Physicians for Social Responsibility: Health Effects of Air Pollution
EPA: Particulate Matter: An Introduction
"The smaller the particle, the more dangerous, because it can travel deeper into the lungs. When particulate matter is breathed in, it can irritate and damage the lungs, causing breathing problems. People who have asthma or some type of lung or heart disease are directly impacted by high levels of PM. The elderly and children are also especially vulnerable to the effects of PM. Many studies have shown links between PM and health effects. Increases in PM have been linked to decreases in lung function, increases in breathing problems and hospitalization, and early death."
American Heart Journal: Heart Rate Variability Associated With Particulate Air Pollution
New York Times: Tiny Bits of Soot Tied to Illnesses -- April 21, 2001
Environment News Service: Tiny Air Pollutants Linked to Heart Attacks -- June 12, 2001
NYT: EPA Finds Some Soot Is Bad, Other Soot Is Worse -- September 11, 2001
Sept 11 -- Unrelated to the attacks, but important nonetheless. "In an unusual test of the toxicity of particles filtered from the same spots at different times, agency scientists found that substances collected near a Utah steel mill when it was running were more harmful to the lungs of volunteers than material captured when the plant was dormant. To some, that result may seem self-evident, but many industry groups had long questioned the health threat from soot...The study was published in a recent issue of The American Journal of Respiratory and Critical Care Medicine...Other studies by the same research team on particles from the air near the mill point to certain metals as the source of harm. The metals, including zinc, iron and copper, appear to form highly reactive molecules, called free radicals, that can damage lung tissue, Dr. Devlin said. These studies have been described at medical meetings but have not yet been published...The [EPA] has found dozens of studies generally concluding that more than 50,000 people die prematurely each year because of illnesses caused by exposure to soot."
Society of Critical Care Medicine: Update on Acute Lung Injury: Mechanisms of Action
Chronic Rhinosinusitis and Asthma: Common Connected Conditions -- 57th Annual Meeting of the American Academy of Allergy, Asthma and Immunology Day 1 - March 16, 2001
Management of Acute Asthma Exacerbation -- 2000 American Academy of Pediatrics Annual Meeting Day 1 - October 28, 2000
Asthma: A Disease of the Young and Old -- 1999 American College of Allergy, Asthma & Immunology Annual Meeting Day 3 - November 14, 1999
Inflammation and Structural Changes in the Airways of Patients With Atopic and Nonatopic Asthma -- Am J Respir Crit Care Med. 2000;162:2295-2301
Air Quality Where You Live
PM: How Particulate Matter Affects the Way We Live & Breathe -- EPA, August 27, 2001
PM: What is it? Where does it come from?
"Particulate matter, or PM, is the term for particles found in the air, including dust, dirt, soot, smoke, and liquid droplets. Particles can be suspended in the air for long periods of time. Some particles are large or dark enough to be seen as soot or smoke. Others are so small that individually they can only be detected with an electron microscope. Some particles are directly emitted into the air. They come from a variety of sources such as cars, trucks, buses, factories, construction sites, tilled fields, unpaved roads, stone crushing, and burning of wood. Other particles may be formed in the air from the chemical change of gases. They are indirectly formed when gases from burning fuels react with sunlight and water vapor. These can result from fuel combustion in motor vehicles, at power plants, and in other industrial processes."
Chief Causes for Concern
PM: is associated with serious health effects; is associated with increased hospital emissions and emergency room visits for people with heart and lung disease; is associated with work and school absences; is the major source of haze that reduces visibility in many parts of the United States, including our National Parks; settles on soil and water and harms the environment by changing the nutrient and chemical balance; causes erosion and staining of structures including culturally important objects such as monuments and statues.
Health problems for sensitive people can get worse if they are exposed to high levels of PM for several days in a row.
Health and Environmental Impacts of PM
Many scientific studies have linked breathing PM to a series of significant health problems, including: aggravated asthma, increases in respiratory symptoms like coughing and difficult or painful breathing, chronic bronchitis, decreased lung function, premature death
EPA's Efforts to Reduce PM
Medical Effects for Firefighters NEW!
J Occup Environ Med 2001 May;43(5):467-473
Adverse respiratory effects following overhaul in firefighters
Burgess JL, Nanson CJ, Bolstad-Johnson DM, Gerkin R, Hysong TA, Lantz RC, Sherrill DL, Crutchfield CD, Quan SF, Bernard AM, Witten ML.
Environmental and Occupational Health, University of Arizona College of Public Health, 1435 North Fremont, Box 210468, Tucson, AZ 85719-4197, USA.
