Emergency Responder Health Monitoring and Surveillance Program(ERHMS)

What is ERHMS?

When disaster strikes, the nation depends on emergency response workers who are 

prepared and trained to respond effectively. The Emergency Responder Health 

Monitoring and Surveillance (ERHMS) system is a health monitoring and surveillance 

framework that includes recommendations and tools specific to protect emergency 

responders during all phases of a response, including pre-deployment, deployment, and 

post-deployment phases.

This framework builds on systems and practices currently in use, and should prove useful 

to persons or organizations involved in all stages of a response. Despite the wide scales 

of events for which responder health monitoring and surveillance is needed, ERHMS 

principles apply to both small- and large-scale events, including local, state, and federal 

level responses.

Why should we implement ERHMS?

The intent of ERHMS is to

• identify exposures and/or signs and symptoms early in the course of an emergency response

• prevent or mitigate adverse physical and psychologicaloutcomes

• ensure workers maintain their ability to respond effectively and are not harmed during responsework

• evaluate protectivemeasures

• identify responders for medical referral and possible enrollment in a long-term health surveillance program

What activities does ERHMS address in each phase of deployment? 

Pre-deployment Phase:

• Rostering and Credentialing of Emergency Response and Recovery 

Workers

• Health Screening for EmergencyResponders

• Health and Safety Training

• Data Management and InformationSecurity

Deployment Phase:

• On-site ResponderIn-processing

• Health Monitoring and Surveillance During ResponseOperations

• Integration of Exposure Assessment, Responder Activity 

Documentation, and Control

• Communications of Exposure and Health Monitoringand 

Surveillance Data during an EmergencyResponse

Post-deployment Phase:

• Responders Out-ProcessingAssessment

• Post-event Tracking of Emergency Responder Health andFunction

• Lessons-learned and After-action Assessments

ERHMS can help meet Public Health Preparedness Capability 14: Responder Safety and Health

For more information on ERHMS, please visit: http://www.cdc.gov/niosh/erhms

National Institute for Occupational Safety and Health (NIOSH) ERHMS Contact: 

erhmsonline@cdc.gov
Emergency Responder Health Monitoring and Surveillance Program(ERHMS)

Pre-deployment Phase

1. Rostering and Credentialing of Emergency Response and RecoveryWorkers

• Maintains accountability for all emergency responders

• Assesses responders’ education, training, and experience to deploy in their assigned responsecapacities

2. Health Screening for EmergencyResponders

• Establishes a baseline physical and emotional health, and immunization status for each emergency responder

• Determines responders’ fitness for deployment

• Allows for more informed interpretation of possible post-deployment adverse healtheffects

3. Health and Safety Training

• Enables responders to fulfill certification requirements to perform duty-specifictasks

• Captures what training arriving responders have when reporting to the disaster and documents itseffectiveness

4. Data Management and InformationSecurity

• Maintains privacy required by law

• Facilitates efficient communication betweenagencies

• Enables reliable, comprehensive monitoring and surveillancepost-deployment

Deployment Phase

5. On-site ResponderIn-processing

• Requires the use of a roster to log responders reporting to adisaster

• Requires that site-specific training (SST) be performed prior to responders entering a disaster controlzone

• Ensures dispensing of personal protective equipment (PPE) during SST training or check-in and -out each day

6. Health Monitoring and Surveillance during ResponseOperations

• Documents the condition of responders’ health, injury, and illness status during emergencyoperations

• Allows for early intervention to stop further injury and illness ofworkers

7. Integration of Exposure Assessment, Responder Activity Documentation, and ControlsintoERHMS

• Requires the development of exposure assessment plans for identified/anticipated hazardousexposures

• Establishes links for medical and public health intervention, compliance, or liabilityactions

• Accounts for responder activities by providing a sense of where responders were operating, for how long, andin 

what capacity, over each day of their involvement in theresponse

• Allows for early intervention and the establishment of controls to maximize the chances for recovery and to stop 

further exposure for workers remainingon-scene

8. Communications of Exposure and Health Monitoring and Surveillance Data during an Emergency Response

• Requires that information about exposure and health data be communicated to workers, intra-organizationally, 

inter-organizationally, and within and outside the ICSstructure

Post-deployment Phase

9. Responder Out-ProcessingAssessment

• Documents responders’ status at the conclusion of their response duties

• Verifies the accuracy of already captured information and collects additional follow-upinformation

• Detects possible acute/short-term adverse mental or physical health effects, and identifies those who need 

further medical evaluation or treatment when used in conjunction with pre- and during-deployment data

• Identifies health trends and potential risks within the population ofworkers

10. Post-event Tracking of Emergency Responder Health andFunction

• Provides the data necessary to determine whether further responder health tracking is warranted and ifso, 

what type of tracking would be most appropriate

11. Lessons-learned and After-actionAssessments

• Assesses how ERHMS has been conducted through all phases and identifies ways to improve itsactivities