Disasters—Keeping Volunteers, Workers, and Responders Safe - Transcript


  • CAPT Lisa Delaney, M.S., CIH

Date/Time: August 21, 2019, 1 p.m. to 2 p.m. Eastern Time

>> Kellee: Good afternoon, I am Kellee Waters, a health communication specialist in CDC’s Center for Preparedness and Response, Division of Emergency Operations. Thank you for joining us for today’s EPIC webinar on keeping volunteers and response workers safe after a disaster.Today, we will hear from Lisa Delaney.If you do not wish for your participation to be recorded, please exit at this time. You can earn continuing education by completing this webinar. Instructions on how to earn continuing education can be found on our website: emergency.cdc.gov/epic. The course access code is “EPIC0821”, with all letters capitalized. To repeat, the course access code to receive continuing education units is, in all caps, “EPIC0821”.Today’s webinar is interactive. To make a comment, click the “Chat” button on your screen and then enter your thoughts. To ask a question, please use the “Q&A” button. The Q&A session will begin after our presenter has finished. Closed captions are available for this webinar.

We are fortunate to have Lisa Delaney as our speaker today. CAPT Delaney is the Associate Director for Emergency Preparedness and Response at NIOSH where she coordinates NIOSH’s response to emergencies, ensures federal response plans incorporate occupational safety and health protection measures, and promotes research in the area of protecting first responders during emergencies. She is a trained Industrial Hygienist and has been with NIOSH for 20 years. Thank you for joining us today. Lisa, please begin!

>> Lisa Delaney: Great and thank you, Kellee. Good afternoon and thank you for joining the webinar. My name is Captain Lisa DeLaney and I’m going to speak about keeping volunteers and first responders safe during a disaster. I’m going to ways to mitigate hazards and talk about our surveillance system, which provides a framework for thinking about how to protect responders during and after a response.

So I work for the national institute for occupational safety and health, NIOSH, and our mission is to help develop new knowledge in the division of occupation and health and transfer that knowledge into practice. After the events of 9/11, we created the emergency preparedness office that coordinated that and as you can see on the slide, we have many of the divisions located across the country that we can draw from during emergencies to help advocate and provide resources to protect workers.

So why do we include occupational safety health in an emergency? During every disaster, chemical release, infectious disease outbreak, workers are at a risk. Ensuring the health and safety of recovery workers is an effective response. It is critical that we provide for the health and safety for the recovery workers so they can help the community impacted by the disaster. At NIOSH, we define workers broadly, we think of police or fire departments or E. M. S. personnel, but there are many different types of workers that come together to respond. You have health care workers, transportation workers, utility workers; the list goes on and on. Additionally, we think of volunteers. Volunteers are working side by side with response workers to help the urgent needs of the community.

I’m going to talk about the federal plans and how they address worker safety and health in the next few slides. Of course, employers are always responsible for the health and safety of their own employee, even when they responding and that can include health and safety training, providing adequate equipment and protective equipment and helping to identify and mitigate any hazards present and following any applicable OSHA regulations.

Within the guide on how the nation responds to disasters and works across various levels of the government, state, local, and fed it is the worker safety and health support annex and that is to provide federal support to recovery organizations to ensure worker safety and health during a required federal response that is led by our colleagues at OSHA, but there are a number of supporting agencies who have unique perspectives on what is happening on the ground and those agencies are listed on the slide, so I won’t go into detail.

As we’re building on the recognition that workers are exposed to longer term and delayed illness that may take years to appear, the national disaster discovered a core area. Here on the slide is the basic incident command system structure. When a response stands out, then commander is responsible for the health and safety of the response, as the response grows more complex and larger that responsibility is designated to the safety officer and the safety officer has responsibilities for ensuring personal safety, monitoring unsafe situations and developing specific safety plans, so gets to know your safety officer. they are an important person on the response.

I won’t have time to go through all of the hazards, but many hazards can be present at a disaster site so I listed some of the categories on the slide. The potential for hazardous substances to be present and the type of work being performed.
There is a need for a unique hazard assessment and oftentimes we may not be able to recognize or identify what those hazards are and it may take time to develop those plans, but decisions have to be made and recommendations early on and throughout the disaster response.

In addition to the hazards of direct response, workers are exposed to the physical danger environment and psychological stresses. I won’t talk about violence, but one of the challenges we’re having facing the Ebola outbreak is the unrest happening in that country. It is preventing some of the work that needs to be done.

