World Trade Center Disaster Response

New York City Department of Health

Day 5: 9/15/01 (Saturday)
8 am-8pm Summary
COMMAND CENTER AND OEM OPERATIONS
Mayor's OEM/HOC - Pier 9#^
OEM/HOC number: 646-756-3063/3064
Fax 212-259-9820

Mayor's OEM
Incident Command Post - IS 98
Tel number: (212) 941 - 5352
Facsimile: (212) 941-5331

DOH EOC number: 212-213-1694/1666

Fax: 212-447-8239 (press room)
DOH staff hotline: 800-527-6900

Disaster zone has been narrowed again

Bordered by Warren, Broadway, Exchange/Thames, West

I. Environmental Workgroup
Occupational Health and Safety Plan for worker safety at site
Request for volunteers is suspended - need to maintain order
Fire Dept is handling rescue operation
But site is turning into a construction site with worker safety issues
Fire Dept not interested in site safety control, but we are held accountable
Monitoring checklist will be made

Air quality
Air sampling is happening for asbestos, being collated
10 sites (north and east of site)
No comprehensive medical screening for fit testing for respirators
Coordination not happening, no central person coordinating inventory
Shortages reported of masks, soap
Masks and respirators are around but no coordination
DCAS will be consulted to see if they can coordinate this activity
Maintaining database, DEC may be able to map data for us
Daily 2pm environmental meeting

Radiation
5 known sources in the WTC rubble, but pose no hazard
See attachment by Kelly McKinney
 Water
Water testing results south and east of site are all negative for bacteria, metals
pending
Water supply though bottled water
Water buffaloes through Army Corps of Engineers are needed, to provide drinking
water as well as hand washing capability

Food and Restaurant Inspection

Javits Convention Center is feeding site - Nat'l Guard will take care of inspection
Restaurants donating food, at right temperature, no inspection issues
Food being stored on cruise boat
Lots of spoiled food in disaster zone, South St Seaport, Tribeca
Plans in place to inspect these places door to door
Will be in Financial District Monday morning
No Notice of Violations will be handed out

Rodent control
Decomposing bodies and food in same area may attract pests

Re-occupation of buildings
Fact sheets have been prepared for building owners and apt residents

Sanitation
Trade Waste Commission - to pick up garbage and clean out fish stalls in Fulton
The Department of Sanitation requested a Commissioner's Order to begin
collection of commercial garbage remaining uncollected south of Canal Street,
Hudson to East Rivers. Completed and sent to both EOC and Incident Command
Post (Original copy in binder).
Portable toilets and handwashing facilities are scarce - DCAS
Antiseptic toilettes was interim measure (inadequate)

II. Med/Clinical Workgroup

Public Safety and Decomposing Human Remains Fact Sheet - completed with use of
CDC advisory, see addendum
Health of Rescue Personnel fact sheet - rewrite as Q and A, see addendum
Combination of EMS, triage sites, and DMAT at ground zero
EMS will decrease their presence
Walk-through inspection tool of worker health being prepared

HI. Epi/Surveillance Workgroup

A. Hospital needs assessment (A Karpati)
Focus on 13 hospitals in downtown and Brooklyn
Minimal needs identified - results from 10 hospitals so far
2200 incident related, 64 admissions
no acute needs
B. ER Acute injury/trauma surveillance (S Wilt)
 Almost finished, data entry continuing
C. Syndromic Surveillance (D Weiss)
Logistically most difficult, today is Day 1, no data yet
Monitor for incident related illness and BT related surveillance
34 EIS officers transported out last night to staff 15 ERs in 12 hour shifts
Cluster analysis will be hopefully performed today
Transportation is main issue
D. First responders/DMAT surveillance (A Goodman)
Started last night, but complicated by multiple providers
Less than 50 patients seen so far in disaster zone triage, mostly minor
Injuries mainly in non-uniformed people, such as Red Cross
Will reach out to 4 downtown hospitals to capture patients that go there
E. 911 Surveillance
Difficult to analyze from Bureau of Labs but it is being worked on

Regular, ongoing surveillance activities

One W Nile Case

IV. Sheltering Workgroup

118 people in 9 shelters last night, shelter in Staten Island closed
10 open tonight, 9 Manhattan, 1 in Brooklyn
Staffing issues are fine

VI. Laboratory Workgroup

No issues

VII. Operations/Facilities
40 Worth St (private): no power
225 Broadway:
253 Broadway (city): access gained
346 Broadway: power, no phones
125 Worth St.: telephones to be installed, Vital Records a priority
2 Lafayette will be made a priority next: power is on, no phones

VIII. MIS
No acute issues

OTHER ISSUES
VIII. Public Relations
Channel 4 TV crew visited meeting briefly
Comprehensive press release being prepared
Only a few press inquiries - some about BT (why?)

IX. Personnel/Staffing

Prepared by THH
 World Trade Center Disaster Response
New York City Department of Health
Day 5: 9/15/01 (Saturday)
-8pm Summary
COMMAND CENTER AND OEM OPERATIONS
Mayor's OEM/HOC - Pier 92
OEM/HOC number: 646-756-3063/3064
Fax 212-259-9820

Mayor's OEM
Incident Command Post - IS 98
Tel number: (212) 941 - 5352
Facsimile: (212) 941-5331

DOH staff hotline: 800-527-6900

8:00 AM
Request for a Commissioner's Order
The Department of Sanitation requested a Commissioner's Order to begin collection of
commercial garbage remaining uncollected south of Canal Street, Hudson to East Rivers.
Completed and sent to both EOC and Incident Command Post (Original copy in binder).

3:30 PM
Department of Consumer Affairs
The DCA is setting up a hotline for the public on the process of submitting insurance
claims, and requesting for information on what documents the department can provide to
certify death. The department can only issue a copy of the death certificate, after
registration of such death certificate. The department has no ability to issue any
document certifying missing persons or other conditions.

4:30 PM
Department of Investigation
The DOI is requesting for a list of all retailers and wholesalers at the Fulton Fish Market
for the Trade Waste Commission to begin the process of collecting garbage in that area.

6:00 PM
OEM
The Mayor's Office of Emergency Management requested to meet with the department
to discuss the health and safety of the rescue workers on site. It was decided that the
department will present a plan for a comprehensive health and safety plan for the workers
on site. This plan will address the general environmental issues, and the occupational and
health issues.
A follow-up implementation meeting is scheduled for Sunday, September 16, 2001, at
9:00 AM at OEM.
 Current Issues
9/15/01 12:00pm
DRAFT

TOPIC OUTSTANDING CONCERNS RESPONSIBLE

PARTY
Radiation and 1) Department of Energy flyovers (still not happened) to measure Gene Mishkin
Monitoring radiation levels
2) National Guard has radiation monitors on the trucks taking
garbage to Freshkill- NEED TO GET RESULTS
Pest Control 1) Garbage collection in wer Manhattan and concern for _ James Gibson
rodents running wild Allan Goldberg
2) DOS collecting garbage ? / «
3) Assessment/plan for perimeter
Food 1) Food distribution at ground zero- 8 supervisors at 8 locations Elliott Marcus
24/7 to continue a presence for monitoring
2) Trade Waste Commission- evaluating all buildings at ground
zero w/4 teams- requesting DOH PHS to accompany for
evaluation of food and sanitary concerns

Restaurant 1) If 4 PHS' accompany Trade Waste Commission- is it possible Elliott Marcus

Inspections to merge this activity w/their request?
2) All other restaurants- need to go to 40 Worth St. to collect
information and set up new operation- 4.5 days worth of
inspections south of 14th Street
3) Have initiated inspections from Canal St. north to 14th
m St.

Water 1) Sampling fire hydrants and tap water south of ground zero to Jim Luke
test for quality concerns- waiting for lab results
2) North of ground zero, sampling results were fine

Air 1) PESH and COSH are coordinating fit-testing of respirators Jessica Leighton
2) OSHA to do monitoring of fit-testing and other air Kelly McKinney
quality/occupational health concerns
3) Worker health and safety concerns down at the site- need to
have regular monitoring (Bectel has offered)
4) Fact Sheet for public re: air quality and respiratory concerns
5) School construction authority and overnight air pump testing
6) EPA/DEP doing phosgene testing
7) Need to recall people who went out without fit-testing
Medical and 1) Blood-borne pathogens Sue Blank
Clinical 2) Risks related to decomposing body parts- will put language
together for this
3) Advisory for workers coming across body parts- mental health
needs associated with this
4) Decomposing body parts and rodent control
Worker Safety 1) Health and Safety Plan (DEC/Bectel) Jessica Leighton
2) Fact sheet regarding general hygienic concerns- handwashing Kelly McKinney
and bathrooms for first responders
3) Decontamination sites for dust removal
Shelters 1) ARC meeting to determine role of shelters Carmen Ramos
2) Only three shelters with double-digit utilization levels- have
staff assigned thru Monday

Surveillance 1) Casualty- Going back to do retro surveillance b/c felt not Marci Layton
good enough- done St. Vincents/Bellvue/Downtown/?; currently Polly Thomas
entering data, will have preliminary report by 9/15
2) Hospital- Very cooperative- doing active assessment at 1 5
hospitals, will prepare summary report cards every 24 hours; also
facilitating to hospital needs
3) Syndromic- (BT, asthma, water, GI illness) EIS teams been
oriented and assigned to hospitals and stationed for 12-hour shifts
4) Disaster Medical Assistance Teams- taking over triage sites at
ground zero and Chelsea Piers to collect first responder info.- not
busy
5) 911 updated?

MIS No acute, emergency issues/Only chronic concerns Ed Carubis

Staff and 1) Building access issues- Stu Mirsky

Operations a. 40 Worth St.- landlord building Kelly McKinney
b. 253 Broadway- City building/DCAS/OEM Rich Naeder
c. 125 Worth, 2 Lafayette, 346 Broadway- Vital Records-
school construction authority will do a check thru for
structural stability, fire alarms, phones, and dust
2) 5pm- buildings meeting- general assessment of all buildings
below Canal
3) Status on paycheck distribution
4) Health Center supervisory coverage
5) Bureau/program roll call chart
6) 800-527-6900-DOH staff number (need to track call volume)

DOH Relocated to Bureau of Labs Mark Foggin

Complaints (212)213-1844
Line
 THE CITY OF NEW YORK
DEPARTMENT OF HEALTH
Rudolph W. Giuliani Neal L. Cohen, M.D.
Afayor Commissioner

nyc.gov/health

Garbage collection from commercial establishments in lower Manhattan had been

suspended since the incident at the World Trade Center. The failure to collect garbage is creating
a nuisance and a health hazard.

The Department of Sanitation is hereby authorized and ordered to collect and to dispose
of such garbage in lower Manhattan, south of Canal Street, from the Hudson River to the East
River.

Date:
i Mojica, MD; MPH
Deputy Commissioner of Health
 NEW YORK STATE EMERGENCY MANAGEMENT OFFICE
1220 Washington Avenue
Building 22 - Suite 101
Albany, NY 12226-2251

Edward F. Jacoby Jr.

Director
SITUATION REPORT

To: Governor George E. Pataki

Cc: Mr. James G. Natoli
Director of State Operations
From: Edward F. Jacoby, Jr.
Director
Date: 9/15/01 -6:00 a.m.

Subject: World Trade Center Plane Crash

Executive Summary:

Consolidated Edison has now installed two generators at the New York Merchantile
Exchange, to support of Monday's of the Exchange, They will be tested today.

