View source for Emergency Responder Health Monitoring and Surveillance

[[File:Emergency Responder Health Monitoring and Surveillance Overview.webm|thumb|An overview of ERHMS]]
'''Emergency Responder Health Monitoring and Surveillance (ERHMS)''' is a health monitoring and surveillance framework developed by a consortium of federal agencies, state health departments, and volunteer responder groups designed to address existing gaps in surveillance and health monitoring of emergency responders.<ref>{{cite web|last=Borkowski|first=Liz|title=Keeping emergency responders safe and healthy|url=http://scienceblogs.com/thepumphandle/2012/10/30/keeping-emergency-responders-safe-and-healthy/|work=The Pump Handle|publisher=ScienceBlogs|accessdate=5 March 2014}}</ref> The framework provides recommendations, guidelines, tools, and trainings to protect [[emergency responders]] during each phase of an emergency response, including pre-deployment, deployment, and post-deployment phases. ERHMS was designed to function within the [[Federal Emergency Management Agency|Federal Emergency Management Agency's]] (FEMA's) [[National Incident Management System]] (NIMS), a systematic approach to emergency management.<ref>{{cite web|url=http://nrt.sraprod.com/ERHMS/ERHMSDocs/ERHMS_Decisionmakers_060512.pdf|title=ERHMS: A Guide for Key Decision Makers|archiveurl=https://web.archive.org/web/20140310211958/http://nrt.sraprod.com/ERHMS/ERHMSDocs/ERHMS_Decisionmakers_060512.pdf|archivedate=10 March 2014|url-status=dead|accessdate=5 March 2014}}</ref> The ERHMS trainings satisfy Public Health Emergency Preparedness capability 14, "Responder Safety and Health."<ref>{{cite news|url=http://www.emsworld.com/news/11172757/femas-emergency-responder-health-monitoring-and-surveillance-erhms-system-now-online|title=FEMA Training for Responder Health Monitoring and Surveillance Now Online|date=18 September 2013|newspaper=EMS World|accessdate=5 March 2014}}</ref><ref>{{cite web|url=https://www.cdc.gov/phpr/capabilities/|title=Public Health Preparedness Capabilities: National Standards for State and Local Planning|publisher=CDC|accessdate=5 March 2014}}</ref>
The guidelines and recommendations address the medical screening, training, rostering, surveillance and health monitoring of emergency responders. The framework includes different backgrounds such as 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. This framework is designed for different types of events, independently of its magnitude, some events may include [[terrorist attacks]], [[chemical spills]], and [[natural disasters]] such as [[hurricanes]], [[floods]] and [[earthquakes]].
== Background and purpose ==
After the health effects among emergency responders to the [[September 11, 2001 attacks]] at the [[World Trade Center (1973–2001)|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.<ref>{{cite news|last=Smith|first=Sandy|title=McKinsey Report Examines NYC Emergency Response to 9/11|url=http://ehstoday.com/news/ehs_imp_35764|accessdate=5 March 2014|newspaper=EHS Today|date=21 August 2002}}</ref>  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.<ref>{{cite web|last=Jackson|title=Protecting Emergency Responders, Volume 3: Safety Management in Disaster and Terrorism Response|url=http://www.rand.org/pubs/monographs/MG170.html|publisher=RAND Corporation|accessdate=5 March 2014|display-authors=etal}}</ref>  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.<ref name="jackson">{{cite web|last=Jackson|first=Brian A.|title=Protecting Emergency Responders at Large-Scale Incidents: Lessons Learned from the Response to the Attacks on the World Trade Center|url=http://www.rand.org/pubs/testimonies/CT291.html|publisher=RAND Corporation|accessdate=5 March 2014}}</ref>
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 [[World Trade Center Health Program|WTC health programs]].”<ref name="bascetta">{{cite web|last=Bascetta|first=Cynthia A.|title=September 11: HHS Needs to Develop a Plan That Incorporates Lessons from the Responder Health Programs|url=http://www.gao.gov/products/GAO-08-610|publisher=Government Accountability Office|accessdate=5 March 2014}}</ref>   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.<ref name="bascetta"/>
