1. 1 Barriers to Evacuation from the WTC on September 11, 2001 National Disaster Medical System Disaster Response Conference April 20, 2004 Robyn R.M. Gershon, MHS, DrPH Principal Investigator NCDP National Center for Disaster Preparedness Columbia University CPHP Center for Public Health Preparedness Columbia University

2. 2 Dr. Kristine Qureshi Dr. Stephen Morse Dr. Elizabeth Smailes Dr. Tracy Durrah Dr. Victoria Raveis Ms. Erin Hogan Dr. Alan Fleischman (NYAM) Dr. Fred Matzner (Our Lady of Mercy Medical Center) Mr. Glenn Corbett (John Jay) Dr. Charles Jennings (John Jay) Dr. Mark Franklin Peyrot (Loyola) Dr. Martin Sherman (Loyola) Dr. Rae Zimmerman (NYU) Mailman School of Public Health: Research Team P.I. - Dr. Robyn Gershon Other Institutions:

3. 3 Study goals Background information on the WTC attacks Evacuation behaviors- what is known/does it apply to high rise buildings Qualitative data findings Preliminary policy implications Lecture Outline

4. 4 1.To identify the individual, organizational, and structural factors that affected evacuation from the WTC on 9/11/01 2.To inform policy and practice in order to improve the safe evacuation of high rise structures Goals

5. 5 Logistical Considerations: Funding timeliness Access to survivors Cooperation across studies Logistical Challenges to Disaster Research

6. 6 Ethical Considerations: Decision-making ability of survivors and assessment of ability How to assess impact of the research on the survivors How to assure confidentiality of data, litigation issues Access to survivors Weighing societal benefits vs. costs to participants, especially when individual benefits may be lacking Ethical Considerations of Disaster Research

7. 7 Building Facts Timeline 9/11 Attacks Evacuation Morbidity and Mortality Background Information

8. 8 South North WTC Complex

9. 9 Timeline of Events Announcement heard in WTC 2 (South) WTC 1 (North) hit WTC 2 (South) hit WTC 2 (South) collapses WTC 1 (North) collapses 8:46 8:55 9:02 9:59 10:28

10. 10 September 11, 2001 North Tower Impact Impact: 8:46 am- American Airlines Flight 11 Collapsed 1 hour and 42 min after impact South Tower Impact Impact: 9:02 am- United Airlines Flight 175 Collapsed 57 minutes after impact

11. 11 In the span of 102 minutes, approximately 18,000 people evacuated the North and South Towers High percentage of people below the impact site survived from both towers 16-18 survivors above impact site in South Tower 0 survivors above impact site in North Tower Approximately 200 people jumped or fell from floors above impact Fatalities below impact line linked to proximity WTC Evacuation

12. 12 1103 injuries or illnesses related to attack −73% treated and released from EDs −16% hospitalized −0.4% died during emergency care 790 physical injuries 152 non-injury conditions Inhalation Burns Fractures Ocular Head Injuries Respiratory Cardiac Neuro/psych Morbidity and Mortality: Injuries/Illness

13. 13 479 rescue workers 157 jetliner crew and passengers 2190 civilian deaths - 1434 in North Tower - 599 in South Tower - 147 location unknown - 10 bystanders (on the ground) 70% worked on upper floors Approximately 800 people in North Tower and 300 people in South Tower were trapped above impact zone Morbidity and Mortality: Fatalities

14. 14 Study Overview Questionnaire Development & Administration Data Analysis Participatory Action Teams Identification of Risk Reduction Strategies & Recommendations Feedback to Participants & Stakeholders Preparation of Reports Qualitative Processes & Analyses Sample Frame Identification and Strategy

15. 15 What is Known: Will not go towards smoke Seek out groups, group size is important Individual and group panic dependent on several key factors Information serves as motivator Familiarity adaptive and pro-social behaviors Human Behaviors in Fire Emergencies

