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NIOSH Response toHurricane Katrina

Yvonne Boudreau, MD, MSPHCenters for Disease Control and Prevention

National Institute for Occupational Safety and Health

For Emergencies, Emphasis is on LOCAL Response

For most emergency events, LOCAL resources (police, fire, medical, public health, etc.) are responsible for incident management

For events that rise to the level of an Incident of National Significance

Department of Homeland Security (DHS) provides coordination of Federal support through the National Response Plan (2004)

http://www.dhs.gov/dhspublic/interapp/editorial/editorial_0566.xml

When Additional Help is Needed…

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Hurricane Katrina made landfall August 28, 2005

Local Request

State of Louisiana and the City of New Orleans requested CDC assistance

CDC Director’s Emergency Operations Centerassembled multidisciplinary team including NIOSH

Available 24/7 at 770-488-7100

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NIOSH Katrina Response Teams

Deployed to New Orleans 9/6 – 10/22

13 industrial hygienists9 medical epidemiologists3 engineers

Photographer

What we Encountered

Debris piles created by destroyed homes…

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... needed to be removed

Tree Debris also required removal

Green Debris: Infested with New Orleans termite, had to be mulched and burned within the city limits

Other waste created exposure concerns

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Cleanup workers at the Superdome...

… were exposed to waste, including human waste

Workers potentially exposed when separating Household Hazardous Waste

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Security Issues

Lodging Issues

Environmental Exposures to workers who slept outdoors

Heat, Insects, Lack of Sleep, etc.

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Access to hygiene

Access to Laundry Facilities

Access to Medical Care

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Makeshift medical clinic in hotel

Access to Immunizations

Mold in homes and commercial buildings

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Chemical Exposure ConcernsChemical Exposure Concerns

Safety IssuesUnstable Buildings

Confined Spaces

Possible toxic gas accumulation/oxygen deficient atmosphere

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CO Poisoning from Generators51 cases and 5 deaths in Katrina affected areas

Electrical Hazards

Roofers: No fall protection

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Exposures in Animal Care Workers

Noise, Bites/scratches, Risk of infection, Rabies

Potential silica exposure during movement of crushed rock and sand

PPE Issues

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Decontamination concerns

Driving Hazards

Some Challenges

Employee demographics(non-union, undocumented, non English-speaking)

The size of the problem

How many workers (difficult to locate)

Multiple Employers

Who is doing what (Diffuse)

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Separating Fact from Fiction

Is the flood water a life-threatening Toxic Soup?

Is the muddy sludge going to eat my skin away?

Will the mold make me sick?

Interactions Between Agencies

Accomplishments

Provided Technical Assistance to 109 different groups representing over 10,000 workers

Conducted 79 worksite visits

Included employers, unions, Federal agencies, city/parish/state institutions and businesses

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Assessment of worker psychosocial and psychological issues

Evaluating New Orleanspolice and firefighters

for post-traumaticstress, depression, etc.

Provided Recommendations at a Debris Site

Safety barriers near moving trucks

Water sprays to reduce airborne dust

PPE (hardhats, breathable coveralls, safety glasses, respirators, ear plugs)Traffic rules enforcementRestriction of flagmen from being in dumping areaHygiene (hand washing, showers)

Enclosed area to change into/out of protective clothing (eg: tent)

Identified Most Frequent Health Issues in Employees of a Private Security Company

TOP TEN1. Lacerations (Fingers/Hand)

2. Lacerations (All other)3. Sinus Congestion4. Emotional Distress5. Insect bites/stings

6. Headaches7. Nausea

8. Heat Exhaustion9. Eye Irritation10. Abrasions

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NIOSH continues to be available for Ongoing Assistance

Assist with short-term field requests from OSHA through FEMA Annex that has been in place since 9/11/2005

OSHA is lead – acting in consulting mode, not enforcementhttp://www.osha.gov/SLTC/emergencypreparedness/nrp_work_sh_annex.html

Respond to employer or employee requests via the NIOSH Health Hazard Evaluation program

http://www.cdc.gov/niosh/hhe

Lessons LearnedLarge contractors generally well-prepared (S&H, PPE, monitoring, etc.)

Smaller contractors generally not as well-prepared

Difficulty locating workers since scattered throughout affected area

No easily accessible roster of who was working and their location/activities

Many non-English speaking workers

Recommendations for Employers/Managers

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Business Checklist for Flu Emergency(applicable to other emergencies)

http://www.pandemicflu.gov/plan/pdf/businesschecklist.pdf

Business Pandemic Influenza Planning Checklist

Take a Team Approach

Identify a disaster coordinator and disaster response TeamDefine roles and responsibilitiesInclude input from labor representatives

Develop a Plan for maintainingbusiness operations

Identify essential employees Identify critical inputs

– Raw materials – Suppliers – Sub-contractor services/ products – Logistics

Train and prepare ancillary workforce

Contractors Employees in other job titlesRetirees

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Anticipate changes in your Product and Services

Plan for an increase or decrease in demand

effects from restrictions on mass gatheringsneed for hygiene supplies

Determine financial impact

different product lines production sites

Plan for impact on Employees and Customers

Allow for employee absences due topersonal or family injury/illness community containment, quarantines, border closures closures of schools, businesses, public transportation

