October 30, 2012 Liz Borkowski, MPH 0Comment

As Sandy’s high winds and water subside, many of us are feeling profoundly grateful to the emergency responders who’ve been putting themselves in harm’s way to keep the rest of us safe. Although their jobs by definition involve working in hazardous situations, there’s a lot their agencies and incident commanders can do to protect response workers. Earlier this year, the National Institute for Occupational Safety and Health released the Emergency Responder Health Monitoring and Surveillance (ERHMS) system, which provides guidelines for protecting emergency responders in a wide variety of emergency settings.

NIOSH worked with the US National Response Team and a range of federal and state agencies, as well as unions and volunteer responder groups, to the develop the ERHMS system, and it has released both a Technical Assistance Document and a Guide for Key Decision Makers. The Guide explains what “response work” entails and why the ERHMS system is necessary, especially during large-scale responses like those for Hurricane Katrina and the Deepwater Horizon disaster:

When disaster strikes, the nation depends on emergency response workers who are prepared and trained to respond effectively. Response work can range from well-contained, localized efforts to massive, diffuse mobilizations and involves a broad array of activities including search, rescue, investigation, assessment, recovery, cleanup and restoration. Such work is carried out by individuals from emergency management, fire service, law enforcement, emergency medical services, public health, construction and other skilled support, disaster relief, mental health, and volunteer organizations. To ensure that emergency workers can meet the challenges of disasters, every effort must be made to protect them from the safety and health risks inherent in their work. Concerns about worker safety and health are apparent in nearly every type of response, and an effective framework of health monitoring and surveillance of workers is necessary to recognize possible health issues and bring these potentially devastating hazardous situations under control.

Previous emergency events have demonstrated that despite analyzing and applying ‘lessons learned’, significant gaps continue to exist in emergency response workers health monitoring and surveillance. These gaps were documented in the Government Accounting Office and Rand reports prepared following the World Trade Center response, but these problems have persisted and, despite improvements, were observed again in Hurricane Katrina and Deepwater Horizon responses.

The persistence of these gaps in emergency responder health monitoring and surveillance, despite considerable attempts to anticipate and correct them, emphasizes that there remains a need for a coherent, comprehensive approach to protecting emergency response workers and a need for detailed, practical guidance on how to implement such an approach.

The two downloadable documents provide very detailed guidance, and NIOSH’s website gives a more concise overview of the ERHMS components. Recommendations address three phases of emergency response: pre-deployment, deployment, and post-deployment.

Pre-Deployment Phase: Each response organization should have a complete roster of their responders, with their registration and credentialing information contained in a single database. Health screenings should assess responders’ physical and emotional health, as well as immunization status, and provide baseline health data to which data collected later can be compared. Responders should undergo all required health and safety training, plus any necessary site-specific training.

Deployment Phase: The Incident Command System should maintain a complete roster of all responders, which may include volunteers. Responders should receive necessary site-specific training and personal protective equipment before entering a designated disaster control zone. Monitoring of individual responders’ injury and illness status should be ongoing, as should surveillance of the responder population as a whole. Exposure data — on chemical, physical, and biological hazards — should be collected, and results communicated to workers.

Post-Deployment Phase: “Simple, concise, and standardized” out-processing assessments should be conducted for all responders. These assessments can help determine if indivudals have been adversely affected by their work and if there are trends within the responder population as a whole. Tracking efforts can identify illnesses or disabilities that develop later. With both assessments and tracking, early identification of adverse consequences can allow for early intervention and maximize chances for recovery. Finally, after-action assessments can yield valuable lessons for future emergency response activities.

A Tools & Resources page offers downloadable fact sheets, recommendations, and other information. As a whole, the site acknowledges time and resource constraints and the wide range of different emergencies to which workers and volunteers respond. For instance, the post-deployment page acknowledges, “Post-event tracking of health may be difficult or costly to conduct on a case-by-case basis,” and suggests, “High-priority worker groups for post-event health tracking would include those most likely to have exposures to hazardous agents or conditions and those reporting outbreaks of similar adverse health outcomes.” Guidance on storm, flood and hurricane response notes, “Pre-deployment (or pre-exposure) biological monitoring for exposure to hazardous chemicals is not generally recommended. Such monitoring is not practical for unanticipated exposures to hazardous chemicals.”

The ERHMS system will be of most use to governments and organizations responsible for emergency response efforts. The rest of us can learn something from it, too, about what goes on behind the scenes of emergency response — or what should go on. It takes time and money to appropriately safeguard the lives and health of those who protect ours. Elected officials’ budget decisions can affect how much money response agencies have for these kinds of activities, and that’s something worth remembering during election season as well as hurricane season.

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