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Responder Safety and Health
Topic Collection
October 20, 2023

Topic Collection: Responder Safety and Health

Protecting the safety and health of disaster responders is critical for obvious reasons, but a safe and healthy workforce is better able to provide the community with an effective, comprehensive, response and recovery. The resources in this Topic Collection focus on safety strategies (e.g., preventing fatigue, ensuring the availability and correct use of personal protective equipment) and maintaining behavioral health (e.g., working through stress and preventing/addressing compassion fatigue). Our Workplace Violence Topic Collection contains additional helpful resources, as does our Mental/Behavioral Health Topic Collection. Worker safety issues specific to responding to contaminated patients, radiation, chemical hazards, and the like are not included in this Topic Collection; materials related to protecting responders in specific environments or from specific hazards may be found in the VHF/Ebola, Zika, Epidemic/ Pandemic Flu, Pre-Hospital, Pre-Hospital Patient Decontamination, Hospital Patient Decontamination, Chemical Hazards, Radiological and Nuclear, and Bioterrorism and High Consequence Biological Threats Topic Collections.

Each resource in this Topic Collection is placed into one or more of the following categories in alphabetical order by author (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category.

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ASPR TRACIE. (2019). Disaster Behavioral Health Self Care for Healthcare Workers Modules.
ASPR TRACIE has worked closely with ASPR At-Risk Individuals, Behavioral Health & Community Resilience (ABC) interagency/ external partner working groups in every disaster recovery operation for the last four years. One continuous knowledge gap identified during this time has been the need for information for front-line healthcare and social services workers to use prior to a disaster to recognize and reduce their stress levels and maintain resilience during recovery. These modules are designed for healthcare workers in all settings, but primarily hospital-based providers.
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ASPR TRACIE. (2022). Tips for Retaining and Caring for Staff after a Disaster. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This tip sheet provides general promising practices—categorized by immediate and short-term needs—for facility executives to consider when trying to retain and care for staff after a disaster or during a public health emergency such as the COVID-19 pandemic.
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Buczek, D. (2015). Fatigue in First Responder Operations. The CIP Report, January 2015: 11-13.
The author defines responder fatigue, explains when it becomes a hazard, lists some of the causes, and provides suggestions for mitigating it.
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Center for the Study of Traumatic Stress. (2020). COVID-19 Pandemic Response Resources.
This webpage includes links to various fact sheets on identifying and managing effect of coronavirus and mental health.
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Centers for Disease Control and Prevention. (2018). Capability 14: Responder Safety and Health. Public Health Emergency Preparedness and Response Capabilities.
The Responder Safety and Health capability is one of the 15 capabilities identified in the Centers for Disease Control as part of the Public Health Emergency Preparedness and Response Capabilities. This capability focuses on the ability to protect public health emergency response staff responding to a critical incident, and is comprised of three functions: 1) Identify responder safety and health risks; 2) Identify and support risk-specific responder safety and health training; and 3) Monitor responder safety and health during and after incident response.
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Centers for Disease Control and Prevention. (2018). Coping With a Disaster or Traumatic Event.
This webpage contains links to resources focused on disaster behavioral health. There are resources geared towards individuals, responders, health professionals, and other community members, and some are categorized by hazard. The “Responders: Tips for Taking Care of Yourself” page includes discussion on burnout and self-care techniques.
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InterAgency Board for Equipment Standardization and Interoperability. (2014). Stress-Related Mental Health Issues in Emergency Responders, First Receivers, Disaster Workers, and Their Families.
This document discusses the need for improved operational approaches to the detection of stress and mitigation of stress-induced mental health disorders in emergency responders and disaster workers. It makes six recommendations, including the need for emergency response departments, agencies, and organizations to provide access to behavioral and mental health programs for their responders and receivers, and their immediate family members, whenever needed.
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Jackson, B.A., Baker, J.C., Ridgely, S., et al. (2004). Protecting Emergency Responders, Volume 3. (Free to download.) RAND Corporation.
This report is based on a literature review, interviews with members of the response community, and information gathered at a conference on occupational safety and health. Recommendations for formalizing "an integrated, incident-wide approach to safety management at major disaster response operations" are included.
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McCarroll, J., Vineburgh, N., and Ursano, R. (Eds.). (2013). Disaster, Disease and Distress: Resources to Promote Psychological Health and Resilience in Military and Civilian Communities. Center for the Study of Traumatic Stress, Uniformed Services University.
This is a compilation of 10 years’ worth of Center fact sheets on military and disaster health and mental health topics. It is geared towards healthcare providers, government and military leadership, service members, families, and communities and raises awareness of and shares strategies for coping with traumatic exposure.
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Murphy, K., and Jewell, S. (2015). Personal Safety and Health for Emergency Responders. (Free registration required.) University at Albany, State University of New York, School of Public Health and Health Professions, Center for Public Health Preparedness.
The objective of this one-hour course is to help emergency responders understand the types of dangers encountered in a disaster setting, as well as the common injuries that are sustained during an emergency response.
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National Academy of Medicine. (2022). National Plan for Health Workforce Well-Being.
Recent studies indicate that more than half of nurses, physicians, medical students, residents, and pharmacists have symptoms of burnout. This publication highlights changes that could be made across the health system and at the organizational level to improve the well-being of the health workforce.
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National Fire Protection Association. (2014). NFPA 1561: Standard on Emergency Services Incident Management System and Command Safety. (Free registration required to view 2014 version.)
This standard includes requirements for emergency services that can help protect the safety of emergency responders and others on the scene of an incident.
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National Fire Protection Association. (2018). NFPA 1500: Standard on Fire Department Occupational Safety and Health Program. (Free access to full standard text with registration.)
This standard provides an overview of the requirements of an occupational medicine program that can reduce risk and promote the health of "fire departments or organizations that provide rescue, fire suppression, emergency medical services, hazardous materials mitigation, special operations, and other emergency services."
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National Institute for Occupational Safety and Health. (2013). Traumatic Incident Stress. Centers for Disease Control and Prevention.
This website highlights the physical, cognitive, emotional, and behavioral symptoms that first responders may experience after a disaster. The Institute provides tips and links to additional resources that can help responders take care of their own emotional health.
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National Institute for Occupational Safety and Health. (2018). Emergency Responder Health Monitoring and Surveillance (ERHMS). Centers for Disease Control and Prevention.
This webpage provides an overview of the surveillance system, which monitors responder health and safety to help develop related guidelines. Links to documents and information about the phases of the system are included.
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National Institute for Occupational Safety and Health. (2018). Emergency Response Resources: Personal Protective Equipment. Centers for Disease Control and Prevention.
The information on this webpage focuses on personal protective equipment (PPE) and includes the following categories: respirators; protective clothing; skin exposures; eye protection; and hearing protection. Links to related resources are provided.
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National Institute of Environmental Health Sciences. (n.d.). Safety Awareness for Responders to Hurricanes: Protecting Yourself While Helping Others. (Accessed 6/17/2019.)
This training tool is a health and safety resource for "skilled support personnel" who will participate in hurricane response and cleanup activities. Responders will gain a basic awareness of identifying and managing hazards associated with hurricane response and cleanup activities.
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Occupational Safety and Health Administration. (n.d.). Emergency Preparedness and Response. (Accessed 8/24/2023.) U.S. Department of Labor.
These resources can help first responders keep themselves safe when responding to a variety of hazards and situations (e.g., blister agents, nerve agents, extreme weather, structural collapse). Information is presented in question and answer format, and links to related resources are provided in each guide.
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Occupational Safety and Health Administration. (2018). PPE (Personal Protective Equipment) for Emergency Response and Recovery Workers. U.S. Department of Labor.
This webpage discusses personal protective equipment (PPE) for emergency response and recovery workers, particularly those responding to natural disaster and chemical (including oil), biological, radiological and nuclear (CBRN) events. (Note that hospital decontamination is different than scene response and should refer to OSHA’s “First Receiver” document in the Hospital Patient Decontamination Topic Collection).
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Radiation Emergency Medical Management. (2019). First Responders in the Field.
This webpage includes links to helpful resources for responders on radiation-specific personal protective equipment, incident response (including casualty management and triage), and online training courses.
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Stamm, B. (2019). The Professional Quality of Life Elements Theory and Measurement.
The ProQOL (short for Professional Quality of Life) is the most commonly used measure of Compassion Fatigue and Compassion Satisfaction, two effects commonly experienced by responders who help people who experience suffering and trauma. In addition to the tool, the researcher provides links to theoretical resources, presentation aids, and other resources that can be helpful when raising awareness of the behavioral health effects on disaster responders.
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Substance Abuse and Mental Health Services Administration. (2018). First Responders: Behavioral Health Concerns, Emergency Response, and Trauma: Disaster Technical Assistance Center Supplemental Research Bulletin.
This document focuses on mental and behavioral health concerns in first responders. It provides background on first responders' behavioral health issues, information on risk and protective factors for behavioral health in first responders, and interventions to reduce behavioral health risks for first responders.
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Substance Abuse and Mental Health Services Administration, Disaster Technical Assistance Center. (2013). Mass Casualty Support and Response Podcast. U.S. Department of Health and Human Services.
This webinar shares information about emotional reactions to mass casualty events, addresses what Medical Reserve Corps team members, Commission Corps Officers, and other responders may encounter in the field during a crisis event, and familiarizes participants with related disaster behavioral health.
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Substance Abuse and Mental Health Services Administration, Disaster Technical Assistance Center. (2014). Tips for Disaster Responders: Preventing and Managing Stress. U.S. Department of Health and Human Services.
This tip sheet presents a series of personal stress prevention and management skills disaster responders and emergency healthcare providers can practice before called upon to respond. It is also available in Spanish: https://store.samhsa.gov/product/Tips-for-Disaster-Responders-Preventing-And-Managing-Stress-Spanish-Version-/SMA14-4873SPANISH.
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U.S. Department of Health and Human Services, Administration for Strategic Preparedness and Response. (2022). Individual Resilience: Factsheet for Responders.
Responders can learn more about resilience and the advantageous role it plays in disaster response and recovery from this factsheet.
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U.S. Department of Veterans Affairs, National Center for PTSD. (n.d.). Types of Debriefing Following Disasters. (Accessed 6/18/2019.)
This resource reviews the different types of debriefing that may be used to support disaster mental health management. The article discusses evidence that debriefing may actually be harmful to those with severe trauma, including those with PTSD.
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U.S. Environmental Protection Agency. (n.d.). Safety Officer Toolbox. (Accessed 5/10/2019.)
This toolkit was created to support the Safety Officer position in an Incident Management Team. Included are forms, guidelines, job aids, and fact sheets, as well as examples of completed documentation that may be referenced by planners responsible for developing health and safety plans for their organizations.
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Usher, L., Friedhoff, S., Cochran, S., and Pandya, A. (2016). Preparing for the Unimaginable: How Chiefs Can Safeguard Officer Mental Health Before and After Mass Casualty Events. Office of Community Oriented Policing Services.
This monograph is comprised of three parts: Why Mental Wellness Matters to You and Your Agency; Preparing for a Mass Casualty Event; and Managing a Mass Casualty Event and Its Aftermath. The last section includes case studies of first responders who experienced negative mental health effects as a result of traumatic experiences, and helpful handouts.
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World Health Organization. (2018). Occupational Safety and Health in Public Health Emergencies: A Manual for Protecting Health Workers and Responders.
This manual provides an overview of the main occupational safety and health risks faced by emergency responders during disease outbreaks and other emergencies. It is focused on needs in low-resource settings, and provides guidance on establishing systems that can reduce occupational exposures, injury, illness, and death among response workers; decrease stress and reduce fears; and promote responder health and well-being.
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Behavioral Health and Resilience: Research and General Guidance