Plan for impact on Employees and Customers (continued)

Evaluate employee access to and availability of physical and

mental healthcare and social services

Utilize corporate, community, and faith-based resources

Identify those with special needs & incorporate their requirements

into preparedness plan

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Establish policies to be implemented during an emergency event

Flexible worksite/hours (telecommuting, staggered shifts)Employee compensation and sick-leave absences unique to a disaster (non-punitive, liberal leave)“Return to work” after event

Establish Authorities, Triggers, and Procedures…

For activating and terminating company’s response plan

For altering business operations (e.g. shutting down operations in affected areas)

For transferring business knowledge to key employees

Ensure that resources are available in all business locations

Enhance IT infrastructures to support employee telecommuting

and remote customer access

Provide access to medicalsupplies

Ensure availability of medical consultation and advice for

emergency response

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Educate Your Employees

Anticipate fear, anxiety, rumors and misinformation

Disseminate the details of your emergency preparedness and

response plan

Ensure that information is culturally and linguistically

appropriate

Develop plan for ongoing communications

Identify community sources for timely

and accurateinformation

Include employees, vendors, suppliers, and customers inside and

outside of the worksite

Most Importantly, test your plan

Conduct exercises/drills in your workplace

Revise the plan as needed

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Online Resources(websites listed in handout)

Preparation for Businesses

OSHA Emergency Evacuation Plan

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Available NIOSH Services

Medical Screening for Workers Pre- and Post-deployment

Reoccupancy Guide

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Dealing with Mold and Mold-related Health Concerns

Yvonne Boudreau, MD, MSPHyboudreau@cdc.gov

303-236-5945

Questions???

NIOSH Response to Hurricane Katrina Yvonne Boudreau, MD, MSPH

Selected Web Sites Department of Homeland Security, National Response Plan http://www.dhs.gov/dhspublic/interapp/editorial/editorial_0566.xml Red Cross Business and Industry Guide for Disaster Preparation http://www.redcross.org/services/disaster/0,1082,0_606_,00.html Institute for Business and Home Safety Disaster Planning Toolkit for the Small to Mid-sized Business Owner http://www.ibhs.org/docs/openforbusiness.pdf US Department of Health and Human Services (DHHS) Pandemic Flu – Planning Checklist for Businesses http://www.pandemicflu.gov/plan/pdf/businesschecklist.pdf Worker Education and Training Program, National Institute of Environmental Health Sciences http://www.niehs.nih.gov/wetp/home.htm Red Cross information on Sheltering in Place http://www.redcross.org/services/disaster/beprepared/shelterinplace.html Occupational Safety and Health Administration (OSHA) Emergency Evacuation Plan for Businesses http://www.osha.gov/SLTC/etools/evacuation/index.html National Institute for Occupational Safety and Health (NIOSH) Services Provided for Employers/Employees Involved in Hurricane Katrina Recovery http://www.cdc.gov/niosh/topics/flood/services.html NIOSH Interim Guidance for Pre-exposure Medical Screening for Workers Deployed for Hurricane Disaster Work http://www.cdc.gov/niosh/topics/flood/preexposure.html NIOSH Interim Guidance for Postexposure Medical Screening for Workers Deployed for Hurricane Disaster Work http://www.cdc.gov/niosh/topics/flood/MedScreenWork.html Centers for Disease Control and Prevention (CDC) Interim Immunization Recommendations http://www.bt.cdc.gov/disasters/hurricanes/pdf/katrina-responder-immun.pdf CDC Information for Response and Cleanup Workers http://www.bt.cdc.gov/disasters/hurricanes/workers.asp NIOSH Interim Guidance for Working Safely in Confined Spaces http://www.cdc.gov/niosh/topics/flood/confined.html NIOSH Interim Guidance on Handling Burning Debris http://www.cdc.gov/niosh/topics/flood/burningdebris.html NIOSH Interim Guidance for Fire Fighting Operations http://www.cdc.gov/niosh/topics/flood/ff-katrina.html

NIOSH Interim Guidance on Health and Safety Hazards Working with Displaced Domestic Animals http://www.cdc.gov/niosh/topics/flood/animals.html CDC Assessing Exposures to Mold http://www.bt.cdc.gov/disasters/mold/report/assessing.asp NIOSH Interim Recommendations for Cleaning/Remediation of Flood Contaminated HVAC Systems – Guide for Building Owners/Managers http://www.cdc.gov/niosh/topics/flood/cleaning-flood-hvac.html Speeding Up Post-disaster Business Building Reoccupancy http://www.abag.ca.gov/bayarea/eqmaps/business/BORP.html CDC Considerations for Reopening Healthcare Facilities Closed Due to Extensive Water and Wind Damage http://www.bt.cdc.gov/disasters/hurricanes/katrina/pdf/reopen_healthfacilities.pdf FEMA (OSHA) Worker Safety and Health Support Annex http://www.osha.gov/SLTC/emergencypreparedness/nrp_work_sh_annex.html NIOSH Health Hazard Evaluation (HHE) Program http://www.cdc.gov/niosh/hhe