DESCRIPTION: In the aftermath of September 11, 2001, thousands of rescue and recovery workers joined the New York City Fire Department (FDNY) in working directly on and adjacent to the debris pile. Analysis of bulk samples of WTC dust indicated the presence of a mixture of toxic particulates, combustion products, and debris fibers. Analysis of sputum of firefighters ten months after exposure showed an excess of these particles, thought to be causally related to upper and lower respiratory illnesses. Preliminary studies performed in firefighters, in the month after September 1 I, 2001 , as well as six months after exposure, indicated an excess of upper and lower respiratory illness, and an excess of stress related incidents. Based upon these results, investigators at Mount Sinai University Medical Center, supported by the Centers for Disease Control and Prevention (CDC), established a consortium of clinics, including the Clinical Center of EOHSI, where WTC workers and volunteers could receive medical and psychological screening. Over 9000 examinations have been completed to date in all of the centers, and 350 examinations have been completed at EOHSI. These examinations indicate an excess of upper and lower respiratory abnormalities and mental health symptoms, still present more than two years after exposure. We propose to continue our role in the surveillance of VVTC workers and volunteers as a clinical center (CC) for further evaluation of WTC workers. This evaluation will include medical and occupational history, physical examination, pulmonary function testing with and without bronchodilators, routine blood tests, urinalysis, and chest x-ray. Workers will complete a self-administered battery of psychological tests designed to screen for psychiatric issues including posttraumatic stress disorder, generalized anxiety disorder, major depression, and alcohol addiction. In particular, workers who continue to manifest upper respiratory problems will receive a directed physical assessment including detailed diagnostic testing of nasal function and structure and referral when appropriate. Workers with persistent mental health symptoms that manifest on standardized questionnaires or are diagnosed by the examining physicians will receive formal evaluation by a mental health clinician and referral for treatment. Data will be collected on the electronic medical record system, Logician, and will be integrated with the data collected at the Data Collection Center.