Attacks set workplace physicians on a new track

The specialty is tackling a different set of occupational concerns following Sept. 11.

By Damon Adams, amednews staff. Feb. 25, 2002.

Linda Holifield-Kennedy, MD, MPH, saw firsthand on Sept. 11, 2001, that a disaster plan can make a difference. She was at her job as medical officer at the Pentagon Occupational Health Clinic when terrorists slammed American Airlines Flight 77 into the building.

"I had no idea until I ran outside and saw the plume of black smoke and the flames coming out of the Pentagon," said Dr. Holifield-Kennedy, who was evacuated with others from the clinic by the military. "It was very strange, like being in a bad movie."

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After briefly returning to treat the injured, Dr. Holifield-Kennedy and others were again evacuated. The medical staff set up a triage and sent the injured to neighboring hospitals.

"This is what we were trained to do," Dr. Holifield-Kennedy said. "It was comforting to me to be in a position to offer some comfort and treatment to the victims."

Through planning and education, occupational doctors say they will be prepared if disaster strikes the workplace again.

"What [Sept. 11] did for us was to say this is possible," said Edward Bernacki, MD, MPH, president-elect of the American College of Occupational and Environmental Medicine and director of the division of occupational medicine at Johns Hopkins School of Medicine. "We're the medical advisers for industry. They're going to look to us for answers."

And the ACOEM is going to be ready. By Sept. 12, 2001, the college had put together an emergency preparedness/disaster response Web site to aid doctors with issues such as infectious diseases and trauma. Guidelines were provided for doctors treating workers reacting to stress.

The site is a key way the ACOEM adapted its efforts following the Sept. 11 attacks, and the tragedy has prompted many occupational and environmental doctors to reexamine how to make workplaces ready for disaster.

First responders

Occupational doctors say the attacks have made the workplace the front line in the war on terrorism. Traditional roles such as monitoring health programs and safety regulations must now be combined with greater emphasis on bioterrorism, they said.

Fears of carpal tunnel syndrome have given way to fears of how employees should handle mail.

"Let's face it, the workplace is where most of these events are going to occur, and we're in the workplace. We'll be the first responders," said Dr. Bernacki,

Occupational physicians at IBM offices in New York made adjustments after Sept. 11, said Alan Engelberg, MD, MPH, director of programs and global processes for IBM's global occupational health services.

They fitted respirators for 150 customer engineers sent to work on computer systems near ground zero in New York. They monitored government Web sites and learned about bioterrorism.

"None of us had ever dealt with this before, so we had to educate ourselves," Dr. Engelberg said.

IBM's doctors started a health surveillance system to track incidents at all IBM locations in which employees thought they saw anthrax. Guidelines were drawn up for mail handlers, including instructions not to open suspicious mail. Disaster and emergency preparedness plans were revisited, as was high-rise safety.

"We have to think about what if somebody slams a plane into one of our buildings," Dr. Engelberg said.

To aid physicians in learning about bioterrorism and other threats, the ACOEM Web site features links to agencies such as the Centers for Disease Control and Prevention and the Occupational Safety and Health Administration. There are also alerts on chemical and bioterrorism and updates on government agency responses.

A stress information section of the ACOEM site tells doctors what distress signals indicate an employee is having difficulty coping with a tragedy.

"Now people are looking at the worst-case scenario in a different light. You just can't let the police or security people worry about it," said Jonathan Borak, MD, chair of ACOEM's council on scientific affairs and associate professor of medicine and epidemiology at the Yale University School of Medicine.

Emergency preparedness and disaster response also will be highlighted at the ACOEM's 87th American Occupational Health Conference, scheduled for April 12-19 in Chicago.

Sessions will address posttraumatic stress disorder, infectious disease in the workplace, ways to limit workplace exposure to terrorism, and handling airborne biologic hazards in health care facilities.