Overview of WTC Health Programs

Following the attack on the WTC, the Congress appropriated  approximately $8.8 billion to FEMA, over several years, for response and  recovery activities. Federal  funds appropriated or awarded for the WTC health programs from  October 2001 through December 2007 have totaled about $369.2 million. Lesson 1: Registering all responders during a response to a disaster  could improve implementation of screening and monitoring services. Lesson 2: Designing and implementing screening and monitoring  programs that foster the ability to conduct epidemiologic research could  improve the understanding of health effects experienced by responders  and help determine the need for ongoing monitoring. Lesson 3: Providing timely mental health screening and monitoring  that is integrated with physical health screening and monitoring could  improve the ability to accurately diagnose physical and mental health  conditions and prevent more serious mental health conditions from  developing. Lesson 4: Including a treatment referral process in screening and  monitoring programs could improve the ability of responders to gain  access to needed treatment. Lesson 5: Making comparable services available to all responders,  regardless of their employer or geographic location, could ensure more  equitable access to services for responders and help ensure that data  collected about responders’ health are consistent and comprehensive. ASPR is also taking steps to  establish a system to register HHS employees and certain other volunteers,  but it has not completed its effort. HHS Has Taken Some Steps to Ensure That Responders Are Registered Following a Disaster, but These Efforts Are Incomplete

Using experience gained from the WTC disaster, HHS’s ATSDR has  developed and tested a Rapid Response Registry (RRR) survey instrument  that state and local entities can voluntarily adopt to register responders  and other individuals exposed to a disaster. HHS Has Not Developed a Plan That Incorporates the Lessons from the WTC Health Programs

HHS has not developed a department-level plan for designing and  implementing responder health programs that incorporates the five  lessons from the WTC health programs. As a result, HHS has not indicated  whether its policies and actions following a disaster or emergency would  apply these lessons, such as by building epidemiologic research into the  design of screening and monitoring services. Another consequence of not  having a plan is that HHS has not described the roles and responsibilities  of its components in designing and implementing responder health  programs. According to the NRF, agencies should clearly define roles and  responsibilities in their disaster preparedness plans, but HHS has not  identified which components would be involved in responder health  programs, which component would take the lead, how the expertise of  various components would be used, and how efforts would be  coordinated. In the absence of a department-level plan describing the roles of all  relevant HHS agencies with regard to responder health programs, NIOSH  developed a proposal in February 2008 for working with some of the  relevant HHS components to develop strategies to ensure responder safety  and health. Although NIOSH’s  proposal for a project to develop strategies for addressing responder  health issues is a step in the right direction, HHS has not developed a  department-level plan that incorporates the five lessons from the WTC  program and defines the roles and responsibilities of all HHS components  with regard to planning and implementing responder health programs. Recommendation for Executive Action

To ensure that effective programs are developed to deal with the health  effects that responders may experience in the event of a future disaster,  we recommend that the Secretary of HHS take the following action:  develop a department-level responder screening and monitoring plan that  defines the roles and responsibilities of HHS components and incorporates  the five lessons identified from the experience of the WTC health  programs. Specifically, this plan should facilitate the registration of all  responders and ensure that screening and monitoring services are  designed to foster epidemiologic research; provide timely mental health  screening and monitoring that is integrated with physical health screening  and monitoring; include a treatment referral process; and make  comparable services available to all responders, regardless of their  employer or geographic location.
Why GAO Did This Study

Following the World Trade Center (WTC) attack, the Congress appropriated more than $8 billion to the Department of Homeland Security's (DHS) Federal Emergency Management Agency for response and recovery activities. The Department of Health and Human Services (HHS) received some of this funding to establish health screening and monitoring programs for responders to the disaster and later received additional appropriations to fund treatment. In total, about $369.2 million has been appropriated or awarded for the WTC health programs. GAO previously reported on problems that these programs have had in ensuring the availability of services for all responders. GAO was asked to examine lessons from the WTC health programs that could guide future programs. GAO examined (1) lessons from the programs' experience and (2) HHS actions or plans that incorporate the lessons. GAO interviewed WTC health program officials and other experts and reviewed DHS and HHS documents.

What GAO Found

GAO identified five important lessons from the experience of the WTC health programs that could help with the development of responder health programs in the event of a future disaster. First, registering all responders during a response to a disaster could improve implementation of screening and monitoring services. Second, designing and implementing screening and monitoring programs that foster the ability to conduct epidemiologic research could improve the understanding of health effects experienced by responders and help determine the need for ongoing monitoring. Third, providing timely mental health screening and monitoring that is integrated with physical health screening and monitoring could improve the ability to accurately diagnose physical and mental health conditions and prevent more serious mental health conditions from developing. Fourth, including a treatment referral process in screening and monitoring programs could improve the ability of responders to gain access to needed treatment. Fifth, making comparable services available to all responders, regardless of their employer or geographic location, could ensure more equitable access to services for responders and help ensure that data collected about responders' health are consistent and comprehensive. HHS has taken steps to facilitate responder registration, but has not developed a department-level plan for responder health programs. HHS's Agency for Toxic Substances and Disease Registry has developed a survey instrument that state and local entities can adopt to register responders and other individuals exposed to a disaster. In a separate effort, HHS's Office of the Assistant Secretary for Preparedness and Response is taking steps to establish a system to register HHS employees and other federal public health and medical personnel who are deployed to a disaster, but it has not completed this effort. HHS has not developed a department-level plan for designing and implementing responder health programs that incorporates the five lessons from the WTC health programs. As a result, HHS has not indicated whether its policies and actions following a disaster or emergency would apply these lessons. Another consequence of not having a plan is that HHS has not described its components' roles and responsibilities for designing and implementing responder health programs. It has not identified which HHS components would be involved in responder health programs, which component would take the lead, how the expertise of various components would be used, or how efforts would be coordinated. In the absence of a department-level plan, HHS's National Institute for Occupational Safety and Health developed a proposal in February 2008 for a project to develop strategies to ensure responder safety and health. While GAO concluded that this proposal is a step in the right direction for addressing responder health issues, it noted that the proposal does not fully address the lessons that have been identified from the WTC health programs.