporarily moved to Bureau of Labs, 455 1st Avenue, NYC.
DOH Command Center telephone number is: 212-447-2667 or 212-447-2668
OEM is located at 20th St. b/t 2nd and 3rd FAX 477-9723
Clinical Workgroup
Temporary clinic set up at 125 Worth St. has been closed.
All DOH clinic staff are to return to work tomorrow.
Advisories on asbestos and phosgene exposure have been prepared, preparation of others
hampered by lack of data on what chemical agents/biologies are at site.
Risk groups, stratified by exposure, have been identified. As far as we know, responders
are wearing N95's
Epi/Surveillance Workgroup
Surveillance staff are working in the Integrated Surveillance offices in the basement
Syndromic Surveillance system being set up - will be initiated tonight at 4 hospitals, at
least by tomorrow, at approximately 15-20 sentinel hospitals by noon 9/13
Broadcast fax system being set up on 1st floor. Broadcast fax sent out at 5 pm 9/12/01.
See addendum
No accurate data on ER visits. Greater NY Hospital reported 2235 ER visits, and only 47
admissions.
.Environmental Workgroup
Asbestos
DEC announced today via a flyer that "asbestos is a killer" (see addendum). Apparently
reported one level of 3.4 fibers/cc.
Air quality testing at WTC site was performed throughout the day. Levels of asbestos
from 0.01 to 0.085 fibers/cc were found at several sites along Chambers St. (see
addendum)
Asbestos testing has taken place in Brooklyn and New Jersey, all which have been below
1% threshold level. ConEd has tested one sample in Manhattan, level of 0.15 fibers/cc.
Hundreds of response personnel, Fire Dept, NYPD, and volunteers down at WTC site are
all potentially being exposed. Concern also that large amounts of rubble and debris,
including cars, are being removed from the site without being cleaned or hosed down to
avoid dust contamination.
OEM reminded re: wetting down trucks with debris.
5,000 N95 masks have arrived but have not been used. 1000 Ml00 masks and 2000
goggles have been ordered, arrival expected by morning 9/13
5 pm meeting at 5 Penn Plaza with EPA, DEC, DOH to discuss issues of air quality,
manner of testing, etc.
Concern that asthma incidence may increase as smoke plume covers more of lower
Manhattan, wind direction has changed, now coming from the south.
Meeting at 4 pm at 5 Penn Plaza with EPA, DEC, DEC, ConEd: see summarized
minutes. Recommendations include:
Strengthen security around site. Cordone off Exchange to Worth to Center. Visitors must
wear disposable masks, workers must wear 1/2 face masks with disposable cartridges.
Much concern about community exposure, cleanup of residential buildings and
apartments. No concern about asbestos washing into sewers.
OEM wants building by building inspection of every structure south of 14th St, including
structural and sanitary inspections, and cleaning of HVAC systems.
Inspectors sent to Stuyvesant High School and Chelsea Pier Food Stalls.
Discussion of whether 125 Worth St. is exempt from this plan.
Vehicles and equipment that make up San Genero Festival in Greenwich Village may
need to be checked.
Will be making recommendation to OEM about need for washing, cleaning, or removal
of asbestos covered clothing for personnel in direct crash area.
Other
Risk of gas leak at site is very real. Other buildings at WTC complex are at risk of
collapse as well.
Concern that freon in tanks in WTC (on roof or in subbasement?) may have been
transformed into phosgene, still leaking from site/rubble. Probability that freon was
consumed in fire and dispersed, although burning PVC pipe may also cause creation of
phosgene gas. Phosgene causes acute lung injury if inhaled in large amounts, best to
avoid altogether, face masks are not protective. No phosgene has been detected by scent
at the site. Possibility of using self-contained breathing apparati is being considered.
EPA will be doing phosgene monitoring tomorrow.
NIOSH is sending 2 personnel to assist with recommendations for construction and
emergency personnel.
Physical exam testing being waved as was done in 1993.
No licenses for radiation for medical purposes in WTC. Further radiation tests to be done
on 9/13.
2 possible sources of radiation were detected, DOE is on their way tonight to begin
testing.
Laboratory Workgroup
4 samples taken yesterday were tested for spores, are being cultured. No identifiable
growth so far.
No plans being made to test more specimens.
Sheltering Workgroup
DOH shelters are still open today although they are not very full, only 2-3 people per
shelter.
