EMERGENCY RESPONSE RESOURCES

The following link redirects to the disaster site management topic page which includes general information on Disaster Site Management. The site provides a series of reports on emergency responders’ safety management in disaster and terrorism response. The different reports cover topics such as rubble and debris, dust and smoke, heat, anthrax, stress, types and use of protective equipment, hazard assessment, risk communications, site management, structural collapse, fire, and explosions. The disaster management page also offers information on other hazards such as asbestos, carbon monoxide, confined spaces chemical and structural hazards and provides guidance on identifying and handling human remains. Other possible hazardous substances and situations such as chemical and structural hazards are also included in the website to ensure the health and safety of workers.

NIOSH Emergency Response Disaster Site Management Page

NIOSH offers different services to employers and employees involved in hurricane recovery. These services include evaluations of workplace hazards, guidance on exposure controls, and access to the health hazard evaluation request program. The following link describes the types of services available for workers and provides information regarding the worksite hazard evaluation program available to workers affected by hurricane recovery.

What Services Can CDC/NIOSH Provide to Employers and Employees Involved in Hurricane Recovery?

Air quality refers to the degree in which the air is free of pollutants. Pollutants in the ambient air can be harmful to human health and are emitted from both natural and anthropogenic sources. Emissions from mobile and stationary sources contribute to indoor and outdoor air pollution. To measure air contamination pollutants are monitored and data is collected to provide an air quality index that indicates the air quality type in a particular area which ranges from good to hazardous.

During flood events different types of substances are dragged by water into other spaces polluting water. Polluted waters may carry toxic substances, microbial agents, allergens and chemicals that can leave residues in indoor structures affecting human health through inhalation or dermal contact.

The presence of this type of contaminants is higher in flooded buildings increasing the risk of exposure by inhalation as a result of aerosolization or other processes. Workers doing activities in indoor environments or involved in cleaning up activities after flooding are particularly at a high risk of exposure and should take precautions to limit their exposure.

Outdoor air quality

Outdoor air quality focuses on the pollutants present in outside ambient air. Criteria pollutants are substances common in outdoor air and are associated to adverse health effects, this pollutants include particulate matter, carbon monoxide, lead, nitrogen dioxide and ozone. We can be exposed to these pollutants in multiple ways while performing outdoor activities.

The Air quality topic page provides information on outdoor air pollutants including criteria pollutants, acrolein, benzene, asbestos, fuel oils, and polycyclic aromatic hydrocarbons, among others. The webpage also provides recommendations for the use of respirators when outdoor air quality decreases due to emergencies such as volcanoes and wildfires. Air now has a forecast of the air quality at any location in the United States. Other resources such as training and infographics are also provided.

CDC Air Quality website.

Indoor air quality

Indoor air quality refers to the quality of the air in an office or other building environments. Low quality indoor air may lead to health problems such as allergic reactions, headaches, eye irritation and aggravate other conditions such as asthma. Problem indicators such as odors, mold, and excessive dust can be present when indoor quality is deficient.

The Indoor environmental quality topic page provides an overview of factors that determine indoor air quality and covers topics such as dampness and mold in buildings, building ventilation, construction, and chemicals and odors that might affect the quality of the air. The website provides some resources such as an action plan to meet building air quality healthy conditions and publications on mold and indoor environmental quality.

NIOSH Indoor Environmental Quality Topic Page

Healthy indoor environments resources

During flooding, systems for heating, ventilating, and air conditioning (HVAC) can become submerged in flood waters. Flood water may carry different types of pollutants such as chemicals, debris, and microorganisms among others. Moisture in this type of systems may lead to the development of favorable conditions for microorganism growth.

The following document provides recommendations to ensure that HVAC systems contaminated with flood water are properly cleaned and remediated contributing to healthy indoor environments. The interim recommendations cover steps before cleaning, HVAC cleaning and remediation, resuming HVAC operations, and access to additional resources.

NIOSH Interim Recommendations for the Cleaning and Remediation of Flood-Contaminated HVAC Systems: A Guide for Building Owners and Managers

Mold prevention and clean up

After major hurricanes and floods, the likelihood of different types of contamination increases. Extensive water damage and subsequent humidity and dampness provide favorable conditions for mold contamination in buildings. This report provides information on mold and factors that contribute to its development and gives general guidelines on how to assess exposure to mold, limit exposure in case there is mold, sample mold, assess microorganisms, clean up, and identify and prevent mold-related health effects.

Mold Prevention Strategies and Possible Health Effects in the Aftermath of Hurricanes and Major Floods

This NIOSH publication offers a description of the development of mold in office buildings, schools, and other nonindustrial buildings due to conditions such as moisture and dampness. Exposure to mold can be associated to the development of adverse respiratory symptoms. The following NIOSH alert provides information for building owners, employees and occupants regarding respiratory diseases associated to exposure to damp work environments. The publication has previous cases of mold in buildings and offers recommendations on symptoms identification, current standards and building maintenance.