Antares Foundation. (2012). Managing Stress in Humanitarian Workers: Guidelines for Good Practice.
These guidelines were originally designed to help manage stress in humanitarian workers, but they were recently updated to apply to disaster medical responders and others. Available in several languages, this document can staff manage stress and help agencies minimize situations that can contribute to stress as much as possible.
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ASPR TRACIE. (2024). Disaster Behavioral Health: Resources at Your Fingertips. U.S. Department of Health and Human Services, Office of the Assistant Secretary of Preparedness and Response.
When disasters strike, the ripple effects can be significant. Incorporating disaster behavioral health (DBH) into all phases of emergency management can ensure resident and responder preparedness, an effective, compassionate response effort, and a more resilient community moving forward. This document provides information on and links to select DBH programs and resources that can be of immediate use to emergency health care providers, emergency management stakeholders, and other professionals and survivors affected by naturally occurring or human-caused incidents.
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Atkins, C. and Burnett, H. (2016). Specialized Disaster Behavioral Health Training: Its Connection with Response, Practice, Trauma Health, and Resilience. Disaster Health. 3(2): 57–65.
This small study, based on a convenience sample of disaster behavioral health responders attending a conference, looked at the relationship between training in key disaster behavioral health interventions, trauma, resilience, number of crises they responded to in the last year; and frequency of training. The authors concluded that the “findings suggest that completing training in both, large and small group and individual and peer crisis intervention techniques may help to increase resiliency and reduce burnout among disaster behavioral health providers.”
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Brooks, S., Dunn, R., Amlot, R., et al. (2016). Social and Occupational Factors Associated with Psychological Distress and Disorder Among Disaster Responders: A Systematic Review. BMC Psychology. 4(18).
The authors conducted a literature review to determine the social and occupational factors related to the psychological impact of disasters on “any occupational group responding to disasters.” They listed pre-disaster factors (e.g., training and preparedness, general health); during-disaster factors (e.g., duration on site and arrival time); and post-disaster factors (professional support, coping strategies) that had an effect on responders.
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Cocciardi, J.A. (2013). Operating Safely in Hazardous Environments: A Review and Refresher. (Book available for purchase.) Jones & Bartlett Learning.
The information in this book can help readers identify and mitigate hazards in the disaster response workplace. Review materials and exercises are included.
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Fujitani, K., Carroll, M., Yanagisawa, R., and Katz, C. (2015). Burnout and Psychiatric Distress in Local Caregivers Two Years After the 2011 Great East Japan Earthquake and Fukushima Nuclear Radiation Disaster. (Abstract only.) Community Mental Health Journal.
The authors surveyed caregivers more than two years after the disaster and found a "significant number" indicated signs of emotional exhaustion and psychological distress. The authors call for long-term psychological support and better working conditions for caregivers.
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Garbern, S., Ebbeling, L., and Bartels, S. (2016). A Systematic Review of Health Outcomes Among Disaster and Humanitarian Responders. (Abstract only.) Prehospital Disaster Medicine. 31(6):635-642.
The authors conducted a meta-analysis of research on the physical and mental health effects experienced by responders to major disasters. It concludes that responders’ health, both mental and physical, needs to be better assessed after disaster work.
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Guilaran, J., de Terte, I., Kaniasty, K. and Stephens, C. (2018). Psychological Outcomes in Disaster Responders: A Systematic Review and Meta-Analysis on the Effect of Social Support. International Journal of Disaster Risk Science. 9(3): 344-358.
The authors reviewed 24 quantitative social support studies on police, emergency medical responders, rescue and recovery workers, firefighters, and military responders to assess the extent of the effects of social support on psychological outcomes in these responders. The results summarize “the strength of social support-outcome associations, while also considering some of the influencing factors (e.g., time, source of support, culture).
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InterAgency Board for Equipment Standardization and Interoperability. (2014). Stress-Related Mental Health Issues in Emergency Responders, First Receivers, Disaster Workers, and Their Families.
This document discusses the need for improved operational approaches to the detection of stress and mitigation of stress-induced mental health disorders in emergency responders and disaster workers. It makes six recommendations, including the need for emergency response departments, agencies, and organizations to provide access to behavioral and mental health programs for their responders and receivers, and their immediate family members, whenever needed.
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Lanza, A., Rodgers, S., and Roysircar, G. (2018). First Responder Mental Healthcare: Evidence-based Prevention, Postvention, and Treatment. Professional Psychology Research and Practice 49(3):193-204.
This article discusses resources for first responder, and a needs assessment for first responder resilience developed by one of the authors. They use this “evidence-based practice knowledge” to present challenges first responders typically face, and recommended interventions.
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Loo, G., Gershon, R., Dimaggio, C., and Canton, D. (2015). Coping Behavior and Risk of Post-Traumatic Stress Disorder Among Federal Disaster Responders. Disaster Medicine and Public Health Preparedness. 1(1): 1-10.
The authors used a web-based survey to evaluate the association of 3 different coping styles with probable PTSD following disaster exposure among 549 federal disaster responders. They found that “avoidant coping behavior” was most closely associated with probable PTSD.
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McCarroll, J., Vineburgh, N., and Ursano, R. (Eds.). (2013). Disaster, Disease and Distress: Resources to Promote Psychological Health and Resilience in Military and Civilian Communities. Center for the Study of Traumatic Stress, Uniformed Services University.
This is a compilation of 10 years’ worth of Center fact sheets on military and disaster health and mental health topics. It is geared towards healthcare providers, government and military leadership, service members, families, and communities and raises awareness of and shares strategies for coping with traumatic exposure.
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National Association of Emergency Medical Technicians.. (2016). 2016 National Survey on EMS Mental Health Services.
This survey was distributed electronically to more than 40,000 emergency medical technicians, paramedics, emergency medical services managers, and medical directors in March 2016. The authors summarize results from nearly 2,200 responses from all 50 states. Overall findings indicate the need for more work in demonstrating care for staff and in communicating about available resources for assistance.
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Pietrzak, R.H., Feder, A., Singh, R., et al. (2014). Trajectories of PTSD Risk and Resilience in World Trade Center Responders: An 8 Year Prospective Cohort Study. Psychological Medicine. 44(1): 205-219.
The authors studied the factors associated with posttraumatic stress disorder (PTSD) symptoms in World Trade Center first responders. They found that prior psychiatric history, Hispanic ethnicity, severity of WTC exposure and WTC-related medical conditions had the strongest relationships with PTSD; greater levels of education and family and work support were protective factors.
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Rudofossi, D. (2013). Understanding the Challenges Facing Our First Responders: Treating Those Who Are Suffering from Trauma and Stress Brought About by Acts of Terrorism. The Alabama Department of Public Health Center for Emergency Preparedness.
These symposium materials feature speakers who discuss treating first responders who are suffering from trauma and stress brought about by traumatic acts (e.g., acts of terrorism).
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Rutkow, L., Gable, L., and Links, J.M. (2011). Protecting the Mental Health of First Responders: Legal and Ethical Considerations. (First page only.) Journal of Law, Medicine, and Ethics.
The authors discuss the ethical and legal issues associated with three key areas in first responder mental health: mental health screening; licensure portability of mental health care providers; and workers’ compensation for mental health claims.
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Sprung, C., Devereaux, A., Ghazipura, M., et al. (2023). Critical Care Staffing in Pandemics and Disasters. CHEST. 164(1): 124-136.
In response to the negative behavioral health effects the COVID-19 pandemic had on many health care workers, the authors created an expert panel to review relevant literature and determine systemic factors and interventions impacting worker mental health and burnout. Recommendations concerning sustaining the workforce (with an emphasis on preventive measures) are included in tables and figures.
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* Stamm, B. (2019). The Professional Quality of Life Elements Theory and Measurement.
The ProQOL (short for Professional Quality of Life) is the most commonly used measure of Compassion Fatigue and Compassion Satisfaction, two effects commonly experienced by responders who help people who experience suffering and trauma. In addition to the tool, the researcher provides links to theoretical resources, presentation aids, and other resources that can be helpful when raising awareness of the behavioral health effects on disaster responders.
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* U.S. Fire Administration. (2019). Emerging Health and Safety Issues Among Women in the Fire Service. Federal Emergency Management Agency.
The number of women serving as career and volunteer firefighters has increased over the past two decades. This report examines how findings from a symposium held in 1994 on women in the fire service continue to apply. The authors highlight existing resources that address these findings and list recommendations for improving the fire service for women and all members.
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VanDevanter, N., Raveis, V., Kovner, C., et al. (2017). Challenges and Resources for Nurses Participating in a Hurricane Sandy Hospital Evacuation. Journal of Nursing Scholarship. 49(6): 635–643.
New York University’s Langone Medical Center had to be evacuated during Hurricane Sandy in 2012. The authors interviewed nurses to determine strengths and challenges associated with the evacuation and found that coworker support, leadership, and “personal resourcefulness” helped nurses respond. Challenges included limited prior disaster experience, training, and education, and the authors emphasize the need for more disaster-related education in schools of nursing.
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Wood, N., Walden, W., Case, B., et al. (2018). Supporting the Emotional Wellbeing of First Responders, Emergency Managers & Disaster Relief Personnel. Federal Emergency Management Agency.
This presentation discusses “information and resources on how to respond to the emotional wellbeing of first responders, emergency mangers and disaster relief personnel.” Topics include vicarious trauma, and the integration of emotional and spiritual care in emergency management.
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Behavioral Health and Resilience: Resources for Responders

