The physical and mental health challenges experienced by 9/11 first responders and recovery workers: A review of the literature

Document Type

Journal Article

Publication Title

Prehospital and Disaster Medicine


Cambridge University Press


School of Medical and Health Sciences




Smith, E. C., Holmes, L., & Burkle, F. M. (2019). The physical and mental health challenges experienced by 9/11 first responders and recovery workers: A review of the literature. Prehospital and Disaster Medicine, 34(6), 625-631. https://doi.org/10.1017/S1049023X19004989


Introduction: In the years following the September 11, 2001 terrorist attacks in New York (USA), otherwise known as 9/11, first responders and recovery workers began experiencing a range of physical and mental health challenges. Publications documenting these provide an important evidence-base identifying exposure-related health challenges associated with environmental exposures from the World Trade Center (WTC) site and describe the key lessons learned regarding both physical and mental health challenges (including symptoms and defined conditions) from the 9/11 disaster response.Methods: A systematic literature review was conducted using the MEDLINE, PubMed, CINAHL, and PsychInfo databases (September 11, 2001 to September 11, 2018) using relevant search terms, truncation symbols, and Boolean combination functions. Publications were limited to journal articles that documented the physical or mental health challenges of 9/11 on first responders or recovery workers.Results: A total of 156 publications were retrieved by the search strategy. The majority (55%) reported a quantitative methodology, while only seven percent reported the use of a qualitative research methodology. Firefighters were the group of responders most frequently reported in the literature (35%), while 37% of publications reported on research that included a mix of first responders and recovery workers. Physical health was the focus of the majority of publications (57%). Among the challenges, respiratory issues were the physical health condition most frequently reported in publications, while posttraumatic stress disorder (PTSD) was the most frequent mental health condition reported on. Publications were published in a broad range of multi-disciplinary journals (n = 75).Discussion: These findings will go some way to filling the current gap in the 9/11 evidence-base regarding the understanding of the long-term health challenges for first responders and recovery workers. © 2019 World Association for Disaster and Emergency Medicine.



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