World Trade Center Evacuation Study Epidemiology 256: Environmental and Occupational Epidemiology Thursday, May 24, 2012 Robyn R.M. Gershon, MHS, DrPH Principal Investigator NCDP National Center for Disaster PreparednessColumbia University CPHP Center for Public Health Preparedness Columbia University Funded by ASPH/CDC
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World Trade Center Evacuation Study
Epidemiology 256:
Environmental and Occupational EpidemiologyThursday, May 24, 2012
Case Study Presentation:The World Trade Center Evacuation
Study• Pre-event facts (Case study book chapter)• Significance• Human Behaviors in Fire Emergencies• Basic Organizational and Structural Facts• WTC Evacuation Study• Case Study Questions
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Significance
• High rises may experience fires and other disaster events
• Certain iconic high rises and public assembly spaces may be likely terrorist targets
• Lessons identified and learned from high rise disasters, including the WTC disaster in 2001 may improve preparedness and response to other high rise events
Human Behaviors in Emergencies
What is Known:• People will generally not go towards smoke• Seek out groups, group size is important• People move towards and stay with group even if it
is not the best option• The faster groups form – the faster they evacuate
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Human Behaviors in Emergencies
What is Known:• Individual and group panic dependent on several
key factors• Information serves as motivator• Leadership is especially important in public spaces
– both for shaping group behaviors and for guidance• Familiarity helps groups to form and minimizes
panic
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Basic Organizational and Structural Facts
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8
South
North
WTC Complex
Typical World Trade Center Office Floor
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• AFTER 1993 BOMBING Port Authority NYNJ Instituted a new EP Program:
• PLANNING
• ORIENTATION
• EDUCATION
• PUBLIC ADDRESS ANNOUNCEMENTS
• OCCUPANT FIRE SAFETY TEAMS
• TEAM TRAINING
• FIRE DRILLS
• CRITIQUE
Preparing for Emergencies
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WTC Worker Protection Programs in Place 9/11
• Codes met and exceeded NYC fire and other applicable building safety codes
• Port Authority Program
• Floor warden system• Annual fire drills• PA system
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Design Features of High Rises
• High rise buildings – robust and redundant• Not usually designed for rapid, full building
evacuation• Not designed to withstand impact of fuel-laden
large aircraft in use today• Rescue of occupants located in inaccessible
areas of high rises above the point of impact is not possible
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WTC, 2001North Tower Impact
(Tower 1)
• 8:46am • 767, 10K gallons • Impact at 94-98th floors• Collapsed 1 hour and 42
• 411 first responders• 147 jetliner crew and passengers• 1,462 in North Tower (1,355 above impact, 93%)• 630 in South Tower (619 above impact, >95%)• 18 bystanders (on the ground)• 24 location unknown in WTC 1 and WTC 2• Total deaths: 2,692• 11% of occupants died, most above point of
impact
WTC Fatalities, 2001
• Age Range– Planes: 2 ½ years – 86 years– Building: 18 years – 79 years
• Post 9/11– 479 illness/deaths of workers at Ground Zero
or Fresh Kills Landfill– 149 traumatic deaths– 33 suicides
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The WTC Evacuation Study* Objectives
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• To identify individual, organizational, and environmental/structural (building) factors that affected evacuation and health outcomes
• To inform policies and practices that support safe evacuation of high-rise structures
• To inform preparedness for other mass evacuations
*Funded by CDC/NIOSH
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WTC Evacuation Study: Overview
Participatory Action Teams
Identification of Risk
Reduction Strategies& Recommendations
Feedback to Participants &Stakeholders
Preparation of Reports
Qualitative Processes &
Analyses
Formative Steps
Questionnaire Development
& Administration
Data Analysis
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WTC Evacuation Study Model
Knowledge(Experience)
BeliefsAttitudes,
Perceptions of Safety Climate,
Perception of Risk, Fear,
Instinct (Gut Feeling)Subjective
Norms
Worksite Compliance and Safety Culture
Behavioral Intentions
Evacuation Behaviors
Outcomes
Individual and Organizational
FactorsInitiation
Group Behaviors
Environmental Enabling Factors Progression
Final Destination
Initiation and Length of Time
Injuries
Long Term
HealthSensory
Cues
Major Study Outcomes
1. Length of time to initiate evacuation
2. Length of time to fully evacuate• Controlling for floor and elevator use (WTC
1 and 2)
3. Injuries (physical)
4. Long term health impact (physical and psychological)
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Quantitative DataDemographics
• Responses: 1767 total • Of these,1444 (82%) evacuated on 9/11/01* Demographics (N=1444):
Once they decided to leave, but BEFORE they began to…