NIOSH Alert: Preventing Occupational Respiratory Disease from Exposures Caused by Dampness in Office Buildings, Schools, and Other Nonindustrial Buildings

Flood conditions contribute to the appearance and development of mold and fungi. Exposure to fungal spores may lead respiratory and skin adverse health effects. OSHA provides a Fact Sheet describing the type of conditions that contribute to the growth of fungi and how to manage it. The factsheet provides specific recommendations on the use of respirators for clean-up workers in different settings that may be exposed to mold and fungi.

OSHA Fact Sheet – Fungi Hazards and Flood Cleanup

After severe wet weather buildings can be flooded providing a perfect environment for mold growth. The center for indoor environments and health provides a list of recommendations for workers on how to protect themselves from exposures related to mold and moistures. The website includes risk messages and recovery recommendations for workers, volunteers and residents regarding storms.

University of Connecticut Health, Center for Indoor Environments and Health – Hurricanes and Mold

Carbon monoxide (CO) is a gas produced as the result of incomplete combustion processes and is characterized by being odorless and colorless. Carbon Monoxide has the ability to combine to hemoglobin forming carboxyhemoglobin. This process inhibits the ability of hemoglobin to transport oxygen, leading to an oxygen deficiency that may result in permanent heart and brain damage or even death. CO properties make it especially difficult to detect, which increases the risk of injury or death by the inhalation of the gas.

During an emergency, usually electrical power deficiencies increase the use of gas powered generators generating CO and some workers may place generators in enclosed spaces which can lead to the accumulation of the gas resulting in CO poisoning.

The CDC carbon monoxide topic page contains reports detailing the problems associated with carbon monoxide from portable generators, motorboats, fires, and other emission sources. Workers can find educational materials, prevention toolkits, factsheets and general safety recommendations to protect themselves. Other materials available include recent publications modelling the effects of the use of gasoline powered generators on indoor CO exposures, clinical guidance for CO poisoning, and disaster surveillance information and resources.

CDC Carbon Monoxide Poisoning Topic Page

Small gasoline-powered tools can pose a serious health hazard following natural disasters. Examples of these tools include pumps, compressors, and generators. They produce high concentrations of CO–a poisonous gas that can cause illness, permanent neurological damage, and death. This web page provides recommendations for employers, equipment users, tool rental agencies, and tool manufacturers for preventing CO poisoning. NIOSH makes available publications on how to prevent carbon monoxide poisoning from small gasoline powered engines, tools, and reports on fatality assessment and control evaluations.

NIOSH Carbon Monoxide Hazards from Small Gasoline Powered Engines Topic Page

After a storm, hurricane, or flooding event, emergency response and recovery workers may encounter massively affected zones which implies the presence of multiple hazards. This hazards may include electrical hazards, carbon monoxide, musculoskeletal hazards, thermal stress, structural instability, hazardous materials, and fire. Therefore the implementation of safety measures in advance to this events is vital. While performing cleanup activities all the previously installed measures and control should be in use. One of the most important parts during emergencies is the use of Personal protective equipment to prevent potential hazards that are not evident. The following recommended pages list potential hazards and provide information and recommendations to prevent, mitigate and control potential exposures during cleanup activities after different types of disasters.

After a flooding event, storm or hurricane hazards associated to cleaning up may rise. Hazards include injury, electrocution, carbon monoxide poisoning and waterborne diseases among others.

The Centers for Disease Control and Prevention provides a resource for Hurricane recovery and preparedness. This document includes key facts to prepare for a hurricane or severe flooding and provides advice on how to prevent illness, injury and hazards, before, during and after a disaster.

CDC Hurricanes – Health and Safety

Flood workers face multiple hazards associated to cleanup activities. NIOSH provides an overview of the hazards flood workers face during cleanup operations and offers recommendations on how to prevent injury and illness while performing cleanup activities.  The publication covers hazards such as carbon monoxide exposure, electrical hazards, structural instability, thermal stress, musculoskeletal hazards, fire, hazardous materials and drowning, among others. Prevention measures for the correct manipulation of heavy equipment and instructions for the use of personal protective equipment are also included.

NIOSH Warns of Hazards of Flood Cleanup Work
En Español

Electrical work poses a hazard for emergency response and recovery workers where burns, falls, and electric shocks can cause injury or death if proper measures are not in place. During emergencies electrical services and equipment might present malfunctions and in some other cases the service might be out. During the installation service hazardous energy might be a source of injury or death. Elements such as overhead lines, circuits, and cables present a hazard for electric shocks and electrocution. Other electricity conducting elements such as ladders and other metal objects present an electrocution hazard. Safe work environments isolating energized components and safety procedures are a main part of safe work.

NIOSH provides different resources on electrical safety and electrocution. These resources include publications and fatality investigations. The electrical safety student manual provides general information on electrical hazards, explaining different types of hazards and types of electricity burns. The manual also provides an overview of a safety model, and how to recognize, evaluate and control electric hazards. Other NIOSH publications evaluate accidental contact with power lines as a cause of electrocution and document their operations to take preventive measures and avoid accidental injury or death. NIOSH publications also provide case studies and investigations that provide examples on how to install safety control measures. NIOSH Fatality Investigation reports and additional resources are also available for consultation.

