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J Occup Environ Med. 2005 Apr;47(4):386-91.

Rethinking first response: effects of the clean up and recovery effort on workers at the world trade center disaster site.

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Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.



We sought to describe the physical and mental health effects of the cleanup and recovery effort on workers at the World Trade Center disaster site.


A mailed survey was sent to truck drivers, heavy equipment operators, laborers, and carpenters. It assessed work-related exposures and somatic and mental health symptoms. In one open-ended question, respondents shared any aspect of their experiences they wished; these 332 narrative responses were analyzed using qualitative techniques.


Respondents reported suffering debilitating consequences of their work, including depression, drug use, and posttraumatic stress disorder. They felt poorly prepared to work in a disaster, lacked protective equipment and training, and felt overwhelmed by the devastation they faced.


These workers' experiences were qualitatively similar to the experiences of the first responders. To protect workers in the future, the focus on preparing "first" responders should be reconsidered more broadly.

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