Accomplishment has been made with the restoration of power shortly before midnight
to the majority of the Park Place network. This reduced the number of electric
customers out of service from more than 12,000 to about 9,300.

The Family Assistance Center, located at 68 Lexington Avenue will be relocated to Pier
94 on Monday.

City Hall is scheduled to re-open Monday Morning.

A Memorial Service will be open to the public, is tentatively scheduled for September
23rd at 3:00 P.M. in Central Park.

Public access will be restricted to all dams in upstate New York. DEC'S Division of Law
Enforcement Staff will enforce the lock down.

SEMO facilitated the process for an 800-ton crane to be erected by Monday to remove
the top of the Plaza to provide better access to potential rescue and recovery sites.

SEMO will be providing staff to the State Economic Development Office at 80 Pine
Street.
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Emergency Coordination Center (518) 457-2200 Webpage: www.nysemo.state.ny.us Fax (518)457-9930
Several promotions will be made tomorrow in the fire department. Among them will be
the Chief of Department, Chief of Operations and about 160 other positions.

Sets of the Architectural, Structural and Utility plans for the WTC that were to arrive at
NYC OEM on 9/15 did not arrive as planned. They are scheduled to arrive this
morning. Plans for them to arrive at SEMO on Monday 9/17 has not changed.

The Insurance Department reports that total cumulative reported losses as of 6:00pm
9/15/01 is 1593. Insurance companies are not invoking war/terrorism exclusions in
personal lines auto/homeowners' policies. Insurers are trying to contact commercial
insiders and building owners to determine status.

The DFO, located at Pier 90 (50th Street and West Side Drive), is now staffed by FEMA
personnel and personnel for all of the Emergency Support Functions (ESF) 1-12 and will
co-locate with SEMO and NYC staff.

75 National Guard personnel will be retrieving mail from the postal facility at 90 Church
Street on Monday. This task must be accomplished within 8 hours.

The first of five centers for un-needed donated goods will be opened at the Hudson
Psychiatric Center today.

Buildings Affected:
WTC buildings collapsed or partially collapsed 1,2,4,5,6,7, Marriott Hotel and
North Bridge. Buildings with major damage: 1 Liberty Plaza, American Express,
US Custom House, East River Savings Bank, N.J. Kallikow & Co., Millennium
Hotel, Federal Building, New York Telephone, 1,2, & 3 world Financial Center,
South Bridge, St Nicholas Greek Orthodox Church, 90 West St. and Bankers
Trust. (Map attached)

Utilities
Almost 1,900 employees are working around-the-clock. This team comprises
electric, gas, and steam field crews, as well as support staff, electrical
contractors, and company environmental, safety, and health personnel. The list
of equipment and materials provided by Central Field Services continues to grow
and, for security reasons, vendors and contractors must be approved and must
wear a badge.

Customers are informed of progress through the Customer Service call system
and press releases and statements to the news media. Representatives are also
staffing the city's Business Command Power at 80 Pine Street. Energy Services
has 80 representatives working with building operators on technical and
restoration issues. Communication with the OEM and other emergency services
continues to ensure that our employees work in stable, safe situations.

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Emergency Coordination Center (518) 457-2200 Webpage: www.nysemo.state.ny.us Fax (518) 457-9930
 Status of Electric System: The number of electric customers with-out electric
service has been reduced from more than 12,000 to about 9,300. Residential
and commercial customers whose power has been restored are being urged to
minimize their use of electricity while work continues. Streetlights are now on in
the Park Place area.

Status of Gas System the Company's high and low-pressure gas distribution
facilities systems have been re-pressurized following isolation from the disaster
zone. Gas Operations is getting assistance from Orange and Rockland,
contractors, and KeySpan to augment their own employees in restoring
customers. A command post with phone lines for customers to contact us for
arranging access is being established.

Status of Steam System: Steam has now been restored to two additional
sections-Church and Warren and Broadway between Chambers and Ann.
Customers are being contacted to see when they will be ready to accept service.
Steam customer outages have been reduced to 73.

Deaths and Injuries:

152 Bodies recovered: 92 identified
60 currently unidentified
24 Emergency Service Responders are confirmed deceased, including:
19 Firefighters
2 EMT's
3 Police
Missing: 4,972
These figures accurate as of 11:00hrs 9/15.

(The protocol for release of information relating to this topic ahas changed. Information
will only be released by the NYPD after consultation with the Medical Examiner's Office.
The report is released only once per day).

Transportation Systems:
The Brooklyn Bridge and Holland Tunnel remain closed. Brooklyn Battery
Tunnel open to MTA buses only. MTA buses operating in all Boroughs.
Checkpoint inspections are being conducted at the Triboro and Henry Hudson
Bridges and the Queens MidTown Tunnel. Limited subway service on several
lines (see-attached list of these and other MTA facilities).

School Status:
No Change since last report.

Search and Rescue Operations:

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Emergency Coordination Center (518) 457-2200 Webpage: www.nysemo.state.ny.us Fax (518)457-9930
 FEMA has 18 USAR teams, which includes dogs as well as structural, medic and
technicians. Operations continuing as previously reported.

New York City:

The New York City medical examiner released the first list Saturday of 39 names
of the confirmed dead from the World Trade Center attack.

New York City Building Department Inspectors will inspect additional buildings in
the disaster area will for structural stability.

City and state agencies in the financial district whose buildings have not been
affected will free up their space for businesses displaced by the disaster. One
City agency has already released 400,000 square feet of space of-space in this
endeavor.

The NYC Building Department will be expediting its' building permit process to
allow for more timely recovery.

The fencing of the area bounded by Chamber Street to Broadway to the north
side of Rector Street to the Hudson River is approximately complete at this time.
It should be completed today.

Five disaster medical assistance teams (DMAT) remain on site in the NYC area.
Personnel from the DMAT have been deployed to downtown NYC: one at
Chelsea Pier and one at Borough Municipal Community College.

As of 1600 on 9/15, 525 DMAT personnel have been deployed to the New York
City area to support the response; 162 are at NYC LGA Marriott; 252 at the
Stewart ANGB.

The disaster portable morgue unit has been set up at LaGuardia Airport. They
are in the process of being moved closer to ground zero.

44DMORT personnel are currently providing 24 hour support to the city medical
examiner.

Shelter and Feeding:

The Salvation Army
> Providing feeding and incidental assistance from 20 mobile canteens and 1
small "Quick Response" feeding unit.
> 2 additional canteens will be on site and ready for service on Monday
morning.
> Feeding 55,000 - 60,000 individuals per day.

ARC reports the following:

10 shelters open

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Emergency Coordination Center (518)457-2200 Webpage: www.nysemo.state.ny.us Fax (518)457-9930
 71 persons sheltered
15 fixed feeding sites
No report; meals and snacks served (9/14, 6pm -9/15, 6pm)

Staging Areas
Staging areas and locations supporting response activities:
> Stewart Air Force Base, Newburgh, NY
> Franklin & Church Streets - Large Equipment
> 80 Centre Street - Small Equipment
> New York City Staging areas:
Randall's Island
Shea Stadium

The Staging Area at 80 Centre Street is scheduled to be closed. One will open
in its place at the Jacob Javits Center.

A list of resources (as of last evening) that have been distributed, on hand and
en-route to the Stewart AFB Staging Area is attached.

State Agencies Involved in Field Operations

• State Emergency Management Office: Fully activated Emergency
Operations Center, with two 12-hour shifts. The day shift is comprised of 35
staff in the Incident Command, Operations, Planning, Logistics, and Finance
sections. Six staff remains assigned to NYC OEM; two with the SEMO
command vehicle and 3 at the Stewart Air Force Base.

• American Red Cross: In addition to sheltering more than 200 persons in 14

shelters and serving approximately 226,000 meals and snacks, the ARC has
issued 450 comfort kits and made 279 health service contacts.

• Aging: Case managers and volunteers have been insuring that hot meals
and water are being delivered to the upper floors of senior complexes on
Beekman and Fulton Streets

• NYS Department Of Agriculture: No additional requests have been

received requiring further action.

• Department of Correction: Will provide SEMO with four clerical staff for
rotating 12-hour shifts starting Monday 9\17\01.

• Education Department: no change from last report

• Emergency Medical Services:

Continuing to provide 20 ambulances to FDNY on a 24-hour rotation.
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Emergency Coordination Center (518)457-2200 Webpage: www.nysemo.state.ny.us Fax (518)457-9930
 Replacement ambulances have been scheduled through the middle of next
week. Stand-by ambulances will continue to be available until no longer
necessary.

The Director of Emergency Management from Connecticut advised that

Connecticut hospitals indicated that they treated approximately 20 walk-in
patients from the WTC incident. One individual was admitted to the Stamford
Hospital and the others were treated and released. Specific medical
conditions were not available. Working closely with our EMS staff at the NYC
OEM on several small issues throughout the night.

• Empire State Development: no change from last report

• Environmental Conservation: Division of Air Resources reports filter based

samples from ppm 2.5 monitors are being retrieved daily and transported to
Albany for analysis. DEC staff along with DOH laboratory staff will begin
additional analysis of the filters beginning this morning.

Division of Water has coordinated with USEPA, Region 2, on plans for

ambient water quality sampling. Sampling is expected at two points near
Battery Park in the lower Hudson. USEPA will also coordinate their efforts
with the Division of Fish and Wildlife/Marine resources, who are planning to
undertake additional fish flesh monitoring.

Division of Environmental Permits continues to work on Pier 25 MTS

Proposal which calls for the dredging of 90-100,000 cubic yards of sediment
from Pier 25 west of Chamber Street. The dredging will enable large tugboat
operators to assist with the WTC debris removal.

DEC continues to work with multiple NYC, State and Federal agencies on
issues concerning debris categorization, air monitoring, water impact issues,
reducing migration of potential contaminants from the WTC site, assessing
sites for storage of debris, assistance with enforcement of work control zones
and assessment of environmental issues. Division of Law Enforcement
(OLE) continues to provide additional site security at several potential threat
targets throughout NY State.

• Office of Fire Prevention and Control: Fire mutual aid resources from the
County of Westchester continue to be deployed in the city of NY. With 4
engine companies and 4 ladder companies. OFPC has 36 personnel actively
engaged at this time in support activities. FDNY indicates no need at this
time for additional mutual aid resources. Requests for structural inspection
support in NYC schools will be discussed with DOS Codes Unit Sunday AM.

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Emergency Coordination Center (518)457-2200 Webpage: www.nysemo.state.ny.us Fax (518)457-9930
 • Office of General Services: Grainger Industrial Supply will place a truck
stocked with critical materials within the restricted area to expedite support.
Grainger catalog available at OPS OGS Desk. OGS purchasing personnel
assigned on-site to support SEMO purchasing. OGS has set up a loaned
copy machine in the back room.

• Health Department: No change since last report

• Division of Housing and Community Renewal: has compiled a list of

projects with vacant housing units in the city.

• Insurance Department: continues to receive and log calls on disaster

hotline between 8am-8pm daily. FAQs listings are being established to post
on website. Contacted insurers to determine the claims handling for personal
auto, homeowners/tenants policies for clean up of dust and soot with no
other damage.

