Unprepared! Unprepared! NIOSH has also found a large # of agencies - - PDF document

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Occupational Health Monitoring for Emergency Responders

Bruce Bernard, MD, MPH

Captain, United States Public Health Service (ret); Consultant, CDC/NIOSH

I have nothing to disclose “The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention.”

NIOSH has also found a large # of agencies are unprepared for most emergencies… and while the Incident Command System (ICS) and NIMS* are out there, most Emergency Responder Groups are not assessed, monitored, or followed‐up adequately….

*NIMS= National Incident Management System

Unprepared! Unprepared!

Before the emergency event (Pre‐ deployment), which responders are:

“Ready” to deploy – physically and mentally fit Qualified, with the right training and licenses Provided all the correct personal protective equipment, gear, immunizations

What do we want to know?

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During an emergency event (Deployment):

Who are the responders deployed and how are we keeping track of them? How are we monitoring their exposures, and how are we protecting them on‐site when there are newly found exposures? How are we tracking their activities and their health and safety during the response ?

What do we want to know?

After the emergency (Post‐Deployment):

What happens with all the data from the response? How do we make decisions about tracking responder health? When is post‐disaster tracking necessary? What can we learn from the information gathered from the response to improve the NEXT response?

We want to know:

How can we document all of this information to ensure and track their health and safety later on…… ERHMS is the Emergency Health Monitoring and Surveillance framework which addresses 3 phases of a response:

Pre‐deployment Deployment Post‐deployment

The goal of ERHMS is to have organized information to be able to prevent short-term and long-term illness and injury in emergency responders and recovery workers.

To Address these things NIOSH created ERHMS To Address these things NIOSH created ERHMS

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Objectives of this Session Objectives of this Session

• 1. Examine ERHMS Framework which documents

exposures/health data prior to AND during emergency response.

• 2. Learn organizing, sharing, communicating data from

monitoring and assessing the health and exposures of responders.

• 3. Use data “Post‐response” to assess which responders

benefit from medical referral, long‐term health surveillance, research, or need no follow‐up.

We set up ERHMS* as a 3-Phase System We set up ERHMS* as a 3-Phase System

DEPLOYMENT POST-DEPLOYMENT PRE-DEPLOYMENT

1 2 3

*Emergency Responder Health Monitoring and Surveillance

ERHMS had input from Multiple U.S. agencies ERHMS had input from Multiple U.S. agencies

NI OSH (coordinator) Federal Govt Agencies:

• Federal Emergency

Management Agency

• Occupational Safety and

Health Administration

• Health and Human Services
• Environmental Protection

Agency

• Homeland Security

Department

• Coast Guard
• InterAgency Board
• US Army Corps of Engineers

State Health Departments:

• e.g., Oregon, California

Volunteer Organizations

• e.g, American Red Cross

Unions:

• E.g., International Assoc of

Firefighters

• Center for Construction and

Research

9

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It has been approved by 17 U.S. Agencies Full Document is Available at:

ERHMS.nrt.org and

www.cdc.gov/niosh/topics/erhms

ERHMS is part of the National Response Team ERHMS is part of the National Response Team

The BEST thing about ERHMS is that it contains “TOOLS,” examples & forms that have been used in actual events…

You don’t have to start from Scratch with ERHMS You don’t have to start from Scratch with ERHMS Recently, NIOSH developed ERHMS InfoManager, a data and statistical package using CDC’s freeware

Epi‐Info to organize responder data.

Create electronic rosters, surveys, medical records, industrial hygiene data Contains templates of surveys, exam forms, etc. Does data analysis, statistics, cross‐tabulation, stratifications, calculates odds ratios, risk ratios, and risk differences, logistic regression https://www.cdc.gov/niosh/erhms/ software/default.html

Pre-Deployment Phase Pre-Deployment Phase

DEPLOYMENT

POST-DEPLOYMENT PRE-DEPLOYMENT

1 2 3

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Emphasizes preparedness for response

Focus : 4 key activities that occur before a response:

Pre-Deployment Phase Pre-Deployment Phase

Rostering and Credentialing Health Screening / Immunizations Health and Safety Training Consent/Data Management/ Information Security

Pre-Deployment

Rostering & Credentialing

Pre-Deployment

Rostering & Credentialing

Creates a list or (roster) of emergency responders

• Documents demographics, contacts, employment

information, credentials, and licenses

The Key Components of Rostering & Credentialing The Key Components of Rostering & Credentialing

• 1. Registration: records the information about each

responder and creates a record

Individual data, training and education, and experience

• 2. Emergency credentialing: allows assignment of

credential level and simplifies placement during an emergency

Based on responder certifications, education, and

• rganization’s vetting and recommendations
• 3. Reverification: requires periodic confirmation of

responder information

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2nd activity to occur before a response:

Pre-Deployment Phase Pre-Deployment Phase

Rostering and Credentialing

Health Screening / Immunizations

Health and Safety Training Data Management / Information Security

Why Require Health Screening? Why Require Health Screening?

