Pre-Deployment

Practical Summary: Rostering and Credentialing

Rostering and credentialing information is gathered during pre-deployment and is used

in the deployment phase to inform on-site responder in-processing and create a roster
of appropriately qualified responders for the incident. The Pre-deployment roster may
be an automated/electronic database or a manual roster.

Initial rostering should be done by the response organization’s Human Resource

personnel before deployment, ideally, when a potential responder first joins a response
organization and updated on a regular basis, typically annually.

Tools used to collect the data may be Basic, Enhanced or Comprehensive.

• Basic tools consist of primarily self-reported information by the responders.

• Enhanced tools incorporate some sort of verification step for one or more pieces
of information, such as conducting background checks or verifying a professional
license.
• Comprehensive tools are mostly electronic systems, coordination during systems
design, features that allow compatibility among organizations and data systems
at deployed locations.

Rostering and Credentialing Tools:

1. Rostering
Information: http://www.scribd.com/doc/127560764/Basic-
Rostering#fullscreen
2. ENGLink: https://eportal.usace.army.mil/sites/ENGLink/Interactive
/default.aspx
3. Emergency System for Advance Registration of Volunteer Health
Professionals (ESAR-
VHP): http://www.phe.gov/esarvhp/pages/about.aspx

Practical Summary: Health Screening

Pre-deployment health screening primarily establishes a baseline physical and

emotional health status of the responder and is also an opportunity to document the
immunization status of the responder.
It is used to document and detect conditions that may impact a responder’s physical
and emotional fitness to perform the essential expected functions of the responder in
an emergency setting.

Health screening information must be kept confidential.

Factors to be Considered During Health Screening:

• Response settings and conditions
• Response tasks
• Personal risk factors
• Cognitive or emotional stability in chaotic and stressful environments
• History of adverse consequences after traumatic exposures
• Concerns for family or dependent care

Health screening can vary in scope by the type of responder and the expected functions
of the responder in an emergency setting. A health professional would typically be the
one who would certify that a responder is fit for deployment in specific assignments.

Fitness Categories:
• Cleared with no restrictions
• Cleared with specified restrictions (e.g., types of activities, exposures)
• Recommended for additional training prior to clearance
• Recommended for further medical screening
• Not cleared for deployment
• Permanent disqualification
• Pending medical consultation or workup

Health Screening Tools:

1. Basic Pre-Deployment
Evaluation: http://www.scribd.com/doc/127782926/Basic-Pre-
Deployment-Evaluation
2. Enhanced Pre-Deployment
Evaluation: http://www.scribd.com/doc/127789079/Enhanced-Pre-
Deployment-Evaluation#fullscreen
3. Comprehensive Pre-Deployment Evaluation
Principles: http://www.scribd.com/doc/127786352/Comprehensive
-Pre-Deployment-Evaluation-Principles
 4. OSHA Respirator Medical Evaluation
Questionnaire: http://www.osha.gov/pls/oshaweb/owadisp.show_
document?p_table=STANDARDS&p_id=9783
5. Advisory Committee on Immunization Practices (ACIP)
Recommendations: http://www.cdc.gov/vaccines/pubs/ACIP-
list.htm

Practical Summary: Health and Safety Training

Pre-deployment health and safety training equips responders with the information and
tools needed to minimize illness and injury while responding to an incident. Health and
safety training during the pre-deployment response phase lessens the dependence on
just-in-time training and site-specific training (SST) during deployment.

Training should occur when a responder first joins an organization and on a regular
basis, typically annually, and is the responsibility of the response organization.

Health and safety training data can be used to…

• Assign responders tasks they can safely carry out
• Identify areas for site-specific training
• Evaluate the impact of training on responder health
• Determine the effectiveness of preparedness training

Response organizations may offer training online or jointly to emergency response

personnel for various reasons, including leveraging of agency resources, such as subject
matter experts, and when dealing with topics that involve multiple groups of
responders.

Health and Safety Training Tools:

1. Responder Training Documentation

Form: http://www.scribd.com/doc/127810067/Responder-Training-
Documentation-Form#fullscreen
2. Web-Based Training:
a. National Preparedness Directorate (NPD) Online
Courses: http://training.fema.gov
b. Citizen Corps: http://www.osha.gov/SLTC/emergencypreparedness/
c. US Fire
Administration: http://www.osha.gov/SLTC/emergencypreparedness/
d. FEMA’s Center for Domestic Preparedness: http://cdp.dhs.gov
e. FEMA Training: http://www.fema.gov/courses
 f. National Clearinghouse for Worker Safety and Health
Training: http://tools.niehs.nih.gov/wetp/
g. NIEHS HazMat Safety &
Training: http://www.niehs.nih.gov/careers/hazmat/
h. OSHA Emergency Preparedness and
Response: http://www.osha.gov/SLTC/emergencypreparedness/

Practical Summary: Data Management and Information Security

ERHMS data is created when a responder first joins a response organization. From the
start, the information must be confidential and maintained in a safe environment
whether electronic or paper.

