NIOSH Program Portfolio

Emergency Preparedness and Response

Inputs: NIOSH Strategic Goals

The NIOSH EPR cross-sector program is developing strategic goals to guide its research and partnership efforts over the next decade.

NIOSH previously used "priority" topic areas (e.g., traumatic injury, hearing loss) to guide its research efforts. Strategic goals take this approach a step further by identifying specific outcomes that we want to target, performance measures for evaluating progress in meeting the outcome goals, and intermediate goals to describe the necessary steps that need to be performed to accomplish the goal.

Setting goals is challenging because it forces us to focus on the subgroup of issues where NIOSH can make the largest impact-a long list would spread our resources too thin to accomplish the goals. Not every worthwhile topic can be included.

Often it is difficult to develop performance measures, as available injury statistics have limitations, and exposure and health outcome measures are typically not available. For EPR, the myriad of potential scenarios potentially encountered with natural or man-made emergencies/disasters cannot be completely known.

NIOSH is ambitiously setting goals to achieve outcomes such as reductions in a national fatality rate. NIOSH is a research agency so we don't often directly influence outcomes; we must partner well and influence other groups to show results.

NIOSH Program Portfolio Approach

NIOSH has been organizing research, guidance, information, and service efforts into specific programs that can be readily communicated and strategically governed and evaluated. Eight NORA Sector Programs represent industrial sectors, and twenty-four Cross-sector Programs organized around adverse health outcomes, statutory programs and global efforts.

The NORA Sector Programs intersect with Cross-Sector Programs in a matrix-like fashion. For example, an Agriculture, Forestry and Fishing Program goal of reducing farm-related deaths and injuries due to tractor rollovers and trucks would likely be a shared goal with the Transportation Program and if appropriate would be adopted by both programs. This approach provides an added advantage and will allow multiple Programs to work towards accomplishment of intersecting goals.

Each of the 32 programs in the NIOSH Program Portfolio has a Manager and Coordinator. Each of the 8 NIOSH Sector Programs facilitates the work of a NORA Sector Council to engage external stakeholders in the process of developing sector goals for the nation and methods to measure the short-term, intermediate and long-term outcomes arising from those goals. The NORA goals for the nation will be considered when choosing NIOSH sector program goals. Cross Sector programs have internal Steering Committees that develop program goals and monitor outcome measures.

These planning efforts will position NIOSH to align with the most current governmental approaches for evaluating program effectiveness, i.e., the Program Assessment Rating Tool (or PART). PART is a mechanism to hold governmental agencies accountable for accomplishing results. As part of our comprehensive approach to performance measurement, NIOSH has engaged the National Academies to independently evaluate our sector and cross-programs for relevance and impact.

Draft Emergency Preparedness and Response Cross-Sector Program Goals

Background

As required by the Office of Management and Budget (OMB), NIOSH program strategic goals will be organized by outcomes such as reduction in injuries and illnesses instead of more general topic areas such as reducing all occupational mortality in the transportation industry. The NIOSH EPR cross-sector program goals are posted for review and comment. We will use NIOSH eNews to announce that draft goals are available for review. NIOSH is interested in your opinion about the relevance and value of strategic goals for the EPR program, and we encourage you to consider working with us on issues of interest to you and your organization.

Introduction

Emergency response workers must understand and assess potential exposures, conduct rescues, administer first-aid, decontaminate personnel and equipment, and attempt recovery activities in constantly changing and complex hazardous environments. Often the precise nature of the hazards cannot be initially described in such an intense and time-urgent setting, nor is exposure limited to only hazardous chemical, biological, or radiological materials; it may also involve fires, explosions, traffic hazards, and crowd control. Pre-event preparation, training, and access to readily available information, field assessment, and safety equipment are critical to minimizing consequent deaths, injuries, and illnesses, and to promote overall workforce resilience. It is not possible to delay or stop the response in order to restructure the organization, management, or approach during an emergency. The emergency environment places responders under a time-urgent, dual-cognitive demand: 1) they must attend to the hazards (including attention to self and crew members' safety and health), and 2) they must perform the work necessary to complete a rescue. The quality of the coordination among crew members as they carry out a rescue can define the probability of risk for death, injury, and illness to those responders.