10 shelters in Manhattan, 1 in Brooklyn, 1 in Staten Island. 1 shelter closed due to
suspicious package delivered. Another shelter closed in Manhattan as well.
100 children who stayed in one shelter last night have been addressed.
No specific information where residents of Battery Park City have relocated to.
Nurse staff personnel have been scheduled until 9 am 9/13
Public schools below 14th St. will not be open tomorrow. Other public schools to be
delayed 2 hours.
Vital Statistics
Burial Desk is up and running at Central Harlem Health Center, regular business has
resumed.
Funeral directors are aware of new location.
3 deaths ascribed to WTC disaster have been issued so far, as of noon today.
Working with OCME to develop electronic form specific for WTC disaster.
Reports of hundreds of unidentified bodies at OCME and Bellevue (reliable?)
Hotline
General public health and missing person hotline is being staffed by DOH personnel.
LifeNet hotline for mental health has been established in English, Spanish, Chinese
Personnel policy
Personnel at all DOH sites above 14lh St. are being asked to return to work tomorrow
(9/13).
All non-essential personnel and non-managerial staff who work below 14th St. should not
report to work.
Managers should begin to assess need for staff to return to work and have plan in place
by Friday.
Equipment and supply shortages at clinics are unknown.
Paychecks will be distributed on Friday. Distribution plan in process.
There are buses running between the Bureau of Labs and Worth St.
Joe Barbera and Brian Flynn from HHS will visit Command Center tonight.
Secretary Tommy Thompson scheduled to meet with Commissioner Cohen tomorrow..
Acronyms:
DEC - Department of Environmental Conservation
DEP - Department of Environmental Protection
9/13/01 ,6: 10 AM
Q
Department of Public Health Disaster Response
World Trade Center Attack
September 12, 2001
Command Center was informed of one shelter being closed (Norman Thomas HS) because of a "bomb
threat" at the Empire State Building. The surrounding area, including hotels and Penn Station was
evacuated. OEM and the Police later declared this to be a hoax.
11:15 PM
Shelter
All (9) shelters will remain open tomorrow, Thursday, September 13. Since some shelters are in schools
which will also reopen tomorrow, Wednesday, September 13, additional staff will be deployed to these
sites. Overnight consultants are Dr. Devi and Janice Stapleton.
Environment/Medical
Environmental and medical concerns include the presence of asbestos on site and the community; presence
of freon tanks (7-7,000 gallon tanks) that may decompose to phosgene gas; volatile organic compounds
(below toxicity level); ballast of the plane consisting of spent Uranium.
Meeting with EPA, NYS DEC, NYC DOH, DEP, ConEd, Mt. Sinai was held at 5 Penn Plaza to discuss the
process of environmental and occupational monitoring, and protection. In addition, results from various
tests for asbestos, lead and vocs were presented and reviewed with the group. Recommendations for
further coordinated testing and review were generated. Group plans to meet to convene regularly at 4:00
PM daily at 5 Penn Plaza.
Initial recommendation:
delineate area of concern for environmental risk
protective personal equipment to be used including Tyvek overalls, goggles, and masks with plOO
filters, and N100 (for individuals not sufficiently exposed to dust)
develop community advisory based on findings, and recommendations for control measures
decontamination procedure
removal of debris
continued assessment and planning for abatement of hazards, including residents in the affected
community
EPA will bring equipment to test for phosgene gas and other toxic gases tomorrow, Thursday,
September 13
Remaining Issues
availability of protective equipment - DC AS is in the process of procuring 5,000 half- face masks with
replaceable filter cartridges, replacement filters, and 10,000 PlOO disposable masks
develop a plan for residents in the community including monitoring for environmental hazards,
relocation of remaining residents and clean-up of the dwelling units and surrounding environment
coordinate the testing processes including the testing procedure
determine radiation levels being emitted from the spent Uraniun
control access to the community and the site
9/13/01, 6:10 AM
establish and implement the process for the distribution and training for the use of personal protective
equipment
Operations/Inspection PHS conducted inspection on site, and found unrefrigerated food for consumption by
rescue workers at Stuyvesant High
Overnight consultants: drs. Kambili, Kellner, Leighton, Perrin and Zucker, and Mr. Goldberg. Two
NIOSH consultants and Dr. Karpati (CDC) arrived today, Wednesday, September 12.
