Unprepared! Unprepared! NIOSH has also found a large # of agencies - PDF document

Occupational Health Monitoring for Emergency Responders Bruce Bernard, MD, MPH Captain, United States Public Health Service (ret); Consultant, CDC/NIOSH I have nothing to disclose “The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention.” Unprepared! Unprepared! NIOSH has also found a large # of agencies are unprepared for most emergencies… and while the Incident Command System (ICS) and NIMS * are out there, most Emergency Responder Groups are not assessed, monitored, or followed ‐ up adequately…. * NIMS= National Incident Management System What do we want to know? Before the emergency event (Pre ‐ deployment), which responders are: “Ready” to deploy – physically and mentally fit Qualified, with the right training and licenses Provided all the correct personal protective equipment, gear, immunizations

What do we want to know? During an emergency event (Deployment): Who are the responders deployed and how are we keeping track of them? How are we monitoring their exposures, and how are we protecting them on ‐ site when there are newly found exposures? How are we tracking their activities and their health and safety during the response ? We want to know: After the emergency (Post ‐ Deployment): What happens with all the data from the response? How do we make decisions about tracking responder health? When is post ‐ disaster tracking necessary? What can we learn from the information gathered from the response to improve the NEXT response? How can we document all of this information to ensure and track their health and safety later on…… To Address these things To Address these things NIOSH created ERHMS NIOSH created ERHMS ERHMS is the Emergency Health Monitoring and Surveillance framework which addresses 3 phases of a response: Pre ‐ deployment Deployment Post ‐ deployment The goal of ERHMS is to have organized information to be able to prevent short-term and long-term illness and injury in emergency responders and recovery workers.

Objectives of this Objectives of this Session Session 1. Examine ERHMS Framework which documents exposures/health data prior to AND during emergency response. 2. Learn organizing, sharing, communicating data from monitoring and assessing the health and exposures of responders. 3. Use data “Post ‐ response” to assess which responders benefit from medical referral, long ‐ term health surveillance, research, or need no follow ‐ up . We set up ERHMS* as We set up ERHMS* as a 3-Phase System a 3-Phase System 2 DEPLOYMENT 1 3 PRE - DEPLOYMENT POST - DEPLOYMENT *Emergency Responder Health Monitoring and Surveillance ERHMS had input from ERHMS had input from Multiple U.S. agencies Multiple U.S. agencies 9 NI OSH (coordinator) State Health Departments :  e.g., Oregon, California Federal Govt Agencies:  Federal Emergency Volunteer Organizations Management Agency  e.g, American Red Cross  Occupational Safety and Health Administration Unions:  Health and Human Services  E.g., International Assoc of  Environmental Protection Firefighters Agency  Center for Construction and  Homeland Security Research Department  Coast Guard  InterAgency Board  US Army Corps of Engineers

ERHMS is part of the ERHMS is part of the National Response Team National Response Team It has been approved by 17 U.S. Agencies Full Document is Available at: ERHMS.nrt.org and www.cdc.gov/niosh/topics/erhms The BEST thing about ERHMS is that it contains “TOOLS,” examples & forms that have been used in actual events… You don’t have to start from You don’t have to start from Scratch with ERHMS Scratch with ERHMS Recently, NIOSH developed ERHMS InfoManager, a data and statistical package using CDC’s freeware Epi ‐ Info to organize responder data. Create electronic rosters, surveys, medical records, industrial hygiene data Contains templates of surveys, exam forms, etc. Does data analysis, statistics, cross ‐ tabulation, stratifications, calculates odds ratios, risk ratios, and risk differences, logistic regression https://www.cdc.gov/niosh/erhms/ software/default.html Pre-Deployment Phase Pre-Deployment Phase 2 DEPLOYMENT 1 3 PRE - DEPLOYMENT POST - DEPLOYMENT

Pre-Deployment Phase Pre-Deployment Phase Emphasizes preparedness for response Focus : 4 key activities that occur before a response: Consent/Data Rostering and Health Health and Management/ Credentialing Screening / Safety Training Information Immunizations Security Pre-Deployment Pre-Deployment Rostering & Rostering & Credentialing Credentialing Creates a list or (roster) of emergency responders  Documents demographics, contacts, employment information, credentials, and licenses The Key Components of The Key Components of Rostering & Credentialing Rostering & Credentialing 1. Registration : records the information about each responder and creates a record Individual data, training and education, and experience 2. Emergency credentialing : allows assignment of credential level and simplifies placement during an emergency Based on responder certifications, education, and organization’s vetting and recommendations 3. Reverification: requires periodic confirmation of responder information

Pre-Deployment Phase Pre-Deployment Phase 2nd activity to occur before a response : Rostering and Health Health and Safety Data Management / Credentialing Training Screening / Information Security Immunizations Why Require Why Require Health Screening? Health Screening? To ensure that EVERY responder, recovery worker, and volunteer is fit for deployment, and is able do the work. Responders need to be assessed in advance (at baseline) as well as periodically so they can be properly placed at the right job in an emergency. What information is What information is included in included in Pre-Deployment Health Pre-Deployment Health Screening? (1 of 3) Screening? (1 of 3) ERHMS suggests collecting: ERHMS suggests collecting: Background Background • Demographics • Demographics • Contact Info • Contact Info • Usual Occupation/Industry • Usual Occupation/Industry • Years at job • Years at job • Supervisor name & phone • Supervisor name & phone • Languages Spoken • Languages Spoken • Prior Military Experience • Prior Military Experience

What information is What information is included in included in Pre-Deployment Health Pre-Deployment Health ERHMS suggests collecting: ERHMS suggests collecting: Screening? (2 of 3) Screening? (2 of 3) Medical History Medical History • Review of Systems • Review of Systems • Specific Allergies • Specific Allergies • Specific mobility limitations • Specific mobility limitations • Prior toxic and traumatic • Prior toxic and traumatic exposures exposures • Past radiation exposure • Past radiation exposure • Smoking hx • Smoking hx • Meds & need for refrigeration • Meds & need for refrigeration • Documenting access needs – • Documenting access needs – hearing aids, braces hearing aids, braces • Immunizations • Immunizations What information is What information is included in included in Pre-Deployment Health Pre-Deployment Health ERHMS suggests collecting: ERHMS suggests collecting: Screening? (3 of 3) Screening? (3 of 3) Behavioral History Behavioral History • Pre ‐ existing psychiatric or • Pre ‐ existing psychiatric or psychological conditions psychological conditions • Post ‐ Traumatic Stress • Post ‐ Traumatic Stress Disorder Disorder • Depression • Depression • Violent tendencies • Violent tendencies • Suicide risk • Suicide risk • Overuse of alcohol • Overuse of alcohol • Drug abuse • Drug abuse Responders found to have elevated risks for developing PTSD and Depression Due to frequency and severity of traumatic exposures. Category PSTD Risk* Law Enforcement 6 ‐ 32% EMT/Paramedics 9 ‐ 22% Firefighters 17 ‐ 32% General Pop 7 ‐ 12% *Derived mostly from small-scale, retrospective studies using self-reported measures, rather than from diagnostic clinical interviews