NY B19 Misc FDR - WTC Disaster Response - NYCDOH - 9-12-01

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September 12, 2001
World Trade Center Disaster
New York City Department of Health= Clinical Response Team

(summary of events)
Events ~9am
• Emergency meeting with Dr. Mojica and senior staff.
• Immediate situation analyzed with input from OEM and other
agencies.
• Various teams activated, i.e. environmental response, clinical
response (logistical coordinator^ Dr. Blank), etc.
Team Coordinators
• Susan Blank
• Katherine Kaye
• Tina Mason
Ensuing events-10am
• Lobby of DOH designated as 'medical site'
• Medical personnel obtained at central office not involved with other
emergency activities were asked to assist in care delivery
• Calls placed to all DOH service delivery sites to assist with personnel
and needed supplies
• Immediate support received from all nearby sites and response from
other boroughs
• Areas in DOH lobby designated as 1) initial triage, 2) stable patient
area, 3) unstable patient area
• 'Supply' area established near information desk
• Minimal supplies were available immediately at DOH, i.e. basic First
Aide kits, etc.
• Triage teams developed and areas designated, composed of physician,
nurse, and recorder(time seen at DOH, name, address, phone number
etc.)
• Nonmedical volunteers assigned to assist triage teams with patient
transport or other duties not requiring medical skills.
• 2 triage teams(physicians skilled in emergency care) initially located
near Lafayette entrance with 1 triage team in 'stable area' located
near Centre street entrance and 'unstable' area located near Worth
street entrance.
• 2 additional teams located in vestibule of Lafayette entrance, to assist
the EMS persons located on the street.
• First disaster victim seen -10:10 am, with steady flow until ~2pm
On going Events
• Lack of supplies evident early, i.e. requests for IV solution,
stethoscopes, sphygmomanometers, oxygen tanks etc. needed not only
by DOH site but emergency facilities located in the area. Bellevue and
DOH clinics received requests for supplies.
• DOH staff volunteered en masse.
• Non-DOH staff also volunteered (received assistance from many
medical personnel affiliated with other institutions), many persons
volunteered to dbnate blood. There was no shortage of persons
offering to help. Staff received and were required to wear white DOH
t-shirts for identification.
• EMS and Fire Department requested supplies, similar needs as the
DOH, i.e. IV solutions, etc.
• Supplies arrived in stages beginning at ~1 lam (from DOH clinics).
Supplies continued to arrive throughout the afternoon. Several types
of critical supplies never arrived, i.e. Nebulizers and Albuterol for
respiratory difficulties.
• Document developed to record patient information and vital signs.
Recorder to obtain patient information simultaneous with
physician/nurse team evaluation of physical complaints. If patient
stable > taken to area near Centre entrance for observation and
continued evaluation by team assigned to that area >if patient unstable
> taken to area near Worth street entrance for stabilization of vital
signs, i.e. IV fluids etc. and await EMS transport to medical facility.
• After ~ 30minutes to 1 hour if patient remains stable and wishes to
leave, another set of vital signs are obtained with time recorded and
the patient signature at time of discharge.
• Late afternoon DOH offered transportation to subways, other
boroughs and Staten Island Ferry.
• Inventory of supplies performed and list given to on-call clinical
response team.
Supplies needed but not received
• MD stethoscopes (difficult to assess respiratory and cardiac status
with lower quality stethoscopes)
• Nebulizer equipment
• Albuterol MDI's
• Regular Insulin
• Eye wash solutions (one kit was delivered at 3pm)
• Blankets (insufficient supply received)
• Disposal gowns
• Face masks with eye shields
• 'Red' bags denoting contaminated materials
45 Individuals triaged. 7 patients referred to hospitals for further evaluation,

20 documented and discharged, 18 documented with no disposition (walked
out of lobby). Estimated additional 10-15 evaluated with no documentation.
Types of Injuries Treated
• 1 broken forearm=splinted
• ? broken clavicle, chest pain
• Multiple respiratory difficulties including Asthma, smoke inhalation,
and hyperventilation
• Shoulder Pain
• Chest Pain
• Eye abrasions
• Severe anxiety.
Individuals referred to hospital(missing one record)

• Elevated Blood Pressure
• Questionable severe anxiety
• ? danger to self
• Severe smoke inhalation
• abnormal blood glucose
• Chest Pain
Lessons Learned
• Volunteers responded promptly.
• Inadequate supplies, BUT many unanswered questions what sort of
supplies should we stock in a site that does not deliver services?
Who will be responsible for supplies, i.e. expiration dates, assuring
appropriate function? Are in-services required? What is the level of
expertise needed for the maintenance?
• Initially only the Lafayette entrance was open, thereby controlling the
flow of patients and staff. But at ~lpm, the Worth and Centre
entrance's were opened with an uncontrolled influx of patients and
staff.
• Many volunteers did not remain in assigned areas, and added to the
appearance of confusion and 'chaos'. Several volunteers
'disappeared' from stations, patients not transported to restrooms or
'stable' area in timely fashion. Information document not collected
as directed by volunteers, we are therefore unable to perform f/u with
patients examined in triage site.
• Several triage teams did not record the time of examination, therefore
we are unable to document physical status at time of discharge.
• Limited number of medical personnel familiar with acute care
procedures.
• Multiple requests for 'stress' counseling received. Multiple requests
for information regarding persons possibly trapped at the WTC site.
• EMS, Police Department and Fire Department continually requesting
supplies (several occasions, just walking in and taking materials).
Overall Assessment and suggestions for future

• Teams deployed in timely fashion
• No critically ill patients seen
• Consider DOH as blood donation site, or transportation to nearest
site.
• Consider listing of DOH staff with recent acute medical care
experience.
• To what extent will we stock supplies?
• One person unloaded and organized supplies, but supply coordinator
needed, separate from person assessing trauma and assigning teams.
This person will assist PD, FD, EMS etc. with requests by keeping
abreast of inventory and dispensing supplies in a equitable manner.
• Volunteer activity must be better coordinated, to maximize their
functions.
• Pray that this is never needed.
Patient information available.
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World Trade Center Disaster Response
New York City Department of Health
9/ll/01:8am-8pm
Incident:
Crash of AA into One World Trade Center
Crash of UA into Two World Trade Center
Evacuation of thousands from WTC
Collapse of Two WTC at 9:58
Collapse of One WTC at 10:25
EOC decisions
HOC activated shortly after 9 am
All work groups met, briefed on status and response plan
Immediate response:
Beth Maldin sent to OEM, did not reach 7 WTC, came back before collapse
Commissioner with Mayor at WTC, caught in debris
Managers asked to come to building
OEM schedule set up at OEM, group coverage for next 3 days
All doctors and nurses on standby
Environmental Workgroup
Assess area for radiologic materials
Assist in collecting materials for BT and toxics
By 5 pm, had tested 2 samples
Asbestos
Will be a large issue, there was asbestos in the buildings
Radiation
Not clear if radiologic substances involved
? radioactive substances in planes?
Water
Safety of supply is unknown
Med/Clinical Workgroup
Clinical services put on alert, then clinic was set up on 1st floor
Only a few casualties being seen in the first few hours, Td needed?
Gather medical staff at 125 Worth to assist in providing care to victims
List of medical professionals who can be called to respond to emergencies
By 5 pm, had seen 45 patients, 17 people referred
OCME had received no bodies yet

Epi/Surveillance
Assess casualties from area hospital
Assess the risk for potential release of BT agents
CDC anthrax stockpile put on alert
A. Hospital based needs assessment
B. ER Acute injury/trauma surveillance

Set up soon after disaster, need to define trauma from event
Staff sent to 4 hospitals in lower Manhattan with abstraction form
Regular, ongoing surveillance activities
Sheltering Workgroup
Shelters activated with Red Cross
Activated plan to provide nursing staff at shelters *
set up, some in schools with children /<vit/\
Laboratory
Lab put on alert immediately to provide tests for asbestos, BT agents
Some samples taken today to test for biologicals
No increase in PCC calls today, some treatment calls from hospitals about anthrax
MIS
Operations/Personnel/Staffing
Ft. Greene set up as alternative EOC
All phones at 125 Worth are out, have to use Nextel phones
Vital Records
Will work with OCME to issue burial permits
Funeral directors will be notified about DOH activities
Incident Report
September 11,2001
On Tuesday, September 11, at 8:45 AM, an American Airline passenger plane enroute to LA
crashed into the north tower of the World Trade Center. At 9:00 AM, another passenger plane
enroute to San Francisco crashed into to the south tower of the WTC. At about 9:30 am, the
south tower collapsed, followed shortly by the north tower.
OEM activated shortly after 9:00 AM.
Call all work groups: Surveillance, Medical, Shelter, Environmental, Laboratory, Vital Records,
MIS, Operations met to be briefed on status, and response plan.
Surveillance -
- assess casualties form area hospital;
- assess the risk for the potential release of bioterrorism agents;
Medical -
- gather medical staff at 125 Worth to assist in providing immediate care to individuals/victims
- generate a list of all medical professionals that may be called to respond to emergencies
Shelter -
- activate plan to provide nursing staff in emergency shelters
Environmental -
- assist in collecting samples for bt and other toxic substances
- assess area for radiological materials
Laboratory -
- provide immediate tests for bt agents
- provide immediate tests for asbestos
- provide assistance in housing police/medical examiner operations
Vital Records
- work with medical examiner in issuing burial permits
MIS
- provide technical assistance with the network and other IT issues
Operations
- assist in moving staff
- assist in collecting supplies and setting up emergency clinic
09-11-2001 01:59pm From-INPHO-HAN +7704889300 1-272 P.002/002 F-6S9
' 'galth Alert Network
This is an official
CDC HEALTH ALERT
DATE: September 11, 2001,13:25
COMMUNICATIONS TOPIC: Initial Health Alert Notice to States and Local Public Health Agencies
SUBJECT: ALERT: Terrorist Activity Response
Due to current events, CDC is on heightened alert status to monitor for any possible unusual
disease patterns associated with today's events, including chemical and biological agents.^
CDC recommends that you initiate heightened surveillance for any unusual disease occurrence or
increased numbers of illnesses that might be associated with today's events.
Please notify all segments of your emergency response system (including epidemiologists/
laboratories, all local public health units, hospital emergency departments and 911 dispatch
centers) to make them aware of this situation.
If you require any assistance or become aware of any unusual occurrence, CDC is available at
our emergency number of (770) 488-7100, 24-hours per day, or (770) 488-4819. You may also
contact us by e-mail at healthalert@cdc.gov or access our website for further information at
www.bt.cdc.gov.
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Red Cross Shelters
September 11,2001
School Borough Address Phone
Bayard Rustln HS Manhattan 351 W. 18th St. 212-675-5350

Seward Park HS Manhattan 350 Grand St. 212-674-7000
Wash. Irving HS Manhattan 40 Irving PI. 212-674-5000

HS Fashion Industry Manhattan 225 W 24th St. 212-255-1235
Chelsea HS Manhattan 131 Avenue of Amer. (6th Ave.) 212-289-7593
Norman Thomas HS Manhattan 111 E. 33rd St. 212-576-0500

City-School Manhattan 16 Clarkson St. 212-691-7801
JHS22 Manhattan 1 1 1 Columbia St. 212-677-5190
IS 131 Manhattan 100 Hester St. 212-925-6386

Comprehensive Day & Night Manhattan 240 2nd Ave.
Curtis HS Staten Island 105 Hamilton Ave. 718-522-6594
Westinghouse HS Brooklyn 105 Johnson St. 718-522-6594
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21:34 Tuesday, September 11, 2001
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1 Brooklyn Hospital Center, Downtown Medical Center 140 0
2 Brooklyn Hospital Center . .
3 Lutheran Medical Center 40 0

