EMERGENCY RESPONDER HEALTH MONITORING AND SURVEILLANCE (ERHMS)

National Response Team Technical Assistance Document

Post-Deployment Phase

Responder Out-Processing Assessment

This is a picture of a NIOSH employee administrating an outprocessing questionnaire.

The out-processing assessment is the minimum post-deployment evaluation that should be conducted for responders. Out-processing assessments are conducted to determine the extent, if any, to which individual responders have been adversely affected by their work during deployment and to assess trends within the population of workers for the purpose of identifying potential risks to others. Conditions encountered by responders may involve complex, uncontrolled environments possibly involving hazardous chemicals including multiple or mixed chemical exposures, microbial agents, physical agents (e.g., temperature, noise, etc.), long work shifts, or stressful experiences. Therefore, all responders should receive an out-processing assessment as part of the demobilization process or as soon as possible after demobilization. Out-processing assessment should be simple, concise, and standardized. Ideally, the out-processing assessment would be a face-to-face interview in the field as responders are preparing to depart back to their duty station. If face-to-face isn't possible, other good options are paper, web, phone interview or conducting the assessment 1 to 2 weeks before or after demobilization.

Post-Event Tracking of Emergency Responder Health and Function

Post-event tracking of responder health may be appropriate because of potential health and safety risks inherent in emergency response work. The goal is to identify adverse health or functional consequences potentially associated with response work (e.g., exposure, illness, injury, or disability–including emotional trauma) and to intervene early to maximize the chances for recovery and to stop further exposure for workers remaining on-scene (i.e., through exposure control or medical treatment).

The decision to opt for further tracking should be based on a variety of factors, including information regarding the responder's exposures, hazardous work activities, concerns expressed by the responder or safety and health personnel, the adequacy of control measures and appropriate adherence, and injuries and illnesses incurred during the deployment. Such information should be viewed in the context of the workers' prior physical and mental health status, and the extent of their prior knowledge and experience with disaster work.

Post-event tracking of health may be difficult or costly to conduct on a case-by-case basis, and it is often more suitable for such decisions to be made for categories of responders with similar exposure histories. 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. See Figure 5 for an illustration of how the flow of information should work.

This is a chart depicting the flow of information leading to decision points and initiation of post-event health monitoring and surveillance. It starts from the deployment roster to exposure and health analysis to a subset of workers identified for health tracking and finally to the health tracking program type. Also shown is a list of Analysis Components that includes; medical monitoring data, medical surveillance data, exposure assessment data, environmental sampling data, exit survey data, responder activity data, pre-deployment baseline data, and medical examination results. A final list contains Long-Term Tracking options. This list contains: medical surveillance program, medical monitoring program, academic research study, periodic health survey program, and no follow-up deemed necessary.

Lessons-learned and After-action Assessments

This is picture of rescue workers cleaning up debris during the World Trade Center response.

Photo courtesy Earl Dotter.

At the conclusion of an event there is a need to assess the conduct of the emergency response through each phase (pre-deployment, deployment, and post-deployment) to identify ways to improve processes and outcomes during each of phase. This insures that the best-possible practices are used, that mistakes are identified, and measures taken so they are not repeated during the next response. Often this is accomplished through a document called an After Action Report . It is essential that a review of the ERHMS be included in the general After Action Report or similar document. Documenting deficiencies in communications of safety and health protocols, examining the tasks and timing of exposures, and noting when rostering was ineffective, all help organizers improve the safety environment and protect emergency responders' safety and health during an emergency.