"Overhaul is the stage in which firefighters search for and extinguish possible sources of reignition. It is common practice not to wear respiratory protection during overhaul. Fifty-one firefighters in two groups, 25 without respiratory protection and 26 wearing cartridge respirators, were monitored for exposure to products of combustion and changes in spirometric measurements and lung permeability following overhaul of a structural fire. Testing at baseline and 1 hour after overhaul included forced vital capacity (FVC), forced expiratory volume in one second (FEV1), serum Clara cell protein (CC16), and serum surfactant-associated protein A (SP-A). Overhaul increased CC16 in both groups, indicating increased alveolarcapillary membrane permeability. Contrary to expectations, SP-A increased and FVC and FEV1 decreased in the firefighters wearing cartridge respirators. Changes in FEV1, CC16, and SP-A were associated with concentrations of specific products of combustion or carboxyhemoglobin levels. Firefighter exposures during overhaul have the potential to cause changes in spirometric measurements and lung permeability, and self-contained breathing apparatus should be worn during overhaul to prevent lung injury."
AIHAJ 2000 Sep;61(5):636-641
Characterization of firefighter exposures during fire overhaul.
Bolstad-Johnson DM, Burgess JL, Crutchfield CD, Storment S, Gerkin R, Wilson JR.
City of Phoenix Personnel, AZ 85003, USA.
"Previous studies have characterized firefighter exposures during fire suppression. However, minimal information is available regarding firefighter exposures during overhaul, when firefighters look for hidden fire inside attics, ceilings, and walls, often without respiratory protection. A comprehensive air monitoring study was conducted to characterize City of Phoenix firefighter exposures during the overhaul phase of 25 structure fires. Personal samples were collected for aldehydes; benzene; toluene; ethyl benzene; xylene; hydrochloric acid; polynuclear aromatic hydrocarbons (PNA); respirable dust; and hydrogen cyanide (HCN). Gas analyzers were employed to continuously monitor carbon monoxide (CO), HCN, nitrogen dioxide (NO2), and sulfur dioxide (SO2). Area samples were collected for asbestos, metals (Cd, Cr, Pb), and total dust. During overhaul the following exceeded published ceiling values: acrolein (American Conference of Governmental Industrial Hygienists [ACGIH] 0.1 ppm) at 1 fire; CO (National Institute for Occupational Safety and Health [NIOSH] 200 ppm) at 5 fires; formaldehyde (NIOSH 0.1 ppm) at 22 fires; and glutaraldehyde (ACGIH 0.05 ppm) at 5 fires. In addition, the following exceeded published short-term exposure limit values: benzene (NIOSH 1 ppm) at two fires, NO2 (NIOSH 1 ppm) at two fires, and SO2 (ACGIH 5 ppm) at five fires. On an additive effects basis, PNA concentrations exceeded the NIOSH recommended exposure limits (0.1 mg/M3) for coal tar pitch volatiles at two fires. Maximum concentrations of other sampled substances were below their respective permissible exposure limits. Initial 10-min average CO concentrations did not predict concentrations of other products of combustion. The results indicate that firefighters should use respiratory protection during overhaul. In addition, these findings suggest that CO should not be used as an indicator gas for other contaminants found in this atmosphere."
Br J Ind Med 1990 Jul;47(7):462-465
Respiratory mortality among firefighters.
Rosenstock L, Demers P, Heyer NJ, Barnhart S.
Occupational Medicine Program, University of Washington, Seattle.
"Although firefighters have been shown in some studies to suffer chronic respiratory morbidity from their occupational exposures, an increased risk for dying from non-malignant respiratory diseases has not been documented in any previous retrospective cohort mortality study. In order to assess the possibility that an unusually strong 'healthy worker effect' among firefighters might mask this increased risk, a mortality analysis of firefighters was carried out in three cities in relation to the United States population and also to a comparison cohort of police officers. The firefighters were employed between 1945 and 1980 and experienced 886 deaths by 1 January 1984; compared with the United States population they had a significantly reduced risk of dying from all causes (SMR = 82, 95% confidence interval, 77-87), and from non-malignant circulatory diseases (SMR = 81, 95% confidence interval 73-89), but no significant difference in risk of non-malignant respiratory diseases (SMR = 88, 95% confidence interval 66-117). Compared with police, the firefighters experienced a trend toward improved mortality outcomes for all causes investigated (SMR = 82), but they had an excess of deaths from non-malignant respiratory diseases (SMR = 141). The results indicate that firefighters are probably at increased risk for dying from non-malignant respiratory diseases; this increased risk may have been missed in previous studies because of the limitations of using a general reference population."
Franklin E. Mirer, PhD
CIH Director Health and Safety Department International Union
UAW 8000 East Jefferson Ave
Detroit, MI 48214
voice phone 313-926-5563; fax phone 313-824-4473
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Medscape Resource Center: Disaster and Trauma
Includes many articles and links for PTSD, as well as the following articles on physical trauma:
"And they've been monitoring it carefully.
Yes, but they're not finding much asbestos there.
"Would you expect any delayed effects on those who inhaled this
No, probably not. The healthy lung quickly clears particulate matter. They would be coughing up dirty sputum for a while, but not much in the way of toxic elements are in the dust. Depending on the degree of damage, the effects of smoke inhalation are also temporary.
