Health Hazard Evaluation of Police Officers and Firefighters After Hurricane Kat

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Health Hazard Evaluation of Police Officers and Firefighters AfterHurricane Katrina --- New Orleans, Louisiana, October 17--28 andNovember 30--December 5, 2005Morbidity and Mortality Weekly ReportApril 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 onAugust 29, 2005, reports of increased injuries and symptoms of physicalillness and psychological strain among New Orleans police officers andfirefighters prompted CDC to conduct a health hazard evaluation of thesetwo groups. Questionnaires were distributed to members of the NewOrleans Police Department (NOPD) and New Orleans Fire Department (NOFD)7--13 weeks after the hurricane. This report summarizes the results ofthat evaluation, which determined that upper respiratory and skin rashsymptoms were the most common physical symptoms reported by policeofficers and firefighters and lacerations and sprains were the mostcommon injuries. In addition, approximately one third of the respondentsreported either depressive symptoms or symptoms of posttraumatic stressdisorder (PTSD), or both. These results underscore the need toincorporate the safety and health of emergency responders into existingdisaster preparedness plans and to provide periodic responder trainingand education in tasks unique to disaster situations. Clinical follow-upof the physical and psychological health of emergency responders shouldbe conducted to better understand, monitor, and treat their healthconditions. Investigators distributed survey questionnaires to NOPD members duringOctober 17--28 and to NOFD members during November 30--December 5. Thesurvey included questions about exposures to floodwater or floodwatersediment, work duties, housing status, physical and mental healthsymptoms, injuries, and whether medical care was sought. Respiratory andgastrointestinal symptoms were considered hurricane related if therespondent reported having the symptom every day or almost every dayduring the preceding 4 weeks and reported not having the symptom beforeHurricane Katrina. A score of greater than 22 on the Center forEpidemiologic Studies Depression Scale was used to define majordepressive symptoms (1), and the Veterans Administration checklist wasused to define symptoms consistent with PTSD (2). NOPD officials estimated that 1,650 police officers were employed by thedepartment before Hurricane Katrina, and 1,200--1,400 police officerswere on duty at the time of the interviews; 912 police officerscompleted the questionnaire, resulting in an estimated overallparticipation rate of 65%--76%. NOFD officials reported 683 firefighterson its most recent (prehurricane) roster; 525 (77%) completed thequestionnaire. Median age of participants was 37 years (range: 19--78years) for police officers and 42 years (range: 20--64 years) forfirefighters. Eighty percent of police officers and 96% of firefighterswere 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; thenumber of responses per question ranged from 845 to 912 for policeofficers and from 487 to 525 for firefighters. Floodwater contact with the nose, mouth, or eye was reported by 51% offirefighters (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 ofpolice officers (618 of 899) and 59% of firefighters (288 of 490)reported that they were not living with their families at the time ofthe survey (Table 1). Police officers and firefighters reported similar prevalences ofphysical health symptoms. Approximately 28% of police officers (236 of848) and 31% of firefighters (162 of 525) reported upper respiratorysymptoms (i.e., head/sinus congestion or nose/throat irritation). Coughwas reported by 21% of police officers (176 of 845) and 23% offirefighters (124 of 525). Skin rash was reported by 54% of policeofficers (493 of 909) and 49% of firefighters (258 of 525) (Table 2).Injuries most commonly reported by police officers and firefighters werelacerations (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 depressivesymptoms. Among all police officers, 31% (279) reported seeing ahealth-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 RespiratoryDisease 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 afterHurricane Katrina, a substantial proportion of police officers andfirefighters in New Orleans had injuries and symptoms of physical andmental illness. The prevalences of reported respiratory symptoms, skinrashes, and injuries were similar to those reported by Katrina reliefworkers through active CDC surveillance in the greater New Orleans area(3). The high prevalence of symptoms for PTSD and major depressivesymptoms among police and firefighters is consistent with reports ofincreased risk for PTSD and depression after natural disasters (4,5).Police officers and firefighters also experienced stressors such asextended working hours, sleep deprivation, hostile communities,separation from their families, and destruction of their homes (6). The relation between floodwater exposure and reported symptoms ofillness is not clear. Hazards in floodwaters vary but can includevarying amounts of sewage, household and industrial chemicals, petroleumproducts, pesticides, and flammable liquids. Floodwaters also canobscure 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 firefighterslikely were compounded by the