Insurance company catastrophe vehicle locations are as follows:

Allstate-SP Parking Corp. 735 6th Ave (between 24th & 25th Streets).
Contact: Ed Chaparro 847-910-5180 or Hector Fernandez 914-837-4917

Travelers-Corner of 14th St. & 10th Ave.

Contact: Ray Stone 860-985-349/860-841-0400

USAA-No vehicle. Catastrophe operations can be reached at 800-531-

8541 or 210-498-5686.

Total cumulative reported losses as of 6:00pm 9/15/01 is 1593. Insurance

companies are not invoking war/terrorism exclusions in personal lines
auto/homeowners' policies. Insurers are trying to contact commercial insiders
and building owners to determine status.

• Office of Mental Health: All NYS Office of Mental Health facilities in the New
York City and Long Island area are fully operational. OMH continues to
support OEM crisis counseling efforts and food supply to the 20 mobile
kitchens the Salvation Army is operating in the disaster area.
Mental Health is sending clerical staff to the Albany EOC.

• Office of Mental Retardation and Developmental Facilities: no change

from last report

• Military & Naval Affairs: National Guard will be processing credentials for
the Ground Zero personnel. Effective this date badges will be required to
enter the hot zone. The NG continues to support security and transportation
missions.

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Emergency Coordination Center (518) 457-2200 Webpage: www.nysemo.state.ny.us Fax (518)457-9930
 • New York State Research and Development Authority: No requests for
support for petroleum fuels has been received.

• Office of Parks. Recreation and Historic Preservation: Also secured 25-

30 tents and providing birthing at Riverbank State Park for the DSP.

• Public Service Commission:

Chairman Helmer has informed the PSC that the 140 West St. building has
been evacuated because of structural instability. Verizon's Toll Switch test
scheduled for 5:00pm 9/15/01 will take place at a later time.

• Salvation Army: The Salvation Army is providing food and incidentals to

workers from 20 Mobile Feeding Units and 1 small "Quick Response" feeding
unit. 2 additional canteens will be on site and ready for service on Monday
morning. The Salvation Army also reports that it has provided assistance to
over 300,000 individuals since the beginning of the operation. 18 Salvation
Army officers from upstate New York have been activated for deployment
early Monday morning. 27 trained trauma counselors are in place, at the
American Express Building, across from "Ground Zero", and are providing
counseling to anyone who is feeling the need to express their despair, fear,
loss or the need for a listening ear.

• State Police: Operations continuing as previously reported.

• Department of Transportation: Has 10 staff and 12 pieces of various

pieces of equipment on standby for deployment to the disaster area. Total
DOT resources deployed to the disaster area includes 51 staff and 58 pieces
of different equipment.

• Thruwav Authority: Thruway is providing 7, 6 Passenger Pickups with

drivers to work 24 Hours per day in NYC, transporting Emergency Response
Personnel as needed and directed by NYC EOC.

Federal Agencies:
No updated information

Other States
The state of New Jersey is opening a Compassion Center

Emergency Coordination Center (518) 457-2200 Webpage: www.nysemo.state.ny.us Fax (518)457-9930

 Surveillance Update
9-15-01

1 - Retrospective ER Surveillance: Retrospective review of all ER visits at 4 hospitals in

downtown Manhattan (Beekman, St Vincents, Bellevue and Beth Israel).

Status: Chart reviews complete at 3 hospitals. To complete Beekman today. Data entry
in progress. Preliminary summary report by this afternoon.

2 - Hospital Assessment: Daily updates from all city hospitals on ER visits (total and
incident related), admissions (total and incident related), deaths (incident related) and
staff/supply needs. Active ascertainment at the 13 hospitals closest to WTC (priority
hospitals); passive elsewhere.

Status: 9/13 priority hospitals completed surveys yesterday. 1572 incident related ER
visits to date; 6 deaths. Only minimal needs identified (3 staff for Cabrini; Td vaccine at
Downstate). No unidentified patients.

3 - Syndromic Surveillance: Surveillance on all ER visits to monitor for increases in

clinical syndromes that may represent WTC incident related illness or a secondary attack
of BT (unexplained pneumonia, fever/rash, respiratory distress, etc). Fifteen hospitals
participating, and EIS officers from CDC are providing 24-7 coverage to ensure all visits
are captured and to facilitate rapid data entry and analysis for disease clusters.

Status: EIS officers began on site surveillance last PM. All hospitals compliant. Data
entry and analysis from last night in progress. Initial report expected by this afternoon.

4 - Rescue Team Injury Surveillance: Injury surveillance among rescue team workers
was put in place at both the primary DMAT site near WTC and at Emergency
departments in lower Manhattan.

Status: Initiated on 9-14. Initial data summary this afternoon.

 09-15-2:001 02:54pm From-INPHO-HAN +7704886300 T-277 P.002/003 F-S96

Health Alert Network -

.-'rom: Health Alert Network
Sent: Friday, September 14,2001 15:17
To: Health Alert Network
Subject: Official CDC NE Region Health Advisory #1 - Sept 14,2001

This is an official
CDC Health Advisory

Protecting the safety of firsr responders and other rescue personnel in New York, Pennsylvania, and the District
of Columbia continues to be a high priority. CDC has received requests for information about management of
exposures to blood or other body fluids that pose a hazard for bloodbome pathogen (hepatitis B virus, hepatitis
C virus, or HTV) transmission. Routes of exposure to blood or other body fluids that merit evaluation include
percutaneous injuries with contaminated sharps, splashes to mucosal surfaces, and visible contamination of
injured skin. Post-exposure management systems should address:

1. Instructions to exposed personnel about reporting exposures and the need for evaluation at sites where
immediate post-exposure treatment services are provided;
2. Assessment and documentation of the nature and severity of the exposures;
3. Provision of post-exposure prophylaxis to prevent hepatitis B or HIV when indicated;
4. Referral for appropriate follow-up care.

Clinicians responsible for post-exposure care are reminded that the National Clinicians1 Post-Exposure
Prophylaxis Hotline is available for around-the-clock advice about assessing and treating occupational
exposures to blood and other body fluids that might pose a threat of hepatitis or HTV. There is no charge for this
service. Call either:

888-488-4911 (toll free) or 415-469-4417 (back-up).

The 24/7 hotline is staffed by experts at the University of California, San Francisco and San Francisco General
Hospital and is funded by the Health Resources and Services Administration and the Centers for Disease
Control and Prevention (CDC). Additional detailed information about post-exposure care after occupational
exposures to blood and body fluids can be found at <http://www.cdc.gQv/ncidQoVhip/gmde/phspep...h.trn>. In
addition, the University of California, Los Angeles and CDC have developed an interactive website
(www.needlestick.mednet.ucla.edu <http://www.neeQUestick.mednei.ncla.edu>) 10 help guide Clinicians in
making decisions about post-exposure care.

You have received this message based upon the Information contained within our emergency notification date base. If you have a different or
additional e-mail or fax address that you would like us to use please notify us as soon as possible by e-mail at heattnalefttScdc.Qov.
 09-15-2001 02:54pm From-INPHO-HAN +7704888300 T-277 P.003/003 F-696

Health Alert Network

rrom: Health Alert Network
Sant: Friday, September 14, 2001 21:08
To* Health Alert Network
Subject: Official CDC Health Update-End of WeaK Report - Sept.U, 2001

This is an official
CDC Health Update
CDC Health tJpdate-End of Week Report
Distributed via Health Alert Network
This report provides a brief update of CDC activities this week.

CDC Team
CDC has sent a total of 53 staff, including 35 epidemiologists, occupational health specialists, and other public
health professionals to supplement local efforts and provide expertise in matters relating to public health. The
epidemiologists will be assigned to hospitals to assist New York health officials and physicians to monitor
diseases; conduct a medical and health needs assessment; identify existing health problems, such as dust or
allergic reactions; and determine if there are new medical needs and if already deployed resources are better
used elsewhere. The team will assist New York City hospitals as directed by state and local health officials.
CDC staff also have special duties to watch for and help prevent possible secondary diseases, including
infectious disease and effects of dust and other debris. In addition, CDC personnel are assisting the city's rescue
vorkers who have been injured or exposed to health-threatening materials during their operations.

Supplies
CDC released one of the eight "12-Hour Push Packages" that are maintained in pre-packaged, pre-positioned
caches in secure storage facilities around the country. "Push Packages" contain Pharmaceuticals, intravenous
supplies, airway supplies,.emergency medication, bandages and dressings, and other materials to cover a
spectrum of medical needs. Each "package" involves several truckloads of materials and is intended to be
sufficient to respond to an emergency involving mass casualties. In addition, CDC provided 84,000 bags of
intravenous fluid and other intravenous supplies, as well as 350 portable ventilators and 250 stationary
ventilators.

Health Alert Network

CDC's Health Alert Network was used to distribute information to health officials in New York City and around
the country regarding incident response and technical issues. Twenty-four states have issued advisories through
their state-based Health Alert Network regarding increased surveillance.

Information
For further information regarding technical issues, please consult the CDC website at www.cdc.gov and click on
"CDC Recommends" in the left column.

For more comprehensive information on the HHS response, go to www.hhs.gov.

You have received this message based upon we information contained within our emergency notification data base. If you have a different or
additional e-mail or fax address that you would like us to use please notify us as soon as possible by e-mail at heatthalprtfflcdc.oov.
 NEW YORK CITY EMERGENCY NUMBERS LIST

Hospitals
NYC
Bellevue Hospital (462 1st Ave.) 2125624141
Beth Israel Med. Or. (170 E. End Ave.) 212 870 9000
Beth Israel Medical Center (16th St/lst Ave) 212 420 2000
Cabrini Medical Center (227 E. 19th St.) 212 995 6000
Chief Medical Examiner 2124472030
City Mortuary 2125623051
Cornell Medical Center (525 E. 68th St.) 212 746 5454
Hospital for Special Surgery (535 E. 70th St.) 212 606 1000
Hospital for Joint Diseases (301 E. 17th St.) 1 888 453 3627
Lenox Hill Hospital (100 E. 77th St.) 2124342000
NY Eye & Ear Infirmary (3 10 E. 14m St.) 2129794000
NYU Downtown (Beekman, 170 Williams St.) 1 888 698 3362
NYU Medical Center (Tisch Hospital, 560 1st Ave.) 2122637300
St. Vincent's Catholic Medical Center, Staten Island 718 354 6300
St. Vincent's Hospital (7m Ave. & 12th St.) 2126047000
St. Vincent's Patient Information Line 2126047285
US Veterans Med. Or. (423 E. 23 St.) 2126867500
NEW JERSEY
Christ Hospital (Jersey City) 2014182710
New Jersey Medical Center 201 915 2000
St. Francis Hospital (Jersey City) 2014182711
St. Mary's Hospital (Hoboken) 2014182712