* Administration for Strategic Preparedness and Response and National Association of County and City Health Officials. (2022). Building Workforce Resilience through the Practice of Psychological First Aid: A Course for Leaders and Teams. (Free registration required.)
This course offers community leaders and teams the opportunity to consider and pursue coping and stress management strategies for supporting colleagues during a disaster response as stress levels increase for workers and the demands on organizations become more urgent.
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* ASPR TRACIE. (2017). The Exchange: Volume 2, Issue 1.
This issue of the newsletter focuses on disaster behavioral health and resilience from the federal (ASPR ABC, OEM, and EPAP); state (Florida’s response to the Pulse nightclub shooting); local (a responder discusses seeking help after managing a traumatic scene); and general (the authors provide an overview of responder behavioral health and emphasize the importance of top-down support for related programs) perspectives.
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* ASPR TRACIE. (2023). ASPR TRACIE Mini Modules to Relieve Stress for Health Care Workers.
These mini-modules are designed for healthcare workers in all settings, but primarily hospital-based providers, staff, and leaders to use prior to and during a disaster to help recognize and reduce their stress levels and maintain resilience. While these mini modules were developed during the COVID-19 pandemic, they can be used before, during, and after any type of incident.
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* Center for the Study of Traumatic Stress. (2020). COVID-19 Pandemic Response Resources.
This webpage includes links to various fact sheets on identifying and managing effect of coronavirus and mental health.
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Center for the Study of Traumatic Stress. (2020). Sustaining the Well-Being of Healthcare Personnel During Coronavirus and Other Infectious Disease Outbreaks.
This one-page tip sheet lists the challenges healthcare personnel face during infectious disease outbreaks followed by “strategies for sustaining healthcare personnel well-being.”
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Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences. (2017). Information for First Responders on Emotional Reactions to Human Bodies in Mass Death.
This document for responders with exposure to decedents provides lessons learned by who have worked with bodies in disaster environments, in order to help first responders with their emotional reactions to mass death. It discusses how working with or around human remains after a disaster may arouse strong feelings of pity, horror, repulsion, disgust, and anger, and how these reactions are normal.
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Centers for Disease Control and Prevention. (2017). Stress Management for Emergency Responders: What Responders Can Do.
This podcast is part of a series that examines sources of stress and what individuals, team leaders, and agency management can do to manage the stress and increase resilience. Tips for reducing stress and lessening its negative impacts are also provided.
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Centers for Disease Control and Prevention. (2018). Coping With a Disaster or Traumatic Event.
This webpage contains links to resources focused on disaster behavioral health. There are resources geared towards individuals, responders, health professionals, and other community members, and some are categorized by hazard. The “Responders: Tips for Taking Care of Yourself” page includes discussion on burnout and self-care techniques.
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Incredible Health. (2022). Nurse’s Resource Guide To Coping with Burnout, Stress, and Mental Health Challenges.
This guide provides an overview of burnout, stress, and other mental health challenges, and highlights strategies and resources for addressing them.
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* Liu, J., McGee, L., and Naturale, A. (2012). Deployment Supports for Disaster Behavioral Health Responders.
This webcast “prepares disaster behavioral health responders and their family members for deployment by reviewing pre- and post-deployment guidelines and ways to prepare for the stress of deployment and reintegration into regular work and family life.”
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* Liu, J., Naturale, A., and David, J. (2012). Self-Care for Disaster Behavioral Health Responders. Substance Abuse and Mental Health Services Administration, Disaster Technical Assistance Center. U.S. Department of Health and Human Services.
Public health emergency healthcare providers can learn about best practices and tools that could enable them and their supervisors to identify and effectively manage stress and secondary traumatic stress in this 60-minute podcast.
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* National Academy of Medicine. (2022). National Plan for Health Workforce Well-Being.
Recent studies indicate that more than half of nurses, physicians, medical students, residents, and pharmacists have symptoms of burnout. This publication highlights changes that could be made across the health system and at the organizational level to improve the well-being of the health workforce.
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* National Association of County and City Health Officials. (2016). Behavioral Health Videos.
This resource provides a series of seven behavioral health videos, available in English, Spanish, and American Sign Language. Video 2 is focused on stress management tips for first responders.
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* National Institute for Occupational Safety and Health. (2013). Traumatic Incident Stress. Centers for Disease Control and Prevention.
This website highlights the physical, cognitive, emotional, and behavioral symptoms that first responders may experience after a disaster. The Institute provides tips and links to additional resources that can help responders take care of their own emotional health.
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* National Institute of Environmental Health Sciences, National Institutes of Health. (2015). Responder & Community Resilience.
This webpage includes links to participant and instructor materials for 2 trainings focused on preparing disaster workers and volunteers, and their supervisors, to proactively recognize and respond to disaster worker stress and trauma. Materials are available in English and Spanish.
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* National Library of Medicine, National Institutes of Health. (2015). Stress and the Relaxation Response: Help for Those Affected by Disasters.
This webinar from the National Library of Medicine Disaster Information Management Research Center (DIMRC) focuses on the relaxation response, a counter-stress capacity. Its elicitation effectively counteracts stress and is therapeutic for a multitude of stress-related disorders and situations. Speakers discuss using the relaxation response for professionals and volunteers affected by stress when responding to disaster.
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Nursing License Map. (2020). 59 Mental Health Resources for Health Care Providers.
This website provides links to behavioral health resources for healthcare workers. Links include those specific to sleep, exercise, healthy eating, counseling and support, mindfulness, entertainment, and positive attitude.
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Social Work License Map. (2022). Mental Health Resources to Support First Responders.
This webpage provides links to mental health resources first responders can use to understand, recognize, and cope with stress in themselves and others and bolster resilience.
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Stamm, B. (2013). Understanding Compassion Fatigue and Compassion Satisfaction: Tips for Disaster Responders. Substance Abuse and Mental Health Services Administration, Disaster Technical Assistance Center.
This podcast can help emergency responders (e.g., healthcare providers, behavioral health professionals) learn about the positive and negative effects of helping disaster survivors.
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Substance Abuse and Mental Health Services Administration. (2014). Tips for Disaster Responders: Understanding Compassion Fatigue. Substance Abuse and Mental Health Services Administration.
This document explains the causes and signs of compassion fatigue, the burnout and secondary trauma a disaster response worker can experience.
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Substance Abuse and Mental Health Services Administration. (2018). Effects of Trauma on First Responders. The Dialogue. 14(1). U.S. Department of Health and Human Services.
This resource presents several articles reflecting the experiences of first responders, and highlights the challenges they face through all phases of disaster response.
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Substance Abuse and Mental Health Services Administration. (2018). First Responders: Behavioral Health Concerns, Emergency Response, and Trauma: Disaster Technical Assistance Center Supplemental Research Bulletin.
This document focuses on mental and behavioral health concerns in first responders. It provides background on first responders' behavioral health issues, information on risk and protective factors for behavioral health in first responders, and interventions to reduce behavioral health risks for first responders.
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* Substance Abuse and Mental Health Services Administration. (2018). Service to Self: Behavioral Health for Fire and EMS (Emergency Medical Services) Personnel.
This self-paced course for responders about their behavioral health includes videos featuring emergency medical technicians and fire personnel, scenarios, and interactive quizzes. It addresses occupational stressors; mental health and substance use issues, including depression, post-traumatic stress disorder, suicidality, and alcohol use; resilience; and healthy coping mechanisms, including demonstrations of stress management techniques.
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Substance Abuse and Mental Health Services Administration. (2020). SAMHSA's Behavioral Health Disaster Response Mobile App. U.S. Department of Health and Human Services.
This app can help disaster responders provide behavioral health support to survivors. Features include a services locator and links to resources for survivors and responders.
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Substance Abuse and Mental Health Services Administration, Disaster Technical Assistance Center. (2013). Mass Casualty Support and Response Podcast. U.S. Department of Health and Human Services.
This webinar shares information about emotional reactions to mass casualty events, addresses what Medical Reserve Corps team members, Commission Corps Officers, and other responders may encounter in the field during a crisis event, and familiarizes participants with related disaster behavioral health.
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Substance Abuse and Mental Health Services Administration, Disaster Technical Assistance Center. (2014). Tips for Disaster Responders: Identifying Substance Misuse in the Responder Community. U.S. Department of Health and Human Services.
This fact sheet describes warning signs of substance use disorders specifically among disaster response workers. It identifies physical, emotional, social, behavioral, and mental indicators, and provides information on when people should seek help. It is also available in Spanish: https://store.samhsa.gov/product/Tips-for-Disaster-Responders-Identifying-Substance-Misuse-In-The-Responder-Community-Spanish-Version-/SMA14-4874SPANISH.
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Substance Abuse and Mental Health Services Administration, Disaster Technical Assistance Center. (2014). Tips for Disaster Responders: Preventing and Managing Stress. U.S. Department of Health and Human Services.
This tip sheet presents a series of personal stress prevention and management skills disaster responders and emergency healthcare providers can practice before called upon to respond. It is also available in Spanish: https://store.samhsa.gov/product/Tips-for-Disaster-Responders-Preventing-And-Managing-Stress-Spanish-Version-/SMA14-4873SPANISH.
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Substance Abuse and Mental Health Services Administration, Disaster Technical Assistance Center. (2014). Tips for Disaster Responders: Returning to Work. U.S. Department of Health and Human Services.
This four-page fact sheet offers tips to help disaster response workers transition back to routine work. It is also available in Spanish: https://store.samhsa.gov/product/Tips-for-Disaster-Responders-Returning-to-Work-Spanish-Version-/SMA14-4870SPANISH.
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Substance Abuse and Mental Health Services Administration, Disaster Technical Assistance Center. (2014). Tips for Families of Returning Disaster Responders: Adjusting to Life at Home. U.S. Department of Health and Human Services.
This fact sheet provides tips for families of disaster response workers who are returning home and trying to adjust to daily life post disaster. It identifies signs of stress and information on when to seek help. It is also available in Spanish: https://store.samhsa.gov/product/Tips-for-Families-of-Returning-Disaster-Responders-Adjusting-To-Life-At-Home-Spanish-Version-/SMA14-4872SPANISH.
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* Texas Nurses Association. (n.d.). Care for the Caregiver. (Accessed 6/18/2019.)
This website is geared towards nurses charged with providing care, often in austere environments. It includes links to pre-, during, and post-disaster resources that can help nurses (and other healthcare practitioners) prepare for, recognize, and manage stress and maintain resilience.
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U.S. Department of Homeland Security. (2012). Project Responder 3: Toward the First Responder of the Future. National Information Sharing Consortium.
Project Responder 3 used facilitated discussions with responders throughout the United States to identify existing response capability gap, which were then categorized into nine domains, including “Responder Health, Safety, and Performance.” Discussion revealed three abilities that are critical to responders: the ability for them to obtain real-time status updates about their families during disaster response; the ability to measure an individual’s resilience to determine whether s/he will perform effectively under stress; and the ability to monitor, in real time, the physical and mental status of responders during an incident.
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U.S. Department of Veterans Affairs, National Center for PTSD. (n.d.). Types of Debriefing Following Disasters. (Accessed 6/18/2019.)
This resource reviews the different types of debriefing that may be used to support disaster mental health management. The article discusses evidence that debriefing may actually be harmful to those with severe trauma, including those with PTSD.
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U.S. Department of Veterans Affairs, National Center for PTSD. (2018). Working with Trauma Survivors: What Workers Need to Know.
This website provides information on the importance of learning about traumatic stress and how approaching survivors with genuine respect, concern, and knowledge about their process can help move them towards recovery.
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* University of Minnesota, School of Public Health. (2013). Responder Self Care App.
This application aids responders during deployment in maintaining their own physical, emotional, and social wellbeing. Checklists for before, during, and after deployment are included. The app also allows users to customize reminders and tips and lists steps that can help responders pack for deployment, take care of daily needs, maintain important relationships, and reflect on their experiences.
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Behavioral Health and Resilience: Resources for Supervisors

