NIOSH Recommends Health Monitoring, Surveillance Framework for First Responders

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Emergency response agencies should develop a health monitoring and surveillance framework that includes key measures for “the entire cycle” of an incident beginning with the period before responders are deployed and concluding after they return, the National Institute for Occupational Safety and Health said Feb. 4.

The recommendations were contained in draft guidance published Feb. 4 in the Federal Register. Written comments are due April 4 (76 Fed. Reg. 6,475).

A NIOSH workgroup developed the draft guidelines to serve as a resource for the National Response Team and to better prepare the government for responding to large-scale disasters, such as the terrorist attacks on the World Trade Center or the Deepwater Horizon oil spill, NIOSH Director John Howard said in a written statement Feb. 1 when the guidelines were made public.

“This document is the result of our shared learning from these events and our combined commitment to protect those workers who respond in times of need,” he said.

Bill Borwegen, director of health and safety for the Service Employees International Union, noted at a Jan. 19 Occupational Safety and Health Administration advisory committee meeting that the National Response Framework, which outlines how to respond to significant threats, addresses the safety and health of responders but does not set requirements for them. Therefore, OSHA could be absent from a disaster site if its presence is not requested by the coordinating agency, leaving responders at risk, Borwegen said.

Pre-Deployment Rostering.

The proposed emergency responder health monitoring and surveillance system should feature pre-deployment preparations, such as a roster of emergency workers, health screening, and training, the guidance document said.

During the response to the World Trade Center attacks, no roster was kept on first responders, complicating future treatment efforts, according to institute officials (40 OSHR 555, 7/1/10).

By creating rosters and registering each responder's credentials, organizations can more effectively assign workers to tasks based on their qualifications, the guidance document said.

In addition, screening exams could be used to determine whether a responder meets the physical and emotional qualifications for the job, the document said.

On-the-spot training, meanwhile, should focus on site-specific potential dangers, it added.

“Many responders infrequently respond to disasters despite having had preparedness training,” the document said. “The problem with infrequent occurrence is lack of reinforcement and loss of retention.”

Deployment Monitoring.

Maintaining a roster of responders should continue at the site of an emergency and as soon as a disaster perimeter is established, the document said.

After determining whether pre-event responder health information provides an adequate baseline, the appropriate authority should decide who needs to be monitored during the response, it said.

Factors to consider include whether contaminant exposures are at levels that could result in adverse health effects; whether exposures are complex or mixed; whether work conditions may result in adverse outcomes; and whether hazardous activities and corresponding control measures are present.

“Monitoring and documenting the illness and injury status of incident personnel during an event is important because it may allow for prompt recognition of risks that may be amenable to intervention,” the document said.

Monitors can glean data from OSHA injury and illness records, health care facilities, or through health surveys they administer themselves, it said.

Post-Deployment Tracking.

Monitors should record sufficient personal and work-related data to identify responders who may need future evaluation and enable medical tracking, the guidance document said.

That information should include contact information, known hazardous exposures or conditions, descriptions of work tasks, answers to qualitative questions on topics such as training, and to questions on injuries or illnesses sustained during the response, it said.

Monitors should also develop criteria for who should be included in post-response medical monitoring and how that monitoring should be conducted, it added.

Written comments are due April 4 and should be submitted to under Docket No. NIOSH-223.

By Greg Hellman

NIOSH's draft document is available at