Response to Disasters: Protection of Rescue and Recovery Workers, Volunteers, and Residents Responding to Disasters

A disaster is a natural or human-made event resulting in such severe physical damage, ecological destruction, loss of human lives, and/or deterioration of health and health services that it threatens the survival of a community and requires an extraordinary response from outside the affected region. Both natural and human-made disasters pose a potential threat to public health. APHA has previously recognized the need for adequate emergency response and rescue measures to protect the health of disaster responders- workers and volunteers alike, as well as that of the community.¹ The current policy primarily addresses disasters caused by the intentional use of weapons and violence to cause destruction and harm. This resolution further addresses the public health impacts and needs, occupational and non-occupational, based on recent experience following natural disasters.

Recognizing that: 
Both the human-made disasters involving the attack on the World Trade Center and recent natural disasters such as hurricanes and tsunamis have presented threats to public health.

In 9/11 response efforts, immigrant and temporary workers were the workers least likely to be provided with proper training and respiratory protection, and were the workers least likely to have medical insurance. Immigrant workers are less likely than U.S.-born workers to file workers compensation claims.²

Following the Katrina hurricane, Latino immigrant workers³ and low-income African American flood evacuees were similarly vulnerable to discrimination.⁴ Contractors have been found to be taking advantage of workers by not paying them and not providing personal protective equipment or training in its use.^5,6

Following disasters, the cleanup creates a situation in which construction workers and residents are at significant risk of injury due to their inexperience, work sites unpredictably affected by damage, production pressures, and normal hazards associated with construction work (pre-Katrina, construction workers already comprise one-fifth of U.S. work-related fatalities);⁷ falls, electrical hazards, chainsaws and motor vehicle crashes and other injuries are particular concerns.⁸ First responders, recovery workers, volunteers and local residents, may also be threatened with violence;⁹ Failure to assess and respond to hazards adequately will threaten returning residents and workers, and could significantly increase long-term cleanup and public health costs.

The public and workers need accurate and timely information about risks in the wake of disasters. They need the information to be communicated in ways they can understand, including in multiple languages and addressing literacy issues including the use of simple diagrams. Agency staff and journalists engaged in risk communication often lack the skills and training to provide these communications appropriately.

Occupational Safety and Health Administration (OSHA) standards require employers to train workers in issues relevant to their jobs, e.g., hazard communication, respiratory protection, hearing conservation, personal protective equipment, blood borne pathogens, and hazardous waste operations and emergency response10 and these regulations should be enforced in the context of a response to a disaster. Regulation 1910.120(a)(1)(v) in particular, covers emergency response operations for releases of, or substantial threats of releases of, hazardous substances without regard to the location of the hazard.

OSHA has also developed resources that have been made available to the public on their Web page;¹¹ However, OSHA's emergency response activities may be dependent upon Federal Emergency Management Agency funding, which may be inadequate for OSHA to meet the essential functions and ongoing demands for assistance. In addition, OSHA does not cover volunteers, and public employees, who play a central role in response activities, are not covered in many states; State-OSHA plans have jurisdiction in 24 states, all of which include coverage for public employees; four of these programs only cover public employees. The remaining states are covered by federal OSHA and do not cover public employees. Each state program has the options of enacting regulations that are at least as effective as the federal regulations. Thus emergency response may vary by state, depending on which agency has jurisdiction and what the specific program regulations include.

Workers need appropriate protective clothing and equipment including the appropriate respirators for their specific situations. Decontamination and sanitary facilities are needed to protect workers and their family members from take-home toxics along with training to emphasize the need for regular decontamination of workers and volunteers, and of their protective gear, tools, equipment, and vehicles, as well as the need for meticulous personal hygiene.

Workers frequently lack information about their workplace rights and about how to follow up in the event of injury or illness. Medical surveillance, including mental health surveillance, is needed for early detection, intervention, and treatment of occupational, environmental, and psychological illnesses and for tracking of long term consequences. Children exposed to environmental contaminants need to be assessed for possible overexposure and toxicity before a mental health diagnosis can be made.

