Disaster Preparedness: Better Planning Would Improve OSHA's Efforts to Protect Workers' Safety and Health in Disasters
Published: 2007-03-28T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: Concerns about the safety and health of workers involved in the response to Hurricane Katrina included their exposure to contaminated floodwaters and injuries from working around debris. The Department of Labor's Occupational Safety and Health Administration (OSHA) is responsible for coordinating federal efforts to protect the safety and health of workers involved in the response to large national disasters. Under the Comptroller General's authority, GAO initiated a number of Katrina-related reviews. For this review, GAO examined (1) what is known about the number of response and recovery workers deployed to the Gulf Coast in response to Hurricane Katrina; (2) the extent to which OSHA tracked injuries and illnesses sustained by these workers; and (3) how well OSHA met the safety and health needs of workers. To address these issues, GAO reviewed reports; analyzed data; interviewed federal, state, and local officials; and conducted site visits.
section_title: What GAO Found
paragraphs: No one, including OSHA,was responsible for collecting information on the total number of response and recovery workers deployed to the Gulf Coast in response to Hurricane Katrina and no one collected it, but 10 federal agencies provided estimates showing that, on October 1, 2005, the agencies had about 49,000 federal workers in the Gulf Coast area. In addition, six of these agencies estimated that their contractors had about 5,100 workers in the area on December 1, 2005, but the other four either did not track the number of workers employed by their contractors or did not employ contractors. Although OSHA was responsible for tracking the injuries and illnesses that federal response and recovery workers sustained during the response to Hurricane Katrina, the agency's efforts to collect it were delayed and it was unable to collect usable information. According to OSHA, the Federal Emergency Management Agency (FEMA) must assign and fund specific responsibilities for each disaster. However, FEMA did not direct OSHA to collect injury and illness data until more than 3 weeks after the hurricane struck. OSHA attempted to collect the data, but the information federal agencies provided were incomplete and unreliable. OSHA and other agencies did track fatalities. They reported nine worker fatalities attributed to work-related accidents: three employees of federal contractors and six nonfederal workers or volunteers. OSHA provided assistance to many response and recovery workers who responded to Hurricane Katrina, but not all workers' safety and health needs were met. OSHA quickly established operations in the Gulf area; intervened in thousands of potentially hazardous situations; and assessed air, water, soil, and noise hazards at many work sites. However, disagreements between OSHA and FEMA about which agency was in charge of providing safety and health assistance to federal agencies and workers and how it would be provided delayed some of OSHA's efforts. Also, some agencies' lack of awareness about the role OSHA plays in a disaster further hindered its ability to provide assistance. As a result, OSHA did not fully meet workers' safety and health needs, particularly their need for training and protective equipment. OSHA also did not coordinate with the Department of Health and Human Services to ensure that workers had needed mental health services, and OSHA was not assigned responsibility for coordinating the needs of nonfederal workers, including state and local agency workers; many immigrants; and volunteers.

section_title: Letter
paragraphs: After Hurricane Katrina hit the Gulf Coast on August 29, 2005, federal  After Hurricane Katrina hit the Gulf Coast on August 29, 2005, federal  agencies undertook one of the largest rescue and recovery efforts in  agencies undertook one of the largest rescue and recovery efforts in  American history. Several agencies sent workers to the three states that  American history. Several agencies sent workers to the three states that  suffered the most damage from the hurricane: Alabama, Louisiana, and  suffered the most damage from the hurricane: Alabama, Louisiana, and  Mississippi. Various reports have raised concerns about the safety and  Mississippi. Various reports have raised concerns about the safety and  health of workers involved in the response to Hurricane Katrina and the  health of workers involved in the response to Hurricane Katrina and the  dangers they faced, from animals such as snakes and alligators to  dangers they faced, from animals such as snakes and alligators to  floodwaters contaminated by chemicals, oil, corpses, and fecal matter.  floodwaters contaminated by chemicals, oil, corpses, and fecal matter.  Public health advisories also warned about high temperatures and the  Public health advisories also warned about high temperatures and the  potential spread of diseases such as West Nile Virus resulting from  potential spread of diseases such as West Nile Virus resulting from  mosquitoes that breed in standing water. In addition, worker advocacy  mosquitoes that breed in standing water. In addition, worker advocacy  groups, public health advisors, and representatives of the Congress have  groups, public health advisors, and representatives of the Congress have  raised concerns about the possibility of latent illnesses among workers  raised concerns about the possibility of latent illnesses among workers  deployed to the Gulf, especially in light of such illnesses among workers  deployed to the Gulf, especially in light of such illnesses among workers  involved in rescue and recovery efforts at the World Trade Center disaster  involved in rescue and recovery efforts at the World Trade Center disaster  site. Many workers at the site in New York were not aware that they had  site. Many workers at the site in New York were not aware that they had  developed debilitating respiratory conditions or post-traumatic stress  developed debilitating respiratory conditions or post-traumatic stress  disorders until months or years after they left the site.  disorders until months or years after they left the site.
The safety and health of workers responding to Hurricane Katrina is  The safety and health of workers responding to Hurricane Katrina is  addressed in a section, or “annex,” of the National Response Plan (NRP) of  addressed in a section, or “annex,” of the National Response Plan (NRP) of  December 2004, the federal plan for responding to domestic emergencies  December 2004, the federal plan for responding to domestic emergencies  and disasters. As lead agency for carrying out the provisions of the Worker  and disasters. As lead agency for carrying out the provisions of the Worker  Safety and Health Support Annex (the Annex), the Department of Labor’s  Safety and Health Support Annex (the Annex), the Department of Labor’s  Occupational Safety and Health Administration (OSHA) is responsible for  Occupational Safety and Health Administration (OSHA) is responsible for  coordinating the worker safety and health efforts of responders— coordinating the worker safety and health efforts of responders— including federal, state, local and tribal governments, and private and  including federal, state, local and tribal governments, and private and  nonprofit organizations—in protecting the safety and health of their  nonprofit organizations—in protecting the safety and health of their  workers when the Annex is implemented. OSHA’s responsibilities under  workers when the Annex is implemented. OSHA’s responsibilities under  the Annex include identifying and assessing health and safety hazards,  the Annex include identifying and assessing health and safety hazards,  providing technical advice and support to safety officials, and collecting  providing technical advice and support to safety officials, and collecting  data on exposures and injuries. Given the large numbers of workers who  data on exposures and injuries. Given the large numbers of workers who  responded to Hurricane Katrina and concerns about their health and  responded to Hurricane Katrina and concerns about their health and  safety, we addressed the following questions: (1) What is known about the  safety, we addressed the following questions: (1) What is known about the  number of response and recovery workers deployed to the Gulf Coast in  number of response and recovery workers deployed to the Gulf Coast in  response to Hurricane Katrina? (2) To what extent did OSHA track injuries  response to Hurricane Katrina? (2) To what extent did OSHA track injuries  and illnesses sustained by these workers? (3) How well did OSHA meet the  safety and health needs of these workers?
To address these objectives, we reviewed reports and documents related  to the federal response efforts for Hurricane Katrina and other recent  disasters; interviewed officials from 10 federal agencies identified by  FEMA and OSHA as having deployed response and recovery workers to  the Gulf Coast: OSHA; the Federal Emergency Management Agency  (FEMA); the Environmental Protection Agency (EPA); the Coast Guard;  the Department of Defense (DOD); the National Guard; the U.S. Army  Corps of Engineers (USACE); and the Departments of Agriculture, Health  and Human Services, and the Interior. We also conducted site visits in  Alabama, Mississippi, and Louisiana where we interviewed federal  officials in all three states and selected state and local officials who were  part of the rescue and recovery efforts. To obtain information on the  number of response and recovery workers who responded to Hurricane  Katrina, we contacted the 10 agencies identified by FEMA and OSHA and  asked them to provide information on the number of workers each agency  employed in the Gulf Coast. To obtain information on injuries and  illnesses sustained by these workers, we asked these same agencies for  this information for their workers. Of the 10 agencies, only four—USACE,  EPA, the Coast Guard, and the Department of the Interior—had data on  workers’ injuries and illnesses that were sufficiently reliable for us to  report. We also obtained data on injuries and illnesses related to Hurricane  Katrina from workers’ compensation claims filed by federal workers, and  information on worker fatalities from OSHA and other federal agencies. To  assess the reliability of the agencies’ data, we talked with agency officials  about their data quality-control procedures and reviewed relevant  documentation. We determined the data were sufficiently reliable for the  purposes of this report. Finally, we interviewed workers’ rights  organizations, including the Mississippi Immigrant Rights Alliance, Boat  People SOS, the Center to Protect Workers’ Rights, and the New York  Committee for Occupational Safety and Health. We conducted our work  from October 2005 to December 2006 in accordance with generally  accepted government auditing standards. For additional information, see  appendix I.
subsections: section_title: Background
subsections: section_title: The Role of OSHA in Occupational Safety and Health
paragraphs: The Occupational Safety and Health Act of 1970 authorizes OSHA to set  occupational safety and health standards, rules, and regulations and to  enforce their compliance. OSHA uses two approaches—enforcement and  compliance assistance.
