As with every other public safety response vocation, 9/11 forever changed the fire and rescue profession. On the morning of September 11, 2001, I was at International Association of Fire Fighters (IAFF) Headquarters, having driven by the Pentagon and across Memorial Bridge to the office located less than a block away from the West Wing of the White House. When the first plane hit the World Trade Center north tower (0846 hrs.), like many, first thoughts were of a flight navigation issue. Perhaps growing up in America causes some of us to try to justify what we are seeing rather than immediately admitting that terrorists could reach our homeland. Minutes later as the second plane struck the south tower (0903 hrs.), there was no explanation other than the obvious: we are under attack.
Focused on the safety circumstances of the firefighters we knew were responding, senior staff at the IAFF assembled in a central location to gather our thoughts and formulate a plan. At 0935 hrs., out the windows of our building, we see the third plane circling the area and two minutes later smoke is billowing from the Pentagon. The call was made to evacuate our building except for senior staff who would spend the coming days and weeks coordinating supportive response to IAFF New York Locals 94 and 854. Resources were also sent to support our members responding to the Pentagon.
As witnessed by the world, thousands of firefighters responded to the World Trade Center. These responders and their families became the immediate focus and remain the focus today. Three hundred and forty-three firefighters were killed on 9/11/2001. However, the dying of those who made it out that day continues. Since 2001, hundreds of those exposed to the carcinogens and breathing particulate matter at Ground Zero have become ill with respiratory diseases and cancer, and many have died. Along with those who were/are physically sick, there are others not exhibiting physical symptoms but experiencing behavioral health issues including depression, anxiety, and PTSD.
This situation has brought increased focus on firefighter cancer, respiratory disease, and behavioral health. Today, 49 states have presumptive cancer or death/disability eligibility laws in place for firefighters. Forty-two states have presumption and/or death/disability laws for heart disease and 36 states have the same for lung disease. The behavior health benefits for firefighters have been slower coming. However, today as we continue to reduce the stigma, 22 states have presumption or benefit eligibility for mental illness and/or PTSD.
Caring for Our Own
The response to 9/11 and the continual evolving impact has also brought changes in how the fire service responds to its own after a major event. We have learned that seeing the horror of a mass killing event is not normal. Therefore, emergency response agencies must prepare responders before an event, be present immediately after and engage for the long-term recovery. The traumatic mental injury that occurs from such an event can continue to impact responders, their families, the emergency response agencies, the survivors, and communities for decades after the incident. Many fire departments have established employee assistance programs (EAP) and critical incident stress management (CISM) programs. Increasingly, however, evidence shows that CISM, including critical incident stress debriefing (CISD), does not improve outcomes compared to non-intervention and further suggests that mandatory or forced debriefs are detrimental. Based on lessons learn from 9/11 and other events the International Association of Fire Fighters (IAFF) has developed the IAFF Peer Support program. This program was established to assist local fire departments in developing peer support counselors and trainers in their own departments so that they are immediately available to assist after a disaster. Responders are more likely to talk to other responders who have experienced the same trauma.
“Emergency response agencies must prepare responders before an event, be present immediately after and engage for the long-term recovery”
The National Fallen Firefighter Foundation (NFFF) has also developed resources known as the Behavioral Health Assistance Program (BHAP). The BHAP is a comprehensive, integrated program with multiple components for firefighter mental health and wellness through crisis intervention. The program also includes guidance on chaplain programs, peer-to-peer support, clinical teams, and therapy animals.
In addition to peer counseling and other post-event interventions, the fire service is focusing on building individual responder resilience before the traumatic events occur. Resilience can be described as the mental, emotional, and behavioral ability to cope with and recover from the experience when faced with stress and/or adversity. For example, the IAFF and others are focused on teaching responders to:
- Respond to stress with positive, flexible thinking
- Increase positive social interactions on and off shift
- Experience more positive emotions during your day
- Manage stress through tactical breathing, meditation, and mindfulness
- Good nutrition and exercise
- Build meaning and purpose in your daily life through spirituality (faith)
Like our counterparts in the military, we know that a resilient individual is better able to leverage mental and emotional behavior skills that promote optimal performance when it matters most.
Data Driven Response Preparedness
After 9/11, every community became New York. Especially in urban centers, responders were on higher alert and focused on preparedness and training. We have a new focus on community risks (and threat) assessment and matching the emergency resources deployed (both mobile and personnel) to the probable risk event. After 9/11, new data systems were developed to help fire departments gather information, evaluate and plan. The Fire Community Assessment/ Response Evaluation System (FireCARES) was built with funds from the DHS/FEMA Assistance to Firefighter Grants. FireCARES is a big data system layering multiple databases to allow mining of intelligence from the combined data. Every fire department in the U.S. has a FireCARES page. FireCARES contains 17 years of response data, parcel/structure hazard level coding, census data, American Community Survey data, fire station locations, local jurisdictional borders and more all layered in a geographic database. FireCARES provides community risk assessment for fire, the capability for drill-down to parcel level, incident heatmaps, response time calculations from each station, and effective response force calculation by department all in a secure AWS cloud platform. Fire chiefs and other fire service leaders can get logins to access the system.
As FireCARES was constructed, it became abundantly clear that local fire departments had little capability to assess their own operations and adjust to ensure adequate resources for future events. Legacy data systems have taken a toll on fire department capability to understand operational gaps in response, personnel needs, equipment, and training. To fill the gap and provide insights to fire chiefs and other leaders, the National Fire Operations Reporting System (NFORS) was built. Once again leveraging DHS/FEMA/ AFG Fire Prevention and Safety funding, NFORS uses data capture technology and powerful analytic algorithms to provide near-real-time insights to local fire departments. NFORS links directly to computer-aided dispatch (CAD) or records management systems (RMS) via API to analyze data providing results in fully interactive dashboards. The NFORS system uses artificial intelligence (AI) to prepare standard incident reports with operational performance analytics on every response. Data-driven insights are key to operational preparedness and overall response capability.
Fire service agencies must prepare for the next – not the last – incident. New threats to the homeland bring new risks and response needs. From active shooter and hostile events to the next large-scale attack, our frontline domestic responders must be ready and resilient. Newly recognized threats are evolving, such as fire being used as a weapon. Fire service leaders must be educated to recognize these forms of attack and not mistake them for customary events. Further, the fire service must continue to plan, train, and practice integrated response with local law enforcement. Joint fire/law enforcement responses will become the norm rather than an anomaly. Fire and LEOs should recognize each other on scenes whether in uniform or not.
Firefighters know all too well how to do memorials. That act of remembrance is an important part of honoring those who serve. Since 9/11, however, we are applying a prevention mentality to cancer, PTSD, and cardiac disease. Today we are more focused on preparing, training, and responding to threats. The legacy of those who have gone before us and those who have been lost is what we learn from them. We must prepare using every bit of information and every resource available to us – and we must continue to take care of each other. We will never forget!