Emergency responder health: what have we learned from past disasters?

Monitoring the Health of Public Health Responders: Development and Use of the Responder Safety, Tracking, and Resilience System (R-STaR) for Hurricane Matthew

On October 7, 2016, Hurricane Matthew traveled along the coasts of Florida, Georgia, and South Carolina causing flooding and power outages. The Georgia Department of Public Health (DPH) developed the Web-based Responder Safety, Tracking, and Resilience (R-STaR) system to monitor the health and safety of public health responders and to inform disaster response planning for Hurricane Matthew. Using R-STaR, responders (n = 126) were e-mailed a daily survey while deployed to document injuries or harmful exposures and a post-deployment survey on their post-deployment health and satisfaction with using R-STaR. DPH epidemiologists contacted responders reporting injuries or exposures to determine the need for medical care. Frequencies were tabulated for quantitative survey responses, and qualitative data were summarized into key themes. Five percent (6/126) of responders reported injuries, and 81% (43/53) found R-STaR easy to use. Suggestions for R-STaR improvement included improving accessibility using mobile platforms and conducting pre-event training of responders on R-STaR. Lessons learned from R-STaR development and evaluation can inform the development and improvement of responder health surveillance systems at other local and state health departments and disaster and emergency response agencies. (Disaster Med Public Health Preparedness. 2019;13:74–81).

What Occupational Health Needs Arise in Workplaces Following Disasters? A Joint Analysis of Eight Cases of Disaster in Japan

OBJECTIVE

To identify occupational health needs arising after disasters.

METHODS

Using semistructured interviews with expert informants, we jointly analyzed the needs arising in eight disaster cases that threatened the lives or health of workers in Japan.

RESULTS

Various types of health issues occurred in a wide range of employees. In total, we identified 100 needs in six phases after disasters and classified them across nine categories of worker characteristics. The proportion of health needs on the list that were applicable in each case varied from 13% to 49%. More needs arose when the companies were responsible for the disaster and when employee lives were lost. We also assessed the list as fairly comprehensive.

CONCLUSIONS

The list developed in this study is expected to be effective for anticipating occupational health needs after disasters.

Risks to emergency medical responders at terrorist incidents: a narrative review of the medical literature

As the threat of international terrorism rises, there is an increasing requirement to provide evidence-based information and training for the emergency personnel who will respond to terrorist incidents. Current major incident training advises that emergency responders prioritize their own personal safety above that of the 'scene and survivors'. However, there is limited information available on the nature of these threats and how they may be accurately evaluated. This study reviews the published medical literature to identify the hazards experienced by emergency responders who have attended previous terrorist incidents. A PubMed literature search identified 10,894 articles on the subject of 'terrorism', and there was a dramatic increase in publications after the 9/11 attacks in 2001. There is heterogeneity in the focus and quality of this literature, and 307 articles addressing the subject of scene safety were assessed for information regarding the threats encountered at terrorist incidents. These articles demonstrate that emergency responders have been exposed to both direct terrorist threats and environmental scene hazards, including airborne particles, structural collapse, fire, and psychological stress. The emphasis of training and preparedness for terrorist incidents has been primarily on the direct threats, but the published literature suggests that the dominant causes of mortality and morbidity in responders after such incidents are the indirect environmental hazards. If the medical response to terrorist incidents is to be based on evidence rather than anecdote, analysis of the current literature should be incorporated into major incident training, and consistent collection of key data from future incidents is required.

How Occupational Health can contribute in a disaster and what we should prepare for the future--lessons learned through support activities of a medical school at the Fukushima Daiichi Nuclear Power Plant in Summer 2011

BACKGROUND

A nuclear accident occurred at the Fukushima Daiichi Nuclear Power Plant of Tokyo Electric Power Company (TEPCO) as a result of a mega-earthquake and tsunami in March, 2011. A large number of workers were engaged in response and recovery operations under a complex structure of involved companies. They were exposed not only to radiation but also to other health hazards. TEPCO implemented programs to prevent radiation exposure, but had no effective systems for managing the other health risks and few occupational health (OH) professionals contributed to the health risk management.

ACTIVITIES

The University of Occupational and Environmental Health (UOEH), Japan, dispatched physicians to a quake-proof building at the plant to provide first-aid services from mid-May, 2011, and took a strategic approach to protecting workers from existing health risks. UOEH presented recommendations on OH systems and preventive measures against heat stress to the Government and TEPCO. The Ministry of Health, Labour, and Welfare issued guidelines to TEPCO and contractors. TEPCO implemented a comprehensive program against heat stress according to the guidelines and in cooperation with UOEH. As a result, we successfully prevented severe heat illness during summer 2011.

DISCUSSION

From our experiences, we believe that the following recommendations should be considered: (1) the role of OH and the participation of experts should be defined in emergency response plans; (2) regulations should allow the national government and main companies involved to lead safety and health initiatives for all workers at disaster sites; and (3) OH professionals, response manuals and drills should be organized at a national level.

Urinary metabolites before and after cleanup and subjective symptoms in volunteer participants in cleanup of the Hebei Spirit oil spill

BACKGROUND

On December 7th, 2007, the Hong Kong tanker Hebei Spirit (HS) (146,848 tons) was crushed by a crane ship near the shore of Taean, Korea. More than 12,547 kl of crude oil spilled into the sea and contaminated the western coastline of the Korean peninsula. For a period of six months after the accident, approximately 1,000,000 volunteers participated in the cleanup. Our goal in this study was to examine the exposure status and acute health effects on volunteers that participated in the oil spill cleanup.

METHODS

A survey questionnaire was filled out by 565 volunteers, requesting information regarding physical symptoms. Out of the total number of participants, urine samples from 105 university student volunteers were collected before and after the cleanup work, and metabolite levels of volatile organic compounds and polycyclic aromatic hydrocarbons were analyzed.

RESULTS

Volunteers that participated for longer cleanup work reported an increase in physical symptoms including visual disturbance, nasal and bronchus irritation, headaches, heart palpitations, fatigue and fever, memory and cognitive disturbance, and abdominal pain. The levels of t,t-muconic acid, mandelic acid, and 1-hydroxypyrene were significantly higher in samples after cleanup than those measured before participation (p<0.05). Other than the associated risk of dermal irritation with the difference in the t,t-muconic acid level between the post- to pre-cleanup levels, no other physical symptoms demonstrated a significant association with changes observed in the levels of urinary metabolites.

CONCLUSIONS

Based on the significant increase of subjective symptoms in volunteers participating in the study, monitoring of the long term health effects, focusing on those with longer exposure, is warranted.