To ensure that EVERY responder, recovery worker, and volunteer is fit for deployment, and is able do the work. Responders need to be assessed in advance (at baseline) as well as periodically so they can be properly placed at the right job in an emergency.

ERHMS suggests collecting: Background

• Demographics
• Contact Info
• Usual Occupation/Industry
• Years at job
• Supervisor name & phone
• Languages Spoken
• Prior Military Experience

ERHMS suggests collecting: Background

• Demographics
• Contact Info
• Usual Occupation/Industry
• Years at job
• Supervisor name & phone
• Languages Spoken
• Prior Military Experience

What information is included in Pre-Deployment Health Screening? (1 of 3) What information is included in Pre-Deployment Health Screening? (1 of 3)

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ERHMS suggests collecting:

Medical History

• Review of Systems
• Specific Allergies
• Specific mobility limitations
• Prior toxic and traumatic

exposures

• Past radiation exposure
• Smoking hx
• Meds & need for refrigeration
• Documenting access needs –

hearing aids, braces

• Immunizations

ERHMS suggests collecting:

Medical History

• Review of Systems
• Specific Allergies
• Specific mobility limitations
• Prior toxic and traumatic

exposures

• Past radiation exposure
• Smoking hx
• Meds & need for refrigeration
• Documenting access needs –

hearing aids, braces

• Immunizations

What information is included in Pre-Deployment Health Screening? (2 of 3) What information is included in Pre-Deployment Health Screening? (2 of 3) ERHMS suggests collecting:

Behavioral History

• Pre‐existing psychiatric or

psychological conditions

• Post‐Traumatic Stress

Disorder

• Depression
• Violent tendencies
• Suicide risk
• Overuse of alcohol
• Drug abuse

ERHMS suggests collecting:

Behavioral History

• Pre‐existing psychiatric or

psychological conditions

• Post‐Traumatic Stress

Disorder

• Depression
• Violent tendencies
• Suicide risk
• Overuse of alcohol
• Drug abuse

What information is included in Pre-Deployment Health Screening? (3 of 3) What information is included in Pre-Deployment Health Screening? (3 of 3)

Due to frequency and severity of traumatic exposures. Category PSTD Risk* Law Enforcement 6 ‐ 32% EMT/Paramedics 9 ‐ 22% Firefighters 17 ‐ 32% General Pop 7 ‐ 12%

*Derived mostly from small-scale, retrospective studies using self-reported measures, rather than from diagnostic clinical interviews

Responders found to have elevated risks for developing PTSD and Depression

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• Document # & frequency of traumatic

exposures from previous deployments

• Share the information with responder

about increased risk on health from traumatic stress Health Care providers should:

Include Behavioral Health History in Screening Include Behavioral Health History in Screening

**Note that personnel with psychiatric conditions under stable control in routine environments may not be suitable responders in emergencies

Health Screening Requirements Health Screening Requirements

For volunteers, health status and

history may be gathered using self‐ reported surveys, reviewed by a licensed health professional.

For other responders, more

extensive health screening with specialized testing may be required using a licensed health professional. Typically, a health professional

certifies that a responder is fit for

deployment for specific assignments.