* Administration for Strategic Preparedness and Response and National Association of County and City Health Officials. (2022). Building Workforce Resilience through the Practice of Psychological First Aid: A Course for Leaders and Teams. (Free registration required.)
This course offers community leaders and teams the opportunity to consider and pursue coping and stress management strategies for supporting colleagues during a disaster response as stress levels increase for workers and the demands on organizations become more urgent.
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American Hospital Association. (2020). Caring for Our Health Care Heroes During COVID-19 *.
This document from 5/20/2020 offers suggestions for how hospitals and health systems can support the mental health, food access, and housing needs of their workforce during the COVID-19 pandemic.
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* ASPR TRACIE. (2017). The Exchange: Volume 2, Issue 1.
This issue of the newsletter focuses on disaster behavioral health and resilience from the federal (ASPR ABC, OEM, and EPAP); state (Florida’s response to the Pulse nightclub shooting); local (a responder discusses seeking help after managing a traumatic scene); and general (the authors provide an overview of responder behavioral health and emphasize the importance of top-down support for related programs) perspectives.
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ASPR TRACIE. (2022). Tips for Retaining and Caring for Staff after a Disaster. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This tip sheet provides general promising practices—categorized by immediate and short-term needs—for facility executives to consider when trying to retain and care for staff after a disaster or during a public health emergency such as the COVID-19 pandemic.
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* ASPR TRACIE. (2023). ASPR TRACIE Mini Modules to Relieve Stress for Health Care Workers.
These mini-modules are designed for healthcare workers in all settings, but primarily hospital-based providers, staff, and leaders to use prior to and during a disaster to help recognize and reduce their stress levels and maintain resilience. While these mini modules were developed during the COVID-19 pandemic, they can be used before, during, and after any type of incident.
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Center for the Study of Traumatic Stress. (n.d.). Stress Management for Health Care Providers. (Accessed 6/17/2019.) Uniformed Services University School of Medicine.
This fact sheet lists strategies healthcare providers can use to help themselves and their coworkers manage stress after disasters.
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* Center for the Study of Traumatic Stress. (2020). COVID-19 Pandemic Response Resources.
This webpage includes links to various fact sheets on identifying and managing effect of coronavirus and mental health.
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Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences. (n.d.). Body Recovery and Stress Management for Leaders and Supervisors. (Accessed 2/14/2020.)
This short, targeted tip sheet can help leaders and supervisors minimize staff stress in a mass casualty environment.
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Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences. (n.d.). Managing a Workplace or Organization After Crisis. (Accessed 7/22/2019.)
This short, targeted tip sheet can help leaders and supervisors structure a healthy response among staff after a disaster.
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Du, B., Rezvani, S., Bigelow, P., et al. (2022). Synthesis of Evidence to Support EMS Personnel’s Mental Health During Disease Outbreaks: A Scoping Review. Safety and Health at Work. 13(4):379-386.
The authors completed a scoping review of literature about EMS personnel mental health during disease outbreaks and factors associated with both favorable and adverse mental health outcomes. They found that the number of articles on the topic increased dramatically during the COVID-19 pandemic. They suggested that providing infection prevention resources, procedures, and training could counter many of the factors associated with adverse mental health outcomes.
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* National Academy of Medicine. (2022). National Plan for Health Workforce Well-Being.
Recent studies indicate that more than half of nurses, physicians, medical students, residents, and pharmacists have symptoms of burnout. This publication highlights changes that could be made across the health system and at the organizational level to improve the well-being of the health workforce.
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* National Institute for Occupational Safety and Health. (2013). Traumatic Incident Stress. Centers for Disease Control and Prevention.
This website highlights the physical, cognitive, emotional, and behavioral symptoms that first responders may experience after a disaster. The Institute provides tips and links to additional resources that can help responders take care of their own emotional health.
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* National Institute of Environmental Health Sciences, National Institutes of Health. (2015). Responder & Community Resilience.
This webpage includes links to participant and instructor materials for 2 trainings focused on preparing disaster workers and volunteers, and their supervisors, to proactively recognize and respond to disaster worker stress and trauma. Materials are available in English and Spanish.
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Substance Abuse and Mental Health Services Administration, Disaster Technical Assistance Center. (2014). Helping Staff Manage Stress When Returning to Work. U.S. Department of Health and Human Services.
This tip sheet includes tips supervisors can use to help ease the transition and manage stress for disaster response workers returning to work, recognize and reduce potential difficulties in the workplace, and enhance positive consequences for all staff. It is also available in Spanish: http://store.samhsa.gov/product/Tips-for-Supervisors-of-Disaster-Responders-Helping-Staff-Manage-Stress-When-Returning-To-Work-Spanish-Version-/SMA14-4871SPANISH
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U.S. Department of Health and Human Services, Administration for Strategic Preparedness and Response. (2022). Individual Resilience: Factsheet for Responders.
Responders can learn more about resilience and the advantageous role it plays in disaster response and recovery from this factsheet.
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United Nations Emergency Preparedness & Support Team. (n.d.). Leadership in Emergencies Toolkit. (Accessed 8/11/2020.)
This toolkit can help managers handle their and their team members’ reactions to extreme stress during disasters and other incidents. It includes tip sheets in three categories: workforce resilience, reactions to stress, and managing in complex emergencies.
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Usher, L., Friedhoff, S., Cochran, S., and Pandya, A. (2016). Preparing for the Unimaginable: How Chiefs Can Safeguard Officer Mental Health Before and After Mass Casualty Events. Office of Community Oriented Policing Services.
This monograph is comprised of three parts: Why Mental Wellness Matters to You and Your Agency; Preparing for a Mass Casualty Event; and Managing a Mass Casualty Event and Its Aftermath. The last section includes case studies of first responders who experienced negative mental health effects as a result of traumatic experiences, and helpful handouts.
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Education and Training

* Administration for Strategic Preparedness and Response and National Association of County and City Health Officials. (2022). Building Workforce Resilience through the Practice of Psychological First Aid: A Course for Leaders and Teams. (Free registration required.)
This course offers community leaders and teams the opportunity to consider and pursue coping and stress management strategies for supporting colleagues during a disaster response as stress levels increase for workers and the demands on organizations become more urgent.
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ASPR TRACIE. (2017). EMS & Infectious Diseases: Challenges & Resources for Provider Protection.
The speakers in this webinar discuss the emergency medical services (EMS) Infectious Disease Playbook and how EMS professionals can use it in their daily practice.
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  • Meghan Treber This is a great resource!
    7/17/2017 2:25:31 PM
ASPR TRACIE. (2019). Disaster Behavioral Health Self Care for Healthcare Workers Modules.
ASPR TRACIE has worked closely with ASPR At-Risk Individuals, Behavioral Health & Community Resilience (ABC) interagency/ external partner working groups in every disaster recovery operation for the last four years. One continuous knowledge gap identified during this time has been the need for information for front-line healthcare and social services workers to use prior to a disaster to recognize and reduce their stress levels and maintain resilience during recovery. These modules are designed for healthcare workers in all settings, but primarily hospital-based providers.
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* ASPR TRACIE. (2023). ASPR TRACIE Mini Modules to Relieve Stress for Health Care Workers.
These mini-modules are designed for healthcare workers in all settings, but primarily hospital-based providers, staff, and leaders to use prior to and during a disaster to help recognize and reduce their stress levels and maintain resilience. While these mini modules were developed during the COVID-19 pandemic, they can be used before, during, and after any type of incident.
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Burrer, S., Delaney, L., Shugart, J. and Victory, K. (2017). Emergency Responder Health Monitoring and Surveillance (ERHMS) Online Training Course (WB2873). Atlanta, GA: The Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Response.
This online course will teach participants to: list and describe the steps in the ERHMS process; describe pre-deployment activities including rostering, training, and pre-deployment health screening; describe how to perform monitoring and ongoing assessment of responders during emergent events; describe how to capture data to identify which responders would benefit from medical referral and long-term health surveillance; and select and implement strategies to prevent or detect disease in the target population.
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* European Centre for Disease Prevention and Control. (2014). Safe Use of Personal Protective Equipment in the Treatment of Infectious Diseases of High Consequence: A Tutorial for Trainers in Healthcare Settings. European Union .
This training program provides information on the proper use of personal protective equipment at the point of care and shares information on procurement, preparedness, and capacity building.
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* Federal Aviation Administration. (2010). First Responder Safety at a Small Aircraft or Helicopter Accident. Federal Aviation Administration.
This set of five training modules can help first responders ensure their safety at an aircraft accident scene.
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Federal Emergency Management Agency. (n.d.). PPMB PER-320: Personal Protective Measures for Biological Events. (Accessed 6/17/2019.)
This one-day, in person course focuses on “the challenges faced by first responders and clinical health care professionals in pre-hospital and hospital environments as they deal with personal protective equipment (PPE) needs and potential contamination issues while dealing with highly infectious diseases.”
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Federal Emergency Management Agency, Emergency Management Institute. (n.d.). IS-102.c: Preparing for Federal Disaster Operations: FEMA Response Partners. (Accessed 2/3/2020.)
Lesson 3 of this course covers accountability, safety, and security. The safety component includes lessons on occupational safety and tips for mitigating hazards frequently encountered in a disaster response situation (e.g., extreme weather, contaminated food/water, injuries, and rashes).
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* Liu, J., McGee, L., and Naturale, A. (2012). Deployment Supports for Disaster Behavioral Health Responders.
This webcast “prepares disaster behavioral health responders and their family members for deployment by reviewing pre- and post-deployment guidelines and ways to prepare for the stress of deployment and reintegration into regular work and family life.”
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* Liu, J., Naturale, A., and David, J. (2012). Self-Care for Disaster Behavioral Health Responders. Substance Abuse and Mental Health Services Administration, Disaster Technical Assistance Center. U.S. Department of Health and Human Services.
Public health emergency healthcare providers can learn about best practices and tools that could enable them and their supervisors to identify and effectively manage stress and secondary traumatic stress in this 60-minute podcast.
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Medical University of South Carolina and National Fallen Firefighters Foundation. (2017). Firefighters Helping Firefighters.
This website features video testimonials from firefighters and supervisors on a variety of topics (e.g., stressors, coping with stress, deciding to get help, and what that experience was like).
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Medical University of South Carolina and National Fallen Firefighters Foundation. (2019). Helping Heroes: A Web-Based Training Course for Providers Working with Firefighters. (Free registration required.)
This course can help behavioral healthcare providers better understand the firefighting culture in order to help staff better manage their negative mental health responses. Throughout the modules, short videos of actual providers discuss their experiences and lessons learned from working with this group of responders. There are additional links (under the “Resources” tab) to related helpful information.
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Murphy, K., and Jewell, S. (2015). Personal Safety and Health for Emergency Responders. (Free registration required.) University at Albany, State University of New York, School of Public Health and Health Professions, Center for Public Health Preparedness.
The objective of this one-hour course is to help emergency responders understand the types of dangers encountered in a disaster setting, as well as the common injuries that are sustained during an emergency response.
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* National Association of County and City Health Officials. (2016). Behavioral Health Videos.
This resource provides a series of seven behavioral health videos, available in English, Spanish, and American Sign Language. Video 2 is focused on stress management tips for first responders.
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National Center for PTSD. (2013). PTSD Coach Online.
This website can help individuals with PTSD (or people experiencing challenges with general life stress) by providing tools that help address stress-related symptoms (e.g., coping with trauma reminders, anxiety, and sleep problems) and bolster problem-solving skills.
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National Child Traumatic Stress Network. (2006). Psychological First Aid – Field Operations Guide.
This guide can help responders use Psychological First Aid "to assist children, adolescents, adults, and families in the aftermath of disaster and terrorism." It includes information about the eight core actions and related handouts for various audiences. (This guide was translated into Simple Chinese in 2020: https://www.nctsn.org/sites/default/files/resources/pfa_field_operations_guide_ch.pdf)
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National Institute of Environmental Health Sciences. (n.d.). Safety Awareness for Responders to Hurricanes: Protecting Yourself While Helping Others. (Accessed 6/17/2019.)
This training tool is a health and safety resource for "skilled support personnel" who will participate in hurricane response and cleanup activities. Responders will gain a basic awareness of identifying and managing hazards associated with hurricane response and cleanup activities.
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* National Institute of Environmental Health Sciences, National Institutes of Health. (2015). Responder & Community Resilience.
This webpage includes links to participant and instructor materials for 2 trainings focused on preparing disaster workers and volunteers, and their supervisors, to proactively recognize and respond to disaster worker stress and trauma. Materials are available in English and Spanish.
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* National Institute of Environmental Health Sciences, National Institutes of Health. (2016). Pathogen Safety Data (PSD) Guide and Training Module.
These training resources were created to support occupational safety and health, and infection control training programs for workers in health care and non-health care settings who may be at risk for exposure to infectious diseases. Included are: PSD Glossary; PSD Guide; PSD Guide Training Module; and PSD Guide Training Module Case Studies.
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* National Institute of Occupational Safety and Health. (2016). Fentanyl: Preventing Occupational Exposure to Emergency Responders.
Resources on this webpage include information on responder exposure risks, the use of personal protective equipment, and trends related to the illegal use of fentanyl across the U.S.
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* National Library of Medicine, National Institutes of Health. (2015). Stress and the Relaxation Response: Help for Those Affected by Disasters.
This webinar from the National Library of Medicine Disaster Information Management Research Center (DIMRC) focuses on the relaxation response, a counter-stress capacity. Its elicitation effectively counteracts stress and is therapeutic for a multitude of stress-related disorders and situations. Speakers discuss using the relaxation response for professionals and volunteers affected by stress when responding to disaster.
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Occupational Safety and Health Administration. (n.d.). Resilience Resources for Emergency Response. (Accessed 8/24/2023.) U.S. Department of Labor.
This web page describes and provides links to educational materials that can assist employees, their families, and supervisors gain awareness of issues related to and maintain physical and behavioral health before, during and after deployment.
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Substance Abuse and Mental Health Services Administration. (2015). Resiliency In Disaster Behavioral Health.
This resource includes discussions of specific behavioral health interventions across the stages of disaster response that also focus on the needs of specific populations. Episode 4 discusses “Resiliency Among First Responders.”
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* Substance Abuse and Mental Health Services Administration. (2018). Service to Self: Behavioral Health for Fire and EMS (Emergency Medical Services) Personnel.
This self-paced course for responders about their behavioral health includes videos featuring emergency medical technicians and fire personnel, scenarios, and interactive quizzes. It addresses occupational stressors; mental health and substance use issues, including depression, post-traumatic stress disorder, suicidality, and alcohol use; resilience; and healthy coping mechanisms, including demonstrations of stress management techniques.
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University of Nebraska Medical Center, HEROES. (n.d.). Personal Protective Equipment. (Accessed 6/18/2019.)
This webpage includes links to videos and interactive learning modules to support proper use of biological personal protective equipment (PPE).
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Watson, P., Taylor, V., Gist, R., et al. (2013). Stress First Aid for Firefighters and Emergency Medical Services Personnel. National Fallen Firefighters Foundation.
Stress First Aid (SFA) is a set of supportive actions designed to help emergency responders (specifically firefighters, EMS, and rescue personnel) assist each other in reducing the negative impacts of stress. SFA guides these responders in how to deliver the "Seven C's" of Stress First Aid (Check, Coordinate, Cover, Calm, Connect, Competence, Confidence) to each other.
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Occupational Safety

