WTC Evacuation Study_ Surviving A Disaster_ Individual

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					             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
World Trade Center




                     2
        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
                  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
  Human Behaviors in Emergencies

What 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
  Human Behaviors in Emergencies

What 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
Basic Organizational and Structural
              Facts




                                      7
                  North




 WTC
Complex



          South
                          8
Typical World Trade Center
        Office Floor




                             9
       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
WTC Worker Protection Programs in
           Place 9/11

                   Port Authority
                 • Codes met and
                   Program
                   exceeded NYC fire
                 • and other applicable
                   Floor warden system
                   Annual safety codes
                 • buildingfire drills
                 • PA system




                                      11
    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
                      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
  WTC
Disaster,
  2001
  Impact
 Zones of
  Planes

            14
            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
          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
     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
                   WTC Evacuation Study:
                        Overview

Formative    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
               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
         Major Study Outcomes

1. Length of time to initiate evacuation

2. 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
                 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
                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
                        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       Frequency
                                       100

    •   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
                                               Quantitative Data

• Building Participants DID NOT KNOW:




                                            e                     s              ls                 rs                 e
                                                                                                                                           of
                   ld                      r                     n            el                   o                tb
                 ou                     we                   tio            w r                flo                h
                                                                                                                ig pe                  t ro
                w                  es                     ca               ai                 in                                    ou
            irs                 bi                    tl
                                                         o              St                 rta ed            f m ca
                                                                                                            o s                  ab
          a                   b                      i                3                 ce ock
        st ad               lo d                Ex                                                        ro f e              re
      re le                y ate                                                      on e l            ht o                u
 he                      sk c                                                       rs wer            ug ans              ts                    24
                      r e lo                                                       o                o                  No
W
                    he                                                          Do                Th me
                W
             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
                Quantitative Data
         Preparedness for Persons with
                  Disabilities
                  Disability Preparedness Scale (alpha = 0.76)




Mean = 0.32
Median = 0.00
Mode = 0.00
Range = 0- 4




                                                                 26
             Quantitative Data
Preparedness 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
                         Quantitative Data
                       Emergency Preparedness
•   Workplace Preparedness for Emergencies
    (8 questions)

    •   Mean     2.8
    •   Median   3.0
    •   Mode     3.0
    •   Range    0-8




                                                28
                            WTC Results on
        Emergency Preparedness Safety Climate
Emergency 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
                  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
                                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                         8:46-9:58




8:00 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
        Study Outcomes
    Length of Time to Initiate*
           Evacuation
            (N=1444)
               Mean      Minimum      Maximum
WTC 1       6 minutes   1 minute     44 minutes
WTC 2       6 minutes   1 minute     44 minutes


* Start of Evacuation - First Awareness



                                                  32
           Delaying Activities
Once 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
    Factors Significantly* Associated
             with Initiation
Individual
- 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
              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
Factors Significantly* Associated with
               Initiation

Organizational
- 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
          Quantitative Data
Outcomes: Length of Time to Descend

WTC 1
Mean: 42 minutes   Rate*: 59 Seconds/floor
Range:1-96 minutes


WTC 2
Mean: 27 minutes    Rate*: 31 Seconds/floor
Range: 0-70 minutes


                * Controlling for floor/elevator use
                                                       37
Significant* Factors Associated with
           Length of Time
Individual
• Disability/medical condition (O.R. = 1.7)
• Injuries (O.R. = 1.9)
• Seriousness (O.R. = 1.8)
• Stopping (O.R. = 3.3.)

Organizational
Emergency 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
                  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
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
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
                  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
                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
    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
  Most Important Lesson Learned


• EMERGENCY PREPAREDNESS=RESILIENCY




                                      45
Regulatory Risk Reduction Strategies
1.   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 disabilities

2.   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
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
Tribute in Lights




                    48
Freedom Tower 9/11/11




                        49
                  Robyn R.M. Gershon
     Department of Epidemiology and Biostatistics
    Philip R. Lee Institute for Health Policy Studies
School of Medicine, University of California, San Francisco
               Robyn.Gershon@ucsf.edu
                     415-476-1890                       50
                                     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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