The Sept. 11 attack on the World Trade Center (WTC) horrified the nation and the world: 2,800 civilians died in the conflagration, and the subsequent collapse of the WTC buildings created what was probably the most dangerous emergency response, rescue and recovery effort in U.S. history. This disaster and the ensuing fires released thousands of tons of matter - much of it hazardous - into the atmosphere.

As the horrors of that day recede, many in the safety and health community are taking a closer look at how well workers were protected as they labored near the former WTC.

At the center of this re-evaluation of an extremely complex situation is a simple, disturbing fact: Four months after the catastrophe, there were reports that half the workers at Ground Zero, perhaps the most hazardous work site in the nation, still were not wearing respirators.

Cooperation Gives Way to Mistrust

Any effort to evaluate worker protections and the use of personal protective equipment (PPE) during the cleanup effort must begin by recognizing the enormity of the problems faced by men and women who often worked heroically to save or protect others. No one was - no one could have been - prepared to deal with a catastrophe on the scale of 9/11, yet many observers reported that the disaster evoked an extraordinary team effort by those in and out of government.

EPA began taking air, dust and water samples near the WTC soon after the disaster and consistently has stated that it never detected any pollutants from the fire and building collapse that are of concern to the general public.

According to poll results released in March, however, 70 percent of New Yorkers said they did not believe EPA or other government agencies' reports that the air quality around Ground Zero is safe.

Rep. Jerrold Nadler, D-N.Y., charged that EPA broke the law and misled the public about the safety of air quality in and around Ground Zero. Nadler issued a "white paper" March 8 that he said documents illegal and improper activity. For example, he alleges EPA erred in allowing New York City (NYC) to handle the testing and remediation of indoor air matters, claiming the city did an inadequate job at both tasks. By failing to oversee the city pursuant to the National Contingency Plan, Nadler said, EPA broke federal law.

Along with these concerns, reports about possible illnesses among workers at and near the WTC site began to surface:

c As many as 120 NYC firefighters are suffering from moderate to severe breathing problems probably caused by working at Ground Zero, according to Dr. David Prezant, the Fire Department of New York's deputy chief medical officer.

c Preliminary results showed that more than 400 day laborers - building maintenance workers who were examined at a Ground Zero medical van - had nearly identical symptoms of respiratory distress. Those symptoms were possibly related to inhalation of toxic substances in WTC dust and debris, according to Dr. Steven Markowitz, medical director of the operation.

This may be only the beginning. Industrial hygienists familiar with the site identified asbestos as the hazard of greatest concern. Because asbestos-related diseases develop slowly, the real story about workers' illnesses may take years, or decades, to unfold.

For Whom the PELs Toll

Confusion about the seriousness of the hazards workers in the WTC area faced were fueled by many factors. One was the difference between OSHA's permissible exposure limit (PEL) for asbestos and EPA's "clearance level."

Bruce Lippy, industrial hygienist for the Operating Engineers National Hazmat Program, was on site throughout the first five weeks of the cleanup and regularly thereafter. "We found that 60 percent of our [asbestos] samples were greater than the EPA clearance level, and that's the primary reason I urged people to keep their respirators on."

Lippy, along with other occupational safety professionals, relied on an EPA standard, rather than the OSHA PEL, to safeguard workers. EPA's clearance level refers to a test required by the Asbestos Hazard Emergency Response Act (AHERA) before an asbestos project can be opened to the public. The level of protection, .02 fibers per cubic centimeter (f/cc), is used to determine if children may re-enter a school building after asbestos has been removed or abated.

By March 28, EPA had conducted 7,251 air samples for asbestos in Lower Manhattan, with 18 of these samples above the agency's standard.

OSHA's PEL for asbestos is less stringent - 0.1 f/cc. As of Feb. 6, OSHA had conducted more than 1,000 asbestos samples, and results ranged from "none detected" to .037 - well below OSHA's PEL, yet above EPA's AHERA "school child" threshold.