4 Beth Israel Medical Center Kings Highway Division 18 .
5 Long Island College Hospital 139 1

6 New York Community Hospital of Brooklyn 11 0
7 Woodhull Medical Center 50 0
8 Brookdale University Hospital 19 0
9 Interfaith Medical Center (BJ) 7 0
10 Kings County Hospital 0 0
11 Interfaith (St. Johns) 4 0
12 Coney Island Hospital 0 0
13 mamonides medical center 28 0
14 Catholic Medical Center-St Mary 5 0
15 Wycoff Heights 15 0
16 Kings County Hospital 17 0
17 University Hospital Brooklyn . .
18 Kingsbrook Jewish Medical Center . .
19 Victory Memorial Hospital 12 0
20 NY Methodist Hospital __30 0 5- o
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21 St. Claire's Hospital 20 27
22 Mt. Sinai . ,
23 Bellevue . • 4jp&$v, »
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Beth Israel - Petric Division 100 0
25 Beth Israel - North Division . .
26 Metropolitan Hospital Center . .
27 New York Eye & Ear Infirmary 3 0
28 New York Downtown Hospital • 4 300 0
29 NYU Medical Center - 34th and 1st avenue . .
30 Memorial Hospital . .
31 North General Hospital

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The SAS System 06:33 Wednesday, September 12, 2001 6
The FREQ Procedure
Table of sex by HOSPNAME
sex(SEX) HOSPNAME
Frequency BELLEVUE BETH ISR NYU DOWN ST. VINC Total

AEL TOWN ENTS
MALE 35 83 52 30 200
FEMALE 16 59 49 15 139
UNKNOWN 3 13 6 6 28
Total 54 155 107 51 367

The FREQ Procedure
Table of trans by HOSPNAME
trans(MODE OF TRANSPORT TO HOSPITAL FACILITY)

HOSPNAME
Frequency BELLEVUE BETH ISR NYU DOWN ST. VI NC Total
AEL TOWN ENTS
AMBULANCE 22 12 1 35 70
WALK- IN 1 16 0 1 18
UNKNOWN 30 125 106 13 274
Total 53 153 107 49 362
Frequency Missing = 5
Table of status by HOSPNAME
Status(PATIENT STATUS) HOSPNAME

AEL TOWN ENTS
STABLE 41 121 1 33 196
CRITICAL 1 0 0 0 1
UNKNOWN 11 34 105 18 lea-

Total 53 155 106 51 ses
Table of hosp by HOSPNAME
hosp(WAS PATIENT HOSPITALIZED) HOSPNAME

AEL TOWN ENTS
HOSPITALIZED 3 7 2 0 12
ER ADMISSION 39 127 1 48 215
UNKNOWN 12 21 104 3 140
Total 54 155 107 51 367

The FREQ Procedure
Table of DISPOSTN by HOSPNAME
DISPOSTN HOSPNAME

AEL TOWN ENTS
ALIVE 40 123 2 1 166
DEAD 0 1 0 0 1
Total 40 124 2 167
For dodeath * HOSPNAME

all data are missing since all
the levels of variable dodeath are missing.
The FREQ Procedure
Table of eye by HOSPNAME
eye(EYE TRAUMA/FOREIGN BODY) HOSPNAME

AEL TOWN ENTS
NO 39 136 105 35 315
YES 15 19 2 16 52
Total 54 155 107 51 367
Table of crush by HOSPNAME
crush(CRUSH INJURY) HOSPNAME

AEL TOWN ENTS
NO 51 150 107 51 359
YES 3 5 0 0 8
Total 54 155 107 51 367
Table of toxic by HOSPNAME
toxic(TOXIC/SMOKE INHALATION) HOSPNAME

AEL TOWN ENTS
NO 33 82 73 29 217
YES 21 73 34 22 150
Total 54 155 107 51 367
Table of burn by HOSPNAME
burn(BURN INJURY) HOSPNAME

AEL TOWN ENTS
NO 52 154 107 49 362
YES 2 1 0 2 5
Total 54 155 107 51 367

The FREQ Procedure
Table of chest by HOSPNAME
chest(CHEST PAIN/RULE OUT MI) HOSPNAME

AEL TOWN ENTS
NO 49 139 105 50 343
YES 5 16 2 1 24
Total 54 155 107 51 367
Table of lacer by HOSPNAME
lacer(LACERATION/CONTUSION) HOSPNAME

AEL TOWN ENTS
NO 43 111 99 34 287
YES 11 44 8 17 80
Total 54 155 107 51 367
Table of bone by HOSPNAME
bone(BONE FRACTURE) HOSPNAME

AEL TOWN ENTS
NO 50 150 107 50 357
YES 4 5 0 1 10
Total 54 155 107 51 367
Table of skin by HOSPNAME
skin(SKIN RASH) HOSPNAME

AEL TOWN ENTS
NO 54 154 107 51 366
YES 0 1 0 0 1
Total 54 155 107 51 367

The FREQ Procedure
Table of neuro by HOSPNAME
neuro(NEUROLOGICAL SIGNS) HOSPNAME

AEL TOWN ENTS
NO 54 154 107 51 366
YES 0 1 0 0 1
Total 54 155 107 51 367
Table of faint by HOSPNAME
faint(SYNCOPE/PRE-SYNCOPE (FAINTING))
HOSPNAME
AEL TOWN ENTS
NO 53 153 107 51 364
YES 1 2 0 0 3
Total 54 155 107 51 367
Table of emotion by HOSPNAME
emotion(EMOTIONAL STRESS) HOSPNAME
Frequency BELLEVUE BETH ISR NYU DOWN ST. VINC Total,

AEL TOWN ENTS
NO 50 131 106 44 331
YES 4 24 1 7 36
Total 54 155 107 51 367
Table of SPRAIN by HOSPNAME
SPRAIN(SPRAIN) HOSPNAME

AEL TOWN ENTS
NO 51 147 107 49 354
YES 3 8 0 2 13
Total 54 155 107 51 367

The FREQ Procedure
Table of other by HOSPNAME
other(OTHER TYPES OF INJURY) HOSPNAME

AEL TOWN ENTS
NO 38 90 38 42 208
YES 16 65 69 9 159
Total 54 155 107 51 367

Pag«2of2 Wednesday, S«ptember 12, 2001 5:45:29 PM
The Mayor has asked that all non-essential personnel remain at home until further notice.
However, all clinic based and health center personnel should report to their regular
assignmentiif possible; otherwise they should report to a clinic or health center nearest to
their home. All managerial personnel should also make every effort to report to their
nearest DOH facility. All personnel are required to "clock-in" and supervisory personnel
should maintain a daily attendance sheet.
All personnel should wait for further instructions.

September 12, 2001
Overnight, the question of asbestos exposure arose, as the World Trade Center (WTC)
was built just prior to stringent regulation about asbestos use in construction,
t
The team, which was now composed of some clinical response staff and some
environmental epi staff focused on coordinating asbestos measurements being made or
about to made by a variety of agencies, including NYC DEP, NYS DEC, NYS DOH,
EPA, culminating in the arrangement of an afternoon (4 P.M.) meeting at 5 Penn Plaza.
Environmental sampling for other potential hazards (e.g. phosgenes - secondary to freon
tanks that were on the roof, or ongoing fires consuming PVC piping -, volatile organics,
acid gases, cyanide) will also be discussed. Additionally, there will be a review of
differences between the state and federal acceptable levels. We also developed a
sampling log system.
The strategy was to consider any environmental recommendations in terms of the levels
of exposure experienced by the following groups of individuals such as:
• transients,
• residents of the immediate vicinity,
• residents at greater distances but downwind,
• clean up crews
• rescue workers
o light exposure
o heavy exposure
We are also trying to work with OEM to determine the numbers of individuals in each of
the above groups.
In addition, we reviewed available materials and drafted health advisories regarding

asthma and eye irritations, dust and ash removal as well as possible asbestos exposure.
We have also developed a staffing plan for 12 hour shifts composed of environmental epi
staff with support from medical and clinical response teams through Sunday. Also two
respiratory experts from NIOSH will be arriving this afternoon.
Supplies from yesterdays clinical response at 125 Worth are being redistributed back to
their clinics of origin.
Staff from yesterday's clinical response have not been extensively utilized today, but are
available for other purposes.
The SAS System 06:33 Wednesday, September 12, 2001
£2
The FREQ Procedure
Table of employ by HOSPNAME
employ(PLACE OF EMPLOYMENT) HOSPNAME

AEL TOWN ENTS
1 WTC 0 1 0 0 1
120 BROADWAY 0 1 0 0 1
280 RECTO ST 0 .1 0 0 1
AMERICAN EXPRESS 0 1 0 0 1
AMERICAN STOCK E 0 1 0 0 1
XCHANGE
ASLAND MGUIT 0 1 0 0 1
BANK OF NEW YORK 0 1 0 0 1
BANK OF NY 1 0 0 0 1
BANKERS TRUST 0 0 0 1 1
BOLTONS 0 1 0 0 1
BUS DRIVER 1 0 0 0 1
CHASE MANHATTAN 0 1 0 0 1
BANK
COMMISSION HPD 0 0 1 0 1
DTC - 55 WATER S 0 1 0 0 1
TREET
DUR AND BRAD STR 0 0 0 1

EET
EMS 0 3 0 0 3
EMT 0 3 0 0 3
FDNY 0 1 0 0 1
FIDELITY INVESTM 0 1 0 0 1
ENTS
FIRE 17 5 3 2 27
GOLDMAN SACHS 0 1 0 0 1
JP MORGAN 0 1 0 0 1
MARRIOTT 1 0 0 0 1
MERRYL LYNCH 0 1 0 0 1
The FREQ Procedure
Table of employ by HOSPNAME
employ(PLACE OF EMPLOYMENT) HOSPNAME

AEL TOWN ENTS
METLIFE 1 0 0 0 1
NEAR WTC 0 1 0 0 1
NYFD 0 1 0 0 1
POLICE 0 13 1 6 . . .20
POLICE DEPARTMEN 0 1 0 0 1
T- SCHOOL SAFETY
PORT AUTHORITY 0 1 0 1 2
SCOR REINSURANCE 0 1 0 0 1
SOFTWARE DEVELOP 0 1 0 0 1
ER
STUDENT 0 1 0 0 1
TUMBLEWEED 0 1 0 0 1
UNKNOWN 33 104 101 39 277
WORLD STREET SYS 0 1 0 0 1

TEMS
WORLD TRADE SECU 0 0 1 0 1

RITY
WTC 0 2 0 1 3
WTC- SYSTEM OPER 0 1 0 0 1

ATION
Total 54 155 107 51 367

The FREQ Procedure
Table of injaddr by HOSPNAME
injaddr(WHERE PATIENT WAS LOCATED WHEN INJURY WAS SUSTAINED.)

