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Background

n September 11, 2001, the Chartered Institute of Environmental Health in the United
Kingdom was in the middle of its annual conference. Astounded by what had happened in
New York and Washington, the Institute took immediate action to assist environmental
health in the U.S. in the aftermath of the terrorist attacks. The Institute donated a sum of money to
the National Environmental Health Association to use in ways that NEHA saw fit.

NEHA's first idea was to forward the funds to public health agencies affected by these events in
the DC, Northern Virginia, and New York City areas. These agencies, however, indicated that
they did not need the financial assistance.

The NEHA Board of Directors discussed the appropriate use of these funds at length. A decision
was made to have a professional writer prepare a "Lessons Learned" report that would examine
the response of environmental health professionals to the events of Sept 11, 2001. A committee
was formed to develop the request for proposal (RFP) that would be sent to professional writers
and reporters, especially those in the impacted areas. The committee would also evaluate the RFP
submissions and select the author. This was done in September of 2002. The writer selected was
Francesca Lyman, an independent writer and columnist for MSNBC who had written several
articles on the health aspects of the events of 9/11. (Her column, Your Environment, can be
found at
http://www.msnbc.com/news/YOURENVIRONMENTH_Front.asp?0dm=C303H
.) Ms.
Lymans articles have appeared in the New York Times, Sierra Magazine, The Los Angeles
Times, Seattle Times, San Francisco Examiner and others. She has a Bachelor of Arts from
Bennington College, Bennington, Vermont, and she currently lives in Kirkland, Washington. Her
report is entitled Messages in the Dust.

It is NEHAs intent to see that environmental health professionals throughout the countryand
even the worldlearn what the lessons from the environmental health response to the attacks
were. Hopefully this will help to better prepare this profession so that should anything ever
remotely similar happen again, the environmental health response will be the best that it can be.

Nelson Fabian, Executive Director
National Environmental Health Association





September 2003









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Preface
wo years after September 11, 2001, when a terrorist attack leveled the World Trade
Center, killing thousands of people, and hit the Pentagon, killing hundreds more, NEHA is
issuing a report assessing the lessons for environmental health that can be learned from
these disasterswidely regarded as the worst and largest international terrorist events in
our nations history.
The images of terror are still vivid to most of us, but not everyone has realized that the nation
experienced a new kind of environmental health emergency as well. When the World Trade
Center and sections of the Pentagon came crashing down that day, the rubble left for rescuers and
cleanup crews was laced with asbestos, heavy metals, diesel fuel, PCBs and dozens of other
toxins. New York City was enveloped in a cloud of smoke, soot and toxic ash. Perhaps for the
first time, the pivotal role of environmental health in terrorism preparedness was made clear.

Since were all on notice to expect some kind of event, NEHA wants to accumulate a base of
knowledge to share with those in all areas of environmental health and public health so that they
can be better equipped for the future, Nelson Fabian, NEHAs executive director, says.

The broad outlines of the incidents at the World Trade Center and Pentagon are fairly well
known. But the inside story on how environmental health professionals worked behind the scenes
to try to make a difference that day and in the months that followed is not well known. These
tragic events offer important opportunities to understand how people responded under stress, as
well as lasting lessons for emergency and environmental response.


In this age of terrorism, environmental health professionals are now on
the frontlines defending public safety.


As is clear to even the least imaginative among us, environmental health professionals are now on
the frontlines in defending public safety in this age of terrorism. That is one of the main reasons
NEHA took on the task of this report. At one time the worst hazards they confronted were
corrosive acids, asbestos and contaminated medical needles, New Yorks Environmental Police
Unit told The New York Times. (1) Today its dirty bombs and more.

People working in the environmental health fields are today being joined by a host of other
professionalsEMS and health first responders, public health nurses and doctors,
epidemiologists, forensic pathologists, police and fire officials, and others.

In fact, the events of 9/11 brought to the fore many issues that have long been simmeringthe
need for first responders to be more mindful of health and safety, the need for all emergency
personnel to be better coordinated and able to communicate with one another, and, of course, the
specter of responding to a biological or chemical terrorist attack.

A month after September 11, testifying before the Senate, Jeffrey P. Koplan, MD, Director,
Centers for Disease Control and Prevention, stated that "Prior to the September 11 attack on the
United States, CDC was making substantial progress toward defining, developing, and
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implementing a nationwide public health response network to increase the capacity of public
health officials at all levelsfederal, state, and localto prepare for and respond to deliberate
attacks on the health of our citizens. The events of September 11 were a defining moment for all
of us." (2)

While not an entirely new issue, 9/11 did bring to the forefront the need to examine how health
and safety issues are handled by first responders, says disaster expert Tricia Wachtendorf. (3)

At the World Trade Center, 450 emergency respondersfully one-sixth of the victims of that
attackperished while doing their jobs, while environmental and medical officials, as well as
volunteers, stood helpless to save them. Hundreds of others were seriously injured.
In the aftermath of the attacks, undoubtedly firefighters now will take greater precautions in
rushing into burning buildings and carry in more sophisticated hand-held radios. What should be
done when it comes to environmental and occupational health?
The mission of this document is to present the facts of responding to a terrorist event as they
apply to environmental health professionals of all kinds, be they hazardous waste specialists or
sanitarians, air quality technicians or public health department managers. Our considerations in
this report cover air and water quality, radiological and bioterrorism threats, hazardous substances
and wastes, waste removal, carting and disposal, and public health interventions of all kinds,
including food handling, sanitation and vector control.
NEHA is interested in describing the important role of assuring environmental health and
safetyand hearing the stories of those unsung heroes whose stories haven't come out, people
at the frontlines who did their regular jobs under rather trying and extraordinary circumstances.
These stories emerge as well as healthy debate on such issues as the communitys right to know
about environmental hazards in their neighborhoods and the need of public officials to balance
the need to weigh top-down control versus community response.

What are some of the major issues in addressing a catastrophic health disaster? What were the
critical management lessons from the experience? How do public health and environmental health
managers need to be better prepared in the future? What was left out last time? What went right
and wrong at crucial decision-making junctures?

This document describes 1) What environmental professionals of all kinds did (and, to some
extent, how they might have worked with first responders) and the pressures on them in response
from the public and the community; and 2) what they might have done differentlywhat they
learned from the experience.

This report is also written to call forth a variety of new perspectivesincluding the following
types of questions: How soon should the government be able to respond to protect public health
and what kind of prior coordination is needed among different agencies? What did the public
expect of its public-interest agencies in such dire circumstances?

Since the events of 9/11, many state and county health departments have started revamping their
emergency response and evacuation plans to prepare for potential acts of terrorism, especially
chemical and biological terrorism. And many experts see