Like countless New Yorkers, Michael Crane, MD, MPH, has his own personal story about the morning of Tuesday, September 11, 2001.
A doctor and public health expert then working for Con Edison, he made his way to Ground Zero on that day. Over the next several weeks, he helped ensure that the company’s workers took proper precautions during the recovery operations. Like thousands of other responders, they were exposed to hazardous conditions, toxic agents, and extreme psychological stress.
As it turns out, safeguarding the health of workers who were at Ground Zero would continue to be a focus of his life and career 25 years later. Mount Sinai had been caring for 9/11 responders since 2001, and he went on to serve as Medical Director for the World Trade Center (WTC) Health Program Clinical Center of Excellence (CCE) at Mount Sinai after the federal WTC Health Program was formally established in 2011.
These days, Dr. Crane’s primary responsibility is overseeing Mount Sinai’s program, which monitors and cares for more than 27,000 first responders in the New York City area. Mount Sinai is the largest of eight Clinical Centers of Excellence that care for about 95,000 responders—firefighters, police, recovery, and cleanup workers and many others who participated in rescue and recovery efforts.
The other New York metropolitan area Centers of Excellence that serve responders are run by the State University of New York at Stony Brook, Rutgers University, Northwell Health, and the New York University Grossman School of Medicine, along with a Fire Department of New York center exclusively for New York City firefighters. These Centers were established to monitor, treat, and support rescue and recovery workers who responded on September 11 and in the following weeks and months.
“Unless we get as many responders as possible, we won’t know the full impact of what happened to these folks,” says Michael Crane, MD, MPH, Medical Director for the World Trade Center (WTC) Health Program Clinical Center of Excellence (CCE) at Mount Sinai. “We need all the data we can get. That’s the real goal when you have an exposure that is unknown.”
These Centers are part of the national WTC Health Program overseen by the U.S. Centers for Disease Control and Prevention. The WTC Health Program is authorized and funded through 2090 under the James Zadroga 9/11 Health and Compensation Act, signed into law in January 2011, and reauthorized by Congress in 2015. Mount Sinai’s World Trade Center Clinical Center of Excellence is located within the Mount Sinai Selikoff Centers for Occupational Health.
The WTC Health Program also oversees programs for survivors—those who lived, worked, or went to school in downtown Manhattan. There are now more than 145,000 people enrolled in the WTC Health Program, including about 57,000 survivors and 95,000 responders. The program also funds medical research into the physical and mental health conditions related to 9/11 exposures.
As the New York region marks another significant anniversary of the attacks, Dr. Crane says Mount Sinai’s Clinical Center of Excellence continues to see new members and encourages other responders who may not yet have sought care to enroll in the program. Staff at Mount Sinai’s Center are available to assist with enrollment in the WTC Health Program.
In this way, Mount Sinai and the other Centers are building on the lessons of public health, which is to follow the lead of those on the ground in identifying possible concerns, gather data, provide care, and use research to understand the results, all while demonstrating a commitment to safeguarding the public and building trust and confidence in the communities affected.
Still, Dr. Crane says he hopes more responders will decide to participate in the program.
“Unless we get as many responders as possible, we won’t know the full impact of what happened to these folks,” says Dr. Crane, who is also a Professor in the Department of Environmental Medicine at the Icahn School of Medicine at Mount Sinai. “We need all the data we can get. That’s the real goal when you have an exposure that is unknown.”
From the beginning, Dr. Crane and other health care experts knew there would likely be long-term respiratory troubles for first responders. A compounding factor would be the heroic efforts of first responders, many of whom would not stop working at the site even when they worried about possible medical issues.
One of the most striking initial symptoms among these responders was “a thunderous cough that would not stop,” which came to be known as the WTC cough.
“I had never heard anything like it,” he says. “It was a sign of healthy people having trouble clearing out their airways, and some of them getting quite distressed.”
