A Reflection from the Front Lines

Twin light beams reach for the sky over New York City at night.

I cannot believe that twenty years have passed since the 2001 attacks on the World Trade Center. Even more remarkable is that I am still here to write this piece. In the middle of the chaos and screams, I distinctly remember thinking to myself, “Damn, this is not going to end well.” On that day, nearly three thousand persons died. And since then, many more have died because they were there on that day in some capacity. To me, the World Trade Center was in my primary area of response for many years prior. My EMS base out of a hospital was located only three city blocks from there. I had routinely responded to hundreds of emergency medical calls in the years prior. It was deeply personal for me.

In the Beginning

It was a clear sunny beautiful day with the bluest skies. I remember that the news was commenting about the elections that day. And then it happened, breaking news about a possible helicopter crashing into the World Trade Center. I immediately thought, “Oh no, not that again,” thinking back to 1945 when an aircraft crashed into the Empire State Building. Were we ready for a similar incident? But then the calls on the radio quickly became frantic and chaotic. The word “helicopter” was quickly replaced by “an airplane.” And even as we initially thought this airplane crash could have been an accident, there was going to be many injured people. The “MCI of all MCIs” was probably too cliché to state but applicable.

From the Archives

As I arrived on scene, so many people were chaotically running in so many directions. People were screaming. Panic and fear filled their eyes and faces. I remember looking up and seeing the thick black smoke billowing out of the tower and thinking: “that is not a helicopter.” As people ran past me, I had this surreal feeling like I was scuba diving into a school of fish. People were running in my direction but never actually touched me as they got near me. It was the best analogy off the top of my head.

Personal Health

I clearly remember breathing that air which then filled my lungs with what I can only describe as crushed glass. It hurt my chest to breathe but what choice did I have? Not do it? A few days later, I kept hearing that the U.S. Environmental Protection Agency Administrator Christie Whitman stated that “the air was safe to breathe and the water was safe to drink.” I thought to myself, “Safe to breathe? What samples of air did they take?” There was no way that what I (along with so many others) breathed in was safe. Years later, Whitman admitted that she was wrong. Too little, too late – at least in my opinion.

Since 2003, I have been enrolled in the World Trade Center Health Registry and I have gone through many ups and downs experiencing physical and mental challenges. So many enrollees have gotten severely ill and even died since 2001. Surviving that day is a tough reminder that we need to do a much better job of preparing ourselves and future generations for the physical and mental health of this job. What better reminder than the current pandemic. As EMTs and paramedics all over the world, and especially in New York City saw, EMS was and always has been on the front lines – and we also lost many colleagues because of it. The physical and mental health toll on our EMS, police and fire colleagues has been enormous – and as an extension, the families of those persons have also been affected.

Lingering Memories

I will never get over hearing and seeing the loud noises that were occurring around me on that tragic day. As I paid closer attention, I figured out that those noises were people crashing onto cars, trucks and the pavement. I first could not understand what all the debris was. And then I wish I had never figured it out.

One of the many things that stick in my mind is the faint echoes of the firefighters’ alarms going off underneath the rubble. There were so many of them and they all seemed out of sync. I knew what those alarms meant – there were many firefighters who were not moving; and there was absolutely nothing that I could do about it. The helplessness was very powerful and frustrating.

I cannot forget how involved my senses were that day and the weeks that followed. I could hear the cries for help and panic throughout the day, and of course the sirens from various agencies. I could see the destruction all over the streets covered with ash and debris. And I could smell something distasteful in the air. Something was burning and it wasn’t just paper. I often tell people that as a paramedic, I usually encounter people at their most vulnerable point in their lives. But many will not understand that on that day, we saw, heard, and smelled things that will stay with us forever.

That day was significant for so many reasons. I keep in touch with some EMS colleagues from that day. Some have remined in EMS; some have become nurses, physician assistants and physicians; others have switched careers. That one act of terror directly affected the course of my career and personal life. I probably would not be so involved in emergency and disaster management had I not lived through that day as a paramedic. Maybe I would not have created and spearheaded a college-based paramedic program in New York City. Maybe I would not have been so involved with departments and universities all over the world in the hopes to share the story so that others can be better prepared. Be here we are, and I am grateful that I can follow the path that was redirected. Emergency and disaster management is now a part of my life. I have tried to use the darkest day in my past to shape a better future for all.


