Many emergency workers in the US do not believe they are adequately prepared to respond to a major disaster such as the World Trade Centre attack. This is a finding of a new report, Protecting Emergency Responders: Lessons Learned from Terrorist Attacks, funded by the US Centre for Disease Control and Prevention's (CDC) National Institute for Occupational Safety and Health (NIOSH).

The report shows a need for research, training and other strategic approaches to help protect emergency workers in terrorist attacks. Its recommendations are based on lessons learned from the terrorist attacks on the World Trade Centre and the Pentagon on September 11th last, and on the bombing of a federal building in Oklahoma City in 1995.

It summarises discussions from a two-day NIOSH-sponsored workshop held last December in New York.

It convened more than 150 participants, including fire fighters, emergency medical services, police, health and safety professionals, construction workers and other trade services. State and federal agencies were also involved.

While the attacks shared characteristics with large natural disasters, the conference highlighted unique challenges presented by the atrocities. The destruction of the World Trade Centre and at the Pentagon reduced normal firefighters' tasks such as reconnaissance and rescue and led to them doing atypical tasks, such as "busting up and hauling concrete", scrambling over a rubble pile, and removing victims and decayed bodies and body parts.

Construction workers were deployed to hazardous environments, while emergency medical personnel performed rescue operations on site such as in the rubble pile at the World Trade Centre.

The report found that the "definition and roles of an emergency responder expanded greatly in the wake of the terrorist attacks, but few of the responders had adequate personal protective equipment, training, or information for such circumstances".

It identifies "significant shortfalls" in the way emergency workers were protected, with many who responded to the attacks suggesting that personal protective equipment "even impeded their ability to accomplish their missions".

Conference participants said that available garments "did not provide sufficient protection against biological and infectious disease hazards, the heat of fires at the sites, and the demanding physical environment of unstable rubble piles, nor were they light and flexible enough to allow workers to move debris and enter confined spaces".

As for respiratory protection, attendees said that under most circumstances self-contained breathing apparatus (SCBA) was "grossly limited by both the weight of the systems and the short lengths of time (about 15 to 30 minutes) they can be used before their air bottles must be refilled. Most participants complained that respirators reduced their field of vision at best, and their face-pieces fogged up at worst.

The report highlights the need for research into personal protective technology, improved education and training programmes and other activities to ensure the health and safety of emergency workers, including those involved in rescue, recovery and restoration missions.

NIOSH intends using the report to plan new research into emergency workers' safety and personal protective technologies and in developing and disseminating guidelines.

Guidelines need to be developed for the selection and use of appropriate personal protective equipment in responding to "long-duration" disasters and bio-terrorism.

Research is needed to outfit all emergency workers at sites of large-scale incidents with effective personal protective equipment and to facilitate standardisation and inter-operability of protective equipment among emergency responder organisations, says NIOSH. The institute also sees the need to provide "useful, real-time safety and health information to responders at incident sites, and to ensure appropriate training on the use of personal protective equipment".

The report is accessible from the NIOSH website at www.cdc.gov/niosh/npptl.