World Trade Center Evacuation Study

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World Trade Center Evacuation Study

  1. 1. World Trade Center Evacuation Study Epidemiology 256:Environmental and Occupational Epidemiology Thursday, May 24, 2012 Robyn R.M. Gershon, MHS, DrPH Principal Investigator Funded by ASPH/CDC CPHP NCDP Center for Public Health National Center for Disaster Preparedness PreparednessColumbia Columbia University University
  2. 2. World Trade Center 2
  3. 3. Case Study Presentation: The World Trade Center Evacuation Study• Pre-event facts (Case study book chapter)• Significance• Human Behaviors in Fire Emergencies• Basic Organizational and Structural Facts• WTC Evacuation Study• Case Study Questions 3
  4. 4. Significance• High rises may experience fires and other disaster events• Certain iconic high rises and public assembly spaces may be likely terrorist targets• Lessons identified and learned from high rise disasters, including the WTC disaster in 2001 may improve preparedness and response to other high rise events 4
  5. 5. Human Behaviors in EmergenciesWhat is Known:• People will generally not go towards smoke• Seek out groups, group size is important• People move towards and stay with group even if it is not the best option• The faster groups form – the faster they evacuate 5
  6. 6. Human Behaviors in EmergenciesWhat is Known:• Individual and group panic dependent on several key factors• Information serves as motivator• Leadership is especially important in public spaces – both for shaping group behaviors and for guidance• Familiarity helps groups to form and minimizes panic 6
  7. 7. Basic Organizational and Structural Facts 7
  8. 8. North WTCComplex South 8
  9. 9. Typical World Trade Center Office Floor 9
  10. 10. Preparing for Emergencies• AFTER 1993 BOMBING Port Authority NYNJ Instituted a new EP Program: • PLANNING • ORIENTATION • EDUCATION • PUBLIC ADDRESS ANNOUNCEMENTS • OCCUPANT FIRE SAFETY TEAMS • TEAM TRAINING • FIRE DRILLS • CRITIQUE 10
  11. 11. WTC Worker Protection Programs in Place 9/11• Codes met and • Port Authority exceeded NYC fire Program and other applicable • Floor warden system building safety codes • Annual fire drills • PA system 11
  12. 12. Design Features of High Rises• High rise buildings – robust and redundant• Not usually designed for rapid, full building evacuation• Not designed to withstand impact of fuel-laden large aircraft in use today• Rescue of occupants located in inaccessible areas of high rises above the point of impact is not possible 12
  13. 13. WTC, 2001 North Tower Impact South Tower Impact (Tower 1) (Tower 2)• 8:46am • 9:02am• 767, 10K gallons • 767, 10K gallons• Impact at 94-98th floors • Impact at 79-84th floors• Collapsed 1 hour and 42 • Collapsed 57 minutes minutes after impact after impact 13
  14. 14. WTCDisaster, 2001 Impact Zones of Planes 14
  15. 15. WTC Fatalities, 2001• 411 first responders• 147 jetliner crew and passengers• 1,462 in North Tower (1,355 above impact, 93%)• 630 in South Tower (619 above impact, >95%)• 18 bystanders (on the ground)• 24 location unknown in WTC 1 and WTC 2• Total deaths: 2,692• 11% of occupants died, most above point of impact 15
  16. 16. WTC Fatalities, 2001• Age Range – Planes: 2 ½ years – 86 years – Building: 18 years – 79 years• Post 9/11 – 479 illness/deaths of workers at Ground Zero or Fresh Kills Landfill – 149 traumatic deaths – 33 suicides 16
  17. 17. The WTC Evacuation Study* Objectives• To identify individual, organizational, and environmental/structural (building) factors that affected evacuation and health outcomes• To inform policies and practices that support safe evacuation of high-rise structures• To inform preparedness for other mass evacuations 17*Funded by CDC/NIOSH
  18. 18. WTC Evacuation Study: OverviewFormative Qualitative Questionnaire Data Participatory Steps Processes & Development Analysis Action Teams Analyses & Administration Identification of Risk Reduction Strategies & Recommendations Preparation Feedback to of Reports Participants & Stakeholders 18