Starting out with stress because I think that is a common denominator in all responses regardless to the type of response. For those who responded in the past, can you think about things that created stress for you while you were on deployment and while you were responding? For me, it comes to the ambiguity of your role, fear of the unknown, you may have long work hours, no one gets enough sleep during responses. I know personally during deep water horizon it was challenging because it was such a prolonged response and it took many months for them to cap the well and prevent the oil from spilling over and for me that was stressful. All of these factors can lead to stress and the response to stress can be immediate or it can happen later and it could be based on your personal experiences or indirectly.

A number of symptoms that can manifest from stressful conditions can be physical, such as fatigue, nausea, headache, cognitive, concentration, can have emotional symptoms such as anxiety, guilt or depression or intense anger or a need to withdraw.

We focused a lot lately on identifying ways to improve our well being and think about resiliency. My expert colleagues at C.D.C. have shared with me that they define resiliency to be able to withstand, recovery, and grow in the face of stressors and changing of demands. There is a number of steps we can take to improve our emotional well being. One is to pace yourself. Oftentimes here at C.D.C., we talk about the response being a marathon and not a sprint and early in the few days of the response, you are in sprint mode, but you quickly need to come to some kind of pace that we can all maintain and stay in for the Long haul. It is important to take frequent rest breaks even if it is to walk around the room for two minute, anything you can do to get away, if it is briefly, it makes a difference and watch out for others. The concept of the buddy system to check in on everyone around you in the response there is a concept called psychological first aid techniques that can help you deal with people who are experiencing stress and I encourage you to look into that because that is a wonderful technique to utilize.

Also, do something you enjoy. If you’re a runner, try to find time to run, maybe you’re not going to get your regular run in, but a 15-minute jog can work wonders for you. If you like to read, find time to read a book and the most important is rest, sleep, eat, and be active.

Unstable work surfaces is in the aftermath of a disaster, particularly hurricanes. What you see on the slide is something you are used to seeing on the news after hurricanes and these debris piles can create traumatic injuries, including falls from trips, slips, or falls. Watch for sharp edges and points and wear appropriate protective clothing. Flip-flops are not something you should be wearing so wear hard hats and gloves and think about collapses or cave ins.

Here is an example of an unstable structure that workers are tempted to enter, but conduct all necessary activities from outside of damaged structures and do not enter the structures if you are uncertain about the stability. It is important that you find competent people to evaluate the structures and have authority to put signs up or make changes so the buildings are safe to enter.

Again, flying debris such as dust, concrete, and metal particles may be generated from moving vehicles or construction activities and debris can cause traumatic injuries from minor eye injuries to fatal, serious injuries. Be aware of your environment, wear safety glasses with side shields or wearing goggles if it is a highly hazardous environment can help protect you while you’re in this exposure. It is important if you’re wearing the eye protect and you look for the E87 mark because it shows it is protected.

Downed electrical wires and cables pose an electrocution hazards and in almost every large response there are injuries that occur based on repairing power lines or downed trees. You should treat all cables as they are energized until proven otherwise. Be aware that gas lines, sewer lines and other lines may be compromised. A couple years ago in my neighborhood in Atlanta, we had hurricane Irma come through. It was downgraded to a tropical storm and we had downed power lines on either side of my road and I kept a safe distance and I thought about all of the times I gave these presentations in the past and they was applying to me.

Another hazard you may encounter is excessive noise from saws, large equipment or tools. Short, intense sounds such as an explosion can cause immediate hearing loss. We see hearing loss that occurs from gradual exposure to loud noise. It is easily preventable by wearing hearing protection, which is fairly inexpensive. It just relies on the responder to wear it, so you have the inexpensive ear plugs or wear the earmuffs that cover the whole ear. If you’re in a high-noise environment, if you’re within a couple of feet of a person and you have to yell to be heard, you should probably be wearing hearing protection. If you leave the noisy environment and you hear ringing, you have probably been exposed and should have been wearing protection. If you are in a high-noise environment, you can put on your P. P. E.

Slip, trips, and falls is a common hazard that we see in responses that can be caused by wet or slippery surfaces, having improper footwear, poor lighting so you can’t see the floor there could be obstacles in your pathway. We hear about falls from ladders or changes from elevations on uneven surfaces. The two photos at the bottom of the slide is photos I took when I served for C.D.C. during the Ebola outbreak. Due to the rainy season, they have these drains that run alongside the road and they don’t have great sidewalks either in Sierra Leone. This is just being aware of your environment and paying attention, so you remain safe.