HOSPNAME
AEL TOWN ENTS
CROWD 0 2 0 0 2
IN SCHOOL 0 1 0 0 1
NEAR WTC 14 53 0 7 74
NOT NEAR WTC 0 1 0 0 1
OUTSIDE WTC DURI 0 1 0 0 1

NG INCIDENT, HOL
LAND TUNNEL @ TI
ME
PICKED UP BY EMT 0 1 0 0
aw
AT CATHERINE LN i Jt
AND EAST BROADW
AY
STUYVESANT HIGH 0 1 0 0
SCHOOL
SUBWAY 0 4 0 1 5
UNKNOWN 14 50 107 31 202
WALL STREET 0 1 0 0 1
WARREN STREET AT 0 1 0 0 1
IS 89 SCHOOL
WTC 26 39 0 12 77
Total 54 155 107 51 367

The UNIVARIATE Procedure

Variable: YEARS (AGE IN YEARS)
Moments
N .. .__^290 Sum Weights 290

c.Mean 39.805895r> Sum Observations 11543.7096
Std Deviation 14.34141 Variance 205.676041
Skewness -0.6621121 Kurtosis 2.70514293
Unconnected SS 518948.069 Corrected SS 59440.3759
Coeff Variation ,36.028357 Std Error Mean 0.84215659
Basic Statistical Measures
Location Variability
Mean 39.80590 Std Deviation 14.34141

Median 40.00822 Variance 205.67604
Mode 34.73151 Range 98.10137
Interquartile Range 16.00822
NOTE: The mode displayed is the smallest of 3 modes with a count of 2.
Tests for Location: MuO=0
Test -Statistic p Value-
Student's t 47.26662 Pr > |t| <.0001

Sign 141 Pr >= |M| <.0001
Signed Rank 21066.5 Pr >= |S| <.0001
Quantiles (Definition 5)
Quantile Estimate
,<'Tt)0"%~'Max 80.2466~^)
99% 74.2521
95% 62.3397
90% 57.5836
75% 0.3 48.0110
{55% Median 40 . 0082")
25% Q1 32.0027
10% 25 . 1 1 78
5% 20.1178
1% -16.3479
(0% Min -17. 8548^>
Extreme Observations
- - Lowest - - --Highest
Value Obs Value Obs
-17.8547945 188 71.4603 300

-17.1534247 245 73.1178 240
-16.3479452 273 74.2521 53
-14.9369863 2 75.7151 243
0.0931507 73 80.2466 225
Hospital_Needs_ -.mmary
D Hospital Name Contact Name Area Phone Emergenc EC Phone EC Fax # Patients
Manhattan Hospitals
8 Beth Israel - Petric Division Ruth Hennessey 2~12 420-3887 420-2881 100
3 St. Claire's Hospital Gary Morrison 212 459-8402 Dorothy C 459-8402 459-8127 20
5 Mt. Sinai Dr. Nathan Case or Dr. Gary Rosenerg 212 241-8888 241-7432 722-2543
6 Bellevue Shelley Manzin/Larry Dugen 212 562-4726 562-4726 562-4796
1 0 Beth Israel - North Division Roselyn Weinstein 212 870-9130 Beeper 91 870-9567 870-9404
11 Metropolitan Hospital Center Sara Shahim " 2 1 2 "423-7554 423-7272 423-7974
12 New York Eye & Ear Infirmary Joseph Corcoran/Mr. Minicus 212 "979-0664 228-0664 3
18 New York Downtown Hospital Michael Rollins-head of Command Ctr "212 "312-5148 ask'forlia 312-5148" 312-5794
19 NYU Medical Center - 34th and 1st avenue Susan Bowan - Ferres 212 263-3700 263-1008" "
20 Memorial Hospital 212
21 North General Hospital Mr. Tom Long 212 423-4252 "Dr. Gregoi 423-4252 423-4204
Manhattan Total "". 123
Brooklyn Hospitals
1 Brooklyn Hospital Center, Downtown Medical Ctr Frederick Alley, CEO 718 250-8000 Frank Mac 250-8000 140
2 Brooklyn Hospital Center Frederick Alley, CEO 718 250-8000 Frank Mac 250-8000
4 Lutheran Medical Center Myles Davis 718 630-7300 "Dr. Louis :6"3"6:7 189 745-6092 40
7 Beth Israel Medical Center Kings Highway Div John Byrne - VP Administration 718 951-3000 Nora Fern. 951-2901 951-2728" " 18
9 Long Island College Hospital Linda Vila 718 780-1776 or beeper: 718-780-2 •522-0703" 139
15 New York Community Hospital of Brooklyn Ms. Marcy 718 692-5305 1 692-5360 692-8454 11
16 Woodhull Medical Center Bess Candice 718 963-8000 ask opera- 963-81 05 50
Margo Johnson, Sr. VP 718 240-5212 240-6169
17 Brookdale University Hospital "" : ""~ " " 19
7
22 Interfaith Medical Center (BJ) 718
23 Kings County Hospital Dr.Kathy Roans 718 245-3928 245- 0
24 Interfaith (St. Johns) 718 4
25 Coney Island Hospital William Walsh - Executive Director 718 616-4100 616-4439 0
26 mamonides medical center Pam Briar 718 283-6009 ER: Dr Murphy, 718-283-1416 28
27 Catholic Medical Center-St Mary Mr Baptiste, executive director 718 221-3402 5
28 Wycoff Heights Todd Storm "718 963-7705 15
29 Kings County Hospital Dr. Rowes 718 245-3131 245-3928 245-5500 17
30 University Hospital Brooklyn Brenda """718 270-630 1 Dan Grave 270-2401 270-1628
31 Kingsbrook Jewish-Medical Center Dr. Coonan or Dr. Farragano 718 604-5455 604-6517
32 Victory Memorial Hospital Mary Conlon - Associate Administrater 718 "567-1411 Director a 567-1260 "567- 1286 12
33 NY Methodist Hospital Marilyn Hill 718 780-3301 "Lauren Ye 780-3301 780"-3770 "" 30
Brooklyn Total 535
All Hospitals 658
Surveys were conducted on 9/1 1/01 from 2:30 to 6:30pm
Page 1
Hospital Needs ûmmary
Hospital Name # Deaths Total beds filled Total beds available # Persons in ER Waiting Room # of Beds Available in ER
Manhattan Hospitals
Beth Israel - Petric Division "o " o 48 0 0
St. Claire's Hospital 27.'.. "I o o " o 0
Mt. Sinai '962 100 o 40
3ellevue 0 0 0 0
Beth Israel - North Division 0 21 " o 0
Metropolitan Hospital Center
0 ""
0 o " "" o 0
New York Eye & Ear Infirmary o 36' • o 0
" 4'_'_" o
New York Downtown Hospital
"
20' ""
8" " o:" 0
\IYU Medical Center - 34th and 1st avenue 38 0 0
Memorial Hospital 0 0 o 0
North General Hospital 4 45 0 0
Manhattan Total "'...^.."731.... "„ 1004 '" 278 ' ' "_' ' 0 40
-' -
Brooklyn Hospitals
58""""
Brooklyn Hospital Center, Downtown Medical Ctr 0 26 o" 6
Brooklyn Hospital Center " o ~19 o " 2
"o ~ "" 6 ""40""
Lutheran Medical Center 115 10
2
Beth Israel Medical Center Kings Highway Div 196 15 8
Long Island College Hospital r 100 '240 "b" 0
New York Community Hospital of Brooklyn o 115 14" 0 0
Woodhull Medical Center 0 0 0
"'"":
"o
13' 0
Brookdale University Hospital 0 337 64 5
" '6
Interfaith Medical Center (BJ) 0 140 10 0
o o ""39""
Kings County Hospital " o 0
Interfaith (St. Johns) b' ~ " 140 3 17" 0
Coney Island Hospital 0 0 38 0 0
mamonides medical center 0 60 20 0 0
Catholic Medical Center- St Mary 0 0 0 o 0
Wycoff Heights 0 0 67 9 0
Kings County Hospital 0 0 33 0 0
University Hospital Brooklyn 60 8 4 8
Kingsbrook Jewish Medical Center 275 '30 0 15
Victory Memorial Hospital 0 150 > 38 0 20
NY Methodist Hospital 0 490 60" "o 0
Brooklyn Total 1 2095 867 101 68
All Hospitals 32 3099 1145 101 108
Page 2
Hospital_Needs_ jmmary
Hospital Name Plan in place Total Morgue Capacity Current Morgue Capacity
Manhattan Hospitals
Beth Israel - Petric Division Unknown o ,. °
St. Claire's Hospital Yes ~ 6
Mt. Sinai Unknown ' " ' "]'"'_ " " 15 " 35
Bellevue .Yes
Beth Israel - North Division Unknown " 4
Metropolitan Hospital Center Unknown
New York Eye & Ear Infirmary Unknown
New York Downtown Hospital Unknown
NYU Medical Center - 34th and 1st avenue Unknown 7
Memorial Hospital Yes 15 14
North General Hospital Unknown 6 3
Manhattan Total 49 56
Brooklyn Hospitals
Brooklyn Hospital Center, Downtown Medical Ctr Yes 58 54
Brooklyn Hospital Center Yes 4 2
Lutheran Medical Center Yes 10 10
Beth Israel Medical Center Kings Highway Div Unknown 4 3
Long Island College Hospital Unknown o 0
New York Community Hospital of Brooklyn Yes 4 2
Woodhull Medical Center Unknown 15 0
Brookdale University Hospital Yes 20 8
Interfaith Medical Center (BJ) Yes 14 10
Kings County Hospital Unknown 60 60
Interfaith (St. Johns) Unknown 14 10
Coney Island Hospital Unknown 34
mamonides medical center Unknown 6 6
Catholic Medical Center-St Mary "Yes " 15 15
Wycoff Heights Unknown 8 _ _ _ 8
Kings County Hospital Unknown
University Hospital Brooklyn Yes 10 8
Kingsbrook Jewish Medical Center Unknown 12 4
Victory Memorial Hospital ""Yes 6 6
" " " 9
NY Methodist Hospital Yes " 10
Brooklyn Total 270 249
All Hospitals " " " '' ' J' 7J" 31 sT _! I 305
Page 3
Medical Advisory: Asbestos and Dust
Asbestos was used in the constaiction of the World Trade Center. Measurements of asbestos fiber
levels are being monitored to determine if there is any risk of exposure. To prevent exposure to
asbestos and to reduce any risk that might exist, the following protective measures are
recommended:
1 - Based on currently available information, persons working at the site should use N95
respiratory masks (TB masks) to prevent inhalation of asbestos fibers and goggles to prevent eye
irritation. Persons who will be going into the building or working in confined spaces should use at
least an N100 mask for respiratory protection. To the extent possible, gloves and coveralls
should be worn and removed before going home. Boots or shoes should be covered, if possible,
and rinsed prior to returning home.
2 - Other risks may include exposure to cyanide and acid gases; levels will be monitored at the site
to determine if any risk exists.
3 - Emergency personnel (firefighters, EMS staff) should remove outer garments and shower
immediately when returning to their firehouse/garage. Uniforms should be separated from other
clothing and washed twice in ordinary detergent.
4 - Persons who were exposed to ash and soot should shower and wash their hair. Clothing
should be washed twice in ordinary detergent, separated from other clothing.