In addition to still working as a paramedic in New York City, I now teach on the college level about public health, emergency and disaster management and community health education. I even guest lecture at a few universities abroad. They always seem to want to hear how we do things in the United States. One of the things that I stress in my lectures is to look at us and learn from our mistakes. I am the first to admit that we could have done so many things differently that day. I hope that I can continue to provide guiding points for those who will come after us.

Lessons Identified

People often use the term “lessons learned.” I often use that opportunity to challenge them if we have really “learned” anything. For example, communication is often cited as one of the key challenges in disasters. We suffered from it then and we still have in communication now. Recent disasters such as Hurricane Ida in the New York tri-state area highlight the importance of good and effective communication. I think that a better term is “lessons identified” because if we keep making the same mistakes, are we really “learning” from them?

Mental Health

If there is one thing that I want to stress on this somber anniversary is the importance of mental health for all first responders – but especially for EMTs and paramedics. The public is quick to recognize and even grant time off for a physical or medical ailment, but when it comes to mental health, there still seems to be deeply embedded stigma about it. I personally know colleagues in police, fire and EMS who have committed suicide over the past twenty years. And it doesn’t matter the type of disaster. We also lost several healthcare workers – physicians, EMTs and paramedics – during this pandemic. We really need to do a better job regarding raising awareness and providing adequate resources. I encourage our EMS brothers and sisters to realize that “it is ok to not be ok” because we do not have a “normal” job and what we do is “different.”


I also want to thank all those agencies and persons who came to assist New York City during the darkest hours on September 11th. I remember that feeling was reborn in 2020 when I saw different ambulances from out of New York State during the peak of COVID-19 in April and May. They came to help us out again. We are an EMS family and we need to look after one another. I especially commend all those volunteer EMS personnel who came to our help on September 11 and again during the COVID-19 response. I am forever grateful. I just hope that that desire to help did not come at a high price to your physical and mental health.

Closing Thoughts

Finally, I hope that we can continue to remember those who lost their lives in the line of duty on that September 11th and since then too. Clearly, September 11th was not a one-day event. It only started on that day, and it continues to evolve every day after. I only hope that we as responders get better at what we do so that the impact of future similar events is less destructive.

I want to take a moment to remind all of us that we need to take better care of ourselves – physically and mentally. We go out of our way to take care of total strangers but when it comes to ourselves and our colleagues, we always seem to fall short.

More from the Author

The fact that in many states, EMS is still not considered an essential service is embarrassing and frustrating. The fact that many EMS personal still must work more than one job to make a livable wage is unacceptable. EMS plays such a vital role as evidenced during this current pandemic. EMS is on the real front line because we encounter patients at their homes, business and streets even before any hospital staff interacts with them. We are the first contact with the healthcare team and start their journey to that definitive care awaiting at a hospital. And to debunk the often-used term, we are not “ambulance drivers.” We just happen to drive an ambulance. We do not call the firefighter who drives the engine “a fire truck driver.” We need to collectively do a better job to promote our profession and make the public understand the important function that EMS does.

We need to not let our younger generations realize that this is not just another history lesson in their textbooks. This is an event that is still occurring and will continue to occur until every one of us who was there dies. May the lives of our fallen brothers and sisters not be in vain. We need to make sure that we better prepare the future generations of EMS so that they do not go through what we went through. We have made some progress, but we certainly still need a long way to go.

There were eight on-duty EMS personnel who died on September 11th in New York City. They are: Carlos Lillo; Ricardo Quinn; Yamel Merino; Mario Santoro; Keith Fairben; Richard Pearlman; Mark Schwartz and David Marc Sullins. In addition, there were so many other off duty EMS personnel wo died trying to help others. Finally, I want to highlight that many other EMS personnel died while in official capacities as firefighters and police officers so we will not forget them. And finally, we remember those who have died since September 11th due to a related illness or disease as well as our military personnel who have died or become ill in the wars thereafter.

Nearly three thousand people died that day. Twenty years later, I am still losing colleagues as a direct result of that fateful day. I hope that I am still around for the next twenty years. I hope that future generations of emergency responders can see what happened on that day and improve the planning and response on so many levels. We owe it to those who made the ultimate sacrifice.

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