Terry Gerton You have done some really important research on first responders at 9/11. 25 years later, you’re still discovering new health consequences among this population. What does that tell us about the limits of what we can know in the immediate aftermath of something like this kind of disaster?

Roberto Lucchini Yeah, absolutely. This is a great question, Terry. I mean, the old problems with this is that we keep, of course, analyzing data, okay, because the 9/11 responders, they are followed every, more or less every year, they have to go to the clinics in New York City for, it’s called monitoring, so there’s a lot of data that is being collected. And in addition to that, we also have research, right? We are funded for research and that we do all sort of assessments trying to understand what can be the exposure related health impacts on these people even after 25 years, right? So I’m particularly interested in the brain because what we know about the exposure due to analysis that were done on the dust — dust was collected at 9/11, indoor and outdoor. So there was a lot of analysis done in the lab and we know the component of those samples. So the component is fundamental understanding of what was the exposure, right? So the components were carcinogens but also other chemicals that we know as neurotoxicants. So that’s why the brain can be a target. And the brain is a kind of a very sophisticated part of our body, right. But at the same time is also vulnerable. So these types of exposure can have an impact even after many years. And so therefore our effort is to look into that as well. We’re talking about cognitive function, cognition, right? Memory concentrations, et cetera. And think about the age of these responders. They’re aging progressively, okay? And so there’s the aging, which is something normal. I mean, myself, I don’t remember quite easily names and dates etc. But then if you’re in in addition to that if you’ve been exposed, if you are still exposed to neurotoxicants your ability to use your cognitive functions can be impacted so that’s why we keep doing this kind of research and science to understand, we use brain imaging, MRI, PET scan, a lot of neuropsychological testing, et cetera, try to focus on these functions. And nowadays, there’s a lot of interesting tools that we can use, machine learning and all of that. And it’s kind of a sophisticated statistical tools that we could apply, for example, to brain imaging. Every time we do this brain imaging, scanning our brain and understanding how the brain is functioning, et cetera, all this information are crucial for us to understand for example this particular study looked into the brain aging like our brain, our body can age normally or kind of in an accelerated mood kind of faster than normal. Why? The whole idea is that if we are exposed to something that is dangerous for the brain, our aging processes can go faster, that’s it, this is the starting idea. So therefore we develop these algorithms, etc. And using them in our study, apply to this brain imaging data, we sort of saw this result that these data can tell us, right? So, the idea that the brain of the responders seems to be older than their chronological age, right? Our age in terms of how old are you, that’s the chronological. But the reality, I mean, the reality of the data that we can observe is telling us that the brain of this individual seems to be on average, on average, like three years older than expected, okay? What does this mean? Well, it’s a precious information for us in terms of what the impact can be in relation to the exposure, because these data, we see them in relation, for example, with the duration of the exposure at ground zero. What does that mean, duration? Well, months. People will stay there many days and months and weeks. So our understanding of the dust in those days was a huge toxic cloud when the tower collapsed, right? You can see, everybody, you can see all those videos. Those of us who were there, actually they experienced themselves, the sky becoming dark because the concentration of that dust, that was the initial days, right. But then during the months, the type of dust was different, smaller, ultra fine, small particles. Those small particles can actually navigate more easily to the brain through our olfactory pathway, through our nose. Through our nose, these particles, very tiny, they can literally navigate directly to the brain. And so we see that phenomenon, which is telling us something about the danger of these types of exposure.

Terry Gerton Dr. Roberto Lucchini is the Professor of Occupational and Environmental Health Sciences at Florida International University. So Dr. Lucchini, I really appreciate you walking us through all of that and the findings that you’ve made. I’m curious, we have known about delayed onset illnesses in our military population for a long time. Agent orange exposure, Gulf War illnesses, burn pits, other military related health conditions that don’t fully emerge for years. You’re now looking at a group of civilian responders. What do you think makes it difficult to translate the lessons we’ve learned from our veteran population onto a civilian responder population?

Roberto Lucchini Another very, very good question, Terry. This is, we always have this kind of link between 9-11 responders and the veterans. Actually, many of our 9/11 responders we’re in contact with became veterans because they went to war zone, Afghanistan, et cetera. So they were exposed to double hit, if you will. 9/11 was chemicals, toxic cloud, and psychological trauma. Two things in parallel. Think about the soldiers. That’s what happened to them as well, okay? So psychological trauma and, okay, emotional, et cetera, and chemicals. So, of course, your question is great. The link is, well, that’s a very intuitive, let’s say, intuitive connection, which means the veterans are being studied, are still studied a lot for PTSD, like mental health impact. The 9/11 responders, yes, as well. And so we see that interplay, if you want, between the exposure, the mental health impact, and also the cognitive. Cognitive is a little bit different from mental health if you, it’s still the brain, all right? But one thing is memory and cognition. The other thing is depression and post-traumatic disorder. They go together, actually, but not necessarily. So we have the responders, for example, that they have PTSD, and also they have cognitive problems. But they have, but we see responders that, for example, they don’t have PTSD, but they have memory and cognitive impact. Our interpretation of that is the duality of the exposure, again, neurotoxic chemicals on one hand, psychological trauma on the other hand. These two can impact the brain a little bit differently. Okay, maybe one or the other, or maybe both of them. And same very, very, I would say very similar situation for the veteran with the difference that, well, 9/11 was an absolutely high intensity exposure in that period of time to a mixture. We call it mixture, different components in that dust. In the war zone, it can happen, but not in that extent. We don’t have buildings like the Twin Towers collapsing, I believe. Of course, we have building that, you know, rocket, et cetera, explosions. Yeah, of course, a lot of dust, a lot chemicals, etc., but probably for a longer period of time for the veterans. Okay, that more or less the difference in terms of the exposure situations.

Terry Gerton So we haven’t had another man-made disaster like 9/11, but we continue to have wildfires, fires in urban areas, earthquakes, natural disasters where first responders are going in, may experience trauma, may experience hazardous exposure. What is the most important lesson that emergency managers and policymakers should carry forward from your research when they’re thinking about their first responders in the next major disaster?

Roberto Lucchini Absolutely. One thing particularly, the need for proper, I say proper PPEs, personal protective equipment. We see that in 9/11 because we have data and this is an enormously important message for today. We see differences between those who are wearing PPEs. The majority didn’t, unfortunately didn’t have, didn’t wear them, but we see differences 25 years later between those who were using or not the PPEs. We see that in these types of brain imaging sort of things. And this is an incredible message to show them, look, we understand when you’re there, no matter where you are, we see, I see the videos from Venezuela and these earthquakes, Colombia, or the whatever in Nepal, all these types with wildfire, etc. Sometimes, of course, when I see those videos, I always focus on the responders, whether they are wearing protective equipment or not. Many times I don’t see them wearing those, unfortunately. And I’m like, I understand them. Everybody knows the first imperative urgency is to save lives. And they don’t really care about themselves. They don’t sleep, they don’t eat, et cetera. But please, please, protect yourself. It’s hard, but you have to do it. Because we can show you the potential consequences even many years later. We’re not talking about cancer obviously because of course there’s also cancer which is another sad reality here.