Asbestos.com and The Mesothelioma Center. (2021). Asbestos and Natural Disasters Guide.
This webpage describes the risks asbestos poses to first responders during and after various types of natural disasters. Strategies for preventing exposure, safely cleaning areas post-disaster, and planning for disasters are also provided.
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ASPR TRACIE. (2022). Infection Prevention and Control: Incorporating Lessons Learned in Managing Special Pathogens.
Speakers share lessons learned in infection prevention and control from the COVID-19 pandemic.
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* ASPR TRACIE. (2023). EMS Infectious Disease Playbook.
This playbook (updated in 2023) synthesizes multiple sources of information in a single planning document addressing the full spectrum of infectious agents to create a concise reference resource for emergency medical services (EMS) agencies developing their service policies. The information can be incorporated into agency standard operating procedures and reviewed by the EMS medical director.
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  • Bridget Kanawati Thank you for your interest in this resource. Unfortunately, funding restrictions preclude our being able to provide printed versions of our resources so all of our products, including this one, are only available electronically. ASPR TRACIE Team
    3/26/2020 2:12:41 PM
  • Frances Thorpe I agree with Tracy, is there a way to order this publication in hard copy format? The information contained in this publication highlights agency infection control policies and is a great resource to have in the department library.
    3/26/2020 12:21:36 PM
  • Tracy Miller Is there any way to order a printed and bound version?
    8/9/2018 5:16:09 PM
ASPR TRACIE. (2023). Opioids: Frequently Asked Questions.
This ASPR TRACIE fact sheet was developed to provide answers to some of the most frequently asked opioid-related questions that affect our audience (e.g., regional ASPR staff, healthcare coalitions, healthcare entities, healthcare providers, emergency managers, and public health practitioners). It includes links to select general and responder-geared resources.
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* Centers for Disease Control and Prevention. (n.d.). Guidance Documents for Protecting Emergency Responders. (Accessed 6/18/2019.)
Four volumes are linked to and included in this set of materials titled, Protecting Emergency Responders. They include the following: 1) Lessons Learned from Terrorist Attacks; 2) Community Views of Safety and Health Risks and Personal Protection Needs; 3) Safety Management in Disaster and Terrorism Response; and 4) Personal Protective Equipment Guidelines for Structural Collapse Event.
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* Centers for Disease Control and Prevention. (2018). Capability 14: Responder Safety and Health. Public Health Emergency Preparedness and Response Capabilities.
The Responder Safety and Health capability is one of the 15 capabilities identified in the Centers for Disease Control as part of the Public Health Emergency Preparedness and Response Capabilities. This capability focuses on the ability to protect public health emergency response staff responding to a critical incident, and is comprised of three functions: 1) Identify responder safety and health risks; 2) Identify and support risk-specific responder safety and health training; and 3) Monitor responder safety and health during and after incident response.
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Centers for Disease Control and Prevention. (2018). Guidance for Emergency Responders in U.S. Virgin Islands and Puerto Rico.
This webpage provides guidance for emergency responders and aid workers traveling to and working in areas of the U.S. Virgin Islands and Puerto Rico impacted by hurricanes and floods. It addresses safety and health considerations for Pre-Travel, On-Response, and Post-Response Planning.
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Centers for Disease Control and Prevention. (2019). Immunization Recommendations for Disaster Responders.
This webpage lists the recommended vaccinations for responders followed by a list of vaccines for which there is no indication due to relatively low probability of exposure.
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* Centers for Disease Control and Prevention, Emergency Preparedness and Response. (2017). Response Worker Health and Safety.
This webpage includes links to health and safety topics that pertain to disaster responders. Resources are also categorized by hazard (e.g., flood and hurricane cleanup, extreme heat, electrical safety).
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Evidence-Based Practice Centers. (2022). Infection Prevention and Control for the Emergency Medical Services and 911 Workforce. Agency for Healthcare Research and Quality.
This document reviews the scientific literature from 2006 to 2022 to examine exposure to and prevention of infectious disease for the emergency medical services (EMS) and 911 workforce, since these workers are frequently exposed to blood or bodily fluids on the job. Because of this, EMS workers had a higher risk of hospitalization and death from SARS-CoV-2 than firefighters. The authors found higher rates of hepatitis C in older staff and of SARS-CoV-2 in minorities. The study also discusses infection prevention and control practices, such as the effectiveness of personal protective equipment and onsite vaccine clinics, which can help protect the EMS workforce.
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* Federal Aviation Administration. (2010). First Responder Safety at a Small Aircraft or Helicopter Accident. Federal Aviation Administration.
This set of five training modules can help first responders ensure their safety at an aircraft accident scene.
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International Labour Organization. (2018). Occupational Safety and Health in Public Health Emergencies: A Manual for Protecting Health Workers and Responders.
This document provides an overview of “risks faced by emergency responders during disease outbreaks and other emergencies, such as natural disasters, chemical incidents, radiological emergencies and emergencies involving conflicts.”
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Jackson, B.A., Baker, J.C., Ridgely, S., et al. (2004). Protecting Emergency Responders, Volume 3. (Free to download.) RAND Corporation.
This report is based on a literature review, interviews with members of the response community, and information gathered at a conference on occupational safety and health. Recommendations for formalizing "an integrated, incident-wide approach to safety management at major disaster response operations" are included.
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National Institute for Occupational Safety and Health. (2018). Cold Stress. Centers for Disease Control and Prevention.
The resources on this webpage can help employers and their staff understand the causes and symptoms of cold stress to help them better prevent, identify, and treat it.
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National Institute for Occupational Safety and Health. (2018). Disaster Science Research Initiative to Enhance Responder Safety and Health. Centers for Disease Control and Prevention.
The aim of this initiative is to better understand and reduce responder health effects from disasters. The webpage includes links to related resources.
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National Institute for Occupational Safety and Health. (2018). Emergency Responder Health Monitoring and Surveillance (ERHMS). Centers for Disease Control and Prevention.
This webpage provides an overview of the surveillance system, which monitors responder health and safety to help develop related guidelines. Links to documents and information about the phases of the system are included.
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National Institute for Occupational Safety and Health. (2018). Heat Stress. Centers for Disease Control and Prevention.
The resources on this webpage can help employers and their staff understand the causes and symptoms of heat stress to help them better prevent, identify, and treat it.
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National Institute of Environmental Health Sciences. (n.d.). Hurricane Worker Podcasts. (Accessed 2/17/2020.) National Clearinghouse for Worker Safety and Health Training.
These short podcasts were developed to help emergency responders and recovery workers prepare for hurricane-related hazards (e.g., mold, debris, and electrical hazards).
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* National Institute of Occupational Safety and Health. (2016). Fentanyl: Preventing Occupational Exposure to Emergency Responders.
Resources on this webpage include information on responder exposure risks, the use of personal protective equipment, and trends related to the illegal use of fentanyl across the U.S.
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Occupational Safety and Health Administration. (n.d.). Emergency Preparedness and Response. (Accessed 8/24/2023.) U.S. Department of Labor.
These resources can help first responders keep themselves safe when responding to a variety of hazards and situations (e.g., blister agents, nerve agents, extreme weather, structural collapse). Information is presented in question and answer format, and links to related resources are provided in each guide.
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Occupational Safety and Health Administration. (n.d.). Radiation Emergency Preparedness and Response. (Accessed 8/12/2021.)
This webpage is intended to help workers and employers who may be involved in emergency response operations or related activities during or following a radiation emergency, and employers and workers who may be impacted by radiation emergencies, but who do not have emergency response roles.
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Radiation Emergency Medical Management. (2019). EPA Emergency Worker Exposure Guidelines.
This web page explains "safe" levels of occupational exposure to radiation, control measures, and protective actions for emergency responders and first receivers.
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The National Institute for Occupational Safety and Health. (2017). Preventing Occupational Exposure to Fentanyl. Centers for Disease Control and Prevention.
Resources on this webpage are grouped by specialty: emergency responders and healthcare personnel in hospital and clinic settings. Information on responder exposure risks, standard operating procedures, the use of personal protective equipment, training, and decontamination is provided for both groups.
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U.S. Department of Justice, Drug Enforcement Administration. (2017). Fentanyl: A Briefing Guide for First Responders.
To address the significant risk fentanyl can have on first responders who may come in contact with it, the Drug Enforcement Administration shares the history of the substance, describes fentanyl-related substances, and lists common illicit forms of the drug. It also shares information on responder exposure risks and treatment, and remediation and decontamination.
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U.S. Department of Labor.. (n.d.). Getting Started - General Business Preparedness for General, Construction and Maritime Industries. (Accessed 6/18/2019.) U.S. Department of Labor.
The information on this webpage is geared towards first responders and includes the following categories: organization of response operations; equipment; training; and hazard assessment and health and safety plans. A table linking to relevant OSHA standards is also included.
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* U.S. Fire Administration. (2019). Emerging Health and Safety Issues Among Women in the Fire Service. Federal Emergency Management Agency.
The number of women serving as career and volunteer firefighters has increased over the past two decades. This report examines how findings from a symposium held in 1994 on women in the fire service continue to apply. The authors highlight existing resources that address these findings and list recommendations for improving the fire service for women and all members.
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World Health Organization. (2016). Protecting the Health and Safety of Workers in Emergency Vector Control of Aedes Mosquitoes.
This document--developed for use by vector control managers, public health workers, healthcare providers, and the like--provides recommendations on essential measures to protect the health and safety of those involved in emergency vector control of Aedes spp. mosquitoes (e.g., space spraying of insecticides and larvicide application).
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World Health Organization. (2018). Occupational Safety and Health in Public Health Emergencies: A Manual for Protecting Health Workers and Responders.
This manual provides an overview of the main occupational safety and health risks faced by emergency responders during disease outbreaks and other emergencies. It is focused on needs in low-resource settings, and provides guidance on establishing systems that can reduce occupational exposures, injury, illness, and death among response workers; decrease stress and reduce fears; and promote responder health and well-being.
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Personal Protective Equipment

