Chief Leader – April 28, 2015
by SARAH DORSEY
Emergency Medical Service workers who responded to the Sept. 11 attacks and their aftermath have higher rates of post-traumatic stress disorder and other illnesses than their unexposed co-workers, FDNY and other medical researchers announced.
The study, released days after Federal lawmakers launched their push to renew the Zadroga Act, was the first to look at EMS workers alone, though several studies have considered them along with firefighters and other first-responders.
Physical, Psych Tolls
The authors found higher rates of PTSD and depression than in a control group of EMS co-workers who weren’t present at the Trade Center site, as well as higher rates of physical illnesses like GERD, which causes chronic acid reflux, and obstructive airways disease.
Researchers with the Fire Department, Montefiore Medical Center and Albert Einstein College of Medicine looked at 2,281 EMS workers, 418 of whom did not work at the Trade Center.
In their most-recent annual medical exams, nearly 17 percent of the exposed workers were found to have probable depression while 7 percent had probable PTSD. (The researchers based those numbers on special questionnaires given during their exams, but did not consider the results to be an official diagnosis.) Three percent had probable harmful alcohol use.
Too Ready for Action
PTSD is a disorder that causes severe stress even long after a terrifying or traumatic event. According to the National Institute of Mental Health, patients may re-experience the trauma through flashbacks or nightmares. They may find themselves avoiding memories of the event, becoming emotionally numb, blanking out about what happened or keeping away from places and things that remind them of it.
They may also show signs of “hyperarousal,” as though the fight-or-flight reaction they had during the event were being continually re-triggered. Sufferers may be quick to anger, may be jumpy or easily startled, and sometimes have trouble falling asleep and difficulty concentrating.
The EMS workers who arrived soonest—on the morning of Sept. 11—were seven times as likely as their co-workers who didn’t work there to have PTSD symptoms, the FDNY study found. Among those early arrivers, more than twice as many showed signs of depression—which can include sadness, hopelessness, and feelings of guilt, worthlessness or anxiety—as the unexposed group. (There is some overlap between the symptoms of PTSD and depression.)
The earliest responders were also nearly four times as likely to have GERD or rhinosinusitis as those who weren’t exposed, and more than twice as likely to have obstructive airways disease. The rates were adjusted for race, age and gender.
Firefighters Had It Worse
Mayris Webber, an epidemiologist who co-authored the study, said that in general, EMS responders to the terrorist attacks had lower rates of related illness than their firefighter counterparts. Ms. Webber is the director of World Trade Center Epidemiology in the FDNY’s Bureau of Health Services.
“Their tasks were different,” she said. “Most weren’t digging and they weren’t on The Pile.” Firefighters often spent hours sifting through rubble. “Every time you find something you want to look at, you pick it up [and] it re-aerosolizes the dust,” Ms. Webber said.
She added that most EMS workers were probably at the site for a shorter period of time.
The authors, among them the FDNY’s Chief Medical Officer David Prezant, did not find elevated levels of cancer among the EMS group.
“It’s relatively soon,” Ms. Webber said, noting that they were able to look at only cancer cases that had been discovered by 2011, since it usually takes at least a couple of years before cancer registries can disclose numbers. The workers are now scattered through several states, requiring the authors to use several registries.
“Some cancers take decades to develop,” she added. And the EMS study was much smaller than most firefighter studies, making it more difficult to find patterns.
Important to Monitor
The EMS workers studied were ethnically diverse—about half the group was white and a little less than a quarter each Latino and black—and 78 percent were male. The group was relatively young on Sept. 11, 2001, with a median age of 36 years old.
The authors concluded that their findings “underscore the importance of continued monitoring and treatment of this workforce.”
The Federal Zadroga Act covers such monitoring and health care for those sickened by the Sept. 11 attacks, and also pays for economic losses. The health-care portion of the law is due to expire in October, though leftover money allocated by Congress can be used for another year. Legislators introduced a reauthorization bill this month that would make Zadroga benefits permanent and lift its $4.3-billion spending cap.
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