Musculoskeletal disorders can happen from having bad posture or bending, twisting, or heavy lifting, so it is to have controls to fit the employee’s capabilities. Here are examples, we may have to lift boxes and bending and kneeling and repetitive tasks. Improving your workstation, I always see people hunched over their laptops working in small spaces, so having better posture, set up your monitor in a way it is ergonomically correct that your head and neck are in line. This is a good example, if you are spending too much time on your keyboard that recommendation that we had earlier related to stress of pacing yourself and taking frequent breaks may help with the issues. Be careful not to lift objects over 50 pounds or utilize a buddy to help you, minimize your motions or awkward postures and you can rotate the job so the same person is not doing the same job the whole day.

You can imagine when you compound that with the hazards of driving during disasters where roadways are flooded, you may not have proper signage, the traffic lights are no longer working there are different ways of entrance and exits out of areas can compound the hazards that already exist. The single most effect precaution you can take while driving a vehicle is wear your seat belt every time. Avoid distractions. Many years ago, we were on a bio response in Texas and the team, we were on so many phone calls and getting calls from headquarters that we designated a person to answer the phone that way the driver was not distracted by their phone ringing and needing to answer the phone to report back to headquarters.

It is important to stay alert because situations may require quick action. Watch for emergency vehicle, watch for other drivers and avoid driving through flood waters.

Confided spaces refer to spaces by design have limited openings for entry and exit. They have unfavorable natural ventilation, which can lead to the production of dangerous air contaminants or lack of oxygen in the environment and they are not intended for anybody to occupy them permanently, so the example is sewers, wells, storm drains, boilers, these are places that people may need to enter during a response for various reasons. Really, if you’re not trained and that is not your specific job task, you should never enter a confined space it is such hazardous environment it can lead to death. Avoid confined spaces and represent that to your leadership to identify the appropriate teams who have the training, the protective equipment, the watchers that entry is being done safely.

Blood borne pathogens such as viruses or bacteria that are Carried in blood can cause disease in people. It can enter your system through open sores, acne, damaged or broken skin or your eyes, nose, or mouth. You should assume that any blood or bodily fluids contaminated with blood are infectious and wear protective equipment, like gloves, if you think there could be splashing or spraying, eye equipment becomes important. Once you remove your P. P. E., you should wash your hands. Depending on your task or the job duties that you expect to perform during a response, you should consider a hepatitis B. vaccination, especially if you’re doing a health care response.

Mold can grow almost anywhere, indoors and outdoors and people can be exposed think skin contact, inhalation or ingestion. You can think of anything with hurricanes or a flood, you have a great nutrient source and in this place, you have wallpaper so that is a great nutrient source. Symptoms can include allergy symptoms and you could have wheezing or difficulty breathing, sneezing. It depends on the amount of contamination and the work activity being conducted. If you’re going in to do remediation that calls for higher levels like in this photo, whereas you’re entering a moldy building and you’re disturbing mold, you can low it to an M95. There are two great resources that I rely on when questions come up about mold and hazards, the E. P. A. has mold and remediation in schools and commercial buildings and C.D.C. issued mold prevention strategies and possible health effects after hurricanes and major floods those are great resources that I encourage you to look into if you want more information.

Food borne disease is also common, especially when you’re in environments where the power has been out and you don’t have the ability to refrigerate or if food came into contact with flood water. When I was in Sierra Leone it was a huge challenge because they were not able to purify their water like we did here in the U.S. We did a lot of boiling water and purchased bottled water. Practice good hygiene before eating and make sure your food is from a safe source and store food safely and drink from portable water sources.

Every response, we hear the tragic stories of families or workers who died as a result of carbon monoxide poisoning. It is a colorless and odorless toxics gas. It is generated from combustion fumes from space heaters, generators, burning wood or charcoal and symptoms can range from mild symptoms from headache to dizziness or death. It is important that you place those generators in areas outside of the home and far enough away that the carbon monoxide will not be entrained into the home. There are stories depending on where you position the generators that we have had deaths associated with generators that are outside. C.D.C. has done a great job in working with our retail partners and providing communication materials and local retail stores that are selling these products during these responses and there is great information on the C.D.C. website if you want to learn more.