Enforcement is carried out primarily by using compliance officers to  inspect employer work sites. Employers whose work sites fail to meet  federal safety and health standards face sanctions, such as paying  penalties for violations of safety and health standards. In this enforcement  capacity, OSHA targets employers for inspection using injury and illness  rates for industries and specific work sites. OSHA also conducts  inspections when employers report fatalities or serious injuries and when  workers file complaints alleging that a violation of a safety or health  standard exists that threatens physical harm or that an imminent danger  exists at their work sites.
Cooperative programs, in contrast, use a variety of incentives to  encourage employers to work with OSHA to reduce hazards and institute  practices that foster safer and healthier working conditions. Such  incentives include free consultations, recognition for exemplary safety and  health systems, and exemption from routine inspections.
OSHA has direct enforcement responsibility for federal workers in all  states and for private sector workers in about half the states. In the  remaining states, OSHA has granted approval for the states to conduct  their own enforcement of private sector, state, and local government work  sites. None of the three states most affected by Hurricane Katrina  conducts its own worker safety and health program; OSHA provides direct  oversight for workers in these states.
OSHA is organized by regional and area offices. The three states most  affected by Hurricane Katrina are located in OSHA’s Region 4 (Mississippi  and Alabama) and Region 6 (Louisiana). Its area offices in these states are  located in Jackson, Mississippi; Mobile, Alabama; and Baton Rouge,  Louisiana  Federal and private sector employers are required by OSHA to maintain  records documenting certain work-related injuries and illnesses: those that  result in death, 1 or more days away from work, restricted work, loss of  consciousness, or a significant injury or illness diagnosed by a physician.  Each employer’s work site is required to record illness and injury data on a  form known as an “OSHA 300 log.” While employers are not required to  submit these logs to OSHA, they must be available for inspection upon  request. Federal agencies are required to submit summary information to  OSHA about their safety and health programs on an annual basis, but these  reports generally do not contain information on specific injuries and  illnesses sustained by their workers.
section_title: The Role of OSHA in a Disaster
paragraphs: Based on lessons learned during the response to the World Trade Center  disaster, OSHA now uses its statutory enforcement discretion during a  disaster to exempt selected employers from normal enforcement  operations and provide technical assistance and consultation in  combination with traditional enforcement as required by the incident. At  the World Trade Center, OSHA made this decision based on the  recognition that a rescue effort should not be hampered, that enforcement  takes time and can affect the speed of the correction of safety and health  hazards, and that its goal was protection, not citation. The Assistant  Secretary of OSHA, in conjunction with regional administrators, makes the  decision when to exercise its enforcement discretion and move to a  technical assistance role, and when to return to traditional enforcement  While federal, state, and local agencies as well as private sector employers  are responsible for ensuring the safety and health of their workers, OSHA  is responsible for coordinating with other federal cooperating agencies to  provide safety and health technical assistance to response and recovery  workers involved in the response to a disaster. The federal cooperating  agencies are DOD; the Departments of Energy, Health and Human  Services, and Homeland Security; and EPA.
As the lead coordinating agency for the Worker Safety and Health Support  Annex (the Annex), OSHA’s coordination responsibilities include  1.  providing occupational safety and health technical advice and  support to safety officials at the Joint Field Office, a temporary  federal facility established at the site of a disaster to coordinate  federal assistance to affected jurisdictions;  2.  developing and implementing site-specific occupational safety and  health plans and ensuring that the plans are coordinated and  consistent among multiple sites;  3. identifying and assessing health and safety hazards and  characterizing the incident environment, to include continued  monitoring of incident safety on a 24-hours-a-day, 7-days-a-week  basis;  4.  monitoring responder personal exposure on a 24-hours-a-day,   7-days-a-week basis, including monitoring for chemical and  biological contaminants, noise, heat or cold, and ionizing radiation;  5.  monitoring the medical condition of responders and, in  conjunction with the Department of Health and Human Services,  evaluating the need for longer term monitoring;  6.  assessing responder safety and health resource needs and  identifying sources for those assets;  7.  developing, implementing, and monitoring an incident personal  protective equipment program—including the selection, use, and  decontamination of the equipment; implementation of a respiratory  protection fit-test program—and distribution of equipment;  8.  collecting and managing data on exposures, accidents, and injuries  to facilitate consistent formatting and data sharing among response  organizations;  9.  communicating with labor unions, contractors, and other  organizations regarding responder safety and health issues;  10. coordinating and providing incident-specific responder training;  11. providing psychological first aid during and after incident response  and recovery activities; and  12. identifying, in coordination with the Department of Health and  Human Services, appropriate immunization and prophylaxis for  responders and recovery workers.
Even though OSHA has been assigned responsibility for coordinating the  activities in the Annex, during an actual disaster, FEMA must issue a  “mission assignment” that authorizes OSHA to receive reimbursement for  carrying out some or all of these activities, depending on the needs of the  disaster and which groups are covered during each response effort.  Without a mission assignment, services provided by an agency cannot be  reimbursed by FEMA. For Hurricane Katrina, FEMA issued mission  assignments to OSHA tasking it with 11 of the 12 activities listed in the  Annex for federal agencies and their workers, including federal contractor  employees. The only activity in the Annex for which OSHA was not  assigned responsibility for Hurricane Katrina was monitoring the medical  conditions of responders, including assessing the need for long-term  medical monitoring because, according to FEMA, it does not have the  authority under the Stafford Act to pay for the collection and management  of data for long-term studies or analysis. FEMA also did not assign  responsibility to OSHA, or any other federal agency, for coordinating the  safety and health of nonfederal workers, except workers employed by  federal contractors. State and local agency employees, private sector  employees other than those employed by federal contractors, and  volunteers were not covered under the Annex. OSHA had difficulty  addressing the needs of nonfederal workers not covered under its mission  assignment, but was able to provide some assistance to these workers  using its own funds.
section_title: No One Collected Information on the Total Number of Response and Recovery Workers Deployed to the Gulf Coast, but 10 Federal Agencies Collected Data on Their Workers
paragraphs: No one, including OSHA, was assigned responsibility for collecting data on  the total number of response and recovery workers deployed to the Gulf  and no one collected it, but 10 federal agencies were able to provide  estimates of the number of federal workers they deployed to the Gulf for  specific points in time. However, only six of them tracked the number of  workers employed by their contractors. According to FEMA and OSHA,  10 federal agencies deployed response and recovery workers to the Gulf in  response to Hurricane Katrina: the Departments of Agriculture, the  Interior, and Health and Human Services; the Coast Guard; DOD; EPA;  FEMA; OSHA; USACE; and the National Guard. We asked officials from  these 10 agencies to provide us with the total number of response and  recovery workers they had in the Gulf Coast from August 2005 through  April 2006. Agency officials said they did not collect data in a way that  would enable them to provide us with unduplicated counts of workers  who rotated in and out of the Gulf Coast area. All 10 agencies, however,  told us they could provide us with estimates of the number of workers  they had in the Gulf Coast area at any specific point in time. Therefore, we  asked them to provide us with information on the number of workers they  employed in the three states on the first of each month for the period from  September 2005 to April 2006.
As shown in figure 1, the agencies estimated that they had about   31,000 federal employees in the Gulf Coast area on September 1, 2005.  That number increased to approximately 49,000 workers on October 1,  2005, and dropped to about 8,500 workers on April 1, 2006.
The National Guard reported having the largest number of federal  employees—about 31,000—in the Gulf Coast area on October 1, 2005, and  FEMA reported the second largest number—about 4,800 workers. The  Coast Guard reported the third largest number of federal employees in  October—approximately 3,100 workers. OSHA reported that it had 84 staff  in the Gulf Coast area on the first of October and November 2005.
Of these 10 federal agencies, only six of the agencies that employed  contractors in the Gulf area—EPA, OSHA, FEMA, and the Departments of  Agriculture, Health and Human Services, and the Interior could provide  data on the number of employees their contractors employed. These  agencies estimated that their contractors had over 5,100 workers in the  Gulf Coast area on December 1, 2005, the month with the largest total  number. FEMA and EPA reported the most contractor employees: FEMA  estimated that it had approximately 3,800 contractor employees at one  point, and EPA estimated that its contractors had about 1,200 workers in  the Gulf area. The other agencies reported much smaller numbers of  contractor employees, ranging from 1 worker to 150. USACE and Coast  Guard officials told us they could provide us with information on the  number of contracts they issued, but they did not know the number of  workers employed under each of these contracts. Officials with DOD told  us that, although DOD employed contractors in the Gulf area, they did not  track the number of workers employed by their contractors. National  Guard officials told us that they did not employ any contractors.
section_title: OSHA Was Unable to Collect Information on Workers’ Injuries and Illnesses
paragraphs: Although OSHA was directed by FEMA to collect information from federal  agencies on injuries and illnesses sustained by federal workers during the  response to Hurricane Katrina, the agency was unable to collect useable  information from all of the agencies that deployed workers to the Gulf.  Four federal agencies provided some information to us on their workers  who were injured or became ill, and OSHA and other agencies provided  information on worker fatalities that occurred during the response.
subsections: section_title: Several Factors Hindered OSHA’s Efforts to Collect Data on Injuries and Illnesses
paragraphs: Although the Annex assigned responsibility to OSHA for collecting data on  workers’ injuries and illnesses during disasters, and FEMA directed OSHA  to collect this information from federal agencies for Hurricane Katrina,  several factors hindered OSHA’s efforts to collect these data as required.  OSHA did not establish a process for gathering these data between the  time the Annex was issued in December 2004 and when Hurricane Katrina  hit the Gulf Coast in late August 2005. According to OSHA officials, during  this 8-month period, they focused their efforts on introducing federal,  state, and local agencies to OSHA’s new role under the Annex in a disaster  rather than developing a process for collecting data on workers’ injuries  and illnesses during a response.