  19. 19. WTC Evacuation Study Model Worksite Individual and Compliance and Organizational Initiation Initiation and Safety Culture Factors Length of Time Knowledge Beliefs(Experience) Attitudes, Perceptions of Safety Climate, Behavioral Evacuation Injuries Outcomes Perception of Intentions Behaviors Risk, Fear, Instinct (Gut Subjective Feeling) Norms Environmental Long Sensory Enabling Term Cues Factors Health Progression Group Behaviors Final Destination 19
  20. 20. Major Study Outcomes1. Length of time to initiate evacuation2. Length of time to fully evacuate • Controlling for floor and elevator use (WTC 1 and 2)3. Injuries (physical)4. Long term health impact (physical and psychological) 20
  21. 21. Quantitative Data Demographics• Responses: 1767 total• Of these,1444 (82%) evacuated on 9/11/01* Demographics (N=1444): • Gender: 58% male • Age, mean yrs: 44 yrs • Age, range: 22-80 yrs • Tenure, mean: 6 yrs • Tenure, range: 0-37 yrs • Marital status: 70% married/partner • Children: 48% • Race: 80% Caucasian • Education: 66% college+ • Employment: 84% private company • Union membership: 7% 21
  22. 22. Quantitative Data Health Status • Pre-existing disability or medical condition: 23% • Including… • Respiratory: 28% • Mobility: 28% • Mental Health: 17% • Heart Condition: 16% • General Medicine: 7% • Sensory Deficit: 6% • Smoking: 19%• 29% of those with a disability/medical condition said their disability affected their ability to walk down large number of stairs 22
  23. 23. Quantitative Data Knowledge• Knowledge Related Emergency Preparedness/Knowledge/Experience (alpha = .77) to Preparedness (10 Questions) 140 • Mean 3.4 • Median 3.0 120 • Mode 2.0 100 Frequency • Range 0-10 80 60 40 20 0 0.00 1.00 2.00 3.00 4.00 5.00 6.00 7.00 8.00 9.00 10.00 Emergency Preparedness/Knowledge/Experience Mean = 3.42, Median = 3.00, Mode = 2.00, SD = 2.41 23
  24. 24. Quantitative Data• Building Participants DID NOT KNOW: 89% 73% 70% 59% 51% 26% 25% 24
  25. 25. Quantitative Data Lack of Familiarity with Building• 56% somewhat familiar• 22% slightly/not at all familiar• 50% did NOT know enough about building to leave on their own• 27% had evacuated the building at least once• 16% reluctant to evacuate 25
  26. 26. Quantitative Data Preparedness for Persons with Disabilities Disability Preparedness Scale (alpha = 0.76)Mean = 0.32Median = 0.00Mode = 0.00Range = 0- 4 26
  27. 27. Quantitative DataPreparedness for Persons with Disabilities 28% reported having a person with a disability on their floor 11% said a plan for evacuation of persons with disabilities was in place 10% said co-workers were assigned to assist persons with disabilities 8% said there was special equipment for the evacuation of persons with disabilities 5% said there was a designated area for persons with disabilities to gather 27
  28. 28. Quantitative Data Emergency Preparedness• Workplace Preparedness for Emergencies (8 questions) • Mean 2.8 • Median 3.0 • Mode 3.0 • Range 0-8 28
  29. 29. WTC Results on Emergency Preparedness Safety ClimateEmergency Preparedness Safety Climate: 8-items mean 2.83, med 3.0, mode 3.0 Had NEVER exited the building as part of a drill Reported NO PLANS regarding where to gather after evacuating NO PLANS for head count NEVER PROVIDED with evacuation plans Had participated in fire drills, but of these, ONLY 11% HAD EVER ENTERED A STAIRWELL Were NEVER PROVIDED with written fire safety instructions WERE NOT familiar with who was in charge 29
  30. 30. Outcomes• Initiation of start time• Length of time to descend/controlled by floor and elevator use• Injuries (physical)• Long term health impact (physical and psychological) 30