You may also be at risk for breathing dust containing ground up building materials that could contain asbestos and other particulates. Applying water so you wet the area and you don’t have the re-aerosol potential of the dust is important. Having appropriate safety and health professionals like the safety officer that I mentioned earlier to conduct hazardous assessments of the presence of dust and wearing personal protective equipment can help to avoid exposures.

Another common hazard that we see, especially as we’re gearing up for hurricane season, this is a common hazard is heat stress. The body’s response to heat stress is heat strain and it includes higher temperatures, humidity, working close to a heat source, strenuous physical activity compounded by wearing imparable protective equipment is contribute to heat strain and disorders that can relate to that like a heat rash, fainting, to more serious conditions like heat exhaustion and heat stroke. It is highly individual how they handle heat stress depending on your age, weight, degree of physical fitness, are you acclimated? Are you used to working outside and it is impacted by use of alcohol or elicited drugs.

We have a number of strategies that can address heat stress, staying hydrated, drinking a lot of waters, sports drinks, watching for signs and symptoms of heat-related illnesses. One of the signs is becoming disoriented. We were in an example a couple years ago and one of our colleagues had a heat illness that we were not aware of and it was like 100 degrees in Atlanta. He started wandering off and seemed confused so we got him in an air conditioned environment and he was fine. The buddy system and watching for signs is so important.

You can reduce the workload that was adopted during deep water horizon. We had people on the beaches picking up the tar balls and we staggered their work shifts when they were not working at the high heat times. They came in earlier in the day and we implemented frequent work breaks and in cool areas that were shaded so they didn’t have issues with the heat. Clothing matters so wearing light weight, loose-fitting clothing, avoiding alcohol, heavy meals is also a good heat prevention strategy.

I did not cover all of the hazards, but we have resources on our website that can help further describe the hazards that I presented and others I was not able to get to on our website. Here is a screen shot of our website. I encourage you to visit our NIOSH website and since we’re planning for the hurricane season, we developed a couple of years ago the NIOSH hurricane key messages and it is a great resource that has the various hazards and links to the FAQ’s, posters, training around the hazards that are most likely to be encountered during a hurricane.

I’m going to switch gears and talk about a program that is near and dear to my heart, it is the emergency responder health monitoring and surveillance system this was developed from lessons learned that occurred in the 9/11 terrorist attacks where we had many different responders coming from all states who urgently went to the site to respond. We didn’t have great tracking of what their exposures were, where they went, how long they were there and all of that impacted our ability to learn and make decisions about long term health of these workers. We developed ERHMS. The goal of ERHMS is to develop a health monitoring and health framework that addresses all phrases of response that includes pre-deployment, deployment, and post deployment. We did not do this in a vacuum. We had federal agencies, state agency, the American Red Cross, and labor unions who came together to come up with the — ultimately, it was adapted as the national response team technical assistance document. Next slide. Thank you.

National response team is an organization of 15 federal departments and agencies that are responsible for coordinating emergency response to oil hazardous and pollution. One is called the TAD, don’t be intimidated. It is a large document. It includes templates and questionnaires that can be adapted by your own organization. Oftentimes people apologizing, I took that questionnaire. We want you to do that, so please utilize it. We have a companion that is a cliff note version of the document and both are available on the website.

We think of ERHMS in three phases, this Venn diagram is a visual reputation of the phases of the response that we have broken down ERHMS into. What we’re talking about is making decisions about the need for long term health monitoring and what the impacts may be to workers then is the center gray circle.

Let’s think about what happened before an incident. What are the questions that we need to address to ensure responders are safe in the field? Are responders ready to deploy? Are they physically and mentally fit? Are they equipped with the right training and licenses? I mentioned about confined spaces that is for someone who has been trained and it is critically important to know who has the right training. Do they have the correct protective equipment and gear? Are they immunized?

What we have done in the pre-deployment phase that is the preparedness part of the response. We want to know who your people are and what they can do and in some cases, credentially is needed to determine who is best suited for a task. It is needed before working in hazardous conditions, immunizations, assessing fitness to deploy to a response. We have volunteers that want to help and contribute, but maybe they just returned from surgery or they had a previously heat illness so that sets them up to be a higher risk at a heat illness, depending them to the gulf during a hurricane may not be the right fit for them.