The second factor that hindered OSHA’s ability to collect data on workers’  injuries and illnesses was that fact that FEMA did not issue a mission  assignment directing OSHA to collect these data for federal agencies’  workers until more than 3 weeks after the hurricane hit the Gulf. FEMA  instructed OSHA to track workers’ injuries and illnesses across all federal  agencies that deployed workers to the Gulf in the mission assignment it  issued to OSHA on September 21, 2005, more than 3 weeks after the  hurricane struck on August 29, 2005.
Third, OSHA tried to collect data on injuries and illnesses for federal  workers in the Gulf Coast area from the logs that OSHA requires agencies  to maintain at each worksite on workers’ injuries and illnesses but  received incomplete or unreliable data from federal agencies. In  November 2005, OSHA asked federal agencies and their contractors to  submit their injury and illness logs for worksites located in the Gulf area to  OSHA headquarters on a monthly basis. However, according to OSHA  officials, because they did not request agencies to provide their injury and  illness logs to OSHA until five or six weeks after the hurricane hit, and  because agencies are normally not required to send their logs to OSHA,  not all agencies submitted their logs. In addition, many of the agencies  could not separate data for workers assigned to the Gulf Coast area  temporarily since employers are not required to establish separate logs for  temporary worksites expected to be in operation for one year or less.  Some agencies provided their logs to OSHA, but the data they provided  were incomplete and unreliable, according to OSHA officials. For  example, one agency’s logs included information on accidents involving  heavy equipment but did not contain information on the related injuries to  workers. OSHA officials cited several reasons for the poor quality of the  data, including the fact that the agencies may have placed a low priority on  recording injuries and illnesses while responding to a disaster.
In technical comments on the draft report, OSHA officials stated that  neither their efforts to educate the federal community about the Annex  nor the more than 3-week delay in receiving its mission assignment  prevented them from developing a system for collecting injury and illness  data.
In a mission assignment, FEMA tasked OSHA to collect these data in order  to facilitate consistent formatting and data sharing among response  organizations. OSHA could then use the data to track emerging trends in  the types of injuries and illnesses sustained by workers so that appropriate  measures, such as providing specific safety training and information on  hazards, could be taken to address emerging safety issues and prevent or  reduce injuries and illnesses. Although OSHA was unable to use injury and  illness data to track emerging trends, it did identify some injuries and  illnesses that occurred during the response through the information it  obtained from other federal agencies at the Interagency Safety Committee  meetings held at the Joint Field Office in each state.
section_title: Available Data from Four Agencies Show Over 3,000 Injuries and Illnesses
paragraphs: Because OSHA could not provide data on injuries and illnesses, we asked  the 10 agencies that deployed workers to the Gulf Coast area for these  data. However, although agency officials told us they collected  information on the injuries and illnesses for their workers on the injury  and illness logs required by OSHA, most of them could not separate out  this information for workers sent to the Gulf Coast. Four of the   10 agencies—EPA, USACE, the Coast Guard, and the Department of the  Interior—collected information on the injuries and illnesses their workers  sustained in the Gulf Coast area using their own data systems. The four  reported that their workers sustained over 3,000 injuries and illnesses  from the end of August 2005 through June 2006 including minor injuries  that would not have been recordable on the OSHA logs. The most  frequently cited injuries were bites from insects such as mosquitoes and  dogs; sunburn; exposure to floodwater; heat stress; and exposures to  chemicals, infectious or biological agents, mold, and carbon monoxide.  (See app. II for additional information on the injury and illness data  provided by these four agencies.) The data were not comparable across  the four agencies because each one collected different types of  information and categorized it differently. For example, EPA used  nonstandard, detailed descriptions of the illness or injury, such as “tripped  on wire and bruised knee,” while the Coast Guard described the health  effects of injuries or exposures using consistent and concise categories,  such as “infected skin” and “skin laceration.”
The Department of Labor’s Office of Workers’ Compensation Program,  another source of data on injuries and illnesses, reported that federal  workers filed 770 claims related to Hurricanes Katrina and Rita from  August 2005 through June 2006. While data on the number of claims were  reliable, the information on the nature and causes of the injuries and  illnesses was not reliable. Therefore, we could not use it to identify the  types of injuries and illnesses sustained by federal workers in the Gulf  Coast area.
section_title: Eleven Worker Fatalities Related to Hurricane Katrina Reported
paragraphs: OSHA and other agency officials identified 11 fatalities of workers  involved in response and recovery work for Hurricane Katrina from  September 2005 through June 2006, 9 of which occurred as a result of  work-related accidents. No worker fatalities directly related to the  response were reported in Alabama. In Louisiana and Mississippi, three  federal agency contractor employees died in work-related accidents,  including two employees of FEMA subcontractors and an employee of a  USACE subcontractor. (See app. II for additional information.)
section_title: OSHA Provided Assistance to Many Agencies and Workers, but Its Efforts to Meet the Safety and Health Needs of All Workers Were Hampered by Several Factors
paragraphs: Although FEMA did not issue a mission assignment to OSHA implementing  the Annex until more than 3 weeks after Hurricane Katrina struck the Gulf  Coast, OSHA was able to establish several of its operations within hours of  the hurricane. FEMA officials told us that all of the NRP’s annexes take  effect when the NRP is implemented, but OSHA officials said they must  first receive a mission assignment from FEMA to receive funding and  begin the work as described in the Annex. OSHA used its own staff and  budget to establish operations and provide assistance to utility workers in  the Gulf Coast before to receiving authorization from FEMA. OSHA staff  developed health and safety plans, provided information on safety and  health hazards to many workers, and intervened in thousands of  potentially hazardous situations. OSHA staff also assessed air, water, soil,  and noise hazards at many worksites. However, OSHA waited to provide  assistance that involved substantial funding—such as deploying worker  safety and health trainers and purchasing protective gear for other federal  agencies—until FEMA formally authorized OSHA to receive  reimbursement for these activities through mission assignments.  Disagreements between OSHA and FEMA delayed issuance of the mission  assignment that implemented the Annex, which delayed OSHA’s efforts to  provide assistance to workers. In addition, lack of awareness by other  agencies about OSHA’s role in a disaster further hindered its efforts.  Because of these and other factors, the agency was unable to ensure that  all workers’ needs for safety and health assistance were met, including  obtaining needed training, protective gear, and mental health services, and  OSHA had difficulty addressing the needs of nonfederal workers not  covered under its mission assignments.
subsections: section_title: OSHA Established Operations Quickly, Developed Health and Safety Plans, Provided Valuable Information, Intervened in Hazardous Situations, and Sampled Work Sites
subsections: section_title: OSHA Quickly Established Operations in the Gulf
paragraphs: OSHA effectively used its existing relationships with private companies  and another federal agency to quickly establish its operations in the Gulf  Coast area and provide safety and health assistance to workers. Through  these relationships, OSHA quickly set up staging areas for its staff,  obtained needed equipment, and provided safety and health information to  workers early in the response. For example, when OSHA had difficulty  finding housing for its staff in New Orleans, it contacted a chemical  company that is part of one of OSHA’s cooperative programs, and the  company gave OSHA space in its parking lot for recreational vehicles that  OSHA used to house several of its field staff. OSHA also obtained support  from the Mine Safety and Health Administration, another agency within  the Department of Labor, for almost 3 months after the hurricane. The  agency provided OSHA with two large trailers equipped with satellite  communications that it uses for mine rescue operations. OSHA used the  trailers as mobile command post centers to communicate with other  agencies at a time when communication in the area was very difficult. The  agency also gave OSHA generators to power electricity and plumbing.
OSHA also capitalized on relationships with utility companies established  during previous responses to hurricanes in the three affected states to  target its safety and health assistance. Utility companies are among the  first responders on the scene of hurricanes, restoring power and  communications in the affected areas. OSHA accompanied the utility  companies to staging areas each morning to brief workers on safety and  distribute printed safety information. OSHA also advised utility workers  on using the proper safety equipment. For example, although utility  workers were trained on how to safely handle downed power lines, some  were not aware that they needed to wear boots with steel shanks to  prevent puncture wounds from debris containing nails and other sharp  objects or that floodwater and drainage pipes could contain alligators,  snakes, or other animals. Figure 2 shows some of the wildlife encountered  by Hurricane Katrina response workers.
OSHA developed a health and safety plan for the federal response to  Hurricane Katrina that included all responders and hazards commonly  encountered. The plan included information on how to    monitor exposures;    provide adequate supplies of protective gear that was    appropriate for the hazard,  fitted to the employee, and  inspected, repaired or replaced as necessary;    provide training on safety and health hazards that was    conducted before deployment,    applicable to general conditions,    customized for different sites, and    customized for specific tasks;    develop decontamination procedures; and    provide psychological first aid and other mental health services.
