Free A Decade of Hope by Dennis Smith Page A

have stopped rescue activities. Luckily she had the strength of will to get assertive, and I then directed her to where I thought the rescue dogs were. So that was a good thing. And yes, she was probably more of an asset at that time than I was.
    After leaving Pace we went to visit one or two local hospitals: Downtown Beekman [near Pace University], and then another hospital right over the Brooklyn Bridge. We then went to headquarters [FDNY headquarters in Brooklyn], because we thought we might be needed throughout the night, though it turned out we were not. We slept at headquarters that night, and the next day we started figuring out what to do in terms of building for the future.
    After 9/11 Dr. Kelly and I went to Fire Commissioner Von Essen, who was a very prohealth and prosafety fire commissioner, and in my opinion did more for health and safety than anyone serving before him [Thomas Von Essen was also a former president of the Uniformed Firefighters’ Association, the union that represents the firefighters.]. We told him this had been a unique exposure, the only time we had been attacked on our own soil. Forget about the political aspects: From a medical perspective, this had been a unique exposure.
    The cloud that day was very thick and did not fully dissipate: 9/11 dust is a very heterogeneous mixture. What we at the ground level were exposed to is called sedimentary dust. By definition it consists of the largest, heaviest particles, the particles that fell closest to Ground Zero. As you go farther out, if you draw concentric circles, the dust that people on the street level are exposed to is by definition smaller, so many think that the greatest exposure to bad stuff is right at the epicenter of the event. Actually, in terms of inhalation exposure, that’s not always true, because we are able to breathe in the smaller particles deeper than we can breathe in larger particles. And sometimes you get more cardiopulmonary and toxic exposures distant from the epicenter, because that dust is coated with all the chemicals of combustion and pyrolysis that have been occurring.
    What was different about the World Trade Center is that, against common teaching, the people at the epicenter inhaled deeply a ton of stuff. Common teaching holds that those large particles at the epicenter would just have caused sinus and upper airway irritation. Because the density was so high, however, we actually inhaled large particles into our lower airways, so the World Trade Center is actually the opposite of a typical disaster, and you got greater inhalation injury at the epicenter.
    Right around Ground Zero you could not see your hand, but as you walked toward the Staten Island Ferry it became gray. What struck me was the sheer grayness of it. I love old movies, and Ground Zero on 9/11 really did look like the movies that were made about the cold war and the A bomb, the H bomb. There was no color. Everything was black and white. It was very, very cloudy, very dusty, nobody around, and very quiet. Total quiet. It could have been in an old end-of-the-world movie.
    I realized that there would be pulmonary consequences that same day, which is why we set up the triage center. But I thought they were going to be the standard smoke-inhalation injury, which is a few days of coughing up stuff and, in certain rare cases, a few months of problems. It was only the next day that my thoughts settled and, after processing what different firefighters had been saying—that the fire smelled different and tasted different—and the fact that there had been much more coughing going on than at a typical fire, that I realized that this could have really catastrophic impacts on people’s health.
    From a health perspective, we needed to investigate the health consequences of 9/11. We would not be stopped by people saying that if we found problems we were going to open up Pandora’s box. The example that we gave Commissioner Von Essen was the