An ERHMS data system documents, manages and maintains all health and safety related
information that is generated in the pre-deployment, deployment, and post-deployment
phases. During the pre-deployment phase this includes information about rostering and
credentialing, health status and health and safety training.

In addition, a data management system facilitates the sharing of data between

responding agencies, particularly during an emergency. IT specialists in each
organization must consider the interoperability of the data collection system used to
ensure sharing across organizations.

Data Management and Information Security Tools:

1. Data Management Checklist: http://www.scribd.com/doc/127811120/Data-

Management-Checklist#fullscreen

Pre-Deployment Summary

Review the list of Requirements of an Effective Pre-deployment ERHMS program and

consider whether or not your organization has met some or all of them. List those that
need further development or verification.

• Rostering and credentialing begins when a responder first joins an organization.

• A health professional would typically be the one who would certify that a
responder is fit for deployment in specific assignments.
• Health screening pertains to both physical and emotional assessment of a
responder.
• All personnel must receive appropriate and required training in advance of
deployment.
• Health and safety training data helps to assign responders to tasks for which they
are prepared.
 • Health and safety training helps to minimize illness and injury while responding
to an incident.

Review the list of Requirements of an Effective Pre-deployment ERHMS program and

consider whether or not your organization has met some or all of them. List those that
need further development or verification.

• Appropriate management of data includes securing the data starting when it is

first collected.
• Personal Identifying Information must be confidentially stored.
• ERHMS data, regardless of electronic or paper, must be capable of being shared
when required.
• All collected ERHMS data MUST be kept confidential and securely stored.
Deployment
Practical Summary: On-Site Responder In-Processing

On-site responder in-processing involves several activities which allow for identifying
personnel, maintaining accountability for responders, and tracking their engagement
during an incident response.

The Centralized Worker Roster is where information about the responder during
deployment is documented and maintained, such as responders’ participation in site-
specific training (SST), use of personal protective equipment (PPE), deployment tasks
and exposures, along with other health and safety related information about the
responder.

Securely linking this roster to other data sources, such as the ERHMS rostering and
credentialing system, enables efficient review and sharing of the data in support of
health monitoring and surveillance, exposure assessment and communication of that
information during and after deployment.

On-Site Responder In-Processing Tools:

1. NIOSH Deepwater Horizon Roster

Form: http://www.scribd.com/doc/127560738/NIOSH-Deepwater-Horizon-
Roster-Form#fullscreen
2. ICS Check-in/Check-out form (ICS 211): http://www.fema.gov/forms/job-aids-
tools-templates
3. Section 5T in ERHMS: http://www.scribd.com/doc/127993229/5T-
Tools#fullscreen

Practical Summary: Health Monitoring and Surveillance

Health Monitoring focuses on information pertaining to the health, injury, and exposure
status of an individual responder.

Surveillance focuses on patterns of illness, injury, or exposures on the overall responder

population. Surveillance systems may involve both active (new surveys) and passive
(existing records) systems and allow tracking health outcomes over time.

Documenting both individual and population impact using health monitoring and
surveillance tools in emergency response can allow for better strategic planning, needed
training, and health and safety controls.
Health Monitoring and Surveillance data are collected and maintained by health and
public health professionals such as the Medical Unit within the Logistics Section in the
ICS structure. Information is shared as needed with other appropriate personnel and the
responders themselves to support prevention of injury and illness.

Health Monitoring and Surveillance Tools:

1. Deepwater Horizon Health Hazard Evaluation

Survey: http://www.scribd.com/doc/127560729/deepwater-
horizon-health-hazard-evaluation-survey

Practical Summary: Integration of Exposures Assessment

Exposure assessment and management is the process of identifying, characterizing,

estimating, and evaluating deployment workplace exposures, and judging the
acceptability of those workplace exposures to environmental agents encountered in an
incident response.

Documenting and assessing exposures are crucial in any efforts to ensure and promote
responder safety and health.

Responder Activities Documentation is a full account of the activities of the responders

over the course of the response. This account should provide some sense of where
responders were operating, for how long, and in what capacity, over each day of their
involvement in the response. See ICS Form 204 – Assignment List.

Initiating an exposure assessment process must occur prior to the first opportunity for a
responder to be exposed. Exposure assessment and documentation continues
throughout the incident response.