* ASPR TRACIE. (2023). EMS Infectious Disease Playbook.
This playbook (updated in 2023) synthesizes multiple sources of information in a single planning document addressing the full spectrum of infectious agents to create a concise reference resource for emergency medical services (EMS) agencies developing their service policies. The information can be incorporated into agency standard operating procedures and reviewed by the EMS medical director.
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2
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  • Bridget Kanawati Thank you for your interest in this resource. Unfortunately, funding restrictions preclude our being able to provide printed versions of our resources so all of our products, including this one, are only available electronically. ASPR TRACIE Team
    3/26/2020 2:12:41 PM
  • Frances Thorpe I agree with Tracy, is there a way to order this publication in hard copy format? The information contained in this publication highlights agency infection control policies and is a great resource to have in the department library.
    3/26/2020 12:21:36 PM
  • Tracy Miller Is there any way to order a printed and bound version?
    8/9/2018 5:16:09 PM
Association for Professionals in Infection Control and Epidemiology. (2014). 2014 Donning and Doffing PPE Competency Validation Checklist.
This checklist can be used by evaluators when testing healthcare professionals' ability to safely and effectively don and doff personal protective equipment.
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Bessesen, M., Adams, J., Radonovich, L., and Anderson, J. (2015). Disinfection of Reusable Elastomeric Respirators by Health Care Workers: A Feasibility Study and Development of Standard Operating Procedures. American Journal of Infection Control. 43(6): 629-634.
This article describes a Department of Veterans Affairs feasibility study on the ability of personnel to safely disinfect respirators under pandemic conditions by following standard operating procedures.
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* Centers for Disease Control and Prevention. (n.d.). Guidance Documents for Protecting Emergency Responders. (Accessed 6/18/2019.)
Four volumes are linked to and included in this set of materials titled, Protecting Emergency Responders. They include the following: 1) Lessons Learned from Terrorist Attacks; 2) Community Views of Safety and Health Risks and Personal Protection Needs; 3) Safety Management in Disaster and Terrorism Response; and 4) Personal Protective Equipment Guidelines for Structural Collapse Event.
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* Centers for Disease Control and Prevention. (2018). Capability 14: Responder Safety and Health. Public Health Emergency Preparedness and Response Capabilities.
The Responder Safety and Health capability is one of the 15 capabilities identified in the Centers for Disease Control as part of the Public Health Emergency Preparedness and Response Capabilities. This capability focuses on the ability to protect public health emergency response staff responding to a critical incident, and is comprised of three functions: 1) Identify responder safety and health risks; 2) Identify and support risk-specific responder safety and health training; and 3) Monitor responder safety and health during and after incident response.
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* Centers for Disease Control and Prevention, Emergency Preparedness and Response. (2017). Response Worker Health and Safety.
This webpage includes links to health and safety topics that pertain to disaster responders. Resources are also categorized by hazard (e.g., flood and hurricane cleanup, extreme heat, electrical safety).
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Chemical Hazards Emergency Medical Management. (2017). Personal Protective Equipment. U.S. Department of Health and Human Services.
This webpage provides links to resources about personal protective equipment for chemical emergencies.
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Chughtai, A., Seale, H., and MacIntyre, C. (2013). Availability, Consistency and Evidence-base of Policies and Guidelines on the Use of Mask and Respirator to Protect Hospital Health Care Workers: A Global Analysis. BMC Research Notes. 6:216.
The authors examined existing policies and guidelines from the Centers for Disease Control and Prevention, the World Health Organization, three high-income countries, and six low/middle-income countries on mask and respirator use for influenza, SARS, and tuberculosis. They found significant variation in choice of products, applications, and specifications. They encourage joint evaluation of evidence and development of a uniform policy to reduce confusion in healthcare settings.
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* European Centre for Disease Prevention and Control. (2014). Safe Use of Personal Protective Equipment in the Treatment of Infectious Diseases of High Consequence: A Tutorial for Trainers in Healthcare Settings. European Union .
This training program provides information on the proper use of personal protective equipment at the point of care and shares information on procurement, preparedness, and capacity building.
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Fisher, E. and Shaffer, R. (2014). Commentary Considerations for Recommending Extended Use and Limited Reuse of Filtering Facepiece Respirators in Health Care Settings. Journal of Occupational and Environmental Hygiene. 11(8):D115-D128.
This article reviews scientific findings on the extended use or reuse of filtering facepiece respirators in healthcare settings. The authors discuss considerations for routine events versus during public health emergencies. The authors express a preference for extended use over reuse and suggest that future recommendations consider new cautions and limitations.
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Lindsley, W., Martin, S., Thewlis, R., et al. (2015). Effects of Ultraviolet Germicidal Irradiation (UVGI) on N95 Respirator Filtration Performance and Structural Integrity. Journal of Occupational and Environmental Hygiene. 12(8):509-517.
The authors exposed material coupons and straps from four models of N95 filtering facepiece respirators to a range of doses of ultraviolet germicidal irradiation to test particle penetration, flow resistance, bursting strengths of coupon layers, and breaking strength of straps. They found small effects on filtration performance and almost no effect on flow resistance, but a reduction in the strength of respirator materials of more than 90% in some models and a 20-51% reduction in breaking strength of straps. The authors suggest that ultraviolet germicidal irradiation is a possible method to disinfect respirators for reuse, but the respirator model used should first be tested to determine the maximum number of disinfection cycles and the dose required to inactivate the specific pathogen.
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Liverman, C., Domnitz, S., and McCoy, M. (2015). The Use and Effectiveness of Powered Air Purifying Respirators in Health Care: Workshop Summary. The National Academies of Sciences, Engineering, and Medicine.
This report summarizes the proceedings of a workshop examining the current state of practice on the use of powered air purifying respirators in healthcare settings and research on their use and effectiveness.
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Methodist Hospital for Surgery. (2014). Buddy System for PPE Placement & Removal. Association for Professionals in Infection Control and Epidemiology.
This document outlines the steps for the "buddy system" for the placement and removal of personal protective equipment.
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National Academies of Sciences, Engineering, and Medicine. (2022). Frameworks for Protecting Workers and the Public from Inhalation Hazards.
This document describes inhalation hazards (e.g., wildfire smoke) and the short- and long-term adverse effects they can have on health. The authors describe the concept of respiratory protection, stressing the importance for employers to learn more about protecting their staff and for individuals to learn more about preventing inhalation hazard effects.
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National Institute for Occupational Safety and Health. (2009). NIOSH Hazard Based Guidelines: Protective Equipment for Workers in Hurricane Flood Response. Centers for Disease Control and Prevention.
This website provides general guidance for personal protective equipment for workers responding in hurricane flood zones and can be adapted to specific conditions.
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National Institute for Occupational Safety and Health. (2014). Limiting Heat Burden While Wearing Personal Protective Equipment (PPE). Centers for Disease Control and Prevention.
This PowerPoint presentation was developed for people responding to the 2014 Ebola outbreak in West Africa. It describes risks for heat-related illness for those who wear personal protective equipment for an extended period of time and recommendations for minimizing risk.
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National Institute for Occupational Safety and Health. (2015). NIOSH Personal Protective Equipment Information (PPE-Info). Centers for Disease Control and Prevention.
This website compiles standards information for personal protective equipment from the U.S. government, American National Standards Institute-accredited standard development organizations, and the International Organization for Standardization. Users can search the database by fields including the category of personal protective equipment, hazard type, standard type, and standard organization.
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National Institute for Occupational Safety and Health. (2016). Preparedness through Daily Practice: The Myths of Respiratory Protection in Healthcare. Centers for Disease Control and Prevention.
This document addresses common myths related to respiratory protection (including N95 respirator use) and provides information to reinforce respiratory protection program administrator responsibilities and healthcare workers' knowledge concerning the proper use of these devices in daily practice, as well as to prepare them for public health emergencies.
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National Institute for Occupational Safety and Health. (2017). National Framework for Personal Protective Equipment Conformity Assessment: Infrastructure. Centers for Disease Control and Prevention.
This document provides a framework to assist in developing, structuring, and managing a personal protective equipment (PPE) conformity assessment (CA) for American workplaces. It discusses how a comprehensive and tailor-made CA program is the most effective way to manage risks of a non-conforming PPE and instill confidence in PPE users. It is the product of collaboration among the National Institute for Occupational Safety and Health (NIOSH) representatives and a broad cross-section of members of the PPE community.
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National Institute for Occupational Safety and Health. (2018). Emergency Response Resources: Personal Protective Equipment. Centers for Disease Control and Prevention.
The information on this webpage focuses on personal protective equipment (PPE) and includes the following categories: respirators; protective clothing; skin exposures; eye protection; and hearing protection. Links to related resources are provided.
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National Institute for Occupational Safety and Health. (2023). Community Respirators and Masks.
This web page provides an overview of hazards in the air (e.g., mold, wildfire smoke, and infectious diseases) and describes the use and protective features of various types of respirators and masks.
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* National Institute of Occupational Safety and Health. (2016). Fentanyl: Preventing Occupational Exposure to Emergency Responders.
Resources on this webpage include information on responder exposure risks, the use of personal protective equipment, and trends related to the illegal use of fentanyl across the U.S.
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New York City Health + Hospitals. (2019). Frontline Hospital Planning Guide: Special Pathogens.
This planning guide from New York City Health + Hospitals provides high-level planning information for frontline hospital multidisciplinary teams to support planning and training for the initial care of suspected special pathogen patients while determining whether and when they will be transferred to another facility for further assessment and treatment.
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Occupational Safety and Health Administration. (n.d.). PPE Assessment. (Accessed 5/3/2019.) U.S. Department of Labor.
This resource provides a checklist on the need for various PPE and related questions that a healthcare facility should ask when conducting an assessment.
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Occupational Safety and Health Administration. (n.d.). Respiratory Protection. (Accessed 8/24/2023.) U.S. Department of Labor.
This webpage contains standards on respirators, respiratory protection, and the medical evaluation program.
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Occupational Safety and Health Administration. (2018). PPE (Personal Protective Equipment) for Emergency Response and Recovery Workers. U.S. Department of Labor.
This webpage discusses personal protective equipment (PPE) for emergency response and recovery workers, particularly those responding to natural disaster and chemical (including oil), biological, radiological and nuclear (CBRN) events. (Note that hospital decontamination is different than scene response and should refer to OSHA’s “First Receiver” document in the Hospital Patient Decontamination Topic Collection).
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Pillai, S., Beekmann, S., Babcock, H., et al. (2015). Clinician Beliefs and Attitudes Regarding Use of Respiratory Protective Devices and Surgical Masks for Influenza. Health Security. 13(4):274-280.
The authors described a survey of infectious disease physicians to learn their perspectives on influenza transmission, personal protective equipment preferences, respirator supplies, barriers to expanded use of respirators, and respirator conservation strategies. Among the findings, respondents widely agreed with recommendations to use surgical masks during seasonal influenza outbreaks. They slightly favored N95 respirators during mild severity pandemics, but two-thirds preferred N95 respirators over surgical masks during a high mortality pandemic. They also preferred extended use or reuse of disposable N95 respirators over elastomeric or powered air-purifying respirators in the event of a respirator shortage.
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Radiation Emergency Medical Management. (2019). First Responders in the Field.
This webpage includes links to helpful resources for responders on radiation-specific personal protective equipment, incident response (including casualty management and triage), and online training courses.
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Smith, J., MacDougall, C., Johnstone, J., et al. (2016). Effectiveness of N95 Respirators Versus Surgical Masks in Protecting Health Care Workers from Acute Respiratory Infection: A Systematic Review and Meta-Analysis. Canadian Medical Association Journal. 188(8):567-574.
The authors conducted a meta-analysis of both clinical studies and surrogate exposure studies comparing N95 respirators to surgical masks to prevent transmission of acute respiratory infections. While the surrogate studies suggested a protective advantage of N95 respirators over surgical masks, the meta-analysis showed insufficient data to definitely determine whether N95 respirators are more protective.
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The Interagency Board for Emergency Preparedness and Response. (2020). Minimum Recommended Guidance on Protection and Decontamination for First Responders Involved in COVID-19 Cases - Detailed Reaction Guide.
This document from 4/10/2020 details personal protective equipment (PPE) considerations for first responders to protect against inhalation, ocular, and dermal exposures to SARS-CoV-2; donning, use, and doffing considerations; cleaning, sanitizing, and disinfecting considerations; decontamination and disinfection procedures and considerations for vehicles, apparatus, and fire stations; and waste management considerations.
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Tomas, M.E., Kundrapu, S., Thota, P., et al. (2015). Contamination of Health Care Personnel During Removal of Personal Protective Equipment. JAMA Internal Medicine.
The authors examine how pathogens can be spread during the removal of PPE.
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U.S. Department of Defense, U.S. Department of Health and Human Services, U.S. Department of Transportation, et al. (2019). Fourth Generation Agents: Safety Awareness for First On-Scene Responders.
This resource was designed to educate and prepare first responders (e.g., law enforcement, fire, and emergency medical services personnel) who may be exposed to a fourth generation nerve agent during a response. It includes sections on agent identification, rescuer protection, and decontamination
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2017). Personal Protective Equipment.
This webpage provides information and links for laboratory workers on personal protective equipment necessary for working with biohazards.
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University of Nebraska Medical Center. HEROES. (2019). HEROES.
HEROES provides an interdisciplinary approach to chemical, radiological, biological, and natural disaster emergency education. This website offers education on a variety of responder personal protective equipment issues (e.g, donning and doffing).
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Plans, Tools, and Templates