Health and safety training is a critical need and we learn how important training is. It does not negate the need for training that happens during deployments, but it happens before you deploy. In 2014-2015 Ebola outbreak, our responders had a four-hour training before they deployed. Once they arrived in country, they received another couple hours of training, so training is very important and critical. It calls for collecting a lot of data about employees that allows you to maintain confidential and privacy of your rostered responders is something you need to plan for. It can’t happen overnight.

During deployments, what do you need to consider during an emergency deployment? Responders are deployed and how are we keeping track of them and that was a concern during 9/11. How are we monitoring their exposures? Are there new exposures that occur? Exposures change over time, so what we find in day one or two of a response may be different in what we find that is present, a week, two weeks or three weeks after activities. How are we tracking their health and safety during and after a response? The deployment phase is focused on tracking responders one they are on site and that includes the onsite processing, so knowing who is on site, making sure they have badges to indicate where they can go there are certain — during deep water horizon, you have your yellow card indicating you received training but you could not get on work site if you did not have the yellow card. It was an important thing to have. It doesn’t have to be fancy or sophisticated. You don’t have to be high-tech.

We encourage self monitoring and surveillance so if illness arrives during response, we have a way of tracking that and responding that goes hand in hand with exposure assessment, activities and controls with our safety officers who are trying to stay up-to-date on what the merging hazards might be as the response changes. And most importantly is communication of the exposures and health data that information needs to be communicated up the chain to accident command. We can’t ignore the public demands, the media demands for information on what is going on, so sharing that information across the board will help avoid rumors and speculation.

Think about any exposures you may have had while deployed for an incident or your staff or there wasn’t a mechanism to get more information. The post deployment gets at that activity. What happens with the data from the response? How do you make decisions about tracking responders’ health? When is tracking necessary? We may not need to track if there are not unique exposures that occurred and what can we learn about the response to apply to the next response?

The post deployment overview emphasizes on recovery from the response and establishes long term monitoring and surveillance. The out processing assessment is critical that provides us one last time to talk to employees and responders about what happened while they were deploying and get feedback, sometimes you can feed that back into the current response or use it for future responses. You can make a determination of there are long term health implications that may need to be monitored and monitoring can take a variety of forms. It can be a simple check-in up to a registry, so there could be a number of ways of how you look at the long term health of responders and after action reporting those of us in the emergency preparedness role this is second nature for us. We always look for ways to improve on the next response.

Let me give you a few examples how ERHMS and we have exercised it with the West Virginia and Idaho health departments and I’m going to go into detail about other examples. During the deep water horizon, we were still in the last moments of finalizing our technical assistance document and we were able to roster employees and workers in the deep water horizon response. So we deployed, at the time, it with the U.S. largest deployment before Ebola took over. We had 100 people in the gulf, so we were asking for basic demographic information about the workers and gathered contact information and asked if they would be willing to participate for future studies or research or other response needs, so ultimately, we collected close to 56,000 names and those names were provided — the roster was provided to the national institute of environmental sciences to aid in their outreach and a follow-up study they are conducting. We made the information available to qualified researchers should they want to stand up and conduct the study.

Obviously, the 2014-2015 Ebola outbreak called for C.D.C. to enhance their existing responder deployment program and they stood up a unit an ERMHS-like unit for pre-deployment, deployment, and post deployment processes. There were a number of health and safety briefings and we improved the role and process with responders. During deployment, we established for the first time an in-country safety officer. At any given time there was 100 C.D.C. staff deployed. There were a number of topics that would come up from safety and security, medical evacuation, sanitation, resiliency and accountability. I did not sleep a lot because I made sure all of our staff checked in and we knew where they were daily. We offered debriefs. We organized volunteer actions like opportunities to build that resiliency and returning deployers. What we found is folks had a difficult time transition flag the fast pace and immediate gratification to the slower pace of the office job and sitting at desk, so we focused on activities to keep them connected to the response even though they returned to their day job.

In 2016, in response to the hurricane Matthew, Department of Health set up responders’ safety tracking and resilient system based on the ERHMS framework. It was a tool to check in on their responders across the state. They were able to find out about injuries that occurred and follow up on the injuries. It was a benefit to the emergency management team because it was you a great tracking tool to collect hours worked and know who was responding. Because of the success, they expanded on it and utilized it in 2017 for hurricane Irma. Workers responded that they felt like someone cared about them so it was a nice resiliency measure as well.