OSHA also assisted other federal agencies in developing similar plans for  their workers and ensured that all of the plans were coordinated and  consistent across the response.
section_title: OSHA Provided Information on Common Hazards on Its Web Site and in Public Places on the Gulf Coast
paragraphs: OSHA also provided information about hazards on its Web site and  directly to workers at public places such as hardware stores where they  purchased materials. For example, OSHA developed 58 small, laminated  “quick cards” and 1-page fact sheets in English and Spanish with  information about hazards and how to address them, such as how to safely  handle traffic in work zones, how to operate a chain saw safely, how to  work safely with electricity, how to prevent falls, and how to use ladders  safely. See figures 3 and 4 for selected quick cards and fact sheets  distributed by OSHA.
OSHA also provided pre-recorded public service announcements on its  Web site with information on safe work practices that could be aired by  local radio stations and stores. According to OSHA officials, one large  national hardware chain played the public service announcements over its  loudspeaker system in stores in the Gulf area as a safety and health  reminder for its customers.
section_title: OSHA Intervened at Work Sites by Correcting Potential Hazards
paragraphs: From the beginning of the response in August 2005 through June 2006,  OSHA’s field staff intervened in more than 15,000 potentially hazardous  situations at work sites throughout the Gulf—6,800 in Louisiana and   8,320 in Alabama and Mississippi. OSHA targeted these visits based on  information it received from other federal agencies and utility companies  about work sites with large numbers of workers or potential hazards. As  shown in figures 5, 6, and 7, OSHA staff intervened in many different types  of hazardous situations, including work zones containing equipment not  protected from traffic by safety cones and individuals working on water  towers and roofs without proper fall protection such as safety harnesses  and guard rails.
OSHA staff offered advice on safety and health measures and followed up  to make sure hazards were corrected. For example, an OSHA official in  Louisiana stopped work at a site until unprotected workers in an aerial lift  50 feet above the ground received safety harnesses and orange cones were  placed around the lift to protect against traffic. On the few occasions when  an employer did not follow OSHA’s recommendations, or if there were  repeat problems with an employer, OSHA would elevate its concerns to  company management or to the federal agency that contracted with the  company and this usually brought abut the needed changes, according to  OSHA officials. For example, OSHA staff told a supervisor at one worksite  that workers repairing a bridge needed safety harnesses to protect them  from falls, but the workers did not have the equipment when OSHA visited  the next day. OSHA staff then called the owner of the company, who  promptly provided the safety equipment and made sure the workers   used it.
Other federal agencies asked OSHA to intervene in hazardous situations.  For example, EPA asked OSHA to monitor the health of workers at the site  of an oil spill where more than a million gallons of crude oil leaked from  an above-ground storage tank. FEMA asked OSHA to provide a hazardous  materials specialist to accompany its staff to jails and Department of  Justice buildings in New Orleans and assess what protective gear was  needed to enter and inspect buildings and to a local hospital to assess  general safety and health hazards. FEMA also asked OSHA to conduct air- monitoring tests and assess hazards at local courts and other public  buildings in the area, and OSHA staff advised FEMA on how to properly  ventilate temporary housing trailers contaminated with formaldehyde gas  emitted by construction materials such as plywood and rugs.
Officials with OSHA and other federal agencies told us that the technical  assistance OSHA provided during the response was well received and was  more effective in protecting workers than if the agency had been operating  in an enforcement mode. The officials noted that enforcement actions can  take months to complete due to the legal requirements of an investigation,  the amount of documentation required, and the due process provided to  employers to appeal citations. By providing technical assistance and  immediately addressing hazardous situations, OSHA officials said they  were able to assist many more workers and correct more hazardous  situations during the response than if they had been operating in an  enforcement mode. OSHA typically conducts about 1,500 inspections each  year in the three affected states—about 430 in Alabama, about 530 in  Louisiana, and about 500 in Mississippi—but intervened in over   15,000 potentially hazardous situations during approximately 11 months   of the response.
section_title: OSHA Sampled Air, Water, Soil, and Noise Levels at Many Work Sites
paragraphs: In addition to providing safety and health technical assistance, OSHA also  took more than 6,000 samples at work sites throughout the Gulf Coast area  to assess air, water, soil, and noise hazards. As shown in figure 8, workers  in the Gulf Coast area faced many airborne hazards.
EPA was responsible for sampling the general environment—such as the  air, water, and soil—in order to assess the dangers to the public, while  OSHA was responsible for sampling worksites for hazardous substances  harmful to workers. For example, OSHA field staff pinned small personal  monitors on workers’ clothing to sample for potential exposure to  hazardous chemicals and substances, and sampled water and soil at  worksites (see fig. 9).
OSHA field staff also monitored unoccupied buildings for carbon  monoxide that may have accumulated from the use of generators before  the building was vacated and to determine whether the siding and shingles  contained asbestos. OSHA officials told us they posted the results of the  samples taken on the agency’s Web site and said they are developing a  data management system for future disasters that will provide faster  access to sampling results.
section_title: Disagreements with FEMA and Lack of Awareness of OSHA’s Role Hindered OSHA’s Efforts to Assist Other Agencies
paragraphs: OSHA and FEMA disagreed about how and when to implement the Annex  and about each agency’s responsibilities in the rescue and recovery effort.  As a result, some of OSHA’s efforts to provide assistance were delayed.  Additionally, before Hurricane Katrina, OSHA provided limited  information to federal, state, and local agencies about the Annex, and  many agencies did not understand the services OSHA can provide or that  OSHA provides technical assistance, not enforcement, in a disaster. This  may have contributed to agencies not inviting OSHA to participate in  emergency preparedness exercises held prior to Hurricane Katrina or  asking for OSHA’s help during the response and recovery efforts once the  storm hit.
subsections: section_title: OSHA and FEMA Disagreed about Implementation of the Annex and about Each Other’s Roles and Responsibilities
paragraphs: FEMA did not issue a mission assignment to OSHA implementing the  Annex until September 21, 2005—more than 3 weeks after the hurricane  hit the Gulf Coast. Before Hurricane Katrina, FEMA and OSHA had not  developed criteria or procedures for implementing the Annex in a  disaster. FEMA officials told us that all of the NRP’s annexes take effect  when the NRP is implemented; however, OSHA said it must first receive a  mission assignment from FEMA to receive funding and begin its work as  described in the Annex. OSHA used its own staff and budget to establish  operations and provide assistance to workers in the Gulf before receiving  authorization for reimbursement from FEMA. However, OSHA delayed  activities that involved substantial funding, such as deploying worker  safety and health trainers and purchasing protective gear for other federal  agencies, until FEMA formally authorized funding through mission  assignments, assuring that such activities would be reimbursed. However,  although FEMA and OSHA were developing procedures for their  operations in future disasters, as of December 2006, these procedures did  not contain criteria that clearly defined when and how OSHA will carry  out its responsibilities under the Annex or the type or magnitude of  disasters in which OSHA will be involved.
FEMA and OSHA also disagreed about which agency was in charge of  worker safety and health for the response and recovery efforts and which  workers should be covered. The agency in charge assumed the role of  Safety Coordinator at the Joint Field Office in each state, where the  federal agencies met to coordinate their response and recovery efforts.
Because of their disagreement about leadership, FEMA and OSHA each  fulfilled the role of Safety Coordinator for different periods of time in  Louisiana, Alabama, and Mississippi, and other federal agencies did not  know which agency was consistently and officially in charge. In addition,  some FEMA officials viewed the role of the Safety Coordinator as  providing support only to FEMA employees and personnel at FEMA- managed facilities. In contrast, OSHA officials saw the role of the Safety  Coordinator as supporting all federal workers, including federal contractor  employees involved in the response. For example, both FEMA and OSHA  officials in Mississippi identified a need for driver training because of the  large number of motor vehicle accidents. FEMA’s Safety Coordinator in  Mississippi sought the driver training for FEMA staff only, while, under its  mission assignment, OSHA had already worked with the National Institute  of Environmental Health Sciences to develop a similar program that was  available to all federal responders.
In addition, under the Annex, OSHA is responsible for coordinating with  the Department of Health and Human Services to monitor the medical  conditions of responders and evaluate the need for long-term medical  monitoring. However, FEMA did not direct OSHA to coordinate this  activity in the mission assignments issued for Hurricane Katrina because,  according to FEMA officials, they do not have the authority under the  Stafford Act to pay for the collection and management of data for long- term studies or analysis. Although it is not clear whether there is a need  for this type of monitoring for response and recovery workers involved in  the response to Hurricane Katrina, the fact that some workers at the World  Trade Center disaster did not exhibit symptoms of illnesses until months  or years after they left the site, and others developed acute conditions at  the site that later worsened or became chronic, highlights the importance  of considering these issues for rescue and recovery workers who  responded to Hurricane Katrina or for those involved in future disasters.
FEMA and OSHA are in the process of developing new procedures for  future disasters. However, the procedures do not specify the type or  magnitude of disaster in which OSHA will be involved, and they include  FEMA’s definition of the scope of the Safety Coordinator as providing  safety and health support only to FEMA employees and personnel at  FEMA-managed facilities, not OSHA’s definition that covers all  responders, including federal contractor employees at all facilities. As a  result, OSHA may have difficulty providing assistance to all workers  involved in future response efforts. The new procedures also do not  resolve the issue of how OSHA will be able to monitor the medical  condition of responders or evaluate the need for long-term medical  monitoring in future disasters as described in the Annex, given that FEMA  does not believe it can authorize such activities or reimburse them under  the Stafford Act.
section_title: Many Agency Officials Were Not Aware of OSHA’s Role in a Large Disaster
paragraphs: OSHA officials told us they did not have enough time to conduct extensive  outreach to other federal agencies in the months between the issuance of  the NRP in December 2004 and the end of August 2005 when Hurricane  Katrina hit the Gulf Coast. They said they planned to inform other federal  agencies about the Annex and OSHA’s new role in large disasters through  a committee comprised of the key federal agencies that have a role in the  Annex in responding to disasters. OSHA was in the process of developing  this committee when Hurricane Katrina hit, but these efforts were  suspended during the response.