  31. 31. Quantitative Data Key Time Periods WTC1 WTC2 range range • First became aware 8:46-9:20 8:46-9:02 • Made decision to leave 8:46-9:30 8:46-9:30 • Began to leave 8:46-9:30 8:46-9:30 • Reached street level 8:46-10:28 8:46-9:588:00 a.m. 8:46 a.m. 8:55 a.m. 9:02 a.m. 9:59 a.m. 10:28 a.m. 11:00 a.m. Tower 1 Tower 2 Tower 1 (North) (North) impact (South) impact collapses Announcement heard Tower 2 (South) 31 in Tower 2 (South) collapses
  32. 32. Study Outcomes Length of Time to Initiate* Evacuation (N=1444) Mean Minimum MaximumWTC 1 6 minutes 1 minute 44 minutesWTC 2 6 minutes 1 minute 44 minutes* Start of Evacuation - First Awareness 32
  33. 33. Delaying ActivitiesOnce they decided to leave, but BEFORE they began to…• Gathering items (40%)• Seeking out friends/co-workers (33%)• Searching for any others (26%)• Making phone calls (18%)• Shutting down/PC-related (8%)• Waiting for direction (7%)• Gathering safety equipment (5%)• Changing shoes (3%)• Trying to obtain permission to leave (1%) 33
  34. 34. Factors Significantly* Associated with InitiationIndividual- Age (O.R. = 1.4) - Management- Delaying activities (O.R. = 3.1) - Military/first responders- Disabilities/medical conditions - Participation in drills- Hesitating (O.R. = 3.7) - Poor knowledge- Injuries (O.R. = 1.4) - Sensory input- Looking for groups (O.R. = 1.5) - Smoking * p< .05 OR = Odds Ratio 34
  35. 35. Quantitative Data Sources of Communication• Obtained info from: – Face-to-face communications (42%) – PA announcement (12%) – Telephone (7%) – Cell phone (7%) – Television (7%) – Radio (4%) – Blackberry (4%) – Computer (2%) 35
  36. 36. Factors Significantly* Associated with InitiationOrganizational- Difficulty locating exits (O.R. = 2.0)- Lack of leaders- Emergency preparedness safety climate ↑ - (O.R. = 3.3); (WTC 1) - (O.R. = 2.4); (WTC 2)Structural/Environmental- Poor signage (O.R. = 3.3)- PA Announcement (Tower 2) * p< .05 36
  37. 37. Quantitative DataOutcomes: Length of Time to DescendWTC 1Mean: 42 minutes Rate*: 59 Seconds/floorRange:1-96 minutesWTC 2Mean: 27 minutes Rate*: 31 Seconds/floorRange: 0-70 minutes * Controlling for floor/elevator use 37
  38. 38. Significant* Factors Associated with Length of TimeIndividual• Disability/medical condition (O.R. = 1.7)• Injuries (O.R. = 1.9)• Seriousness (O.R. = 1.8)• Stopping (O.R. = 3.3.)OrganizationalEmergency preparedness safety climate ↑ (O.R. = 2.3)Structural• Any adverse environmental condition (O.R. = 4.6)• Any damage (O.R. = 2.3)• Multiple sources of communication• Overcrowding on stairs or in lobbies (O.R. = 2.2) 38 *p < .05
  39. 39. Quantitative Data Outcomes: Injuries/Long Term Health• Physical Injuries: 37% (n=530) • Surface Trauma 12% (n=172) • Inhalation Injury 11% (n=164) • Orthopedic Injury 7% (n=104) • Eye injury 4% (n=60) • General Trauma 4% (n=51)• Psychological Injuries: 25% (n=357)• Severity: • 63% sought medical care • 7% were hospitalized 39
  40. 40. Significant* Factors Associated with Injuries• Disability/Medical condition (O.R. = 2.0)• Fear for employment (O.R. = 4.9)• Female gender (O.R. = 1.9)• Lack of familiarity (O.R. = 2.7)• Less participation in drills• Not feeling personally responsible for own safety• Physical capability was low (O.R. = 2.8)• Starting from higher floor• Stopping• Supervisor would not approve (O.R. = 6.4)• Unsure of stairs *p < .05 40
  41. 41. Significant* Factors Associated with Injuries• Any environmental condition• Any structural damage• Difficulty in following stairway route• Inadequate training• Lack of emergency preparedness• Making phone calls• Multiple sources of communication• Problem with shoes (O.R. = 2.6) *p < .05 41
  42. 42. Study Outcomes Long Term Injury Patterns• 221 persons (15.4%) of the evacuees reported at least one long- term injury related to evacuation of the WTC on 9/11 (some reported more than one condition).• Long-term mental health problems were most common. Condition n Mental Health 132 Respiratory 61 Orthopedic 30 Medical 18 Cardiac 5 Vision / Hearing 5 42