Mental Health Services

English LifeNET (DOH) (800) 543-3638 or 212 995 5824
Spanish LifeNET (DOH) (877) 298-3373 or 212 533 7007
Chinese LifeNET (DOH) (877) 990-8585 or 212 254 2731
St. Vincent's Hospital 212 604 8220 (Grief Counseling/Volunteers)
Bellevue Hospital 212 562 4877/3120 (Crisis Hotline)
Red Cross 2127871000
Metropolitan Hospital Center 2124236262
Westchester 914 925 5320
Ackerman Institute for the Family 2128794900
American Psychological Association 1 800 964 2000 (Public Education Info. Line)
City University of NY - Volunteer Line 2127945588
Department of Mental Health Services 2124425000
FDNY Family Crisis Center 718 352 2140
Friends, Inc. (Mott Haven, Bronx: 9-6) 718 401 6603
Jewish Board of Family and Children's Services 212 397 4090 (Main Number)
Brooklyn Jewish Board, 57 Willoughby Street (718) 855-6900
Bronx Jewish Board, 750 Astor Avenue (718) 882-5000jiress 0 for operator
Manhattan Jewish Board, 120 W 57th Street (212) 397-4250
Queens Jewish Board, 243-02 Northern Blvd. (718) 423-6200, press 0 for operator
Riverdale Jewish Board, 4049 Henry Hud. Pkwy (718) 549-6900, press 0 for operator
SI Jewish Board, 2795 Richmond Avenue (7 1 8) 76 1 -9800, press 0 for operator
Lincoln Medical and Mental Health Ctr. (Bronx) 7185795000
NY Presbyterian Hosp. (Westchester) 1 888 NYH 5700
NY Presbyterian Hosp. (Westchester) - Schools and 9149975779
Organizations
Port Authority 71 8 751 8200; 973 642 0165

New York City Department of Health September 15, 2001, 6:00 P.M.
American Airlines 1 800 245 0999
United Airlines 1 800 932 8555

Emergency Health Numbers

CDC Emergency 770 488 7100
Emergency Preparedness - PHS 3014432401, 1167
New York Greater Hospital Association 212 506 5401; 917 451 0336 (Doris/Contact Pager)
FBI Hotline 212 324 3000
FBI Tipline 18664835139
Medical Examiner ID Line (For NYPD, not Gen. Pub) 2124472713
Medical Examiner Main Office (") 2124472030
New York State Disaster Assistance 1 800 462 9029
NYCDOH Burial Desk 9262150,3686538
ISS^St/S^Ave Fax: 926 2526
NYCDOH Poison Control 212 POISONS
NYPD Tipline 718 765 4300

Informational Websites and Phone Numbers

FBI Website www.ifccfbi.gov
Court Issues 1 800 COURT NY
Port Authority Info. www.panvni.com
Port Authority Employees Call 1 973 565 55017 5502/ 55037 5504
Stranded NYC Visitors www.nvcvisit.com
NYC Tourism Board (stranded visitors) 212 484 1222
New York Great Hospital Association Website
United Way www.uwnvc.org
Department of Defense www.defenselink.mil/news/releases/html
BOGUS WEBSITE http://www.nv.com/wtclist.html

WTC Firms' Information Lines

To report a person who 's safe 212 704 8188
AON Corporation 18662564154
Brown and Wood 1 800 464 8555
Cantor Fitzgerald 212 940 81627 84827 8492; 212 893 6073
CARR Futures 1 800 755 7620; 312 762 7677 (Chicago)
CIBC World Market 2128566000
Commodities Futures Training Commission 1 800 765 3277
Delloite & Touche 1 888 243 7666
Empire Blue Cross/Blue Shield 1 8667618265
Fiduciary Trust Co. International 1 800 632 2350
FUJI Bank 1 888 537 FUJI (3854)
HSBC Investment Bank 1 888 386 4722
Instinct Employee Hotline 3107549
Keefe Bruyette & Woods 1 800 726 0006
Kemper Insurance 1 800 622 9966
Lee Hecht Harrison 201 782 3704
Marsh & McLennan; Mercer, Guy Carpenter, 2123456000
Seabury & Smith and MMC Enterprise Risk
Maxcor Financial 212317 1000
Merrill Lynch 1 877 637 9040
Morgan Stanley 1 888 883 4391
Pitney Bowes 1 8009323631
Windows on the World 1 8772265170
Thatcher, Profitt, Wood 1 800 698 4567

New York City Department of Health September 15, 2001, 6:00 P.M.
Radioactive Material in the Remains of the World Trade Center

The New York City Department of Health (DOH) has determined that there are five
known radioactive sources in the WTC remains, as follows:

Two 1O mCi 63 Ni sealed sources

One IS mCi 63 Ni sealed source
Approximately 1000 Ibs of depleted uranium in each of the two airliners.

We have determined that these sources represent no hazard to responders in turn out gear
and respirators, but would like to locate the sources and dispose of them in a lawful and
safe way.

To do this, we have requested the assistance of the US Department of Energy (DOE) and
the Army National Guard.

DOE (RAP) has suggested to monitor the pile of rubble from its edges from time to time,
as more material is removed—using their most sensitive instruments— to find the sources
before the workers get to them.

In addition, we have asked the Air National Guard to provide 24/7 radiation monitoring
teams with scintillation detectors at the point where trucks loaded with remains will leave
the site. These probably would be the hose-down sites. These detectors would be used to
survey trucks as they are, without unloading them, which should take about one minute
per truck. If a "hot" load is found, it will be parked for analysis by DOH or DOE, then
sent to NYC Sanitation radioactive waste storage sites in Brooklyn or the Bronx for
further study and testing. At some final point this material will be disposed of as
radioactive waste or returned to the manufacturer if undamaged.
 NEW YORK CITY DEPARTMENT OF HEALTH

PUBLIC HEALTH ADVISORY: HEALTH OF RESCUE PERSONNEL

What risks do human body parts found inside of exploded and collapsed buildings pose
to rescue workers?

There is no threat of a general outbreak of infectious disease among workers at the site. You may be
at risk for infection if you cut yourself with an object contaminated with blood, body fluids or tissue,
or if these materials touch your eyes, nose or mouth or areas of broken skin. Bad odors that come
from decomposing bodies, although unpleasant, are not harmful.

What should I do if I'm injured or splashed?

Immediately report to your supervisor any injuries or splashes to eyes, nose, mouth or broken skin by
blood or body fluids so that appropriate medical evaluation and care can be provided. Infections can
be prevented if you follow appropriate precautions.

What precautions should rescue workers take?

Do not touch bodies or body parts directly. Rescue workers who expect they might have direct
contact with human remains should do the following:

• Wear heavy-duty waterproof gloves to protect against injury from sharp objects.
• Use eye protection and respirators equipped with OVAG cartridges to protect eyes, nose,
and mouth from splash exposures and noxious odors.
• Wear protective garments to protect skin and clothes.
• Immediately wash hands with soap and water after removing gloves.
Alcohol-based hygiene products are a useful substitute only when hands are not
visibly soiled.

How can my overall health be affected from exposure to decomposing remains?

Seeing decomposing remains can cause emotional trauma, grief, anger and sadness. Immediately
after the disaster, it will be normal for you to feel:

• Numbness • Denial or shock

• Flashbacks and nightmares • Grief reactions to loss
• Anger • Despair
• Sadness • Hopelessness

What should a rescue worker do if he or she experiences emotional distress?

Several studies following the Oklahoma City Bombing found that many rescue and relief workers
experienced emotional distress. However, many did not believe they needed help and would not seek
services despite feeling emotional distress. It is important to get help by talking with family, friends,
religious leaders or neighbors if you are feeling:

• Normal emotional responses such as grief, anger, guilt, shame, helplessness, hopelessness,
and emotional numbness.
 9/15/1 5:38 pm
NEW YORK CITY DEPARTMENT OF HEALTH

ADVISORY: HEALTH OF RESCUE PERSONNEL

What risks do human body parts found inside of exploded and collapsed buildings
pose to rescue workers?

You may be at risk for infection if you cut yourself with an object contaminated with
blood, body fluids or tissue, or if these materials touch your eyes, nose or mouth or areas of broken
skin. Bad odors that come from decomposing bodies, although unpleasant, are not
harmful. There is no threat of a general outbreak of infectious disease among workers at
the site.

What should I do if I'm injured or splashed?

Immediately report to your supervisor any injuries or splashes to eyes, nose, mouth or
broken skin by blood or body fluids so that appropriate medical evaluation and care can be
provided. Infections can be prevented if you follow appropriate precautions.

What precautions should rescue workers take?

Do not touch bodies or body parts directly. Rescue workers who expect they might have
direct contact with human remains should do the following:

• Wear heavy-duty waterproof gloves to protect against injury from sharp objects.
• Use eye protection and respirators equipped with OVAG cartridges to protect eyes, nose,
and mouth from splash exposures and noxious odors.
• Wear protective garments to protect skin and clothes.
• Immediately wash hands with soap and water after removing gloves.
o Alcohol-based hygiene products are a useful substitute only when hands are not
visibly soiled.

How can my overall health be affected from exposure to decomposing remains?

Seeing decomposing remains can cause emotional trauma, grief, anger and sadness.
Immediately after the disaster, it will be normal for you to feel:
• Numbness • Denial or shock
• Flashbacks and nightmares • Grief reactions to loss
• Anger • Despair
• Sadness • Hopelessness

What should a rescue worker do if he or she experiences emotional distress?

Several studies following the Oklahoma City Bombing found that many rescue and relief
workers experienced emotional distress. However, many did not believe they needed help and
would not seek services despite feeling emotional distress. It is important to get help by talking
with family, friends, religious leaders or neighbors if you are feeling:
 9/15/1 5:38 pm
NEW YORK CITY DEPARTMENT OF HEALTH

• Normal emotional responses such as grief, anger, guilt, shame, helplessness, hopelessness,
and emotional numbness.
• Confusion, disorientation, indecisiveness, worry, shortened attention span, memory loss,
and difficulty concentrating.
• Physical reactions such as tension, fatigue, edginess, difficulty sleeping, body aches or
pain, nausea, change in appetite, being startled easily, change in sex drive and racing
heartbeat.
• Interpersonal problems such as distrust, irritability, conflict, withdrawal, isolation, and
feeling rejected or abandoned, being distant, judgmental, or over-controlling.

Or

If you experience Post-Traumatic Stress Disorder, which is less common and could include:
• Feeling as if you or the world is unreal.
• Re-experiencing the event during the day or as nightmares.
• Being frightened of leaving home or losing interest in normal activities.
• Feeling prolonged and increased anxiety, nervousness, or fear of losing control.
• Abusing drugs or alcohol.

If these feelings remain longer than a month, we urge you to seek help from medical or mental
health professionals, or disaster service organizations like the American Red Cross.

American Red Cross (212) 787-1000

English Life NET (800) 543-3638
Spanish Life NET (877) 298-3373
Chinese Life NET (877) 990-8585

Do I need to contact law enforcement about any remains found?

