Health Hazard Evaluation of Police Officers and Firefighters After Hurricane Kat

[Guest guest]

Health Hazard Evaluation of Police Officers and Firefighters After

Hurricane Katrina --- New Orleans, Louisiana, October 17--28 and

November 30--December 5, 2005

Morbidity and Mortality Weekly Report

April 28, 2006

[Tables omitted. Go to the website for the complete version.

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5516a4.htm

<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5516a4.htm> ]

In the weeks after Hurricane Katrina struck the U.S. Gulf Coast on

August 29, 2005, reports of increased injuries and symptoms of physical

illness and psychological strain among New Orleans police officers and

firefighters prompted CDC to conduct a health hazard evaluation of these

two groups. Questionnaires were distributed to members of the New

Orleans Police Department (NOPD) and New Orleans Fire Department (NOFD)

7--13 weeks after the hurricane. This report summarizes the results of

that evaluation, which determined that upper respiratory and skin rash

symptoms were the most common physical symptoms reported by police

officers and firefighters and lacerations and sprains were the most

common injuries. In addition, approximately one third of the respondents

reported either depressive symptoms or symptoms of posttraumatic stress

disorder (PTSD), or both. These results underscore the need to

incorporate the safety and health of emergency responders into existing

disaster preparedness plans and to provide periodic responder training

and education in tasks unique to disaster situations. Clinical follow-up

of the physical and psychological health of emergency responders should

be conducted to better understand, monitor, and treat their health

conditions.

Investigators distributed survey questionnaires to NOPD members during

October 17--28 and to NOFD members during November 30--December 5. The

survey included questions about exposures to floodwater or floodwater

sediment, work duties, housing status, physical and mental health

symptoms, injuries, and whether medical care was sought. Respiratory and

gastrointestinal symptoms were considered hurricane related if the

respondent reported having the symptom every day or almost every day

during the preceding 4 weeks and reported not having the symptom before

Hurricane Katrina. A score of greater than 22 on the Center for

Epidemiologic Studies Depression Scale was used to define major

depressive symptoms (1), and the Veterans Administration checklist was

used to define symptoms consistent with PTSD (2).

NOPD officials estimated that 1,650 police officers were employed by the

department before Hurricane Katrina, and 1,200--1,400 police officers

were on duty at the time of the interviews; 912 police officers

completed the questionnaire, resulting in an estimated overall

participation rate of 65%--76%. NOFD officials reported 683 firefighters

on its most recent (prehurricane) roster; 525 (77%) completed the

questionnaire. Median age of participants was 37 years (range: 19--78

years) for police officers and 42 years (range: 20--64 years) for

firefighters. Eighty percent of police officers and 96% of firefighters

were male. Police officers had a median job tenure of 8 years (range:

<1--41 years); median tenure for firefighters was 13 years (range:

<1--40 years). Not all participants responded to all questions; the

number of responses per question ranged from 845 to 912 for police

officers and from 487 to 525 for firefighters.

Floodwater contact with the nose, mouth, or eye was reported by 51% of

firefighters (254 of 500) and 30% of police officers (258 of 864); 52%

of police officers (473 of 910) and 63% of firefighters (330 of 524)

reported rescuing citizens from flooded areas. Sixty-nine percent of

police officers (618 of 899) and 59% of firefighters (288 of 490)

reported that they were not living with their families at the time of

the survey (Table 1).

Police officers and firefighters reported similar prevalences of

physical health symptoms. Approximately 28% of police officers (236 of

848) and 31% of firefighters (162 of 525) reported upper respiratory

symptoms (i.e., head/sinus congestion or nose/throat irritation). Cough

was reported by 21% of police officers (176 of 845) and 23% of

firefighters (124 of 525). Skin rash was reported by 54% of police

officers (493 of 909) and 49% of firefighters (258 of 525) (Table 2).