AHA Center for Health Innovation. (2022). The CLEAR Field Guide for Emergency Preparedness.
This field guide encourages emergency management stakeholders to break down silos in the emergency management system by incorporating public health officials, local health departments, hospitals and health systems, fire and emergency medical services, and emergency management leaders into emergency preparedness. The guide lists action strategies, resources, and field examples in four priority areas: e.g., strengthening cross-sector partnerships; building workforce capacity and resilience; sharing information; and normalizing a culture of preparedness.
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American Industrial Hygiene Association. (2020). Emergency Response Planning Guidelines.
The Association's Emergency Response Planning Committee developed these guidelines for those who respond to actual or suspected releases of acutely toxic airborne substances. These guidelines were created based on the assumption that exposure would be "once-in-a-lifetime, short-term (typically 1-hour)."
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ASPR TRACIE. (2018). Hospital Personal Protective Equipment Planning Tool (compliant PDF).
The Hospital Personal Protective Equipment (PPE) Planning Tool is designed to help hospitals determine approximate PPE needs based on special pathogen category and a number of facility specific variables. Calculators are included for Ebola Virus Disease/Viral Hemorrhagic Fever (EVD/VHF) as well as special respiratory pathogens such as Middle East Respiratory Syndrome/Severe Acute Respiratory Syndrome (MERS/SARS), and for pandemic influenza. Access the Excel version of the tool at: https://files.asprtracie.hhs.gov/documents/aspr-tracie-hospital-ppe-planning-tool.xlsx
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* ASPR TRACIE. (2023). EMS Infectious Disease Playbook.
This playbook (updated in 2023) synthesizes multiple sources of information in a single planning document addressing the full spectrum of infectious agents to create a concise reference resource for emergency medical services (EMS) agencies developing their service policies. The information can be incorporated into agency standard operating procedures and reviewed by the EMS medical director.
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  • Bridget Kanawati Thank you for your interest in this resource. Unfortunately, funding restrictions preclude our being able to provide printed versions of our resources so all of our products, including this one, are only available electronically. ASPR TRACIE Team
    3/26/2020 2:12:41 PM
  • Frances Thorpe I agree with Tracy, is there a way to order this publication in hard copy format? The information contained in this publication highlights agency infection control policies and is a great resource to have in the department library.
    3/26/2020 12:21:36 PM
  • Tracy Miller Is there any way to order a printed and bound version?
    8/9/2018 5:16:09 PM
Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences. (2017). Assessment Instruments for First Responders and Public Health Emergency Workers.
This document describes instruments and measures that assess a broad range of work-life stressors. Included are measures for career satisfaction, fatigue, and identification and sensitivity, among others.
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* Centers for Disease Control and Prevention. (2018). Capability 14: Responder Safety and Health. Public Health Emergency Preparedness and Response Capabilities.
The Responder Safety and Health capability is one of the 15 capabilities identified in the Centers for Disease Control as part of the Public Health Emergency Preparedness and Response Capabilities. This capability focuses on the ability to protect public health emergency response staff responding to a critical incident, and is comprised of three functions: 1) Identify responder safety and health risks; 2) Identify and support risk-specific responder safety and health training; and 3) Monitor responder safety and health during and after incident response.
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Edison, L. (2017). R-STaR-Responder Safety, Tracking, and Resilience and Hurricane Matthew. Georgia Department of Public Health.
This PowerPoint presentation includes information on a state-specific database used by the Georgia Department of Public Health to roster, credential, track and monitor responders before, during and after Hurricane Matthew in 2016.
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Federal Emergency Management Agency. (2013). Incident Command System Form: Safety Message/Plan (ICS 208).
This optional form can be completed by the Safety Officer and included in an Incident Action Plan.
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Federal Emergency Management Agency. (2013). Worker Safety and Health Support Annex.
This annex provides an overview of the federal support that will be made available to local, State, territorial, tribal, insular area, and federal response and recovery organizations to ensure worker safety and health during incidents requiring a coordinated federal response.
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National Institute for Occupational Safety and Health. (2016). Examples of Pre-Deployment Screening Tools Used by Selected Emergency Response Units. Centers for Disease Control and Prevention.
This document provides examples of, and links to pre-deployment responder health screening tools used by selected emergency response units, including Interim Guidance for Pre-exposure Medical Screening of Workers Deployed for Hurricane Disaster Work; Center for Domestic Preparedness Responder Screening Tool; American Red Cross, and CDC Responder Readiness Medical Clearance.
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* National Institute of Environmental Health Sciences, National Institutes of Health. (2016). Pathogen Safety Data (PSD) Guide and Training Module.
These training resources were created to support occupational safety and health, and infection control training programs for workers in health care and non-health care settings who may be at risk for exposure to infectious diseases. Included are: PSD Glossary; PSD Guide; PSD Guide Training Module; and PSD Guide Training Module Case Studies.
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Occupational Safety and Health Administration. (2018). Worker Safety and Health Resources for Hurricane and Flood Cleanup and Recovery. U.S. Department of Labor.
This webpage includes links to fact sheets and other tools related to hurricane and flood cleanup and recovery. Topics include: mold; electrical; heat; ladders; falls; general response and recovery; PPE; floods; and hurricanes.
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Pipeline and Hazardous Materials Safety Administration. (2024). 2024 Emergency Response Guidebook (ERG). U.S. Department of Transportation.
This version of the guidebook can help first responders respond to hazardous materials incidents within the first 30 minutes.
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Shugart, J. (2017). Utilizing the Emergency Responder Health Monitoring and Surveillance System to Prepare for and Respond to Emergencies. Centers for Disease Control and Prevention.
This article provides an overview of the Emergency Responder Health Monitoring and Surveillance System and its applicability to emergency preparedness and response.
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* Stamm, B. (2019). The Professional Quality of Life Elements Theory and Measurement.
The ProQOL (short for Professional Quality of Life) is the most commonly used measure of Compassion Fatigue and Compassion Satisfaction, two effects commonly experienced by responders who help people who experience suffering and trauma. In addition to the tool, the researcher provides links to theoretical resources, presentation aids, and other resources that can be helpful when raising awareness of the behavioral health effects on disaster responders.
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* Texas Nurses Association. (n.d.). Care for the Caregiver. (Accessed 6/18/2019.)
This website is geared towards nurses charged with providing care, often in austere environments. It includes links to pre-, during, and post-disaster resources that can help nurses (and other healthcare practitioners) prepare for, recognize, and manage stress and maintain resilience.
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Tuscarawas County Health Department. (2018). Responder Health & Safety Plan.
This plan describes the potential hazards and related risks responders might face during a public health emergency in Tuscarawas County, Ohio, and the actions the health department will take to protect them from such risks.
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U.S. Department of Health and Human Services. Office of the Assistant Secretary for Preparedness and Response. (2015). 2016 Force Protection: Health and Safety Plan.
The 2016 Force Protection: Health and Safety Plan (HASP) is specific to National Disaster Medical System (NDMS) staff. It includes sections on personal protective equipment, training, general safety and health requirements, medical services and first aid, sanitation, roadway safety, fire and life safety, security, and logistics safety. It also includes forms and job action sheets in the appendices.
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U.S. Department of Homeland Security. (2016). Health and Safety Planning Guide for Planners, Safety Officers, and Supervisors for Protecting Responders Following a Nuclear Detonation.
This guidance can help preserve responder health and safety in the event of a 10 kiloton improvised nuclear device within the first 72 hours of a detonation and is one of the few sources of information for advice about scene hazard control /mitigation and environmental considerations.
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U.S. Department of Justice, Office for Victims of Crime (OVC). (2017). Vicarious Trauma Toolkit.
OVC recognized that professionals’ response to crime victims can either set a path forward to healing or be re-traumatizing and professionals themselves can be traumatized by these events. The toolkit was developed on the premise that exposure to the traumatic experiences of other people—vicarious trauma—is an inevitable occupational challenge for those helping victims. This publication includes tools and resources to provide the knowledge and skills necessary for organizations to address the vicarious trauma needs of their staff.
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U.S. Environmental Protection Agency. (n.d.). Safety Officer Toolbox. (Accessed 5/10/2019.)
This toolkit was created to support the Safety Officer position in an Incident Management Team. Included are forms, guidelines, job aids, and fact sheets, as well as examples of completed documentation that may be referenced by planners responsible for developing health and safety plans for their organizations.
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U.S. Environmental Protection Agency. (2017). EPA’s Emergency Responder Health and Safety Manual.
This manual outlines “steps that EPA must take to protect the Agency’s emergency responders from job-related injuries, accidents, and exposures to hazardous materials.” It may be used as a reference by other organizations.
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* University of Minnesota, School of Public Health. (2013). Responder Self Care App.
This application aids responders during deployment in maintaining their own physical, emotional, and social wellbeing. Checklists for before, during, and after deployment are included. The app also allows users to customize reminders and tips and lists steps that can help responders pack for deployment, take care of daily needs, maintain important relationships, and reflect on their experiences.
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Responder Fatigue