Yes, in the setting of a disaster, remains should be brought to the attention of appropriate
law enforcement and forensic representatives for identification.
 sa
i&as* PERSONAL SAFETY & HEALTH PROTECTION
RECOMMENDATIONS
FOR SEARCH AND RESCUE PERSONNEL

Personal Protective Equipment (PPE)

All personnel in the work area should wear the following:
• Hard hats
• Steel-toed/heavy duty work shoes
• Long pants and long sleeve work shirts
• Safety glasses/eye protection
• Respiratory protection
S Ground zero: approved respirator (P-100)
^Other areas: dust mask (N-100/R-100)
Work Area Safety Concerns
• Watch surroundings at all times
• Be alert for materials and debris that may fall from damaged buildings
• Be aware of walking and working surfaces (slip/trip/fall hazards)
• Cap and secure unused pressurized cylinders
• As far as practical, try to keep the generation of dusts to a minimum
• Use the buddy system
Work Area Health Concerns
• Clean respirators and eye wear as frequently as possible
• No consumption of foods that have not been covered or properly sealed
• When leaving work area:
S Dust off clothing
•S Clean or scrape off shoes
•S Wash hands and face
Heavy Equipment Operations
• Stand clear of operating equipment and vehicles
• Avoid entering crane swing'radius
• Use tag lines when lifting loads
• Use spotter during lifting operation and for personnel safety in area (no lifting over personnel/equipment)
• All equipment operators wear proper PPE when leaving equipment (see above)
• Be cautious of operating speeds in work areas and especially when leaving the area
•S Recommend speeds no faster than 10 mph until outside hazard areas

EMERGENCY SIGNALS
IMMEADIATELY STOP WORK/EVACUATE AREA: Three (3) repeated short
blasts of siren/air horn
STOP WORK/REMAIN SILENT: One (1) long blast of siren/air horn
RESTART WORK: One (1) long and two (2) short blasts of siren/air horn
 Clinical/ Environmental Committee Weekend Coverage
9/15-16/01

Saturday day
manager: Katherine Kaye
Jim Miller
MD: Rachel Kramer
Bob Carlin
Environmental specialist: Jessica Leighton
Food/water/radiation: Allan Goldberg
Administrative staff: Andrew Faciano

Saturday night
manager: Andy Goodman
MD: Jo-Ann Bennet
Deborah Berg
Environmental specialist:
Food/water/radiation: Jim Luke (at IS89, 212-941-5352)
Administrative staff: Amy Auchincloss

Sunday day
manager: Andrea Lyman
MD: Bob Carlin
Baah Asante
Environmental specialist: Jessica Leighton
Food/water/radiation: Elliot Marcus
Faina Stavinsky (at IS89, 212-941-5352)
Administrative staff: Amy Auchincloss

Sunday night
manager: Deborah Berg
MD: Steve Friedman
Environmental specialist: Jessica Leighton
Food/water/radiation: RayNieves (at IS89, 212-941-5352)
Administrative staff: Carla Rodriguez
 New York City Departments of Health and Mental Health News
September 16, 2001
g TERRORISE ATTACKS
;u»ly
Recovery Raises
Health Concerns
By Laurie Garrett,
Graham Rayman
and Sean Gardiner
STAFF WRITERS
As New York enters Day Five of its terror-
ist catastrophe, health and police officials
are stepping up efforts to protect the living
and deal with the dead.
Rescuers are racing the clock, trying to dis-
inter bodies before rot sets in, which could
be a source of disease and render body parts
unidentifiable.
Friday's cool rains, which could promote
decay, raised worries about the status of the
bodies and the safety of rescuers.
"I don't think it's an urgent public health
issue as much as it is a search and recovery
issue," New York City Health Commissioner
Neal Cohen told Newsday. "I know it impacts
on the time it will take to execute recovery."
But as time goes by, Cohen said, "longer
range we have to look at water as a potential
source for [health] concerns. And we're going
to address it."
Concerns about infectious diseases — both
in terms of rotting bodies and potential biot-
errorism — have led health officials to create
an aggressive citywide disease surveillance
net. And fears that radiation from medical
equipment may be in the rubble have prompt-
ed special surveys around ground zero.
The city Health Department and the medi-
cal examiner's office have been supplement-
ed with federal and regional staff. On Friday,
34 Epidemic Intelligence Service officers ar-
rived from the national Centers for Disease
Control and Prevention in Atlanta to help
track city disease trends. A CDC officer will
be posted in each major hospital in the city.
The Health Department is leading this ef-
fort from a slapdash setup inside the old
Public Health Laboratories Building at First
Avenue and 26th Street, having been forced
to abandon its downtown facilities Tuesday.
Across the street, outside the medical ex-
aminer's office, somber-faced police officers,
wearing medical garb over their uniforms,
huddle outside the facility on First Avenue.
These officers, as well as detectives and
correction officers, are assigned to perhaps
the worst job in the operation: morgue detail.
While relatives of the missing fill out de-
tailed missing-persons reports at the citv ar-
^varw-j^.w™..
.f^KVIf^flxUKKf
^*uajr
mory, the morgue detail undertakes the grim
process of attempting to identify the bodies.
Because of the nature of the work, the of-
ficers will be rotated.
"It's a day-by-day thing," a police official
said. "You have to understand that people
will lose their minds doing this. Even the cop
who has 20 years on the job, who has been at
homicide scenes, can't do this day after day."
Items removed from the body are all cata-
loged, placed in evidence bags and marked.
Officials at the temporary morgues are
coming across a large number of tiny body
parts, police sources said. In one case, they
cataloged a lung. ',
A more hopeful mood prevails at the
Health Department, where, so far,
worst-case scenarios have not played out.
There is no evidence of bioterrorism, Dr.
Marcelle Layton said, though her surveil-
lance team remains on alert for such agents
as anthrax, smallpox and plague.
City health workers, along with the recent-
ly arrived CDC scientists, are monitoring
every hospital in the five boroughs for unusu-
al disease trends. In particular, they are
looking for signs of clusters of encephalitis,
pneumonia, respiratory disease and acute
neurological problems.
"We are most concerned about those brave
souls who have to be down there 24 hours a
day, in rescue operations, and will be for
weeks to come," said Layton, who normally
heads the city's infectious diseases depart-
ment. "We are starting today to set up a spe-
cial surveillance to look at diseases in those
[rescue) groups."
Dr. Patrick Meehan, director of the CDC's
National Center for Environmental Health,
arrived Friday to assist Layton. He said the
key disease concerns for rescue workers are
blood-borne pathogens, such as hepatitis
and HIV. To prevent exposure, Meehan
said, all rescue workers should wear latex
gloves, goggles and hepafilter masks.
Another potentially serious problem is ra-
dioactivity from medical devices that were in
the buildings, said the city's Associate Health
Commissioner Kelly McKinney. The Nuclear
Regulatory Commission flew radiation sur-
veillance missions over the area Thursday,
finding nothing worrisome. But nevertheless
McKinney said the health department will Rescue workers lift a body from the rubble at the World
steo UD radiation monitnriniy .SaturHav
6r1<niONALAID

Bell^ue^sychiatry Chief£reatesAction Plan to Tame

By ROBIN POGREBIN
When Dr. Manuel Trujillo got
home to his East Side apartment late
Tuesday night, there were 39 mes-
sages on his machine from, friends
and family menibers expressing con-
cern or wanting to talk. Many had
called from his native Spain.
To Dr. Trujillo, 55, director of psy-
chiatry at Bellevue Hospital Center,
the messages attest to the factsthat
the disaster at the Twin Towers'has
the potential to affect everyone the
world over. So many now feel help-
: less. So many will need to heal.
To help begin the healing, Dr. Tru-
jillo has spent the last four days
directing teams of doctors from his
hospital to fan out around New York
City, counseling people in how to
i cope now and prepare fbir later.- ^.
I to a certain perverse way, this is
the easy part. Dr. Trujillo said. Peo-
ple are being swept along by the
'• swirl of staggering events, trying to

4 ! find answers in the company of oth-

• ers seeking the same. The worst, he
warned, is yet to come — when peo-
, pie,are,ieft,with the quiet,.terrible
*,-•#•,•..->-,*,T 4-..- -* '• v-" r^"n"sR*em'orll"'
Dr. Manuel Trujillo, director of psychiatry ^at Bellevue Hospital
isaid that the worst was yet to come: the task of facing a
• task of. facing loss alone. ^Sv^j^
.»V,/.$/3ftj)ber..will be,worse,",jhe.said.
"Thereality of their Josses begins to .
;WetehX '•-' -i^Ki^-jA".'-. •
iTrying to'
"aunting
'a slight, couray«ian[?iWio wears a
jacket Wd^lp^leaks %ith .$
; heavy iSp'ai^^coMf ^appears to . .„-:^..--,,.^-t.,«., ywufi.fjjiyc I
. ;haye _beOT,prepanng his whole pro-1! ^help pepple;recqye.r,;their..l/m,
'fessibnai'iife. for a' crisis of this mag-' i'.'; Counselors must walk a^fii
..tft^mms&.^f-™-'- *M;-:.'f." rDr..~Trujillo-said, --berweea
^B<P^§^e;rthetson 6i a;veteri- • available to those whojirdfstu
- .1 'nanari"and a housewife, .Dr; Trujillo and leaving them alone.N'fJh;]
;'.•• tapae.to the United States;in 1970 to riasset up two244our 1
^counsefing:J(212)5t) -da>"night af.^he,69th,.R ""
xlp his residency at Pilgrim Psychiat- ^mory.ohi Lexington j'Avenue. :-aaove^,
'ric Center in.West3rentwood, N.Y., "My responsamtviS^n* ' :.25th Street,-where family meinbers*%
and then at the .'Albert Einstein: Col- had crowded to find out;lnforma<wn: ^
lege of Medicine in the Bronx. about their loved onpsfin;a <L~r«^!--"
'',:.; He has been a professor of clinical
psychiatry at several area universi-
ties, and in addition to heading Belle- f over guidelines f
vue's psychiatry department, a posi- T:-OUS populations .
tion he has held since 1991, he is vice
chairman of the. psychiatry depart-
,meht at New York University.. ' ,
Despite all his training, Dr. Truji-
llo said nothing could have prepared
v
him for the events of the last several i-Health and various. me
days. "In my worst .nightmare, I
would never have .considered this clergy, i. .-nsni.; '/ii^tteiaimcs
would happen/'.he said. ...:..'.~._;• -! 'Despite the best intentions;, ttys^
Yet to watch Dr.jTrujillp inove efforts seemed chaotic>at;best, wfUi
around Bellevue is to observe a man i mental health professionals, circulat-
in control, concerned but not frantic, ing but rarely if even engaging. ^Dri
still able to greet his co-workers with -- —0. .v ul ule peo_ Trujillo said this ,.was oinderstand-
conversation and a smile.
Dr. Trujillo said he and his team
•SfSS'gSXEi momentous. "-You'never know:
had tried to be flexible in determin-
ing the greatest area of need for their
'$?;&&}<& how much people want you, so you'
have to tentatively dance around it'
services. When doctors were crying
cssyrffiaJVS till you find the rhythm and the melo-i
f«y in how to deal witlTit,"-'he said '•
•"'That will take a little time." t- 'j
New York Post, Saturday, September 15, 2001 ! hypost.com
 Rooftop Potable Water Tanks Reoccupation Advisory

Now that buildings are ready to be reoccupied by residents in the area below Canal Street the
Department of Health would like to remind the public that potable rooftop water tanks are required
to be inspected annually by a permitted rooftop tank inspector or a licensed plumber in accordance
with Article 141.03 of the New York City Health Code.

It is recommended that building owners or those buildings operated by a management company that
have a rooftop potable water tank have their tank inspected as soon as possible and that the tank be
drained and refilled as a minimum before reoccupation occurs. Residence are urged to run all of the
water faucets in their apartments as soon as they reoccupy. ^

If you have any questions or concerns please call (212) - For further information.
 THE CITY OF NEW YORK
DEPARTMENT OF HEALTH
Rudolph W. Giuliani Neal L. Cohen, M.D.
Mayor Commissioner

nyc .gov/health
' Health & Safety Precautions for Rescue Workers

•S Cover all body surfaces. This includes wearing:

• Coveralls
• Gloves
Goggles
• Water-impermeable footwear ^

•S Use respiratory protection and make sure someone checks the fit of the mask. A respirator that does not fit
correctly provides no protection (* see footnote below).
• Do not eat, drink, or smoke before properly removing respirator and gloves AND washing your
hands.
r\-{^f&V^A/lAv y* \^f - •"• j~s_ .q - » - - i

Avoid dehydration: Drink enougn fluids BO that you are urinating every 4 hours. Don't wait until you are
thirsty.