Injuries most commonly reported by police officers and firefighters were

lacerations (police officers: 20% [184 of 912] and firefighters: 24%

[127 of 525]), sprains/strains (13% [120 of 912] and 25% [130 of 525]),

falls (9% [84 of 912] and 10% [54 of 525]) and animal bites/stings (11%

[104 of 911] and 8% [41 of 525]) (Table 2). Of 525 firefighters, 114

(22%) reported symptoms consistent with PTSD, and 133 of 494 (27)

reported major depressive symptoms. Of 912 police officers, 19% (170)

reported PTSD symptoms and 26% (227 of 888) reported major depressive

symptoms. Among all police officers, 31% (279) reported seeing a

health-care provider for post-hurricane illnesses and injuries;

health-care utilization among firefighters was not assessed.

Reported by: BP Bernard, MD, RJ Driscoll, PhD, Div of Surveillance,

Hazard Evaluations, and Field Studies, M Kitt, MD, Div of Respiratory

Disease Studies, National Institute for Occupational Safety and Health;

CA West, MSN, MPH, SW Tak, ScD, EIS officers, CDC.

Editorial Note:

The findings from these surveys indicate that, 7--13 weeks after

Hurricane Katrina, a substantial proportion of police officers and

firefighters in New Orleans had injuries and symptoms of physical and

mental illness. The prevalences of reported respiratory symptoms, skin

rashes, and injuries were similar to those reported by Katrina relief

workers through active CDC surveillance in the greater New Orleans area

(3). The high prevalence of symptoms for PTSD and major depressive

symptoms among police and firefighters is consistent with reports of

increased risk for PTSD and depression after natural disasters (4,5).

Police officers and firefighters also experienced stressors such as

extended working hours, sleep deprivation, hostile communities,

separation from their families, and destruction of their homes (6).

The relation between floodwater exposure and reported symptoms of

illness is not clear. Hazards in floodwaters vary but can include

varying amounts of sewage, household and industrial chemicals, petroleum

products, pesticides, and flammable liquids. Floodwaters also can

obscure physical hazards (e.g., storm debris or drainage openings);

other threats are posed by displaced domestic animals (7,8).

The inherent dangers of the work of police officers and firefighters

likely were compounded by the environmental hazards and personal

stressors after Hurricane Katrina. In addition, certain police officers

and firefighters were assigned to atypical activities (e.g., narcotic

control officers who performed search and rescue operations) for which

they might not have been adequately prepared. Full clinical diagnostic

assessment of physical and psychological health is necessary to

determine the breadth and scope of illness in persons with persistent

symptoms. The National Institute for Occupational Safety and Health has

prepared guidance for medical screening to assess the fitness of persons

for deployment as recovery workers after a hurricane (9). These

guidelines also can be used as a part of periodic medical evaluations to

assess whether emergency responders meet minimal physical requirements

to perform work duties.

The findings in this report are subject to at least three limitations.

First, only police officers and firefighters working at the time of the

surveys were included, introducing the possibility of participation

bias. Second, responses to traumatic events can provoke a range of

reactions, including intensifying preexisting symptoms; therefore, new

symptoms alone are not adequate to fully document physical or mental

illness. Finally, even psychological symptoms persisting for >1 month

might be normal and reversible acute stress and grief reactions;

responses to the questionnaire alone are not sufficient to diagnose PTSD

or major depression (10).

Reducing risks for illness and injury to police officers, firefighters,

and other emergency responders requires combining the capabilities of

multiple government and private response agencies. Safety and health

guidelines for emergency responders should be incorporated into existing

disaster preparedness plans. These should include periodic disaster

response training and education in tasks unique to disaster situations.

Additional information regarding safety management strategies and

guidance for emergency workers is available at

http://www.cdc.gov/niosh/docs/2004-144, and comprehensive information

regarding prevention of worker illness and injury after hurricanes and

other natural disasters is available at

http://www.cdc.gov/niosh/topics/flood.

Acknowledgments

This report is based, in part, on data contributed by E Page, MD, AL

Tepper, PhD, B King, MPH, A Markey, MS, C Dowell, MS, C Mueller, MS, J

Hurrell, PhD, K Mead, MS, A Warren, MPH, L -McKernan, MPH, T

Hales, MD, L Ewers, PhD, Div of Surveillance, Hazard Evaluations, and

Field Studies, and S Brown, MPH, National Institute for Occupational

Safety and Health, CDC.

