Conducting Responder Health Research and Biomonitoring During and Following Disasters

Categories: Emergency Response/Public Sector

October 18th, 2013 2:22 pm ET - John A. Decker, M.S., R.Ph., C.I.H.; Renée Funk, DVM, MPH&TM, MBA, DACVPM; D. Gayle DeBord, Ph.D.

When responding to a disaster, emergency workers may face unique health risks from exposures to hazardous chemical and environmental contaminants in forms and circumstances often not seen in other occupations. While the paramount needs to be addressed in a disaster are the protection of people in the disaster zone and the safety and health of the responders, disasters often provide the opportunity to conduct research on potential short- and long-term health effects among responders. Knowledge gained from such research will improve the ability of safety and health professionals, administrators, and coordinators to safeguard responders as immediate rescue, recovery, and clean-up activities proceed. As well, it will improve our procedures for safeguarding responders in future emergencies. While this can provide a unique opportunity, the disaster environment presents many challenges for research while response is proceeding.
These limitations include the following:

response activities are the first priority,
researchers or research institutions may have limited access to incident leadership who can approve of research activities,
engaging emergency response personnel is difficult in research activities not immediately pertinent to the response,
marshaling necessary resources quickly will be difficult, and
timely recognition of research questions that are important for occupational health and safety will be difficult.

Online Training
Separate from the potential research described here, emergency responders’ health should be monitored and surveillance conducted to track potential health issues that may arise as a result of response activities. NIOSH has developed the following online courses to assist organizations with their surveillance efforts.IS-930: Emergency Responder Health Monitoring and Surveillance (ERHMS) System: Leadership Training This educational offering is to introduce the Emergency Responder Health Monitoring and Surveillance (ERHMS) system to leaders in organizations responsible for planning and executing an incident response that optimizes the health and safety of response, remediation, recovery, and volunteer workers at the local, regional, State, tribal, and Federal levels.WB2254: Emergency Responder Health Monitoring and Surveillance (ERHMS) This educational offering is to provide a recommended health monitoring and surveillance framework, referred to as the Emergency Responder Health Monitoring and Surveillance (ERHMS) system, which includes specific recommendations and tools for all phases of a response, including the pre-deployment, deployment, and post-deployment phases. The intended audience is emergency managers, emergency responders, medical personnel, health and safety representatives, epidemiologists, or anyone who may be involved in implementing an ERHMS system in their organization.

Online Training

Separate from the potential research described here, emergency responders’ health should be monitored and surveillance conducted to track potential health issues that may arise as a result of response activities. NIOSH has developed the following online courses to assist organizations with their surveillance efforts.IS-930: Emergency Responder Health Monitoring and Surveillance (ERHMS) System: Leadership Training

This educational offering is to introduce the Emergency Responder Health Monitoring and Surveillance (ERHMS) system to leaders in organizations responsible for planning and executing an incident response that optimizes the health and safety of response, remediation, recovery, and volunteer workers at the local, regional, State, tribal, and Federal levels.WB2254: Emergency Responder Health Monitoring and Surveillance (ERHMS)

This educational offering is to provide a recommended health monitoring and surveillance framework, referred to as the Emergency Responder Health Monitoring and Surveillance (ERHMS) system, which includes specific recommendations and tools for all phases of a response, including the pre-deployment, deployment, and post-deployment phases. The intended audience is emergency managers, emergency responders, medical personnel, health and safety representatives, epidemiologists, or anyone who may be involved in implementing an ERHMS system in their organization.

This blog describes factors to consider for the conduct of disaster research, as well as including biological monitoring (biomonitoring) during and after a disaster.

Deciding When to Conduct Disaster Health Research

A research study on responders can be costly and difficult to design. Researchers should consider whether the proposed study will produce useful, reliable results, especially in this era of limited resources. In a recent publication in the journal Disaster Medicine, NIOSH staff developed a decision process, to help researchers and institutions determine whether a research study is warranted. The rationale includes certain factors that should be considered to proceed with research. For a list of factors click here.
While there are no predetermined thresholds that would necessarily sway a decision whether or not to conduct a research study during an emergency response, , such as increased incidence of responder injuries or illnesses during emergency operations, or excessive exposures of responders to toxic contaminants,, there are several controlling or ”gatekeeper” factors that should be satisfied for responder research to proceed. These gatekeepers include the following:

Scientific questions (research questions must be based on sound theoretical foundations).
Exposures (exposures must be present, as well as a method to characterize and document exposures. The proposed research should result in information about an exposure-outcome relationship. An exposure gradient that identifies responders at differing levels of exposures can improve the ability to detect dose-response relationships.
Study design. Research has sufficient validity and ability to answer the questions that need to be answered.
Feasibility factors (Identification and location of subjects is possible. Funding and expertise are available. Data-related hurdles, including those related to study size and statistical power, can be overcome. Regulatory-related clearances, for instance, institutional review board clearances, can be quickly obtained.)

Because of the many complexities associated with both the decision to conduct responder health research and the actual responder research, pre-planning should be done to identify research opportunities. To facilitate the process, an organization or agency contemplating research should, as part of its pre-planning efforts, create a science planning team of experienced subject matter experts from diverse scientific disciplines (e.g., occupational medicine, industrial hygiene, toxicology, epidemiology, psychology, and emergency response). Optimally, the team should be substantially separate from those primarily responsible for conducting the response. Once a disaster commences, the science planning team should rapidly convene to review, refine, and prioritize any previously developed generic plans to identify event-specific potential research needs.

Deciding When to Conduct Biomonitoring

As part of an emergency response, biomonitoring or the measurement of how much of a given substance gets inside a person’s body, is often considered. Improved estimates of exposure and effect from biomonitoring can be used to assess exposure-response relationships, potential health consequences, and effectiveness of control measures. Disaster settings, however, pose significant challenges for biomonitoring. NIOSH staff have also developed a decision process for determining when to conduct biomonitoring during and following disasters. The decision process was published in Military Medicine in January. Decision processes were developed for biomonitoring performed as part of occupational health (public health) investigations and for biomonitoring intended to support research studies. Two factors, appropriateness and feasibility, were identified that would support the decision to conduct biomonitoring.
The results of research conducted at disaster sites can not only help protect emergency responders in the future but can also provide valuable information that may help protect workers in other fields as well. We urge those working in the field to use the tools above to develop generic research plans that can be customized to fit a specific disaster.
John A. Decker, M.S., R.Ph., C.I.H.; Renée Funk, DVM, MPH&TM, MBA, DACVPM; D. Gayle DeBord, Ph.D.
Dr. Decker is a Senior Scientist in the NIOSH Office of the Director.
Capt. Funk is Deputy Associate Director in the NIOSH Emergency Preparedness and Response Office.
Dr. DeBord is the Associate Director for Science in the NIOSH Division of Applied Research and Technology.

Resources

Decker JA, Kiefer M, Reissman DB, Funk R, Halpin J, Bernard B, Ehrenberg RL, Schuler CR, Whelan E, Myers K, Howard J. A decision process for determining whether to conduct responder health research following large disasters. Am J Disaster Med 2013 Jan/Mar; 8(1):25-33.
Decker JA, DeBord DG, Bernard B, Dotson GS, Halpin J, Hines CJ, Kiefer M, Myers K, Page E, Schulte P, Snawder J. Recommendations for biomonitoring of emergency responders: focus on occupational health investigations and occupational health research. Mil Med 2013 Jan; 178(1):68-75.