Basic Steps to Exposures Assessment, Documentation and Controls:

1. Define the specific task that you are assessing

2. List the associated hazards
3. For each hazard use the AIHA Hazard Risk Analysis Worksheet to assess health
ratings , exposure ratings, uncertainty ratings, and risk levels.
4. List the specific types of controls needed to prevent injury or illness. Use general
control categories, such as(from most preferred to least preferred)
“Elimination,” “Substitution,” “Engineering Controls,” “Administrative Controls
or “PPE.”

Integration of Exposures Assessment Tools:

 1. OSHA e-HASP Software: Health and Safety Plan
templates: http://www.osha.gov/dep/etools/ehasp/index.html
2. ERHMS Section 7T: http://www.scribd.com/doc/127849987/7t-
Intergration-of-Exposure#fullscreen
a. OSHA Deepwater Horizon Personal Protective Equipment
(PPE) Matrix: http://www.osha.gov/oilspills/gulf-operations-
ppe-matrix.pdf
b. AIHA Incident Safety and Health Management
Handbook: http://www.aiha.org/aboutaiha/Pages/IHOEHSR
esources.aspx
c. NRT Fatigue Management Risk Assessment
Tool: http://nrt.org/production/NRT/NRTWeb.nsf/AllAttach
mentsByTitle/SA-
1049TADFinal/$File/TADfinal.pdf?OpenElement

Practical Summary: Communication of Health Monitoring and Surveillance

Data

Communication of Health Monitoring and Surveillance Data provides critical

information, resulting from ERHMS activities, that needs to be shared and exchanged
within and between response organizations, with the public, and with responders.

Efficient communication of health monitoring and surveillance data allows for better
health monitoring, coordination between decision makers, and fulfills an ethical
obligation to provide responders with the information needed for making decisions
about their own health and safety.

Communication of this sensitive information should be done by those who understand

the information and are trained on how to share it with a given audience (e.g. a health
professional may share information with a responder about their exposure risks or
information communicated to the public may be vetted through the ICS officials).

Communication of Health Monitoring and Surveillance Data Tools:

1. Department of Homeland Security Privacy Act Statement
Form: http://www.dhs.gov/xlibrary/assets/privacy/privacy_guidance_e3.pdf

Deployment Summary

Four primary activities take place in the deployment phase to ensure the health and
safety of responders during and after deployment.
On-site Rostering and In-processing
Health Monitoring and Surveillance
Integrating Exposure Assessment, Activities Documentation, and Controls
Communication of Health Monitoring and Surveillance Data

These activities are closely linked and work together to establish a basis for
understanding the health and safety needs of responders, addressing those needs, and
communicating appropriate information to those responsible for responder health and
safety monitoring and surveillance.

Deployment Summary: On-Site Responder In-Processing

On-site responder in-processing involves several activities which allow for identifying
personnel, maintaining accountability for responders, and tracking their engagement
during an incident response.

The Centralized Worker Roster is where information about the responder during
deployment is documented and maintained, such as:
• Participation in site-specific training (SST)
• Use of personal protective equipment (PPE)
• Deployment tasks and exposures
• Other health and safety related information about the responder

Securely linking this roster to other data sources, such as the ERHMS rostering and
credentialing system, enables efficient review and sharing of the data in support of
health monitoring and surveillance, exposure assessment and communication of that
information during and after deployment.

Deployment Summary: Health Monitoring and Surveillance

Health monitoring focuses on information pertaining to the health, injury, and exposure
status of individual responders.

Surveillance focuses on patterns of illness, injury, or exposures in the overall responder

population.

Surveillance systems may involve both active (new surveys) and passive (existing
records) systems and allow tracking health outcomes over time.

Documenting both individual and population impact using health monitoring and
surveillance tools in emergency response can allow for better strategic planning, needed
training, and health and safety controls.
Health monitoring and surveillance data are collected and maintained by health and
public health professionals such as the Medical Unit within the Logistics Section in the
ICS structure. Information is shared as needed with other appropriate personnel and the
responders themselves to support prevention of injury and illness.

Deployment Summary: Integration of Exposure Assessment

Exposure assessment and management is the process of identifying, characterizing,

estimating, and evaluating deployment workplace exposures, and judging the
acceptability of those workplace exposures to environmental agents encountered in an
incident response.

Documenting and assessing exposures are crucial in any efforts to ensure and promote
responder safety and health.

Deployment Summary: Responder Activities Documentation

Responder activities documentation is a full account of the activities of the responders

over the course of the response. This account should provide some sense of where
responders were operating, for how long, and in what capacity, over each day of their
involvement in the response. See ICS Form 204 – Assignment List.

Initiating an exposure assessment process must occur prior to the first opportunity for a
responder to be exposed. Exposure assessment and documentation continues
throughout the incident response.

Deployment Summary: Communication of Health Monitoring and

Surveillance Data

Communication of health monitoring and surveillance data provides critical information

from ERHMS activities that needs to be shared and exchanged within and between
response organizations, with the public, and with responders.