If asbestos was the hazard of greatest concern and if none of OSHA's samples revealed asbestos levels above the agency's PELs, why should workers heed OSHA's advice to wear respirators?

According to OSHA Region II Director Pat Clark, OSHA advised workers inside the "green zone," the constantly shrinking area where the rescue and recovery work went on, to wear respirators because the site was everchanging and filled with many unknown hazards.

While EPA data showed few samples above the AHERA clearance level, the agency's data appeared to conflict with Lippy's results, as well as those of other private groups.

"I don't care what the sampling results say. We have a toxic soup down there," said Lee Clarke, senior safety and health coordinator in District Council 37 of the American Federation of State, County and Municipal Employees (AFSCME). It's a view widely shared by other experts.

EPA and OSHA tested for hazards individually, but some health professionals worried about possible "synergistic effects" among these contaminants. Mercury, dust, silica, lead, fiberglass, benzene and many other substances were released into the air when the twin towers collapsed, pulverizing everything inside of them.

Superfund Site?

Many workers cleaning up the inside of buildings outside the green zone never faced the temptation to remove their respirator - because they never had one in the first place. Soon after Sept. 11, EPA stated the air in Lower Manhattan outside the green zone was safe, and no respiratory protection was needed there.

What outraged Congressman Nadler and many New Yorkers was that EPA issued its statements without ever testing air inside buildings near the green zone. Sampling done by private organizations in some buildings found concentrations of asbestos in dust that far exceeded EPA's 1 percent definitional threshold for material containing asbestos.

EPA countered that indoor air quality is outside its mission and that it was up to NYC's Department of Health (DOH) to handle the matter.

In a Jan. 17 letter, OSHA Administrator John Henshaw wrote, "Because materials containing asbestos were used in the construction of the twin towers, the settled dust from their collapse must be presumed to contain asbestos."

In a series of scathing memos critical of EPA's response to the disaster, Cate Jenkins, a senior chemist in EPA's hazardous waste division, argued that asbestos levels in Lower Manhattan were so high the entire area should be declared a Superfund site. According to Jenkins, the asbestos contamination in Lower Manhattan, up to seven blocks away from Ground Zero, is comparable or higher than that found in Libby, Mont., a designated Superfund site.

EPA did not respond to repeated requests for comment on Jenkins' memos.

The economic and political consequences of declaring Lower Manhattan a Superfund site would have been profound, a fact that only fueled suspicion about EPA's pronouncements.

"It's not unreasonable to make the area a Superfund site," said Stephen Levin, M.D., medical director of the Mount Sinai I.J. Selikoff Center for Occupational and Environmental Medicine.

By late January, Levin said he had already seen more than 100 patients who worked in Lower Manhattan and developed various respiratory ailments he attributed to breathing the air without proper respiratory protection.

"The data doesn't really support making it a Superfund site," countered Kelly McKinney, DOH associate commissioner. For weeks, he said, EPA and other agencies collected samples, and the vast majority were below EPA action levels, especially the air results.

The Wild West?

While public agencies and private organizations argued, workers, many of them immigrants or undocumented aliens, hired to clean up the buildings near Ground Zero faced the risk of exposure to hazards with limited protection. This is what led the New York Committee for Occupational Safety and Health (NYCOSH) to push for the medical monitoring done at the van outside the green zone.

"We expected to screen for two weeks and see 200 people," Markowitz said. "Demand was so great we stayed open five weeks and saw 500 people."

"What's happening in Lower Manhattan in general is an entirely uncoordinated, haphazard effort," declared

David Newman, an industrial hygienist with NYCOSH, in describing the indoor asbestos cleanup process. "It's the Wild West out there."

Newman charged that there have been no protocols or leadership on what kind of testing should be done prior to cleaning up affected buildings, so that the cleanup can be designed appropriately. Nor were there protocols on clearance testing for reoccupancy from any government agency.

