The New York City Health Department issued long-awaited instructions to doctors Thursday for treating and detecting illnesses related to the Sept. 11 attacks, including a warning that smoking can make those health problems worse.
The agency had previously offered instructions for treating post-traumatic stress disorder, substance abuse and mental illness following the attacks, but health experts and advocates complained the city had no instructions for treating physical ailments.
Since 2001, thousands of firefighters, police officers and construction workers who worked in the debris of the World Trade Center site have been screened for a host of medical ailments, including lung disease and gastrointestinal problems.
"Five years after the World Trade Center attacks, many New Yorkers have disaster-associated physical and mental health conditions," city Health Commissioner Thomas Frieden said. He said the guidelines would help doctors better recognize and treat those illnesses.
The guidelines are considered crucial for ground zero workers living in other states where the doctors are less familiar with the symptoms and most effective treatments.
The Associated Press reported last week that more than 600 ground zero workers in 34 states have received medical screening for exposure to toxic dust at the site.
The guidelines suggest particular questions to ask, tests to give, and ways to treat the 9/11 patients.
They also carry a specific warning about tobacco.
"The risk and severity of many WTC-related diseases are heightened by tobacco use. Exposure to secondhand smoke may also exacerbate WTC-related diseases," the guidelines state. "All WTC-exposed people and their family members who use tobacco should be advised to quit, and all who attempt to quit should be provided with medications to help them quit."
The medical protocol will be mailed to all doctors in New York, and distributed elsewhere by the federal government.
"It's about time," said Rep. Carolyn Maloney, D-N.Y. "Some might ask why it took so long to get them out or why the city did not do this sooner."
The city-run World Trade Center Health Registry is tracking the long-term health effect of the attacks on 71,000 people, including those who lived or worked in lower Manhattan.
Mount Sinai Medical Center is also preparing a major study of thousands of ground zero workers, to be released days before the fifth anniversary of the attacks.
Kathy Kirkland of the Association of Occupational and Environmental Clinics, which administers a nationwide screening program for ground zero workers, said before the release that many doctors would not know what type of lung test to give such patients, or connect an intestinal problem to Sept. 11.
A House committee plans to hold a hearing on Sept. 11 health issues next week.