Notice to Readers: New York City Department of Health Response to Terrorist Attack, September 11, 2001

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In response to two jet aircraft crashing into and causing the collapse of the 110-storied World Trade Center (WTC) towers and the subsequent destruction of nearby portions of lower Manhattan, the New York City Department of Health (NYCDOH) immediately activated its emergency response protocol, including the mobilization of an Emergency Operations Center. Surveillance, clinical, environmental, sheltering, laboratory, management information systems, and operations were among the preestablished emergency committees. Because of its proximity to the WTC site, an emergency clinic was established at NYCDOH for triage and treatment of injured persons. NYCDOH focused its initial efforts on assessing the public health and medical impact of the attack and the resources needed to respond to it such as the care and management of large numbers of persons injured or killed by the crash; subsequent fire and building collapse; the health and safety of rescue workers; the environmental health risks (e.g., asbestos, smoke, dust, or chemical inhalation); other illnesses related to the disruption of the physical infrastructure (e.g., waterborne and foodborne diseases); and mental health concerns. Despite the evacuation and relocation of NYCDOH's headquarters, the department continued essential public health services, including death registration.

A rapid assessment conducted by NYCDOH during the first 24 hours after the incident indicated that most emergency department (ED) visits were for minor injuries; approximately 10%--15% of ED patients were admitted and few deaths occurred. Hospital bed and staff capacity was adequate.

Following the incident, NYCDOH prioritized four surveillance activities: 1) in collaboration with the Greater New York Hospital Association, an ongoing assessment of hospital staffing and equipment needs, and cumulative numbers of incident-related ED visits and hospital admissions; 2) an epidemiologic assessment of the types of injuries seen during the first 48 hours after the attack at one tertiary referral hospital and the four EDs closest to the crash site where the largest number of incident-related cases presented; 3) prospective surveillance of illnesses and injuries among rescue workers evaluated at the four hospitals and Disaster Medical Assistance Team triage units located at the crash site; and 4) active surveillance in EDs for specified clinical syndromes to identify unusual disease manifestations or clusters associated with these incidents, including those syndromes that could result from the release of a biologic agent. To assist NYCDOH with syndromic surveillance, CDC Epidemic Intelligence Service officers have been stationed at EDs in 15 sentinel hospitals distributed throughout the five New York City boroughs. Other NYCDOH activities included an already existing syndromic surveillance system to monitor 911 emergency calls. No unusual patterns of illness have been identified. NYCDOH also conducted laboratory testing of environmental samples and did not find evidence of a biologic agent release.

Air quality, safety of the municipal water supply, restaurant safety and rodent control, and other environmental conditions in the area continue to be monitored by NYCDOH, in collaboration with local, state, and federal agencies, to ensure the health and safety of workers at the site and residents in the immediate vicinity. Frequent alerts are sent by broadcast facsimile and electronic mail to advise metropolitan New York health-care providers of ongoing public health concerns related to the aftermath of the attack. Advisories have been developed to address the public's concerns about such issues as asbestos exposure in collapsed buildings, decomposing bodies, and managing emotional trauma. Working with the American Red Cross, NYCDOH school health program has provided nursing services and physician consultations to Red Cross shelters. The shelters serve families and persons displaced by the incident and provide respite to rescue workers. NYCDOH nurses provide nursing assessments, first-aid services, and medical referrals when needed.

In response to events in lower Manhattan and the related attack on the Pentagon in Washington, DC, the Federal Response Plan was activated. The U.S. Department of Health and Human Services (DHHS) deployed federal resources under Emergency Support Function #8 (Health and Medical) to augment the state and local medical response. A shipment of intravenous supplies, airway supplies, emergency medication, bandages and dressings, and other materials arrived in New York City the night of September 11; this was the first emergency mobilization of the National Pharmaceutical Stockpile. NYCDOH and the health department in Washington, DC, also obtained adequate supplies of tetanus vaccine from vaccine manufacturers. CDC has sent epidemiologists, occupational health specialists, industrial hygienists, and other public health professionals to supplement local efforts. Information about federal support of the local public health response is available from DHHS at <http://www.hhs.gov>.

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