Rethinking first response: effects of the clean up and recovery effort on workers at the world trade center disaster site.

Objective: We sought to describe the physical and mental health effects of the cleanup and recovery effort on workers at the World Trade Center disaster site.

Methods: A mailed survey was sent to truck drivers, heavy equipment operators, laborers, and carpenters. It assessed work-related exposures and somatic and mental health symptoms. In one open-ended question, respondents shared any aspect of their experiences they wished; these 332 narrative responses were analyzed using qualitative techniques.

Results: Respondents reported suffering debilitating consequences of their work, including depression, drug use, and posttraumatic stress disorder. They felt poorly prepared to work in a disaster, lacked protective equipment and training, and felt overwhelmed by the devastation they faced.

Conclusions: These workers' experiences were qualitatively similar to the experiences of the first responders. To protect workers in the future, the focus on preparing "first" responders should be reconsidered more broadly.