New Health Monitoring and Surveillance Tool For First Responders

Source: NIOSH August 2012 eNews
By John Howard, M.D., Director, NIOSH

Emergency responders have been called to duty over the past decade by an increasing number of natural and man-made disasters, as evidenced by 9/11 in 2001, Hurricane Katrina in 2005, and Deepwater Horizon oil spill in 2010. As each large-scale disaster occurred, the importance of how best to ensure the safety and health of paid and volunteer emergency responders before, during, and after a disaster has grown. While some guidance had been developed about how best to prepare response workers both before and during deployment, less attention had been placed on assessing responders’ health after they complete their deployment.
Post-deployment assessment is important because long-term health effects on responders following disasters may not be readily apparent for many years, and reconstruction of exposure information needed for a long-term health monitoring and surveillance program can be difficult. This information includes where each responder was, doing what job tasks, for what length of time, what they were exposed to, as well as other important pieces of information. The Government Accountability Office and others have called for this information to be collected more prospectively throughout an incident. This information can be used both during the incident to mitigate acute safety and health concerns as well as provide the critical information needed to set up long-term health monitoring and surveillance systems quickly and effectively.
With this in mind, in 2008 NIOSH convened a multidisciplinary public health workgroup to address these concerns. The Emergency Responder Health Monitoring and Surveillance (ERHMS) system was developed in 2011 by this workgroup. It includes both written guidance and epidemiology/surveillance tools as examples of current best practices for protecting response, remediation, and recovery workers and volunteers.
The system is described in a new federal publication, “Emergency Responder Health Monitoring and Surveillance: Technical Assistance Document,” which was recently published by the National Response Team, an organization of 15 Federal departments and agencies, including NIOSH, responsible for coordinating emergency preparedness and response.
The ERHMS system can be applied in both smaller, localized incidents, as well as larger incidents. Importantly it provides guidance to help protect emergency responders before, during, and after an incident. The document provides tools and resources for response organizations that will help in ensuring the health and safety for responders within each phase of the incident and will assist organizations in monitoring the health of responders in the post-incident phase.
The next step in the development of this system has been to implement and field-test the principles and components of ERHMS in real-world emergency response events, practice exercises, and training venues. NIOSH successfully implemented some of the components of ERHMS in the Deepwater Horizon oil spill in 2010 such as rostering, injury and illness surveillance, and Health Hazard Evaluations. We more fully demonstrated ERHMS in a large scale interagency training exercise conducted last year, which also tested the utility of hand-held electronic data collection techniques.
NIOSH and other stakeholders among the centers and institutes of the U.S. Centers for Disease Control and Prevention (CDC) are currently seeking funding to conduct advance training seminars for public health agencies to learn more about ERHMS and other CDC-developed disaster response resources in order to better translate this research into practice.
The full ERHMS document as well as a summary document is available on the NIOSH web site or on the NRT web site at For a comprehensive list of emergency response resources from NIOSH please go to