OSHA’s efforts to inform state and local agencies about its role under the  Annex were limited to making presentations and staffing information  booths at training sessions conducted by the Department of Homeland  Security after the NRP and Annex became effective in April 2005. The  sessions were offered in seven cities to state and local emergency and  health officials from fire departments, police departments, and local  hospitals. The Department of Homeland Security chose to visit cities it  considered likely targets in future terrorist attacks: the District of  Columbia, Chicago, New York, Los Angeles, Seattle, Miami, and Houston.  According to OSHA and FEMA officials, the presentations were attended  by individuals from federal, state, and local agencies; trade groups; and  support personnel. OSHA officials also said they provided information  about the Annex at meetings and conferences held by organizations such  as the National Governors’ Association. These presentations, however,  were not targeted to the key state and local agencies involved in disaster  response efforts, such as state emergency management agencies.
Officials from several federal, state, and local agencies told us that they  did not understand OSHA’s role in a disaster response, including providing  information on potential hazards, recommending proper protective gear,  and testing for hazardous substances at work sites. They also did not  know that, in a disaster, OSHA switches from enforcing regulations by  conducting inspections of work sites to providing technical assistance.  National Guard and EPA officials we interviewed told us they did not  know OSHA’s role in disaster response. Representatives from state police  and fire departments in Louisiana, the state highway patrol in Alabama,  and the Federal Law Enforcement Officers Association—an organization  that represents officers from more than 50 different federal law  enforcement agencies—said they did not know that OSHA provides  technical assistance in a disaster or that they could have asked for   OSHA’s help.
section_title: OSHA Was Not Invited to Participate in Emergency Preparedness Exercises Held Prior to Katrina
paragraphs: Because many federal, state, and local agency officials did not understand  the assistance OSHA could provide in a disaster or its role under the  Annex, OSHA was not invited to participate in many of the emergency  preparedness exercises the agencies held prior to Hurricane Katrina.  Moreover, in the few exercises to which OSHA was invited, the Annex was  never implemented. For example, OSHA attended a national emergency  preparedness exercise conducted by FEMA in June 2005 that simulated a  response to a large, destructive hurricane, but the exercise did not include  implementing the safety and health Annex. OSHA headquarters officials  told us they thought the Annex was not implemented during these  exercises because other agency officials did not fully understand the  assistance OSHA can provide in a disaster or its new role under the Annex.  OSHA’s participation in state and local emergency preparedness exercises  held prior to Hurricane Katrina was also limited. Two of OSHA Area Office  Directors in the affected states told us they had difficulty getting invited to  participate in state and local emergency preparedness exercises, and often  when they were invited, they did not play an active role in the exercise.  For example, the Director of OSHA’s Mobile Area Office told us he  attended regional training exercises on his own initiative. It took him a  year to convince the sponsoring agencies that OSHA provides assistance in  a disaster, at which point they incorporated OSHA into an exercise  involving a chemical spill from a railroad car, but OSHA’s services were  not used during the exercise.
Since its response to Hurricane Katrina, OSHA officials say the agency has  been invited to participate in more emergency response exercises where  the Annex is implemented and the agency plays an active role. OSHA  officials also told us they plan to participate in an exercise sponsored by  EPA in 2007 that will simulate a large chemical spill. OSHA’s regional and  area office directors told us they continue to look for opportunities to  participate in regional, state, and local emergency preparedness exercises.
section_title: OSHA Was Only Partially Successful in Providing Training, Distributing Protective Gear, Serving Nonfederal Workers, and Providing Mental Health Services
subsections: section_title: Some of OSHA’s Training Was Delayed, and Some Agencies Did Not Request Needed Training from OSHA Because They Did Not Realize It Was Available
paragraphs: Because OSHA and FEMA disagreed about the process for issuing the  mission assignment authorizing OSHA to receive reimbursement for its  safety and health training to workers, FEMA did not issue it until more  than 3 weeks after the hurricane hit the Gulf Coast. As a result, OSHA and  its cooperating agency, the National Institute of Environmental Health  Sciences, reported that trainers who were ready to begin work in the  aftermath of the storm were not deployed to Mississippi until October  2005 or to Louisiana until November 2005. In addition, some agencies did  not ask OSHA to provide training because they did not realize that OSHA  offered this type of training. For example, EPA regional officials told us  that, although their response managers noted a need for driver safety  training in October 2005 because of the large number of motor vehicle  accidents that occurred in the Gulf Coast area during the initial response  efforts, it was not provided until March 2006 because it took them several  months to determine that OSHA could provide this training. Workers faced  many hazardous driving conditions during the response to Hurricane  Katrina, including missing road signs or signs pointing the wrong  direction, debris-strewn streets, intersections without working traffic  signals, and lack of street lights—which made nighttime driving especially  hazardous. (See fig. 10.)
FEMA authorized OSHA to receive reimbursement for establishing a  personal protective equipment program as described in the Annex for  other federal agencies that included the selection, ad hoc distribution, fit,  use, and decontamination of equipment for the response to Hurricane  Katrina. While OSHA field staff distributed ear plugs, eye goggles,  respirators, and safety vests to workers throughout the Gulf from supplies  they had on hand for the use of OSHA staff, the agency was unprepared to  establish a program that included procuring and distributing needed  equipment on an ad hoc basis to other agencies as required by its mission  assignment from FEMA. In its lessons learned from the World Trade  Center disaster, OSHA recognized the need to ensure an adequate supply  of personal protective equipment before a future incident and to develop a  program to ensure for the storage, transportation, and distribution of this  equipment through FEMA and other federal agencies. However, OSHA did  not have such a program in place prior to Katrina, and OSHA and FEMA  disagreed on how to obtain personal protective equipment: OSHA ordered  equipment from its Cincinnati Technology Center, while FEMA ordered  equipment from its contractor. In addition, OSHA had not made prior  arrangements for storing the equipment during the response. OSHA and  FEMA resolved their disagreements about suppliers and OSHA arranged to  store equipment in its area offices and FEMA-managed facilities near the  Joint Field Offices in Louisiana and Mississippi, but these difficulties  delayed the provision of some equipment to workers and highlighted the  need to establish a personal protection equipment program in advance of a  disaster.
Some federal agency officials reported needing advice on proper  protective gear, and other officials reported a shortage of equipment. For  example, National Guard officials in Louisiana told us they would have  liked information from OSHA on the hazards workers were facing,  recommendations on how to protect workers, and assistance in obtaining  protective equipment such as rubber boots needed to protect workers  from contaminated floodwaters. USACE officials told us they had  difficulty obtaining sufficient supplies of protective equipment such as  gloves and reflective vests.
OSHA officials told us the agency has not yet fully addressed what the  personal protective equipment program, as defined in the Annex, should  entail. Issues to be addressed include obtaining agreement with FEMA on  how such equipment should be purchased and where it will be stored, how  the equipment will be distributed at disasters, and which workers will be  entitled to receive the equipment.
section_title: The Need for Mental Health Services Exceeded the Assistance OSHA Provided
paragraphs: FEMA tasked OSHA with coordinating with the Department of Health and  Human Services to ensure that mental health assistance was provided to  workers during the response to Hurricane Katrina. However, OSHA did  not coordinate with them to ensure that all workers in the Gulf area who  needed mental health services received them, and OSHA had difficulty  obtaining these services. OSHA and FEMA officials told us it was difficult  to get mental health counselors to go to the base camps where workers  lived during the response and to get counselors to provide services during  off-hours to workers who did not have standard work schedules. They also  said it was difficult to obtain mental health services for non-FEMA  employees because while FEMA believed its contract with a unit of the  Department of Health and Human Services, Federal Occupational Health ,  to provide counseling would cover all federal workers responding to  Hurricane Katrina, the contractor interpreted the contract to only cover  FEMA workers. In addition, instead of sending counselors to work sites  throughout the Gulf, the contractor provided a toll-free number for  workers to call. This was not an effective way to provide services because  phone service in the Gulf was widely disrupted, and OSHA and FEMA  officials said they thought on-site counseling was a better way to help  workers. Although the contractor eventually provided services to non- FEMA employees by sending counselors to work sites and base camps in  the Gulf area and distributing literature about available services, these  efforts did not begin until late December 2005—too late to address the  needs of response workers who were most in need of these services and  the needs of many recovery workers involved early in the response.