In 2008, NIOSH coordinated a multi-agency effort to begin drafting the ERHMS framework.<ref name="ISHN">{{cite news|title=NIOSH develops tool to monitor disaster responders' health|url=http://www.ishn.com/articles/93838-niosh-develops-tool-to-monitor-disaster-responders--health|accessdate=5 March 2014|newspaper=Industrial Safety & Hygiene News (ISHN)|date=10 August 2012}}</ref><ref>{{cite web|last=Howard|first=John|title=New Health Monitoring and Surveillance Tool For First Responders|url=https://www.cdc.gov/niosh/enews/enewsV10N4.html|publisher=CDC|accessdate=5 March 2014}}</ref>
=== 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), 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.<ref>{{cite journal|last=Michaels|first=David|author2=John Howard|title=Review of the OSHA-NIOSH Response to the Deepwater Horizon Oil Spill: Protecting the Health and Safety of Cleanup Workers|journal=PLOS Currents: Disasters|date=18 July 2012|series=Edition 1|volume=4|pages=e4fa83b7576b6e|doi=10.1371/4fa83b7576b6e|pmid=24678440|pmc=3957409 |doi-access=free }}<!--|accessdate=5 March 2014--> {{open access}}</ref><ref>{{cite web|title=First Responders' Safety -- Lessons from the BP Oil Spill|url=http://ohsinsider.com/search-by-index/accidentsincidents/first-responders-safety-lessons-from-the-bp-oil-spill#|work=OHS Insider|accessdate=5 March 2014}}</ref><ref name="kitt">{{cite journal|last=Kitt|first=Margaret M.|author2=John A. Decker |author3=Lisa Delaney |author4=Renee Funk |author5=John Halpin |author6=Allison Tepper |author7=James Spahr |author8=John Howard |title=Protecting Workers in Large-Scale Emergency Responses: NIOSH Experience in the Deepwater Horizon Response|journal=Journal of Environmental and Occupational Health|date=July 2011|volume=53|issue=7|pages=711–715|doi=10.1097/JOM.0b013e31822543b6|pmid=21697736|s2cid=11060351|url=https://zenodo.org/record/1234891}}</ref>
Difficulties encountered in the spill response led NIOSH researchers to make recommendations that were then implemented in the evolving ERHMS framework.<ref name="kitt"/> 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.
== Brief summary of guidelines ==
[[File:ERHMS framework phases.png|thumb|ERHMS framework phases]]
=== Pre-deployment phase ===
On the pre-deployment phase the ERHMS framework makes an emphasis on preparedness and establishes the foundations for monitoring and surveillance of responders. Pre-deployment focuses on key activities including rostering and credentialing of emergency response and recovery workers, health screening and immunizations, health and safety training and data managing and information security.<ref name="hellman">{{cite news|last=Hellman|first=Greg|title=NIOSH Recommends Health Monitoring, Surveillance Framework for First Responders|url=http://www.bna.com/niosh-recommends-health-n4866/|accessdate=6 March 2014|newspaper=Occupational Safety & Health Reporter|date=10 February 2011}}</ref><ref>{{Cite web|url=https://www.cdc.gov/niosh/erhms/predeploy.html|title=CDC - Pre-Deployment - Emergency Responder Health Monitoring and Surveillance (ERHMS) - NIOSH Workplace Safety and Health Resource|date=2018-12-06|website=www.cdc.gov|language=en-us|access-date=2019-05-10}}</ref>
=== Deployment phase ===
During deployment, ERHMS guidelines recommend additional as-needed on-site rostering and on-site safety training. The deployment phase focuses on key activities such as on-site responder in-processing, health monitoring and surveillance, exposure assessment activities and controls, and communication of exposure and health data. Further, ERHMS recommends 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 provide recommendations on how to conduct all of these activities and also how to communicate environmental exposures to workers in real time.<ref name="hellman" />
=== Post-deployment phase ===
ERHMS post-deployment guidelines focus on out-processing assessment, determination of need for health tracking and after action reporting. The guidelines recommend conducting 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, ERHMS provides for the creation of an [[After action report|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.<ref name="hellman" />
== Publications ==
=== Technical documents and online training ===
