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Background Terrorist attacks are exceptional events that place first responders in high risk situations. When terrorist attacks occur, first responders will play an integral role in the response to, and management of, these events. Providing a core component of the ‘frontline’ response to terrorism, first responders will potentially be exposed to a variety of health and safety risks, including physical injury, death, exposure, infection, contamination, and psychological effects such as anxiety, post-traumatic stress, and depression. Objectives The objective of this research was to gain an understanding of risk perception and willingness to work during terrorist events. Specifically, this research aimed to investigate willingness to work among paramedics and emergency medical technicians (EMTs) who had responded to the 9/11 World Trade Centre (WTC) terrorist attacks. Methods Focus groups and interviews were conducted with New York based first responders to discuss their willingness to work and response to the 9/11 attacks. Conclusions First responders reported a number of primary risks that concerned them during their response to the 9/11 terrorist attacks. These were injury and death, and potential contamination and exposure. The key concerns reported by first responders with providing the frontline response to the attacks related primarily to health and safety, communication issues, the need for accurate and timely information, and the need for suitable training and education. First responders often reported a difficulty in finding a balance between personal safety and duty of care. Despite these risks and concerns, all study participants reported a willingness to work on the day. Willingness to work during subsequent terrorist and bioterrorist events in the future was influenced by the provision of better personal protective equipment (PPE), communication strategies, and the development of targeted and specialised training and education programmes.

Willingness to work during a terrorist attack: A case-study of first responders during the 9/11 World Trade Centre terrorist attacks