According to a FEMA official, the agency recently began an effort to  review its contracts to ensure that non-FEMA employees are explicitly  covered in the event of a future disaster response. However, OSHA  headquarters officials told us that, in their opinion, ensuring that mental  health services are available to workers in a disaster response should not  be part of OSHA’s responsibilities under the Annex because the agency  does not have the resources needed; this responsibility should be placed  with a federal agency that has subject matter expertise and access to  appropriate mental health resources, such as the agencies within the  Department of Health and Human Services. OSHA officials we interviewed  said they are coordinating with FEMA and the Department of Health and  Human Services to improve the delivery of psychological first aid and  informational materials during future disasters. Such efforts include  distributing pamphlets to workers and their families throughout the Gulf  area; consulting with other agencies to learn what types of mental health  assistance are most appropriate for workers who respond to disasters;  developing pamphlets on mental health issues for employers, employees,  and their families; and distributing these pamphlets to OSHA area offices  and other federal agencies to use during future disaster responses.
section_title: Although OSHA Provided Some Information and Training to Nonfederal Workers in the Gulf, the Safety and Health Needs of Some Workers Were Not Met
paragraphs: Although OSHA staff intervened to assist any worker when they observed  unsafe work practices, some of the safety and health needs of nonfederal  workers not covered by OSHA’s mission assignments for Hurricane  Katrina—state and local government employees, immigrants, and  volunteers—involved in the response were not met. OSHA officials in  Alabama, Louisiana, and Mississippi said it was difficult to address the  needs of these populations. The mission assignment FEMA issued to  OSHA only covered federal workers and federal contractor employees.  OSHA’s efforts, therefore, were focused on those workers, and no other  federal agency had responsibility for meeting the safety and health needs  of nonfederal workers. OSHA had limited access to state and local  workers because the states did not request the agency’s assistance. OSHA  also had difficulty addressing the needs of immigrant workers because of  language barriers, low literacy levels among some immigrants, the  transience of many employers that hire immigrant workers, and  immigrants’ fear of deportation and the federal government. In addition,  OSHA had no authority to compel volunteer workers in the Gulf to follow  safe work practices.
Some state and local agency officials reported that they could have  benefited from additional assistance from OSHA, including information  about potential hazards and protective equipment for their workers. For  example, Louisiana state troopers involved in recovering bodies were  provided with boots and gloves, but officials said they would have liked  additional information on potential hazards and guidelines on appropriate  protective gear such as waders and on proper decontamination  procedures. Similarly, many state and local agencies reported that they did  not have waders to protect workers from contaminated flood waters. An  official with the New Orleans Police Department told us the only staff who  had waders to use during rescue efforts were fishermen and hunters who  owned their own waders. However, because the governors of the three  states most affected by Hurricane Katrina did not request OSHA’s  assistance, the mission assignments issued to OSHA by FEMA did not  cover state or local workers, they only covered federal workers. As a  result, OSHA’s efforts were focused on providing assistance to federal  agencies and workers.
Several advocacy groups have issued reports highlighting the worker  safety and health issues among immigrant workers in the Gulf Coast area  who lacked information on hazards, training, and protective equipment.  For example, a study by the Advancement Project, the National  Immigration Law Center, and the New Orleans Worker Justice Coalition  concluded that, in their opinion, the level of health and safety training and  equipment provided to many workers in the Gulf area, including  immigrants, fell well below federal standards.
OSHA trained its staff on the cultural aspects of working with immigrant  populations, hired some bilingual field staff, and built relationships with  immigrant advocacy groups. For example, OSHA’s Mississippi Area Office  hired several Hispanic staff to provide training to immigrant workers and  participated in several local cultural events and job fairs to improve  workers’ awareness of OSHA’s role in protecting workers. In addition,  OSHA officials in Alabama, Louisiana, and Mississippi developed worker  safety literature in Spanish and Vietnamese, two languages frequently used  by non-English speaking workers in the Gulf Coast area, and distributed  the literature at cultural events sponsored by immigrant groups. The unit  that conducted most of OSHA’s training in the Gulf area through an  interagency agreement, the National Institute of Environmental Health  Sciences, developed brochures in Spanish and Vietnamese. (See fig. 11.)
OSHA officials told us they issued five public service announcements in  Spanish and translated 26 safety and health technical assistance  documents into Spanish and 3 into Vietnamese. They also said they  worked closely with the Mexican Consulate offices in Houston, Texas and  Atlanta, Georgia to address concerns about the safety of Hispanic workers  involved in the response. For example, according to OSHA, the consulate  in Houston arranged several events in New Orleans designed to give the  Hispanic community a chance to raise concerns and meet with OSHA staff.  In addition, OSHA officials said they worked with local Catholic churches  to reach Hispanic workers in the New Orleans area.
OSHA also raised concerns about the safety and health of volunteers who  arrived in the Gulf Coast area to assist in the recovery efforts, including  concerns about the lack of training and protective equipment among the  volunteers. For example, OSHA staff encountered several volunteers  working on roofs without the proper training or proper fall protection.  OSHA staff intervened when they encountered such situations and,  according to agency officials in the Gulf area, provided on-site training and  protective equipment to volunteer workers when it was available.
section_title: Conclusions
paragraphs: Although OSHA did not have a lot of time to prepare for its new role in a  disaster between the time the NRP became effective and when Hurricane  Katrina struck the Gulf Coast, the agency moved quickly to provide  assistance to workers who were part of the early response effort and those  involved in recovery work. In preparing for future disasters, however, it is  important for OSHA to note the areas in which its efforts in responding to  Hurricane Katrina could have been improved. Without the ability to collect  data on injuries and illnesses sustained by workers involved in disaster  recovery efforts, OSHA cannot fulfill its role as defined in the Annex to  identify trends and use this information to prevent further injuries and  illnesses by informing workers and their employers about potential safety  and health hazards. Furthermore, unless OSHA and FEMA clearly define  their roles, the type and magnitude of the disasters in which OSHA will be  involved, and how and when the Annex will be implemented, there may  continue to be delays in providing critical assistance and information  needed to protect workers in future disasters. As a result, workers may  sustain injuries and illnesses that could have been prevented. In addition,  if OSHA and FEMA do not resolve the issue of who is responsible for  assessing the need and paying for long-term medical monitoring of  workers involved in a response effort, these needs may not be met in  future disasters.
Because OSHA has not taken a proactive role in educating many federal,  state, and local agencies and their workers about the role the agency plays  in large disasters, some of the agencies do not know about the assistance  OSHA can provide or how to request it. Similarly, by not seeking  opportunities to participate in emergency preparedness exercises held by  federal, state, and local agencies, OSHA has not been able to demonstrate  the assistance it can provide or how the agencies can obtain its services  during a disaster. As a result, without knowledge of OSHA’s role, it is  unlikely that state and local agencies will request OSHA’s assistance in  future disasters, hampering the agency’s ability to meet the safety and  health needs of nonfederal workers, many of whom are first responders.  Further, because OSHA was not prepared to establish a program for  providing information on what protective equipment is needed or how to  use it during future disasters or for ensuring that agencies obtain adequate  supplies of equipment, workers may not be properly protected from  potential hazards. Finally, some workers’ needs for mental health services  in future disasters may not be not met, and the full extent of workers’  unmet mental health needs will not be known because OSHA has not  coordinated with the Department of Health and Human Services to  determine how it will assess the need for mental health services or ensure  that these services are provided to rescue and recovery workers.
section_title: Recommendations for Executive Action
paragraphs: In order to improve the ability to meet workers’ safety and health needs in  the event of a future disaster, the Secretaries of the Departments of Labor  and Homeland Security should direct the Administrators of OSHA and  FEMA to    clearly define the criteria to be used in deciding when OSHA will be  responsible for carrying out its duties under the Worker Safety and  Health Support Annex to the National Response Plan, including the  types and magnitude of disasters in which OSHA will be involved,  and    clearly define OSHA’s and FEMA’s roles under the Worker Safety  and Health Support Annex, including resolving the issue of how the  need for long-term medical monitoring of workers involved in the  response to future disasters will be met; and    proactively work to provide information to federal, state, and local  agencies about OSHA’s role in a disaster and the assistance it can  provide under the Worker Safety and Health Support Annex,  including seeking opportunities for OSHA to participate in  emergency preparedness exercises at federal, state, and local levels.
In addition, the Secretary of the Department of Labor should direct OSHA  to    establish a process for collecting data on injuries and illnesses  sustained by workers who respond to disasters as defined in the  Worker Safety and Health Support Annex to the National Response  Plan, such as requiring employers to record injuries and illnesses on  logs maintained at each disaster work site and periodically submit  them to OSHA during the response;    use the information collected on injuries and illnesses to identify  safety and health hazards and analyze injury and illness trends; and    develop, implement, and monitor an incident personal protective  equipment program as defined in the Worker Safety and Health  Support Annex.
In order to improve the ability to meet workers’ needs for mental health  services in the event of a future disaster, the Secretaries of the  Departments of Labor and Health and Human Services should    develop a plan for coordinating and providing mental health  services to response and recovery workers as described in the  Worker Safety and Health Support Annex to the National Response  Plan.
section_title: Agency Comments and Our Evaluation
paragraphs: We provided a draft of this report to the Secretaries of the Departments of  Agriculture, Health and Human Services, Homeland Security, the Interior,  and Labor; EPA; the Coast Guard; DOD; the National Guard; and USACE  for comment. We received written comments from the Departments of  Health and Human Services and Labor, which are reproduced, along with  our response in appendixes III and IV. Both agencies also provided  technical comments, which we incorporated in the report as appropriate.
