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Occupational exposures to hazardous materials and to high levels of psychological stress are predictable consequences of civilian disasters and result commonly in physical and mental health problems among first responders. Emergency plans must anticipate these occupational health consequences of disaster and be prepared to address them.To assess the contribution of occupational medicine to emergency response after the attacks on the World Trade Centre of September 11, 2001.Historical reviewNew York had a network of Centres of Excellence in Occupational Health in place prior to September 11, 2001. These Centres were established in 1987, supported financially by the State of New York, and focused on the prevention, diagnosis, and treatment of injuries and illnesses among workers. They were staffed by trained personnel and provided a wide range of services including occupational medicine, occupational health nursing, industrial hygiene, ergonomics, and social work services.The New York Centres of Excellence in Occupational Health were able to provide medical care to first responders immediately after September 11, 2001. Within a few weeks they had evaluated several hundred responders – firefighters, police, paramedics, and volunteers. Persistent cough, termed ‘World Trade Centre cough’, asthma, anxiety, depression, and post-traumatic stress disorder (PTSD) were the symptoms most commonly seen in the initial post-attack period. These symptoms were most severe in the most heavily exposed responders and were more frequent among 9/11 first responders than among unexposed workers in the same trades.Documentation of these health effects and their persistence was critical in demonstrating that the attacks on the World Trade Centre and their aftermath had produced physical and mental health effects among first responders; in establishing the need for long-term medical and epidemiologic follow-up of the first responder population; and in ensuring that this follow-up included comprehensive diagnosis and treatment of both physical and mental health conditions. Follow-up of the 9/11 responders continues to the present, is supported by the US government through the National Institute for Occupational Safety and Health (NIOSH), and has documented multiple exposure-related health problems in this population including restrictive lung disease, chronic sinusitis, gastro-esophageal reflux disease (GERD), PTSD, depression, and cancer.Pre-positioned resources in occupational medicine are an essential component of disaster response. Emergency preparedness planning must include long-term investments in occupational and environmental health services.