• Gathering items (40%)• Seeking out friends/co-workers (33%)• Searching for any others (26%)• Making phone calls (18%)• Shutting down/PC-related (8%)• Waiting for direction (7%)• Gathering safety equipment (5%)• Changing shoes (3%)• Trying to obtain permission to leave (1%)
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Factors Significantly* Associated with Initiation
Individual- Age (O.R. = 1.4)- Delaying activities (O.R. = 3.1)- Disabilities/medical conditions- Hesitating (O.R. = 3.7)- Injuries (O.R. = 1.4)- Looking for groups (O.R. = 1.5)
Structural• Any adverse environmental condition (O.R. = 4.6)• Any damage (O.R. = 2.3)• Multiple sources of communication• Overcrowding on stairs or in lobbies (O.R. = 2.2)
38*p < .05
Quantitative Data Outcomes: Injuries/Long Term Health
• Severity:• 63% sought medical care• 7% were hospitalized
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Significant* Factors Associated with Injuries
• Disability/Medical condition (O.R. = 2.0)• Fear for employment (O.R. = 4.9)• Female gender (O.R. = 1.9)• Lack of familiarity (O.R. = 2.7)• Less participation in drills• Not feeling personally responsible for own safety• Physical capability was low (O.R. = 2.8)• Starting from higher floor• Stopping• Supervisor would not approve (O.R. = 6.4)• Unsure of stairs
40*p < .05
Significant* Factors Associated with Injuries
• Any environmental condition• Any structural damage• Difficulty in following stairway route• Inadequate training • Lack of emergency preparedness• Making phone calls• Multiple sources of communication• Problem with shoes (O.R. = 2.6)
41*p < .05
Study Outcomes Long Term Injury Patterns
Condition n
Mental Health 132
Respiratory 61
Orthopedic 30
Medical 18
Cardiac 5
Vision / Hearing 5
• 221 persons (15.4%) of the evacuees reported at least one long-term injury related to evacuation of the WTC on 9/11 (some reported more than one condition).
• Long-term mental health problems were most common.
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Lessons LearnedFrom Evacuees
• Staying calm (“Behaving”)• Instincts• Mutual support• Leadership (group)• Directions/encouragement of first responders/NY/NJ
Port Authority• Integrity and condition of stairwells• General lack of massive overcrowding on stairwells
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Lessons Learned from the WTC Evacuation Study
• Human behaviors in this high rise fire were as predicted – Design features that support these behaviors will be
most effective • Training and drilling improve competency
– These should be mandatory • EP safety climate was associated with reduced
evacuation times, injuries and long term mental health problems.– EP Best practices should be implemented in all high
rise work settings
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Most Important Lesson Learned
• EMERGENCY PREPAREDNESS=RESILIENCY
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Regulatory Risk Reduction Strategies
1. NYC high-rise fire safety codes: Emergency Action Plan §6-02– EAP must specify the procedures for:
• Sheltering in-place• In-building relocation• Partial evacuation• Full evacuation
– Pre-planning for persons with disabilities
2. Designation and certification of an Emergency Action Plan Director (EAPD) §9-08– EAPD has the authority to implement this in the absence of
lawful authorities (i.e., they become the incident commander)
• Sherman MF, Peyrot M, Magda LA, Gershon RRM. Modeling pre-evacuation delay by evacuees in World Trade Center Towers 1 and 2 on September 11th, 2001: A revisit using regression analysis. Fire Safety Journal. 2011; 46(7) 414-424.
• Gershon RRM, Magda LA, Riley HEM, Sherman MR. The World Trade Center evacuation study: factors associated with initiation and length of time for evacuation. Fire and Materials. February 2011. doi:10.1002/fam.1080.
• Gill KB*, Gershon RRM. Disaster mental health training programs in NYC following September 11, 2001. Disasters. 2010;34(3). doi:10.1111/j.1467-7717.2010.01159.x
• Gershon RRM, Rubin MS, Qureshi KA, Canton AN, Matzner FJ. Participatory action research methodology in disaster research: results from the World Trade Center evacuation study. Disaster Medicine and Public Health Preparedness. 2008; 2(3):142-149.
• Qureshi KA, Gershon RRM, Smailes E, Raveis V, Murphy B, Matzner F, Fleischman A. A roadmap for the protection of disaster research participants: findings from the WTC evacuation study. Prehospital and Disaster Medicine. 2007; 22(6):484-49.
• Gershon RRM, Qureshi KA, Rubin MS, Raveis VH. Factors associated with high-rise evacuation: qualitative results from the World Trade Center Evacuation study. Prehosp Disaster Med. 2007; 22(3):165-173.
• Gershon RRM, Gemson DH, Qureshi K*, McCollum MC. Terrorism preparedness training for occupational health professionals. J Occup Environ Med. 2004;46(12):1204-1209.
• Nandi A, Galea S, Tracey M, Ahern J*, Resnick H, Gershon RRM, Vlahov D. The effects of job loss, unemployment, work stress, and work satisfaction on the persistence of probable PTSD: results from a cohort study of New York City metropolitan area residents one year after the September 11 attacks. J Occup Environ Med. 2004;46(10):1057-1064.
• Gershon RRM, Hogan E, Qureshi KA*, Doll L. Preliminary results from the World Trade Center evacuation study-New York City, 2003. Morb Mortal Wkly Rep. 2004; 53(35):815-816. 51