The Department of Health and Human Services agreed with our  recommendations. The Department of Labor agreed with our  recommendation for OSHA to establish a process for collecting data on  injuries and illnesses sustained by workers who respond to disasters as  defined in the Annex, although it noted several challenges in doing so.  Although the agency did not comment on the other recommendations, it  disagreed with our findings in several areas and provided additional  information on the actions it took to provide assistance to agencies and  workers. Officials with the Department of Homeland Security stated in  oral comments that they agreed with our findings and recommendations  and provided written technical comments, which we incorporated as  appropriate. The Department of the Interior, the Coast Guard, and the  National Guard also provided technical comments, which we incorporated  as appropriate. DOD did not respond to our request for comments.  Officials with EPA, USACE, and the Department of Agriculture told us that  they had no comments on the report.
We will make copies of this report available upon request. In addition, the  report is available at no charge on GAO’s Web site at http://www.gao.gov.
If you have any questions about the report, please contact me at   (202) 512-5988 or at bertonid@gao.gov. Contact points for our Offices of  Congressional Relations and Public Affairs may be found on the last page  of this report. Key contributors to the report are listed in appendix V.
section_title: Appendix I: Scope and Methodology
paragraphs: We met with OSHA national, regional, and area office officials to obtain a  general understanding of their specific roles and responsibilities under the  National Response Plan (NRP) and the Worker Safety and Health Support  Annex (the Annex). We documented the steps OSHA took to ensure the  safety and health of workers in the Gulf Coast area during the response to  Hurricane Katrina; the extent of the agency’s coordination with other  federal, state, and local government officials; and the lessons learned that  included any new initiatives that had been implemented or were being  considered.
We also met with officials from federal agencies that, according to OSHA  and FEMA officials, deployed federal workers and contractor employees  to the Gulf Coast in response to Hurricane Katrina: OSHA; FEMA; EPA; the  Coast Guard; DOD; the National Guard; USACE; and the Departments of  Agriculture, Health and Human Services, and the Interior. As a part of our  interviews, we asked about them the extent of their involvement with  OSHA, lessons learned, and specific initiatives being implemented or  planned to address the challenges faced by their workers during Hurricane  Katrina. In addition, we interviewed representatives of several workers’  rights groups to obtain their perspectives on the role OSHA played in  protecting the safety and health of workers involved in the response to  Hurricane Katrina, including the safety and health of the immigrant  population. These groups included Boat People SOS, the Mississippi  Immigrants Rights Alliance, the Center to Protect Workers’ Rights, and the  New York Committee for Occupational Safety and Health. We also  reviewed several studies on emergency preparation, response, and  recovery efforts conducted prior to and during Hurricane Katrina.
We conducted our work from October 2005 to December 2006 in  accordance with generally accepted auditing standards.
subsections: section_title: Analysis of Agency Documents
paragraphs: We reviewed provisions of the NRP and the Annex to identify the specific  roles and responsibilities of OSHA in an incident of national disaster or a  catastrophic event. We also reviewed state emergency management plans  in Alabama and Louisiana to determine whether these state plans had  provisions for ensuring the safety and health of rescue and recovery  workers. Mississippi did not have a current state emergency management  plan.
section_title: Site Visits
paragraphs: To provide some perspectives on the extent of OSHA effectiveness for  ensuring safety and health of workers at the state and local levels, we  conducted site visits in Alabama, Louisiana, and Mississippi, the states that  suffered the most damage from Hurricane Katrina. We spoke with OSHA  regional and area officials as well as federal officials from FEMA, EPA,  and USACE. We also interviewed many state and local response and  recovery workers, including state police in Louisiana and Mississippi; local  law enforcement in New Orleans, Louisiana and Jackson, Mississippi;  firefighters in New Orleans, Louisiana; the Louisiana Department of  Wildlife and Fisheries; the Louisiana Department of Environmental  Quality; and a county emergency management official in Mississippi. In  addition, in March 2006, we attended a conference sponsored by the  National Institute of Environmental Health Sciences that discussed the  various lessons learned and challenges federal agencies encountered  during the responses to Hurricanes Katrina and Rita.
section_title: Data from Federal Agencies on Injuries and Illnesses
paragraphs: Because OSHA was unable to collect useable data on the number of  injuries and illnesses sustained by federal workers in the Gulf Coast area,  we asked the 10 agencies that sent rescue and recovery workers to the  Gulf Coast to provide this information. Although agency officials told us  that they tracked illnesses and injuries on the work site logs that OSHA  requires them to maintain, they were not able to separate out this  information for all workers deployed to the Gulf Coast because injuries  and illnesses are recorded at the work sites where workers are  permanently assigned, not the work sites to which they were temporarily  assigned during the response.
We asked these agencies whether they maintained their own data on  workers who were injured or became ill as a result of their work in the  Gulf area. Four of the 10 agencies—EPA, USACE, the Coast Guard, and  the Department of the Interior—provided data on injuries and illnesses for  workers deployed to the Gulf Coast that were sufficiently reliable for us to  report. However, each of these agencies used different methods to report  this information. In an effort to summarize the injury and illness data  reported by the agencies, we developed a coding scheme for classifying  and combining the data on injuries and illnesses provided by EPA and  USACE into more consistent and concise categories. For example, we  classified an injury described in USACE’s data as “contractor chain saw  operator suffered laceration,” as a “laceration,” and an injury described in  EPA’s data as “employee lost his footing and fell onto the deck landing,” as  a “trip/fall.” We determined that the codes used by the Coast Guard were  sufficiently reliable in coding scheme to use to report the number and  types of injuries and illnesses sustained by their workers. We received the  data from the Department of the Interior too late to include it in its  entirety but provided a brief summary of the types of injuries and illnesses  sustained by its workers in the Gulf Coast area (see app. II).
In addition, to determine the number and types of injuries and illnesses  sustained by their workers, we looked at the nature and causes of the  injuries and illnesses reported by the four agencies and, where possible,  the number of injuries and illnesses reported for each month. Because  some incidents reported by EPA and USACE contained more than one  injury or illness, we used more than one code to report on the type of  injury or illness sustained. For example, we classified an injury reported  by EPA where an employee had “pulled and strain neck and back from a  motor vehicle accident,” as a “motor vehicle accident” and a “pain/strain.”  As a result, the total number of injuries and illness reported by the  agencies may differ from the numbers we reported.
section_title: Data on Federal and State Workers’ Compensation Claims
paragraphs: Because the data on injuries and illnesses provided by the federal agencies  on their workers were limited, we obtained information on workers’  compensation claims filed by federal workers from the Department of  Labor’s Office of Workers’ Compensation Programs in order to obtain  more information about injuries and illnesses sustained by federal workers  involved in the response. The Office of Workers’ Compensation Programs  provided us with data on 770 claims related to Hurricanes Katrina and Rita  filed from August 2005 through June 2006. However, we found that the  data provided to us on claims filed by federal workers were not  sufficiently reliable to use in reporting the types of injuries and illnesses  sustained by federal workers involved in the response.
section_title: Appendix II: Data on the Estimated Number of Federal Workers Who Responded to Hurricane Katrina and Their Injuries and Illnesses
paragraphs: Officials with OSHA and FEMA told us the following federal agencies sent  workers to Alabama, Louisiana, and Mississippi—the three states that  sustained the most damage from Hurricane Katrina—to perform rescues  and conduct recovery work such as clearing debris:  1.  the Department of Agriculture;  2.  the Department of the Interior;  3.  the Coast Guard;  6.  the Department of Health and Human Services, including the Centers  for Disease Control and Prevention, the National Institutes of Health,  the Food and Drug Administration, the Office of Force Readiness and  Deployment, and the Substance Abuse and Mental Health Services  Administration;  9.  DOD, including the Air Force, Army, Navy, and Marine Corps; and  10. the National Guard.
In early May 2006, we asked these agencies to provide us with the number  of employees and contract employees they employed in the three states to  assist with rescue and recovery work related to Hurricane Katrina from  the beginning of the response through April 1, 2006. Many agency officials  told us that they could not provide the total number of workers for the  entire period because they did not collect data in a way that would enable  them to provide us with unduplicated counts of workers who rotated in  and out of the Gulf Coast area. However, many said they could provide us  with estimates of the total number of workers for specific points in time so  we requested such data from all 10 agencies.
We asked them to provide the total number of full-time equivalent workers  they employed in Alabama, Louisiana, and Mississippi on the first day of  each month from September 1, 2005, through April 1, 2006. We also asked  them to exclude employees of other agencies that were temporarily  assigned to them or volunteers who were not government employees or  contractors. All of the agencies submitted estimates for their federal  employees working in the Gulf area, although some agencies were not able  to provide information on all personnel deployed to the Gulf Coast. Only 6  of the 10 agencies tracked information on the number of workers  employed by their contractors in these three states to work on response  and recovery work related to Hurricane Katrina: the Departments of  Agriculture, the Interior, Health and Human Services, EPA, OSHA, and  FEMA. Although officials with three of the other four agencies—the  Department of Defense, USACE, and the Coast Guard—said they  employed contractors in the Gulf, they did not track the number of  workers employed by their contractors. Officials from the National Guard  told us they did not employ contractors in the Gulf Coast area.
We obtained data from OSHA and the other agencies on 11 response and  recovery workers who died in the Gulf, 9 of whom were killed in work- related accidents. OSHA provided information on 10 fatalities, 9 of which  were work-related, and USACE on 2 fatalities, one of which was work- related. All of the other agencies said that none of their workers was  killed during the response to Hurricane Katrina. (See table 1 for additional  information on these fatalities.)
