This article reviews lessons learned about managing the safety and health of workers who were involved in disaster response, recovery, and cleanup after the 2001 World Trade Center (WTC) disaster. The first two sections review ongoing responder health burdens and the tragic toll of this disaster from a worker safety and health perspective. The remaining sections address changes in federal infrastructure, response planning, and resources for protection of response and recovery personnel. Proper preparation includes pre-event and "just-in-time" disaster-worker training on likely hazards, organizational assets for hazard monitoring, and hands-on instruction in the use of assigned protective equipment. Good planning includes predeployment medical review to ensure "fitness for duty" and considers the following: (1) personal risk factors, (2) hazards likely to be associated with particular field locations, and (3) risks involved with assigned tasks (eg, workload and pace, work/rest cycles, available resources, and team/supervisory dynamics). Planning also should address worker health surveillance, medical monitoring, and availability of medical care (including mental health services). Disaster safety managers should anticipate likely hazards within planning scenarios and prepare asset inventories to facilitate making timely safety decisions. Disaster safety management begins immediately and provides ongoing real-time guidance to incident leadership at all levels of government. Robust standards must be met to reliably protect workers/responders. An integrated and measurable multiagency safety management function must be built into the incident command system before an incident occurs. This function delineates roles and responsibilities for rapid exposure assessments, ensuring cross-agency consistency in data interpretation, and timely, effective communication of information and control strategies. The ability to perform this safety management function should be tested and evaluated in exercise simulations and drills at multiple levels. Joint planning and exercising of the safety management plan and its function are effective ways to build interagency relationships and to be more systemic in managing logistics for safety equipment and converging personnel. Planning must include mechanisms to enable safety decisions to be implemented-such as effective and rapid scene control (site access), personnel tracking, and safety enforcement. Worker safety and health preparedness and leadership are essential for protecting workers and promoting resiliency among personnel involved in disaster response, recovery, and cleanup.
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