  43. 43. Lessons Learned From Evacuees• Staying calm (“Behaving”)• Instincts• Mutual support• Leadership (group)• Directions/encouragement of first responders/NY/NJ Port Authority• Integrity and condition of stairwells• General lack of massive overcrowding on stairwells 43
  44. 44. Lessons Learned from the WTC Evacuation Study• Human behaviors in this high rise fire were as predicted – Design features that support these behaviors will be most effective• Training and drilling improve competency – These should be mandatory• EP safety climate was associated with reduced evacuation times, injuries and long term mental health problems. – EP Best practices should be implemented in all high rise work settings 44
  45. 45. Most Important Lesson Learned• EMERGENCY PREPAREDNESS=RESILIENCY 45
  46. 46. Regulatory Risk Reduction Strategies1. NYC high-rise fire safety codes: Emergency Action Plan §6-02 – EAP must specify the procedures for: • Sheltering in-place • In-building relocation • Partial evacuation • Full evacuation – Pre-planning for persons with disabilities2. Designation and certification of an Emergency Action Plan Director (EAPD) §9-08 – EAPD has the authority to implement this in the absence of lawful authorities (i.e., they become the incident commander) 46
  47. 47. Lessons Learned…and Implemented• 2002: OSHA Compliance Document- Emergency Action Plans• 2003: Society for Fire Protection Engineers Guide: Human Behavior in Fires• 2005: NIOSH: Emergency Preparedness for Businesses• 2005: FEMA Emergency Management Guide for Businesses• 2007: NFPA Std on Disaster/Emergency Preparedness Management• 2007: NFPA 101 Life Safety Code• GAPS: ARE HIGH RISE BUSINESS OCCUPANCIES COMPLYING?? Public Assembly Places??? 47
  48. 48. Tribute in Lights 48
  49. 49. Freedom Tower 9/11/11 49
  50. 50. Robyn R.M. Gershon Department of Epidemiology and Biostatistics Philip R. Lee Institute for Health Policy StudiesSchool of Medicine, University of California, San Francisco Robyn.Gershon@ucsf.edu 415-476-1890 50
  51. 51. References• Sherman MF, Peyrot M, Magda LA, Gershon RRM. Modeling pre-evacuation delay by evacuees in World Trade Center Towers 1 and 2 on September 11th, 2001: A revisit using regression analysis. Fire Safety Journal. 2011; 46(7) 414-424.• Gershon RRM, Magda LA, Riley HEM, Sherman MR. The World Trade Center evacuation study: factors associated with initiation and length of time for evacuation. Fire and Materials. February 2011. doi:10.1002/fam.1080.• Gill KB*, Gershon RRM. Disaster mental health training programs in NYC following September 11, 2001. Disasters. 2010;34(3). doi:10.1111/j.1467-7717.2010.01159.x• Gershon RRM, Rubin MS, Qureshi KA, Canton AN, Matzner FJ. Participatory action research methodology in disaster research: results from the World Trade Center evacuation study. Disaster Medicine and Public Health Preparedness. 2008; 2(3):142-149.• Qureshi KA, Gershon RRM, Smailes E, Raveis V, Murphy B, Matzner F, Fleischman A. A roadmap for the protection of disaster research participants: findings from the WTC evacuation study. Prehospital and Disaster Medicine. 2007; 22(6):484-49.• Gershon RRM, Qureshi KA, Rubin MS, Raveis VH. Factors associated with high-rise evacuation: qualitative results from the World Trade Center Evacuation study. Prehosp Disaster Med. 2007; 22(3):165- 173.• Gershon RRM, Gemson DH, Qureshi K*, McCollum MC. Terrorism preparedness training for occupational health professionals. J Occup Environ Med. 2004;46(12):1204-1209.• Nandi A, Galea S, Tracey M, Ahern J*, Resnick H, Gershon RRM, Vlahov D. The effects of job loss, unemployment, work stress, and work satisfaction on the persistence of probable PTSD: results from a cohort study of New York City metropolitan area residents one year after the September 11 attacks. J Occup Environ Med. 2004;46(10):1057-1064.• Gershon RRM, Hogan E, Qureshi KA*, Doll L. Preliminary results from the World Trade Center evacuation study-New York City, 2003. Morb Mortal Wkly Rep. 2004; 53(35):815-816. 51

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