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World Trade Center Evacuation Study Epidemiology 256: Environmental and Occupational Epidemiology Thursday, May 24, 201

World Trade Center Evacuation Study Epidemiology 256: Environmental and Occupational Epidemiology Thursday, May 24, 2012. Robyn R.M. Gershon, MHS, DrPH Principal Investigator. Funded by ASPH/CDC. NCDP National Center for Disaster PreparednessColumbia University. CPHP

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World Trade Center Evacuation Study Epidemiology 256: Environmental and Occupational Epidemiology Thursday, May 24, 201

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  1. World Trade Center Evacuation StudyEpidemiology 256:Environmental and Occupational EpidemiologyThursday, May 24, 2012 Robyn R.M. Gershon, MHS, DrPHPrincipal Investigator Funded by ASPH/CDC NCDP National Center for Disaster PreparednessColumbia University CPHP Center for Public Health Preparedness Columbia University

  2. World Trade Center

  3. 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

  4. 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

  5. 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

  6. 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

  7. Basic Organizational and Structural Facts

  8. WTC Complex North South

  9. Typical World Trade Center Office Floor

  10. Preparing for Emergencies • 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

  11. 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

  12. 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

  13. WTC, 2001 South Tower Impact (Tower 2) 9:02am 767, 10K gallons Impact at 79-84th floors Collapsed 57 minutes after impact North Tower Impact (Tower 1) • 8:46am • 767, 10K gallons • Impact at 94-98th floors • Collapsed 1 hour and 42 minutes after impact

  14. WTC Disaster, 2001 Impact Zones of Planes

  15. WTC Fatalities, 2001 • 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

  16. 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

  17. The WTC Evacuation Study* Objectives • 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

  18. WTC Evacuation Study: Overview Formative Steps Qualitative Processes & Analyses Questionnaire Development & Administration Data Analysis Participatory Action Teams Identification of Risk Reduction Strategies& Recommendations Preparation of Reports Feedback to Participants & Stakeholders

  19. WTC Evacuation Study Model Worksite Compliance and Safety Culture Individual and Organizational Factors Initiation Initiation and Length of Time Knowledge (Experience) Beliefs Attitudes, Perceptions of Safety Climate, Perception of Risk, Fear, Instinct (Gut Feeling) Behavioral Intentions Evacuation Behaviors Outcomes Injuries Subjective Norms Environmental Enabling Factors Long Term Health Sensory Cues Progression Group Behaviors Final Destination

  20. Major Study Outcomes • Length of time to initiate evacuation • Length of time to fully evacuate • Controlling for floor and elevator use (WTC 1 and 2) • Injuries (physical) • Long term health impact (physical and psychological)

  21. Quantitative DataDemographics • Responses: 1767 total • Of these,1444 (82%) evacuated on 9/11/01 • Demographics (N=1444): • Gender: 58% male • Age, mean yrs: 44 yrs • Age, range: 22-80 yrs • Tenure, mean: 6 yrs • Tenure, range: 0-37 yrs • Marital status: 70% married/partner • Children: 48% • Race: 80% Caucasian • Education: 66% college+ • Employment: 84% private company • Union membership: 7%

  22. Quantitative DataHealth Status • Pre-existing disability or medical condition: 23% • Including… • Respiratory: 28% • Mobility: 28% • Mental Health: 17% • Heart Condition: 16% • General Medicine: 7% • Sensory Deficit: 6% • Smoking: 19% • 29% of those with a disability/medical condition said their disability affected their ability to walk down large number of stairs

  23. Emergency Preparedness/Knowledge/Experience (alpha = .77) 140 120 100 Frequency 80 60 40 20 0 0.00 1.00 2.00 3.00 4.00 5.00 6.00 7.00 8.00 9.00 10.00 Emergency Preparedness/Knowledge/Experience Mean = 3.42, Median = 3.00, Mode = 2.00, SD = 2.41 Quantitative DataKnowledge • Knowledge Related to Preparedness (10 Questions) • Mean 3.4 • Median 3.0 • Mode 2.0 • Range 0-10

  24. Quantitative Data • Building Participants DID NOT KNOW: 3 Stairwells Exit locations Where stairs would lead Doors on certain floors were locked Thought roof might be means of escape Not sure about roof Where sky lobbies were located

  25. Quantitative DataLack of Familiarity with Building • 56% somewhat familiar • 22% slightly/not at all familiar • 50% did NOT know enough about building to leave on their own • 27% had evacuated the building at least once • 16% reluctant to evacuate

  26. Quantitative DataPreparedness for Persons with Disabilities Disability Preparedness Scale (alpha = 0.76) Mean = 0.32 Median = 0.00 Mode = 0.00 Range = 0- 4