•S Follow decontamination instructions AND wash your hands before eating or smoking.

•S Follow decontamination instructions AND wash your hands before (and after) using the toilet.

/ Leave the site immediately and go to first aid station if you:

• develop signs and symptoms of heat exhaustion or heat stroke:
if you feel cold and sweaty, are overheated, have an irregular or fast heart rate, are nauseous, or
become confused
• have chest pain
• are short of breath or have difficulty breathing
• become physically or emotionally exhausted
• are bleeding or if someone bleeds on you
• if blood, body fluids or tissues contact your eyes, mouth, nose, or any non-intact skin
• and when you need to change clothing

S Before going home, remove contaminated clothing and wipe your footwear. Don't bring your
contamination home with you!

S When you get home, remove clothes immediately and place in a plastic bag until washing. Launder twice-
separately from other laundry. Wash off shoes and other items, then throw the sponge away in a plastic bag.

* Checking the fit requires, at a minimum, a negative pressure test and a positive pressure test. For a cartridge respirator,
check the negative pressure by covering the cartridges fully with your bare hands. Suck air in using your lungs. You should
feel a tight suction around the seal of the respirator. For a positive pressure test, cover the exhalation valve fully and blow
out. You should feel the respirator puff out without air escaping from the seal. If either test fails, try adjusting the tightness of
the strap or select a different size respirator.
 "In

Moving Back In

[Items 1-3 are excerpts from NYSDOH draft booklet on planning for and weathering
floods, storms and power outages that might be helpful for WTC Disaster.]
t
1. Cooking on "portable" grills or camp stoves

In the event of a power outage or interruption of gas service, never use a

grill or camp stove in the house because dangerous carbon monoxide
fumes could build up and cause illness or even death.

2. Safety of stored foods

Generally food in the refrigerator will remain cold for four to six hours if the
door isn't opened. A full freezer will stay frozen for two days; a half-full
freezer for about one day. After a prolonged power outage, go through
your refrigerator and freezer and discard food that was not kept cold
enough. The key to determining which food is safe to eat is knowing the
temperature at which the food has been kept. The refrigerator should be
40 degrees Fahrenheit or below.

Remember the general rule: When in doubt, throw it out!

Refrigerated Foods: Keep or Eat?

There are foods that some people store in the refrigerator that also can be
kept out at room temperature for a few days. If you have any of the foods
listed below stored in your refrigerator and the temperature in your
refrigerator goes above 40 degrees, these foods should be okay.

• Butter and margarine

• Hard cheese
• Fresh fruit and vegetables (except fresh sliced fruit and raw
sprouts)
• Fruit juices
• Dried fruits and coconut
• Fresh herbs and spices
• Opened jars of vinegar-based salad dressing, peanut butter,
jelly, relish, taco sauce, barbecue sauce
• Mustard, ketchup and olives
• Fruit pies

Throw away moldy items or food with an unusual odor or appearance.

Throw away the following foods if they have been above 40°F for more than 2
hours.
 z*H
o

• Raw or cooked meat, poultry and seafood

« Meat-topped pizza, lunchmeats
• Casseroles, stews or soups
• Milk/cream, yogurt, soft cheese
• Mayonnaise, tartar sauce, or creamy dressings
• Cooked pasta, potato, rice, and salads prepared from these foods
» Refrigerator and cookie doughs
» Fresh eggs, egg substitutes
• Cream-filled pastries (home-made only)
• Custard, chiffon or cheese pies
• Gravies

Frozen Foods: Keep, Eat orRefreeze?

Despite your best efforts, the food in your freezer may partially or
completely thaw before power is restored. Foods may be safely cooked
and eaten or refrozen if they still contain ice crystals. Foods that have
completely thawed, but are still cold and have been kept cold for no longer
than 1 or 2 days after thawing - may be eaten or refrozen if the following
criteria are met:

Fruits-may be eaten or refrozen if they still taste and smell good. Fruits
beginning to ferment are not dangerous to eat, but will have an off-flavor.

Vegetables-should not be eaten or refrozen if thawed completely since

bacteria multiply rapidly in these foods. If ice crystals are present, eating
or refreezing is possible.

Meat and poultry-should be discarded if the color or odor is poor or

questionable or if the meat has been warmer than 40°F for 2 hours.
Unspoiled meat may be cooked and then eaten or refrozen.

Fish and shellfish -should not be eaten or refrozen if thawed completely

since these foods are extremely perishable. You may eat or refreeze if ice
crystals are present.

Frozen dinners - keep refrigerated and cook as soon as possible.

Ice Cream - discard.

3. Food safety precautions in the event of prolonged power outage

In the winter, do not put your food outside to stay cold. Putting food
outside is not advisable for a number of reasons. First, the temperature
that is good for refrigerated foods (40 degrees or less) is too warm for
frozen food which should be between 0 and -10 degrees F, and vice
versa. Secondly, the sun could warm the food to too high a temperature
causing bacteria to grow. Lastly, animals could get into your food and
contaminate it.
i
Eat the most perishable items first, such as leftovers, meat, poultry and
foods containing milk, cream, sour cream or soft cheese.

The freezer should be between 0 and -10 degrees F. Keep what cold air
you have in your freezer inside. Don't open the door any more than ,
necessary. You'll be relieved to know that an unopened full freezer will
stay at freezing temperatures about 2 days; a half-full freezer aboufl day.
The kind of food in the freezer makes a difference. For instance, foods
with a high water content, such as meat or fruit, will stay frozen longer
than food with a low water content, such as bread.

If your freezer is not full, group packages so they form an "igloo" to protect
each other. Place them to one side or on a tray so that if they begin
thawing, their juices won't get on other food. And, if you think power will be
out for several days, try to find some dry ice (see box below).

How Much Dry Ice to Buy for Your Freezer

How Big How Full How Much How Long
is the is Dry Ice to Will Food
Freezer? Freezer? Buy? Stay Safe?
10 cubic Full 25 pounds 3 - 4 days
feet
10 cubic Half Full 25 pounds 2-3 days
feet
18 cubic Full 50-100 2 days
feet pounds
18 cubic Half full 50-100 Less than 2
feet pounds days
 4

Handling Dry Ice

Handle dry ice with caution and in a well-ventilated area. Don't touch it with
bare hands; wear gloves or use tongs.

If there are widespread power outages, emergency officials may be

distributing dry ice. Check for central distribution points.

To locate a distributor of dry ice, look under "ice" or "carbon dioxide" in the
phone book.

Wrap dry ice in brown paper for longer storage. One large piece lasts longer
than small ones. In upright freezers, place dry ice on each shelf.

The temperature of dry ice is -216 ° F; therefore, it may cause freezer burn on
items located near it or touching it. Separate dry ice from the food using a
piece of cardboard.

Fill partly empty freezers with crumpled paper to lessen air currents, which
cause dry ice to dissolve.

Cover the freezer with blankets, adding crumpled newspaper for added
insulation. Be sure air vent openings are left open to allow gas from dry ice to
escape. In addition, the power may be restored and ventilation will be
needed.

Although dry ice can be used in the refrigerator, block ice is better. If your
refrigerator's freezer is thawing out, you can put the block ice in the
refrigerator's freezer along with your refrigerated perishables such as
meat, poultry, and dairy items.

4. Cleaning

5. Operating air conditioners or window ventilation units

6. Restarting HVAC systems

7. Inspecting and servicing rooftop water storage tanks

NYSDOH suggestion: Inspection for integrity of tank and system should be
required. Other annual maintenance (e.g. draining, cleaning?) is
recommended.
Bureau Liaisons for Health Centers Managers
September 17,2001

If you need to contact a NYCDOH Bureau representative with questions and or

instructions regarding staff who present at your borough-based health centers, please
contact the person listed below at (212) 213-1694 or (212) 213-1666.

Family and Community Health: Scottie Owings-Leaks

Disease Intervention: Deborah Mack
Medical and Professional Education and Training: Roberta Gonzalez/Janice Smith
Regulatory and Environmental Health: Diana Lament
Health Care Access: Jim Capoziello/Joyce Weinstein
Health Support Services: Georgia Davidson
Community HealthWorks: Not Applicable
Public Affairs: Not Applicable
Legal Affairs: Not Applicable

Please note: It is essential that all staff sign-in and you collect contact information for each
person.
 Shelter Client Usage

Shelter 9/11-12 9/12 9/12-13 9/13 9/13-14 9/14 9/14-15 9/15 9/15-16
9P-9A 9A-9P 9P-9A 9A-9P 9P-9A 9A-9P 9P-9A 9A-9P 9P-9A
# clients # clients # clients # clients # clients # clients # clients # clients # clients
Seward Park 3 11 6 9 3
HS 3, C ' ^~~

Washington 2 75 20 36 38
Irving HS 11 J 3^
1 //3
Fashion 5 4 20 31 21
Industry HS (+8 tourists)
Chelsea HS 3 9 1 1 0 + used for
emergency
workers
respite 6 Z /3
Norman
Thomas HS
7 20
13 ..5' ~?^
City School HS 3-5 6 7 6 8 2 + used for
construction
crew respite •3 / ' 3
JHS22 0 2 4 3
.3 0
C
£
IS 131 10 8 6 10 10
Ik £ /^
Comprehensive
Day&Night HS
Bayard Rustin
0

6
0

Closed
0

Closed
0

Closed
~%a£Sl/'
//Closed
* / "
Closed
5"
Closed
HS

Curtis HS, SI ~+100 kids 2 0 0 Closed

Qo&^ C/i(Q&b 6&W
Westinghouse 2 0 0 p
HS, BK O /3^? ~
 9/11 Personal P r i v a c y

MAYOR'S CITY AGENCY HOTLINE

Where: OTB Site, 1501 Broadway (near 45? Street), 8th Floor
JiA^U*^7! ' • ''••
When: ayatsdm, 24/7, until... \l Spadaro, 917-559-6968 (beeper),[
Contact:

Need: Supervisory Presence & 10 Staff to answer phone

All City agencies will be represented; DOH staff is needed

24/7, to answer public health concerns about birth

certificates, etc.

A list of staff that will report on Monday, Sam, should be faxed to Bill Spadaro.
WTC RESCUE TEAM INJURY SURVEILLANCE—Summary data
(As of 9/15/01 20:00 hrs)

Facilities missing: Beth Israel and St. Vincent's

Injury type by medical facility.

tH! fOBlsxys prat
^wespsjsf -yggyr^o-j'pgfr Ww">«tv*£:'5=SJ?V3*:=!55ss3S5f:
NXDJBeekman
Contusion 4 1 3

Eye irritation/Injury 12 1 8 3
Fracture 2 2

Laceration 9 4 5

Other 25 1 18 6
Psychological stress 1 1

Skin irritation/Rash 6 6

Smoke/Dust Inhalation 18 1 12 5
Sprain/Strain 23 5 10 8

Injury type 'Other' breakdown.

clMSSJXlSSIl;
0

Abdominal Pain, Vomiting, Malaise, CP 1

Asthma 2
ASTHMA EXACERBATION 1
BLEEDING UNBILICAL HERNIA 1
Blister 3
BLISTERS 1
Chest Pain 4
DEHYDRATION 2
DEHYDRATION, NAUSEA, VOMITING 1
DIABETIC—GLUCOSE 1
Finger pain related to cold hands/wet gloves 8hrs 1
Gl DISTURBANCE 1
HEADACHE 2
Hypoglycemia 1
Seasonal Allergies 1
Viral URI 1
Wheezing 1

-1 -
 Injury type by rescue unit.

