Also affected were the estimated 40,000 responders  who were involved in some capacity in the days, weeks, and months that  followed, including personnel from many government agencies and private  organizations as well as other workers and volunteers. Several federally funded programs monitor the health of people who were  exposed to the WTC attack and its aftermath. Of the four programs that offer medical examinations to WTC  responders, the only one that is open to federal workers who responded to  the disaster in an official capacity is the one implemented by HHS. Health Monitoring Programs Implemented by State and Local Governments or Private Organizations Have Made Progress

Three federally funded programs implemented by state and local  governments or private organizations—the FDNY WTC Medical  Monitoring Program, WTC Medical Monitoring Program (worker and  volunteer program), and New York State responder screening program— have made progress in monitoring the physical and mental health of  people affected by the WTC attack. The FDNY program completed initial screening for over 15,000 firefighters  and emergency medical service personnel, and the worker and volunteer  program completed initial screening for over 14,000 other responders. The New York State program screened about 1,700 of the estimated 9,800  state workers and National Guard personnel who responded to the WTC  disaster. Programs Provide Data for WTC-Related Health Research

In addition to providing medical examinations, these three programs—the  FDNY program, the worker and volunteer program, and the New York  State program—have collected information for use in scientific research to  better understand the health consequences of the WTC attack and other  disasters. For example, the FDNY program reported on the injuries and illnesses  experienced by firefighters and emergency medical service workers after  responding to the attack. Registry  officials would like to conduct subsequent follow-up surveys periodically  through about 2023—20 years after the program began in 2003—but have  not yet secured funding for long-term monitoring. Program Officials Are Concerned That Current Federal Funding Arrangements Will End before Needed Monitoring Is Complete

Officials from the FDNY, worker and volunteer, and WTC Health Registry  programs are concerned that current federal funding arrangements for  programs designed to track participants’ health over time may be too short  to allow for identification of all the health effects that may eventually  develop. HHS’s Program for Screening Federal Responders Has Accomplished Little and Is on Hold

HHS’s OPHEP established the WTC Federal Responder Screening Program  to provide medical screening examinations for an estimated 10,000 federal  workers who responded to the WTC disaster in an official capacity and  were not eligible for any other medical monitoring program. The program began in June 2003—about a year later than  other monitoring programs—and completed screenings for 394 workers. Lessons from WTC Health Monitoring Programs Could Assist Future Monitoring Efforts

Officials involved in the WTC health monitoring programs implemented by  state and local governments or private organizations—including officials  from the federal administering agencies—derived lessons from their  experiences that could help officials design such programs in the future. They include the need to quickly identify and contact people affected by a  disaster, the value of a centrally coordinated approach for assessing  individuals’ health, the importance of monitoring both physical and mental  health, and the need to plan for providing referrals for treatment when  screening examinations identify health problems. Concluding Observations

Federally funded programs implemented by state and local governments  or private organizations to monitor the health effects of the WTC attack on  thousands of people who responded to the disaster have made progress. Because of this program’s limited activity, and the inability of federal  workers to participate in other monitoring programs because of the  assumption that they would have the opportunity to receive screening  examinations through the HHS program, many federal responders may not  have had an opportunity to identify and seek treatment for health  problems related to the WTC disaster. For state responders, the  opportunity for continued monitoring could be lost if they are not  informed that they are now eligible to participate in the worker and  volunteer program.
Why GAO Did This Study

After the 2001 attack on the World Trade Center (WTC), nearly 3,000 people died and an estimated 250,000 to 400,000 people who lived, worked, or attended school in the vicinity were affected. An estimated 40,000 people who responded to the disaster--including New York City Fire Department (FDNY) personnel and other government and private-sector workers and volunteers--were exposed to numerous physical and mental health hazards. Concerns remain about the long-term health effects of the attack and about the nation's capacity to plan for and respond to both short- and long-term health effects in the event of a future attack or other disaster. Several federally funded programs have monitored the physical and mental health effects of the WTC attack. These monitoring programs include one-time screening programs and programs that also conduct follow-up monitoring. GAO was asked to assess the progress of these programs. GAO examined (1) federally funded programs implemented by state and local government agencies or private institutions, (2) federally administered programs to monitor the health of federal workers who responded to the disaster in an official capacity, and (3) lessons learned from WTC monitoring programs. GAO reviewed program documents and interviewed federal, state, and local officials and others involved in WTC monitoring programs.

What GAO Found

Three federally funded monitoring programs implemented by state and local governments or private organizations after the WTC attack have provided initial medical examinations--and in some cases follow-up examinations--to thousands of affected responders to screen for health problems. For example, the FDNY medical monitoring program completed initial screening for over 15,000 firefighters and emergency medical service personnel, and the worker and volunteer program screened over 14,000 other responders. The New York State responder screening program screened about 1,700 state responders before ending its examinations in 2003. Most state responders have not been informed that they are now eligible to participate in the worker and volunteer program, and New York State responders could miss the opportunity for continued monitoring. These monitoring programs and the WTC Health Registry have collected information that program officials believe researchers could use to help better understand the health consequences of the attack and improve treatment. Program officials expressed concern, however, that current federal funding arrangements for long-term monitoring may be too short to allow for identification of all future health effects. In contrast to the progress made by other federally funded programs, the Department of Health and Human Services' (HHS) program to screen federal workers who were sent by their agencies to respond to the WTC disaster has accomplished little and is on hold. The program--which started about one year later than other WTC monitoring programs--completed screening of 394 of the estimated 10,000 federal workers who responded in an official capacity to the disaster, but HHS officials suspended examinations and the program has not screened anyone since March 2004. The program's limited activity and the exclusion of federal workers from other monitoring programs because of the assumption that they could receive screening examinations through the HHS program may have resulted in many federal responders losing the opportunity to identify and seek treatment for their WTC-related health problems. Officials involved in WTC health monitoring programs cited lessons from their experiences that could help others who may be responsible for designing and implementing health monitoring efforts that follow other disasters, such as Hurricane Katrina. These include the need to quickly identify and contact people affected by a disaster; to monitor for mental health effects, as well as physical injuries and illnesses; and to anticipate when designing disaster-related monitoring efforts that there will likely be many people who require referrals for follow-up care and that handling the referral process may require substantial effort. HHS and New York State officials provided comments on the facts contained in this testimony and GAO made changes as appropriate.