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1 October 2001

  • New York City Department of Health Response to Terrorist Attack, September 11, 2001.

    US Centers for Disease Control. MMWR 2001; 50(38): 821-822.

    Correspondence: No contact information listed. Full text available online:

    In response to two jet aircraft crashing into and causing the collapse of the 110-storied World Trade Center (WTC) towers and the subsequent destruction of nearby portions of lower Manhattan, the New York City Department of Health (NYCDOH) immediately activated its emergency response protocol, including the mobilization of an Emergency Operations Center. Surveillance, clinical, environmental, sheltering, laboratory, management information systems, and operations were among the preestablished emergency committees. Because of its proximity to the WTC site, an emergency clinic was established at NYCDOH for triage and treatment of injured persons. NYCDOH focused its initial efforts on assessing the public health and medical impact of the attack and the resources needed to respond to it such as the care and management of large numbers of persons injured or killed by the crash; subsequent fire and building collapse; the health and safety of rescue workers; the environmental health risks (e.g., asbestos, smoke, dust, or chemical inhalation); other illnesses related to the disruption of the physical infrastructure (e.g., waterborne and foodborne diseases); and mental health concerns. Despite the evacuation and relocation of NYCDOH's headquarters, the department continued essential public health services, including death registration.

    A rapid assessment conducted by NYCDOH during the first 24 hours after the incident indicated that most emergency department (ED) visits were for minor injuries; approximately 10%--15% of ED patients were admitted and few deaths occurred. Hospital bed and staff capacity was adequate.

    Following the incident, NYCDOH prioritized four surveillance activities: 1) in collaboration with the Greater New York Hospital Association, an ongoing assessment of hospital staffing and equipment needs, and cumulative numbers of incident-related ED visits and hospital admissions; 2) an epidemiologic assessment of the types of injuries seen during the first 48 hours after the attack at one tertiary referral hospital and the four EDs closest to the crash site where the largest number of incident-related cases presented; 3) prospective surveillance of illnesses and injuries among rescue workers evaluated at the four hospitals and Disaster Medical Assistance Team triage units located at the crash site; and 4) active surveillance in EDs for specified clinical syndromes to identify unusual disease manifestations or clusters associated with these incidents, including those syndromes that could result from the release of a biologic agent. To assist NYCDOH with syndromic surveillance, CDC Epidemic Intelligence Service officers have been stationed at EDs in 15 sentinel hospitals distributed throughout the five New York City boroughs. Other NYCDOH activities included an already existing syndromic surveillance system to monitor 911 emergency calls. No unusual patterns of illness have been identified. NYCDOH also conducted laboratory testing of environmental samples and did not find evidence of a biologic agent release.

    Air quality, safety of the municipal water supply, restaurant safety and rodent control, and other environmental conditions in the area continue to be monitored by NYCDOH, in collaboration with local, state, and federal agencies, to ensure the health and safety of workers at the site and residents in the immediate vicinity. Frequent alerts are sent by broadcast facsimile and electronic mail to advise metropolitan New York health-care providers of ongoing public health concerns related to the aftermath of the attack. Advisories have been developed to address the public's concerns about such issues as asbestos exposure in collapsed buildings, decomposing bodies, and managing emotional trauma. Working with the American Red Cross, NYCDOH school health program has provided nursing services and physician consultations to Red Cross shelters. The shelters serve families and persons displaced by the incident and provide respite to rescue workers. NYCDOH nurses provide nursing assessments, first-aid services, and medical referrals when needed.

    In response to events in lower Manhattan and the related attack on the Pentagon in Washington, DC, the Federal Response Plan was activated. The U.S. Department of Health and Human Services (DHHS) deployed federal resources to augment the state and local medical response. A shipment of intravenous supplies, airway supplies, emergency medication, bandages and dressings, and other materials arrived in New York City the night of September 11; this was the first emergency mobilization of the National Pharmaceutical Stockpile. NYCDOH and the health department in Washington, DC, also obtained adequate supplies of tetanus vaccine from vaccine manufacturers. CDC has sent epidemiologists, occupational health specialists, industrial hygienists, and other public health professionals to supplement local efforts. Information about federal support of the local public health response is available from DHHS at

  • Novice drivers' accidents and violations a failure on higher or lower hierarchical levels of driving behaviour.

    Laapotti S, Keskinen E, Hatakka M, Katila A. Accid Anal Prev 2001; 33(6): 759-769.

    Correspondence: Sirkku Laapotti, Department of Psychology, University of Turku, Turku 20014-FIN, FINLAND (email:

    BACKGROUND: Novice drivers are believed to be at greater risk of traffic crashes.

    OBJECTIVES: To study differences in crash and offence rates between male and female novice drivers of different age.

    METHODS: The study compared crash and offence rates of 28,500 novice drivers in Finland. The drivers reported in a mailed questionnaire, how many crashes they had been involved in and how much they had driven during their whole driving career. All the drivers had a driving experience of 6-18 months. Information about offenses for a 2-year period was obtained from an official register of drivers' licenses. The drivers were classified into three age brackets: 18-20, 21-30 and 31-50 years. The effect of driving experience was controlled by dividing the drivers into different mileage brackets. The data was analyzed and the results were discussed in the framework of the hierarchical model of driving behavior.

