Twenty Years On: Impact on Innovation

This past September marked the 20th anniversary of the September 11 terrorist attacks in New York, Washington, DC, and Shanksville, Pennsylvania. We remember all of those who lost their lives that morning, citizens, flight crews on four different airplanes, and first responders; and all those who have lost their lives since that morning—those who have died as a result of injuries and disease as a direct result of those horrific events and those men and women who have given their lives in military service to their country. Although this tragedy occurred in the United States, the entire world changed that day. The impact will be with us for generations to come. We will all remember them and their sacrifice!

Often in the aftermath of a tragic event, innovation takes hold and we make changes in what we do and how we do it. Over the past 20 years, the world has seen two major military conflicts, one in Afghanistan and the other in Iraq. We have also witnessed a wide variety of natural disasters and refugee displacements. The military engagement and humanitarian challenges have been significant and have resulted in enormous change. The comments here reflect those of health and medicine and not the geopolitical issues at hand.

The cause and effect regarding trauma care, post-traumatic stress disorder (PTSD), the development and deployment of telemedicine, and many other changes, have occurred as a direct result of this event. In her recent publication in the Harvard Gazette, Christina Pazzanese comments on how the 9/11 disaster was a “communal event” affecting everyone, not just military targets or individuals. ¹ This brought a whole new understanding to PTSD and how we recognize and treat it. Training and preparation changed, including the creation of new frameworks and constructs for responses at all levels. As a result of the military engagements in both Afghanistan and Iraq, military medicine evolved in its ability to respond. In fact, the integration and utilization of telemedicine grew significantly from 1991 to the present time as a direct result of the ongoing war on terror. Trauma systems, both in training and responding, evolved as discussed by D'Angelo et al. ^2,3 Several telemedicine-focused companies and the American Telemedicine Association grew in size and capability, in many ways shaping and preparing us for being able to respond to this pandemic we are currently in.

Much has been written on the impact 9/11 had on our ability to respond medically, physically, and psychologically. The event changed societal benefits as Poulin posited in his study. ⁴ For example, a search of the word string “changes in trauma care since the 9/11 attack” in Google resulted in 49,000 items that include peer reviewed journal articles, news articles, reports, etc. A simple PubMed search of “telemedicine and the military” during the period 2001–2021 yields more than 660 results. Many of the innovations that have occurred in the past 20 years can be attributed to the events of 9/11. ^{5 –8}

As we have reported in the past 20 years of this journal, technology has changed rapidly. This change is driven by many things, including our desire to respond and, of course, the unexpected drive of consumer demand. In the context of 9/11 was how do we respond emotionally, physically, militarily, etc.? The 21st century has seen unprecedented growth in technologies across the entire spectrum of human life. Innovation has crept into our daily lives as well as into those characters who would do us harm. Innovation has both good and bad applications. We must always remain vigilant.

Twenty years on the emotions remain raw and there will be healing overtime. All tragedies influence human societies in immeasurable ways. Our ability to respond to future events grew substantially from the events on 9/11. We remain committed to the memories of those who have gone before us and we apply our new knowledge in the hope we will be better prepared.