Responding to concerns raised by

NYCOSH and other groups that government officials were not doing enough to protect workers in the area near the former WTC, OSHA on Jan. 25 began random inspections of buildings in the area.

By late March, OSHA's Clark had good news to report. The agency visited 22 buildings near the site of the former WTC and found cleanup operations in eight of these buildings. OSHA opened 39 inspections and issued eight citations, but all were for safety violations.

"We did a variety of tests - bulk samples and personal samples - for a wide range of hazards," she said. "We found nothing that would have required workers to wear respirators, though they were generally wearing respirators." OSHA detected no asbestos.

Respirator Response

Especially in the early days of the disaster, providing the proper respiratory protection to workers inside the green zone posed a daunting challenge. Here, where a largely unionized and English-speaking work force labored around the clock, approximately 800 federal and state OSHA staffers were on site with them to offer advice, not citations.

OSHA personnel from around the country volunteered to help the over-worked staff from OSHA's Manhattan area office, an office that was obliterated by the Sept. 11 attack. Everyone from OSHA escaped from their WTC headquarters just before it collapsed. For months, OSHA's Manhattan area staff worked long hours out of a tiny, makeshift office approximately 2 miles uptown from Ground Zero.

Antonio Pietroluongo, OSHA's assistant area director for safety, said that by Sept. 15, he was working 17 to 20 hours a day at Ground Zero. "My best therapy was to be back at work," he said.

Observers on the scene confirmed that OSHA personnel labored long and hard to ensure the safety of everyone involved in rescue and recovery at the former WTC. "The people at OSHA worked very, very hard, and they excelled at being safety professionals," said Michael J. Fagel, Ph.D., CHCM, a technical support specialist contracted to the Department of Justice's Office of Domestic Preparedness. Fagel was at Ground Zero from Sept. 17 through Nov. 24.

An early challenge was determining which type of respiratory protection was appropriate. The National Institute for Occupational Safety and Health (NIOSH), along with EPA and OSHA, decided on half-face, negative-pressure respirators with P-100, organic vapor/acid gas cartridges.

"Thousands of samples collected subsequently have reinforced that this initial choice was correct," said Lippy of the Operating Engineers.

NIOSH, along with many safety equipment manufacturers, helped to meet a second problem: obtaining and transporting thousands of respirators to New York in a hurry, at a time when the nation's air transportation system was at a standstill. NIOSH officials contacted the International Safety Equipment Association, and manufacturers quickly sent respirators and other kinds of PPE to New York and Virginia, where the Pentagon had been hit.

"We were sending stuff out by the truckload," said Ron Herring, director of marketing for MSA, a Pittsburgh-based manufacturer of safety equipment that helped lead the respirator effort.

Acting on its emergency response plan, Draeger Safety, another Pittsburgh safety equipment company, did not wait to be asked for help. By Sept. 14, according to marketing communications manager Shelli Cosmides, Draeger had sent out four truckloads of equipment to New York City, including 10,000 respirators.

North Safety Products of Cranston, R.I., sent out a truckload of respirators the afternoon of Sept. 11. Because the company is located so near New York City, the shipment was one of the first to arrive at Ground Zero.

Many safety equipment companies also donated products and services. For example, LouAnne Koerschner, business operations manager at St. Paul-based 3M, said the company donated $1 million in products, including 65,000 respirators.

During the first weeks after the attack, OSHA reported it was distributing 4,000 respirators a day; by early March, the total figure had risen to 113,500.

Choosing the right kind of respirator, transporting sufficient numbers of them to New York and distributing the devices to the workers who needed them showed what could be achieved when businesses and government agencies cooperated.

"There was no turf," Fagel said. "It was, 'What do you need?'"

Like Loose Neckties

Safety and health professionals soon discovered that it was easier to get the right respirators on site than it was to get workers to wear them or wear them properly.

