Before 9/11, the term, “first responder,” was not widely used, if at all.

The term came into common usage in the wake of that horrific day in 2001 to describe the thousands of public health and safety personnel — firefighters, police, EMTs, and others — who responded to the scene of the terrorist attacks, particularly the devastation of the World Trade Center’s Twin Towers in New York. While some object to the overuse of the “first responder” term by the media, saying it is more accurate to specify exactly which agencies responded to an incident, the term has continued to be important in addressing the long-term effects of the terrorist attacks on the emergency personnel who were present at Ground Zero.

Rubble from the Twin Towers continued to smolder for more than three months after the attacks, releasing poisonous smoke and toxic dust as responders worked the scene. Contemporarily, thousands of survivors and responders continue to struggle with “certified” illnesses linked to Ground Zero exposure.

 

Quantifying health effects

Firefighting has always been a dangerous job. In addition to the obvious hazards posed by flames and collapsing buildings, dangers that are less visible can be present on even the most routine fire run. Long before 9/11, it was standard for crews to wear protective gear and self-contained breathing apparatus to protect themselves from exposure to carcinogens and other toxins.Before 9/11, the term, “first responder,” was not widely used, if at all. Click To Tweet

But the sheer enormity of the 9/11 disaster, along with the length of time crews spent at the scene, raised awareness of these risks and brought the health of the first responders into the forefront of national discussion. The New York City Department of Health and Mental Hygiene, the Fire Department of New York (FDNY) and other researchers began carefully monitoring cancer rates among people who had prolonged exposure to the World Trade Center site.

Among findings published in the 2010 WTC Medical Working Group annual report and cited on the New York City government’s 9/11 Health website:

  • FDNY found that nearly 9,000 firefighters with World Trade Center exposure may be at greater risk for cancer than firefighters who were not exposed.
  • The WTC Health Registry found increases in rates of prostate cancer, thyroid cancer and multiple myeloma, a blood cancer, among nearly 34,000 WTC rescue and recovery workers in comparison to average rates among New York State residents after adjusting for age, race/ethnicity, and gender.
  • Prostate and thyroid cancer rates were higher than expected among nearly 21,000 rescue and recovery workers enrolled in the WTC Health Program when compared to typical rates in New York, New Jersey, Connecticut, and Pennsylvania, where the majority of the responders lived.

These are just a few of many findings of the numerous studies conducted in the past 18 years in an attempt to quantify the hidden damage done by 9/11. The studies also suggested that, given the long latency period for most cancers, further monitoring of WTC responders would be necessary to track any increase in illnesses over time.The enormity of 9/11, along with the length of time crews spent at the scene, brought the health of the first responders into the forefront of national discussion. Click To Tweet

 

Political fight 

Although 9/11 brought the country together for a time, it did not take long before the healthcare needs of first responders became a more divisive political issue. A number of Federal programs were established to help individuals battling 9/11-related illnesses, but there was little consensus on how to fund them or for how long. This summer, one such issue came to a noisy conclusion in Congress.

The September 11th Victim Compensation Fund was due to run out of money in December 2020. The fund was created to provide compensation to anyone who was killed or suffered physical harm resulting from the airplanes’ impacts or the debris removal efforts in the aftermath of those impacts, regardless of whether they were a first responder or a civilian. (PDF link).

Still, it was the first responders who became the face of the issue, and their most vocal advocate was, of all people, a comedian—Jon Stewart, who was still the host of the New York-based “The Daily Show” in 2001. When the time came to renew the fund in 2015, a permanent version of the fund was voted down in favor of a temporary, five-year renewal. When the issue came up again this year, Stewart attacked Congress for failing to permanently authorize the fund and seemingly turning their backs on the 9/11 emergency crews. “They responded in five seconds, they did their jobs. With courage, grace, tenacity, humility. Eighteen years later, do yours!” Stewart stated at the time.The Senate and House both voted in favor of the “Permanent Authorization of the September 11th Victim Compensation Fund Act. Click To Tweet

Finally, they did. Over this past summer, the Senate and House both voted in favor of the “Permanent Authorization of the September 11th Victim Compensation Fund Act.” This legislation preserved funding for the program, if not permanently, at least through 2090, far beyond the expected lifespan of anyone who was an adult in 2001.

