EMS World Expo 2024 Opening Ceremony: Remembering 9/11 and the Lessons Learned by EMS

By Michael S. Gerber

“This is a really tough day for us,” Glenn Aseada, MD, chief medical director for the Fire Department of New York, said during the opening ceremony of EMS World 2024. It was Sept. 11, the 23rd anniversary of the attacks on the World Trade Center. “It seems like just yesterday.”

Aseada was joined by John Peruggia, a retired FDNY EMS chief who served in command roles at Ground Zero, and Cesar Escobar, currently an assistant chief at FDNY. In a keynote panel discussion moderated by EMS World’s Josh Hartman, who also responded to the attacks, they shared their stories of that day and the lessons learned for EMS.

Peruggia had been in his car driving into work when he got a call that a plane had hit one of the WTC towers. He thought it was a joke at first—he had just returned from a vacation and figured his staff on the department’s planning team was messing with him. Then he emerged from the Brooklyn-Battery Tunnel onto Manhattan and saw for himself—the second tower had just been hit. He parked his car and made his way to the scene.

Several miles across the city, at FDNY’s EMS training center in Queens, Escobar was getting ready for a day of continuing education. As soon as people realized this wasn’t just a minor incident, academy staff began jumping in every vehicle and responding to the scene. But dozens of EMS clinicians, also hoping to head to the scene and help take care of what they imagined to be thousands of patients, were left stranded with no way to get there. So they commandeered a transit bus—the driver was more than willing to accommodate. In the end, hundreds of EMS personnel responded to the scene.

But the common theme among all speakers was that, once they were there, it looked like a war zone. And there weren’t too many lives to be saved.

“Unfortunately, the EMS providers that worked during that whole time didn’t treat many of those who were involved in the direct attack, because most of them, unfortunately, were killed almost instantaneously,” Peruggia said.

Other EMS clinicians never made it to the scene—they were stopped by “walking wounded” who were heading north on foot to escape the scene and needed help.

Lessons Learned

The rapt audience also heard the panel discuss some of the lessons learned from that day. Some are well known at this point, yet not completely solved. Agencies at Ground Zero had poor communication, not just because infrastructure was destroyed, but because they operated completely independently—when police in a helicopter saw that one of the towers was leaning, the news wasn’t relayed to fire and EMS personnel. At the time, even the fire and EMS sides of FDNY rarely trained together. That has changed, yet the speakers acknowledged that both in New York and in other communities across the world, silos remain.

“I think we're still trying to do well at that because I think we have a lot of room for improvement when it comes to partnering with other public safety agencies that will respond to major incidents and catastrophes in your communities,” said Escobar.

Some of the changes that arose in the aftermath of 9/11 were put to the test during COVID-19 when New York City was one of the epicenters of the pandemic. As other communities saw call volumes drop initially, with people staying home instead of going to the hospital, New York struggled to manage a high number of calls, overwhelmed hospitals, and staffing issues thanks to clinicians becoming exposed to COVID and being ill themselves.

Because of some issues with mutual aid after 9/11, both New York and the federal government worked to improve the ability to move EMS resources across state lines and support communities hit by disasters.

“The Fire Department of New York City does not usually call for help, right? We are the help,” Escobar said. “And for us to mobilize and enact the national ambulance contract through FEMA and our partners in the New York State Department of Health was something that really helped us manage the pandemic, and that early activation of that service really helped us coordinate the resources."

It was a sharp contrast to the days immediately following the World Trade Center attacks, when mutual aid ambulances lined up on Manhattan’s West Side Highway as people labeled them with medical tape to try to improve accountability and coordination, or when state troopers had to stop and turn away responders trying to enter the city who had not been officially invited or approved to assist in the response.

Remembering Those Who Died

Prior to the keynote presentation, the ceremony opened with a moving recognition of the responders lost because of 9/11—both the hundreds of firefighters, EMS clinicians, and law enforcement officers killed on that day, and the dozens and dozens more who have died since from illnesses related to the response.

“Let us also reflect on the profound impact their actions have had on our profession,” Hartman said. "The legacy they have left behind is one of resilience and determination. Their sacrifice has inspired countless others to join our ranks, to train harder, prepare more thoroughly, and serve the same level of selflessness. Today we carry that legacy forward."

Hartman also read words from a letter that former President George W. Bush sent to EMS World for the occasion. “Today we pause to honor those first responders who made the opening sacrifice on September 11, 2001,” wrote Bush, who was president on the day of the attacks. “I urge those gathered to use this occasion to pay tribute to these selfless souls by recalling their devotion, celebrating their lives, and honoring their service.”

In addition to the keynote address, the crowd was welcomed by Las Vegas Mayor Pro Tem Brian Knudsen, who reminded the thousands of EMS clinicians in the audience to spend their money in his city—and promised them the tax dollars would be used to support first responders.

Fernando Gray, chief of the Las Vegas Fire & Rescue Department, encouraged attendees to take advantage of everything the conference offers. “I will say, as someone that cut their teeth, so to speak, in the fire service as an EMS provider: absorb all the lessons, the opportunities, the new equipment, the educational components that are going to be provided this week.”

Honoring EMS Providers and Researchers

Several awards were also presented or announced, including the National EMS Awards of Excellence (winners can be found here). In addition, the National EMS Quality Alliance was honored with the Nicholas Rosecrans Award for the organization’s lights and sirens collaborative; and two scientific abstracts were announced as winners of the best clinical and best educational research in the UCLA Prehospital Care Research Forum International Scientific Symposium, held each year as part of EMS World Expo.