EPA is securing half-face masks with replaceable filter cartridges for immediate availability; coordinating
with OEM
Dr. Leighton arrived after the meeting/briefing at on site command center concluded. Drs. D'Andrea and
Markowski were present for the briefing. Next meeting is scheduled for 6:00 AM, Thursday, September
13. Messrs. Goldberg and Carlino will attend. Dr. T. Matte (CDC) will try to attend.
Current Status
3 major decontamination sites have been set-up at West and Harrison Streets, Church and Franklin,
and Water and Old Slip.
2 radiation monitoring vanes to check debris trucks for radiation as they exit
radiological experts from the DOE will be available Thursday, September 13
THE CITY OF NEW YORK
DEPARTMENT OF HEALTH
Rudolph W. Giuliani Neal L. Cohen. M.D.
Mayor Commissioner
The New York City Department of Health requests the following emergency supplies:
ITEM QUANTITY
'C,-^/^Cx
/;/?> xyl
x
To prevent exposure to asbestos and to reduce any risk that might exist, the following
protective measures are recommended:
- Persons working at the site should use N95 respiratory masks (TB masks) to prevent
inhalation of asbestos fibers and goggles to prevent eye irritation.
Persons who will be going into the building or working in confined spaces should use at
least an N100 mask for respiratory protection.
To the extent possible, gloves and coveralls should be worn and removed before going
home. Boots or shoes should be covered, if possible, and rinsed prior to returning home.
- Other risks may include exposure to cyanide and acid gases; levels will be monitored at
the site to determine if any risk exists.
- Emergency personnel (firefighters, EMS staff) should remove outer Scents and
shower immediately when returning to their firehouse/garage. Uniforms should be
separated from other clothing and washed twice in ordinary detergent.
- Persons who were exposed to ash and soot should shower and wash their hair. Clothing
should be washed twice in ordinary detergent, separated from other clothing.
- To reduce exposure to dust from building debris, the material should be wetted and
covered with a tarp during transport and storage. After the truck is emptied, the truck bed,
wheels and tires should be rinsed off.
Asbestos:
Risk based on fiber size (length and diameter):
Long (>1/5,000A of an inch) as compared with short (1710,000th of an inch) fibers are
more likely to cause injury to the lung;
Generally smaller diameters or width fibers are associated with mesothelioma while
larger widths are associated with lung cancer.
Disease has long latent period and risk is substantially increased with smoking.
Limits - 100,000 fibers per meter3 for average 8-hour exposure (OSHA 1994). NYS
regulations may be more stringent.
Cyanide:
signs and symptoms - headache, giddiness, sense of sinking, short of breath, palpitations,
and convulsions
Limits:
Fatal @ > 90 ppm after 30 to 60 minutes
> 300 ppm within few minutes
1. By 11:00am, Beth Maldin completed updates to hot topics on WNV [VR and
for DOH employees on 788-2222. Beth has ail info on how to update the IVR
system. Dirad contact number is 518-438-6000, ext. 204 (Jennifer), ext. 142
(tech support).
2. Consistent with reports of a fire at the downtown Verizon central office, DOH
lost voice, fax, IVR, email, internet access, and network connectivity between
125 Worth Street and the other agency locations. This also includes existing
WNV hotline access to the WNV system over the internet.
3. Most voice service was apparently lost during 9/11 late afternoon timeframe,
although there were significant outages since morning of 9/11.
4. Email and internet access were apparently also lost during between 6:30pm
and 9:20pm.
5. Confirmed with Joe Sorrentino at DOITT that fire and subsequent flood at
West Street CO has caused major damage to telecom lines in the lower
Manhattan area. At 9/11, 10:15pm, there was no estimated timeframe for
restoration of service. Joe confirmed that service prioritization is being
handled by OEM, and any requests for prioritization should go through them.
6. Joe Sorrentino recommended that DOH consider moving operations from the
125 Worth Street location, since communications are not likely to be restored
soon. (Joe Sorrentino cell phone # 917-769-1077)
7. Confirmed with DOITT that the Bureau of Laboratories at 455 1st Avenue ties
in to a different Verizon CO switching office, and that service should not be
impacted at that location.
8. Confirmed through Bill Gross, Mayor's Office of Operations, at approx.
I2:30am 9/12, that it would likely be several days before service is restored at
125 Worth Street (Bill Gross cell phonej 1 Confirmed that
Sanitation and HHC also have lost phone service at 125 Worth Street location.
Action Items ;
1. By 9am, attempt to use ISDN backup lines to restore network and email
service at 125 Worth Street. \. Prior to 9am, confirm the status of
and network access to other DOH locations from 455 1st Avenue.
