I want to revisit this issue today – the issue of lung damage in the first responders to the tragic crash at the World Trade Center on 9/11/01. Some months ago I explained the results of a seven year study, led in part by Thomas Aldrich. You can read the study here. I bring it up again because it is important enough to, but also because this week another proposed settlement is being offered to those brave men and women – fire fighters and emergency medical service personnel, as well as police and others. Today, I can understand the results of the study better – and explain it better. The results have helped establish that real, extensive and permanent harm has occurred. The settlement may best be explained elsewhere, but I will attempt to get the gist here.
Tens of thousands of persons have sued the City of New York, the Port Authority and others for what they feel – or their attorneys’ feel- is negligence with regard to supervision and protection after the crashes. The hearings and negotiations have been going on for some time. One bone of contention is lawyer fees and compensation. There is also a fund set up already, from a federal grant that addresses some of the payout. Workers are concerned about diseases that they currently have and ones they may develop. To be clear, though Dr. Aldrich’s team only studied the lung function of fire department and EMS workers, similar outcomes would be expected for some of the plaintiffs. It looks like there is an option for a one time payout, for payouts based on severity; chronic, acute, progressive, disabling – and also access to medical care – though that may be included in the federal grant as it is referred to as an insurance fund.
In rereading the NEJM study, I see that the subjects in that study had a significant and severe loss of lung function in the first year after 9/11 and those that responded earlier and longest had the worst outcomes. Here is what I didn’t know so well when I first read the story - lung function testing by spirometry!
So the FEVone – Forced Expired Volume – A person blows ALL of the air out of their lungs (measured in liters) and the amount that comes out in one second is captured and compared. The rescue workers had at least normal function before 2001 – (Normal is to expel about 5 liters in the total exhale and the FEVone predicted would be at least 70% of 5 liters. Most responders were between 3.5 and 4.5 at baseline). There was a significant decline in the first year and this did not rebound. The results continued to stay below the baseline over the years, with EMS workers starting with the lowest values but FDNY losing the most. It appears that each set lost a whole liter w/ regard to FEVone in six years. I mean that if their baseline FEV was 4.5 liters, after six years, the same test results in a 3.5 liter FEV one. [There are 1000ml in one liter]
An average person – non smoker- loses around 30 ml a year. Though the average ml /year lost by these persons was similar – the first year they lost an incredible 267 to 585 ml. Remember you and me, who do not smoke or have other lung impairing exposures only lost 30 ml that year! So though the rate of decline has not kept accelerating for these people, the loss from baseline has remained. The loss of function in smokers was not as drastic at first because they had poor baseline numbers – but their over all outcomes were worse.
There was also a small percentage of persons with the classic less than .7 FEVone that could be indicative of COPD and probably is, as Dr. Aldrich told me that there was coughing and shortness of breath in the study participants. We know now what this could mean - years of long and short acting bronchodilator therapy, corticosteroids, oxygen, pulmonary rehab, lung volume reduction therapy. There is every reason to believe that the responders will have some limited amount of functioning, possibly a debilitating condition and even death.
This does not even begin to address the risk of cancer that these same people face and the significant increase for both that smokers already had and have – who will sort that out?? I believe that the plaintiffs have a lot to think about and now we can all understand WHY, a little better.
No comments:
Post a Comment