Emergency Responder Health Monitoring and Surveillance “ERHMS” John Halpin, M.D., MPH and Renee Funk DVM, MPH Emergency Preparedness and Response Office National Institute for Occupational Safety and Health

Overview 1) Background 2) Overview of ERHMS concepts 3) Evaluation of the ERHMS concept 4) Past and Recent activities 5) Future activities planned

Background Why this is important….. 3

Precursor to ERHMS concepts

“To effectively characterize the consequences to responders’ long-term health, it is clear that an accurate registry of involved responders, preferably compiled as the response is under way, is a prerequisite to any eventual surveillance or treatment effort.”

“Understanding where people were and what they were doing during the event is key for post-event intervention, and it is very difficult to reconstruct after the fact if the data were not originally collected.”

“Tracking of post-disaster health problems is also complicated by lack of baseline data and accountability information for responder activities during the response.”

GAO Report on WTC Health Monitoring 8

Recommendations include the need to: –Quickly identify and contact people affected by a disaster –Monitor for mental health effects, as well as physical injuries and illnesses –Anticipate when designing disaster-related monitoring efforts that there will likely be many people who require referrals for follow-up care. 9

Overview of ERHMS 10

Goals of ERHMS Pre- Event: Ensure only qualified, trained, and properly equipped personnel are selected for deployment During Event: Ensure all receive sufficient on site training, monitoring, and risk assessment. Post: Ensure responders receive long-term tracking of health where appropriate and recommended

Schematic of ERHMS Post-event tracking decision

EHRMS Tracking Decision Process 13

ERHMS Workgroup members NIOSH (coordinating) National Response Team American Red Cross Army Center to Protect Workers’ Rights Coast Guard Dept of Homeland Security Env Protection Agency Fed Emerg Mngt Agency HHS, Asst Sec for Prep and Response InterAgency Board International Assoc of Firefighters Natl Inst for Env Health Sciences (NIEHS) Occupational Safety and Health Administration US Army Corps of Engineers State Health Depts: OR, CA 14

Evaluation 15

NIOSH Docket 223

Internal and External Peer Review Internal Review –NIOSH (DSHEFS, EID) –NCEH External Review –Civilian Contractor (Phillips and Jordan) –PRIMA (Public Risk Management Assoc) –ACOEM (American College of Occ and Env Medicine) –AIHA (American Industrial Hygiene Assoc) –IAB (Inter-Agency Board) 17

Applications of ERHMS Deepwater Horizon Response Federal Bio-Terror Response Exercise 19

Deepwater Horizon Response 20

Deepwater Horizon Response 21

Deepwater Horizon Response Pre-Placement Evaluation 22

Roster efforts at Staging Areas

NIOSH Report of UC/BP Injury and Illness Data 25

NIOSH Report of UC/BP Injury and Illness Data

Federal Bio-Terror Response BOTE (Bio-Response Operations and Training Exercise) 27

BOTE Exercise Designed to conduct and evaluate improved anthrax sampling strategies and decontamination technologies Exercised the cooperation and coordination of officials from law enforcement, public health, and environmental agencies –Dept of Justice –Dept of Homeland Security –Dept of Energy –Environmental Protection Agency –Centers for Disease Control and Prevention –Idaho National Labs

Goals for the BOTE Exercise Data collection and analysis of the following issues: –Responder credentialing and training –Responder baseline medical status (medical conditions, medications, immunizations) –PPE requirements and use –Health Surveillance (injuries, illnesses, pre-entry vitals) –Exposure assessment and safety data (PPE breaches, etc) –Self-reported documentation of health and safety over course of event (physical and mental health, use of PPE, hazardous exposures) 29

Electronic Data Collection 30

Future Activities 31

Future plans for ERHMS project “Implementation” phase of development –Electronic database –Field Tools –Training materials –Field-testing of ERHMS concepts