Emergency Responder Health Monitoring and Surveillance

An overview of ERHMS

Emergency Responder Health Monitoring and Surveillance (ERHMS) is a health monitoring and surveillance framework developed by the National Response Team, an organization of 15 federal departments and agencies responsible for coordinating emergency preparedness and response.[1] The framework includes recommendations, guidelines, tools, and trainings for use in protecting emergency responders during each phase of an emergency response, including pre-deployment, deployment, and post-deployment.

The guidelines and recommendations address the medical clearance, training, and health monitoring of workers from emergency management, fire service, law enforcement, emergency medical services, public health, mental health, disaster relief, and volunteer organizations, as well as construction and other skilled support who may be participating in a broad range of activities including assessment, search and rescue, investigation, recovery, cleanup and restoration. Events in which the framework could be employed include chemical spills, natural disasters such as hurricanes, floods, and earthquakes, and terrorist attacks.

ERHMS was designed to function within the Federal Emergency Management Agency's (FEMA's) National Incident Management System (NIMS), a systematic approach to emergency management.[2] The ERHMS trainings satisfy Public Health Emergency Preparedness capability 14, "Responder Safety and Health."[3][4] ERHMS has 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.

Background and purpose

After the health effects among emergency responders to the September 11, 2001 attacks at the World Trade Center became apparent, public health and government officials began to call for improved emergency worker health monitoring and surveillance in the event of future disasters.[5] A 2004 joint report from RAND Corporation and the National Institute for Occupational Safety and Health (NIOSH) entitled “Protecting Emergency Responders, Volume 3” called for enhanced protection of emergency workers in future emergency events and described several areas of improvement.[6] Testimony from RAND in 2007 declared that there had been insufficient protection of 9/11 recovery workers and that future disasters should have an incident safety management structure in place that can make safety decisions and has the equipment, capabilities, and authority needed to implement and enforce them effectively.[7]

In 2008, the Government Accountability Office (GAO) released a report entitled, “September 11: HHS Needs to Develop a Plan That Incorporates Lessons from the Responder Health Programs.” This report called for a “plan for responder screening and monitoring services that defines the roles of HHS components and incorporates the lessons from the WTC health programs.”[8] The report named five lessons learned, including registering all responders, implementing robust physical and mental health screening and monitoring, providing treatment referral services, and ensuring that all responders, regardless of employment status or location, could access the same screening and monitoring programs and services.[8]

The 2007 RAND testimony also concluded that the lessons of 9/11 had not been implemented in the response effort for Hurricane Katrina.[7] According to the GAO, during the Katrina response, emergency response workers were not accurately rostered, and lack of cooperation between FEMA and the Occupational Safety and Health Administration (OSHA) led to inadequate monitoring of workers’ safety and health.[9]

In 2008, NIOSH coordinated a multi-agency effort to begin drafting the ERHMS framework.[10][11]

Influence of the Deepwater Horizon oil spill response

See also: Deepwater Horizon oil spill response

In 2010, while the ERHMS framework was still in development, the Deepwater Horizon oil spill took place. NIOSH and the Unified Area Command (UAC), the response command center for the spill, implemented some of the initial ERHMS guidelines, including deployment-phase rostering, injury and illness surveillance, assessment of and protection from chemical and environmental exposures, as well as prompt and accessible communication with workers and their communities.[12][13][14]

Difficulties encountered in the spill response led NIOSH researchers to make recommendations that were then implemented in the evolving ERHMS framework.[14] These recommendations included improving the rostering process both in the pre-deployment and deployment phases to ensure registration of all workers involved and better communication and transmission of guidance about environmental risks. Additional recommendations for the deployment phase included increased personal protective equipment (PPE) use, better management of heat stress, and improved reporting of exposures, illnesses, and injuries. NIOSH also recommended the creation of a decision matrix to determine the need for biological monitoring of workers. These recommendations were addressed in the finalized ERHMS documents.

Publication

The ERHMS working group released the documents for public comment in 2011.[14][15] Among the groups that provided comments were the New York City Office of Emergency Management, the Collaborative for People with Disabilities, the National Clearinghouse for Worker Safety and Health Training, the National Association of State EMS Officials, the National Association of Emergency Medical Technicians, and Brigham and Women's Hospital.[16] In 2011, NIOSH implemented ERHMS in a large scale inter-agency training exercise.[10]

The finalized framework, titled in full the “Emergency Responder Health Monitoring and Surveillance (ERHMS) NRT Technical Assistance Document (TAD)” was published on January 20, 2012, and a companion document, “Emergency Responder Health Monitoring and Surveillance: A Guide for Key Decision Makers,” was published on February 6, 2012.[17] The ERHMS framework is explained in two trainings; an online course consisting of four one-hour modules for all responders, and a one-hour leadership training module.[18][19][20]

Brief summary of guidelines

Pre-deployment phase

ERHMS guidelines for the pre-deployment phase include rostering and credentialing the emergency workers, screening workers for medical and psychological problems to determine their role in the response and to establish baselines, and conducting health and safety training.[21]