:onstaiction

MS-FDNY 1
IMS-Other ~2

DNY 10 ~2

ireDept- ~\
)ther
IYPD 26

Hher 35 12 ~5
xjency
'olice-Other

;anitation

Inknown

Itilities

Rescue unit type 'Other' breakdown.

GoG^MGM!
0

AIR ONE CRANE 1

Army 3
ARMY NATIONAL GUARD 1
Boston welder 1
Con Edison 1
DMAT2 1
DMAT member 1
DMAT team member 1
Engineer 1
FEMA 1
FEMA Deputy Sheriff 1
GUARDIAN ANGELS 1
LOCAL 731 LABORER 1
Medical Examiner's Office 1
NATIONAL GUARD 2
NY State Trooper 1
NYDOT SUPERVISOR 1
NYPD Auxilliary Police 1
Red Cross 2
 CnTifif-rtf^lIOtKSr

RESIDENT OF AREA 1
RETIRED 1
SEARCH AND RESCUE AMERICAN CANINE ASSOCIATION 1
UNEMPLOYED 2
UNKNOWN 1
Volunteer 10
Volunteer Canteen Worker 1

Patient disposition by medical facility

Transported to another medical facility

Treated and released 36 27

Unknown 4
GNYHA / NYSDOH / NYCDOH New York City Hospital Needs Assessment
|
Report Date September 15, 2001

Cumulative Total incident

Cumulative ED visits Admissions related Total incident- Available Available non-
since incident since incident Total incident-related admissions related deaths Any critical care # waiting in critical care
Last Report number since last number since patient visits (number number since number since Any staff supplies Jnidentified beds ED beds Morgue
Date / Time report) ast report) since last report) ast report) ast report) needs needs patients adult/pads) adult/peds) adult/peds) Capacity
'riority hospitals
ieekman 9/1 5 2pm 404 (1st report) 24 389 21 2 N N 0 10/nopeds 0/0 40/8 65
Bellevue 9/14 11pm 400 (60) 60(0) 283 (7) n/a 1(0) N N 0 27/10 0/0 144/27 n/a
Beth Israel 9/1 5 2pm 607 (1st report) 362 249 21 0 N N 0 33/ no peds 0/0 209/ no peds 9
Brooklyn 9/14 5pm 668 (1st report) 137 187 0 0 N N 0 32/2 7/0 na/6 4
Cabrini 9/15 2am 343 (50) 110(33) 175(1) n/a 0 N N 0 17/ no peds 14 221/ no peds 11
Columbia 9/1 4 3pm n/a n/a 33 n/a 0 N N 0
Long Island College 9/15 4pm 760 (130) 314 (59) 229 (8) 41 1(0) N N 0 21/2 2/1 210/8 7
Lutheran 9/1 5 5pm 624 (1st report) 282 89 ) 0 N Td vaccine 0 24/ no peds 10/5 74/5 6
NY Hospital 9/1 5 6pm 365 (1st report) 345 119 26 2 Burn RN N 0 17/12 32/8 43/9 16
NYU 9/1 5 4am 258 (18) n/a 130 (0) 2 0 N N n/a 14/17 0/0 43/3 6
Roosevelt 9/15 2pm 453(122) 202(21) 107 (3) 4 0 N N 0 23/ no peds 0 48/ no peds 4
St. Luke's 9/1 5 2pm 51 (34) 241 (48) 42(4) 0 0 N N 0 23/ no peds 0 48/ no peds n/a
St. Vincent's 9/15 10am n/a n/a 539 (not updated) n/a 4 (not updated) N N 0 18/1 5/1 95/19 6

TOTAL 2571 (23) 121 10

i .„. .
Other NYC Hospitals (n=17)
Brookdale 9/14 11am 96 0 N N 0
Coney Island 9/14 10am 32 0 n/a n/a n/a
Downstate 9/14 11am 42 0 N N 0
Hospital for Special S fi/1411pm 3(0) 0 N N 0
Jacob! 9/1 5 7am 150(6) 0 N N 0
Joint Diseases 9/14 1pm 54 0 N N 0
North Central Bronx 9/15 3pm 12(0) 0 N N 0
North General 9/14 12pm 27 0 N N 0
Peninsula 9/14 10am 32 0 N N 0
SI University 9/14 1pm 220 0 N N 0
St. John's Episcopal 9/14 12am 4 0 N N 0
Mount Sinai 9/1 5 7am 29(0) 0 N N 0
Methodist 9/14 6pm 106 0 N N 0
NY Westchester Squa 9/15 1130am 19 0 N N 0
NY Hospital Queens 9/i46pm [ 29 0 N N 0
Bl - Kings Hwy 9/1 5 2pm 62 0 N N 0
Bl- Singer 9/1 5 2pm 16 0 N N 0

TOTAL 933 0
 Current Issues
9/16/01 5:00pm
DRAFT

TOPIC OUTSTANDING CONCERNS RESPONSIBLE

PARTY
Radiation and 1) Department of Energy flyovers (still not happened) to measure Gene Mishkin
Monitoring radiation levels
2) National Guard has radiation monitors on the trucks taking
garbage to Freshkill- NEED TO GET RESULTS
Pest Control 1) Garbage collection in lower Manhattan and concern for James Gibson
rodents running wild Allan Goldberg
2) DOS collecting garbage ?
3) Assessment/plan for perimeter
Food l)Fulton Fish Market Clean-up beginning, DOH Inspection and Elliott Marcus
Trade Waste Commission Coordinating
2)Inspections are responding to rotting meat complaints at
Moran's.
3) DOH is asking OEM to periodically wash down triage site area
because dust problems.
4) DOH is following up with unauthorized vendors in site area.
Water 1) Sampling fire hydrants and tap water south of ground zero to Jim Luke
test for quality concerns- waiting for lab results
2) North of ground zero, sampling results were fine
Air 1) Need 2pm results for 5pm meeting Jessica Leighton
Kelly McKinney
Medical and 1) Mental Health Counselors needed at I.S. 89 - DMH contacted Sue Blank
Clinical and now following up.
2) Burn Unit nurses for Cornell are needed: DMAT is following
up.
3) CDC decomposing body advisory issues - leather gloves are
ok, cloth are not. DOH will follow up with OEM not to distribute
to workers.
4) Hand washing kits still not on site or being ordered. Follow up
with DCAS. Follow up role and status of USS Comfort.
5) DOH has reassigned staff to do fit testing for rest of today.
Army role unclear and needs to be clarified. Does DOH need to
continue to do this activity?
6) Reoccupation advisory ready for Dr. Mojica's review
7) DCAS creating respirator, cartridge and fit testing database.
Status of inventory is unclear.
8) Final Mental Health advisory is with Dan Still who will
follow up.
Worker Safety 1) Health and Safety Plan (DEC/Bectel) Jessica Leighton
2) Fact sheet regarding general hygienic concerns- hand washing Kelly McKinney
and bathrooms for first responders
3) Decontamination sites for dust removal
Shelters 1) Ten open and staffed. Staffing scheduled till 9am Monday. Carmen Ramos
But continued staffing after that is planned. Low utilization
except at 4 sites. See addendum.
Surveillance See Addendum for cumulative data. Marci Layton
1) Casualty- Report promulgated and focus will also include New Polly Thomas
Jersey. Also need to get medical charts from 125 Worth Street.
Will include non-priority hospitals. DOH will continue to do
hospital survey.
2) Hospital- EIS staff is getting better data. Project is planned for
only 2 weeks.
3) Syndromic- No unusual clusters noted. Group will do
incubation period time charts.
4) 9 1 1 - Need for recommendations and input for data collection
form.
5) CDC surveillance is offering assistance on Medical
Informatics, PHIPPO is offering HAN Support. M. Layton to
follow up.
6) Death updates on a regular basis. Follow up with OEM.
MIS No acute, emergency issues/Only chronic concerns Ed Carubis
Staff and 1) Building access issues- Stu Mirsky
Operations 125 Worth Street Kelly McKinney
Verizon is installing lines (120 plus) Rich Naeder
AC units being inspected and cleaned
General cleaning asked for
346 Broadway being added to priority list
2) Bureau Liaison advisory sent to all Health Centers for
employee guidance.
3) DOH to reopen new Mailroom by Wednesday
4) Mayor opening up Citywide Agency Hotline for the public
Fran Paris to follow-up with J. Morris on staffing issues, resource
need.
DOH Relocated to Bureau of Labs Mark Foggin
Complaints (212)213-1844
Line
 Surveillance Update
9-16-01

1 - Retrospective ER Surveillance: Retrospective review of all ER visits at 4 hospitals in

downtown Manhattan (Beekman, St Vincents, Bellevue and Beth Israel).

Status: Chart reviews complete at 4 hospitals, except for ER admissions at Beekman, and
? need to do burn admissions at Cornell . Data entry to be completed today. Preliminary
summary report to be prepared.

2 - Hospital Assessment: Daily updates from all city hospitals on ER visits (total and
incident related), admissions (total and incident related), deaths (incident related) and
staff/supply needs. Active ascertainment at the 13 hospitals closest to WTC (priority
hospitals); passive elsewhere.

Status: 13/13 priority and 17 passive hospitals completed surveys yesterday. To date at
these 30 hospitals:

Incident related ER visits: 3504 Total to date

23 since last report

Incident related admissions (13 priority hospitals) 121 Total to date

Incident related deaths: 10 Total to date

0 since last report

Only minimal needs identified (burn nurse for Cornell; Td vaccine at

Lutheran). No unidentified patients.

3 - Syndromic Surveillance: Surveillance on all ER visits to monitor for increases in

clinical syndromes that may represent WTC incident related illness or a secondary attack
of BT (unexplained pneumonia, fever/rash, respiratory distress, etc). Fifteen hospitals
participating, and EIS officers from CDC are providing 24-7 coverage to ensure all visits
are captured and to facilitate rapid data entry and analysis for disease clusters. EIS
officers will do more detailed case investigations for syndromes of most concern (e.g.,
encephalitis, sepsis (>2 and < 55 years), unexplained deaths, bot-like symptoms)

Status: Completion rate for medical syndrome MUCH improved by having EIS officers
present on-site. Overall summary reports and report by hospital to be prepared this
afternoon. No unusual clusters detected to date.

4 - Rescue Team Injury Surveillance: Injury surveillance among rescue team workers
was put in place at both the primary DMAT site near WTC and at Emergency
departments in lower Manhattan (Beekman, St Vincents, Bellevue and Beth Israel). In
addition, the EMS triage sites will be included starting today.