Identifying serious problems in emergency response during or after an event indicates the failure of prevention and preparation. To be sure, specific problems will occur during any emergency. However, good preparation means that the organization will rapidly and smoothly adjust to the changing circumstances and will continue the rescue. A less-than-successful adaptation to such environmental changes indicates the need for improved preparation. Such failures on-scene must be translated into proactive training via "lessons learned" (see the Outcomes section). Preparedness also includes cognitive and emotional preparation, i.e., workforce resilience, to be able to function effectively in the face of emotionally-charged or highly disturbing circumstances; and adequate hydration, nutrition, rest, and sleep during an emergency response extending beyond a few hours or a shift.

Research, evaluation, and subsequent communication and training of emergency responders to maximize preparedness in all phases of a response are essential in reducing risks and promoting overall workforce resilience. Proactive use of lessons learned and a comprehensive assessment of emergency response activities, including management, organizational structure, crew-based collaboration, communication, preparation, training, equipment availability, and decontamination procedures, are key to improving safety and health outcomes. Focus on pre-event interventions that reduce the risk of exposure to hazards in the emergent environment offers the best approach to preventing loss.

DRAFT GOALS

1. SAFETY CLIMATE

Strategic Goal: Reduce injuries and enhance the health, safety, and resilience of emergency responders by improving the organization of emergency response work.

Discussion:
Improved preparation, better organization, and more consistent adherence to best practices during emergency operations will minimize exposures, prevent consequent injuries and illnesses, and promote workforce resilience. The overall safety climate in an emergency setting is influenced by many factors, including the nature of the hazards, management practices, crew-based collaboration, communication, preparation, and training, that address all phases of a response, from pre-event preparation to after-action review and treatment.

Overall Performance Measure:
Develop and evaluate a set of new best practices or recommended performance measures to improve the organization of emergency response activities and to promote a pro-active crew-based safety climate. Reduce exposures, illnesses, or injuries attributable to improvements in safety climate.

2. PERSONAL PROTECTIVE EQUIPMENT (PPE)

Strategic Goal: Emergency response organizations with responsibilities associated with hazardous materials response will reduce exposures to inhalation and dermal hazards.

Discussion:
During the earliest phases of response operations, before technical expertise can be brought to bear or supplemental safety equipment can be located, responders and safety managers need guidelines, checklists, or other decision-making tools to assist in developing appropriate initial and reevaluated protection strategies.

Overall Performance Measure:
Reduce the number of injuries and illnesses to first responders as a result of improper selection or use (or non-use) of PPE.

3. SURVEILLANCE

Strategic Goal: Emergency response organizations will use the results from analyses of data from a surveillance system(s) developed by NIOSH to improve emergency responder safety and health. The surveillance system will identify problems for corrective action through the systematic collection, analysis, and interpretation of exposure, hazard, injury, and illness data.

Discussion:
The systematic collection, analysis, and interpretation of health and exposure data can give decision makers valuable information for improving the safety and health of those called upon during disasters. Surveillance data can also be useful to identify subgroups at risk of exposure to specific hazards so that appropriate prevention can be implemented, follow-up can be planned, and possible intervention can be implemented. For example, the rapid identification of specific respiratory illnesses among emergency responders may allow for monitoring of other workers and facilitate the introduction of controls and risk management at the site, as well as for long-term surveillance of affected workers.

Overall Performance Goal:
Reduce the development of illnesses or injuries attributable to occupational exposure during disaster response through the use of prevention tools developed from information from short and long-term surveillance reporting systems.

4. CHARACTERIZATION/ASSESSMENT OF POTENTIAL HAZARDS

Strategic Goal: Enhance hazard characterization by the development of methods to better evaluate the spatial and temporal distribution of gases, vapors, aerosols, as well as liquids or particulates associated with surface contamination.

Emergency response and remediation workers will reduce potential exposures to terror agents by utilizing improved identification and characterization methods.

Discussion:
Knowledge of distribution, re-suspension, and persistence of aerosol is extremely important in determining the risk from aerosol agents that are disseminated naturally (as in influenza), accidently, or purposely through terrorist events. Therefore, developing methods to evaluate the spatial and temporal distribution of biological and chemical aerosols is critical in identifying sampling strategies, predicting exposure-based risks, designing personal protective equipment and engineering controls, and identifying science-based clearance strategies for re-occupancy. In addition, increased information on distribution of gas and vapor hazards as well as distribution of surface contaminants should help reduce exposures to emergency responders and receivers and improve decontamination procedures.

When a terror event occurs, the causative agent, whether chemical, biological, or radiologic/nuclear, needs to be quickly identified. At times, the terror event may entail multiple agents released either simultaneously or sequentially. Better methods to identify these agents are needed. Rapid and field deployable methods that can be used for environmental assessment will be essential to quickly identifying the causative agent.