NIOSH Traumatic Injury: Electrical Safety Topic Page

This NIOSH publication includes recommendations that can be used to help save the lives of workers who have contact with electrical energy. Previous incidents have shown that immediate resuscitation could help save the lives of electrocution victims. This document provides access to previous case reports and provides recommendations to prevent electrocution, install safe practices, and advises on the use of cardiopulmonary resuscitation and advance cardiac life support.

NIOSH Alert: Request for Assistance in Preventing Fatalities of Workers Who Contact Electrical Energy

The OSHA electrical topic page provides access to the industry specific applicable OSHA standards. Construction specific information is available to protect employees from electrical hazards. Hazard recognition in working environments is supported by explaining the hazards of contact with power lines, misused equipment, lack of the use of protective equipment and improper use of cords and elements conductive electricity. OSHA provides possible solutions to address these hazards and diminishes the risk of injury or death by electrical hazards. OSHA offers additional training to anticipate hazards and avoid injury.

OSHA Electrical Topic Page

Usually after storm, flood, or hurricane events, power lines are down and generators are used as power sources. When generators are not properly handled there is a potential risk for electrocution. NIOSH provides recommendations to prevent electrocutions associated with the use of portable generators. This page describes backfeed effects and provides safeguard recommendations against backfeed.

Preventing electrocutions associated with portable generators plugged into household circuits

The OSHA electrical topic page provides access to the industry specific applicable OSHA standards. Construction specific information is available to protect employees from electrical hazards. Hazard recognition in working environments is supported by explaining the hazards of contact with power lines, misused equipment, lack of the use of protective equipment and improper use of cords and elements conductive electricity. OSHA provides possible solutions to address these hazards and diminishes the risk of injury or death by electrical hazards. OSHA offers additional training to anticipate hazards and avoid injury.

The following page provides fast facts to inform workers about the most common types of fall hazards at the workplace and the impact they have in different workplaces. The website provides some examples of controls that can be applied to prevent work related falls. NIOSH features the use of an app designed to use ladders safely. The app provides indications according to the position of the ladder, infographics, and additional information are also available for employers and emergency response and recovery workers.

Falls from Elevations Topic Page

During and after a fire event, emergency response and recovery workers are in risk of exposure to hazards such as smoke inhalation, extreme heat, falls, burns, injury, irritation, and death. The following links provide publications and reports, that are part of the fire fighter fatality investigation and prevention program (FFFIPP), addressing common adverse health consequences for workers during and after fires, including rhabdomyolysis, hyperthermia, sudden cardiac death, and injuries. The page also provides advice on related topics such as carbon monoxide, heat stress, and respirators.

The large amounts of debris caused by hurricanes, floods and storms can lead to an extended clean-up involving many methods of debris disposal. Clean-up workers who may be less familiar with fire safety than are firefighters may use burning as a method of debris disposal. This document contains guidelines for preventing injury and illness during burning activities as a result of smoke inhalation, heat stress, burns, or use of heavy equipment.

NIOSH Interim Guidance on Health and Safety Issues Among Clean-Up Workers Involved with Burning of Hurricane Debris

During response to emergencies such as hurricanes and flooding potential hazards are present and workers involved in fire service operations are usually part of the emergency response and recovery workers present at affected locations. This document provides safety recommendations for preventing injury, illness, and death among fire fighters working in response to a hurricane. Recommendations cover topics such as prevention of exposure to carbon monoxide, heat stress, and use of personal protective equipment.

NIOSH Interim Guidelines for Fire Fighting Operations in a Hurricane Response

NIOSH conducts independent investigations of firefighter line of duty deaths. The program was implemented after constant work-related firefighter deaths. The objective of the program is to conduct investigation on firefighter fatality and recommend strategies to prevent death and injury among firefighters. The program investigates medical deaths and traumatic injury deaths assessing personal and workplace factors. Other factors are also investigated, examples of this are estimations of physical demands, exposure to chemicals, presence of coronary artery disease and fitness and wellness programs implemented in the fire departments. Circumstances investigated include burns, falls, structural collapse, electrocution, motor vehicle incidents, and diving incidents.

This web page provides access to complete lists of NIOSH investigation reports and other fire fighter safety publications and resources. The reports describe different cases and provide recommendations for preventing the development of rhabdomyolysis and injuries, and prevent exposures to diesel exhausts, heat stress, dermal exposure to polycyclic aromatic hydrocarbons, and traffic hazards, among others.

NIOSH Fire Fighter Fatality Investigation and Prevention Program

Substances that have the ability to create a physical or health hazard are considered hazardous.  During and after emergencies there is risk of exposure to hazardous substances of different origins but mainly to chemical hazards. Due to their properties chemical hazardous substances may be, but are not limited to being toxic, explosive, flammable, self-reactive, oxidizing, or corrosive. Exposure to these substances by different routes including inhalation, dermal absorption, or ingestion can lead to adverse health effects, enhancing the need to know about the hazards associated to these substances beforehand.

Chemical agent information is needed for emergency response and recovery workers to appropriately plan for risks resulting from possible chemical incidents. Several organizations have developed information databases, including short-term and long-term criteria, each with specific purposes, exposure scenarios, and severity of adverse health effects considered in their development.

