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NIOSH Programs > Emergency Preparedness and Response > Strategic Goals
Emergency Preparedness and ResponseInputs: NIOSH Strategic GoalsThe NIOSH EPR cross-sector program is developing strategic goals to guide its research and partnership efforts over the next decade. NIOSH previously used "priority" topic areas (e.g., traumatic injury, hearing loss) to guide its research efforts. Strategic goals take this approach a step further by identifying specific outcomes that we want to target, performance measures for evaluating progress in meeting the outcome goals, and intermediate goals to describe the necessary steps that need to be performed to accomplish the goal. Setting goals is challenging because it forces us to focus on the subgroup of issues where NIOSH can make the largest impact-a long list would spread our resources too thin to accomplish the goals. Not every worthwhile topic can be included. Often it is difficult to develop performance measures, as available injury statistics have limitations, and exposure and health outcome measures are typically not available. For EPR, the myriad of potential scenarios potentially encountered with natural or man-made emergencies/disasters cannot be completely known. NIOSH is ambitiously setting goals to achieve outcomes such as reductions in a national fatality rate. NIOSH is a research agency so we don't often directly influence outcomes; we must partner well and influence other groups to show results. NIOSH Program Portfolio ApproachNIOSH has been organizing research, guidance, information, and service efforts into specific programs that can be readily communicated and strategically governed and evaluated. Eight NORA Sector Programs represent industrial sectors, and twenty-four Cross-sector Programs organized around adverse health outcomes, statutory programs and global efforts. The NORA Sector Programs intersect with Cross-Sector Programs in a matrix-like fashion. For example, an Agriculture, Forestry and Fishing Program goal of reducing farm-related deaths and injuries due to tractor rollovers and trucks would likely be a shared goal with the Transportation Program and if appropriate would be adopted by both programs. This approach provides an added advantage and will allow multiple Programs to work towards accomplishment of intersecting goals. Each of the 32 programs in the NIOSH Program Portfolio has a Manager and Coordinator. Each of the 8 NIOSH Sector Programs facilitates the work of a NORA Sector Council to engage external stakeholders in the process of developing sector goals for the nation and methods to measure the short-term, intermediate and long-term outcomes arising from those goals. The NORA goals for the nation will be considered when choosing NIOSH sector program goals. Cross Sector programs have internal Steering Committees that develop program goals and monitor outcome measures. These planning efforts will position NIOSH to align with the most current governmental approaches for evaluating program effectiveness, i.e., the Program Assessment Rating Tool (or PART). PART is a mechanism to hold governmental agencies accountable for accomplishing results. As part of our comprehensive approach to performance measurement, NIOSH has engaged the National Academies to independently evaluate our sector and cross-programs for relevance and impact. Draft Emergency Preparedness and Response Cross-Sector Program GoalsBackgroundAs required by the Office of Management and Budget (OMB), NIOSH program strategic goals will be organized by outcomes such as reduction in injuries and illnesses instead of more general topic areas such as reducing all occupational mortality in the transportation industry. The NIOSH EPR cross-sector program goals are posted for review and comment. We will use NIOSH eNews to announce that draft goals are available for review. NIOSH is interested in your opinion about the relevance and value of strategic goals for the EPR program, and we encourage you to consider working with us on issues of interest to you and your organization. IntroductionEmergency response workers must understand and assess potential exposures, conduct rescues, administer first-aid, decontaminate personnel and equipment, and attempt recovery activities in constantly changing and complex hazardous environments. Often the precise nature of the hazards cannot be initially described in such an intense and time-urgent setting, nor is exposure limited to only hazardous chemical, biological, or radiological materials; it may also involve fires, explosions, traffic hazards, and crowd control. Pre-event preparation, training, and access to readily available information, field assessment, and safety equipment are critical to minimizing consequent deaths, injuries, and illnesses, and to promote overall workforce resilience. It is not possible to delay or stop the response in order to restructure the organization, management, or approach during an emergency. The emergency environment places responders under a time-urgent, dual-cognitive demand: 1) they must attend to the hazards (including attention to self and crew members' safety and health), and 2) they must perform the work necessary to complete a rescue. The quality of the coordination among crew members as they carry out a rescue can define the probability of risk for death, injury, and illness to those