environmental hazards and personalstressors after Hurricane Katrina. In addition, certain police officersand firefighters were assigned to atypical activities (e.g., narcoticcontrol officers who performed search and rescue operations) for whichthey might not have been adequately prepared. Full clinical diagnosticassessment of physical and psychological health is necessary todetermine the breadth and scope of illness in persons with persistentsymptoms. The National Institute for Occupational Safety and Health hasprepared guidance for medical screening to assess the fitness of personsfor deployment as recovery workers after a hurricane (9). Theseguidelines also can be used as a part of periodic medical evaluations toassess whether emergency responders meet minimal physical requirementsto 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 thesurveys were included, introducing the possibility of participationbias. Second, responses to traumatic events can provoke a range ofreactions, including intensifying preexisting symptoms; therefore, newsymptoms alone are not adequate to fully document physical or mentalillness. Finally, even psychological symptoms persisting for >1 monthmight be normal and reversible acute stress and grief reactions;responses to the questionnaire alone are not sufficient to diagnose PTSDor major depression (10). Reducing risks for illness and injury to police officers, firefighters,and other emergency responders requires combining the capabilities ofmultiple government and private response agencies. Safety and healthguidelines for emergency responders should be incorporated into existingdisaster preparedness plans. These should include periodic disasterresponse training and education in tasks unique to disaster situations.Additional information regarding safety management strategies andguidance for emergency workers is available athttp://www.cdc.gov/niosh/docs/2004-144, and comprehensive informationregarding prevention of worker illness and injury after hurricanes andother natural disasters is available athttp://www.cdc.gov/niosh/topics/flood. Acknowledgments This report is based, in part, on data contributed by E Page, MD, ALTepper, PhD, B King, MPH, A Markey, MS, C Dowell, MS, C Mueller, MS, JHurrell, PhD, K Mead, MS, A Warren, MPH, L -McKernan, MPH, THales, MD, L Ewers, PhD, Div of Surveillance, Hazard Evaluations, andField Studies, and S Brown, MPH, National Institute for OccupationalSafety and Health, CDC. References Weissman MM, Sholomskas D, Pottenger M, Prusoff BA, Locke BZ. Assessingdepressive symptoms in five psychiatric populations: a validation study.Am J Epidemiol 1977;106:203--14. Blanchard EB, - J, Buckley TC, Forneris CA. Psychometricproperties of the PTSD checklist (PCL). Behav Res Ther 1996;34:669--73. CDC. Surveillance for illness and injury after Hurricane Katrina---NewOrleans, Louisiana, September 8--25, 2005. MMWR 2005;54:1018--21. Fullerton CS, Ursano RJ, Wang L. Acute stress disorder, posttraumaticstress disorder, and depression in disaster or rescue workers. Am JPsychiatry 2004;161:1370--6. Ginexi EM, Weihs K, Simmens SJ, Hoyt DR. Natural disaster anddepression: a prospective investigation of reactions to the 1993 midwestfloods. Am J Community Psychol 2000;28:495--518. International Association of Fire Fighters. Reports from the hurricanefrontlines: Katrina 2005. Washington, DC: International Association ofFire Fighters; 2005. Available athttp://daily.iaff.org/katrina/katrina.htm?c=report. US Environmental Protection Agency. Environmental assessment summary forareas of Jefferson, Orleans, St. Bernard, and Plaquemines parishesflooded as a result of Hurricane Katrina. Washington, DC: USEnvironmental Protection Agency; 2005. National Institute of Environmental Health Sciences. Safety awarenessfor responders to Hurricane Katrina: protecting yourself while helpingothers. Washington, DC: US Department of Health and Human Services,National Institutes of Health, National Institute of EnvironmentalHealth Sciences; 2005. CDC. Interim guidance for pre-exposure medical screening of workersdeployed for hurricane disaster work. Washington, DC: US Department ofHealth and Human Services, CDC, National Institute for OccupationalSafety and Health; 2005. Available athttp://www.cdc.gov/niosh/topics/flood/preexposure.html. American Psychiatric Association. Diagnostic and statisticalmanual---text revision (DSM-IV-TR, 2000). Arlington, VA: AmericanPsychiatric Association; 2000. -------------------------------------------------------------------------- Public Affairs Director, New York Committee for Occupational Safety andHealth116 Street, Suite 604, New York NY 10038jbennett@... Tel: ext. 14Fax: Please visit our website: http://www.nycosh.org <http://www.nycosh.org/>Subscribe to our free biweekly Update on Safety and Health by sending ane-mail message to subupdate@... NYCOSH is a non-profit provider of occupational safety and healthtraining, advocacy and information (including technical assistance andindustrial hygiene consultation) to workers and unions throughout theNew York metropolitan area. Our membership consists of more than 250union organizations and 400 individuals: union members, health andsafety activists, injured workers, healthcare workers, attorneys, publichealth advocates, environmentalists and concerned citizens. 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