References

Weissman MM, Sholomskas D, Pottenger M, Prusoff BA, Locke BZ. Assessing

depressive symptoms in five psychiatric populations: a validation study.

Am J Epidemiol 1977;106:203--14.

Blanchard EB, - J, Buckley TC, Forneris CA. Psychometric

properties of the PTSD checklist (PCL). Behav Res Ther 1996;34:669--73.

CDC. Surveillance for illness and injury after Hurricane Katrina---New

Orleans, Louisiana, September 8--25, 2005. MMWR 2005;54:1018--21.

Fullerton CS, Ursano RJ, Wang L. Acute stress disorder, posttraumatic

stress disorder, and depression in disaster or rescue workers. Am J

Psychiatry 2004;161:1370--6.

Ginexi EM, Weihs K, Simmens SJ, Hoyt DR. Natural disaster and

depression: a prospective investigation of reactions to the 1993 midwest

floods. Am J Community Psychol 2000;28:495--518.

International Association of Fire Fighters. Reports from the hurricane

frontlines: Katrina 2005. Washington, DC: International Association of

Fire Fighters; 2005. Available at

http://daily.iaff.org/katrina/katrina.htm?c=report.

US Environmental Protection Agency. Environmental assessment summary for

areas of Jefferson, Orleans, St. Bernard, and Plaquemines parishes

flooded as a result of Hurricane Katrina. Washington, DC: US

Environmental Protection Agency; 2005.

National Institute of Environmental Health Sciences. Safety awareness

for responders to Hurricane Katrina: protecting yourself while helping

others. Washington, DC: US Department of Health and Human Services,

National Institutes of Health, National Institute of Environmental

Health Sciences; 2005.

CDC. Interim guidance for pre-exposure medical screening of workers

deployed for hurricane disaster work. Washington, DC: US Department of

Health and Human Services, CDC, National Institute for Occupational

Safety and Health; 2005. Available at

http://www.cdc.gov/niosh/topics/flood/preexposure.html.

American Psychiatric Association. Diagnostic and statistical

manual---text revision (DSM-IV-TR, 2000). Arlington, VA: American

Psychiatric Association; 2000.

------------------------------------------------------------------------

--

Public Affairs Director, New York Committee for Occupational Safety and

Health

116 Street, Suite 604, New York NY 10038

jbennett@... <mailto:jbennett@...>

Tel: 212-227-6440 ext. 14

Fax: 212-227-9854

Please visit our website: http://www.nycosh.org <http://www.nycosh.org/>

Subscribe to our free biweekly Update on Safety and Health by sending an

e-mail message to subupdate@... <mailto:subupdate@...>

NYCOSH is a non-profit provider of occupational safety and health

training, advocacy and information (including technical assistance and

industrial hygiene consultation) to workers and unions throughout the

New York metropolitan area. Our membership consists of more than 250

union organizations and 400 individuals: union members, health and

safety activists, injured workers, healthcare workers, attorneys, public

health advocates, environmentalists and concerned citizens. We welcome

contributions of any amount to support our work, which can be made by

visiting http://www.nycosh.org <http://www.nycosh.org/> and clicking on

the " Donate Now " logo. Contributions to the New York Committee for

Occupational Safety and Health, Inc. (NYCOSH) are tax deductible as

provided by law. A copy of NYCOSH's last annual report may be obtained

from us or from the office of the Attorney General, State of New York,

Charities Bureau, 120 Broadway, New York, NY 10271.

NYCOSH's 9/11-related work is conducted in partnership with the United

Church of Christ's National Disaster Ministries, with additional support

from the September 11th Fund created by the United Way of New York and

the New York Community Trust.

NYCOSH is a union shop. Its staff is represented by the United Steel,

Paper and Forestry, Rubber, Manufacturing, Energy, Allied-Industrial and

Service Workers International Union (USW) Local 4-149.