Responder Health and Safety: Who Cares for the Caregivers?

April 1, 2009
The author explores methods of improving the existing quality of protection afforded responders during emergency situations.

During emergency situations, such as natural or man-made disasters, often the last people thought to need care are the first responders, the caregivers. Medical force protection (Med FP) is the preservation of a force so that it is healthy, fully capable and can be applied at the decisive time and place. It consists of actions taken to counter the debilitating effects of environment, disease and selected stressors through preventive measures for personnel, systems and operations (adapted from the NATO definition).

A holistic approach to responder health and safety is necessary. The components of a successful system include equipment, training, funding, standards/protocols, planning/preparedness, community involvement and support, use of technology and provider health and wellness.

Alongside this overarching review of current methods, other related incident and system-wide practices offer additional opportunities for enhanced quality of protection for responders and supporting personnel. An academic review demonstrates that significant improvements can be attained by use of standardized Med FP practices and the development of robust safety and health management systems (SHMSs).


The key elements of Med FP are measured assessment of the overall threat, field risk/hazard assessment, health and safety risk management and continuous audit and surveillance. Figure 1 represents an informal graphic of how Med FP should be approached. Like other successful programs, this process should employ continuous improvement and assessment of applied decisions and actions for desired effects and outcomes.

When discussing Med FP, reference should be given to the Worker Safety and Health Annex (2004) from the National Response Plan. This document, also listed under OSHA's Emergency Preparedness and Response directive, is a model guide for the overarching management of any responder health and safety program. And while this (referenced) document primarily is focused on incidents of national significance, the presented outline for coordination and necessary actions is cornerstone to any response agency's processes and standards documents.

Second, and by no means less important, the outstanding work of the RAND Corp., in cooperation with NIOSH, should be recognized for developing the “Protecting Emergency Responders” series, which illustrated numerous gaps in current theories of practice and public expectations of emergency responders in their efforts. Their highly acclaimed work is necessary reading for all professionals engaged in development and application of Med FP programs for their respective organizations.


During recent disasters and at other times of emergency in our nation, certain workplace safety and health regulations have been “set aside” to better allow for the performance of a task or evolution. However helpful this might appear to a group that employs the practice of management by objective (MBO), the fact remains that when these decisions are made, they affect the human resources as well as the tactical issues that they are meant to resolve.

When established regulations or ordinances are (temporarily) lifted to facilitate emergency operations, the affected organization must assure sufficient protective standards still remain in effect to adequately protect the responders engaged. While not an optimal state, this premise will reassure workers and leaders of basic protective measure being in place. This is an underpinning to successful (and safe) operations.

Military responders have specific standards for uniforms, standard operating procedures (SOPs) for actions performed and a litany of other guiding documents and principles from which to operate. Similarly, the nation's fire departments follow very detailed national consensus standards (such as National Fire Protection Association), and industry best practices shared through both formal and informal networks alike. These two organizations provide model systems of having solid base documents from which to operate, and continuous in-service or refresher training to update personnel with new information, refresh perishable skills and assess performance to the organization's objectives.

This same level of information sharing is not readily apparent in the uniformed services of police departments, EMS systems and similar responder agencies. While the National Institute of Justice (NIJ) does offer numerous courses and hosts many informational conferences each year, its ability to research and promulgate standards significantly is less than that of their fire department counterparts.

The emergency medical services community (commonly a third-party entity in the public safety arena) woefully is unrepresented at the national level, and simply unable to lead any of the programmatic changes necessary in order for better health and safety programs to be implemented in their departments or systems. This fact is very troubling, since many agencies utilize their EMS components to “take care of” their personnel. Examples are EMS workers tending to firefighters in a Rehab Sector at a working fire incident, similar support to hazardous materials technicians dressed out in Level-A suits or police special operations forces who often are exposed to life-threatening situations as part of their high-risk efforts.

One would think that these medics would have the best information, most up-to-date resources and be most capable in the performance of Med FP for their respective organization. The sad fact is, they are not. True, most perform their duties flawlessly and support their colleagues with professionalism and expert skill — but are they performing optimally, or just well enough to suffice?


In addition to the obvious — albeit subtle — issue of equipment standardization, there is an underlying gap in the foundation of standards for educating identified personnel in key safety and health roles. The National Fire Academy has remarkable programs, and many fire departments and others from across the country (or abroad) have taken advantage of these offerings. However, the typical 16-hour course based upon fire-ground incident safety and health, or the 16-hour course on general member health and wellness, does not adequately prepare those who are termed as “incident safety officers” (ISO) or “health and safety officers” (HSO) for truly austere field conditions such as those often seen in response to national or state-wide catastrophes.

In recent years, many agencies have attempted to improve internal programs to better prepare their health and safety generalists for field deployments, but little of this information has been shared across the scope of emergency responders. There remains an air of territorialism and vertical information processing versus the necessary cross-functional development and sharing of key ideas and practices with all parties involved in these responses. There is no central oversight organization.

Traditional public safety organizations do not require their personnel to (typically) be familiar with areas of risk that many private industries mandate for assured compliance with established regulatory standards. What often is seen are more general practice safety officers who may or may not have a background in one specialty (such as HazMat, SWAT operations, etc). They have little experience in job hazard analysis, risk control methods, interpretation of qualitative and quantitative data or the ability to develop robust safety and health management systems (SHMS) to address expected and non-routine hazards that their personnel might encounter when deployed.


