World Trade Center: A Case Study

The 9/11 attacks on the World Trade Center was the largest attack on U.S. soil to date, but it destroyed more than just buildings. It is well known that 2,974 people in lower Manhattan and 343 first responders from the Fire Department of the City of New York were killed in the line of duty. However, it is lesser known that for the next 10 months, until the site closed on July 25, 2002, FDNY workers were continually subjected to dangerous working conditions, fear for the personal safety and were in contact with the victims’ body parts. This is due to the fact that the fire department was a large part of the rescue, recovery and cleanup. Trends of Elevated PTSD Risk in Firefighters Exposed to the World Trade Center Disaster: 2001-2005 by Amy
Berninger looks at the effects the incident had on the workers of ground zero, focusing on the increasing risk of developing PTSD. Since the attacks, the mental health of firefighter, police officers and paramedics has become much more of an interest in research fields. It has been proven that disasters caused by human intent like terrorist attacks cause more negative psychological damage than natural disaster like earthquakes or hurricanes. One of the most prevalent negative psychological consequences would be posttraumatic stress disorder. PTSD is associated with poor mental and physical health, “violent behavior”, adjustment issues, and poor work performance. The study conducted by Berninger from September 12, 2001 to September 11, 2005 was to examine the changes in prevalence or correlation of PTSD in the first 4 years after 9/11. A few other studies have been conducted to estimate the amount of victims and rescuers diagnosed with PTSD after the 9/11 attacks, but these studies were focused on the prevalence of mental health issues, not the year-to-year changes. There is one other human intent disaster where PTSD was extensively studied, the Oklahoma City Bombing. This study found that 35% of survivors and 13% of firefighters were diagnosed with PTSD after the bombing. After 9/11, a program was implemented to screen and monitor FDNY rescue workers who were exposed to the 9/11 disaster.
FDNY-WTC-MMP, which stands for the Fire Department of New York World Trade Center Medical Monitoring Program, used health evaluations consisting of a physical exam by a physician and self administered questionnaires consisting of question pertaining to the WTC site, physical health symptoms, mental health symptoms, and other variables that were ongoing and scheduled every 12 to 18 months to obtain information about rescue workers. It is important to note that only a trained clinician can determine PTSD, therefore it was not possible to diagnose any participants of this study as having PTSD. Since the outcome of this study was based on self-administered questionnaires and a confirmatory diagnosis cannot be made, participants were studied to determine an “elevated risk.” The term “elevated risk” has been used in previous studies to determine those who may be at an increased risk of developing a mental health condition like PTSD. This study required two different conditions to be satisfied on the questionnaires to score positive for elevated PTSD risk. The first condition required a minimum of two affirmative responses to the arousal domain of the questionnaire, at least one affirmative response to the re-experience domain, and a minimum of three affirmative responses to the avoidance/numbing domain. The second condition was a summation of at least 9
affirmative responses out of a possible 14 questions. The final analytic sample group consisted of 10,074 male fire department personnel. WTC exposure was separated into 4 categories in increasing severity: (1) personnel that arrived on day 1 and were present during the tower collapses, (2) personnel that arrived on day 1 post WTC collapse, (3) personnel that arrived on day 2, and (4) personnel that arrived anytime between day 3 and day 14. During the 4-year study, 2,281 participants retired by the time this study was concluded.
A total of 1,402 personnel retired with a disability, 58 of which were a psychological disability. Of the 8,679 participants that were still employed at the conclusion of the study, 9.8% reported symptoms sufficient enough to show an elevated risk of PTSD in the first year. 9.9% reported symptoms in year 2, 11.7% showed symptoms in year 3, and 10.6% showed symptoms in year 4. Also, 15.5% reported difficulty functioning at home or work in year 1, 17.2% reported difficulty in year 2, 15.4% reported difficulty in year 3, and 14% reported difficulty in year 4. Work-related stressors, including the loss of firefighter coworkers, were also associated with an elevated risk of PTSD in 1,663
participants. This study was a large success in two different ways. The research aspect of this study was able to prove that fire department personnel are subjected to many situations where the risk of developing PTSD is extremely high and that it should be looked at much more in depth than previously thought. It also served a dual purpose of being able to identify personnel that were involved with the terrible events of that fateful day and assess their risk of developing PTSD. Those that were found to have an increased risk were able to get the help that they needed to minimize the possibility of developing PTSD. It has been shown that coping resources and social support from family and friends are able to minimize or eliminate PTSD onset. A study of Iraq war operation veterans showed that unit support, personal resilience, and post-deployment social support were associated with decreased PTSD and depression symptoms. This study shows that simple self-administered questionnaires can help those that have been part of a disaster by identifying these individuals that might be at an increased risk of developing PTSD and allow them to get help to minimize the severity of the event.