Emergency Responder Emergency Responder Health Monitoring and Health Monitoring and

Surveillance Surveillance “ERHMS”“ERHMS”

John Halpin, M.D., MPH and Renee Funk DVM, MPHjhalpin@cdc.gov RFunk@cdc.gov

Emergency Preparedness and Response OfficeNational Institute for Occupational Safety and Health

OverviewOverview

1)  Background 

2)  Overview of ERHMS concepts

3)  Evaluation  of the ERHMS concept

4)  Past and Recent activities

5)  Future activities planned

BackgroundWhy this is important…..

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Precursor to ERHMS conceptsPrecursor 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

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GAO Report on WTC Health GAO Report on WTC Health MonitoringMonitoring

• 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 ERHMSGoals 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 ERHMSSchematic of ERHMS

Post-event tracking decision

EHRMS Tracking Decision Process EHRMS Tracking Decision Process

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ERHMS Workgroup membersERHMS 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

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NIOSH Docket 223

Internal and External Peer Internal and External Peer ReviewReview

• 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.orgwww.ERHMS.nrt.org

Applications of ERHMSDeepwater Horizon Response

Federal Bio-Terror Response Exercise

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Deepwater Horizon Response

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Deepwater Horizon Response

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Deepwater Horizon ResponseDeepwater Horizon ResponsePre-Placement EvaluationPre-Placement Evaluation

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Roster efforts at Staging Roster efforts at Staging AreasAreas

Roster efforts at Staging Roster efforts at Staging AreasAreas

NIOSH Report of UC/BP Injury and NIOSH Report of UC/BP Injury and Illness DataIllness Data

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NIOSH Report of UC/BP Injury and NIOSH Report of UC/BP Injury and Illness DataIllness Data

Federal Bio-Terror ResponseBOTE

(Bio-Response Operations and Training Exercise)

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BOTE ExerciseBOTE 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 ExerciseGoals 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 Future plans for ERHMS projectproject

• “Implementation” phase of development– Electronic database– Field Tools– Training materials– Field-testing of ERHMS

concepts