 

Raised awareness 

The struggle of the 9/11 first responders to win coverage for their illnesses has raised awareness among emergency personnel, especially firefighters, of the need to be proactive in tracking and recording incidents of exposure to toxins and other dangerous environments. The online training tool, FirstForward, recently incorporated a feature that allows users to easily track such incidents. Having readily accessible records makes it easier to spot patterns among members of a crew, and provides first responders with a way to document incidents that may later become important to a legal case or medical diagnosis.

Another tool the industry has developed is the Firefighter Near Miss program sponsored by the International Association of Fire Chiefs (IAFC). This website invites firefighters to share stories of dangerous situations, with the hope that their colleagues can learn from their experiences.

In addition to promoting discussion of risk mitigation and best practices in the field, IAFC’s website offers information about health risks and the importance of monitoring one’s physical well-being. Firefighters’ accounts include not only narrow escapes from intense fires and other dangers, but also advice on recognizing signs of long-term physical issues — ranging from cancer to PTSD — which can pose just as much danger to an emergency responder as falling timbers or burning cars.Firefighter Near Miss invites firefighters to share stories of dangerous situations, with the hope that their colleagues can learn from their experiences. Click To Tweet

The public might be surprised to realize how prevalent hazards can be, even when performing routine firefighting duties. One study conducted by the Firefighter Safety Through Advanced Research (FSTAR) program found that despite wearing full protective gear, firefighters can have systemic exposures to polycyclic aromatic hydrocarbons, or PAHs, which are carcinogens created from burning rubber or tar. Industrial sites present a risk of exposure to PAHs, but so do most residential home fires. This reinforces the need to fully document any incident where exposure to toxins is likely, both to aid in a possible future diagnosis and to track the possible causes of any subsequent illnesses.

Another study cited on the IAFC website verified that there is an exposure-response relationship between firefighting activities and certain types of cancer, particularly lung cancer and leukemia. The study also suggested that gathering and maintaining data on such factors as length of employment, number of runs, and time spent on runs could be helpful in assessing the risk of developing cancer.

 

Enforcing policies 

Despite the obvious need to take every precaution to reduce health risks, some fire departments have had trouble getting the message across. Since carcinogens and other toxins stay on a firefighter’s clothing and equipment, one key to reducing exposure is thoroughly cleaning equipment and changing out of soiled gear. Keith Collins, who writes for the American Military University website “In Public Safety,” found that in some agencies, the crews resisted this seemingly common-sense advice. “In every firehouse across America there are guys and gals who like to keep their gear dirty to show that they did work. Some firefighters keep gear dirty as a memento of their accomplishment.”Despite the obvious need to take every precaution to reduce health risks, some fire departments have had trouble getting the message across. Click To Tweet

The problem with dirty gear, though less obvious than directly breathing in smoke, is no less significant. When humans sweat, their pores open up.  For firefighters, this provides and effective entryway through which soot, ash, and chemical residue can more easily enter the body. Thus, Collins urged that firefighters be diligent about cleaning their equipment and their clothes. The key, he said, was for departmental leadership to change their teams’ mentality through training and education.

In practice, departments have found that a combination of training and compliance tools can help ensure all members of the team are on the same page regarding best practices, with the goal of shifting the workplace mentality away from what might be considered “cool” and toward what is most conducive to health and safety. The key is for departmental leadership to change their teams’ mentality through training and education. Click To Tweet

 

Hope for the future 

The losses are staggering, the struggle for recovery is real, and the sacrifices made by the first responders of 9/11 should never be forgotten. Yet, as a new generation of brave men and women enter the response industry, perhaps the increased awareness and better tools of the trade will help keep them safer and healthier than their predecessors, or at least give them far more viable weapons in their fights for fair treatment and compensation to come.