9/12/01
ASBESTOS AWARNESS
"It can be a killer!"
WHAT
• Used for building insulation
• It is generally white and fibrous
• The dryer it is, the more dangerous it becomes
HAZARDS
• Causes types of respiratory cancer
• Long lead time before an illness occurs
• Smoking while exposed increases the risk of cancer by
twenty times.
• The asbestos fibers on your clothes can be carried to
your home.
CONTROLS
• The wetter the better.
• Respirators should be worn at all times within the
contaminated area.
• Your last line of defense - Tvek suits with hood, gloves,
respirators, disposable boots, goggles ... should be
worn at all times.
• Where decontamination stations are present, use them!
THE CITY OF NEW YORK
DEPARTMENT OF HEALTH
Rudolph W. Giuliani Neal L Cohen, M.D.
Mayor Commissioner
September 12, 2001
ALERT: Terrorist Attack at the World Trade Center in New York City:
/ Medical and Public Health Issues of Urgent Concern
Please Share this Alert with the Following Key Staff at Your Hospital:
1 - Hospital Administration
2 - All Medical and Nursing Staff
3 - Emergency Departments
4 - Hospital Safety Director
5 - Hospital Pharmacy and Laboratories
TO: Emergency Medicine Directors, Infection Control Practitioners and Infectious Disease
Physicians, and Other Persons on the NYCDOH Broadcast Facsimile Alert
FROM: Marcelle Layton, MD, Assistant Commissioner

We are sending this broadcast alert in response to the tragic terrorist attack at the World Trade
Center yesterday morning. We want to alert you to the following issues:
A) There is Currently No Evidence of a Biologic, Radiologic or Chemical Attack: The NYC

Department of Health (DOH) has received no information suggesting that a biologic, chemical
or radiologic terrorist attack has occurred in New York City. There is currently NO evidence
that there were any chemical or biologic agents on the planes. Moreover, biologic agents
would likely not have survived an explosion of that magnitude. Therefore, at this time, we
are not recommending antibiotic prophylaxis for NYC residents.
However, we do request that you be especially alert to ANY unusual disease issues over
the next three weeks. Urgent health issues for which we would want to be notified
immediately include:
1 - Any unusual increase or clustering in patients presenting with clinical symptoms

that suggest an infectious disease outbreak (e.g., >_ 2 patients presenting with
unexplained pneumonia, respiratory failure or sepsis - especially if occurring in persons
who are otherwise healthy. In addition, please notify us regarding a sudden increase in
flu-like symptoms).
2 - A suspect case of any of the following infectious diseases:
Anthrax Brucellosis Q Fever Tularemia

Botulism Plague Smallpox
Please report immediately to the Communicable Disease Program at the NYC Department of
Health if you evaluate patients with any of these suspected illnesses or conditions. The
Emergency Operations Center for the NYCDOH has been relocated to the Public Health
Laboratories at First Avenue and 27th Street. Please contact us at the following numbers:
Surveillance Office: 212-447-2676

NYCDOH Command Center: 212-447-2667or 2668,
or if unable to get through, please call the Poison Control Center at 212-764-7667 or the
Office of Emergency Management at the contact number listed at the end of this alert.
The NYC Department of Health will be establishing an active surveillance program with
sentinel hospitals throughout the city over the next two weeks to monitor for an increase in
patients presenting with unusual disease syndromes. Surveillance staff will be contacting
emergency room directors at these sites to request their participation in this program.
B) Assessment of Acute Care Hospital Needs: Greater New York Hospital Association
(GNYHA) is continuing to monitor hospital needs by regular telephone contact. Additionally,
the NYCDOH has sent surveillance teams to hospitals with higher numbers of casualties, to
better assess morbidity and mortality related to this attack. A GYNHA representative is at the
Mayor's Office of Emergency Management if you have any urgent health care resource needs.
C) Reporting Fatal Cases and Information on Mortuary Issues, Including Death Certificate
Registration for Deaths Related to this Incident
a. ALL deaths directly or secondarily related to this terrorist incident should be reported
to the Office of the Chief Medical Examiner at 212-447-2030.
b. The NYCDOH Burial Desk for registration of death certificates has been temporarily
moved to the Central Harlem Health Center. Please notify all Funeral Directors
regarding the relocation of this office:
NYC Health Department Burial Desk

Central Harlem Health Center .
2238 Fifth Avenue (at 135th Street)
New York, NY 10035
Telephone: 212-926-2150 or 212-368-6538

FAX: 212-926-2526
D) Handling of Corpses
All handling of remains should be performed using Standard Precautions. This includes masks
and face shields to protect mucous membranes from potential splashes, and the use of
disposable gowns or similar protective cover garments if close contact is anticipated. Heavy-
duty rubber gloves should be worn to prevent exposure to blood or body fluids, with attention
to sharp fragments of bone or debris that can pose a risk of percutaneous injury.
E) Smoke and Dust Advisory

Asbestos was used in the construction of the World Trade Center. Measurements of asbestos
fiber levels are being monitored to determine if there is any risk of exposure. Individuals who
have a history of heart and lung conditions or are in areas where smoke or dust is visible are
advised to remain indoors with the windows shut and air conditioners on recirculate or turned
off. Persons with difficulty breathing or chest pain are advised to seek medical care
immediately.
There are no acute symptoms with asbestos exposure. The risk of disease in this type of
setting is deemed to be low. There are no tests that can be done, including chest radiographs,
to tell if exposure has occurred, nor to predict if pulmonary disease will occur in the future. A
medical advisory regarding issues related to asbestosis is attached.
F) Td Vaccine Availability
Standard recommendations for use of Td vaccine should be followed for wound management.
If additional vaccine supplies are needed by your hospital, please contact the Mayor's Office
of Emergency Management Command Center at the number listed below.
The Mayor's Office of Emergency Management has been temporarily relocated. In the event
that you require acute assistance, please contact the city's command center at 212-477-
9610. Representatives from the New York City and State Departments of Health, as well as the
Health and Hospital Corporation and the Greater New York Hospital Association have
representatives on site. As telephone lines are limited, only emergency calls should be made to
the numbers listed above.
CDC EMERGENCY RESPONSE 770 499-7107 QS^lS/01 04-:lGP P . 004
SBM2-2001WED) 11:24 HtlAB
Centers for Disease Control and IVcvcntion Recommendation?
CDC Assessment: Oklahoma Ci ty Site Visit 4/24/95
CDC was asked on Day 5 to visit the Federal Building and immediate environs to advise on
Biological and Chemical haswds, appropriate use of personal protective equipment, and related
safety issues. The site visit was made on Day 6.
General Observations:
1. Oil-site personnel have established excellent procedures for all aspects of health and
safely.
2. The personal protective equipment/clothing used during rescue operations ore certainly
adequate for the minima] biohazardous risk associated with this operation.
3. Given the nature of disaster rcsuce operations, general sanitation is good,

recommending lhat all personnel wash thcif hands before entering canteen Food service areas.
Portable bandwashing stations may need to be provided at several locations.
1 , There are no known biohozards thai pose o public health concern or individual Cttntetvs
10 rescue workers.
2. Bodies in this. collapsed building do not pose specific infectious disease risk TO
workers. Bodies will begin lo decompose, and in that process any Infectious diseases that my have
been in the living person will also decompose. Although the decomposition process will begin to
smell bad, no infectious agents arc associated with that process.
3 . Rescue personnel who handle bodi«? (or/ body parts) are wearing disposable Tyvekjump-
suits, rubber gloves, respirators and hard hats. Disposable covers may be wprr\« boots.
4. Rescue personnel who are involved with activities like rubble removal arc cither wearing
fire-fighter's bunker gear or military fatigues. Both groups are wearing hard bats, respirators, boots,
and leather work gloves.
5._ Personnel who have been involved with rescue operations have been out-processing
through decon, stations. Respirator cartridges and gloves are discarded, boots are sprayed with tysol
(1 :50 dilution with water), and appropriate uniform parts are also decontaminated',
There have beta staffing difficulties at the dccon station?; these difficulties arc being
addressed and control will remain with the Oklahoma City Fire Department.
CDC EMERGENCV RESPONSE 770 *E»-7107 ^'^(iS) 5*3841 4488 P. 01 8/821
SfP-12-2001 (WED) 11=25 HETAB
Suggested Personal Protective Equipment

• Tyvek suits, booties (avoid speding eotturimiionj - to avoid skin contact with
biological CPOWWnarits
• Safety Shoes because of construction debns
• Hard Hals with Face Shields (splashes)
• At Least Disposable Respiratofs-N95flbs^««W1«Bl«B
o HEPA filters would be the best - contaminated dust will also be issue
O Also filters containing charcoal will help with odors.
• Double Glove* (Niirii*) or One pair of Nfctte and Ons pair of thicker ™bbcr gloves
there is a major problem with punctures from sharp bones.
9/12/01, 11:21 PM, NEW YORK CITY DEPARTMENT OF HEALTH
Recommendations for Worker and Visitor Safety
Affected Area Definition: Based on available asbestos test results and distribution of dust
& debris, the site is defined by the Hudson River on the west and the following street
boundaries:
On the north: Worth Street

On the east: Centre and Nassau Streets
On the south: Exchange and Thames Streets
Site Control: Site control is needed to assure that all workers and visitors are aware of
these recommended precautions and possess recommended personal protective
equipment. In addition, site control is needed to assure decontamination and dust
suppression of debris coming off site.
Visitor Protection: It is recommended that anyone entering the site, but not scheduled to
actively work in debris or to disturb dust wear at a minimum a disposable cup-type (i.e.,
not fan-folded or duck bill) N100 or PI00 respirator and goggles. Upon exiting the site,
the respirator should be disposed of by being placed in a plastic bag.
Worker Protection: It is recommended that anyone working in debris or performing

decontamination within the site such that surface dust is disturbed and re-suspended in
the air, wear at a minimum a half-face, reusable respirator with replaceable PI00 filter(s),
goggles, and either fire-fighting (turnout) gear or disposable Tyvek coveralls. Replace
filters when breathing resistance is too great or after one week of use. Upon exiting the
site, gross decontamination of reusable fire-fighting (turnout) gear should occur.
Disposable coveralls should be removed and placed in a plastic bag.
Decontamination: All vehicles leaving the site, should be hosed down with water.
Anyone performing decontamination should wear a half-face, reusable respirator with a
replaceable PI00 filter, goggles, and either fire-fighting (turnout) gear or disposable
Tyvek coveralls.
Hauling and Storage of Debris: All debris leaving site and stored off-site should be
wetted and covered with a tarp.
Hazard Assessment: Environmental testing needs to continue to better characterize levels

of asbestos and other potentially hazardous materials within the site and in other off-site
locations. Initial testing has demonstrated the presence of asbestos. A sampling plan to
determine the level of risk in the community needs to be determined and implemented as
soon as possible.
9/12/01, 11:21 PM, NEW YORK CITY DEPARTMENT OF HEALTH
Equipment To Be Ordered:
Half- face reusable Respirators

• 500 smalls
• 4000 medium
• 1000 large
• 15,000 sets of P100 filters
Disposable Cup Respirators (N100 or P100)

• 500 small
• 8500 medium
• 1000 large
Goggles
• 13,000 pairs
NEW YORK CITY EMERGENCY NUMBERS LIST
Mental Health Services

English LifeNET 212 995 5824
Spanish LifeNET 212 533 7007
Chinese LifeNET 2122542731
St. Vincent's Hospital 2126048220
Transportation/Transit
DOT 2 12/7 18 CALL DOT
MTA (City) 718 330 3000
MTA (State) 2128787000
Transit Bureau (NYPD) 7182433441
FAA 202 267 3484
Volunteers/Blood Donation/Monetary Donations

American Red Cross 1 800 GIVE LIFE
212 875 2067/8/9
1 800 801 8092
Red Cross Relief 1 800 HELP NOW (800 257 7575 Spanish)
Doctors/Medical 5184317600
2126043850
NYC Blood Center 2 12 893 BLOOD
Patient/Missing Persons Information

NYPD Missing Persons Information 447 2998/9; 447 8207/10
492 1st Ave (Walk-ins are welcome)
St. Vincent's Patient Information Line 2126047285
1 866 761 8265
Patient/ Missing Persons Information 2 12 560 2730 (in NYC)
1 800 222 6459 (outside NYC)
Port Authority Workers Missing Persons Info. 1 973 565 5505
NYPD Families (ONLY) 212 866 4165/6; 212 856 4167
FBI Website www.ifccfbi.gov
BOGUS WEBSITE www.ny.com/wtc/list.html
FDNY Families (ONLY) 7189992541
American Airlines 1 800 433 7300
United Airlines 1 800 241 6522
Wall Street Workers Patient Information 1 888 883 4391 (Morgan Stanley)
To report a person who's safe 212 704 8188
Emergency Health Numbers

NYCDOH Poison Control 2 12 POISONS
NYCDOH Burial Desk 9262150,3686538
135th Si/5* Ave Fax: 926 2526
CDC Emergency 770 488 7100
Emergency Preparedness - PHS 3014432401, 1167
FBI Hotline 2123243000
WTC Tipline 718 765 4300
Medical Examiner 2124472713
Main Office 212 447 2030
New York City Department of Health September 12,2001,6:00 P.M.

