NYC Seal

New York City Department of Health
Responds to the World Trade Center (WTC) Disaster

During business hours, please call the Provider Hotline at 866-692-3641. Please let the hotline operator know that you are a physician calling regarding a suspicious case, and they will refer your call to a NYCDOH or CDC physician consultant.

If you are unable to get through, please call one of the following temporary numbers for the Communicable Disease Program:




After hours, please call the Poison Control Center at 212-764-7667. (If that number is not working, please call 1-800-222-1222).

September 13, 2001

UPDATE #2: 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 New York City Department of Health

We are sending this broadcast alert to update you on urgent public health issues following the terrorist attack at the World Trade Center on Tuesday, September 11, 2001.

  1. The New York City Department of Health (NYCDOH) has relocated its headquarters to the Department's Public Health Laboratories at 455 First Avenue.
    NYCDOH is working closely with other City, State and Federal agencies, including the Centers for Disease Control and Prevention in a coordinated response to the World Trade Center disaster. Until further notice, please report only urgent communicable and environmental health issues to the following telephone numbers:

    Communicable Disease Issues:   212-447-2676 or 212-578-0823
                                            FAX: 212-532-5241 or 212-447-2678
    Environmental Issues:     212-684-1710 or 212-684-1896
    For other Urgent Public Health Issues, or if above numbers do not answer: 212-684-1628

    If you experience difficulty getting through to any of these numbers, please call the NYC Poison Control Center at 212-764-7667 (212-POISONS).

    Routine communicable disease reports (i.e., paper reports) should be sent by mail, as they will be forwarded to us.

  2. Environmental Risks Posed by Asbestos and Dust
    Asbestos was used in the construction of the World Trade Center. Tests performed indicate that asbestos may be present in an area marked by Worth St. to the North, Centre and Nassau Sts. to the East, and Exchange and Thames Sts. to the South. The health risk posed by a single exposure of short duration is very low. The risk to persons who have not been present in the affected area following the disaster is also thought to be extremely 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.

    At a minimum, anyone who needs to enter the affected area should wear a disposable cup-type (i.e., not fan-folded or duck-bill) N100 or P100 respirator and goggles. Workers in contact with debris or surface dust in the affected area should contact their employers or the NYCDOH (212-684-1710 or 212-684-1896) for specific recommendations regarding needed protective equipment.

    Increased particulate matter and dust released during recent days may cause eye and/or respiratory irritation, particularly for persons with underlying pulmonary disease, including asthma or COPD. Individuals who have a history of heart and lung conditions and who are in areas where smoke or dust is visible are advised to remain indoors with the windows shut. It is advised that air conditioners be operated on the "recirculate" mode, so that outside air is not pumped inside, or if this is not possible, that they be turned off. Persons who experience difficulty breathing or chest pain are advised to seek medical care immediately.

    Environmental testing is continuing to better characterize levels of asbestos and other potentially hazardous materials within the affected site and in other off-site locations.

  3. There is Currently No Evidence of a Biologic, Radiologic or Chemical Attack:
    The NYCDOH has received no information suggesting that a biologic, chemical or radiologic terrorist attack has occurred in the City. There is currently NO evidence - including laboratory tests on environmental samples taken from the affected area - that any chemical or biologic agents were released. Moreover, biologic agents would likely not have survived an explosion of that magnitude. We are not currently 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 suspected case of any of the following diseases:

      Q Fever
      Hemorrhagic fevers

      Please report immediately to the Surveillance Office at the NYC Department of Health (interim telephone number: 212-447-2676 or 212-578-0823) if you evaluate patients with any of these suspected illnesses or conditions. If you cannot get through to these numbers, please call the NYC Poison Control Center at 212-764-7667.

    The NYC Department of Health also has established an active surveillance program with sentinel hospitals throughout the city. Collaborating with emergency department staff, we will be monitoring for increases in patients presenting with certain disease syndromes (e.g., respiratory disease with fevers, gastrointestinal illness, neurological syndromes, and fever with rash), and other illnesses (e.g., asthma exacerbations) that may be associated with this attack. We anticipate that this surveillance will continue for 2-3 weeks.

  4. Reporting Fatal Cases and Information on Mortuary Issues, Including Death Certificate Registration for Deaths Related to this Incident

    1. 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.

    2. 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

  5. Mental Health Needs
    Clearly, many patients may present with emotional distress or grief reactions in the aftermath of this enormous tragedy. Patients and their families may be referred to the Department of Mental Health Services Hotline at 212-995-5824 for counseling.

  6. Hospital Material or Personnel Needs
    In the event that you require acute assistance, please contact the Greater New York Hospital Association (212-246-7100 or 212-506-5405).

  7. Rescue Worker Exposures to Potentially Contaminated Body Fluids
    During rescue operations, some rescue workers may come in contact with potentially contaminated body fluids. If such exposures occur percutaneously, to non-intact skin, or to mucous membranes, we suggest that facilities refer to their institutional protocols for managing potential exposures to blood-borne pathogens, or that they consult the infectious disease experts who routinely manage these situations in their hospitals.

  8. West Nile Testing
    Laboratory testing for West Nile virus is still available at the Public Health Laboratories. However, we are unable to offer transportation pick-up service at this time due to other pressing transportation needs. We request that hospitals arrange their own transportation of clinical specimens (Monday-Thursday, during regular business hours) to:

    Immunology Laboratory
    Public Health Laboratories
    455 First Avenue (between 26 and 28th St)

    Serum specimens should be kept refrigerated; cerebrospinal fluid specimens should be kept frozen at -70 oC. The West Nile case report form should be completed and a copy included with each clinical sample. A copy of the case report form should also be faxed to 212-532-5241. Please call the laboratory at the number listed above if you have any questions regarding proper specimen transport.

  9. 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 NYCDOH at 212-447-2676 or 212-578-0823.

We appreciate your cooperation and understanding as we all work together to deal with the ongoing consequences of this tremendous tragedy.

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