Databases offer their users the possibility to consult by name, the properties, physical descriptions, exposure routes, target organs, associated symptoms in case of exposure, personal protection recommendations, standards, and first aid for a particular chemical.

The NIOSH chemical hazards webpage has available resources that offer detailed information about particular chemical agents. An example of this is the chemical hazards emergency medical management website, where there is information for first responders for how to prepare to respond, how to conduct themselves arriving in the scene, and how to conduct casualty triage, assessment, treatment and transport, and train and plan. Some substances included are ammonia, chlorine, hydrogen cyanide, mustard agents, nerve agents, phosgene and other hazardous chemicals. Other resources that offer similar information including PPE recommendations are the Emergency Response Safety and Health database and the NIOSH pocket Guide to Chemical Hazards. The last resource, has a printer version available and also provides an app that allows users to look for the chemical structures, exposure limits, chemical and physical properties, emergency treatment, respirators selection, and signs and symptoms of exposures.

NIOSH Emergency Response Chemical Hazards Page

Extreme heat poses a risk for emergency response and recovery workers who may have to endure long hours outdoors. After a long time with heat exposure and without proper control, the body loses its capacity to balance its temperature which could lead to the apparition of adverse health effects. Occupational exposure to heat stress has been associated with heat stroke, exhaustion, rashes, cramps and dehydration. Symptoms to identify heat stress may include confusion, seizures, headaches, nausea, and loss of coordination. There are some protective measures workers can take to prevent heat stress including hydration and control of heat exposure.

In the following link, NIOSH provides different types of materials to inform workers and employers to illnesses and consequences associated with extreme heat. Some of these materials include infographics, publications describing previous cases of heat related death and injury in agricultural workers, recommendations for the construction industry on hydrations and recommendations applicable to all workers to protect themselves from heat illness. NIOSH has other tools such as an app to prevent workers from exposure to extreme heat and a heat stress podcast so workers can learn to identify symptoms and how to prevent and control them.

NIOSH Heat Stress Topic Page

Musculoskeletal hazards are common across all work settings. Depending on the type of activity, different ergonomic controls must be in place to prevent injury. Activities that involve the use of heavy elements, vibration, repeat movements, and stay in a particular position and sustain an awkward posture can lead to musculoskeletal adverse effects.  Emergency response and recovery workers are in risk of exposure to musculoskeletal hazards after working during long hours in extreme conditions that can imply difficult and repetitive motions. Musculoskeletal hazards may lead to the development of chronic pain in extremities, muscles, illness, injury, disorders and pain. This hazard may be present across multiple activities and industries including agriculture, construction, healthcare, manufacturing, mining, and transportation among others.

NIOSH offers a bibliographic database of occupational safety and health publications, interventions across industrial sectors, ergonomic recommendations, studies, and other resources to workers and employers to reduce and prevent ergonomics hazards. An example of these resources is the NIOSHTIC-2 website, which offers more than a thousand bibliographic entries covering specifically musculoskeletal or ergonomic hazards in different occupations and industries. Materials offering solutions and controls to prevent ergonomic and musculoskeletal hazards in the workplace, according to the activity performed, are offered by NIOSH. The website includes different recommendations covering the use of ergonomic programs in the workplace with a respective evaluation of the potential hazards of each activity, some manuals, apps and guidelines and recommendations regarding posture, and the use of tools.

NIOSH Ergonomics and Musculoskeletal Disorders Topic Page

Flood zones present different types of hazards for workers, therefore the use of personal protective equipment is important to prevent injury. The page provides general guidance on the use and selection of personal protective equipment focusing on five hazards involving floodwater exposure, slick and unstable surfaces, electrical contact, sharp jagged debris, and contact with human and animal remains.

NIOSH Hazard-Based Interim Guidelines: Protective Equipment For Workers In Hurricane Flood Response

To protect workers from contact with flood waters and protect them from physical, chemical and biological hazards, the use of protective clothing and equipment is necessary. This page provides information on hazards to flood cleanup workers, and guidance for selecting appropriate clothing and protective equipment according to the type of activity and situation each worker faces.

NIOSH Interim Guidance on Personal Protective Equipment and Clothing for Flood Response Workers

Personal protective equipment is very important for any emergency responder. The following page provides information concerning the proper use of respirators.  Publications referring to respirator approval for chemical warfare, protective equipment for structural collapse events, and selection of PPE are provided. The NIOSH Personal protective equipment page provides informational materials regarding the proper use of PPE under different conditions and situations. The materials cover previous experiences with respirators and their selection, use of protective clothing to protect against biological agents, PPE for flood responders, infection control and hearing protection.

NIOSH Emergency Response Personal Protective Equipment Page

Rescue and recovery workers face different types of challenges during their emergency response activities. It is important to minimize exposure by all routes when working in these environments. This OSHA factsheet describes the importance of taking precautions to minimize exposures to contaminated flood waters emphasizing proper hand hygiene and the use of protective gloves.