Tools for Screening Physical/Behavioral Health Exams Tools for Screening Physical/Behavioral Health Exams

• 1. Red Cross Pre-deployment health Questionnaire

http://www.dovebof.org/dshr/disaster_dro_pre-assign_questionnaire.pdf

• 2. ASPR medical & Physical Pre-response Requirements: pages 18-19

https://files.asprtracie.hhs.gov/documents/ndms-health-and-safety-plan.pdf

• 3. USCENTCOM [2017]. Pre-deployment guide revision 4.2. Tampa, FL: US

Government Central Command, DoD Expeditionary Civilian https://www.dcpas.osd.mil/expeditonary/pdf/CEW_Pre_DeploymentGuide_062 017.pdf

• 4. USCGAA [2010]. United States coast guard auxiliary aviation program flight

crew medical screening form. Washington, D.C.: U.S. Coast Guard Auxiliary Aviation Program http://cgaux.org/~forms/archive/a7042.pdf

• 5. DoD [2015]. Pre-deployment health assessment form (DD 2795). Washington,

D.C.: Department of Defense https://www.esd.whs.mil/Portals/54/Documents/DD/forms/dd/dd2795.pdf

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Keep Responder medical conditions confidential and treated as a medical record ONLY Clearance Info is released to Emergency Response Organization, e.g.:

Cleared for regular deployment without restriction Cleared for specialized or high‐risk tasks, austere environments Cleared for deployment with specified restrictions/accommodations Cleared with additional training for __________ (Explained) Not cleared for deployment

Confidentiality/ Disposition Confidentiality/ Disposition

ERHMS Health Screening Summary ERHMS Health Screening Summary

ERHMS requires a review of individual responder medical data be used for fitness determination AND that the decision

• 1. Be documented in the employee’s record
• 2. Designate a fitness for deployment category with

restrictions listed

• 3. Designate a date when determination was

completed

• 4. Be updated periodically (annually or as

conditions change)

Third Activity:

Health and Safety Training Pre-Deployment Phase Pre-Deployment Phase

Rostering and Credentialing Health Screening / Immunizations Health and Safety Training Data Management / Information Security

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Pre-Deployment

Health and Safety Training

Pre-Deployment

Health and Safety Training

We want to ensure responders receive training on:

• Roles and responsibilities
• Threats, hazards, and protective

actions

• Notification, warning, and

communications procedures

• Emergency response procedures
• Evacuation, shelter, and

accountability procedures

• Use of PPE, emergency equipment
• Emergency shutdown procedures

Health & Safety Training Health & Safety Training

• Hazard communication
• Respiratory protection
• Personal Protective

Equipment (PPE)

• Hazardous waste operations
• Access to employee exposure

medical records

• Safety awareness
• Self care/Buddy care
• Decontamination
• Disaster characterization
• Communications
• Site operations

Examples of Training Courses

• All training completed by the responder should be documented

in each responder’s records by their agency, and in a Master‐list.

Health & Safety Training Health & Safety Training

Lessens the dependence on “Just‐in‐time” training and

site‐specific training (SST) during an emergency deployment. ALLOWS managers to:

• Know which responders are trained
• Assign the trained responders specialized roles prior to

an emergency

• Be able to evaluate the impact of training on responder

health later on

• Determine the effectiveness of preparedness training

and whether it reduces injuries

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4th Activity: Consent/Data

Management/Information Security

Pre-Deployment Phase Pre-Deployment Phase

Rostering and Credentialing Health Screening / Immunizations Health and Safety Training Consent/Data Management / Information Security

Informed Consent Informed Consent

 A policy for consent for disclosure of responder information must be in place for all response phases.  Responders must be informed EARLY in CLEAR LANGUAGE about consent regarding health monitoring, medical surveillance, and/or participation in emergency response research Data Management & Information Security (Pre-Deployment) Data Management & Information Security (Pre-Deployment) For ERHMS to work across agencies, computer specialists and data experts must:

• Communicate, make decisions about

the ways they collect data on their emergency responders during the pre‐deployment phase

• Ensure Mutual Levels of Security

Standards between agencies so some data may be accessed, but PII protected

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Data Management & Information Security Data Management & Information Security

• Confidentiality ‐ only be accessible to authorized personnel

and protect Personally Identifiable Information (PII)

• Integrity ‐ be accurate and complete
• Availability ‐so authorized personnel can access information

when necessary

• Standardized information ‐ to facilitate communication

between different agencies during an event.