responders. Identifying serious problems in emergency response during or after an event indicates the failure of prevention and preparation. To be sure, specific problems will occur during any emergency. However, good preparation means that the organization will rapidly and smoothly adjust to the changing circumstances and will continue the rescue. A less-than-successful adaptation to such environmental changes indicates the need for improved preparation. Such failures on-scene must be translated into proactive training via "lessons learned" (see the Outcomes section). Preparedness also includes cognitive and emotional preparation, i.e., workforce resilience, to be able to function effectively in the face of emotionally-charged or highly disturbing circumstances; and adequate hydration, nutrition, rest, and sleep during an emergency response extending beyond a few hours or a shift. Research, evaluation, and subsequent communication and training of emergency responders to maximize preparedness in all phases of a response are essential in reducing risks and promoting overall workforce resilience. Proactive use of lessons learned and a comprehensive assessment of emergency response activities, including management, organizational structure, crew-based collaboration, communication, preparation, training, equipment availability, and decontamination procedures, are key to improving safety and health outcomes. Focus on pre-event interventions that reduce the risk of exposure to hazards in the emergent environment offers the best approach to preventing loss. DRAFT GOALS1. SAFETY CLIMATEStrategic Goal: Improve the organization of emergency response work to reduce exposure to risks and to enhance the health and safety of emergency responders.Discussion: Improved preparation, better organization, and more consistent adherence to best practices during emergency operations will minimize exposures, prevent consequent injuries and illnesses, and promote workforce resilience. The overall safety climate in an emergency setting is influenced by many factors, including the nature of the hazards, management practices, crew-based collaboration, communication, preparation, and training, that address all phases of a response, from pre-event preparation to after-action review and treatment. Overall Performance Measure: By 2016, develop and evaluate five new best practices or standards to improve the organization of emergency response activities and to promote a pro-active crew-based safety climate. Reduce exposures, illnesses, or injuries attributable to improvements in safety climate by an estimated 10%. Goal 1.1: Increase the implementation of best management practices (BMPs), standard operating procedures (SOPs), and countermeasures through active partnerships with emergency response and support professions. Areas of interest may include work hours, shift work, management structure, coordination and communication, safe work practices especially safety climate, and front-line worker control.
Goal 1.2: Increase implementation of guidelines for hours of work, shift structure, and shift rotations to reduce fatigue and to promote individual and work crew safety and resilience.
Goal 1.3: Increase implementation of recommendations for workload demands and job autonomy.
Goal 1.4: Improve the psychometrics of workforce resilience by improving measures of both resilience and traumatic stress.
Goal 1.5: Improve knowledge about current safety climate.
Goal 1.6: Develop appropriate medical screening and monitoring programs for workers involved in rescue and recovery at the location of the threat.
2. PERSONAL PROTECTIVE EQUIPMENT (PPE)Strategic Goal: Improve PPE assortment, proper selection and wear, and decontamination.Discussion: During the earliest phases of response operations, before technical expertise can be brought to bear or supplemental safety equipment can be located, responders and safety managers need guidelines, checklists, or other decision-making tools to assist in developing appropriate initial and reevaluated protection strategies. Overall Performance Measure: By 2016, reduce by 10% the number of injuries and illnesses to first responders as a result of improper selection or use (or non-use) of PPE. Goal 2.1: Increase appropriate use of PPE by improving guidelines for selecting PPE during early phases of a response.
Goal 2.2: Evaluate the efficacy of decontamination procedures for PPE and equipment used by responders including the resulting deterioration and impact upon equipment life-cycle.
Goal 2.3: Improve procedures/guidance for estimating the PPE requirements (quantities) for disaster response.
Goal 2.4: Improve safety equipment logistics, including the inventory and dispersion of donated equipment following a disaster.
Goal 2.5: Identify best practices to prevent cross-contamination from victims to health care providers and support personnel.
Goal 2.6: Evaluate the potential exposures associated with contaminated PPE.
Goal 2.7: Reduce exposures to hazardous materials that may result in acute and chronic health effects.
Goal 2.8: Develop new personal protective equipment that provides sufficient protection from physical, chemical, and biological hazards while minimizing any physiological burden.
Goal 2.9: Identify and evaluate occupational risks that may increase the incidence or severity of cardiovascular and respiratory disease among firefighters.