From the very beginning of the operation until months later, many observers pointed to poor compliance with the requirement to use respirators as one of the most serious safety and health shortcomings at the site. The National Institute of Environmental Health Sciences (NIEHS) directed attention to this problem in its Oct. 6 report on the early response to the disaster, noting, "respiratory protection is rare."

According to data compiled by Lippy, from Oct. 2 to Oct. 16, respirator use by heavy-equipment operators was never above 50 percent and at times dipped to 20 percent, despite intense education efforts of the union.

A slightly different story comes from Robert Adams, the director of health and safety for the city's Department of Design and Construction (DDC), which managed the site. "We've had compliance as high as 80 percent, and then it has dipped down to 50 [percent]," Adams said in a Feb. 1 interview. "It's an ongoing issue we address routinely every day."

Bob DiBaro, health and safety director for the International Brotherhood of Teamsters' Local 804, thought he could explain the discrepancy in reported respirator use. "We had 60 percent to 70 percent compliance when the inspectors were walking around. In reality, I'd say it was 30 percent to 40 percent."

Lippy complained that, on top of the long hours and discomfort of wearing the devices, poor role models abounded at Ground Zero. Supervisory personnel from many organizations on site regularly entered the restricted zone without respiratory protection.

"Respirators were worn much like loose neckties, hanging below the neck," Lippy said. "Compliance at Ground Zero was generally terrible."

Regulations Out the Window?

By all accounts, OSHA personnel worked diligently passing out respirators and teaching workers to perform positive and negative fit checks in the early weeks of the recovery effort. OSHA, however, did not perform the fit tests required under its respirator standard until December. Respirators are not fully effective without fit tests.

According to Lippy, fit tests for the respirators were not widely offered at Ground Zero until Oct. 17, or 36 days after the attacks. At this point, the Operating Engineers arranged for medical testing and quantitative fit testing with the help of 3M in a special mobile vehicle stationed near Ground Zero. MSA later pitched in, spending $150,000 to fit test thousands more after 3M left the site.

"OSHA worked very hard," Lippy said, "but one has to ask why, if its own standard requires this, it took 36 days before it happened?"

A number of labor representatives privately complained that during health and safety meetings held on site, OSHA had too little authority. "Because this was such a horrendous situation, enforcement agencies adopted the attitude that all regulations went out the window, and that was totally irresponsible," AFSCME's Clarke contended.

OSHA may have had little choice. Ultimate control of the site remained in the hands of New York City. At first, the Fire Department of New York managed the response. Later, it was DDC. The emotions surrounding the loss of so many NYC firefighters may have contributed to a crucial decision that hindered the enforcement of normal safety and health standards at Ground Zero: The site was always considered to be in a "rescue and recovery" mode.

Because Ground Zero remained an emergency site, OSHA never had jurisdiction to impose fines for worker safety violations.

"There's no legal impediment against them enforcing," said Donald Elisburg, a long-time OSHA expert who co-authored an initial NIEHS report on the response to the WTC disaster. "But it was a matter of OSHA's policy interpretation, one that goes back many years, that at a rescue and recovery site, they did not engage in enforcement activities."

In addition, the unprecedented complexity of the operation required the use of four contractors, making the safety effort more difficult.

Safety and Health Plan Delayed

If OSHA's enforcement role at Ground Zero was circumscribed, it may be unfair to blame the agency.

In addition to the politics of emotion that required calling Ground Zero a rescue and recovery site long after any hope of saving lives had vanished, OSHA's lack of clout could reflect the Bush administration's emphasis on a cooperative approach with business. The terrorist attacks, and the resulting surge of patriotic national unity, did not increase the appetite in Washington for a confrontational approach toward private industry. Still, many safety and health experts, particularly those with labor ties, questioned OSHA's failure to compel the use of respirators.

One labor representative, who described himself as a strong supporter of OSHA, attended the daily safety meetings and complained that the agency had little clout in decision-making.

