World Trade Center-Related Physical and Mental Health Burden Among New York City Fire Department Emergency Medical Service Workers

BACKGROUND:  Previous studies have documented the emergence of physical and mental conditions among World Trade Center (WTC) rescue/recovery workers in general, and firefighters and police officers in particular, although little is known about the health impact of WTC on emergency medical service (EMS) workers. We described the current health burden among Fire Department of New York (FDNY) EMS workers and examined its association with work at the WTC disaster site. We also compared the health burden in FDNY EMS workers with the burden in FDNY firefighters.

METHODS:  In this 12-year observational cohort study, covering the period September 11, 2001 (9/11) through December 31, 2013, we used confirmed FDNY physician diagnoses to estimate the cumulative incidence of physical health conditions including rhinosinusitis, gastroesopheal reflux disease (GERD), obstructive airways disease (OAD) and cancer among EMS workers and firefighters who were active on 9/11. Validated screening instruments were used to estimate the incidence of mental health symptoms including probable post-traumatic stress disorder (PTSD), probable depression and probable harmful alcohol use. We quantified physical and mental health comorbidities and used Poisson models to assess the association between WTC-exposure and health conditions in EMS workers.

RESULTS:  Among 2,281 EMS workers, the 12-year post-9/11 cumulative incidence of rhinosinusitis was 10.6% (n=241); GERD 12.0% (n=274); OAD 11.7% (n=266); cancer 3.1% (n=70); probable PTSD 7.0% (n=158); probable depression 16.7% (n=375); and probable harmful alcohol use 3.0% (n=67). Approximately 9% of EMS workers (n=197) had physician diagnoses for at least two of three aerodigestive conditions: rhinosinusitis, OAD and GERD; and nearly 7% (n=166) screened positive for at least two of the three mental health conditions: probable PTSD, probable depression and probable harmful alcohol use. Compared with the unexposed, EMS workers who arrived earliest on 9/11 had higher adjusted relative risks (aRR) for nearly all conditions, including rhinosinusitis (aRR = 3.7; 95% CI: 2.3-6.1); GERD (aRR = 3.8; 95% CI: 2.4-6.1); OAD (aRR = 2.4; 95% CI: 1.7-3.5); probable PTSD (aRR = 7.0; 95% CI: 3.7-13.5); and probable depression (aRR = 2.3; 95% CI: 1.6-3.1). Compared with firefighters, EMS workers had lower cumulative incidence of most conditions except for probable PTSD and probable depression, where the rates were similar.  

CONCLUSIONS:  Twelve years after 9/11, this study documented the high burden of physical and mental health conditions associated with WTC-exposure among FDNY EMS workers. These findings underscore the importance of continued monitoring and treatment of this workforce.