Feldman Debra M, Baron Sherry L, Bernard Bruce P, Lushniak Boris D, Banauch Gisela, Arcentales Nicole, Kelly Kerry J, Prezant David J
National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA.
Chest. 2004 Apr;125(4):1256-64. doi: 10.1378/chest.125.4.1256.
New York City firefighters responding to the World Trade Center (WTC) disaster on September 11, 2001, were exposed to numerous hazards. A medical screening program was conducted 3 weeks after the disaster on a sample of firefighters.
To determine whether arrival time at the WTC and other exposure variables (including respirator use) were associated with symptoms and changes in pulmonary function (after exposure - before exposure).
A cross-sectional comparison of firefighters representing the following groups: (1) firefighters who arrived before/during the WTC collapse, (2) firefighters who arrived 1 to 2 days after the collapse, (3) firefighters who arrived 3 to 7 days after the collapse, and (4) unexposed firefighters.
Fire Department of New York City (FDNY) Bureau of Health Services on October 1 to 5, 2001.
A stratified random sample of 362 of 398 recruited working firefighters (91%). Of these, 149 firefighters (41%) were present at the WTC collapse, 142 firefighters (39%) arrived after the collapse but within 48 h, 28 firefighters (8%) arrived 3 to 7 days after the collapse, and 43 firefighters (12%) were unexposed.
New/worsening symptoms involving the eyes, skin, respiratory system, and nose and throat (NT), and changes in spirometry from before to after exposure.
During the first 2 weeks at the WTC site, 19% of study firefighters reported not using a respirator; 50% reported using a respirator but only rarely. Prevalence ratios (PRs) for skin, eye, respiratory, and NT symptoms showed a dose-response pattern between exposure groups based on time of arrival at the WTC site, with PRs between 2.6 and 11.4 with 95% confidence intervals (CIs) excluding 1.0 for all but skin symptoms. For those spending > 7 days at the site, the PR for respiratory symptoms was 1.32 (95% CI, 1.13 to 1.55), compared with those who were exposed for < 7 days. Mean spirometry results before and after exposure were within normal limits. The change in spirometry findings (after exposure - before exposure) showed near-equal reductions for FVC and FEV(1). These reductions were greater than the annual reductions measured in a referent population of incumbent FDNY firefighters prior to September 11 (p <or= 0.05). There was a 60% increased risk of a decline of >or= 450 mL in FEV(1) in those arriving during the first 48 h compared to the referent (p <or= 0.05).
The symptoms and pulmonary function changes following exposure at the WTC demonstrate the need for improvements in respirators and their use, as well as long-term medical monitoring of rescue workers.
2001年9月11日应对世贸中心（WTC）灾难的纽约市消防员面临众多危险。灾难发生3周后对一组消防员进行了医学筛查。
确定到达世贸中心的时间及其他暴露变量（包括呼吸器使用情况）是否与症状及肺功能变化（暴露后 - 暴露前）相关。
对代表以下几组的消防员进行横断面比较：（1）在世贸中心倒塌之前/期间到达的消防员；（2）在倒塌后1至2天到达的消防员；（3）在倒塌后3至7天到达的消防员；（4）未暴露的消防员。
2001年10月1日至5日纽约市消防局（FDNY）卫生服务局。
从398名招募的在职消防员中分层随机抽取362名（91%）。其中，149名消防员（41%）在世贸中心倒塌时在场，142名消防员（39%）在倒塌后但48小时内到达，28名消防员（8%）在倒塌后3至7天到达，43名消防员（12%）未暴露。
涉及眼睛、皮肤、呼吸系统以及鼻和喉（NT）的新出现/加重的症状，以及暴露前后肺活量测定的变化。
在世贸中心现场的前2周，19%的研究消防员报告未使用呼吸器；50%报告使用了呼吸器但很少使用。基于到达世贸中心现场的时间，皮肤、眼睛、呼吸和NT症状的患病率比值（PRs）在暴露组之间呈现剂量反应模式，除皮肤症状外PRs在2.6至11.4之间，95%置信区间（CIs）不包括1.0。对于在现场停留超过7天的人，与暴露少于7天的人相比，呼吸道症状的PR为1.32（95%CI，1.13至1.55）。暴露前后肺活量测定的平均结果在正常范围内。肺活量测定结果的变化（暴露后 - 暴露前）显示用力肺活量（FVC）和第1秒用力呼气容积（FEV₁）的下降几乎相等。这些下降大于2001年9月11日前纽约市消防局在职消防员参考人群每年的下降幅度（p≤0.05）。与参考人群相比，在最初48小时内到达的人FEV₁下降≥450 mL的风险增加了60%（p≤0.05）。
世贸中心暴露后的症状和肺功能变化表明需要改进呼吸器及其使用，以及对救援人员进行长期医学监测。