Response agencies should work diligently to ensure that their personnel have requisite training prior to responding. Joint field offices (JFOs) established for event coordination commonly strive to integrate the health and safety representatives from each of the supporting emergency support functions (ESFs) to better share information on the front lines during deployments. By establishing a more thorough generalist curriculum for responding health and safety personnel prior to field activity, the agencies can better prepare their staff for what waits for them in the field.

Table 1, while not all-inclusive, indicates common areas of knowledge a health and safety officer should be very familiar with and trained in.

We should strive to use mature methods of managing resources, and utilize proven safety and health practices centered on specific focus areas. This will provide expected outcomes and enhance the current decentralized system of information sharing and common applications of best practices to increase Med FP. Key (core) elements to successful force protection are listed in Table 2.


The time to implement a formal Med FP management program that follows best-practice standards and conventions for all emergency responders in the field is now.

Regardless of career or volunteer position; federal, state, municipal or private organization; or the often overlooked supportive non-government organization (NGOs), all responders in the field should expect the same level of over-watch and assurance that the provision of a high performance health and safety system is in place to protect them. Currently, there are numerous agencies collecting data, promulgating myopic recommendations, focusing their energies on their select target (audiences) and working within their common frames of reference. Little (effective) coordination up, down or laterally is occurring between these organizations and the gaps are evident.

A viable solution to coordinating the myriad of information gathered from agencies involved in differing aspects of responder safety is the establishment of a new center or an institute solely dedicated to the collection of information from various groups, establishing standards for resources and professional development requirements and essentially functioning as a clearinghouse. This organization would be similar to the Centers for Disease Control and Prevention, in such that it would be aligned under the U.S Department of Health and Human Services (DHHS) as a contributing agency to the overall mission. Its sole focus would be responder safety and health.

The newly established center should be managed by a cross-functional group of individuals from the represented industries or fields of practice. Such a group might include a medical officer, fire services officer, private industry leader or personnel from numerous other representative functions. The leadership would develop pragmatic and holistic objectives, assure a means of meeting such are in place and then work through public education and professional development to system maturation.

As awareness increases of the benefits of providing care for the caregivers, it is anticipated that support of such a center being established will increase, potentially leading to formal request of DHHS to fund and staff such an organization to better prepare and protect our nation's emergency responders. One could postulate that without effective research, adequate funding and coordination, who will care for our caregivers?

Scott H. Kalis is manager of environmental, health and safety, and the program manager for the Business Preparedness Program for Raytheon's Norfolk Virginia Depot Operations. Kalis joined Raytheon in 1988 on a defense program for the Raytheon Technical Services Co. (RTSC) business, and has held positions of progressively greater responsibility in program leadership and management. Before joining Raytheon, he worked for the NSA at Ft. Meade, Md., on a surveillance and intelligence program. Kalis has a degree in Emergency Medical Services and holds numerous professional certifications. He is active with the American Society of Safety Engineers (ASSE), and has served most recently as a local chapter's president. He currently supports this group of health and safety professionals as their regional delegate. Kalis has volunteered for 19 years with the Virginia Beach Department of Emergency Medical Services as a paramedic and technical rescue captain. He now serves as a volunteer brigade chief in the Operations Division supervising several rescue stations, the city's SWAT medics and MCI/Terrorism Response Teams. He recently was appointed as one of the city's first flight medics assigned to their new EMS/Police Med-Evac unit. He also works in an “on-call” capacity for the U.S. Department of Health and Human Services as an intermittent employee with the Virginia-1 Disaster Medical Assistance Team (DMAT) as their lead health and safety officer and a critical care paramedic tasked primarily with force protection.


U.S. Department of Labor — Occupational Safety and Health (OSHA); “Emergency Preparedness and Response — Worker Safety and Health Support Annex;”

Jackson, B., Peterson, D.J., Bartis, J., LaTourrette, T., Brahmakulam, I., Houser, A., Sollinger, J. (2002); Protecting Emergency Responders (Conference Proceedings); “Lessons Learned From Terrorist Attacks;” RAND Science and Technology Policy Institute.

LaTourrette, T., Peterson, D.J., Bartis, J., Jackson B., Houser, A. (2003); Protecting Emergency Responders (Volume 2); “Community Views of Safety and Health Risks and Personal Protection Needs;” RAND Science and Technology Policy Institute.

Jackson, B., Baker, J., Ridgely, S., Bartis, J., Linn, H. (2004); Protecting Emergency Responders (Volume 3); “Safety Management in Disaster and Terrorism Response;” RAND Science and Technology Policy Institute and NIOSH.

Willis, H., Castle, N., Sloss, E., Bartis, J. (2006); Protecting Emergency Responders (Volume 4); “Personal Protective Equipment Guidelines for Structural Collapse Events;” RAND Science and Technology Policy Institute and NIOSH.


Physical Safety Environmental Compliance Security Operations Industrial Hygiene Mental Health Occupational Health/Preventative Medicine Recordkeeping Wellness Programs


Planning and Preparedness — Exploitation of current research and available data. Use of Technology — Use of automation and allocation of shared technology assets. Standards and Protocol Development — Open sharing of best-practices and lessons-learned. Funding — Invest sufficient resources (both monetary and human capital). Equipment — Use high-performance tools and systems. Strive for inter-operability where feasible. Community Involvement and Support — Engage private industry and community planning organizations. Training — Facilitate Table-Top (TTX) and Field-Training (FTX) exercises. Responder Health and Wellness — Cardio and physical fitness programs aimed at prevention.

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