3. ENGINEERING/TECHNOLOGICAL INTERVENTIONS AND CONTROLSStrategic Goal: Improve engineering controls, technology, and tools to minimize responders' exposures to or hazards associated with CBRN, toxic industrial compound (TIC), and other hazardous materials.Discussion: Poor integration of engineering controls during structural design and procedural development usually results in almost total dependence on PPE to minimize exposures or hazards during emergency response operations. Engineering control interventions should be evaluated and implemented, even though complete control of CBRN, TICs, and hazardous exposures may not be possible by engineering controls alone. Overall Performance Measure: By 2012 reduce by 10% exposure through improved engineering/technological interventions and controls. Goal 3.1: Conduct pilot/demonstration projects, cross-over technological applications, and applied-research investigations to mitigate or control worker health and safety threats from CBRN, natural and industrial disasters.
Goal 3.2: Improve engineering control methods to harden building construction to resist CBRN, TIC, and other hazardous exposure agents, e.g., "shelter-in-place" technology.
4. CHARACTERIZATION/ASSESSMENT OF POTENTIAL HAZARDSStrategic Goal: Develop methods to evaluate the spatial and temporal distribution of gases, vapors, and aerosols, as well as liquids or particulates associated with surface contamination.Discussion: Knowledge of the distribution, resuspension, and persistence of aerosol is extremely important in determining the risk from aerosol agents that are disseminated naturally (as in influenza), accidentally, or purposely through terrorist events. Therefore, developing methods to evaluate the spatial and temporal distribution of biological and chemical aerosols is critical in identifying sampling strategies, predicting exposure-based risks, designing personal protective equipment and engineering controls, and identifying science-based clearance strategies for reoccupancy. In addition, increased information on distribution of gas and vapor hazards as well as distribution of surface contaminants should help reduce exposures to emergency responders and receivers and improve decontamination procedures. Overall Performance Goal: By 2012, reduce by 10% severity and incidence of injuries and illnesses through better characterization/assessment of potential hazards. Goal 4.1: Improve coordination internally and with partners to identify and prioritize relevant knowledge gaps and program needs in order to implement sampling and analytical research.
Goal 4.2: Improve technologies used in near real-time and hand-held instruments to reduce response time and increase sensitivity, specificity, and reliability.
Goal 4.3: Improve the ability of responders and government authorities to quickly and adequately identify the degree of contamination.
Goal 4.4: Reduce potential exposures by improving the implementation and communication of appropriate exposure criteria during emergency responses (i.e., appropriate implementation of OSHA PELs, NIOSH RELs, AEGLs, and IDLH values).
5. SUBGROUP-SPECIFIC STRATEGIESStrategic Goal: Improve subgroup awareness, develop targeted messages, and expand subgroup-preferred channels.Discussion: Generic protective guidance applicable to all groups within all environments is limited in its effective applicability, and as such the protective message may not reach all of its intended audience due to cultural and social differences. Further, subgroups may not fully understand or appreciate the importance of receiving and implementing protective guidance. Overall Performance Goal: By 2014, reduce the injury and illness rate by 15% in underserved cultural/social subgroups of the response and recovery worker community. Goal 5.1: Improve subgroup-specific health prevention awareness by focusing attention on targeted messages that consider cultural diversity, high-risk groups, and occupational settings.
6. SURVEILLANCEStrategic Goal: Develop surveillance reporting systems to improve emergency responder safety and health through the systematic collection, analysis, and interpretation of exposure, hazard, injury, and illness data.Discussion: The systematic collection, analysis, and interpretation of health and exposure data can give decision makers valuable information for improving the safety and health of those called upon during disasters. Surveillance data can also be useful to identify subgroups at risk of exposure to specific hazards so that appropriate prevention can be implemented, follow-up can be planned, and possible intervention can be implemented. For example, the rapid identification of specific respiratory illnesses among emergency responders may allow for monitoring of other workers and facilitate the introduction of controls and risk management at the site, as well as for long-term surveillance of effected workers. Overall Performance Goal: By 2014, reduce by 25% the development of long-term illnesses attributable to occupational exposure during disaster response through the use of prevention tools developed from information from short-and long-term surveillance reporting systems. Goal 6.1: Develop a comprehensive inventory of current and planned U.S. government and stakeholder emergency response surveillance and registry resources.
Goal 6.2: Develop standards that include quantitative and qualitative factors for NIOSH and its stakeholders to use in assessing and improving the timeliness, flexibility, and sensitivity of surveillance data. Interoperability with other national surveillance standards should be addressed.
Goal 6.3: Improve the dissemination and application of public health preparedness surveillance information to reduce occupational injuries and health consequences associated with emergency response.
Goal 6.4: Improve surveillance data on injury and illness rates in underserved cultural/social subgroups of the response and recovery community.