The ERHMS working group released the documents for public comment in 2011.<ref name="kitt" /><ref>{{cite news|url=http://ehstoday.com/fire_emergencyresponse/news/niosh-comment-emergency-responder-health-0204|title=NIOSH Seeks Comment on Emergency Responder Health Monitoring and Surveillance Recommendations|last=Walter|first=Laura|date=4 February 2011|newspaper=EHS Today|accessdate=5 March 2014}}</ref> 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]].<ref>{{cite web|url=https://www.cdc.gov/niosh/docket/archive/docket223.html|title=NIOSH Docket Number 223: Emergency Responder Health Monitoring and Surveillance|publisher=CDC|accessdate=5 March 2014}}</ref>
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.<ref name="ERHMSNRT">{{cite web|url=http://erhms.nrt.org|title=Emergency Responder Health Monitoring and Surveillance Document|publisher=National Response Team|accessdate=5 March 2014}}</ref>   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.<ref>{{cite web|url=https://cdc.train.org/DesktopModules/eLearning/CourseDetails/CourseDetailsForm.aspx?tabid=62&courseid=1045755&backURL=L0Rlc2t0b3BTaGVsbC5hc3B4P3RhYklkPTYyJmdvdG89YnJvd3NlJmJyb3dzZT1rZXl3b3JkJmtleXdvcmQ9ZXJobXMma2V5b3B0aW9uPUJvdGgmY2xpbmljYWw9Qm90aCZsb2NhbD1BbGwmQnlDb3N0PTA=|title=Emergency Responder Health Monitoring and Surveillance (ERHMS) Online Training Course|publisher=CDC TRAIN|accessdate=5 March 2014}}</ref><ref>{{cite web|url=https://cdc.train.org/DesktopModules/eLearning/CourseDetails/CourseDetailsForm.aspx?tabid=62&courseid=1046729&backURL=L0Rlc2t0b3BTaGVsbC5hc3B4P3RhYklkPTYyJmdvdG89YnJvd3NlJmJyb3dzZT1rZXl3b3JkJmtleXdvcmQ9ZXJobXMma2V5b3B0aW9uPUJvdGgmY2xpbmljYWw9Qm90aCZsb2NhbD1BbGwmQnlDb3N0PTA=|title=IS-930: Emergency Responder Health Monitoring and Surveillance (ERHMS) System: Leadership Training|publisher=CDC TRAIN|accessdate=5 March 2014}}</ref><ref>{{cite web|url=http://www.ucdenver.edu/academics/colleges/PublicHealth/research/centers/maperc/education/conferences/weston/Documents/Updates.pdf|title=Updates from the NIOSH Office of the Director|last=Kitt|first=Margaret M.|publisher=NIOSH|archiveurl=https://web.archive.org/web/20140310212240/http://www.ucdenver.edu/academics/colleges/PublicHealth/research/centers/maperc/education/conferences/weston/Documents/Updates.pdf|archivedate=10 March 2014|url-status=dead|accessdate=5 March 2014}}</ref>
=== Software  ===
NIOSH developed a free software platform named [https://www.cdc.gov/niosh/erhms/erhms-info-manager.html ERHMS Info Manager] designed to track and monitor emergency response and recovery workers during a response. The software supports organizations efforts to implement the ERHMS framework, facilitating data collection, assessment, analysis and reporting.
== Further reading ==
* [http://erhms.nrt.org ERHMS documents]
* [https://www.cdc.gov/niosh/topics/erhms/ NIOSH ERHMS topic page]
*[https://www.cdc.gov/niosh/erhms/erhms-info-manager.html ERHMS Tools & Resources]
* [https://cdc.train.org/DesktopModules/eLearning/CourseDetails/CourseDetailsForm.aspx?tabid=62&courseid=1046729&backURL=L0Rlc2t0b3BTaGVsbC5hc3B4P3RhYklkPTYyJmdvdG89YnJvd3NlJmJyb3dzZT1rZXl3b3JkJmtleXdvcmQ9ZXJobXMma2V5b3B0aW9uPUJvdGgmY2xpbmljYWw9Qm90aCZsb2NhbD1BbGwmQnlDb3N0PTA= ERHMS leadership training]
* [https://cdc.train.org/DesktopModules/eLearning/CourseDetails/CourseDetailsForm.aspx?tabid=62&courseid=1045755&backURL=L0Rlc2t0b3BTaGVsbC5hc3B4P3RhYklkPTYyJmdvdG89YnJvd3NlJmJyb3dzZT1rZXl3b3JkJmtleXdvcmQ9ZXJobXMma2V5b3B0aW9uPUJvdGgmY2xpbmljYWw9Qm90aCZsb2NhbD1BbGwmQnlDb3N0PTA= ERHMS emergency responder training]
== See also ==
* [[National Incident Management System]] (NIMS)
* [[National Response Plan]] (NRP)
* [[National disaster recovery framework]] (NDRF)
* [[World Trade Center Health Program]]
* [[Response analysis]]
== External links ==
* [https://www.youtube.com/watch?v=yBp9sX_pako ERHMS overview video]
* [https://www.cdc.gov/niosh/topics/emergency.html NIOSH Emergency Preparedness & Response website]
* [http://www.fema.gov/national-incident-management-system National Incident Management System (NIMS)]
* [https://www.cdc.gov/phpr/ CDC Office of Public Health Preparedness and Response]
* [http://www.nrt.org/ National Response Team website] {{Webarchive|url=https://web.archive.org/web/20110812041443/http://www.nrt.org/ |date=2011-08-12 }}
== References ==
{{reflist|2}}
[[Category:Emergency services in the United States]]
[[Category:Occupational safety and health]]