OSHA Fact Sheet – Hand hygiene and Protective Gloves in Hurricane-Affected Areas

Potential hazards are present during clean up and recovery activities. OSHA developed a Personal protective equipment (PPE) matrix recommending the use of specific PPE based on the type of activity the worker performs. The matrix recommends a type of PPE by task.

OSHA fact Sheet – Hurricane Sandy PPE Matrix

Spaces which by design have limited openings for entry and exit, unfavorable natural ventilation which could contain or produce dangerous air contaminants, and which are not intended for continuous employee occupancy are considered confined spaces and working in these environments requires special precautions. Emergency response and recovery workers may have to work in confined spaces such as pits, sewers, tunnels, pipelines, degreasers, ventilation and exhaust ducts among others. Air does not flow in a normal way in these spaces and gases and other substances may stay trapped increasing the possibility of explosion. In other cases, oxygen can be depleted and limit the respiratory capacity. When the work is necessary in these spaces the exposure time must be limited and must be conducted with the appropriate precautions, including the use of personal protective equipment.

The NIOSH confined spaces topic page provides publications describing cases in which the incidents lead to the death of workers are presented. A manual with information on the recognition of confined spaces, describing the types of hazards associated with working in confined spaces, recommendations on PPE and safe work practice advice is offered. Other materials such as a report of the fatality assessment and control evaluation (FACE) program which recognizes hazards in the workplace and provides recommendations for addressing them, and a publication that provides information on hazard prevention and control measures and strategies applied to confined spaces.

NIOSH Confined Spaces Topic Page

The following link provides interim guidance for working safely in confined spaces. This document was originally developed for Hurricane Katrina, where flooding and the consequent transportation of materials through the water may lead to its release in confined spaces, or where the restriction of evacuation routes can create confined spaces. This information is applicable for emergency response and recovery workers whose job requires entry in confined spaces. This document provides NIOSH interim guidelines regarding work in confined spaces in response to a hurricane and offers PPE recommendations.

NIOSH Interim Guidance: Working Safely in Confined Spaces

During emergencies domestic animals might be displaced creating potential health and safety hazards for responders. This document provides information on preventing injury and illness that may be caused by bites, scratches, rabies among others, which constitute safety hazards for workers that may be in contact with displaced domestic animals.

Interim Guidance on Health and Safety Hazards When Working with Displaced Domestic Animals

During and after emergencies health care workers may face multiple hazards as a result of a higher influx of patients and alterations in the everyday work conditions. These unusual conditions can include electricity, cuts, flooding, contamination of the water supply, lack of staff, and lack of supplies or equipment, among others. Hazards health care workers could face while working in an emergency may include exposure to infectious agents, needle stick injuries, chemical hazards, physical hazards, traumatic incident stress, violence, and long hours of work. Emergency responders and workers involved in health care need to be aware about the hazards they face and need to receive the necessary training to know how to act and stay safe during emergencies.

NIOSH provides resources to prevent hazards healthcare workers might be exposed to during emergencies. Some of these resources include publications, field notes, infographics, factsheets, training tools, and reports. Some examples of emergencies in which health care workers require special safety measures, such as Ebola, are provided in the website aiming to protect the health of workers. Other resources such as health and safety practices for healthcare workers are also provided.

Health Care Workers Topic Page

During emergencies exposure to blood and other body fluids are common. Health care workers are at special risks of exposure to blood borne infectious diseases. Concerns include the transmission of human immunodeficiency virus (HIV) and hepatitis. This webpage offers recommendations to establish work practices that prevent exposure to body fluids. Other resources offered include information on bloodborne pathogens, recommendations to prevent needle-sticks and sharps injuries, engineering controls, Personal protective equipment, and management and treatment guidelines.

NIOSH Bloodborne Infectious Diseases HIV/AIDS, Hepatitis B Virus, and Hepatitis C Virus Topic Page

Depending on the magnitude of an emergency, some events might be more destructive than others and have associated more fatalities. It is important to provide the proper identification and care for the bodies, and to protect the health and safety of the emergency responders and recovery workers on the location. Hazards when working with human remains may include a risks of infection with bloodborne pathogens and diarrheal diseases. Therefore the use of controls, protocols and standard protection measures is vital to ensure a dignified treatment of the victims while protecting the health and safety of the workers.

This report describes the health concerns associated with the identification of human victims after a tsunami in the Indian Ocean. Identification and proper handling of victims can be a challenge after a massive event. This report describes a previous experience using temporary morgue operations after the 2004 Tsunami. It describes the hazards of accidental injury with sharps and needles and manipulation of solid waste and biohazardous waste. The report provides recommendations for the proper management of waste and the use of personal protective equipment such as surgical masks, respirators, and latex gloves to protect themselves from multiple hazards.

Health Concerns Associated with Disaster Victim Identification After a Tsunami

The following website provides recommendations for individuals who must have direct contact with human remains. Recommendations include proper hygiene practices and the use of personal protective equipment to prevent contact with body fluids, blood or fecal material resulting of handling human bodies. Additionally to the interim guidance, some additional resources from the pan American health organization and the word health organizations are also mentioned.

