Training Needs of Pediatricians Facing the Environmental Health and Bioterrorism Consequences of September 11th YUE-YUNG HU, B.S. 1 , RICHARD E. ADAMS, PH.D. 1,2 , JOSEPH A. BOSCARINO, PH.D., M.P.H. 3 , AND DANIELLE LARAQUE, M.D. 2 Abstract Objective: The September 11, 2001, terrorist attacks have been called “the worst environmental disaster in the history of New York City.” As a result of the extensive nature of the destruction, our objective as pediatricians was to determine the experi- ence and training needs of tri-state child health professionals in responding to the environmental health and bioterrorism-related demands placed on their practices. Methodology: American Academy of Pediatrics members in New York, Connecticut, and New Jersey were sent either a web-based or a paper survey requesting demographic data and data about post-9/11 practice experience and perceived knowledge with regard to environmental health and bioterrorism. Results: Of the 1,396 respondents, 21% believed their practices to have been “very [much] affected” by the attacks. Eleven percent were often/very often asked by parents about air quality, 12.6% about environmental toxins, 4.3% about antibiotics for anthrax, and 4.2% about potassium iodide for nuclear events. Fifty-seven percent and 49.1% of respondents had patients present with environmental health and bioterrorism-related complaints, respectively. Most (86%) reported that their medical training had not sufficiently prepared them to meet these demands. Few considered themselves to be knowledgeable about bioterrorism (23.9%), local environmental issues (14%), air quality (11.4%), or environmental toxins (12.6%). Gender, race, practice setting, practice location, specialty, and level of training were associated with demands on practice. Location, age, years in practice, and gender were associated with level of preparedness. Conclusions: Our results indicate that nearly all child health professionals would benefit from post-disaster education, espe- cially trainees. A role for the pediatric associations in the dissemination of this crucial information is implied. Key Words: Children, environmental health, bioterrorism, toxins, disaster preparedness, September 11. Introduction THE EVENTS OF SEPTEMBER 11, 2001 represent the most serious terrorist attack on American soil, re- sulting in massive destruction in lower Manhattan. The World Trade Center (WTC) and several sur- rounding buildings were reduced to more than 1,500,000 tons of debris (1, 2). Fires from the build- ings, started by the initial combustion of 90,000 L of jet fuel, continued to burn for 99 days, their toxic plumes sustained and amplified by burning office materials and diesel exhaust from continuously op- erating rescue and recovery machinery and vehicles (3). Highly alkaline dust consisting of pulverized cement, glass fibers, asbestos, lead, polycyclic aro- matic hydrocarbons, polychlorinated biphenyls, organochlorine pesticides, and polychlorinated fu- rans and dioxins blanketed the city (4), settling in- side homes, schools, and workplaces. Thus, the events of 9/11 have been described by the New York Committee for Occupational Safety and Health as “the worst environmental disaster in the history of New York City” (5). Following the attack, fears of biological mani- festations of terrorism and concerns about the en- vironmental consequences of the attacks emerged. In October 2001, community residents filled pub- lic forums with questions about the area’s health hazards (3). Seven local schools delayed their re- openings due to parents’ objections about the air quality (6). Moreover, at this time anthrax ap- peared in United States Post Offices and other lo- cations, sparking discussions of bioterrorism preparation. Among Google’s top queries that month were “anthrax” (#1), “milzbrand” (#4), “cipro” (#5), and “smallpox” (#7) (7). Today, pub- lic anxieties remain: a New York Magazine cover story, describing increased incidences of respira- tory, renal, cardiac and oncologic ailments among 1156 © THE MOUNT SINAI JOURNAL OF MEDICINE Vol. 73 No. 8 December 2006 1 (Ms. Hu is an M.D. Candidate) Stony Brook University School of Medicine, Stony Brook, NY, 2 Department of Pediatrics, Mount Sinai School of Medicine and 3 Geisinger Health System, Danville, PA. Address all correspondence to Danielle Laraque, M.D., F.A.A.P., Department of Pediatrics, Box 1198, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, New York, NY 10029-6574; email danielle.laraque@mssm.edu