Status: Initiated on 9-14. As of 2 PM on 9/15, 100 on site responders were seen at one of
these medical facilities. Most common injuries were: Other (n=25, see attached table),
sprain/strain (n=23), smoke/dust inhalation (n=18), and eye irritation (n=12). Most
injuries occurred among persons in non-uniformed (other) services (See attached table for
details), NYPD (n=26), and FDNY (n=l 0). Few required admission to hospital.
 Shelter Client Usage

Shelter 9/11-12
9P-9A
# clients
9/12
9A-9P
# clients
9/12-13
9P-9A
# clients
9/13
9A-9P
# clients
9/13-14
9P-9A
# clients
9/14
9A-9P
# clients
9/14-15
9P-9A
# clients
9/15
9A-9P
# clients
9/15-16
9P-9A
# clients
//~f?
3 11 6 9 3
Seward Park
HS
2 75 20 36
3 o £ 1
Washington 38
Irving HS
Fashion 5 4 20 31 21
17 A •1 7 ^?
Industry HS (+8 tourists) 43 °l 43
Chelsea HS 3 9 1 1 0 + used for
emergency
^
20
workers
respite
•t }
/3 ?
Norman
Thomas HS
7
,03 g ^ L/ ^ 7-
City School HS 3-5 6 7 6 8 2 + used for
construction
crew respite 3 ! .3 r
JHS22 0 2 4 3

8 6 10 ^
0 ,2 c:
IS 131 10 10
Jfe I /A c-
Comprehensive 0 0 0 0
Day&Night HS
<^P/
\d ,'3' 3
Bayard Rustin 6 Closed Closed Closed //Closed Closed
HS
a,, 4
Curtis HS, SI ~+ 100 kids 2 0 0 Closed

Si
CUi<cfr C Cei^ c i' cA"" -/
Westinghouse 2 0 0 -
HS, BK y!\*™" >l3^:^^
 .*£—•-—-•

OEM

OCCUPUTIONAL AND ENVIRONMENTAL HEALTH MANAGER

rf DOH
K.flWqM. McKEUJW
^ivEpfusr^
ENTAL HEALTH COMMITTEE OEM AND FEDERAL RE
LDERS" PHS. EPA. P
OH. FIRE/EMS, POLICE. NIOSH, C
H FOR RESACE

.NESS SURVEILLANCE

J_
OCCUPUTIONAL SAFETY AND HEALTH ENVIORNMENTAL
SECTION CHIEF SECTION CHIEF
FEMA USPHS/EPA

PPE/DECON • SAFETY WATER/FOODA/ECTOR AIR

NIOSH/CDC SITE SAFETY MANAGEMENT
BECHTEL/ COASTGUARD
STRIKE TEAM

CLEAN-UP ADMIN.
RECORDS
SITE ACCESS

RECORDS IH
SITE ACCESS NIOSH/CDC
recognition eval,
control of hazards

OCC Med.
surveillance
ARMY?
 DEPARTMENT OF HEALTH

NEAL L. COHEN, M.D. SANDRA MULLIN

Commissioner Associate Commissioner

FOR IMMEDIATE RELEASE CONTACT: SANDRA MULLIN/GREG BUTLER

Sunday, September 16, 2001 (212) 447-8232*
(917) 578-6208

IN RESPONSE TO THE WORLD TRADE CENTER DISASTER,

NEW YORK CITY DEPARTMENT OF HEALTH PROVIDES HEALTH AND SAFETY
PRECAUTIONS AND CONDUCTS ESSENTIAL PUBLIC HEALTH ACTIVITIES

Working closely with City, State and Federal agencies since September 11, the New York City
Department of Health has been conducting several public health activities in response to the World
Trade Center disaster. Foremost among these are monitoring air quality in the general vicinity of the
World Trade Center, working with other agencies to ensure that worker safety measures for search
and rescue workers are in place, conducting surveillance for illnesses and injuries at New York City
Hospitals, and mobilizing environmental investigation teams to ensure the safety of the food and
water supplies.

Monitoring Air Quality and Respiratory Issues

While excavation continues at the site, the Health Department has been monitoring the air quality
tests being conducted by the U.S. Environmental Protection Agency (EPA) and the New York City
Department of Environmental Protection (DEP). Tests are ongoing but thus far, tests have shown
asbestos levels that are below the threshold of concern. Nonetheless, workers who are involved in
the recovery mission have been equipped with half-face masks and goggles, as well as protective
clothing, to reduce exposure to any paniculate matter including dust. Based on the asbestos test
results received thus far, the general public's risk for any short or long term adverse health effects are
very low. A fact sheet detailing DOH recommendations can be found on the DOH website at
nyc.gov/health.

The Health Department has produced a Public Health Advisory for residents and people returning
to work in the nearby area. Residents and workers are advised to guard against dust and soot which
can cause respiratory symptoms and eye and throat irritation. Residents in the immediate area are
advised to keep windows closed and to avoid strenuous outdoor activity in the area affected. A fact
sheet detailing DOH recommendations can be found on the DOH website at nyc.gov/health.

Medical Surveillance
The New York City Department of Health is monitoring several medical issues throughout the City.
- - More - -

*The Main Office of the NYC DOH has been temporarily relocated to 455 1st Avenue.
Deloris Sands - Home Rentry for Residents &Occupants (9-16 am).doc Page 1

DRAFT 9/16/01 9:40am (dkass)

Public Health Advisory for People Returning to Work and

Residents Re-Entering their Homes: Recommendations for Protecting Your Health

What steps have building owners and managers taken to ensure building safety?

Before building owners and managers are permitted to allow residents and occupants to return, they have
been required to assess and certify the stability and safety of their buildings. Specifically, no building may
be re-occupied unless each of the following steps have been taken:

1) the structure has been thoroughly assessed for strength and stability,
2) gas service has been checked and restored, with the help of Con Edison;
3) electrical service is operating, and any exposed wires or damaged fixtures have been repaired or
removed;
4) building water service is operating, roof water tanks have been flushed and re-filled and, if
necessary, cleaned.
5) steam service has been checked and restored, where appropriate;
6) the building has been assessed for hazardous materials and if any have been found, they have
been removed according to applicable regulations;
7) building mechanism systems have been inspected and cleaned and repaired, as necessary,
including heating, ventilation and air conditioning systems;
8) the interior of commercial buildings and common areas of residential buildings have been cleared
of dust and debris.

In addition, New York City is requiring building owners and managers to communicate with building
occupants and be available to answer questions regarding building conditions. If you have questions about
any of the above issues, you should contact your building owner, manager or superintendent.

What steps should I take upon returning to my workplace or home?

In a workplace, speak to your supervisor to see if there are special startup and cleaning procedures. In very
dusty places, clean-up may be necessary before equipment can be restarted. Follow the cleaning
procedures discussed below for cleaning an apartment.

In your home, you should check first make sure that conditions are safe. You should enter your home
dressed in long sleeve shirts and pants, and with closed-toe shoes. Upon entry:

• Check for the smell of gas. If the office or apartment smells of gas, leave immediately and report it to
your building manager and to Con Edison.
• Check for broken glass and fixtures. Wrap any broken glass in paper and mark it "broken glass." If
large pieces of glass are broken, ask your building superintendent for help.
• Run hot and cold water from each of the taps for at least two minutes, or until water runs completely
clean, whichever is longer.
• Flush toilets until bowls are refilled. For air pressure systems, you may need to flush several times. If
there are any problems with the toilet or plumbing system, call a plumber — do not try to fix the
problem yourself.
• Follow the cleaning procedures discussed below.

I have heard that asbestos was released from the collapse of the World Trade Center.
What is asbestos, and should I worry about it being present in my home?
Deloris Sands - Home Rentry for Residents &Occupants (9-16 am).doc Page 2

Asbestos, a naturally occurring fibrous mineral, was used in the construction of the World Trade Center.
The destruction of the World Trade Center buildings released large amounts of dust and ash, some of
which contained asbestos.

City, State and Federal agencies have conducted samples of dust, debris and air since the World Trade
Center collapse. Though most of the samples have no asbestos, some have found very small amounts of
asbestos. These amounts have little potential to create airborne asbestos fibers at levels that pose
significant short- or long-term risks to occupants.

Exposure to inhaled asbestos primarily affects the lungs. The risk of lung disease from the inhalation of
asbestos fibers depends on the intensity and duration of exposure. In general, lung disease has resulted
from intense asbestos exposure experienced over a period of many years, primarily in occupational
settings. The risk of developing an asbestos-related illness following an exposure of short duration is low.
However, because some of the dust is very fine, the Department of Health is recommending that every
effort be made to not let the dust get airborne.

How should I clean my apartment when I move back in ?

The best way to remove dust is to use a wet rag or wet mop. Sweeping with a dry broom is not
recommended because it can make dust airborne again. Where dust is thick, you can directly wet the dust
with water containing a small amount of detergent or soap, and remove it in layers with wet rags and
mops. Dirty rags can be rinsed under running water, being careful to not leave dust in the sink to dry.
When done, used rags and mops should be put in plastic bags while they are still wet and bags should be
sealed and discarded (cloth rags can be washed, see instructions below). Rags should not be allowed to dry
out before bagging and disposal or washing.

Because some dust particles are so small, standard vacuuming can put dust back into the air where it can
be inhaled. HEPA (high efficiency particulate) vacuums capable of trapping very fine particles are
preferred. They are now widely available in stores and may be shared by more than one family. If a HEPA
vacuum is not available, it is recommended that either HEPA bags or dust allergen bags be used with your
regular vacuum. If these options are not available to you, open windows (as long as the air outside is not
dusty or smoky) when you are vacuuming and consider wearing a well-fitting dust mask. Allergic
individuals, asthmatics or others who might suffer most from inhaling dust should not be present when
vacuuming with a conventional vacuum.

Carpets and upholstery should be not be shampooed, since wetting them will force dust deeper into the
material.

If your apartment is very dusty, you should wash or HEPA vacuum your curtains. If curtains need to be
taken down, wrap them in a plastic garbage bag and take them down slowly to prevent putting dust in the
air.

To clean plants, rinse leaves with water. Pets can be washed with running water from a hose or faucet;
their paws should be wiped to avoid tracking dust inside the home.

How can I remove dust front the air?

Air purifiers may help reduce indoor dust levels. HEPA air purifiers are superior to other models in
filtering the smallest particles. Air purifiers are only useful for removing dust from the air. They will not
remove dust already deposited on floors, shelves, upholstery or rugs. Keep windows closed when using an
air purifier.

Additional precautions include.

Deloiis Sands - Home Rentry for Residents &Occupants (9-16 am).doc Page 3

• Avoid sweeping
Keep outdoor dust from entering the home;
• Keep windows closed if the air outside is dusty or smoky,
• Clean or change the air conditioner filter before starting the air conditioner the first time;
If the air outside is dusty or smoky, only use the air conditioner to re-circulate air (closed vents);
• Remove shoes before entering the home for several days (once you first make sure there is no broken
glass)

Do I need to wash all my clothes and linen?

Dusty clothes should be washed separately from other clothing. Wash heavily soiled or dusty clothing or
linens twice. Remove lint from washing machines and filters in the dryers with each laundry load.

What should I do with food left in my apartment?

The power outage in much of lower Manhattan may have caused refrigerated and frozen food to spoil.
Raw or cooked meat, poultry and seafood, milk and milk-containing products, eggs, mayonnaise and
creamy dressings, and cooked foods should be thrown out if power was out for two or more hours. Frozen
foods that have thawed should be thrown away. Do not re-freeze thawed food.

Throw away any food that may have been contaminated with dust. Since food sealed in cans, jars, or
containers with tight-fitting lids will not be contaminated, wash cans and jars with water and wipe them
clean. When it comes to food left in your building, if in doubt, throw it out