Interim Health Recommendations for Workers who Handle Human Remains

Massive fatalities after a disaster require a special management to guarantee a correct and dignified treatment and disposition of the bodies. This manual provides the technical information needed to support authorities in the proper management of dead bodies to ensure its correct recovery, identification, transfer and final disposal. This publication includes topics such as preparedness for mass deaths, operations coordination, organization of necessary personnel, methods for identifying human remains, health considerations in cases of mass fatalities, sociocultural aspects, psychological aspects, case studies from previous emergencies, and recommendations.

PAHO Management of Dead Bodies in Disaster Situations

These interim forms were developed by NIOSH as survey tools for occupational safety and health purposes in the response to Hurricane Katrina but may be applicable for other responses. The interim forms are posted here to provide information to occupational safety and health professionals who are interested in NIOSH efforts to prevent injuries and illnesses among hospital, shelter, and health department employees involved in a disaster response, and who may be looking for tools to ensure health and safety in their own operations.

The interim forms are key to critical information for assessing the potential occupational safety and health impacts of disaster response on health care, health department, and shelter employees.

The following links provide access to four different occupational health and safety survey tools. The forms are designed to be used in case a worker became ill, injured or was exposed to chemical or blood hazards; to evaluate medical care facilities, assess regional operation centers, health departments, and shelters. The forms aim to evaluate personal protection measures, supplies, safety and health controls, recordkeeping systems, training, operations, equipment, assistance, and programs in place among others.

• Occupational Health and Safety Survey Tool – Hospitals and Medical Care Facilities
• Occupational Health and Safety Survey Tool – ROC/JFO/Health Dept/Field
• Occupational Health and Safety Survey Tool – Shelters

Medical screenings prior to deployment are important to ensure the safety of the responder. The assessment of the health and fitness to perform a particular activity under determined circumstances is crucial to ensure a proper response and also to protect workers from unintended exposures that may cause detrimental health effects. Establishing a health baseline can improve not only personnel staffing activities, but also can protect emergency response and recovery workers by ensuring they have proper equipment and training. A health baseline also offers a comparison framework before and after an event, which can support analysis activities about unintended exposures workers may have faced and that can have long-term affectations.

This document provides interim guidance on medical screening for workers before beginning disaster response activities. These materials were developed for Hurricane Katrina but may be applicable for other hurricane responses. The interim guidance provides the rational to do a medical screening and further explains the type of screenings available, the time in which they should be done, and which information should be collected.

NIOSH Interim Guidance for Pre-exposure Medical Screening of Workers Deployed for Hurricane Disaster Work

Recovery areas after a natural disaster can be unstable and pose potential hazards for workers during recovery activities. Due to this potential risk, medical screenings should be undertaken after leaving the affected area to assess and protect the health of the workers. This document provides guidance on the level and type of screening that might appropriate for workers after finishing their activities in recovery areas.

NIOSH Interim Post exposure Medical Screening of Workers Leaving Hurricane Disaster Recovery Areas

First responder and workers in recovery areas should be immunized to prevent illness and injury. Some vaccines are required such as tetanus and hepatitis B, while others are recommended such as typhoid, hepatitis A or rabies. These last ones are recommended depending on the type of activities and locations where responders will be working. This page provides information on required immunizations for hurricane responders.

CDC Immunization Recommendations for Disaster Responders

During emergencies the use of motor vehicles and machines can increase to accelerate the pace and efficiency of response and recovery operations. This can increase the risks of suffering accidents associated to the operation of motor vehicles and machines. An example of this situation are emergency medical service workers that have been involved in vehicle crash-related injuries. Operational controls must be in place to mitigate hazards associated to the manipulation of machines that can lead to amputations, burns and permanent injuries. Hazards such a as fatigue present during emergencies have also been associated to motor vehicle accidents that could lead to injury or permanent death.

NIOSH has a motor vehicle safety at work webpage that offers guidance to prevent incidents related with motor vehicles. The center identifies risk factors for work related crashes, and promotes and communicates evidence-based policies and practices. The webpage offers different resources to employer to stablish safety programs to maintain workers safe on the road. Other resources include animated images to promote safe driving, crash facts, publications, projects, initiatives, and factsheets.

NIOSH Motor Vehicles Topic Page

Machinery-related hazards are present in virtually every industry. Workers are exposed to these hazards daily in construction, farming, and manufacturing. Emergency response and recovery workers are in risk of exposure to physical hazards associated to the manipulation of machines. The following webpage informs employers and employees about potential injuries that can happen as a result of machine manipulation such as amputations, burns or blindness, and provides advice on the use of safeguards to protect workers.

NIOSH Machine Safety Topic Page

Skid-steer loaders have many potential hazards associated to their operation such as rollover and run over accidents. This alert describes previous death cases involving skid-steer loaders and offers recommendations for preventing incidents of this type. Recommendations include following safety operations, and use current safeguards such as control interlocks, side screens, rollover protective structures, and operator restrains.