3. Plan for and identify issues around a potential move of D:OH command to 455
1st Avenue. This includes plan for moving data stores at ± 25 Worth Street by
sneakemet to Labs so that work can continue there. Check PC availability at
BOL training room. \. Address issues around unavailabi
IVRs tie in to the affected Verizon CO. \. Explore use of DOH website to c
3. MIS has database person available at 7:30am at 125 Worth Street throughout
the day to provide assistance as needed.
4. Additional MIS staff can be called in as needed.
September 12, 2001
"cotS tyvek overaUs and N95 masks for use by emergency rescue crew
- ordered through the CDC additional suppl.es;
considered trace;
Operations
I ± toSlg supplies and setting up emergency c.inic
World Trade Center Attack
Surveillance Workgroup
9-11-01 Activities
I. Immediate Surveillance Activities to Assess Trauma Related Illness, and Hospital Needs
The Surveillance Workgroup immediately initiated two separate surveillance systems:
A - Hospital Needs Assessment: A telephone survey was conducted targeting all Manhattan and
Brooklyn acute care hospitals (See Survey for details). Briefly, the following information was
obtained:
Emergency Contacts (telephone/fax)
Total number of patients seen related to incident
Total number of deaths related to incident
Bed occupancy &
Emergency Department occupancy
Assess for staff shortages by job title, and determine if hospital had a plan for
emergency staffing
Supplies needed (blood, iv solution, ventilators)
Morgue occupancy and capacity
/ •' .1-^' ' •' t A , X ^
Results fas of 6 PM):[ We were1 able to contact 11/22 (50%) Manhattan hospitals and all
20 Brooklyn hospitals. Only 20 of the 31 hospitals reported seeing incident-related
morbidity and mortality. Overall, there were 658 ER visits related to the terrorist event
(535 in Manhattan, and 123 in Brooklyn) and 32 deaths. The average number of ER
visits by hospital was 33 (range 0 -140). Most deaths were reported by St Clares (n=27),
though we do not have data from Bellevue where most bodies have been taken. Sudha
Reddy prepared a more detailed summary of the survey findings. (ALSO as acute
issues/needs were identified these were called into the OEM EOC).
While doing the survey, we became aware that Greater NY Hospital Association
(GNYHA) and (?) New York State Department of Health were conducting similar
surveys (Due to communication systems breakdown, this information had not been
forwarded to us from the MOEM Command Center, as we had been initially tasked with
this assignment). The GNYHA and NYCDOH findings were combined (See Access
spreadsheet), with combined results on 17/22 Manhattan hospitals.
A linelist by hospital was prepared and demonstrated that only 7 hospitals were seeing >
50 victims through their E.D.s:
Next Steps:
- Although currently, GNYHA states that they have sufficient staff to support
these surveys, if they need assistance, they will request NYCDOH help through
our OEM EOC liaison.
- At the present time, most NYC hospitals are not seeing large numbers of
victims. Therefore, a more detailed needs assessment for staff and equipment &
needs may not be necessary. This situation should be re-assessed in the morning.
Issues to decide: It is likely that most surviving victims with trauma related injuries
have been seen at hospitals, and that ongoing morbidity and mortality related to the plane
crashes will mostly involve first responders involved in consequence management.
Therefore, there may not be a need to continue to actively tracking physical trauma at city
hospitals, and instead just rely on the GNYHA surveys and OEM EOC to assess patient
volume and only repeat the survey if there are reports of increases in injury related visits.
However, if staff resources allow, we may want to complete the ER surveys for 9-11-01
at hospitals with significant patient volumes:
1 - The teams at St. Vincents and Downtown were not able to complete the ER
visit charts.
2 - Hospital admissions were not reviewed at most hospitals (except Beth Israel),
however we do have the admission logs for all 4 sites.
3 - There are several hospitals with high volumes that were not surveyed,
including Long Island College Hospital, Brooklyn Hospital and NYU-Tisch. In
addition, St Clares hospital reported 27 fatal cases, a higher number than all other
hospitals.
C. Surveillance for overall casualties - The primary staging area for mortuary response is at the
Office of the Medical Examiner. They will have primary authority and the most complete data
on deaths related to this event. In addition, the DOH Burial Desk is another source of
information, though delayed. This office was temporarily transferred to the Central Harlem
Clinic.