  27. Quantitative DataPreparedness for Persons with Disabilities • 28% reported having a person with a disability on their floor • 11% said a plan for evacuation of persons with disabilities was in place • 10% said co-workers were assigned to assist persons with disabilities • 8% said there was special equipment for the evacuation of persons with disabilities • 5% said there was a designated area for persons with disabilities to gather

  28. Quantitative DataEmergency Preparedness • Workplace Preparedness for Emergencies (8 questions) • Mean 2.8 • Median 3.0 • Mode 3.0 • Range 0-8

  29. WTC Results onEmergency Preparedness Safety Climate Emergency Preparedness Safety Climate: 8-items mean 2.83, med 3.0, mode 3.0 Had NEVER exited the building as part of a drill Reported NO PLANS regarding where to gather after evacuating NO PLANS for head count NEVER PROVIDED with evacuation plans Had participated in fire drills, but of these, ONLY 11% HAD EVER ENTERED A STAIRWELL Were NEVER PROVIDED with written fire safety instructions WERE NOT familiar with who was in charge

  30. Outcomes • Initiation of start time • Length of time to descend/controlled by floor and elevator use • Injuries (physical) • Long term health impact (physical and psychological)

  31. Quantitative DataKey Time Periods WTC1WTC2 rangerange • First became aware 8:46-9:208:46-9:02 • Made decision to leave 8:46-9:308:46-9:30 • Began to leave 8:46-9:308:46-9:30 • Reached street level 8:46-10:28 8:46-9:58 8:00 a.m. 8:46 a.m. 8:55 a.m. 9:02 a.m. 9:59 a.m. 10:28 a.m. 11:00 a.m. Tower 1 (North) impact Tower 2 (South) impact Tower 1 (North) collapses Announcement heard in Tower 2 (South) Tower 2 (South) collapses

  32. Study OutcomesLength of Time to Initiate* Evacuation(N=1444) * Start of Evacuation - First Awareness

  33. Delaying Activities 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%)

  34. 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) • Management • Military/first responders • Participation in drills • Poor knowledge • Sensory input • Smoking * p< .05 OR = Odds Ratio

  35. Quantitative DataSources of Communication • Obtained info from: • Face-to-face communications (42%) • PA announcement (12%) • Telephone (7%) • Cell phone (7%) • Television (7%) • Radio (4%) • Blackberry (4%) • Computer (2%)

  36. Factors Significantly* Associated with Initiation Organizational • Difficulty locating exits (O.R. = 2.0) • Lack of leaders • Emergency preparedness safety climate ↑ • (O.R. = 3.3); (WTC 1) • (O.R. = 2.4); (WTC 2) Structural/Environmental • Poor signage (O.R. = 3.3) • PA Announcement (Tower 2) * p< .05

  37. Quantitative Data Outcomes: Length of Time to Descend WTC 1 Mean: 42 minutes Rate*: 59 Seconds/floor Range:1-96 minutes WTC 2 Mean: 27 minutes Rate*: 31 Seconds/floor Range: 0-70 minutes * Controlling for floor/elevator use

  38. Significant* Factors Associated with Length of Time Individual • Disability/medical condition (O.R. = 1.7) • Injuries (O.R. = 1.9) • Seriousness (O.R. = 1.8) • Stopping (O.R. = 3.3.) Organizational Emergency preparedness safety climate ↑ (O.R. = 2.3) 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) *p < .05

  39. Quantitative Data Outcomes: Injuries/Long Term Health • Physical Injuries: 37% (n=530) • Surface Trauma 12% (n=172) • Inhalation Injury 11% (n=164) • Orthopedic Injury 7% (n=104) • Eye injury 4% (n=60) • General Trauma 4% (n=51) • Psychological Injuries: 25% (n=357) • Severity: • 63% sought medical care • 7% were hospitalized

  40. 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 *p < .05

  41. 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) *p < .05

  42. Study Outcomes Long Term Injury Patterns • 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.

  43. 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

  44. 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

  45. Most Important Lesson Learned • EMERGENCY PREPAREDNESS=RESILIENCY

  46. Regulatory Risk Reduction Strategies • 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 • 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)

  47. Lessons Learned…and Implemented • 2002: OSHA Compliance Document- Emergency Action Plans • 2003: Society for Fire Protection Engineers Guide: Human Behavior in Fires • 2005: NIOSH: Emergency Preparedness for Businesses • 2005: FEMA Emergency Management Guide for Businesses • 2007: NFPA Std on Disaster/Emergency Preparedness Management • 2007: NFPA 101 Life Safety Code • GAPS: ARE HIGH RISE BUSINESS OCCUPANCIES COMPLYING?? Public Assembly Places???

  48. Tribute in Lights

  49. Freedom Tower 9/11/11

  50. Robyn R.M. Gershon Department of Epidemiology and Biostatistics Philip R. Lee Institute for Health Policy Studies School of Medicine, University of California, San Francisco Robyn.Gershon@ucsf.edu 415-476-1890

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