NIOSH Alert: Preventing Injuries and Deaths from Skid Steer Loaders
En Español

Hurricanes, storms and floods are associated to an increased risk of exposure to multiple hazards for humans and animals. During these events some pets and other non-domestic animals may require shelter, the installation, care and maintenance of the locations and animals may present some hazards for workers, which should take preventive measures to prevent hazards such as bites, or exposure to loud noise. Emergency response and recovery workers will also have to spend long hours in outdoor environments, which increases their risk of exposure to different hazards such as extreme temperatures, noise, contact with poisonous plants and animals, and vector-borne diseases. The following websites provide information on how to prevent injury and illness as a result of working outdoors or working with animals.

Workers in kennel areas may face different physical hazards. NIOSH did a Health Hazard Evaluation in one of this locations to evaluate noise exposures among workers. This report provides a detailed description of the activities performed, the noise level exposure, and the prevention programs implemented to protect workers’ health.

Noise exposures and hearing loss assessments among animal shelter workers

Outdoor workers are exposed to multiple hazards including physical, biological and chemical hazards. This page offers recommendations to workers on how to prevent extreme cold and heat, noise, sun exposure, poisonous plants, insects, and vector-borne diseases.

Hazards to Outdoor Workers, spider/scorpion/tick

Hurricanes, storms, or floods have associated detrimental impacts on infrastructure. During past events, some radiation facilities have been activity as a result of natural disasters, creating additional emergencies.

As part of archive records, this page contains general information for workers that may be exposed to radioactivity as a result of radiation dispersal from the Fukushima radioactive incident. The information focuses on airline workers and mail handlers.

Worker Information

The variety of situations emergency response and recovery workers face may lead to the development of traumatic incident stress. The manifestation of traumatic incident stress involve physical, emotional, behavioral and cognitive stress. Some of this symptoms might be difficult to identify since long hours of work may produce similar symptoms such as fatigue, thirst, and mental confusion. Nevertheless there are specific emotional, physical, cognitive and behavioral symptoms of traumatic incident stress that can facilitate the identification of this condition. This symptoms can include, but are not limited to, confusion, nightmares, disorientation, memory problems, fatigue, headaches, pains, anxiety, guilt, denial, emotional outburst, and behavioral changes. Some workers present strong reactions while performing their activities on site, while others present them later and it can last from some days to weeks.

The following topic page provides NIOSH recommendations for workers to reduce the risk of experiencing stress during and after a traumatic event. The site also describes symptoms to recognize the presence of traumatic incident stress, and offers access to multiple publications associated to the topic such as reports on previous documented cases of traumatic incident stress in the mining industry and firefighting. Other publications offer recommendations for emergency managers on how to make decisions during these events. Additional resources provide access to coping tools and materials.

NIOSH Traumatic Incident Stress Topic Page

During disaster operations fatigue is common among workers it could be exacerbated by long hours of work, not favorable environmental conditions and deficient infrastructure. This document is intended to serve as a hands-on manual to assist organizations with the development of programs and plans to address fatigue issues among disaster workers. The manual covers all phases of disaster operations, describes fatigue risk factors and provides recommendations on organizational fatigue management and incident specific fatigue management.

Guidance for managing worker fatigue during disaster operations

This publication provides basic information for emergency response workers to prevent, identify, and control symptoms of traumatic incident stress. This document offers a chart listing physical, cognitive, emotional and behavioral symptoms that can be developed after a traumatic incident. The publication describes the dangers of traumatic incident stress and offers recommendations on what to do on-site and at home if traumatic incident stress presents. Finally, it includes resources for coping and additional tools for informing themselves.

Traumatic Incident Stress: Information For Emergency Response Workers
En Español

This web page provides general information for individuals, parents, and families for coping during and after a disaster or traumatic event. The webpage offers different resources for responders including preparation steps before the response in order to learn as much as possible about the role the responder will be performing, steps to take during the response to understand and identify fatigue symptoms, burnout and secondary traumatic stress, and recommendations for adjusting to life and returning to work daily activities after a response.

CDC Emergency Preparedness and Response: Coping with a Disaster or Traumatic Event

The National Child Traumatic Stress Network (NCTSN) provides materials with educational purposes addressed for different populations. These materials can be used by emergency response and recovery workers to protect themselves against fatigue and stress. The learning center offers a variety of resources for psychological recovery. One of these courses is the psychological first aid online course which puts the participant in a role of a provider in a post-disaster setting. The training offers videos, activities and guidance from experts in this field and can be accessed in the following link.

Interactive Online Course for Psychological First Aid Training

The National Child Traumatic Stress Network (NCTSN) partners at the Hyogo Institute for Traumatic Stress in Kobe Japan offer a psychological first aid guide that can be accessed through the NCTSN resources page, where additional materials are available to reduce the distress caused by traumatic events and cope. Flood resources cover a description of these events and provides recommendations on how to act and prepare before, during and after an event.

Psychological First Aid (Japanese Version)
Flood resources
Materials on the Impact of Earthquakes and Tsunamis on Children and Families

Three removal can be a common activity for emergency response and recovery workers during and after an emergency. The operation of chainsaws for these activities may lead to injury. Safeguards against injury while using a chain saw are necessary to protect the health and safety of emergency response and recovery workers. Besides operation of chainsaws that may lead to injury, other common hazards associated to tree removal are electrocutions and falls. Although OSHA has established regulations relevant to tree trimming operations including the recognition and avoidance of unsafe conditions, and establishment and maintenance of working distances from energized conductors, incidents can still happen. Some controls may include proper maintenance of equipment, use of appropriate protective equipment and training.

