Report gives injury statistics from 9/11

Inhalation injuries were the most common medical conditions seen in five New York City EDs in the first 48 hours after the Sept. 11 attack on the World Trade Center, according to a new report from the Atlanta-based Centers for Disease Control and Prevention. (For information on how to access the report, see "Resources" at the end of this article.)

Here are key findings:

• More than half of the survivors were treated for inhalation injuries, eye injuries, or both, without other injuries. Smoke, dust, debris, or fumes caused most of these injuries.

• Rescue workers, firefighters, police officers, emergency medical services, and other disaster-related personnel made up 29% of patients treated directly as a result of the attacks. Rescue workers sustained significantly more eye injuries than other survivors, but fewer burns.

• Among 790 injured survivors, EDs treated and released 606 survivors, and 139 were hospitalized for further management.

"I am not surprised about the numbers of inhalation injuries, with the collapse of the huge towers and the amount of debris suspended in the air," says Bettina Stopford, RN, chair of the national Weapons of Mass Destruction (WMD) work group for the Des Plaines, IL-based Emergency Nurses Association. "Rescue workers lived on the pile for days on end and were continually exposed," Stopford says. She adds that the inhalation injury rate is reminiscent of a large-scale fire response. "Unfortunately, most victims in the collapse did not survive, so the statistics of victim exposure would be low," she says.

Injuries sustained by rescue workers included exhaustion, temperature issues, puncture wounds, sprains, strains, fractures, respiratory issues from the dust, and eye injuries from the dust and debris, says Stopford. "The injured rescue workers sought brief periods of medical care and were primarily interested in being returned as quickly as possible to work," she notes. "This didn’t always allow for definitive care of an injury, but immediate care only."

Here are three recommendations of the report:

  • improving post-disaster surveillance before disasters occur, with use of electronic data to speed injury reporting;
  • standardizing patient record keeping to improve of point-of-care data collection and public health reporting;
  • improving ED record keeping and reporting systems to track disaster-related health effects.

Stopford notes that this area was in a unique situation of having an intensive emergency management plan. "They were able to draw on local assets rapidly, which is where the impact will always be, regardless of how many federal assets are available."

Stopford says the report’s findings show that federal assets must be quickly mobilized in a large-scale disaster, so community responders can focus on maintaining the medical system and access local supplies. "Perhaps staging federal caches of supplies in strategic areas of the country could be considered," she suggests. Stopford says that standard, "nonexotic" supplies seemed to be most in demand, such as eye and respiratory protection and basic medical equipment, as opposed to WMD antidotes, she says. "That may have changed if a biological, chemical, or radiological contaminant had been introduced to the scene," she adds.

The best strategy is to have a high index of suspicion for a WMD attack and be able to identify it early, says Stopford. "Appropriate assets will need to be moved in quickly, using a pre-existing plan to disseminate the needed supplies," she concludes. 

Resources

The Centers of Disease Control and Prevention (CDC) report, Rapid Assessment of Injuries Among Survivors of the Terrorist Attack on the World Trade Center — New York City, September 2001, can be accessed free of charge on the CDC web site: www.cdc.gov/mmwr/preview/mmwrhtml/mm5101a1.htm.

Paper copies (Item 869-045-00037-3) are available for $2 from the Superintendent of Documents, U.S. Government Printing Office, P.O. Box 371954, Pittsburgh, PA 15250. Telephone: (866) 512-1800 or (202) 512-1800. Fax: (202) 512-2250.

Source

For more information about the CDC report, contact: Bettina M. Stopford, RN, CNE, Denver Health Medical Center, 777 Bannock St., MC0261, Denver, CO 80204. Telephone: (303) 436-3431. Fax: (303) 436-6213. E-mail: bettina.stopford@dhha.org. E-mail: orders@gpo.gov.