Data must be secure and maintain:

Deployment Phase Deployment Phase

DEPLOYMENT

POST-DEPLOYMENT PRE-DEPLOYMENT

1 2 3

Deployment Phase Deployment Phase

On‐site Responder In‐processing Health Monitoring and Surveillance Exposure Assessment, Activities, and Controls Communication

• f

Exposure and Health Data

Deployment Phase also addresses four key activities:

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Deployment: On‐Site Responder

Rostering

Deployment: On‐Site Responder

Rostering

Allows control of the Emergency Site using roster information

– Accounts for personnel, equipment, resources, and tasks

Tracks who enters and leaves an incident scene Limits access, isolates hazardous area, and denies entry Deployment: On‐Site Responder

Badging

Deployment: On‐Site Responder

Badging

Allows visual identification of responders, with a name, photo, title, organization, role, security level, dates. A badge can allow role‐based and secure access for location, participation, and computer access. Allows for tracking of personnel and assignments. Responder and specific site location Amount, type, and condition Training and fit‐testing for issued equipment Change‐out schedules

Deployment:

Document Personal Protective Equipment by:

Deployment:

Document Personal Protective Equipment by:

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“Just‐in‐Time” or

“Toolbox” training acquaints emergency responders with special conditions or exposures identified or anticipated at the specific site…

Deployment:

Document Site-Specific

Training

Deployment:

Document Site-Specific

Training

Both for the Response and for EACH individual Responder

Deployment:

Handle Post‐Event Disposition and Security

Deployment:

Handle Post‐Event Disposition and Security

Decide early where secure transfer & long‐term

storage of the roster, badging, and training records will be located and who will have access.

Plan Demobilization Early in Response Plan Demobilization Early in Response Plan for…

• Responders leaving the response

prematurely!

• Exit interviews (de‐briefing)
• Exit health survey
• Follow‐up of responders
• File storage

While the Command Team is preparing In‐processing, it also needs to be working on documentation for Demobilizing responders.

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Deployment Phase Deployment Phase

On‐site Responder In‐processing Health Monitoring and Surveillance Exposure Assessment, Activities, and Controls Communication

• f

Exposure and Health Data

Deployment Phase addresses four key activities: How We Define Health Monitoring… How We Define Health Monitoring…

THINK “Individual” Responder Examining changes in an individual responder’s exposures or health status on-site or during the event Evaluating Signs and Symptoms of injury and illness Relates to targeted responder exposures on-site (e.g., lead, radiation, solvents, carbon monoxide, infectious disease) during her/his work duties

Health Monitoring Health Monitoring

• Some responders may need more extensive health monitoring

because of hazardous conditions or exposures, preexisting medical problems, or dealing with emotional trauma.

• Others MAY NOT be in a targeted monitoring program.

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Who Carries out Health Monitoring Who Carries out Health Monitoring Health monitoring should be carried out or supervised by a health practitioner with knowledge, skills, and experience in

• ccupational health exposure.

Deployment Health Surveillance Deployment Health Surveillance

Surveillance is the cornerstone of ERHMS: Surveillance is the ongoing, systematic collection, analysis, interpretation, and dissemination of illness and injury data related to an event’s responder population, And IS USED for action. Helps detect health effects early, so incident command can use better controls to prevent them from getting worse Provides data to evaluate health risks on‐site Give responders information about how response work affects their health

Deployment Health Surveillance’s

Importance (1 of 2 slides)

Deployment Health Surveillance’s

Importance (1 of 2 slides)

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Highlights lapses in workplace control measures, provide feedback to risk assessments Findings from Surveillance Analyses have provided data to improve training, PPE, and identify performance gaps

Deployment Health Surveillance’s

Importance (2 of 2 slides)

Deployment Health Surveillance’s

Importance (2 of 2 slides)

Deployment Health Surveillance Deployment Health Surveillance

Active: Collecting new data

through health check‐ups, surveys, interviews, exposure monitoring

Passive: relying on existing

health data, first aid reports; need cooperation of health‐ care providers — laboratories, hospitals, health facilities.

Surveillance can be:

Deployment Health Surveillance Deployment Health Surveillance

Surveillance is related to monitoring in two ways:

• 1. Health & Environmental

Monitoring data can be used for surveillance.

• 2. Surveillance makes it

possible to target individual monitoring that may need to be done during deployment.

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Health Surveillance Data Health Surveillance Data Once data are collected they should be:

Evaluated for quality, coded, analyzed, and interpreted in a timely manner. Described in a brief and easily understood report. Disseminated to all responders, union groups, employers, government agencies, state and local health authorities, and the public Communicated to stakeholders as close to real‐time as possible

Who Performs Health Surveillance Who Performs Health Surveillance

In the Emergency Response Command Staff, need to have dedicated staff ‐‐ epidemiologists, health & infection control specialists, to analyze and interpret the data generated.