7. ENVIRONMENTAL MICROBIOLOGYStrategic Goal: Improve the understanding of environmental microbiology of threat agents, including environmental factors that influence the introduction, spread, and control of these agents.Discussion: Critical gaps exist in the knowledgebase of environmental microbiology and the relationship to public health emergency caused by microbial agents. Microbial pathogens are considered to include bioterrorism agents, emerging infectious pathogens, and nonselect agents. Establishing the presence of threat agents in the environment ideally would be supported by validated and effective sampling, detection, and quantification of the target agents, as well as specific identification of pathogens and their antimicrobial susceptibilities. It would be desirable to have the capability to estimate risk of infection to human populations using data such as number and viability of organisms in an environment, persistence of agents in the environment, dose-infection relationships through various environmental media, and antimicrobial resistance patterns. Finally, it would be desirable to develop and understand the efficacy and effectiveness of a range of risk reduction strategies for contaminated environments, including environmental controls, personal protective equipment, and disinfection strategies. Overall Performance Goal: By 2016, improve the ability to evaluate, understand risk of infection, and improve risk reduction strategies for five threat agents, with focus on those agents within the BioWatch program. Goal 7.1: Improve the ability to sample and analyze a range of threat agents in a variety of media with high sensitivity and specificity.
Goal 7.2: Improve understanding of the risk of infection by focusing on selected factors contributing to virulence, transmissibility, aerobiology, and persistence of microbes in the environment. For this goal, focus on science-based approaches to evaluating a microbe's potential for airborne transmission and environmental persistence to improve exposure-preventive interventions for workers.
Goal 7.3: Improve the understanding and implementation of techniques and procedures for risk reduction of individuals in biological agent contaminated environments.
Goal 7.4: To ensure appropriate worker preparedness and appropriate levels of personal protective equipment, improve the database on the presence of enzootic threat agents in the environment, with prioritization of those microorganisms included within the BioWatch program.
8. ENVIRONMENTAL AND BIOLOGICAL MONITORING OF TERRORISM AGENTSStrategic Goal: Improve the identification and characterization of terror agents to reduce exposures to response and remediation workers.Discussion: When a terror event occurs, the causative agent, whether chemical, physical, or biological, needs to be quickly identified. At times, the terror event could be the result of multiple agents either simultaneously or subsequently. Better methods to identify these agents are needed. In some cases, it may be preferable to measure what or how much agent is actually absorbed into the body using biomonitoring techniques. This would be especially true if the chemical was dermally absorbed as air concentrations would not give a good indication of exposure. For other hazards, the only way to measure exposure is by looking at changes in the body that occur after exposure. Rapid and field deployable methods that can be used for either environmental or biological assessment of exposure will be essential to quickly identify the causative agent. In addition, one method of augmenting the effect of exposure to biothreat agents is vaccination. Emergency responders, decontamination workers, health care workers, laboratory personnel, and others have the potential for short-term or long-term exposure to biothreat agents or mixtures of biothreat agents at doses which can range from low levels to overwhelming doses which potentially could even overcome immunity from vaccination. Successful vaccination results in measurable biothreat agents antibody titers. Exposure to biothreat agents also can induce natural immunity which can serve as a biological marker of exposure. Cumulative sub-clinical exposures to biothreat agents over time may lead to frank disease status. Critical gaps exist in the efficient measurement of antibodies to numerous biothreat agents as existing methods can measure only one analyte per assay. Array assay methods are needed to measure numerous analytes simultaneously so as not to overwhelm the country's analytical capacity after a multiple bioterrorism event. Overall Performance Measure: By 2010, ten new methods for identifying environmental contamination or internal dose will be available in case of a terror event. These methods would reduce the numbers of workers exposed since more rapid identification of the terror agent would occur and appropriate protection and workplace controls would be instituted. Note: It is anticipated that much of the proposed research may occur in collaboration with external organizations, including the Environmental Protection Agency and CDC's National Center for Environmental Health. Goal 8.1: Develop methods to identify exposure to chemical terror agents.
Goal 8.2: Improve the ability to rapidly sample for antibodies to multiple biothreat agents and toxins simultaneously.
Goal 8.3: Improve the ability to rapidly sample for multiple serum antibodies to biothreat agents and toxin vaccines simultaneously.
Goal 8.4: Evaluate the efficacy of personal protective equipment (PPE) by employing to reduce exposure emergency responders, health care personnel and decontamination workers to terror agents.
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NIOSH Portfolio Program:Emergency Preparedness and Response |
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