Overall Performance Goal:
Reduce the incidence and severity of injuries and illnesses through improved and more rapid characterization/assessment of potential hazards.

Develop new methods for identifying environmental contamination in case of a terror event. These methods would reduce the number of workers exposed and injured since more rapid identification of the terror agent would occur and the appropriate protection, workplace controls would be instituted.

5. ENGINEERING/TECHNOLOGICAL INTERVENTIONS AND CONTROLS

Strategic Goal: As appropriate and feasible, improve engineering controls, technology, and tools to reduce responder's exposures to or hazards associated with CBRN, toxic industrial compounds, and other hazardous materials.

Discussion:
Poor integration of engineering controls during structural design and procedural development usually results in almost total dependence on PPE to minimize exposures or hazards during emergency response operations. Engineering control interventions should be evaluated and implemented, even though complete control of CBRN, toxic industrial compounds, and hazardous exposures may not be possible by engineering controls alone.

Overall Performance Measure:
Reduce exposure through improved engineering/technological interventions and controls.

6. ENVIRONMENTAL MICROBIOLOGY

Strategic Goal: Emergency response organizations will improve their understanding of environmental microbiology threat agents, including environmental factors that influence the introduction, spread, and control of these agents. Emergency responders will enhance their capability to respond to a biological threat, whether naturally occurring or deliberately introduced.

Discussion:
Critical gaps exist in our knowledge about environmental microbiology, and these disparities impede the ability of public health responders to take appropriate action in emergency situations that involve microbial agents. Microbial agents are considered to include bioterrorism agents, emerging infectious pathogens, and non-select agents. Establishing the presence and level of threat agents in the environment ideally would be supported by validated and effective sampling, detection, and quantification of the target agents, as well as specific identification of pathogens and their antimicrobial susceptibilities. It is also critical to have the capacity to estimate risk of infection to human populations using data such as number and viability of organisms in an environment, persistence of agents in the environment, dose-infection relationships through various environmental media, and antimicrobial resistance patterns. Finally, it is important to develop and understand the effectiveness of a range of risk reduction strategies for contaminated environments, including environmental controls; personal protective equipment; disinfection strategies; and, when Available and indicated, medical countermeasures like immunization or antimicrobial prophylaxis.

Overall Performance Goal:
Improve the ability to evaluate, understand risk of infection, and improve risk reduction strategies for biological threat agents.

7. BIOLOGICAL MONITORING OF TERRORISM AGENTS

Strategic Goal: Emergency response and remediation workers will reduce the potential impact of exposures to terror agents by utilizing improved biological monitoring methods.

Discussion:
When a terror event occurs, the causative agent, whether chemical, biological, or radiologic/nuclear, needs to be quickly identified and exposures assessed. At times, the terror event may entail multiple agents released either simultaneously or sequentially. Better methods to identify absorbed chemical or biological agents and to quantify internal exposure are needed. In particular, rapid methods for measuring what or how much agent is actually absorbed into the body using various biomonitoring techniques would be beneficial, especially when clinical evaluation is needed. Cumulative exposures to chemical agents (and perhaps some biological agents) at levels insufficient to produce acute symptoms or illness may over time lead to frank disease or other adverse health effects, and biomonitoring is an important tool for early identification and monitoring of such exposures.

Additionally, vaccination can augment protection against some biothreat agents. Successful vaccination results in measurable antibody titers. Exposure to biothreat agents also can induce natural immunity, which can serve as a biological marker of remote or recent exposure. Critical gaps exist in the efficient measurement of antibodies to numerous biothreat agents, as existing methods can measure only one analyze per assay.

Overall Performance Measure:
In collaboration with other groups within the Centers for Disease Control and Prevention, develop new methods for evaluating internal doses following a terror event. These methods would reduce the number of workers affected since more rapid and accurate identification of those with significant absorption of the terror agent would occur, and appropriate treatment would be instituted for those who need it. In addition, such methods would permit better monitoring of the effectiveness of exposure protections and more precise identification of those needing further medical follow-up or monitoring.

 

NIOSH Portfolio Program:

Emergency Preparedness and Response

Program Description
Inputs
• Economic Factors
• Occupational Risks
• NIOSH Strategic Goals
• Emerging Issues
• Partners
• NIOSH Contacts
Activities
• NIOSH Research Projects
• NIOSH-Funded Research Grants
• Technical Assistance
Outputs
• Publications
• Topic Pages
• Research to Practice
• Conferences
Outcomes
Review & Evaluation
• Program Review
• National Academies Evaluation