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SEP-12-2001 17:32 NYS Warning Point 518 457 9930 P.01/13
New York State Emergency Management Office

1220 Washington Avenue
Building 22, Suite 101
Albany, NY 12226-2251
FACSIMILE TRANSMISSIOH
ACTION INFO
IMMEDIATE
PRIORITY
ROUTINE MESSAGE NUMBER

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518 457 9930 P. 02/13
5EP-12-2001 17=32 NYS Warning Point
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TOTAL-
bEP-12-2001 10:02 NYCDhP DERTft 71 y 595 4690 P.01
S
WORLD T RADE CENTER INCIDENT?- 9/1 1/01 j
SAMPLE RESULTS -~ —--"
SAMPLE # LOCATION RESULT
1 23 Barclay Street 1 % chrysotile
2 217 Broadway 4% chrysotile
3 Church St & Vesey St negative
4 North east Church St & Vese 1.3% chrysotile
5 Across 90 Church Street negative
6 Barclay St & Church St 4.8% chrystotile
7 Warren St & Church St trace
8 Church St & Murray St less than 1%
9 Park Place & Church St 4% chrystotile
10 Church St & Dey St less than 1%
11 Church St & Cortland less than 1% chrysotile
Response Summary Tab?e-1
9/11 «M
Sample # Location Matrix Lead Cone Asbeslos • Total VQCs. ppbv
111981 Corner of Greenwich & Warren SI Oust 120 mg/Kg <l%CJuysolile NA

NYC
1 t 1980 Comer or Reade & Hudson St Oust 250 mgJKg < 1% ChyfsotiJe NA
NYC
111979 Comer of Murray SI & West Side Dust 20U mg/Kg <! 49% Chrysolite NA
NYC < 1% Amosile
111978 Corner of West Broadway & Warren Dust 170 mg/Kg None Delected NA
NYC
307/561 ftemsen St @ Promenade Air ND 0.004S fiber/cc ChrysolUe 42'
Brooklyn
562 Reinsert St @ Promenade Air ND O.flCMB ftber/cc Chrysolile NA
Brooklyn
308/563 Cranbe;ry St @ Columbia Air ND None Detected ND
Brooklyn
309/564 Congress St @ Columbia Air NO O.OQ4B iiber/cc Chrysolile ND
Biooktyn
310/665 Coufi S( @ Montague Air NO None Delected 5
Brooklyn
116/667/666 near Command Center Air ND None Detected Q.6J
Liberty ParK
117/665/668 near Command Center Air ND None Detected D.6J
Liberty Park
if8/66f/664 looking al Elf is island Air NO None Delected O.6J
Liberty Park
19/664/663 looking al World Trade Center Air ND None Delected ND
Liberty Park
3 ppb toluene, 7 ppb benzene, 1 ppb elhylbenzene, 3 ppb styfene, 1 ppb m & p xylene, 3 ppb chtoromelhane
ppb trichloroffLJoromelhane. 19 ppb non large! freon compouncfs
in air Oeleclion limit 5.0 micfugroms/cubic meter

Sample # -ocation Matrix _ead Cone Asbestos Total VOCs, ppbv
111981 Corner of Greenwich & Warren St Dust 120mg/Kg < 1 % Chrysotile NA

NYC
111980 Corner of Reade & Hudson St Dust 250 mg/Kg < 1 % Chyrsotile NA
NYC
111979 Corner of Murray St & West. Side Dust 200 mg/Kg 4.49% Chrysotile NA
NYC < 1 % Amosite
111978 Corner of West Broadway & Warren Dust 170 mg/Kg None Detected NA
NYC
307/561 Remsen St @ Promenade Air ND ' 0.0048 S/cc Chrysotile 42*
Brooklyn
I 562 Remsen St @ Promenade Air ND 0.0048 S/cc Chrysotile NA
Brooklyn
308/563 Cranberry St @ Columbia Air ND None Detected ND
Brooklyn
309/564 Congress St @ Columbia Air. ND 0.0048 S/cc Chrysotile ND
Brooklyn
310/565 Court St @ Montague Air ND None Detected 10
Brooklyn
416/667/668 near Command Center Air ND None Detected 0.6J
Liberty Park
417/665/666 near Command Center Air ND None Detected 0.6J
I
Liberty Park
418/661/664 looking at Ellis Island Air ND None Detected 0.6J
Liberty Park
419/664/663 looking at World Trade Center
Liberty Park
Air ND None Detected ND
ff
* 3 ppb toluene, 7 ppb benzene, 1 ppb ethylbenzene, 3 ppb styrene, 1 ppb m & p xylene, 3 ppb chloromethane
5 ppb trichlorofluoromethane, 19 ppb non target freon compounds
SEP-12-20B1 17:33 NVS U,rnln3 Polnt
513 457
CON E D I S O N COMPANY OF NEW YORK, INC

E N V I R O N M E N T , HEALTH AND SAFETY
4 IRVING PLACE
NEW YORK, NEW YORK 10003
2 12«9S2«8_1_94
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NYS Warning Point
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WORLD T RADE CENTER INCIDENT - 9/11/01

; SAMPLE RESULTS
r
SAMPLE H LOCATION RESULT
1 23 Barclay Street 1% chrysolite
2 217 Broadway 4% chryaotile
3 Church St & Vesey St negative
4 North east Church St & Vese 1 .3% chrysolite
5 Across 90 Church Street jnegative
6 Barclay St & Church St 4.8% chrystollle
7 Warren St & Church St trace
8 Church St & Murray St ess than 1%
9 Park Place & Church St 4% chryatotlle
10 Church St & Day St easthan 1%
11 Church St & Cortland ess than 1%chrysotlle
•.
TOTfiU P.01
TOTQL P.14
Department of Public Health Disaster Response
World Trade Center Attack
9/12/2001 8:15PM
Offices of DOH have been temporarily moved to Bureau of Labs, 455 1st Avenue, NYC.
DOH Command Center telephone number is: 212-447-2667 or 212-447-2668
OEM is located at 20th St. b/t 2nd and 3rd FAX 477-9723
Clinical Workgroup
Temporary clinic set up at 125 Worth St. has been closed.
All DOH clinic staff are to return to work tomorrow.
Advisories on asbestos and phosgene exposure have been prepared, preparation of others
hampered by lack of data on what chemical agents/biologies are at site.
Risk groups, stratified by exposure, have been identified. As far as we know, responders
are wearing N95's
Epi/Surveillance Workgroup
Surveillance staff are working in the Integrated Surveillance offices in the basement
Syndromic Surveillance system being set up - will be initiated tonight at 4 hospitals, at
least by tomorrow, at approximately 15-20 sentinel hospitals by noon 9/13
Broadcast fax system being set up on 1st floor. Broadcast fax sent out at 5 pm 9/12/01.
See addendum
No accurate data on ER visits. Greater NY Hospital reported 2235 ER visits, and only 47
admissions.
.Environmental Workgroup
Asbestos
DEC announced today via a flyer that "asbestos is a killer" (see addendum). Apparently
reported one level of 3.4 fibers/cc.
Air quality testing at WTC site was performed throughout the day. Levels of asbestos
from 0.01 to 0.085 fibers/cc were found at several sites along Chambers St. (see
addendum)
Asbestos testing has taken place in Brooklyn and New Jersey, all which have been below
1% threshold level. ConEd has tested one sample in Manhattan, level of 0.15 fibers/cc.
Hundreds of response personnel, Fire Dept, NYPD, and volunteers down at WTC site are
all potentially being exposed. Concern also that large amounts of rubble and debris,
including cars, are being removed from the site without being cleaned or hosed down to
avoid dust contamination.
OEM reminded re: wetting down trucks with debris.
5,000 N95 masks have arrived but have not been used. 1000 Ml00 masks and 2000
goggles have been ordered, arrival expected by morning 9/13
5 pm meeting at 5 Penn Plaza with EPA, DEC, DOH to discuss issues of air quality,
manner of testing, etc.
Concern that asthma incidence may increase as smoke plume covers more of lower
Manhattan, wind direction has changed, now coming from the south.
Meeting at 4 pm at 5 Penn Plaza with EPA, DEC, DEC, ConEd: see summarized
minutes. Recommendations include:
Strengthen security around site. Cordone off Exchange to Worth to Center. Visitors must
wear disposable masks, workers must wear 1/2 face masks with disposable cartridges.
Much concern about community exposure, cleanup of residential buildings and
apartments. No concern about asbestos washing into sewers.
OEM wants building by building inspection of every structure south of 14th St, including
structural and sanitary inspections, and cleaning of HVAC systems.
Inspectors sent to Stuyvesant High School and Chelsea Pier Food Stalls.
Discussion of whether 125 Worth St. is exempt from this plan.
Vehicles and equipment that make up San Genero Festival in Greenwich Village may
need to be checked.
Will be making recommendation to OEM about need for washing, cleaning, or removal
of asbestos covered clothing for personnel in direct crash area.
Other
Risk of gas leak at site is very real. Other buildings at WTC complex are at risk of
collapse as well.
Concern that freon in tanks in WTC (on roof or in subbasement?) may have been
transformed into phosgene, still leaking from site/rubble. Probability that freon was
consumed in fire and dispersed, although burning PVC pipe may also cause creation of
phosgene gas. Phosgene causes acute lung injury if inhaled in large amounts, best to
avoid altogether, face masks are not protective. No phosgene has been detected by scent
at the site. Possibility of using self-contained breathing apparati is being considered.
EPA will be doing phosgene monitoring tomorrow.
NIOSH is sending 2 personnel to assist with recommendations for construction and
emergency personnel.
Physical exam testing being waved as was done in 1993.
No licenses for radiation for medical purposes in WTC. Further radiation tests to be done
on 9/13.
2 possible sources of radiation were detected, DOE is on their way tonight to begin
testing.
Laboratory Workgroup
4 samples taken yesterday were tested for spores, are being cultured. No identifiable
growth so far.
No plans being made to test more specimens.
Sheltering Workgroup
DOH shelters are still open today although they are not very full, only 2-3 people per
shelter.
10 shelters in Manhattan, 1 in Brooklyn, 1 in Staten Island. 1 shelter closed due to
suspicious package delivered. Another shelter closed in Manhattan as well.
100 children who stayed in one shelter last night have been addressed.
No specific information where residents of Battery Park City have relocated to.
Nurse staff personnel have been scheduled until 9 am 9/13
Public schools below 14th St. will not be open tomorrow. Other public schools to be
delayed 2 hours.
Vital Statistics
Burial Desk is up and running at Central Harlem Health Center, regular business has
resumed.
Funeral directors are aware of new location.
3 deaths ascribed to WTC disaster have been issued so far, as of noon today.
Working with OCME to develop electronic form specific for WTC disaster.
Reports of hundreds of unidentified bodies at OCME and Bellevue (reliable?)
Hotline
General public health and missing person hotline is being staffed by DOH personnel.
LifeNet hotline for mental health has been established in English, Spanish, Chinese
Personnel policy
Personnel at all DOH sites above 14lh St. are being asked to return to work tomorrow
(9/13).
All non-essential personnel and non-managerial staff who work below 14th St. should not
report to work.
Managers should begin to assess need for staff to return to work and have plan in place
by Friday.
Equipment and supply shortages at clinics are unknown.
Paychecks will be distributed on Friday. Distribution plan in process.
There are buses running between the Bureau of Labs and Worth St.
HIV care issues

