Caring for the aging population of 9/11 responders

Millions of Americans sat stunned in front of TV sets on Sept. 11, 2001, as the worst foreign attacks on U.S. soil in history took place from the cockpits of four hijacked airliners-turned-weapons of destruction.

The images were horrifying: a plane burning in a Pennsylvania field after passengers intervened to bring it down en route to its target, the U.S. Capitol building, all on board lost; another diving into a wing of the Pentagon, sending employees to run for their lives; and, perhaps worst of all, two jets crashing into and leveling New York’s iconic World Trade Center Twin Towers, 110 stories each, resulting in 2,753 known deaths.

Shock, disbelief and sadness descended upon a nation glued to the news in a pre-social media world. Meanwhile, those who experienced the devastation in person as they worked on site faced the grim reality firsthand – and many continue to feel the impact 23 years later.

“We know from the research that people who were closest in physical proximity to the event itself were most affected by it,” says Mark Macgowan, an associate dean and professor of social work in the Robert Stempel College of Public Health & Social Work, whose research, teaching, and clinical work focuses on survivors and responders to mass casualty events. “The more ‘personalized’ the event, the more-intense and the more-lasting the effects,” he adds. Macgowan singles out individuals responsible for recovering remains from the rubble, for example, as potentially still dealing with the mental health fallout.

The vast majority of those exposed in the earliest days to the 9/11 site have been diagnosed with at least one related physical or mental health condition. Responders to the attack, who initially wore no personal protective equipment, inhaled a fine dust of cement particles, asbestos, heavy metals and chemicals that has caused catastrophic health consequences, among them a variety of cancers.

TENDING TO THE DIASPORA

FIU has set the groundwork for a research center dedicated to the ongoing health concerns of Sept. 11 responders. Such individuals have access to a federally funded program that provides medical monitoring and treatment through clinical facilities in New York and New Jersey.

Dr. Roberto Lucchini, a professor of occupational and environmental health science in the Robert Stempel College of Public Health & Social Work and medical doctor, served for eight years as the director of the World Trade Center health program at the Mount Sinai School of Medicine in New York. In that role, he analyzed the medical data of 9/11 responders to understand how the public health system might best address their needs.

Since Lucchini’s arrival at FIU, in 2020, he has led the charge to study the health status of retirees migrating out of the city.

“They feel forgotten when they come here,” he says of the growing number moving to Florida. Thousands, representing some 6-7% of a 100,000+ population, are known to reside in the state, although the figure is likely even higher, he adds. “Thanks to FIU, we started to work with them.”

Through radio ads and community activities, the university has encouraged relocated responders to share contact information, via a toll-free number and dedicated web site, so they might be considered for inclusion in research studies. (Relatedly, FIU and Lucchini are actively advocating for federal funding to establish a designated clinical center that would offer both physical and mental health care services in Florida.)

“They are happy that someone is reaching out to them,” Lucchini says, “and they tell us their stories.”

THE WORK BEGINS

A clinical trial co-led by Macgowan and Lucchini will investigate how to reduce the mental health challenges of former responders living away from the support system they have known for more than two decades. The team secured a $700,000 grant from the Centers for Disease Control and Prevention to reduce a recognized “significant mental health burden related to the World Trade Center collapse.”

Macgowan identified the possible benefit of offering a personalized, clinician-supported remote intervention that responders in Florida could access “to manage some of their symptoms that are still troubling.” The focus is on post-traumatic stress symptoms as well as anxiety, depression and sleep issues.

The project is one of several Lucchini envisions FIU researchers undertaking in the coming years. Others include studies related to aging (for which a proposal has been made to the National Institutes of Health), cancer, women’s health and cognitive impairment/early-onset dementia.

Even 23 years later, the passionate physician emphasizes the human value of putting resources behind understanding what those who ran toward the terrorst site continue to go through and how best to support them.

“Obviously, I care about them,” he says. “They were serving us, and now we have to help them.”