Chain saws are widely used to remove fallen trees and tree branches after hurricanes and other natural disasters. This CDC fact sheet provides information on chain saw safety and tips on avoiding injury from the release of bent trees or branches.

Preventing Chain Saw Injuries During Tree Removal After a Disaster

Many tree trimmers and their employers may lack training and knowledge of OSHA standards and/or may be unaware of the risk posed by inadequate or improper safety procedures and equipment. This Alert describes eight incidents involving five electrocutions and three fatal falls of tree trimmers. Based on previous experience the alert can provide guidance on how to prevent incidents associated to tree trimming.

Preventing Falls and Electrocutions During Tree Trimming

West Nile virus is a mosquito-borne disease. Its transmission happens when an infected mosquito transmits the virus to human hosts by biting them. Infected people may not develop symptoms, in other cases symptoms may include high fever, headache, neck stiffness, disorientation, muscle weakness, and paralysis. Although less than one percent of infected people develop serious illness, some cases may have severe complications with direct affectation to the central nervous system.  Emergency response and recovery workers are at risks of developing a mosquito-borne disease when they work for prolonged hours outdoors.  The NIOSH West Nile Virus (WNV) topic page provides detailed information and frequent asked questions about West Nile Virus and the potential occupational hazards and risks of WNV exposure and infection. Some of the resources available for workers and employers are insect repellent use and safety guidelines, fast facts to protect workers from mosquitoes and ticks, brochures with recommendations for protecting outdoor workers from West Nile virus exposure, OSHA West Nile virus factsheet, and steps to reduce the risk of being bitten for mosquitoes.

NIOSH West Nile Virus Topic Page

This brochure contains answers to questions relevant to outdoor workers regarding West Nile Virus, as well as recommendations for the prevention of exposure to West Nile Virus by outdoor workers. Some of the relevant information covers who is at risk of infection, when are workers at risk of WNV exposure, where are mosquitoes commonly found, how to handle dead animals, recommendations for employers of outdoor workers, and recommendations for workers.

NIOSH Recommendations for Protecting Outdoor Workers from West Nile Virus Exposure
En Español

Federal Emergency Management Agency (FEMA) Hurricane Page
The Federal Emergency Management Agency (FEMA) is an independent agency reporting to the President and tasked with responding to, planning for, recovering from and mitigating against disaster. FEMA developed a guide designed to provide advice on how to make a plan and be prepared for a hurricane. In addition to recommendations before the hurricane, this guide has some general safety tips for the post-hurricane stage and offers a checklist for preparedness.

National Institute of Environmental Health Sciences (NIEHS) – Hurrican Response
The National Institute of Environmental Health Sciences has developed resources aimed to protect the health and safety of workers responding to emergencies. This page offers training resources focused on safety awareness for responders after hurricanes and other topics such as debris removal, mold remediation, and hazardous materials. Additional resources include guidelines in Spanish and Vietnamese, technical workshops, and documents from external agencies. National Institute of Environmental Health Sciences (NIEHS – Hurrican Response

Department of Health and Human Resources (HHS): Hurricane Harvey 2017
Hurricane season in 2017 caused damage in different areas in the United States. The Public Health Emergency webpage presents resources for professionals in different areas such as health care, public health and general worker safety. The site provides links to federal agencies that contain information on how to be prepared and response to hurricanes and floods, types of protective equipment that could be used and hazards such as mold and dampness.

CDC Emergency Preparedness and Response – “Key Facts About Hurricane Readiness”
CDC developed a reference document with key messages for its use in preparation, during and after hurricanes and floods. The page provides the key messages document, recommendations and essential tips to help general public to prepare for hurricanes, flooding and similar disasters and cope with their aftermath.

CDC Emergency Preparedness and Response – “Tsunamis”
Tsunamis are seismic waves created after a big proportions disturbance. The tsunamis topic page offers general information about health concerns after a tsunami. Covered information includes tsunami generalities, infectious disease concerns, food & water safety and information for specific groups. The page provides related links with information from external organizations.

OSHA Quick Cards for Cleanup/Recovery
OSHA has different publications related to cleanup and recovery. This webpage lists OSHA factsheets available for workers covering different potential hazards. Topics include cleanup hazards, decontamination, demolition, falls, fungi hazards and hand hygiene among others.

Safety Guidelines for Post-Disaster Recovery and Reconstruction Operations Recovery Manual
The University of Nebraska-Lincoln developed safety guidelines for post-disaster operations. These guidelines provide advice on the safe management of post-disaster activities, covering different hazard scenarios that vary from PPE use and selection to the prevention of chemical, biological, ergonomic, psychological, and fall hazards.

Guidelines for Protecting Mortuary Affairs Personnel from Potentially Infectious Materials
The technical guide 195 A provides reference on health hazards mortuary workers may face. This guide describes the potential risks associated with contact with human remains. The technical guide is designed to provide guidance regarding safety measures to protect workers against blood borne pathogens and other microbiological agents associated with handling human remains.