Buczek, D. (2015). Fatigue in First Responder Operations. The CIP Report, January 2015: 11-13.
The author defines responder fatigue, explains when it becomes a hazard, lists some of the causes, and provides suggestions for mitigating it.
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Patterson, P.D., Higgins, J.S., Van Dongen, H., et al.. (2018). Evidence-Based Guidelines for Fatigue Risk Management in Emergency Medical Services. Prehospital Emergency Care.
The authors describe the literature review and consultation process used to develop evidence-based guidelines and recommendations regarding fatigue risk management.
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Slumber Yard Team. (2021). How Can First Responders Manage Sleep And Stress?
This resource highlights various effects of the COVID-19 pandemic on first responders, specifically stress, lack of sleep, and burnout. An infographic and strategies and tips for self care are provided.
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U.S. National Response Team. (2009). Guidance for Managing Worker Fatigue During Disaster Operations: Technical Assistance Document: Volume 1.
This document addresses worker fatigue during large-scale disaster operations and can serve as a hands-on manual to assist organizations with the development of programs and plans to address fatigue issues among disaster workers.
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Select Occupational Safety and Health Standards

envirosafety. (n.d.). Hard Hat Facts. (Accessed 7/5/2019.)
This free fact sheet lists standards and equipment that can help responders protect their heads when working on scenes where there is the potential to be struck by falling objects. (A link to the full standard, 1910.135, which must be purchased, is also included in this Topic Collection.)
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Minnesota Department of Labor and Industry. (2015). Fact Sheet: Contents of a First Aid Kit. Occupational Safety and Health Division.
This factsheet complies with American National Standards Institute (ANSI Z308.1) and lists recommended basic first aid supplies.
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National Fire Protection Association. (2014). NFPA 1561: Standard on Emergency Services Incident Management System and Command Safety. (Free registration required to view 2014 version.)
This standard includes requirements for emergency services that can help protect the safety of emergency responders and others on the scene of an incident.
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National Fire Protection Association. (2018). NFPA 1500: Standard on Fire Department Occupational Safety and Health Program. (Free access to full standard text with registration.)
This standard provides an overview of the requirements of an occupational medicine program that can reduce risk and promote the health of "fire departments or organizations that provide rescue, fire suppression, emergency medical services, hazardous materials mitigation, special operations, and other emergency services."
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NC State University. (n.d.). Emergency Eyewash Factsheet. (Accessed 5/1/2019.)
This one-page factsheet highlights how eyewash stations must comply with American National Standards Institute (ANSI) standards; lab responsibilities are also listed.
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Occupational Safety and Health Administration. (n.d.). Eye and Face Protection. (Accessed 5/1/2019.) U.S. Department of Labor.
This standard (1910.133) details requirements and criteria for eye protection for employees working in areas where hazards such as flying particles or chemical gases or vapors may cause injury. A table that lists filter lenses by operation, electrode size, arc current, and minimum protective shade is also included.
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Occupational Safety and Health Administration. (n.d.). Foot Protection. (Accessed 5/1/2019.) U.S. Department of Labor.
This standard (1910.136) details requirements and criteria for foot protection in situations where there is a danger of foot injuries due to falling or rolling objects, or objects piercing the sole, or electrical hazards. Consensus standards are also listed.
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Occupational Safety and Health Administration. (n.d.). Hand Protection. (Accessed 5/1/2019.) U.S. Department of Labor.
This standard (1910.138) details requirements and criteria for hand protection in situations where hands are exposed to hazards or at risk for cuts or burns.
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Occupational Safety and Health Administration. (n.d.). Hazardous Waste Operations and Emergency Response. (Accessed 11/3/2021.) U.S. Department of Labor.
This guidance document provides information that can help employers assure compliance during decontamination and hazardous materials training and responses. It includes the section "Provisions of HAZWOPER for Emergency Response Operations" which highlights the importance of plans, response procedures, training, medical surveillance, and personal protective equipment.
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Occupational Safety and Health Administration. (n.d.). Head Protection. (Accessed 5/1/2019.) U.S. Department of Labor.
This standard (1910.135) details requirements and criteria for head protection for employees working in areas where falling objects may cause injury. Consensus standards are also listed.
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Occupational Safety and Health Administration. (2006). Major Requirements of OSHA's Respiratory Protection Standard 29 CFR 1910.134. U.S. Department of Labor.
This standard (1910.134) details requirements and criteria for respiratory protection. This webpage provides the major requirements for this standard, to include: respiratory protection program, selection of respirators, medical evaluation, fit testing, use of respirators, maintenance and care, training and information, and program evaluation.
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Oregon OSHA. (2011). Fact Sheet: High Visibility Safety Apparel-Unraveled.
This fact sheet includes information on high visibility garments that can be used by emergency personnel on the scene of an incident. (A link to the full standard, ANSI/ISEA 107-2010, which must be purchased, is also included in this Topic Collection.)
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The American Society of Safety Professionals. (2011). ANSI/ISEA 207-2011 American National Standard for High-Visibility Public Safety Vests - Electronic Copy. (Excerpts of this standard are available on select vendor websites; the full standard is available for purchase.)
This standard lists requirements for high visibility vests and includes specifications related to color and retroreflection.
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The American Society of Safety Professionals. (2014). ANSI/ISEA Z358.1-2014 American National Standard for Emergency Eyewash & Shower Equipment - Electronic Copy. (Excerpts of this standard are available on select vendor websites; the full standard is available for purchase.)
This standard includes requirements for shower and eyewash equipment for the emergency treatment of eyes or other body parts of an employee who has been exposed to hazardous materials. It includes emergency showers, eye washes, eye/face washes, and combination units.
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The American Society of Safety Professionals. (2015). ANSI/ISEA Z308.1-2015 American National Standard for Minimum Requirements for Workplace First Aid Kits and Supplies - Electronic Copy. (Excerpts of this standard are available on select vendor websites; the full standard is available for purchase.)
This standard lists requirements for first aid kits designed for use in the work environment.
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Agencies and Organizations

American Conference of Governmental Industrial Hygienists.
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American Industrial Hygiene Association.
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American Society for Testing and Materials.
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American Society of Safety Professionals.
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Board of Certified Safety Professionals.
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Centers for Disease Control and Prevention. Emergency Preparedness and Response. Response Worker Health and Safety.
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Centers for Disease Control and Prevention. Resources for Emergency Health Professionals.
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Centers for Disease Control and Prevention. The National Institute for Occupational Safety and Health (NIOSH).
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Centers for Disease Control and Prevention. World Trade Center Health Program.
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Council for Accreditation in Occupational Hearing Conservation.
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Headington Institute.
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Institute for Diseases and Disaster Management. Tools and Resources. NYC Health + Hospitals.
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International Critical Incident Stress Foundation.
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International Safety Equipment Institute.
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National Association of Emergency Medical Technicians. Initiatives.
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National Environmental Health Association.
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National Fire Protection Association. Codes and Standards.
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National Institute for Occupational Safety and Health. Emergency Response Resources: Emergency Responders. Centers for Disease Control and Prevention.
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National Safety Council. Safety at Work.
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The National Center for PTSD.
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U.S. Department of Health and Human Services. Radiation Emergency Medical Management.
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U.S. Department of Health and Human Services. Substance Abuse and Mental Health Services Administration (SAMHSA).
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U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. Disaster Technical Assistance Center.
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U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. First Responders and Disaster Responders Resource Portal.
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U.S. Department of Labor. Occupational Safety and Health Administration. Emergency Preparedness and Response.
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U.S. National Response Team, Guidance, Technical Assistance, & Planning. Health and Safety.
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Uniformed Services University of the Health Sciences. Center for the Study of Traumatic Stress.
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University of Nebraska Medical Center. HEROES. HEROES.
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This ASPR TRACIE Topic Collection was refreshed and comprehensively reviewed in June and July 2019 by the following subject matter experts (listed in alphabetical order): Eric Alberts, BS, CEM, CHPP, CHEP, FPEM, FPEMC-HC, SEM, Orlando Health, Inc. (Hospital System); Jim Bolen, MS, Planning Section Chief, Butler County / State of Ohio AHIM; Dianna Bryant, PhD, CIH, CSP, Director, Institute for Rural Emergency Management, University of Central Missouri; John Hick, MD, HHS ASPR and Hennepin County Medical Center; Mark P. Jarrett, MD, MBA, MS, SVP & Chief Quality Officer, Associate Chief Medical Officer, Northwell Health, Professor of Medicine, Zucker School of Medicine at Hofstra/Northwell; Rachel Kaul, LCSW, CTS, Senior Advisor for Behavioral Health, DHHS/ASPR/EMMO; LT Joshua Medero Padin, ASP, MS, PhD Candidate, USPHS, Commissioned Corps, and Program Manager/ Industrial Hygienist, OS, ASPR/NDMS; April Naturale, PhD, Disaster Recovery and Community Resilience Senior Manager, ICF; Mary Russell, EdD, MSN, Healthcare Emergency Response Coalition, Palm Beach County FL; and Susan Schmitz, MAIDP, US Department of Veterans Affairs, Veterans Health Administration, Veterans Emergency Management Evaluation Center (VEMEC).  

It was comprehensively reviewed in the Fall of 2015 by the following subject matter experts (listed in alphabetical order): Eric Alberts, BS, FPEM, CHS-V, CDP-1, CHPP, CHEP, SEM, CFRP, FABCHS, Orlando Health, Inc. (Hospital System); James Bolen, MS, Operations Manager, Warren County (Ohio) Emergency Management Agency; Joseph Cocciardi, PhD, MS, CIH, CSP, REHS/RS, ASPR Safety Officer/NDMS-OPMED Safety; John Hick, MD, HHS ASPR and Hennepin County Medical Center; Mark Jarrett, MD, MBA, MS, Sr. Vice President and Chief Quality Officer, Associate Chief Medical Officer, North Shore-LIJ Health System and Professor of Medicine, Hofstra – North Shore LIJ School of Medicine; April Naturale, PhD, Senior Technical Specialist, ICF International; and Mary Russell, EdD MSN, Emergency Services, Boca Raton Regional Hospital.

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