The Environmental Protection Agency may permit local authorities to determine housing re-occupancy criteria, but it is critical that the EPA work with all local government agencies to ensure that all re-occupancy occurs according to standards that are adequately protective of public health and that are sensitive to the needs of vulnerable populations. Analysis and remediation of soil and groundwater must precede reconstruction of housing, businesses and public facilities, such as schools, to prevent harm to users of the site; guidelines need to be established based on the most sensitive exposed individuals, based on current knowledge of epidemiology and toxicology, and include the occurrence of multiple chemical exposures.^12,13

Important disaster response lessons can be taken from the experience of the post-9/11 period when thousands of workers and residents, young and old, were unnecessarily exposed to toxic substances after being assured by EPA that the air was safe to breathe. At the same time workers were left unprotected by OSHA when it declined to enforce its respiratory protection standard and other regulations. Research and surveillance activities have found serious health conditions as a result of these exposures.^14,15 As part of disaster response, OSHA, in recent disasters, has temporarily suspended enforcement in specific geographic areas. For example the search and rescue phases of the disaster response were prolonged after 9/11 and the World Trade Center site, effectively precluding OSHA enforcement for many months. In the future, OSHA enforcement should be reinstated immediately once the necessary infrastructure and other resources for OSHA to function have been reestablished. 

The National Response Plan by the Department of Homeland Security¹⁶ provides for worker and community protection through hazard identification, environmental sampling, personal exposure monitoring, collecting and managing exposure data, development of site-specific safety plans, immunization and prophylaxis, and medical surveillance, medical monitoring and psychological support.

Therefore, APHA recommends the following actions be taken to reduce the risks to rescue and recovery workers, volunteers and residents responding to disasters, including pregnant women facing additional risk: 

1. In future disasters, implement the sections of National Response Plan's Safety and Health Worker Annex; and the Community Environmental Testing and Monitoring Provisions.
2. Presume Contamination Until Proven Otherwise. In an area that has suffered serious damage, level and type of contamination is not immediately known. Therefore, until evaluation and testing can be completed, disaster impact zones where recovery and restoration sites are located must be approached in this manner to provide adequate safety to all involved.
3. OSHA and EPA enforcement should be reinstated immediately once the necessary infrastructure and other resources for OSHA and EPA to function have been reestablished. Federal and state OSHA agencies and EPA must be provided additional resources earmarked for enforcement, and include coverage of public employees. 
4. Assess Occupational and Environmental Hazards. This assessment should be provided as specified in OSHA regulation 1910.120, the Hazardous Waste Operations and Emergency Response Standard (HAZWOPER); or Injury and Illness Prevention Programs provided under some state OSHA plans (e.g., California;¹⁷ Washington¹⁸). 
5. Assure Appropriate Decontamination and Sanitary Facilities. Pursuant to the health and safety standards under OSHA or the appropriate state-plan, facilities must be provided for adequate decontamination. Also, access to use of hand-washing and toilet facilities and potable water must also be included.
6. Respond to Findings From Environmental Monitoring. Follow-up with ongoing testing needs to also include remediation, plus monitoring and treatment of possible health effects.
7. Adopt Criteria for the Remediation of Contaminated Soil Prior to Reconstruction. A standardized and enforceable process and policy for evaluating soil contamination and conducting thorough remediation prior to facility reconstruction must be central to a disaster preparedness plan. Federal funds allocated for rebuilding and renovating public facilities, such as schools, should carry a requirement to test and remediate contaminated soil on site to the most health protective level possible.
8. Train and Protect Cleanup Workers and Volunteers. OSHA should specify the minimum training and equipment that must be provided to workers engaged in cleanup and recovery and pursue enforcement of these standards. Health and safety of workers participating in emergency response under Emergency Management Assistance Compact responses needs to be better coordinated. 
9. Provide Medical Surveillance for All Public and Private Sector Rescue, Response, and Cleanup Workers, Including Volunteers. Local public health departments should receive funds to enable outreach and screening programs for common disaster-related health conditions, including mental health issues. 
10. Protect Vulnerable Workers Including Immigrants, Temporary Workers and Others at Risk of Exploitation, and Place Priority on Hiring Local Workers.
11. Adopt Uniform Re-occupancy Standards that are Sensitive to the Needs of Vulnerable Populations. 
12. Provide Environmental Health Information and Training to Health Care Providers and Public Health Professionals. A wide range of health professionals in state and local health departments, medical clinics and other health care facilities need information to adequately assess environmental exposures throughout the community, including on the increased vulnerability of children. CDC and EPA have funded pediatric units in each region that can provide training resources for this purpose.
13. Ensure that deployed disaster response workers receive workers' compensation coverage from their home states.
14. Encourage the development of additional scientific knowledge is needed regarding best practices in disaster response, to enable more standardized operational response to future disasters. 
15. Require that all contractors and subcontractors who receive federal disaster relief funds for rescue, response, and cleanup work collect and maintain records of their employees. These records should contain, at a minimum, social security number, home address, phone number, period of employment, job tasks, work location and potential exposures. These data should be filed in a confidential registry maintained by the federal government (e.g., Agency for Toxic Substances and Disease Registries in conjunction with the National Institute for Occupational Safety and Health) to audit and evaluate for possible adverse health and safety outcomes. 

