EMERGENCY RESPONDER HEALTH MONITORING AND SURVEILLANCE (ERHMS)

National Response Team Technical Assistance Document

Deployment Phase

On-site Responder In-processing

The processes of personnel identification, accountability, and tracking can be referred to as the responder roster. Whenever the level of response is greater than what the first tier of local responders can handle, a roster should be used to log everyone who reports to the disaster site and is engaged in the response or remediation work. The logistics function of the incident command system? (ICS) is responsible for collecting this information into a comprehensive rostering system. But accountability also includes parallel and linkable procedures that are conducted by the Planning function of the ICS (example–demobilization) and by the Command function of the ICS (Safety Officer). Site-specific training is required and must occur before responders enter a designated disaster control zone (see 29 CFR 1910.120). Strategies for implementing site-specific training should be pre-planned to the extent feasible, with consideration given to different training materials necessary to meet expected and unexpected health and safety hazards onsite.

A variety of personal protective equipment (PPE) may be needed by response workers and volunteers, and for many workers, this equipment will be issued or dispensed to them during their site-specific training or as they arrive at the response scene and are placed on the response roster. This central function or location for issuing PPE to responders serves as an opportunity for recording in the ERHMS data system the amount, type, and condition of the PPE that is issued to each responder.

This is a sample worker badge from the World Trade Center response.

Health Monitoring and Surveillance During Response Operation

Health monitoring and surveillance are two different but complementary methods to protect the health and safety of incident responders during an emergency operation. Monitoring refers to the ongoing and systematic collection, analysis, interpretation, and dissemination of data related to an individual incident responder's injury and illness status. This allows for the evaluation of occurrences and levels of exposures, for an individual responder, and assessment of how that exposure is affecting them.

Surveillance refers to the ongoing and systematic collection, analysis, interpretation, and dissemination of illness and injury data related to an event's emergency responder population as a whole. This allows for tracking emergency responder health (illness and injury) trends within the defined population during response. A mechanism to allow tracking should be an integral part of the response to any event.

Integration of Exposure Assessment, Responder Activity Documentation, and Controls into ERHMS

This is a picture of an American Red Cross truck in the field during a disaster response.

Photo courtesy Earl Dotter.

Response workers and volunteers may be exposed to many chemical, physical, and biological hazards in the course of their work. Obtaining accurate and valid worker exposure information is a crucial element in ensuring exposures are correctly characterized, risk is communicated appropriately, and sufficient information is available for making evidence-based decisions on how to protect the health and safety of response workers (e.g., work process changes, PPE, and work practice controls). The exposures addressed in this document include biological, chemical and physical hazards, and psychological stressors, such as sights and smells of death, exposure to the wounded, and risk of becoming a casualty. There are three risk management categories, as described later in this document,that safety officers, industrial hygienists, and other public health professionals ascertain from the assessment process: acceptability of exposures, unacceptability of exposures, and uncertainty of exposures (which requires further information gathering).

Communication of Exposure and Health Monitoring and Surveillance Data

There is a picture of a response worker being interviewed for chemical exposure. In the same picture, a sampler is being attached to the worker for personal breathing space monitoring.

Communication is critical throughout the course of an emergency response. The scope of communications in an emergency response has many facets, including psychology (phase-dependent), messages (content, timing), audiences, and spokespersons. The collection of environmental exposure data and individual health and safety monitoring data, along with aggregate surveillance data, is relevant to protecting all responders involved in an event both short-term and long-term, but it is not an end unto itself. This information must be communicated to workers, both internal and external to the organization, and inside and outside the ICS structure. Although it is common for organizations to track and report data they are collecting within their own operational structures, the need for tracking and communicating more broadly is key to informing responders who need the information about pro-active steps they can take to protect themselves from hazardous exposures while attempting to protect the environment, rescue and identify survivors, or recover those who have died. See Figure 3 for how the ICS communication system works.