Deployment Phase Deployment Phase

On‐site Responder In‐processing Health Monitoring and Surveillance Exposure Assessment, Activities, and Controls Communication

• f

Exposure and Health Data

Deployment Phase addresses four key activities:

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Deployment Phase

Exposure Assessment

Deployment Phase

Exposure Assessment ERHMS wants Exposure Assessment and Monitoring to be documented as part of the

• verall record.

Exposure monitoring data need to be analyzed and used in real‐time during the response, as well as post‐event for evidence and documentation of hazardous exposures. Deployment

Exposure Assessment

Deployment

Exposure Assessment

Exposure monitoring can take place:

• On an individual responder,
• A group of responders, or
• In an area where responders

are completing tasks. Information on the type of monitoring completed should be placed in each responders’ record (whether it was for their

• wn work activities, or for group,
• r area monitoring)

Responder Activities Must be Documented Responder Activities Must be Documented

• Would include: tasks,

locations, and duration.

• See Incident Command (ICS)

Form 204 – Assignment List.

SLIDE 20

Tools for Integrating Exposure Assessment, Activities Documentation, and Controls Tools for Integrating Exposure Assessment, Activities Documentation, and Controls

• 1. OSHA e‐HASP Software: Health and Safety Plan templates

http://www.osha.gov/dep/etools/ehasp/index.html

2. FEMA ICS Form 208 Site Safety and Control Plan 3. NIOSH Health Hazard Evaluation of Deepwater Horizon Response Workers 4. NIOSH Interim Information - Chemical Exposure Assessment Considerations for Use in Evaluating Deepwater Horizon Response Workers and Volunteers 5. OHSA On-Shore Deepwater Horizon Personal Protective Equipment Matrix for Gulf Operations 6. The Society of Federal Health Professionals (AMSUS) - Recommendations for Biomonitoring of Emergency Responders: Focus

• n Occupational Health Investigations and Occupational Health

Research.

Deployment Phase Deployment Phase

On‐site Responder In‐processing Health Monitoring and Surveillance Exposure Assessment, Activities, and Controls Communication

• f

Exposure and Health Data

Deployment Phase addresses four key activities:

Deployment Communications Deployment Communications

Information should flow: within the Incident Command System, through the Public Information Officer, to and from the responders, to the public and media.

Incident Command and Public Information Officer Organization Organization 1 Organization Organization 2

Public and Media Responders

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How is Communication of Health Monitoring and Surveillance Data Done? How is Communication of Health Monitoring and Surveillance Data Done?

• Coordinate with Public

Information Officers (PIOs)

• Be forthcoming & transparent to

responders, the public, and media

• Always Protect Personal

Identifying Information (PII)

Deployment Summary:

Planning for DATA

Deployment Summary:

Planning for DATA

• Information technology safeguards to prevent unauthorized

access to personal identifying information (PII)

• Planning for records obtained during deployment which

includes:

• IT personnel
• Secure transfer
• Long‐term storage
• Custodial care
• Future retrieval

ERHMS wants all parties to consider early on:

Worker Demographic Information:

• Name
• Age
• Gender
• Unique identifying number

Employment status

• Contact information
• Pre‐event health assessment

information (e.g., fitness for deployment, medication needs [e.g. refrigeration], respirator fit testing)

Worker Incident Related Information:

• Job assignment
• Valid current professional

licenses & trade certifications

• Personal protective equipment

dispensed

• Site‐specific training
• Medical Surveillance
• Demobilization
• Out‐processing information

ERHMS Data Systems

Pull together the Pre- Deployment and Deployment Information… Pull together the Pre- Deployment and Deployment Information…

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Post-Deployment Post-Deployment

DEPLOYMENT

POST-DEPLOYMENT PRE-DEPLOYMENT

1 2 3

Post-Deployment Phase Post-Deployment Phase

Establishes process for ongoing long‐term monitoring and/or surveillance of responder health post‐response. This is conducted by the ERHMS unit, overseen by the Safety Officer.

Post-Deployment Phase Post-Deployment Phase Post‐deployment

addresses three key activities that occur after response:

• 1. Responder Out‐Processing
• 2. Determining the Need for

Long‐Term Tracking

• 3. After‐action Reporting

SLIDE 23

Post-Deployment

Responder Out-processing

Post-Deployment

Responder Out-processing

All responders should complete formal check‐out activities, called “out‐processing” with end of

• deployment. Obtain:
• Health status (physical and

behavioral) during deployment and at demobilization.