"Bechtel, and then Liberty Mutual, called the shots," he said, referring to the two firms that supervised safety at the site. "They gave their run-down of what they felt were the issues, like who should wear what kind of masks. OSHA really had no participation in that." Enforcement of respirator use, he added, "never came into play."

The site had no safety and health plan until Oct. 29, nearly seven weeks after the attacks.

All of the contractors involved in the rescue and recovery effort at Ground Zero declined to answer questions about safety or any other aspect of their operations at the site. Liberty Mutual also declined to comment on its operations, referring to a long-standing policy of protecting the privacy of its clients.

OSHA's Partnership Agreement

A turning point in OSHA's role at Ground Zero came Nov. 20 with the signing of a partnership agreement between the agency, the city of New York, contractors and other organizations. Prior to then, OSHA compliance officers acted primarily as consultants, offering advice and assistance - and no citations - to workers and employers.

In the partnership document, OSHA officially agreed to not issue fines or citations for any kind of violation, including failure to wear respirators, while the contractors promised to address the concerns of the compliance officers.

NYCOSH's Newman pointed out that, under the agreement, workers lost the right to file complaints and that its "no citation" element violated OSHA's rules concerning such agreements.

OSHA's Clark countered that it was only one of OSHA's "internal directives" that barred it from dropping its enforcement powers in a partnership agreement. She argued that the WTC disaster presented a unique set of circumstances that justified this departure from past practice.

Given the weak hand OSHA held at Ground Zero, the partnership agreement may have been the best deal the agency could get. Clark argued that even if OSHA had tried to use its enforcement powers, the companies could have fought the citations in court, leaving workers with little immediate protection.

The agreement succeeded in giving OSHA more clout at the WTC site, according to DiBaro and others. "There was a significant difference after the partnership agreement," he said. "OSHA teamed up with the outside companies, and they did inspections together."

In March, OSHA released data indicating its approach at the WTC may have succeeded in some ways. Private contractors working at Ground Zero had a lost workday injury and illness rate of 2.1 per 100 workers through Dec. 31. This compares with a 4.3 national average for construction work.

Given the extraordinary hazards of the WTC site, the numbers suggest a genuine achievement, particularly with respect to safety hazards.

Yet, it appears the partnership agreement had little effect on respirator use, and if workers were exposed to significant health hazards, it could take many years for the illnesses to show up.

The 90 Percent Solution?

Defenders of the safety and health compliance effort at Ground Zero argue that it was a uniquely challenging environment, given the complexity of the various tasks, the multiple contractors and the pressures of the situation.

Lippy and others, however, point out that at the Fresh Kills site in Staten Island, where the Ground Zero debris was sorted and inspected, respirator use was reported to be consistently near 90 percent.

"The irony is that the debris is pulled by workers from one of the most dangerous sites I have ever seen, and then wetted and hauled to a site where the debris is carefully sorted by workers who are wearing protective equipment much more consistently," Lippy said.

DOH's McKinney countered that the partnership agreement at Fresh Kills was virtually identical to the one in force at Ground Zero.

Several observers said Fresh Kills was managed just as if it were a HAZWOPER site, "Why," Lippy asked, "could we get 90 percent respirator compliance at Fresh Kills and only 30 percent at Ground Zero?"

What the experts are saying
Bruce Lippy, CIH, CSP, industrial hygienist "We found that 60 percent of our [asbestos] samples were greater than the EPA clearance level." Pat Clark, OSHA Region II Director "We did a variety of tests - bulk samples and personal samples - for a wide range of hazards. We found nothing that would have required workers to wear respirators, though they were generally wearing respirators."
Stephen Levin, M.D., medical director of the Mount Sinai I.J. Selikoff Center "It's not unreasonable to make the area a Superfund site." Joel Shufro, NYCOSH executive director "The agencies have made it a priority to get the Lower Manhattan financial and stock markets up and running at any cost. In so doing, they have allowed thousands of people to be exposed to substances that haven't even all been identified."