{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T18:23:25Z","timestamp":1791829405246,"version":"4.3.4"},"reference-count":29,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["New Solut"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:p>Drawing on direct experience at Ground Zero as part of the National Institute of Environmental Health Sciences Worker Training Program (NIEHS WTP) initial assessment team, this essay argues that the psychological injuries sustained by World Trade Center (WTC) cleanup workers were occupational exposures\u2014parallel in origin, severity, and duration to the physical health damage now formally recognized under the WTC Health Program and the Zadroga Act. Both categories of harm developed simultaneously, were documented simultaneously, and were fought for simultaneously. Both continue today.<\/jats:p>\n                  <jats:p>September 11th was a sacred historical moment that produced catastrophic trauma and extraordinary human solidarity in equal measure. Honoring that solidarity requires unflinching honesty about what it cost the people who answered the call\u2014in their lungs, their minds, and the years that followed.<\/jats:p>\n                  <jats:p>The essay traces the evolution of occupational safety practice from a field that had no framework for psychological hazards to one slowly building the tools to address them\u2014through the opioid crisis, through COVID-19, and through the National Institute of Environmental Health Sciences Worker Training Program's development of trauma-informed disaster response curricula, peer support infrastructure, and all-hazards mental health training designed to protect both responders and the communities they serve.<\/jats:p>\n                  <jats:p>Central arguments include psychological hazards require systematic approaches equal in rigor to physical hazard controls; stoicism culture functions as an organizational toxin; compassion fatigue and moral injury are clinical realities, not character failings; and early intervention\u2014including peer support, structured debriefing, and embedded mental health professionals\u2014saves lives.<\/jats:p>","DOI":"10.1177\/10482911261481790","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T14:47:41Z","timestamp":1788965261000},"page":"260-274","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["25 Years Down the Road: 9\/11 Mental Health Reflections on the World Trade Center Cleanup"],"prefix":"10.1177","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2447-0173","authenticated-orcid":false,"given":"Joseph \u201cChip\u201d","family":"Hughes","sequence":"first","affiliation":[{"name":"Senior Advisor, MDB, Inc., Chapel Hill, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Earl","family":"Dotter","sequence":"additional","affiliation":[{"name":"Harvard School of Public Health Visiting Scholars Program"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1196\/annals.1314.001"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-021-12354-8"},{"key":"e_1_3_4_4_2","unstructured":"Dotter E. http:\/\/www.earldotter.com\/."},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1080\/19338244.2022.2156975"},{"key":"e_1_3_4_6_2","unstructured":"Zadroga J. 9\/11 Health and Compensation Act of 2010. Pub L No 111-347. 111th Congress 2nd Session ed. 2011."},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1289\/ehp.11164"},{"key":"e_1_3_4_8_2","unstructured":"List of WTC-Related Health Conditions 42 C.F.R. Sect. 88.15 (2023)."},{"key":"e_1_3_4_9_2","unstructured":"Substance Abuse and Mental Health Services Administration (SAMHSA). National Survey on Drug Use and Health 42 https:\/\/nsduhweb.rti.org\/respweb\/homepage.cfm."},{"key":"e_1_3_4_10_2","unstructured":"National Institute of Environmental Health Sciences (NIEHS) WTPW. About the Worker Training Program (WTP) https:\/\/www.niehs.nih.gov\/careers\/hazmat\/about_wetp (2025)."},{"key":"e_1_3_4_11_2","unstructured":"National Institute of Environmental Health Sciences (NIEHS). WTPW. HAZMAT Disaster Preparedness Training Program https:\/\/www.niehs.nih.gov\/careers\/hazmat\/training_program_areas\/hdpt (2026)."},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00420-020-01552-3"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.3390\/ejihpe11040116"},{"key":"e_1_3_4_14_2","volume-title":"Ensuring worker safety and health in the aftermath of disasters","author":"National Institute of Environmental Health Sciences (NIEHS) WTPW","year":"2025","unstructured":"National Institute of Environmental Health Sciences (NIEHS) WTPW. Ensuring worker safety and health in the aftermath of disasters. Research Triangle Park, NC 2025."},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2009.07.003"},{"key":"e_1_3_4_16_2","unstructured":"U.S. Environmental Protection Agency OOIG. EPA\u2019s Response to the World Trade Center Collapse: Challenges Successes and Areas for Improvement 2003."},{"key":"e_1_3_4_17_2","unstructured":"Retka J. Birth of an OSHA Policy https:\/\/publicintegrity.org\/environment\/toxic-labor\/birth-of-an-osha-policy\/ (2023)."},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1080\/20008198.2020.1869399"},{"key":"e_1_3_4_19_2","volume-title":"Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized","author":"Figley C","year":"1995","unstructured":"Figley C. Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. 1995."},{"key":"e_1_3_4_20_2","unstructured":"Czachor EM. 9\/11-Related illnesses have now killed same number of FDNY firefighters as day of attacks: \u201cAn ongoing tragedy\u201d. September 25 2023."},{"key":"e_1_3_4_21_2","unstructured":"DeGeurin M. 9\/11-Related sickness has killed more cops than the actual attack. September 10 2019."},{"key":"e_1_3_4_22_2","unstructured":"Heyman M Dill J Douglas R. The Ruderman White Paper on Mental Health and Suicide of First Responders. 2018."},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1097\/JOM.0000000000001782"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17207645"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1177\/14604086221079441"},{"key":"e_1_3_4_26_2","doi-asserted-by":"publisher","DOI":"10.1093\/annweh\/wxac013"},{"key":"e_1_3_4_27_2","unstructured":"National Institute of Environmental Health Sciences (NIEHS) WTPW. Responder & Community Resilience https:\/\/tools.niehs.nih.gov\/wetp\/index.cfm?id=2528&cb=6983 (2026)."},{"key":"e_1_3_4_28_2","unstructured":"Retka J McCabe S Huang J et al. Toxic Labor. Public Integrity Group and Columbia Journalism School. September 28 2023."},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.1177\/10482911251337444"},{"key":"e_1_3_4_30_2","volume-title":"Implementing effective workplace solutions to prevent opioid use disorder: a resource guide for the mining industry","author":"National Institute for Occupational Safety and Health (NIOSH) MSAHAM","year":"2024","unstructured":"National Institute for Occupational Safety and Health (NIOSH) MSAHAM. Implementing effective workplace solutions to prevent opioid use disorder: a resource guide for the mining industry. 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