Greg Gould says he can still remember the toxic smell of the Sept. 11, 2001, terrorist attacks on the World Trade Center.
He was on top of the rubble by 10 p.m. that night, working in search and rescue, and from what he saw, Gould said he was not surprised to learn a new study found rescue workers still suffered lung damage seven years later.
"There was a lot of dust, there was a lot of debris and dust flying around everywhere and there were a lot of fires burning," said Gould, a fire protection specialist for the New York State Office of Fire Prevention and Control. "If you've ever been to a structure fire -- the smell is horrendous, the toxic fumes that it puts off, it is absolutely not a normal smell."
New York City doctors released the results of a seven-year study of members of the New York City Fire Department Wednesday, showing that the lung damaged suffered by first responders at the world trade center might be permanent.
Researchers in the study, which was run in conjunction with the New York City officials, doctors and firefighters, were able to include 91 percent of the responding workers -- a total of 10,870 firefighters and 1,911 EMS workers -- who were at the World Trade Center rubble between Sept. 11 and Sept. 24, 2001.
By 2008, the rescuers who had significant declines in lung function a year after the attack had still not recovered, and the recorded drop in lung function was about 12 times the rate seen in normal aging. The research was published Wednesday in the New England Journal of Medicine.
Gould said he had only a paper mask "you could go into a hardware store and buy" to protect him from what the researchers described as "a dense, persistent dust cloud of pulverized building materials and chemical by-products of combustion."
Some workers at Ground Zero had either specialized N-95 masks to weed out chemicals or SCBA -- self contained breathing apparatus -- masks.
Yet Gould seemed to escape lung damage although some of his colleagues who worked alongside him have had respiratory problems. Every year, he has a PFT or a pulmonary function test.
"Personally, I have had no decline in my lung function," said Gould.
Studying Who Got Sick and Why
"Exposed people want to have answers. Not just for themselves but for entire group," said Dr. David Prezant, senior author of the study and Chief Medical Officer of the Office of Medical Affairs, for the New York City Fire Department (FDNY). "I was at 9/11 and was exposed myself."
Prezant teamed up with doctors from New York University, Montefiore Medical Center and the Albert Einstein College of Medicine, among others, to track the workers exposed during the 9/11 attacks.
He said the partnership between the fire department, management and doctors in New York gave the study advantages over other research that has tried to assess health problems caused by the Sept. 11 attacks.
"Every worker in our study is a proven exposed worker," said Prezant.
Fire departments often use the same lung-function test from Prezant's study in physicals firefighters need to pass to stay on the job -- so unlike many other studies on the topic, these researchers had access to lung-function tests given to firefighters before 9/11 to compare to the tests after the attack.
Prezant also didn't have to recruit for study subjects from the general public, which might have skewed the results.
Major Study on Breathing Problems of 9/11 First Responders
"Our study is not influenced by selecting the most ill or least ill," said Prezant.
Overall, the study showed the proportion of firefighters with below-normal lung function went from 3 percent before the attacks to 18 percent after. Eight years later that number stabilized at 13 percent.
"We take these answers and immediately translate them into monitoring and treatment initiatives," Prezant said.
Doctors, politicians and lawyers have all looked to previous studies as a call, not only for better treatment, but better prevention too.
"The 9/11 terrorist attack resulted in an unprecedented environmental disaster. The urgency of the search and rescue efforts led to first responders not being diligent in protecting themselves from the dust cloud by wearing properly fitted respiratory protection, such as disposable NIOSH N95 masks," said Dr. James Sublett of the American College of Allergy, Asthma and Immunology.
"An emphasis on worker protection would have likely ameliorated the type of permanent lung damage demonstrated in this follow-up of the firemen and EMS workers," he said.
Lung specialists who reviewed the study said the damage to the rescue workers at Sept. 11 exceeds the usual smoke damage from fires.
"The decrease is much greater than that observed with historical smoke and dust exposure and appeared to permanently reduce lung function," said Dr. Mark Gladwin, chief of Pulmonary, Allergy and Critical Care Medicine at the University of Pittsburgh Medical Center. "There was an expectation that this would improve in the overall cohort, but this did not happen."
However, doctors pointed out that the study did have a silver lining. Although the firefighters and EMTs did not recover during the study period, they didn't get worse after the first year.
"While recovery does not appear to have occurred to any significant degree, the good news is that after the original damage to lung function the rate of lung function loss returned to the normal range," said Dr. Neil Schachter, the medical director at the Respiratory Care Department at Mount Sinai Hospital in New York City.
"The event had not caused an accelerating loss of lung function, as has been the case with some exposures," he said.