"Which clears itself after some time?
That's right. People suffering from carbon monoxide poisoning are generally taken care of in hyperbaric chambers until the carbon monoxide is cleared from their systems.
"Do all the trauma centers have hyperbaric chambers?
No, not even all the burn units. The major hyperbaric chamber is at Jacobi Hospital in the Bronx. Usually the firefighters know that and when victims are suffering from severe carbon monoxide poisoning, they are all transported there. I don't know whether any of the people from the World Trade Center were taken there or not. I hadn't heard anything about it, and wouldn't expect that this would have been an issue at the World Trade Center site, because the people in the upper stories, those who would have suffered smoke inhalation injuries, died.
"Do you think we are prepared for a chemical or biological threat?
Well, yes, as much as possible. People who work in the area of trauma are well aware of the various chemical problems; during the Persian Gulf war everyone was well aware of it. I had volunteered during the Persian Gulf and we had special decontamination procedures, and vaccinations for germ warfare. We had special masks and chemically impervious uniforms, among other things. These probably are still stockpiled somewhere."
"As physicians trained in medicine and surgery, we were hoping to aid in all aspects of the health personnel efforts. However, we found that our specific service was one of the busiest subspecialties. We began treating many of the firefighters, police officers, and emergency medical technicians for a variety of ocular conditions. The most commonly encountered problems included chemical conjunctivitis, superficial punctate keratopathy, corneal abrasions, and corneal foreign bodies."
Medscape Resource Center: Bioterrorism: Preparing for the Future
Predicting health impacts of the World Trade Center Disaster: 1. Cognitive condensation, halogenated hydrocarbons, and traumatic perturbation (The full article is available as a pdf file) -- Rodrick Wallace and Deborah Wallace, 08 October 2001 NEW!
Abstract: "The recent attack on the World Trade Center, in addition to direct injury and psychological trauma, appears to have exposed an exceedingly large population to dioxins, dibenzofurans, related endocrine disruptors, and a multitude of other physiologically active chemicals arising from the decomposition of the massive quantities of halogenated hydrocarbons and other plastics within the affected buildings. Combining recent theoretical perspectives on immune, CNS, and sociocultural cognition with empirical studies of those affected by past toxic fire incidents suggests the appearance of complex, developing spectra of synergistically linked social, pshchosocial, psychological, and physical symptoms among the 100,000 or so persons directly affected by the attack. The expected pattern greatly transcends a simple 'Post Traumatic Stress Disorder' model, and may come to resemble particularly acute forms of Gulf War Syndrome."
Coping with a National Tragedy -- Articles from the American Psychiatric Association
Includes the following:
Field Manual: For Mental Health and Human Service Workers in Major Disasters
MedscapeWire: When Disaster Strikes: A Call to Clinicians
MedscapeWire: Helping Children Handle Disaster-Related Anxiety
Medscape Resource Center: Disaster and Trauma
Includes the following:
"One of the things that biology has taught us is that PTSD represents a type of a response to trauma, but not the only type of response. It is a response that seems to be about the failure to consolidate a memory in such a way as to be able to be recalled without distress...It is, again, too early to know how big of a problem this is going to be for New York. Although, just doing the math, even by the most conservative estimates of the prevalence of PTSD, we have so many people who were directly affected. By directly affected, I mean running from the scene of the World Trade Center as the buildings were collapsing. So, I don't mean watching it and witnessing it, which is in itself trauma, or feeling frightened by the implications, which is also traumatic, or losing loved ones which is also traumatic. Certainly, many people are involved in the rescue efforts, that's traumatic, and there are a lot of people that we don't hear about. We are all hearing about the fire fighters and the policemen and the rescue workers. There are scores of city workers that have just been thrown into this and are now being confronted with scenes and sights and devastation that they have not been prepared for. We didn't have a good way of planning for this event, so the number of people that are potentially going to be affected by this trauma is very very large. Now we have to watch and see what is the response going to be. We have an opportunity to watch the response unfold over time.
"I think talking about the trauma is really important. Not everybody wants to do it. I don't think people should be forced. I think there are ways to be helpful to people who don't want to talk about a trauma, but you may not be able to get rid of their PTSD, because that's really going to involve processing and not avoidance. So people who say they don't want to talk about this, they can't talk about this, need to be told that, 'Well, your difficulty in discussing this is called avoidance, which is one of the hallmarks of posttraumatic stress disorder. However, since the problem here is that the reason why you don't want to talk about it is because the memory's so distressing, and memory's aren't erasable, we have to find a way to make that memory less distressing.'"
Response Guidelines for Occupational Physicians Who May Deal with Psychological Trauma in the Workplace as a Result of the September 11 Terrorist Attacks -- American College of Occupational and Environmental Medicine