• PPE used…
• Activities
• Adequacies of controls
• What went wrong/right
• Contact information

Responder Out-processing Responder Out-processing

Prepare Out‐Processing EARLY in the Deployment Phase, because responders will be demobilized at all times during a response. The Recall of conditions is best right after they have happened, so obtain information early Face‐to‐Face interviews are the best method! Other methods include paper surveys, websites, or phone interviews within 1 to 2 weeks after demobilization. Note: If a responder should leave the scene without proper processing, then it is the responsibility of the deploying agency to obtain this information.

Responder Out-processing Responder Out-processing

Responders should be given written information on pertinent exposures found at the site, and who to contact should they experience problems. Efforts should be made to follow‐up responders after post‐ deployment by phone to ensure no physical or behavioral concerns related to the incident has occurred. Follow‐up may depend on exposures, activities, and nature of deployment.

Note: Responder health Information should be handled as confidential information.

SLIDE 24

Post-Deployment Phase Post-Deployment Phase Post‐deployment addresses three key

activities that occur after response:

• 1. Responder Out‐Processing
• 2. Determining the Need for Long‐Term

Tracking

• 3. After‐action Reporting

Post-Deployment: Long-Term Health Tracking Post-Deployment: Long-Term Health Tracking Long‐term health tracking involves

• ngoing health monitoring and/or

surveillance of responders. Tracking helps to identify delayed or long‐term adverse effects that may develop as a result of the deployment experience. Note: In some incidents there will be no need for long‐ term tracking, but an assessment will need to be done to know when this is necessary. Note: In some incidents there will be no need for long‐ term tracking, but an assessment will need to be done to know when this is necessary.

Deciding to Implement Long‐term Tracking Takes into account:

Responder’s hazardous work exposures Hazardous work activities Adequacy of control measures Injuries/Illnesses incurred during deployment Concerns expressed by others (e.g., politicians, public)

Post‐Deployment Tracking Post‐Deployment Tracking

SLIDE 25

How to do Long-Term Health Tracking (Based on ERHMS Data) How to do Long-Term Health Tracking (Based on ERHMS Data)

Deployment Roster Workers Identified for Health Tracking

Exposure and Health Analysis Health Tracking Program Type

HOW to Determine Need for Health Tracking of Responders HOW to Determine Need for Health Tracking of Responders

1st step: Examine the total deployment roster which

includes ALL responders who were engaged in the response (include all contractors, sub‐contractors, and volunteers.) (Note: The deployment roster may differ from the pre‐deployment roster.)

Deployment Roster Workers Identified for Health Tracking

Exposure and Health Analysis Health Tracking Program Type

HOW to Determine Need for Health Tracking of Responders HOW to Determine Need for Health Tracking of Responders 2nd step: Examine information

• btained before and during the event

Examine:

• Medical Monitoring Data
• Medical Surveillance
• Exposure Assessment Data
• Environmental Sampling Data
• Out‐processing Interview Data
• Responder Activity Data
• Pre‐deployment Baseline Data
• Medical Examination Results

Is there a need for post‐event tracking

• f responder health or is more

information needed ? Deployment Roster Workers Identified for Health Tracking

Exposure and Health Analysis Health Tracking Program Type

SLIDE 26

HOW to Determine Need for Health Tracking of Responders HOW to Determine Need for Health Tracking of Responders 3rd Step: After analyzing Exposure and Health data, determine those workers or groups of responders who may benefit from long term surveillance (health tracking). Data may show that none of the workers, a sub‐set, or all

• f the workers may be

included in long‐term health tracking.

Deployment Roster Workers Identified for Health Tracking

Exposure and Health Analysis Health Tracking Program Type

HOW to Determine Need for Health Tracking of Responders HOW to Determine Need for Health Tracking of Responders There are several health tracking

• ptions. The tracking program

type is based on the needs of the workers. Options: Medical Surveillance program Medical Monitoring program Responder Research Periodic Health Survey Program No follow‐up deemed necessary

Deployment Roster Workers Identified for Health Tracking

Exposure and Health Analysis Health Tracking Program Type

Post-Deployment Phase Post-Deployment Phase Post‐deployment

addresses three key activities that occur after response:

• 1. Responder Out‐processing
• 2. Determining the Need for

Long‐Term Tracking

3. After‐action Reporting

SLIDE 27

After-Action Reporting After-Action Reporting After demobilization, we assess the emergency response’s 3 phases, then identify ways to improve health monitoring and surveillance for the next response

This after‐action assessment of ERHMS functions and activities is important to be included in the larger, incident‐ focused after‐action report.