References

1. American Public Health Association Policy Statement 20027: Protecting the Health and Safety of Workers Who Respond to Disasters. APHA Policy Statements,1948 -present, cumulative. Washington, D.C.: APHA, Available at http://www.apha.org/legislative/policy/policysearch/index.cfm?fuseaction=search_results&YearofPolicy=2002, Accessed March 14, 2006.
2. American Public Health Association Policy Statement 20039: Workers' Compensation Insurance - Increased Funding for Prevention of Occupational Disease and Injury. APHA Policy Statements, 1948 - present, cumulative. Washington, D.C.: APHA. Available at: http://www.apha.org/legislative/policy/policysearch/index.cfm?fuseaction=search_results&YearofPolicy=2003. Accessed March 14, 2006.
3. Pritchard J. Immigrants often unpaid for Katrina work. Associated Press. 11/5/05. Available at: www.nola.com/newsflash/weather/index.ssf?/base/business-51/1131212045258720.xml&storylist=hurricane. Accessed November 14, 2005.
4. Bernstein J, Eisenbrey R, Savner S, Greenberg M, Principles for Gulf Coast Reconstruction, Economic Policy Institute, http://www.epi.org/content.cfm/memo_gulf, Accessed November 21, 2005.
5. Natural Resources Defense Council. On the Ground in New Orleans: An NRDC Fact-finding Mission, October 2005. Worker Safety. http://www.nrdc.org/health/effects/katrina/journalpage5.asp. Accessed March 7, 2006.
6. Rebuilding after Katrina: A population-based study of labor and human rights in New Orleans (2006). Available at http://www.hrcberkeley.org/download/report_katrina.pdf. Accessed June 16, 2006.
7. OSHA Construction E-tool. Available at: www.osha.gov/SLTC/etools/construction/index.html. Accessed: November 15, 2005.
8. OSHA Offers Assistance for Hurricane Katrina Cleanup and Recovery Workers (Press Release.) Available at: www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=NEWS_RELEASES&p_id=11557. Accessed: November 17, 2005.
9. Hsu Spencer S. FEMA Pulls Out of Lower Ninth: Agency Calls for Troops, Reporting Threats of Violence. Washington Post. December 5, 2005.
10. U.S. Department of Labor. Occupational Safety and Health Administration. Keeping Workers Safe During Clean Up and Recovery Operations Following Hurricanes, 2005. Available at: www.osha.gov/OshDoc/hurricaneRecovery.html. Accessed December 8, 2005. 
11. U.S. Department of Labor. Occupational Safety and Health Administration. Best Practices for Hospital-Based First Receivers of Victims from Mass Casualty Incidents Involving the Release of Hazardous Substances. 2005. Available at: www.osha.gov/dts/osta/bestpractices/firstreceivers_hospital.html, Accessed December 8, 2005.
12. Center for Health, Environmental and Justice (CHEJ) (2005) Building Safe Schools, Invisible Threats, Visible Actions, A Report of the Child Proofing Our Communities Campaign, CHEJ, Falls Church, VA. November 2005.
13. Schools of Ground Zero: Early Lessons Learned in Children's Environmental Health, Bartlett and Petrarca, (c) 2002, American Public Health Association and Healthy Schools Network, 300 pp.
14. EPA. Whitman Details Ongoing Agency Efforts to Monitor Disaster Sites, Contribute to Cleanup Efforts. [press release]. September 18, 2001. Available at: www.epa.gov/wtc/stories/headline_091801.htm. Accessed November 15, 2005.
15. Physical Health Status of World Trade Center Rescue and Recovery Workers and Volunteers -New York City, July 2002 - August 2004. Morbidity and Mortality Weekly Report , 53(35): 807-812. September 10, 2005. Available at www.cdc.gov/mmwr/preview/mmwrhtml/mm5335a1.htm. Accessed December 8, 2005.
16. United States Department of Homeland Security. National Response Plan, December 2004. Available at http://www.dhs.gov/xlibrary/assets/NRP_FullText.pdf, Accessed December 5, 2005.
17. Title 8 of the California Code of Regulations (CCR), requires every California employer to have an effective Injury and Illness Prevention Program in writing that must be in accord with T8 CCR Section 3203 of the General Industry Safety Orders. Available at http://www.dir.ca.gov/t8/15353.html, Accessed June 16, 2006.
18. Washington State Industrial Safety and Health Act, Core Rules, Accident Prevention Program. Available at www.lni.wa.gov/WISHA/Rules/corerules/HTML/296-800-140.htm, Accessed June 16, 2006.

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