Deployment phase

During deployment, ERHMS guidelines recommend additional as-needed on-site rostering and on-site safety training. Further, they recommend the implementation of a Health and Safety Plan (HASP), which monitors and documents worker activities and use of personal protective equipment, assesses any potential exposures, and surveys responder illness and injury, both physical and mental, throughout the duration of the response. In addition, the guidelines recommend that information about environmental exposures be communicated to workers in real time.[21]

Post-deployment phase

ERHMS post-deployment guidelines provide for exit interviews or surveys to capture and analyze exposures in order to determine the need for long-term monitoring of emergency responder health, or to identify subsets of responders who would benefit from future health monitoring. In addition, the guidelines recommend long-term follow-up in instances in which delayed or long-term adverse effects of deployment are possible. Finally, the guidelines provide for the creation of an after-action report, in which the management of the emergency response during all phases would be evaluated in order to identify lessons learned and areas for improvement.[21]

Contributors

United States agencies that contributed to the framework include NIOSH, a division of the Centers for Disease Control and Prevention (CDC), FEMA, the U.S. Coast Guard, the Department of Defense (DOD), the Department of Health and Human Services (DHHS), the Department of Labor, the Department of Homeland Security, and the National Institute of Environmental Health Sciences (NIEHS), among others. The consortium also included other stakeholders such as the Center for Construction Research and Training (CPWR), state health departments, and volunteer responder group the American Red Cross.[17]

Further reading

See also

External links

References

  1. ↑ Borkowski, Liz. "Keeping emergency responders safe and healthy". The Pump Handle. ScienceBlogs. Retrieved 5 March 2014.
  2. ↑ "ERHMS: A Guide for Key Decision Makers" (PDF). Retrieved 5 March 2014.
  3. ↑ "FEMA Training for Responder Health Monitoring and Surveillance Now Online". EMS World. 18 September 2013. Retrieved 5 March 2014.
  4. ↑ "Public Health Preparedness Capabilities: National Standards for State and Local Planning". CDC. Retrieved 5 March 2014.
  5. ↑ Smith, Sandy (21 August 2002). "McKinsey Report Examines NYC Emergency Response to 9/11". EHS Today. Retrieved 5 March 2014.
  6. ↑ Jackson; et al. "Protecting Emergency Responders, Volume 3: Safety Management in Disaster and Terrorism Response". RAND Corporation. Retrieved 5 March 2014.
  7. 1 2 Jackson, Brian A. "Protecting Emergency Responders at Large-Scale Incidents: Lessons Learned from the Response to the Attacks on the World Trade Center". RAND Corporation. Retrieved 5 March 2014.
  8. 1 2 Bascetta, Cynthia A. "September 11: HHS Needs to Develop a Plan That Incorporates Lessons from the Responder Health Programs". Government Accountability Office. Retrieved 5 March 2014.
  9. ↑ Sherrill, Andrew. "Disaster Preparedness: Better Planning Would Improve OSHA's Efforts to Protect Workers' Safety and Health in Disasters". Government Accountability Office. Retrieved 5 March 2014.
  10. 1 2 "NIOSH develops tool to monitor disaster responders' health". Industrial Safety & Hygiene News (ISHN). 10 August 2012. Retrieved 5 March 2014.
  11. ↑ Howard, John. "New Health Monitoring and Surveillance Tool For First Responders". CDC. Retrieved 5 March 2014.
  12. ↑ Michaels, David; John Howard (18 July 2012). "Review of the OSHA-NIOSH Response to the Deepwater Horizon Oil Spill: Protecting the Health and Safety of Cleanup Workers". PLOS Current Disasters. Edition 1. doi:10.1371/4fa83b7576b6e.
  13. ↑ "First Responders' Safety -- Lessons from the BP Oil Spill". OHS Insider. Retrieved 5 March 2014.
  14. 1 2 3 Kitt, Margaret M.; John A. Decker; Lisa Delaney; Renee Funk; John Halpin; Allison Tepper; James Spahr; John Howard (July 2011). "Protecting Workers in Large-Scale Emergency Responses: NIOSH Experience in the Deepwater Horizon Response". Journal of Environmental and Occupational Health. 53 (7): 711–715. doi:10.1097/JOM.0b013e31822543b6. PMID 21697736.
  15. ↑ Walter, Laura (4 February 2011). "NIOSH Seeks Comment on Emergency Responder Health Monitoring and Surveillance Recommendations". EHS Today. Retrieved 5 March 2014.
  16. ↑ "NIOSH Docket Number 223: Emergency Responder Health Monitoring and Surveillance". CDC. Retrieved 5 March 2014.
  17. 1 2 "Emergency Responder Health Monitoring and Surveillance Document". National Response Team. Retrieved 5 March 2014.
  18. ↑ "Emergency Responder Health Monitoring and Surveillance (ERHMS) Online Training Course". CDC TRAIN. Retrieved 5 March 2014.
  19. ↑ "IS-930: Emergency Responder Health Monitoring and Surveillance (ERHMS) System: Leadership Training". CDC TRAIN. Retrieved 5 March 2014.
  20. ↑ Kitt, Margaret M. "Updates from the NIOSH Office of the Director" (PDF). NIOSH. Retrieved 5 March 2014.
  21. 1 2 3 Hellman, Greg (10 February 2011). "NIOSH Recommends Health Monitoring, Surveillance Framework for First Responders". Occupational Safety & Health Reporter. Retrieved 6 March 2014.
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