Efficient communication of health monitoring and surveillance data allows for better
health monitoring and coordination between decision makers, and fulfills an ethical
obligation to provide responders with the information needed for making decisions
about their own health and safety.

Communication of this sensitive information should be done by those who understand

the information and are trained on how to share it with a given audience (e.g. a health
professional may share information with a responder about their exposure risks or
information communicated to the public may be vetted through the ICS officials).
Post-Deployment
Practical Summary: Out-Processing Assessment

The objective of out-processing is to document: 1) responders’ work activities and

locations, 2) exposures, 3) illnesses, symptoms or injuries experienced during
deployment, and 4) health status at the conclusion of response duties. This information
can identify health trends, exposures of concern, and provide information which may be
useful in the current and future responses.

All responders should receive an out-processing assessment as part of the

demobilization process.

Planning for demobilization needs to begin as soon as the emergency command staff
initially arrives on the scene (during the Deployment Phase).

Information regarding self monitoring for future health concerns should be

disseminated to responders as part of the demobilization process.

Out-Processing Assessment Tools:

1. Department of Homeland Security Post-Deployment Assessment

Forms: http://www.scribd.com/doc/127560736/Department-of-Homeland-
Security-Documents-Used-to-Conduct-Post-Deployment-Assessment#fullscreen
2. ICS Form 221 Demobilization Checklist:
http://www.scribd.com/doc/127959911/Form-221-Fillable#fullscreen

Practical Summary: Post-Event Tracking

Long-term (post-event) health tracking is the ongoing monitoring and surveillance of

responder health for potential delayed or long-term adverse effects as a result of the
deployment experience.

Long-term health tracking should only be established when data suggest it is needed.
None, some or all responders may be identified for long-term health tracking.

The goal is to identify adverse health or functional consequences potentially associated

with response work and to intervene early to maximize the chances for recovery and to
stop further exposure for workers remaining on-scene.

Use the Long-term Health Tracking Model presented to design a Health Tracking
Program. Post-deployment data should be obtained from responders as close to
demobilization as possible and then repeated as prescribed by the post-event tracking
system established.

Information that needs to be collected includes any pertinent data (pre-, during-, and
post-deployment), based on the guidance offered in this section, which describes the
detailed post-event health status of responders or categories of responders.

Data is collected, updated, and maintained by the appropriate Technical Specialists in

the ICS Unit reporting to the Safety Officer. At a minimum, the deploying organization
should be the repository for their responders’ updated health tracking information.
However, the tracking program may be managed at the local, state or national level.

Post-Event Tracking Tools:

1. Behavioral Health Measures (Section

10T): http://www.scribd.com/doc/127963385/10t-Post-Deployment#fullscreen
2. Sheehan Disability Scale (SDS): http://www.cqaimh.org/pdf/tool_lof_sds.pdf
3. NIOSH Publication No. 2008-115: First Responders: Protect Your Employees with
an Exposure Control Plan Survey: http://www.cdc.gov/niosh/docs/2008-115/

Practical Summary: Lessons Learned and After-Action Assessment

At the conclusion of an event there is a need to assess how the emergency response has
been conducted through the pre-deployment, deployment, and post-deployment
phases specific to the ERHMS guidance and try to identify ways to improve during each
of these periods. This ensures that the best-possible practices are used and that
mistakes are identified and measures taken so that they are not repeated the next time.

Practices such as identifying deficiencies in communications of safety and health

protocols, examining when and where there were exposures, how health monitoring
and surveillance efforts were implemented, how PPE was performed or were used and
noting when rostering was ineffective all help organizers improve the safety
environment and protect emergency responder safety and health during an emergency.

Often this is accomplished through a document called an After Action Report (AAR).

It is essential that ERHMS be included in the general AAR or similar document.

After-Action Reporting Tools:

1. Homeland Security Exercise and Evaluation Program, Volume III: Exercise

Evaluation and Improvement Planning, Rev. Feb.
2007: https://hseep.dhs.gov/support/VolumeIII.pdf
 2. A Leader’s Guide to After-Action Reviews, Department of the Army, TC 25-20,
1993: http://www.au.af.mil/au/awc/awcgate/army/tc_25-20/tc25-20.pdf
3. HSEEP AAR Template: http://www.scribd.com/doc/127961885/Hseep-AAR-IP-
Template-2007#fullscreen

Post-Deployment Summary

Three primary activities take place in the post-deployment phase to enable response
organizations to recover from deployments and prepare for future deployments:

1. Responder out-processing (including immediate referral for medical or

psychological assessment/treatment as needed)
2. Long-term health monitoring
3. After-action report

These activities are closely linked and work together to establish a basis and process for
protecting the health of responders and improving future performance.