Lesson learned on the 20th Anniversary of 9-11: Frontline workers need long-term investments in mental health support

By Chief Ronald J. Siarnicki, Executive Director, National Fallen Firefighters Foundation

Twenty years later, I still remember what trauma looked like etched on the faces of firefighters at the World Trade Center site when a team from the National Fallen Firefighters Foundation (NFFF) and I arrived on scene September 12, 2001. It’s not something you can ever forget.

The NFFF presence was requested to assist at the World Trade Center site by FEMA just hours after the terrorist attacks as the scope and impact on the FDNY became clear. The National Fallen Firefighters Foundation was established by Congress in 1992 to support and honor frontline heroes who die in the line of duty. So we were ready to help when we got the call. We quickly assembled a team from fire departments in the Washington DC Area and headed straight to New York City.

But as soon as we got there, we faced a level of trauma and tragedy that U.S. firefighters had never before experienced. We quickly understood we needed to expand our capabilities and look for resources and support that we could utilize to assist the fire service and their families through this unprecedented amount of grief and loss.

Truth be told, up until that point, many departments and organizations across the country did not fully address the behavioral health needs of their organization and it was recognized that a standardized approach was needed. Often times, counseling intervention for fire service members only included marital, financial and substance abuse support. But September 11, 2001 was different. Not only did we lose an unprecedented number of firefighters, we also realized that supporting the families and co-workers left behind would require behavioral and mental health support with a new and intense focus on trauma.

We set up an office in the Sheraton Towers and worked with the FDNY Counseling Service Unit and the International Association of Firefighters to devise an action plan. While we knew peer support was most effective, we also knew that getting firefighters to leave the scene and talk with someone wouldn’t work. Crews had pledged not to leave the World Trade Center site until they had accounted for the bodies of all their missing firefighters. So, the peer teams went to them. They visited with them standing in the rubble. They talked one-on-one with firefighters when they took water breaks and they were there to listen and offer support however it was needed and in whatever time could be found before crews went back to their harrowing and horrifying work.

We stayed on scene offering that level of support for 17 weeks and 20 years later we are still there. The NFFF continues to support the FDNY behavioral health program through the FDNY Counseling Services Unit and the FDNY Family Assistance Unit to ensure that those dealing with grief and trauma get the help and support they need.

We’ve learned two key lessons along the way:

  1. A peer component is important for trauma support of frontline workers. Those who are grieving relate best to those who have walked in similar shoes. It creates a safe zone and helps eliminate what we call negative celebrity status – the idea that they’re worthy of attention because something terrible has happened to them.
  2. Everyone reacts differently to trauma, and they all reach out for help in their own time. Some need support right away. Others wait years – even 20 years – and some will never reach out for help at all. So the responsibility of organizations like ours and many others is to make sure that we continue to offer mental health support – not just at the time of a major trauma – but as long as you can afterward so whenever people are ready to ask for help; help is there to provide it.

These are important lessons that inform how we support the co-workers and families of fallen firefighters across the country two decades later and I hope they offer helpful guidance to others as they work to support additional groups of frontline workers amid the COVID-19 pandemic.

The FDNY knows that we are here for them as long as they need us. We’ve been able to bring this same promise to the fire service as a whole. Our trauma, grief and behavioral health counseling program is something we now offer to fire service organizations across the U.S. as they’re dealing with their own traumatic events and line of duty deaths. These days peer support uses an approach called Stress First Aid. It was developed for the military, modified for the fire service and is now being adapted for many other frontline workers including law enforcement and trauma healthcare workers treating COVID patients.

Understanding the importance of trauma and stress first aid for firefighters and other frontline workers is one of the many legacies of the 343 heroic FDNY members who died on 9/11 and the more than 250 members who have died of 9/11 related illnesses. So, as we honor their memory today, we do so understanding not only how many lives they saved by running into the towers that fateful day, but also how many more have been preserved in the ensuing years as a result of the lessons we’ve learned while processing our collective grief and immeasurable loss.

Chief Ronald Jon SiarnickiChief Ronald J. Siarnicki is Executive Director of the National Fallen Firefighters Foundation and the First Responder Center for Excellence. Learn more about the National Fallen Firefighters Foundation at