Ground Zero First Responders: The Impact of 9/11 Decades Later

The attack on the twin towers on September 11, 2001, was one of the most devastating events in American history. Thousands lost coworkers, family, and friends that morning in Lower Manhattan, and countless others suffered acute injury and mental trauma. Not foreseen, however, were the chronic effects the horrific events would have on those who lent a helping hand to the victims. Now, nearly two decades after the deadly attacks, ground zero first responders continue to feel the effects of that day: the tragic cost of their altruism and bravery. 

Those at the scene of the attack and in proximate neighborhoods have suffered from chronic illness and injury proven to be directly linked to the aftermath of the twin towers’ collapse (Dunn et al., 2018). According to the World Trade Center (WTC) Health Program, a group dedicated to providing healthcare to those affected by the attacks, the top five conditions affecting first responders and survivors are Chronic Rhinosinusitis, Gastroesophageal Reflux Disease, Asthma, Cancers, and Sleep Apnea (2019). There are also a number of conditions that are less obvious and more difficult to describe. These invisible disorders, such as PTSD, anxiety, and depression, can occur as a result of major traumatic events and can cause both physical and mental stress in a person. The majority of the patients (69.8 percent) enrolled in the WTC Health Program were, in fact, witness to a traumatic event (eg. death, injury, or suicide) on 9/11 (Farfel et al, 2008).

Aerial photograph of the 9/11 dust cloud. The deadly 9/11 dust cloud [Photograph]. (2017, September 23). Retrieved from

The formation of the dust cloud on 9/11 proved to be the most destructive to long-term health. It produced detrimental byproducts that continue to impact first responders, victims, and civilians years later. 80-90 percent of the 9/11 dust cloud was composed of highly alkaline macroparticles, which when inhaled, causes chemical and physical irritation in the head, lungs, and both respiratory and gastroesophageal epithelia (Lippmann et al, 2015). Some researchers identified a specific symptom of 9/11-linked respiratory damage called “WTC cough,” which arose from the inhalation of large dust particulates of a caustic nature (Chi Chen et al, 2002). Long-term exposure to the WTC dust cloud is linked to an increased risk of cancer development and other severe respiratory diseases.

Due to the vast number of individuals affected by 9/11-related illnesses, many programs have been founded to provide healthcare and support to those still suffering. The World Trade Center Health Program, established by the 2010 James Zadroga 9/11 Health and Compensation Act, is a government organization that provides health services to those affected, and publishes data on the demographics and progress of its members (Dunn et al, 2018). Over the past four years, overall enrollment in the program has increased dramatically as more and more chronic health issues are diagnosed post-9/11. This includes 14,815 responders (including firefighters, recovery and clean-up crew, and volunteers) and 15,683 survivors (those present on the day of the attack or worked, lived, or went to school in the disaster zone) enrolled between 2015 and 2019 (World Trade Center Health Program, 2019). 

Photograph from 9/11 of first responders working to clear debris and stop fires in the dust cloud. Morgan, P. (n.d.). Firefighters work at the scene after the collapse of the World Trade Center towers in New York on Sept. 11, 2001. [Photograph]. Retrieved from

Despite the measures taken to address the chronic health issues faced by thousands of first responders and civilians through the WTC Health Program, there are still speculations about ways in which management organizations could have contained the WTC dust cloud more efficiently. Risk analysis assessments confirm that only 21 percent of those who volunteered at ground zero wore protective face gear, and more than half of those present were directly caught in the dust cloud (Centers for Disease Control and Prevention, 2004). Moreover, the lack of urgency that governmental research organizations took with regard to addressing the chemical makeup of the dust cloud and the chronic implications of WTC cough is a lesson to be learned in the case of future unpredictable health risks (Lippmann et al, 2015). 

There is a need for a federal committee designed to deal with risk management of unpredictable disasters. The ability to institutionalize the goals of containment and control in dire situations could have the potential of saving hundreds of lives. By having the foresight to envision not only the immediate effects but the long-term impacts of an event like 9/11, we can make the bravery shown and sacrifices made low-risk in the long-run.

Edited by Alexa Rome

Placed by Sri Ponnazhagan


Centers for Disease Control and Prevention. (2004, September 10). Physical health status of World Trade Center rescue and recovery workers and volunteers — New York City, July 2002–August 2004. Retrieved February 7, 2020, from Morbidity and Mortality Weekly Report website:

Chi Chen, L., & Thurston, G. (2002). World Trade Center cough. The Lancet, 360, 37-38.

The deadly 9/11 dust cloud [Photograph]. (2017, September 23). Retrieved from

Dunn, L., & Fox, M. (2018, September 11). 9/11 first responders begin to feel the attack’s long-term health effects. NBC News. Retrieved from

Facts about the WTC health program. (2019, November 19). Retrieved February 7, 2020, from World Trade Center Health Program CDC website:

Farfel, M., DiGrande, L., Brackbill, R., Prann, A., Cone, J., Friedman, S., … Thorpe, L. (2008). An overview of 9/11 experiences and respiratory and mental health conditions among World Trade Center Health Registry enrollees. Journal of urban health : bulletin of the New York Academy of Medicine, 85(6), 880–909. doi:10.1007/s11524-008-9317-4

Lippmann, M., Cohen, M. D., & Chen, L. C. (2015). Health effects of World Trade Center (WTC) Dust: An unprecedented disaster’s inadequate risk management. Critical reviews in toxicology, 45(6), 492–530. doi:10.3109/10408444.2015.1044601

Lowers, H. A., Meeker, G. P., Lioy, P. J., & Lippmann, M. (2009). Summary of the development of a signature for detection of residual dust from collapse of the World Trade Center buildings. Journal of exposure science & environmental epidemiology, 19(3), 325–335.

Morgan, P. (n.d.). Firefighters work at the scene after the collapse of the World Trade Center towers in New York on Sept. 11, 2001. [Photograph]. Retrieved from

Overall enrollment in the WTC health program [Chart]. (2019, November 13). Retrieved from

Shao Lin, Joan Reibman, James A. Bowers, Syni-An Hwang, Anne Hoerning, Marta I. Gomez, Edward F. Fitzgerald, Upper Respiratory Symptoms and Other Health Effects among Residents Living Near the World Trade Center Site after September 11, 2001, American Journal of Epidemiology, Volume 162, Issue 6, 15 September 2005, Pages 499–507,

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