Oregon health authority deployed their state emergency registry in Oregon to respond to a mass shooting and they implemented and they mirrored our ERHMS before, during, and after activities to help make sure their responders stayed safe during their deployments and they felt and reported they felt supported as well.

I want to briefly mention for those in health departments that we work closely with our C.D.C. colleagues who oversee the public health emergency preparedness capabilities agreement and they are the national standard for preparedness planning. Responder safety and health is capability 14 and you will see aspects of ERHMS in those capabilities and they can address those capabilities.

We have a number of training opportunities online; the first listed here is our train website on the C.D.C. website is the full ERHMS training. The second hosted by FEMA is an adaptive, shorter version meant for leaders. We have two in-person courses here in Atlanta through our preparedness emergency and response and have done trainings pending funding and availability. We are currently piloting a course with a broader course with our disaster epidemiology colleagues, a course at Aniston’s preparedness and response in Alabama. It is a FEMA training center if you’re interested in attempting one of the pilot courses or if you’re state or federally funded by FEMA. I will be happy to talk to you. My information will be at the end of the presentation and we can talk about the course and talk about getting you enrolled.

ERHMS calls for the collection of data and what we heard when we went to the trainings is some of the local, smaller groups didn’t have the custom built software to manage the data so we developed ERHMS manager. It can be used for large or small groups. We have a training manual and training videos to help you use it. It is based on epi info, but it can be used by any organization that wish to implement ERHMS and we have tools available and you can create your own that information does not come back to C.D.C.
It is free of charge. It is a standalone software tool for you to implement and we’re not collecting any of the data ourselves.

I know I have thrown a lot at you over this presentation, but I’m going to leave you with a couple of resources, our NIOSH website and our ERHMS website, a general website if you have questions about ERHMS and I have my personal e-mail. If you don’t want to use the zoom platform to ask questions, feel free to e-mail me and I will be happy to talk to you.

>> Kellee: We will transfer to the Q&A session. Jonathan, can you read the first question?

Jonathan Lynch: There have been questions if this will be — if the record willing be posted online? I guess people want to use it for their own training purposes and the answer is yes. It takes a week to get posted on the EPIC site but it will be there.

So the first question comes from Melissa who asks, is there a responder PE deployment suggested checklist?

>> Lisa Delaney: Yeah, I think that is challenging. I don’t think one exists, but it is a challenge because we don’t know — we can’t predict what PPE might be needed depending on what response so it would be individual and site specific. Our guidance online can help guide you on what you can anticipate based on the disaster, but it boils down to being a site-specific decision.

Jonathan Lynch: Our next question is are there opportunities for collaborative work with international NGO’s?

>> Lisa Delaney: I would say yes. There are always opportunities. We would love to learn more what your challenges are, what your needs respect. We did partner with world health organization a couple years ago after the outbreak because our, especially health care workers were disproportionately impacted by the Ebola outbreak and we were trying to advocate and develop materials through world health to highlight what the needs are in an international space, which may look different. I connected training from nearly African country was in attendance where a coordinated cluster of an agency with them. I will be happy to talk with you offline about opportunities.

Jonathan Lynch: Following up on that, a question for groups that takes volunteers from Stephanie, can you go into more detail of how to engage volunteers during times an emergency isn’t going on, such as activities to engage them? Following up on that, especially in regards to training volunteers ahead of time.

>> Lisa Delaney: That is a great question and that is an area I would like to do more in. I have been — I have thought about trying to attend the national conferences to get the word out about our program and what resources are available. During responses, we tend to get connected and questions come up and I talked, I know Puerto Rico, the hurricanes that impacted Puerto Rico we were able to talk to a number of organizations, but our program talks about pre-deployment planning. NIOSH does not have strong partnerships with those organizations, but that is something I would like to change. Please send me your contact information and we can follow up.

Jonathan Lynch: How often do you need to change PPE masks?

>> Lisa Delaney: So respirators, depending on the classification, most people wear filtering face respiratory and those in hot environments should be worn on a hot environment because they will get wet and sticky and we recommend they are changed out on a minimum a daily basis. The respirators that are the rubber, plastic material can be reused. What you do is wash them out and clean them and you can replace the cartridges. Another indication when a respirator has trouble breathing through it that the filter is so clogged that you have to change them out.

