Health and Safety Leadership Alliance and Institutes of Health mark the 25th anniversary of September 11 with a call for faster access to coordinated treatment
SAN DIEGO, Calif., September 11, 2026. Health & Safety Leadership Alliance and Institutes of Health (IOH) call on public agencies, employers, insurers, and third-party claims administrators to ensure that first responders have timely access to coordinated care for complex physical and psychological injuries.
The organizations issued the call on the 25th anniversary of September 11. The anniversary commemorates the 343 members of the Fire Department of the City of New York (FDNY) killed while responding to the attack on the World Trade Center, along with every person who was lost that day and all who joined the rescue and recovery. Earlier this month, the FDNY added 36 names to its World Trade Center Memorial Wall. Each belonged to an FDNY member who died during the past year from an illness related to work at the World Trade Center. Hundreds of FDNY members have now died from those illnesses, and many more continue to live with their effects.
“Twenty-five years after September 11, the number 343 remains fixed in our national memory,” said retired Battalion Chief David Picone, CEO of the Health & Safety Leadership Alliance. Picone served as Health and Safety Battalion Chief for the City of San Diego Fire-Rescue Department. “The losses did not end when the fires were extinguished. Honoring those we lost also requires us to care for the people who survived and continue to carry injuries home from service.”
First responders often enter care with more than a single diagnosis. Post-traumatic stress disorder (PTSD) may be intertwined with chronic pain, brain injury, disrupted sleep, depression, anxiety, cognitive problems, and substance use. Pain interferes with sleep. Poor sleep worsens mood and concentration. Trauma can heighten pain and drive isolation. By the time a first responder asks for help, the problem may have spread into family life, physical health, and the ability to work.
“When these conditions interact, sending a first responder from one disconnected appointment to another is not enough,” said Dr. Tomer Anbar, Founder and CEO of Institutes of Health. “Clinicians must work from one coordinated plan, reassess progress together, and adjust treatment before one problem becomes another barrier. We call this the Architecture of Care because the structure of treatment should match the full pattern of injury.”
Fragmented referrals, lengthy authorization processes, interrupted treatment, and clinicians unfamiliar with public safety culture often delay access to appropriate care. The U.S. Fire Administration has stated that fire departments are more likely to experience a suicide than a line-of-duty death. The Alliance and IOH said this warning requires more efforts to reduce stigma. Peer support can help a member come forward, but the treatment and claims systems must be prepared to act when that member asks for care.
The organizations call for every department to have a clear path from peer support to specialized clinical care. They urge employers, public agencies, insurers and TPAs, to treat early access as a safety issue. When a case is complex, care should be informed by first responder culture, coordinated across disciplines, and sustained at an intensity that matches the injury. Recovery remains possible even after long periods away from work, but it becomes less likely when care is delayed, fragmented or interrupted before trust and progress take hold.
“To remember is to respond,” Dr. Anbar said. “We should not leave first responders behind after the ceremony ends, after the apparatus returns to the station, or after an injury can no longer be seen. They responded when the country needed them. When they need care, we have an obligation to respond with the same urgency.”
About Health and Safety Leadership Alliance
Health & Safety Leadership Alliance is a multi-stakeholder educational leadership platform serving workers’ compensation, occupational health and public safety. It brings together public safety professionals, risk managers, claims professionals, clinicians, insurers, health systems and other stakeholders to advance evidence-based education, research and system improvement. More information is available at hslalliance.org.
About Institutes of Health
Institutes of Health is a California occupational health and rehabilitation organization specializing in complex trauma, chronic pain, brain injury, PTSD, sleep problems and substance use disorders. Its integrated clinical teams provide medical, psychological, neurocognitive, physical, occupational and related rehabilitation services focused on functional recovery and return to work. More information is available at institutesofhealth.org.