In their monitoring of both first responders and survivors, public health officials continue to see respiratory conditions, specifically chronic rhinosinusitis (an inflammation of the sinuses), and asthma, among the top five conditions. Other leading conditions include gastroesophageal reflux disease (GERD), cancer, and post-traumatic stress disorder (PTSD). To address these and other mental health concerns, the WTC Health Program provides mental health services to eligible members.
Of note, cancer has become an increasingly important part of the program’s work, with more than 25,000 responders and 27,000 survivors nationwide being diagnosed with cancer, according to the program. Some of the most frequently covered cancer conditions treated by the program include non-melanoma skin cancer, prostate cancer, breast cancer, melanoma, and lymphoma.
The WTC Health Program covers yearly monitoring for those enrolled and treatment. Regular monitoring is important because many of these conditions may develop years after exposure, experts say. It’s also important to build relationships with clinicians who can track these patients over time and to ensure there are no obstacles to care that might discourage regular monitoring.
Another critical element of the WTC Health Program is that it generates data that has been the basis of publications by researchers. Recent findings by the Mount Sinai team indicates PTSD may accelerate brain aging in 9/11 responders, and that harmful substances, contaminated environments, and hazardous materials may contribute to conditions such as PTSD, GERD, respiratory disorders, diabetes, and chronic headaches.
For those who seek out monitoring and care, the prognosis can be promising, even for those facing more complex conditions and cancers. This care has included lung transplants, according to Dr. Crane.
“If you come to the program, I am optimistic that you will find the best care available anywhere. We will strive to optimize your lifespan and optimize the joy that you have in that life while you’re living it,” he says. He hopes doctors will continue to refer patients to the WTC Health Program.
In fact, multiple studies show the value of this ongoing treatment. For example, a study of more than 28,000 responders found that those enrolled in the WTC Health Program had a 13 percent lower risk of death. The study was published in the Annals of Epidemiology in March 2026.
Dr. Crane also expresses concern for the group of survivors who lived in downtown Manhattan and returned to live there in the weeks and months after the attacks. Health authorities believe this group of people may be as large as 400,000, and the effects of longer-term exposure to lower levels of environmental hazards that come from living many years downtown with the residual environmental effects are not known, according to Dr. Crane.
The World Trade Center Environmental Health Center at NYC Health + Hospitals and the William Street Clinic assess and treat these survivors, which includes residents, students, workers, or passersby who may be sick from 9/11-exposures.
Dr. Crane says those who lived in lower Manhattan during this period should consider applying to the WTC Health Program and get their 9/11-related symptoms monitored. He hopes increased participation in the program will help public health authorities expand the data they are now collecting on possible longer term health effects, especially for young children who were exposed for longer periods while they were growing up and their bodies were developing.
“The pollution from the collapse of the buildings was significant,” Dr. Crane says. “It’s an ongoing concern for all of us in the program given what we are seeing with the responders. These folks who lived in the community may have had somewhat lower-level but longer-duration exposure. We’re especially concerned about those young people whose bodies were changing in the presence of toxins.”
During the early years, survivor enrollment in the program had lagged significantly behind the responder enrollment, but this has been changing over the last decade. Survivors now represent more than 39 percent of the total number of program participants. Experts believe this is probably the result of greater awareness of the program, and the delayed onset of some medical conditions. About 59,000 participants are survivors, compared with about 95,000 responders.
“We hope that people will join and participate because we think there may be problems there,” Dr. Crane says. “Quite frankly, we don’t even know what they are.”
About the World Trade Center Health Program
The WTC Health Program is a limited federal health care program that provides health care for certified WTC-related health conditions at no out-of-pocket cost to those directly affected by the September 11 attacks in New York, at the Pentagon, and in Shanksville, Pennsylvania. The program was established by the James Zadroga 9/11 Health and Compensation Act of 2010. It is administered by the National Institute for Occupational Health and Safety (NIOSH) part of the Centers for Disease Control and Prevention in the U.S. Department of Health and Human Services. To learn more about the WTC Health Program, click here.