    RESULTS: Young novice drivers and especially young male drivers showed more problems connected to the higher hierarchical levels of driving behavior than middle-aged novice drivers. The number of crashes and offenses was highest among the young males and their crashes took place more often at night than female or older drivers' accidents. Female drivers showed more problems connected to the lower hierarchical levels of driving behavior, e.g. problems in vehicle handling skills.

    DISCUSSION: Ways of measuring crash risk of different driver groups were also discussed, as well as the usefulness and reliability of self-reports in studies of driver behavior and crash history.

  • Evidence-based road safety: the Driving Standards Agency's schools programme (editorial).

    The Cochrane Injuries Group Driver Education Reviewers: Achara S, Adeyemi B, Dosekun E, Kelleher S, Landley M, Male I, Muhialdin N, Reynolds L, Roberts I, Smailbegovic M, van der Spek N. Lancet 2001; 358: 230-232.

    Correspondence: Ian Roberts, Public Health Intervention Research Unit, London School of Hygiene and Tropical Medicine, London, WC1B 3DP, UK (email:

    Driver education has a long history as a road safety strategy and considerable effort has been given to assessing its effectiveness. A major concern with driver education is that it may encourage teenagers to obtain a driving license and start driving sooner than they would have otherwise. In 1999 a systematic (Cochrane) review, including all studies with some form of non-intervention group, concluded that there was no evidence that driver education reduces motor vehicle crash involvement, and that such programs encouraged earlier licensing which could result in more crashes by young drivers. In March 2000, the British Government launched its road safety strategy and set out how it plans to achieve a 40 percent reduction in road deaths and serious injuries by 2010. The plan proposed to address the problem of teenage road deaths with driver education programs in schools and colleges. The authors wrote to government officials to question the wisdom of this policy. The official response justified continuing the expanded program of education by citing a driver education industry-sponsored study of 947 teenage students that assessed attitudes, knowledge, and intended behavior before and after a safety presentation. There was no comparison group and the response rate was low at 36 percent. The authors comment on the need for evidence-based policy.

  • Global road safety and the contribution of big business (editorial).

    Mohan D, Roberts I. BMJ 2001; 323: 648.

    Correspondence: Dinesh Mohan, Transportation Research and Injury Prevention Programme, WHO Collaborating Centre, Indian Institute of Technology, Hauz Khas, New Delhi 110016, INDIA (email: or Ian Roberts, Public Health Intervention Research Unit, London School of Hygiene and Tropical Medicine, London, WC1B 3DP, UK (email:

    In 1999, the World Bank announced the formation of a partnership of more than 70 corporations, organizations, and government agencies to address the problem of road injuries. The partnership includes automobile manufacturers and companies from the alcohol beverage industry. Most of the 3000 deaths and 30,000 serious injuries that occur each day are in low- and middle-income nations. Pedestrians, pedal cycle riders, and motorcycle and scooter users comprise a large proportion of the casualties. The authors express concern that the policies and practices supported by this group are not based upon evidence. For example, the partnership sponsors programs for child pedestrians in Africa and Asia because children do not have the necessary knowledge to deal with traffic. The authors suggest that the partnership should use some of its funds to support the World Health Organization to establish an evidence base for interventions to increase road safety. The authors also recommend funding for demonstration projects and research.

  • Relationship between licensing, registration, and other gun sales laws and the source state of crime guns.

    Webster DW, Vernick JS, Hepburn LM. Injury Prev 2001; 7(3): 184-189.

    Correspondence: Daniel W. Webster, Center for Injury Research and Policy, Johns Hopkins School of Public Health, 624 N. Broadway, Room 593, Baltimore, MD 21205-1996, USA (email:

    BACKGROUND: Firearm availability is positively associated with the risk of homicide. In the United States, federal law requires that potential firearm purchasers undergo a check of their background so that sales are denied if, for example, they have been convicted of serious crimes. The thoroughness of this background check is not consistent across states. Some states have extensive regulatory systems that include registration of firearms, licensing of buyers, and very restrictive eligibility criteria for gun purchases. Other states allow simple 'instant check' procedures that are vulnerable to fraud.

    OBJECTIVES: To determine the association between licensing and registration of firearm sales and an indicator of gun availability to criminals.

    METHODS: Tracing data on all crime guns recovered in 25 cities in the United States were used to estimate the relationship between state gun law categories and the proportion of crime guns first sold by in-state dealers.

    RESULTS: In cities located in states with both mandatory registration and licensing systems (5 cities), a mean of 33.7 percent of crime guns were first sold by in-state gun dealers, compared with 72.7 percent in cities that had either registration or licensing but not both (7 cities), and 84.2 percent in cities with neither licensing nor registration (13 cities). Little of the difference between city groups was explained by potential confounders. The share of the population near a city that resides in a neighboring state without licensing or registration laws was negatively associated with the outcome.

    DISCUSSION: States with registration and licensing systems appear to do a better job than other states of keeping guns initially sold within the state from being recovered in crimes. Proximity to states without these laws, however, may limit their impact.

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Rev. 30-Sep-2001 at 10:39 hours.