II. Prospective Surveillance for Unusual Illness due to Concern about Bioterrorism
Although extremely unlikely due to the magnitude of the explosions at the World Trade Center,
we have decided to proceed with surveillance for unusual illness to monitor for a bioterrorist
event. Given the enormity of this attack, there is always the possibility of a second incident.
To assess for unusual disease clusters or manifestations, the following have been implemented or
are under development:
A - Broadcast alert to City Hospitals — An alert was prepared that addressed several &
issues of public health concern related to this attack. The primary issue emphasized was
the need for medical providers to be alert for unusual disease occurrences, including
clinical manifestations suggestive of potential bioterrorist agents, such as anthrax and
smallpox, as well as any unusual disease cluster.
Issues: We were unable to send the alert by broadcast fax or email due to the
communication system failures at DOH. A paper and electronic copy of the alert
were sent to the HOC, and the GNYHA will fax these using their system.
The NYCDOH number listed for reporting concerns about bioterrorism was 212-
788-9830. It is unclear if the phone systems here will be restored anytime soon.
Alternative numbers listed included the Poison Control Center, as well as an
emergency line at the EOC.
B - Continued Monitoring of the 911 System - Due to the expected increase in overall
calls to EMS, it is unclear if the CD 911 surveillance system looking for an increase in
the ratio of calls due to respiratory illness/overall calls will be useful over the next several
days. The other issue is that there may be an increase in respiratory calls due to dust
exposure, which will require active epidemiologic investigations to differentiate this from
an infectious cause. Farzad Mostashari should be consulted in the AM to determine the
best methods for prospectively monitoring 911 calls over the next 3 weeks (focus on
spatial clustering w the current statistical algorithms for citywide and boro wide
increases in ILL illness).
Tracee Treadwell, MD discussed the drop in systems that were used during last years
Democratic and Republican conventions, as well as during the Superbowl to obtain basic
information from ER physicians regarding the clinical syndromes for all patients seen.
Their experience is that medical providers were cooperative as long as the forms were
VERY concise, and that the major obstacle was relying on hospitals to do data entry. We
all agree that in the aftermath of the WTC incident, that ER physicians would be easily
engaged and cooperative in participating in this survey for a 3-week period. IN addition,
if internet access can be obtained, we will have the ability to send this information to
CDC for rapid analyses using pre-prepared programs that use CUSUM and SODA to
detect disease clusters. We would also hope to geocode the data to use stat scan to look
for any clustering in time or space.
i
Therefore, the following steps were taken on 9-12-01 in preparation for this effort:
1 - Draft survey form was developed (Mike Phillips), along with an instruction
sheet for emergency department staff. Although this form will focus on BT
related disease, we will also capture minimal data on trauma and respiratory
illness related to dust/debris exposure.
2 - Draft protocol for how DOH will recruit E.R. directors to participate, as well
as how DOH staff will be deployed to ensure compliance and obtain the
completed forms on a regular basis to bring back to DOH for centralized data
entry and analyses.
3 - DOH staff sent to retrieve forms (PHAs, etc) may also be used to obtain
summary data on hospital statistics, overall admits, ICU occupancy, etc.
Issues to address:
1 - It is unclear if and how many staff will report to work on 9-12. Therefore, we
may need to initially limit this effort to higher risk hospitals (downtown
Manhattan and Brooklyn). Need to determine the best way to utilize surveillance
staff on site at hospitals.
1. Complete section A and B: write patient admit date, admit time, zip code of residence and
zip code of place of work in spaces provided on surveillance form.
2. Determine if patient is a first responder (police, fire or emergency medical personnel) and
check appropriate box.