16. 16 What is Known: Social contact neutralizes threat Evacuation behaviors related to prior experience and practice- “auto-pilot” Lack of leader, ambiguity leads to milling behaviors Move towards and stay with group even if it is not the best option Human Behaviors in Fire Emergencies

17. 17 Key Informant Interviews In-depth Interviews Focus Groups Qualitative Data

18. 18 Individual Barriers: Disabilities and poor physical condition Last minute work-related tasks Taking personal items, making calls Footwear Waiting for instructions/direction Poor familiarity with WTC building Fear of negative impact on job Individual Facilitators: Direct evidence of magnitude Intuition Prior experience Factors Associated with Evacuation

19. 19 Organizational Barriers: Lack of internal communication Confusion re: fire safety responsibility Lack of preplanning for disabled Variability in training Poor commitment to safety climate Lack of orientation to building Lack of visitor planning Lack of direction on street Subway level mismanagement Breakdown in Fire Safety procedures Lack of info on building egress point limits Factors Associated with Evacuation Organizational Facilitators: Fire drill participation Support from senior management Fire safety procedures in addition to PANYNJ

20. 20 Structural Barriers: Poor visibility of exit signs Lack of back-up communication systems Elevator communication Locked egress (re-entry points) Stairwell width Stairwell design (e.g., switching) Debris/water/smoke Factors Associated with Evacuation Structural Facilitators: Well lit stairwells

21. 21 Individual: –Degree of personal responsibility –Familiarity with building, especially exit points –Determine time to descend –Disability preparations –Comfortable footwear –Start evacuation immediately Preliminary Recommendations

22. 22 Organizational: –Delineation of responsibilities –Written plans, policies that target full evacuation if necessary –Training, mandatory, new, annual, and orientation –Drills to include stairwells, 3 flight minimum –Leaders chosen with experience –Responsibilities of building owners, lease holders, employers and employees –Coordination/pre-planning with local agencies Preliminary Recommendations

23. 23 Structural: –Redundancy of communication systems –Communication in elevators –Signage –Lighting –Egress Preliminary Recommendations

24. 24 Phase III: Questionnaire Development & Administration Security badge list from Port Authority of NY/NJ in December 2003 ~100,000 employees in WTC 1, 2, 7 Current as of April 2001 Excel spreadsheet file –Names –Employer Names –Tower –Floor –WTC phone # –Badge type (permanent employee, contractor, PANYNJ employee)

25. 25 Sample underwent “cleaning” –WTC 7 employees removed –Names of deceased removed (checked 3x) –Duplicate entries removed 30,000 sampling frame (randomly selected) –20,000 randomly selected from sample to receive recruitment letter Questionnaire cont.

26. 26 Questionnaire: Process Hard copy, web-based, and email versions Recruitment letter w/ return post card –Accept/decline –In WTC 1 or 2 on 9/11 –Bar code –Web based or paper version option (mailed or emailed) –Code # serves as web based user ID After 2 weeks, no card or web completion first reminder card Two month data collection phase

27. 27 Preliminary Recommendations High rise occupancies High risk occupancies Inform: –Building owners, leaseholders, employees –Code development –Building design –Regulatory compliance –Emergency planners Next Steps: –Develop and evaluate model evacuation plan –Meet with OSHA, WTC builders –Widespread dissemination to reach all stakeholders

28. 28 OSHA 1910: Occupational Safety & Health Standards Subpart E– Means of Egress: 1910.37 Means of Egress 1910.38 Employee Emergency Plans Appendix to Subpart E--Means of Egress Subpart K– Medical and First Aid: 1910.151 Medical Services and First Aid Subpart L– Fire Protection: 1910.155 through 1910.165 Subpart Z– Toxic and Hazardous Substances: 1910.1200 Hazardous Communications

29. 29 http://cpmcnet.columbia.edu/dept/sph/CPHP/ wtc.html Thank you World Trade Center Evacuation Study