So, where has ERHMS been used? So, where has ERHMS been used?

Currently, CDC Emergency Response Center: ERHMS deployed for deployer safety and health plan as permanent part of Emergency

• perations

Georgia DPH uses ERHMS framework to track self‐reported data on injury, illness and behavioral health and reimbursement hours daily on responders. It is now used during Hurricanes.

Where else has ERHMS Been Used? Where else has ERHMS Been Used?

Roseburg Oregon Mass Shooting 2015

• ERHMS applied to credential, screen, train and

monitor responders. – ERHMS used during deployment, caseload monitoring, and communication; post‐ deployment f/u.

Gulf Oil spill 2014

– 45,000 workers rostered – ERHMS documentation used to determine if specific training reduced injuries – ERHMS allowed qualified researchers to recruit rostered individuals in long‐term research

SLIDE 28

Interested in Implementing ERHMS? Interested in Implementing ERHMS?

Where do you Begin?

– NIOSH is finalizing the ERHMS PRIMER. – A Step‐by‐Step Guide on how to carry out Emergency Response Health Monitoring and Surveillance – Includes ALL attachments/examples for setting up a Program in all 3 phases of a response – No cost, applicable for local, state, federal agencies as well as volunteer groups – Stay tuned…

ERHMS Summary: ERHMS Summary:

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1 3 2

Synthesis of Pre-, Deployment and Post-Deployment Information Synthesis of Pre-, Deployment and Post-Deployment Information

Pre‐Deployment Information:

• Name
• Age
• Gender
• Contact information
• Credentials, Licenses
• Employment status
• Pre‐event health

assessment information (e.g., fitness for deployment, medication needs e.g., refrigeration, respirator fit testing)

• Prior Training

Deployment Information:

• Job assignment/s
• New Certifications
• PPE dispensed
• Site‐specific training/

retraining

• Special Monitoring
• Health Status

ERHMS Data Systems Post‐Deployment Information:

• Out‐Processing Interview
• Health status
• Activity data
• New Exposure

Information

• PPE dispensed

SLIDE 29

ERHMS Online Trainings ERHMS Online Trainings

IS‐930: Emergency Responder Health Monitoring and Surveillance (ERHMS) System: Leadership Training: http://training.fema.gov/EMIWeb/IS/courseOverview.aspx? code=IS‐930

– CEU: 0.1

WB2254: Emergency Responder Health Monitoring and Surveillance (ERHMS): http://cdc.train.org/DesktopModules/eLearning/CourseDet ails/CourseDetailsForm.aspx?courseId=1045755

– CME: 3.0 CNE: 2.9 CPE: 0.3 AAVSB/RACE: 3.5 CECH: 3.0 CEU: 0.3

Question 1: Health Monitoring of Responders Question 1: Health Monitoring of Responders

Four key activities in support of responder health and safety in the ERHMS framework that

• ccur during a response to an incident include

all but which of the following? A.On‐site Responder In‐processing B.Health Monitoring and Surveillance

• C. After‐Action Reporting and Follow‐up

D.Assessment of Responder Activities and Controls Used

Question 2: Health Monitoring

• f Responders

Question 2: Health Monitoring

• f Responders

Deciding to implement long‐term tracking (health surveillance) should take into account all but one of the following: A.Responder’s hazardous work exposures B.Adequacy of control measures during the response C.Injuries/Illnesses incurred during deployment D.Concerns expressed by internet bloggers and

certain media

SLIDE 30

Question 3: Health Monitoring of Responders Question 3: Health Monitoring of Responders

All of the following are good reasons to conduct Health Monitoring on scene except which one?

• A. When responders may be experiencing similar

symptoms

• B. When structural conditions appear to be dangerous to

responders

• C. When there are increases in frequency or severity of

adverse health outcomes

• D. When safety officials must fulfill public health interest
• r political interest for an exposure or health effect of

public concern

Thanks for your Attention Thanks for your Attention

Bruce Bernard, MD, MPH

brucebpb4@gmail.com