3. Imprint lower right hand corner with addressograph stamp or label
4. Affix to patient chart (this is not a permanent part of the patient's medical record).
1. Complete section C: Check the appropriate box that describes the one predominate clinical
syndrome seen in your patient
2. When completed, please place completed form in designated area.
version: 9/12/01
NEW YORK CITY DEPARTMENT OF HEALTH
ENHANCED EMERGENCY ROOM SURVEILLANCE
Instructions:
1. COMPLETE FORM FOR EACH PATIENT ADMITTED TO THE EMERGENCY DEPARTMENT
2. STAMP FORM AT BOTTOM RIGHT WITH PATIENT ADMISSION IMPRINT CARD
C.Please check the one predominant syndrome from the following list that best represents the
primary condition of the patient:
D None of the following
D Trauma
D Rash with fever (do NOT check unless both are present)
If you have any questions, please call ??? and ask for the doctor on duty
After hours, call the Poison Control Center (212-) and ask for the doctor on call
Version: 9/12/01
World Trade Center Attack
ED-Based Syndromic Surveillance Options
1. Rationale for enhanced surveillance
a. After such a complex terrorist attack, we need to anticipate potential
secondary biological devices of equal sophistication
b. Some risk that the planes involved in the attack were carrying
biological agents that were dispersed during the explosion
c. Need to assess prospectively any increase in respiratory illness caused
by exposure to toxic chemicals and particulate matter
d. Need to assess prospectively any ongoing traumatic injuries (e.g., in
first responders)
9/12/01 6:47 AM
2. Transportation of staff and data to and from hospitals
3. Data entry personnel at DOH
4. Epidemiologic support at DOH to analyze data
v. Response to aberration detection
1. Rapid response epidemiologic field investigation to
characterize illness, identify potential agent and risk
factors
9/12/01 6:47 AM
Patient Imprint Card or Label If imprint card is unavailable:
Last Name:.
First Name:
MedRec#:
D Female D Male
Date of visit: f
Age:
Home Zip Code: j
r ~
For age less than one year please use "1"
j Work Z ip Code:
Was patient in southern Manhattan (below Canal St) on Tuesday, September llth
after the attack? (circle one) YES NO Don't Know
Please check the ONE PREDOMINANT syndrome from the following list that best
represents the PRIMARY condition of the patient
D iNone of the following
D Trauma
D (Smoke or dust inhalation
D iExacerbation of underlying respiratory condition (Asthma/ COPD)
D jAnxiety reaction (including somatic complaints, insomnia)
D Diarrhea / gastroenteritis (including vomiting or abdominal cramps)
I iUpper or lower respiratory infection WITH fever
D Sepsis or non-traumatic shock
D JRash WITH fever (do NOT check unless both are present)
D (Meningitis, encephalitis, or unexplained acute encephalopathy
D Botulism-like syndrome (cranial nerve impairment and weakness)
D Unexplained death with a history of fever
IF YOU HAVE ANY QUESTIONS OR NEED TO REACH THE NYC DEPARTMENT OF HEALTH, PLEASE CALL
212-447-2676 AND ASK FOR THE DOCTOR ON DUTY. IF NO ONE IS AVAILABLE AT THAT NUMBER, CALL
THE POISON CONTROL CENTER AT 212-764-7667.
Patient Imprint Card If imprint card is unavailable:
Last Name:.
First Name:
Med Rec #:
D Female D Male
Home Zip Code: Work Zip Code: \s patient within 10 blocks of the World Trade Cente
Please check the ONE PREDOMINANT syndrome from the following list that best
represents the PRIMARY condition of the patient
D None of the following
D [Trauma
D Smoke or dust inhalation
D Exacerbation of underlying respiratory condition (Asthma/ COPD)
D Upper or lower respiratory infection WITH fever
Diarrhea / gastroenteritis (including vomiting or abdominal cramps)
Sepsis or non-traumatic shock
Rash WITH fever (do NOT check unless both are present)
Meningitis, encephalitis, or unexplained acute encephalopathy
Botulism-like syndrome (cranial nerve impairment and weakness)
Unexplained death with a history of fever
IF YOU HAVE ANY QUESTIONS OR NEED TO REACH THE NYC DEPARTMENT OF HEALTH, PLEASE CALL
212-447-2676 AND ASK FOR THE DOCTOR ON DUTY. IF NO ONE IS AVAILABLE AT THAT NUMBER, CALL
THE DOH COMMAND CENTER AT 212-447-2667 OR THE POISON CONTROL CENTER AT 212-764-7667.
9/12/01
2:00 p.m.
CLINICAL/MEDICAL
12TH FLOOR
ROOMS 1210,1213,1217
Room 1213
212-576-8416 - Sue Blank
212-576-8458 - Jessica Leighton
212-578-0829 - Jo Anne Bennett
212-578-0807
212-578-0881 - Margrit Kaminsky
Room 1217
212-576-8461 -Andy Goodman
212-576-8460 - Mary Perrin
212-576-8462 - Jim Miller
212-576-8463 -Elliot Marcus
PUBLIC AFFAIRS is temporarily relocated in the HIV Library, at the Bureau of Labs,
Room 1233.
SHELTERS
Room 1223 - 212-576-8452
Maria-Teresa Lechuga
Richard Fox
fjllC