Previous emergency events have demonstrated that, despite analysis and application of lessons learned, there are still significant gaps and deficiencies in health monitoring and surveillance for emergency response workers (including police, fire, and emergency medical personnel, as well as public health personnel and cleanup/repair/ restoration/recovery workers). These gaps and deficiencies were documented in the RAND reports prepared following the World Trade Center response, but they have persisted and, despite improvements, were observed again in the Hurricane Katrina and Deepwater Horizon responses. The persistence of these gaps and deficiencies 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 these groups of workers and for detailed, practical guidance on implementing such an approach. Any effort to meet this need must incorporate a variety of measures, including the following: (1) medical screening that focuses on assessment of fitness and ability to safely and effectively deploy on a response; (2) training regarding hazards to be anticipated and protective measures to mitigate them; (3) approaches to centralized tracking or rostering of responders; (4) surveillance and monitoring for exposures and adverse health effects, including supporting efforts in environmental monitoring and assessment; (5) outprocessing assessments on completion of response duties and deployments; and (6) follow-up or long-term surveillance or monitoring for potential delayed or long-term adverse effects of the deployment experience. Similarly, such a system must include activities to be performed at all stages in the response spectrum - prior to, during, and following deployment. Any guidelines or recommendations for procedures to implement these protections must be fully compatible with and function within the National Incident Management System (NIMS) structures, which have been adopted as the accepted standard organizational focus for emergency response at all levels (local, state, and federal) and for all incident sizes and types. Further, the procedures must be understandable and usable by Incident Command System (ICS) leadership and health, safety, and medical personnel (see Appendix A for a description of the ICS structure). In response to this continuing need, a consortium of federal agencies, state health departments, and volunteer responder groups was convened by the National Institute for Occupational Safety and Health (NIOSH). This set of guidelines and recommendations is the product of those deliberations. It is intended to address all aspects of protecting emergency responders and should be applicable over the full range of emergency types and settings. It is intended to be of use to all those involved in the deployment and protection of emergency responders, including incident management leadership; leadership of response organizations; health, safety, and medical personnel; and the workers themselves.