Jonathan Lynch: Great, Melissa, a follow-up question, what pathways are suggested to be used for responders to conduct check-ins during deployment? What are other backup options? How often should responders check in?

>> Lisa Delaney: That is situationally depends. When we have folks deployed, if it is a not a highly hazardous environment or super stressful, we check in on them a couple times a week in independent of their own response deployment chain. In Africa, because of the situation, we did daily check-ins because we had people in remote areas and what I ended up doing because we had a 100 people at a time, I checked in — [inaudible]

Jonathan Lynch: I’m sorry, everyone. We had a brief loss of audio.

>> Lisa Delaney: Oh, I’m frozen. Apparently we’re having technical difficulties on my computer. The question was how frequent should you do check-ins, it could be daily if you’re concerned about hazards. It could be a couple times a week. I look at it, also, oftentimes we don’t want to be a burden to the fellow deployers so having independent response, and you can talk to them and share your concerns or the stressors and having a periodic check in also helps with that resiliency piece.

Jonathan Lynch: Elle Lewis asks would the pilot training be appropriate for epidemiologists.

>> Lisa Delaney: I would say yes, because the course is combined with ATHSDR’s ace program, so it does dig deep into disaster epi. We are piloting it now and we hope to have it a standing course. Yes, I would encourage epidemiologists to attend.

Jonathan Lynch: Another question, should volunteers be cleared by a medical professional from the deploying agency or their personal doctor?

>> Lisa Delaney: That is a policy decision for the volunteer organization, but I would say I highly recommend it. I think we never want to become a burden to the response and so sending out deployers or volunteers or responders that are fit to do the assignment that they are tasked to do, it might be different levels. You might be cleared to fit in an operation center or command post or going out into the field and doing something more laborious there might be levels of clearance so they might come into play for volunteers, too. I think it is a personal decision, but it is something that is worthwhile to pursue.

Jonathan Lynch: We have two requests to see Lisa DeLaney’s contact information again. Can we call that last slide back up? It should be back up in one second. Let me just say, captain DeLaney, you are brave giving out your e-mail.

>> Lisa Delaney: I have staff. I can triage

Jonathan Lynch: We’re getting close to tend of time, there is an app on behavioral disaster response, information for responders as well as survivors, can you comment on. Resources, something people can access?

>> Lisa Delaney: It is the organization that focuses on mental health and they have many resources available. Maybe that is something we can follow up on and send links.

Jonathan Lynch: Absolutely, if anyone has a question that we need to confer to our partners, you can send the question to CDC.GOV and we have had SAMHSA questions in the past. Dan says thanks for the great briefing. Thank you, Dan. We are updating our regional/country plan. Do you have a developed annex or NS6N8 guide for earthquake reception and shelter health surveillance? Having a list of infectious risks and evacuees post earthquake could help guide surveillance.

>> Lisa Delaney: Our colleagues have responsibility for shelter activities so; I would refer you to talk with them to see what resources they have and Jonathan, that is something I’m sure you can follow up on.

Jonathan Lynch: Absolutely. One last question and Kellee will say goodbye. Any suggestions for recording fellow hospital workers. I’m looking for staff across the facility and — lost audio.

>> Lisa Delaney: I’m not sure if everyone heard the question because I think Jonathan froze up. For recruiting staff, you can find people in various parts of your organization that are up to the task and respond and not to pigeonhole and look for specific job titles. During the Ebola outbreak, we deployed 1,000 people to Africa from C.D.C. and we pulled from people who don’t normally respond, maybe make it look fun, because it is and look for untapped resources. Don’t pigeonhole in certain job taskss

Jonathan Lynch: It is fun and you make a big difference. We’re going to end the Q&A session. If we did not get a chance to get to your question or you have a follow-up you can send an e-mail to EPIC@CDC.GOV and we will — to Lisa or to a different group within the C.D.C.

>> Kellee: Thank you again for joining us for today’s webinar. If you have additional questions, you may e-mail them to epic@cdc.gov. As a reminder, today’s presentation has been recorded, and you can earn continuing education units for your participation. Please follow the instructions found on emergency.cdc.gov/epic. The course access code is “EPIC0821” with all letters capitalized. Thank you again everyone. Goodbye!

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Communication Access Realtime Translation (CART) is provided in order to facilitate communication accessibility. CART captioning and this realtime file may not be a totally verbatim record of the proceedings.
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Page last reviewed: August 27, 2019