State AIDS Institute called, has conducted needs assessment of HIV/AIDS organizations
serving lower Manhattan, some concern that clients/patients do not have access to
medication and delivered meals (due to police lines, debris, etc). HRSA has promised
financial resources to assist all HIV/AIDS patients in area affected by disaster and rescue
effort.
Joe Barbera and Brian Flynn from HHS will visit Command Center tonight.
Secretary Tommy Thompson scheduled to meet with Commissioner Cohen tomorrow..
Acronyms:
DEC - Department of Environmental Conservation
DEP - Department of Environmental Protection
9/13/01 ,6: 10 AM
Q
Department of Public Health Disaster Response
September 12, 2001
Wednesday, September 12, 2001

10:15 PM
Command Center was informed of one shelter being closed (Norman Thomas HS) because of a "bomb
threat" at the Empire State Building. The surrounding area, including hotels and Penn Station was
evacuated. OEM and the Police later declared this to be a hoax.
The shelter was subsequently reopened.
11:15 PM
Shelter
All (9) shelters will remain open tomorrow, Thursday, September 13. Since some shelters are in schools
which will also reopen tomorrow, Wednesday, September 13, additional staff will be deployed to these
sites. Overnight consultants are Dr. Devi and Janice Stapleton.
Environment/Medical
Environmental and medical concerns include the presence of asbestos on site and the community; presence
of freon tanks (7-7,000 gallon tanks) that may decompose to phosgene gas; volatile organic compounds
(below toxicity level); ballast of the plane consisting of spent Uranium.
Post-meeting notes from Environmental is attached.
Meeting with EPA, NYS DEC, NYC DOH, DEP, ConEd, Mt. Sinai was held at 5 Penn Plaza to discuss the
process of environmental and occupational monitoring, and protection. In addition, results from various
tests for asbestos, lead and vocs were presented and reviewed with the group. Recommendations for
further coordinated testing and review were generated. Group plans to meet to convene regularly at 4:00
PM daily at 5 Penn Plaza.
Initial recommendation:
delineate area of concern for environmental risk
protective personal equipment to be used including Tyvek overalls, goggles, and masks with plOO
filters, and N100 (for individuals not sufficiently exposed to dust)
develop community advisory based on findings, and recommendations for control measures
decontamination procedure
removal of debris
continued assessment and planning for abatement of hazards, including residents in the affected
community
EPA will bring equipment to test for phosgene gas and other toxic gases tomorrow, Thursday,
September 13
Remaining Issues
availability of protective equipment - DC AS is in the process of procuring 5,000 half- face masks with
replaceable filter cartridges, replacement filters, and 10,000 PlOO disposable masks
develop a plan for residents in the community including monitoring for environmental hazards,
relocation of remaining residents and clean-up of the dwelling units and surrounding environment
coordinate the testing processes including the testing procedure
determine radiation levels being emitted from the spent Uraniun
control access to the community and the site
9/13/01, 6:10 AM
establish and implement the process for the distribution and training for the use of personal protective
equipment
Operations/Inspection PHS conducted inspection on site, and found unrefrigerated food for consumption by
rescue workers at Stuyvesant High
Overnight consultants: drs. Kambili, Kellner, Leighton, Perrin and Zucker, and Mr. Goldberg. Two
NIOSH consultants and Dr. Karpati (CDC) arrived today, Wednesday, September 12.
Thursday, September 13, 2001

2:30 AM
EPA is securing half-face masks with replaceable filter cartridges for immediate availability; coordinating
with OEM
Dr. Leighton arrived after the meeting/briefing at on site command center concluded. Drs. D'Andrea and
Markowski were present for the briefing. Next meeting is scheduled for 6:00 AM, Thursday, September
13. Messrs. Goldberg and Carlino will attend. Dr. T. Matte (CDC) will try to attend.
Current Status
3 major decontamination sites have been set-up at West and Harrison Streets, Church and Franklin,
and Water and Old Slip.
2 radiation monitoring vanes to check debris trucks for radiation as they exit
radiological experts from the DOE will be available Thursday, September 13
Rudolph W. Giuliani Neal L. Cohen. M.D.
Mayor Commissioner
To Whom It May Concern:
The New York City Department of Health requests the following emergency supplies:
ITEM QUANTITY
N95 Respirator Masks 10,000

N100 Respirator Masks 1,000
Goggles '2,000
'C,-^/^Cx
/;/?> xyl
x
^Benjamin Mojica, MD, M^H ~ " " " /'DATE

Deputy Commissioner^
Asbestos and Dust
Asbestos was used in the construction of the World Trade Center. Measurements of
asbestos fiber levels are being monitored to determine if there is any nsk of exposure.
To prevent exposure to asbestos and to reduce any risk that might exist, the following
protective measures are recommended:
- Persons working at the site should use N95 respiratory masks (TB masks) to prevent
inhalation of asbestos fibers and goggles to prevent eye irritation.
Persons who will be going into the building or working in confined spaces should use at
least an N100 mask for respiratory protection.
To the extent possible, gloves and coveralls should be worn and removed before going
home. Boots or shoes should be covered, if possible, and rinsed prior to returning home.
- Other risks may include exposure to cyanide and acid gases; levels will be monitored at
the site to determine if any risk exists.
- Emergency personnel (firefighters, EMS staff) should remove outer Scents and
shower immediately when returning to their firehouse/garage. Uniforms should be
separated from other clothing and washed twice in ordinary detergent.
- Persons who were exposed to ash and soot should shower and wash their hair. Clothing
should be washed twice in ordinary detergent, separated from other clothing.
- To reduce exposure to dust from building debris, the material should be wetted and
covered with a tarp during transport and storage. After the truck is emptied, the truck bed,
wheels and tires should be rinsed off.

9/12/01,2:30 am
Technical background and recommendations for DOH staff:
Asbestos:
Risk based on fiber size (length and diameter):
Long (>1/5,000A of an inch) as compared with short (1710,000th of an inch) fibers are
more likely to cause injury to the lung;
Generally smaller diameters or width fibers are associated with mesothelioma while
larger widths are associated with lung cancer.
Health effects from swallowing asbestos are unclear.
Disease has long latent period and risk is substantially increased with smoking.
Asbestosis — inhalation exposure

Symptoms: shortness of breath, often accompanied by rales or cough
Limits - 100,000 fibers per meter3 for average 8-hour exposure (OSHA 1994). NYS
regulations may be more stringent.
Preliminary results (9/12,2 am): 6 samples

2 from DEP, #1 = not detected, #2 = 1%
4 from BOL, 3 specimens were negative, 1 @ < 1 %
Cyanide:
signs and symptoms - headache, giddiness, sense of sinking, short of breath, palpitations,
and convulsions
Limits:
Fatal @ > 90 ppm after 30 to 60 minutes
> 300 ppm within few minutes
OSHA time waited average is 10 ppm
Nitrogen dioxide is used as an indicator.
Is red-orange-brown gas with a very pungent odor
Odor threshold is ~ 0.053 ppm

Recommended exposure limit is 1 ppm
OSHA time waited average is 3 ppm
Additional issues to be addressed:
Mental health issues (PTSD)

MIS Emergency Response Activity/Status Report
September 12, 2001 5:00am
Submitted by Edward Cambis
1. By 11:00am, Beth Maldin completed updates to hot topics on WNV [VR and
for DOH employees on 788-2222. Beth has ail info on how to update the IVR
system. Dirad contact number is 518-438-6000, ext. 204 (Jennifer), ext. 142
(tech support).
2. Consistent with reports of a fire at the downtown Verizon central office, DOH
lost voice, fax, IVR, email, internet access, and network connectivity between
125 Worth Street and the other agency locations. This also includes existing
WNV hotline access to the WNV system over the internet.
3. Most voice service was apparently lost during 9/11 late afternoon timeframe,
although there were significant outages since morning of 9/11.
4. Email and internet access were apparently also lost during between 6:30pm
and 9:20pm.
5. Confirmed with Joe Sorrentino at DOITT that fire and subsequent flood at
West Street CO has caused major damage to telecom lines in the lower
Manhattan area. At 9/11, 10:15pm, there was no estimated timeframe for
restoration of service. Joe confirmed that service prioritization is being
handled by OEM, and any requests for prioritization should go through them.
6. Joe Sorrentino recommended that DOH consider moving operations from the
125 Worth Street location, since communications are not likely to be restored
soon. (Joe Sorrentino cell phone # 917-769-1077)
7. Confirmed with DOITT that the Bureau of Laboratories at 455 1st Avenue ties
in to a different Verizon CO switching office, and that service should not be
impacted at that location.
8. Confirmed through Bill Gross, Mayor's Office of Operations, at approx.
I2:30am 9/12, that it would likely be several days before service is restored at
125 Worth Street (Bill Gross cell phonej 1 Confirmed that
Sanitation and HHC also have lost phone service at 125 Worth Street location.
Action Items ;
1. By 9am, attempt to use ISDN backup lines to restore network and email
service at 125 Worth Street. \. Prior to 9am, confirm the status of
and network access to other DOH locations from 455 1st Avenue.
3. Plan for and identify issues around a potential move of D:OH command to 455
1st Avenue. This includes plan for moving data stores at ± 25 Worth Street by
sneakemet to Labs so that work can continue there. Check PC availability at
BOL training room. \. Address issues around unavailabi
IVRs tie in to the affected Verizon CO. \. Explore use of DOH website to c
6. Identify 3 single phone lines at BOL to transfer WinFax system to BOL.

Attempt to coordinate with David Haddow to facilitate move. Explore
moving agency BizCom fax server to BOL as well. \1 Personal Privacy
7 Receive software from Joel Ackelsberg for entering hospital surveillance info.
Coordmate with EHS (Jose Bemtez) about utilizing MISA data entry staff
over next 3 weeks. Identify location for key entry and install software at that
location.
Staffing Update 81innnrri t, B locations north of 14th Street to

1. MIS
report to work in AM, Wednesday, 9/12. ^^^
7 MIS will place technical staff on 24x7 schedule starting at 9am Wednesday,
97 2 until no longer required. Several technical support staff will report to
125 Worth Street at 9am, and increased staff support will be provided to 455
3. MIS has database person available at 7:30am at 125 Worth Street throughout
the day to provide assistance as needed.
4. Additional MIS staff can be called in as needed.
September 12, 2001
"cotS tyvek overaUs and N95 masks for use by emergency rescue crew
- ordered through the CDC additional suppl.es;
considered trace;
"derations to CentralHar.ern, (.35* and 5* Ave)
"plide technica, assistance with the network and other IT issues
Operations
I ± toSlg supplies and setting up emergency c.inic
Surveillance Workgroup
9-11-01 Activities
I. Immediate Surveillance Activities to Assess Trauma Related Illness, and Hospital Needs
The Surveillance Workgroup immediately initiated two separate surveillance systems:
A - Hospital Needs Assessment: A telephone survey was conducted targeting all Manhattan and
Brooklyn acute care hospitals (See Survey for details). Briefly, the following information was
obtained:
Emergency Contacts (telephone/fax)
Total number of patients seen related to incident
Total number of deaths related to incident
Bed occupancy &
Emergency Department occupancy
Assess for staff shortages by job title, and determine if hospital had a plan for
emergency staffing
Supplies needed (blood, iv solution, ventilators)
Morgue occupancy and capacity
/ •' .1-^' ' •' t A , X ^
Results fas of 6 PM):[ We were1 able to contact 11/22 (50%) Manhattan hospitals and all
20 Brooklyn hospitals. Only 20 of the 31 hospitals reported seeing incident-related
morbidity and mortality. Overall, there were 658 ER visits related to the terrorist event
(535 in Manhattan, and 123 in Brooklyn) and 32 deaths. The average number of ER
visits by hospital was 33 (range 0 -140). Most deaths were reported by St Clares (n=27),
though we do not have data from Bellevue where most bodies have been taken. Sudha
Reddy prepared a more detailed summary of the survey findings. (ALSO as acute
issues/needs were identified these were called into the OEM EOC).
While doing the survey, we became aware that Greater NY Hospital Association
(GNYHA) and (?) New York State Department of Health were conducting similar
surveys (Due to communication systems breakdown, this information had not been
forwarded to us from the MOEM Command Center, as we had been initially tasked with
this assignment). The GNYHA and NYCDOH findings were combined (See Access
spreadsheet), with combined results on 17/22 Manhattan hospitals.
A linelist by hospital was prepared and demonstrated that only 7 hospitals were seeing >
50 victims through their E.D.s:
St Vincents Bellevue Beth Israel

