Emergency Responder Health Monitoring and Surveillance

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Emergency Responder Health Monitoring and
Surveillance ERHMS
John Halpin, M.D., MPH and Renee Funk DVM,
MPHjhalpin_at_cdc.gov
RFunk_at_cdc.gov Emergency Preparedness and
Response OfficeNational Institute for
Occupational Safety and Health
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Overview

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

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BackgroundWhy this is important..
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Precursor to ERHMS concepts
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• 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.

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• 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.

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

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GAO Report on WTC Health Monitoring
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GAO Report on WTC Health Monitoring

• 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.
  

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Overview of ERHMS
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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

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Schematic of ERHMS
Post-event tracking decision
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EHRMS Tracking Decision Process
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ERHMS Workgroup members

• 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

• 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

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Evaluation
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NIOSH Docket 223
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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)

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www.ERHMS.nrt.org
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Applications of ERHMSDeepwater Horizon
ResponseFederal Bio-Terror Response Exercise
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Deepwater Horizon Response
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Deepwater Horizon Response
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Deepwater Horizon ResponsePre-Placement
Evaluation
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Roster efforts at Staging Areas
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Roster efforts at Staging Areas
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NIOSH Report of UC/BP Injury and Illness Data
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NIOSH Report of UC/BP Injury and Illness Data
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Federal Bio-Terror ResponseBOTE (Bio-Response
Operations and Training Exercise)
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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

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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)

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Electronic Data Collection
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Future Activities
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Future plans for ERHMS project

• Implementation phase of development
• Electronic database
• Field Tools
• Training materials
• Field-testing of ERHMS concepts