Downtown Beekman NYU Long Island College Hospital
Brooklyn Hospital
Issues Related to Ongoing Surveillance for Hospital Needs;
1 - ? Coordinating Surveillance at Hospitals: To ensure that we do not duplicate efforts, a
decision was made at the MOEM EOC that the GNYHA would be primarily responsible
for ongoing surveys of the burden on hospitals and their staff and supply needs. The
surveys will be brief and focus primarily on number of ER visits, hospital admissions,
deaths and available beds. GNYHA is also providing a clearing house for hospitals to
request additional staff and supplies, and these requests are forwarded to OEM.
Next Steps:
- Although currently, GNYHA states that they have sufficient staff to support
these surveys, if they need assistance, they will request NYCDOH help through
our OEM EOC liaison.
- At the present time, most NYC hospitals are not seeing large numbers of
victims. Therefore, a more detailed needs assessment for staff and equipment &
needs may not be necessary. This situation should be re-assessed in the morning.
Decision issues: ? Need to do the more detailed needs assessment at the 7

hospitals listed above (NOTE: In addition to the NYCDOH
Hospital-Based Needs Assessment Form, the CDC has
faxed a draft form to Dr Ramon at PHL that we may want
to review.) IF we decide to do this more detailed survey
based on reports from the OEM EOC that GNYHA is
reporting continuing numbers of casualties, than we should
FIRST notify our OEM EOC liaison to inform OEM,
GNYHA and NYSDOH.
2 - Web-Based Surveillance for Acute Care Hospitals:

This morning, the CDC notified NYCDOH regarding the availability of a Web-based
system for the rapid assessment of hospital capacity and acute staff/equipment shortages.
This system was developed through DARPA by the Oracle Corporation for monitoring
hospital needs during a bioterrorist event. Farzad Mostashari MD contacted Oracle and
determined that this system could potentially be very useful in the event of ongoing
demand on hospitals. The contact at Oracle (Brian Jones) was amenable to modifying the
database to follow our hospital survey form, with fields to track traumatic injuries. In
addition, a database of NYC hospitals was sent to allow assignment of password
protected user IDs. Instructions for accessing the Website were drafted (url is
http ://www.leaders-svcs/net.pls/portal3 01.
Due to the ongoing communication breakdown in lower Manhattan (unable to receive

phone calls, internet email, or internet access), we were not able to pursue this further.
We were told that Bill Ballard (518-457-9916) at the NYSDOH was in contact with
Oracle as well, but have no details on its current status and availability.
As the number of ER visits and admissions have stabilized, this system may no longer be
necessary. But in the event that GNYHA reports increasing admissions and hospital
shortages, and internet access is restored, this Website may allow more timely and
complete data to be obtained. The decision to pursue this should be made in
coordination with NYSDOH, CDC (on site team), GNYHA and OEM in the AM. I
received an email from Brian Jones at 6:00 PM last night, that the system would be ready
by 7 PM. However, we soonafter lost all internet and phone communications.
Oracle Corporation DARPA

Brian. E. Jones John Silva
Practice Director TEL: 410-916-1260
Oracle Consulting CELL: 703-925-7150
(703) 925-7045 Office
(703) 925-7001 Fax
Brian.e.Jones@oracle.com &
B. Emergency Record Review to Assess Morbidity and Mortality

To better assess the range and magnitude of morbidity and mortality, surveillance teams were
sent to the 4 Manhattan hospitals reporting the highest numbers of ER cases: Bellevue (TNTC),
St Vincents (280), Beth Israel (200) and Downtown Beekman (300). A case ascertainment form
was developed to assess types of injury, where patient was at time of injury, and case status.
Surveillance teams of 2-6 persons were dispatched, and attempted to review ER sheets for all
patients seen since 9 AM on 9-11, as well as review admission logs (and ideally in-patient charts
if accessible). Sudha Reddy has prepared a summary of our findings. Case ascertainment was
not complete at all hospitals, and charts on admitted patients were not always accessible.
Issues to decide: It is likely that most surviving victims with trauma related injuries
have been seen at hospitals, and that ongoing morbidity and mortality related to the plane
crashes will mostly involve first responders involved in consequence management.
Therefore, there may not be a need to continue to actively tracking physical trauma at city
hospitals, and instead just rely on the GNYHA surveys and OEM EOC to assess patient
volume and only repeat the survey if there are reports of increases in injury related visits.
However, if staff resources allow, we may want to complete the ER surveys for 9-11-01
at hospitals with significant patient volumes:
1 - The teams at St. Vincents and Downtown were not able to complete the ER
visit charts.
2 - Hospital admissions were not reviewed at most hospitals (except Beth Israel),
however we do have the admission logs for all 4 sites.
3 - There are several hospitals with high volumes that were not surveyed,
including Long Island College Hospital, Brooklyn Hospital and NYU-Tisch. In
addition, St Clares hospital reported 27 fatal cases, a higher number than all other
hospitals.
C. Surveillance for overall casualties - The primary staging area for mortuary response is at the
Office of the Medical Examiner. They will have primary authority and the most complete data
on deaths related to this event. In addition, the DOH Burial Desk is another source of
information, though delayed. This office was temporarily transferred to the Central Harlem
Clinic.
II. Prospective Surveillance for Unusual Illness due to Concern about Bioterrorism
Although extremely unlikely due to the magnitude of the explosions at the World Trade Center,
we have decided to proceed with surveillance for unusual illness to monitor for a bioterrorist
event. Given the enormity of this attack, there is always the possibility of a second incident.
To assess for unusual disease clusters or manifestations, the following have been implemented or
are under development:
A - Broadcast alert to City Hospitals — An alert was prepared that addressed several &
issues of public health concern related to this attack. The primary issue emphasized was
the need for medical providers to be alert for unusual disease occurrences, including
clinical manifestations suggestive of potential bioterrorist agents, such as anthrax and
smallpox, as well as any unusual disease cluster.
Issues: We were unable to send the alert by broadcast fax or email due to the
communication system failures at DOH. A paper and electronic copy of the alert
were sent to the HOC, and the GNYHA will fax these using their system.
The NYCDOH number listed for reporting concerns about bioterrorism was 212-
788-9830. It is unclear if the phone systems here will be restored anytime soon.
Alternative numbers listed included the Poison Control Center, as well as an
emergency line at the EOC.
B - Continued Monitoring of the 911 System - Due to the expected increase in overall
calls to EMS, it is unclear if the CD 911 surveillance system looking for an increase in
the ratio of calls due to respiratory illness/overall calls will be useful over the next several
days. The other issue is that there may be an increase in respiratory calls due to dust
exposure, which will require active epidemiologic investigations to differentiate this from
an infectious cause. Farzad Mostashari should be consulted in the AM to determine the
best methods for prospectively monitoring 911 calls over the next 3 weeks (focus on
spatial clustering w the current statistical algorithms for citywide and boro wide
increases in ILL illness).
C - Prospective ER Based Syndrome Surveillance for Diseases Suggestive of BT:

We had a team meeting late last night to discuss possible options for actively conducting
hospital based surveillance for a 3-week period post event. It was decided that surveys
by phone or in person assessing impressions from ER, ICU and ID staff (similar to what
was done during Y2K) was not a reliable method for assuring the ability to detect a
bioterrorist event.
Tracee Treadwell, MD discussed the drop in systems that were used during last years
Democratic and Republican conventions, as well as during the Superbowl to obtain basic
information from ER physicians regarding the clinical syndromes for all patients seen.
Their experience is that medical providers were cooperative as long as the forms were
VERY concise, and that the major obstacle was relying on hospitals to do data entry. We
all agree that in the aftermath of the WTC incident, that ER physicians would be easily
engaged and cooperative in participating in this survey for a 3-week period. IN addition,
if internet access can be obtained, we will have the ability to send this information to
CDC for rapid analyses using pre-prepared programs that use CUSUM and SODA to
detect disease clusters. We would also hope to geocode the data to use stat scan to look
for any clustering in time or space.
i
Therefore, the following steps were taken on 9-12-01 in preparation for this effort:
1 - Draft survey form was developed (Mike Phillips), along with an instruction
sheet for emergency department staff. Although this form will focus on BT
related disease, we will also capture minimal data on trauma and respiratory
illness related to dust/debris exposure.
2 - Draft protocol for how DOH will recruit E.R. directors to participate, as well
as how DOH staff will be deployed to ensure compliance and obtain the
completed forms on a regular basis to bring back to DOH for centralized data
entry and analyses.
3 - DOH staff sent to retrieve forms (PHAs, etc) may also be used to obtain
summary data on hospital statistics, overall admits, ICU occupancy, etc.
4 - Ed Carubis has identified a potential pool of data entry staff to assist.
Issues to address:
1 - It is unclear if and how many staff will report to work on 9-12. Therefore, we
may need to initially limit this effort to higher risk hospitals (downtown
Manhattan and Brooklyn). Need to determine the best way to utilize surveillance
staff on site at hospitals.
2 - Ideally, transportation staff can be assigned to assist with routine pick up of

these forms to deliver to a central location for data entry. Ideally, these forms
should be collected at least twice a day, with routine analyses.
3 - A protocol needs to be developed, along with a more detailed case

investigation tool for responding to an increase in illness suggestive of BT.
Key Contact Numbers:
OEM - 477-9610 or 477-9750 PHS Emerg Preparedness 301-443-2401/1167
GNYHA - 259-0727 OCME - Dave Schomburg - 447-2036
CDC EOC-770-488-7100 EMS Metrotech Dispatch 718-442-4730

770-488-8251 EMS Central office 718-999-2111
Rudolph W. Giuliani Neal L. Cohen, M.D.
Mayor Commissioner

Enhanced Emergency Department Surveillance
Instructions
Triage nurses/clerks &
1. Complete section A and B: write patient admit date, admit time, zip code of residence and
zip code of place of work in spaces provided on surveillance form.
2. Determine if patient is a first responder (police, fire or emergency medical personnel) and
check appropriate box.
3. Imprint lower right hand corner with addressograph stamp or label
4. Affix to patient chart (this is not a permanent part of the patient's medical record).
Health care provider
1. Complete section C: Check the appropriate box that describes the one predominate clinical
syndrome seen in your patient
2. When completed, please place completed form in designated area.
version: 9/12/01
NEW YORK CITY DEPARTMENT OF HEALTH
ENHANCED EMERGENCY ROOM SURVEILLANCE
Instructions:
1. COMPLETE FORM FOR EACH PATIENT ADMITTED TO THE EMERGENCY DEPARTMENT
2. STAMP FORM AT BOTTOM RIGHT WITH PATIENT ADMISSION IMPRINT CARD
A. Patient admit date: (MM/DD/YYYY) / /

Time (24 hour clock): (HH:MM) :
Date of birth (MM/DD/YYYY): __/__/__ OR_Age (YEARS):
ZIP code of residence:
ZIP code of place of work:
B. Is the patient a first responder (fire/police/emergency medical personnel) ?
D Yes D No D Unknown
C.Please check the one predominant syndrome from the following list that best represents the
primary condition of the patient:
D None of the following
D Trauma
D Respiratory illness due to inhalation of particulate matter
D Upper or lower respiratory tract infection with fever
D Diarrhea/gastroenteritis (including vomiting, abdominal pain, or any other GI distress)
D Rash with fever (do NOT check unless both are present)
D Sepsis or non-traumatic shock
D Meningitis, encephalitis or unexplained acute encephalopathy/delirium
D Botulism-like syndrome (cranial nerve impairment and weakness)
D Unexplained death with a history of fever

PATIENT ADMIT CARD IMPRINT:
If you have any questions, please call ??? and ask for the doctor on duty
After hours, call the Poison Control Center (212-) and ask for the doctor on call
Version: 9/12/01
ED-Based Syndromic Surveillance Options
1. Rationale for enhanced surveillance
a. After such a complex terrorist attack, we need to anticipate potential
secondary biological devices of equal sophistication
b. Some risk that the planes involved in the attack were carrying
biological agents that were dispersed during the explosion
c. Need to assess prospectively any increase in respiratory illness caused
by exposure to toxic chemicals and particulate matter
d. Need to assess prospectively any ongoing traumatic injuries (e.g., in
first responders)
2. Options for enhanced ED syndromic surveillance

a. Concise patient-level tool completed by clinicians
i. Advantages: accurate patient-level data capture; acceptable (if
short); easy way to capture denominator/numerator data
ii. Disadvantages: large amount of data to collect, transport and
data enter; potential not to be acceptable to all facilities
b. Concise patient-level tool completed by dedicated ED-based
surveillance staff
i. Advantages: acceptable to clinicians;
ii. Disadvantages: data capture not as accurate/complete or as
timely
c. Qualitative survey of ED and ICU staff by DOH surveillance staff
i. Advantages: easier to manage; may be more acceptable
ii. Disadvantages: less accurate data capture; no
denominator/numerator data capture; less able to detect
aberrations in data
3. Proposed enhanced ED syndromic surveillance

a. CDC questionnaire/database deployed and used at WTO meeting
(Seattle), both national political conventions, and the Super Bowl
i. Advantages: system has been used previously and shown to
work; data can be analyzed both locally and at CDC, where
complementary analytical tools have been developed to detect
aberrations
ii. Disadvantages: need Internet access to use all features
iii. Features
1. Questionnaire: Initial data filled-out by triage staff;
clinician needs only a few seconds to complete
2. Database: maintained by Oracle; secure extranet site
located in Virginia; password-protected and encrypted
iv. Needs
1. Hospital-based staff
9/12/01 6:47 AM
2. Transportation of staff and data to and from hospitals
3. Data entry personnel at DOH
4. Epidemiologic support at DOH to analyze data
v. Response to aberration detection
1. Rapid response epidemiologic field investigation to
characterize illness, identify potential agent and risk
factors
9/12/01 6:47 AM
Patient Imprint Card or Label If imprint card is unavailable:
Last Name:.
First Name:
MedRec#:
D Female D Male

Instructions: FOR EACH PATIENT SEEN AT THE EMERGENCY DEPARTMENT
1. Stamp form at top left with patient imprint card
2. Triage/registration and health care provider fill out respective sections
3. Place in drop box Hospital Code
Triage/Registration Complete This Section
Date of visit: f
Age:
Home Zip Code: j
r ~
For age less than one year please use "1"
j Work Z ip Code:
Was patient in southern Manhattan (below Canal St) on Tuesday, September llth
after the attack? (circle one) YES NO Don't Know
Health Care Provider Complete This Section
Please check the ONE PREDOMINANT syndrome from the following list that best
represents the PRIMARY condition of the patient
D iNone of the following
D Trauma
D (Smoke or dust inhalation
D iExacerbation of underlying respiratory condition (Asthma/ COPD)
D jAnxiety reaction (including somatic complaints, insomnia)
D Diarrhea / gastroenteritis (including vomiting or abdominal cramps)
I iUpper or lower respiratory infection WITH fever
D Sepsis or non-traumatic shock
D JRash WITH fever (do NOT check unless both are present)
D (Meningitis, encephalitis, or unexplained acute encephalopathy
D Botulism-like syndrome (cranial nerve impairment and weakness)
D Unexplained death with a history of fever
IF YOU HAVE ANY QUESTIONS OR NEED TO REACH THE NYC DEPARTMENT OF HEALTH, PLEASE CALL
212-447-2676 AND ASK FOR THE DOCTOR ON DUTY. IF NO ONE IS AVAILABLE AT THAT NUMBER, CALL
THE POISON CONTROL CENTER AT 212-764-7667.
Patient Imprint Card If imprint card is unavailable:
Last Name:.
First Name:
Med Rec #:
D Female D Male

Instructions: FOR EACH PATIENT SEEN AT THE EMERGENCY DEPARTMENT
1. Stamp form at top left with patient imprint card
2. Triage person and physician fill out their respective sections AFFIX LABEL HERE
3. Place in drop box
;j
TO BE FILLED OUT BY TRIAGE
Date: [71 _________

For age less than one year please use "1"
Home Zip Code: Work Zip Code: \s patient within 10 blocks of the World Trade Cente
after the attack? (circle one) YES NO Don't Know
TO BE FILLED OUT BY PHYSICIAN
Please check the ONE PREDOMINANT syndrome from the following list that best
represents the PRIMARY condition of the patient
D None of the following
D [Trauma
D Smoke or dust inhalation
D Exacerbation of underlying respiratory condition (Asthma/ COPD)
D Upper or lower respiratory infection WITH fever
Diarrhea / gastroenteritis (including vomiting or abdominal cramps)
Sepsis or non-traumatic shock
Rash WITH fever (do NOT check unless both are present)
Meningitis, encephalitis, or unexplained acute encephalopathy
Botulism-like syndrome (cranial nerve impairment and weakness)
Unexplained death with a history of fever
IF YOU HAVE ANY QUESTIONS OR NEED TO REACH THE NYC DEPARTMENT OF HEALTH, PLEASE CALL
212-447-2676 AND ASK FOR THE DOCTOR ON DUTY. IF NO ONE IS AVAILABLE AT THAT NUMBER, CALL
THE DOH COMMAND CENTER AT 212-447-2667 OR THE POISON CONTROL CENTER AT 212-764-7667.
9/12/01
2:00 p.m.
' SPACE RELOCATION FOR DEPARTMENT OF HEALTH

Bureau of Labs
455 1st Avenue
NYC 10016
CLINICAL/MEDICAL
12TH FLOOR
ROOMS 1210,1213,1217
Room 1213
212-576-8416 - Sue Blank
212-576-8458 - Jessica Leighton
212-578-0829 - Jo Anne Bennett
212-578-0807
212-578-0881 - Margrit Kaminsky
Room 1217
212-576-8461 -Andy Goodman
212-576-8460 - Mary Perrin
212-576-8462 - Jim Miller
212-576-8463 -Elliot Marcus
PUBLIC AFFAIRS is temporarily relocated in the HIV Library, at the Bureau of Labs,
Room 1233.
Temporary Telephone Numbers

FAX: 447-8239
Big Room
212-447-8233 -JessicaMorris
212-447-8232 - Greg Butler
212-447-2686 -Fran Paris
Office with Door

212-447-8237 - Sandra Mullin
Office with Window & Door

212-447-8236 - Andrew Tucker
Room 1237
212-447-2981 (Library)
Available for other personnel and possibly a fax machine and/or Internet access.
SURVEILLANCE & EPIDEMIOLOGY

ROOMS B006 AND 8003
Computer Room (B006) - 212-447-8290

Don Weiss-212-447-8291
Phone Room (115) - 212-447-7601

212-447-8190
SHELTERS
Room 1223 - 212-576-8452
Maria-Teresa Lechuga
Richard Fox
cmosland c:\emergency\space relocation for Department of Health0912011400

j2A;6H£ L
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NY B19 Misc FDR - WTC Disaster Response - NYCDOH - 9-12-01

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NY B19 Misc FDR - WTC Disaster Response - NYCDOH - 9-12-01

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\

September 12, 2001

World Trade Center Disaster

New York City Department of Health= Clinical Response Team

45 Individuals triaged. 7 patients referred to hospitals for further evaluation,

Individuals referred to hospital(missing one record)

Overall Assessment and suggestions for future

OCME had received no bodies yet

A. Hospital based needs assessment

B. ER Acute injury/trauma surveillance

Regular, ongoing surveillance activities

OEM activated shortly after 9:00 AM.

' 'galth Alert Network

SUBJECT: ALERT: Terrorist Activity Response

increased numbers of illnesses that might be associated with today's events.

centers) to make them aware of this situation.

contact us by e-mail at healthalert@cdc.gov or access our website for further information at

-> -v>( H>

School Borough Address Phone

Bayard Rustln HS Manhattan 351 W. 18th St. 212-675-5350

Wash. Irving HS Manhattan 40 Irving PI. 212-674-5000

Chelsea HS Manhattan 131 Avenue of Amer. (6th Ave.) 212-289-7593

Norman Thomas HS Manhattan 111 E. 33rd St. 212-576-0500

IS 131 Manhattan 100 Hester St. 212-925-6386

Curtis HS Staten Island 105 Hamilton Ave. 718-522-6594

Westinghouse HS Brooklyn 105 Johnson St. 718-522-6594

3 Lutheran Medical Center 40 0

5 Long Island College Hospital 139 1

Obs hospnam tptincid tdthincid ^/J VH

31 North General Hospital

The FREQ Procedure

Table of sex by HOSPNAME

Frequency BELLEVUE BETH ISR NYU DOWN ST. VINC Total

Total 54 155 107 51 367

The FREQ Procedure

Table of trans by HOSPNAME

trans(MODE OF TRANSPORT TO HOSPITAL FACILITY)

UNKNOWN 30 125 106 13 274

Total 53 153 107 49 362

Table of status by HOSPNAME

Status(PATIENT STATUS) HOSPNAME

Frequency BELLEVUE BETH ISR NYU DOWN ST. VI NC Total

STABLE 41 121 1 33 196

UNKNOWN 11 34 105 18 lea-

Table of hosp by HOSPNAME

hosp(WAS PATIENT HOSPITALIZED) HOSPNAME

Frequency BELLEVUE BETH ISR NYU DOWN ST. VINC Total

ER ADMISSION 39 127 1 48 215

UNKNOWN 12 21 104 3 140

Total 54 155 107 51 367

The FREQ Procedure

Table of DISPOSTN by HOSPNAME

Frequency BELLEVUE BETH ISR NYU DOWN ST. VINC Total

ALIVE 40 123 2 1 166

Total 40 124 2 167

Frequency Missing = 200

For dodeath * HOSPNAME

The FREQ Procedure

Table of eye by HOSPNAME

eye(EYE TRAUMA/FOREIGN BODY) HOSPNAME

Frequency BELLEVUE BETH ISR NYU DOWN ST. VI NC Total

NO 39 136 105 35 315