Because OSHA was unable to collect data on the number of injuries and  illnesses sustained by federal workers in the Gulf Coast area, we asked the  10 agencies that sent workers to the Gulf Coast area to provide this  information. Although agency officials told us that they tracked illnesses  and injuries on the worksite logs that OSHA requires them to maintain,  they were not able to separate out this information for all workers  deployed to the Gulf Coast because injuries and illnesses are recorded at  the worksites where workers are permanently assigned, not the worksites  to which they were temporarily assigned during the response.
We asked these agencies whether they maintained their own data on  workers who were injured or became ill as a result of their work in the  Gulf Coast area. Four of the 10 agencies—EPA, USACE, the Coast Guard,  and the Department of the Interior—provided data on injuries and  illnesses for workers in the Gulf area that were sufficiently reliable for us  to report. However, each agency used different descriptions of the injuries  and illnesses to report the information collected. In an effort to summarize  the data reported by the agencies, we developed our own categories to use  in classifying and collapsing the descriptions of injuries and illnesses  provided by EPA and USACE into more consistent and easily understood  categories. For example, for an injury described in USACE’s data as  “contractor chain saw operator suffered laceration,” we reclassified it as a  “laceration;” and for an injury described in EPA’s data as “employee lost  his footing and fell onto the deck landing,” we reclassified it as a “trip/fall.”  We determined that the descriptions and categories used by the Coast  Guard were sufficiently clear to use in reporting the number and types of  injuries and illnesses sustained by their workers. We received the data  from the Department of the Interior too late to reclassify it and report it in  its entirety, but we provided a brief summary of the types of injuries and  illnesses sustained by its workers deployed to the Gulf Coast on page 58.
To determine the number and types of injuries and illnesses sustained by  their workers deployed to the Gulf Coast, we looked at the nature and  causes of the injuries and illnesses reported by the agencies and, where  possible, the number of injuries and illnesses reported for each month.  Because some incidents reported by EPA and USACE contained more  than one injury and/or illness, we used more than one code to report on  the type of injury and illness sustained. For example, where EPA reported  that an employee had pulled and strain neck and back from a motor  vehicle accident, we classified it as “motor vehicle accident” and  “pain/strain.” As a result, the total number of injuries and illness reported  by these agencies may differ from the types of injuries and illnesses  reported for that same time frame.
EPA reported information on the number of injuries and illnesses  sustained by their federal workers and contractor employees. (See   table 2.)
EPA also provided information on the types of injuries and illnesses these  workers sustained. (See table 3.)
USACE reported information on the number of injuries and illnesses  sustained by their federal workers and contractor employees. (See   table 4.)
USACE also reported information on the types of injuries and illnesses  sustained by these workers. (See table 5.)
The Coast Guard provided information on injuries and illnesses sustained  by their workers and contractor employees from November 2005 though  March 2006 in several different categories. According to Coast Guard  officials, about 5 percent of the data it received on illnesses and injuries  that occurred during this period had not been entered into its injury and  illness tracking system. It reported data on the number of types of  exposures their federal workers and contractor employees experienced  during the response. (See table 6.)
The Coast Guard also reported the number of injuries sustained by their  federal workers and contractor employees. (See table 7.)
In addition, the Coast Guard provided data on the health effects of the  injuries and illnesses sustained by their federal workers and contractor  employees. (See table 8.)
The Coast Guard noted which symptoms occurred during workers’  deployment and which occurred post-deployment. (See table 9.)
Finally, the Department of the Interior reported that 90 workers sustained  injuries or illnesses during the response to Hurricane Katrina from August  2005 through April 2006. They included injuries such as falls, slips and  trips; strains from lifting; dermatitis from exposure to poison ivy; and  reactions from exposures to toxins, dust, gas or chemicals.
We took several steps to assess the reliability and reasonableness of the  data the agencies provided. To assess the reliability of the agencies’ data,  we talked with agency officials about their data quality control procedures  and reviewed relevant documentation. For example, we asked about the  types of procedures and systems they had in place to ensure that the data  were collected and reported consistently. We found the data were  sufficiently reliable for the purposes of this report.
section_title: Appendix III: Comments from the Department of Health & Human Services
section_title: Appendix IV: Comments from the Department of Labor and GAO’s Response
subsections: section_title: GAO’s Response to OSHA’s Comments
paragraphs: 1.  We disagree that our report does not fairly and adequately capture the  actions OSHA took to prevent occupational injuries and illnesses and  work-related fatalities in the Hurricane Katrina response operations.  The information on pages 15 through 27of the report details many of  these activities, but the purpose of the report was to provide a broader  picture of OSHA’s overall effectiveness. While the magnitude of the  activities accomplished by OSHA’s field staff was noteworthy, the  agency’s overall effectiveness was hampered by its lack of preparation  for implementing its responsibilities under the Annex at the national  level. This was also noted by the Department of Homeland Security’s  National Preparedness Task Force, which stated in its technical  comments that, “As a signatory agency, Department of Labor should  have anticipated and put in place mechanisms to ensure the success of  OSHA in meeting their Workforce Safety responsibilities.” In addition,  our work focused on OSHA’s activities through December 2006, not  December 2005.  2.  Although OSHA provides more detailed information about its action  during the response to Hurricane Katrina, our report mentions many of  these same activities. For example, on page 33 of the report, we stated  that OSHA distributed personal protective equipment to many agencies  and workers; on pages 25 to 27, we noted that OSHA sampled many  worksites for hazards; on pages 19 and 20, we provided examples of  the quick cards and fact sheets OSHA developed and distributed  throughout the Gulf; and on page 21, we discussed the thousands of  interventions that the agency’s staff conducted.  3.  We agree that OSHA, nor any other federal agency, was responsible for  collecting information on the number of workers deployed to the Gulf  area in response to Hurricane Katrina. In the absence of such  information, we attempted to collect it ourselves but, as noted in the  report, were not entirely successful because many of the agencies we  contacted did not have systems in place for tracking the number of  workers deployed.  4.  We noted on page 9 of the report that the mission assignment FEMA  issued to OSHA implementing the Annex for Hurricane Katrina  included all of the activities listed in the Annex except long-term  medical monitoring. We measured the effectiveness of OSHA’s  performance only against those activities included in its mission  assignment.  5.  Despite OSHA’s efforts, as noted on page 32 of the report, other agency  officials told us that there still were gaps in the training provided to  workers involved in the response effort and additional information was  needed about available training.  6.  While we agree that establishing a personal protective equipment  program for a disaster response is a difficult and complex task, we  continue to believe that the underlying issue is the need for OSHA to  define how it will implement and monitor such a program as specified  in the Annex. The issues that OSHA raises need to be addressed in  developing an incident personal protective equipment program for  future disasters, including developing a process for deciding what  providing equipment on an “ad-hoc” basis means, what types of  equipment will be provided, who will provide it, which workers will  receive it, and where will it be stored.  7.  We disagree with OSHA’s comment that our statement about its lack of  coordination with the Department of Health and Human Services is  inaccurate. Our statement is based on OSHA’s lack of coordination  before the disaster in order to ensure that the cooperating agencies  were adequately prepared to meet the mental health needs of workers.  Furthermore, in technical comments on the report, the Department of  Homeland Security’s National Preparedness Task Force also noted this  lack of coordination. It stated that OSHA did not seek assistance from  cooperating agencies that have provided mental health services during  major events in the past, such as the Department of Health and Human  Services’ Substance Abuse and Mental Health Services Administration.  8.  We disagree with OSHA’s assertion that the report does not accurately  reflect the awareness of the Annex among federal agencies before  Hurricane Katrina. As noted in the report, many of the agency officials  we interviewed who were in charge of day-to-day operations in the  Gulf area were not aware of OSHA’s role or the services it could  provide. We continue to believe that OSHA needs to provide  information to federal, state, and local agencies about its role in a  disaster, including seeking opportunities to participate in emergency  preparedness exercises at all levels of government. Because so many  responders are associated with nonfederal agencies, it is particularly  important for OSHA to reach out to state and local agencies to provide  this information.  9.  We used the word “suspend” to describe the fact that, in its press  releases, OSHA noted that it had “exempted” large areas of the three  affected states from its normal enforcement operations for specific  periods and limited its inspections to cases involving fatalities,  catastrophic accidents, or complaints, as noted on page 7 of the report.  We changed the wording of the report in response to OSHA’s technical  comments and no longer use the term “suspend.” However, we believe  that this is an accurate reflection of the change in OSHA’s activities  during a disaster.  10. The challenges OSHA recognizes in its comments regarding the use of  its standard recordkeeping forms (OSHA forms 300 and 301) to collect  data on injuries and illnesses sustained by workers during a disaster  correctly identify some of the drawbacks involved in using the forms  for this purpose. OSHA’s comments also emphasize the need for it to  develop a process for collecting needed data that overcomes the  challenges identified. We disagree, however, that the forms are a good  platform on which to build such a process. They do not contain  detailed information on injuries, and employers are not required to  include many of the more minor injuries and illnesses sustained by  workers, such as those requiring only first aid. In addition, the use of  the logs could cause confusion among federal agencies about whether  the standard rules for recording injuries and illnesses are to be applied.  For example, federal agencies are not normally required to submit  their injury and illness logs to OSHA, but OSHA will need to obtain this  information on a timely basis during a disaster response in order to  monitor injuries and illnesses and identify trends.
section_title: Appendix V: GAO Contact and Staff Acknowledgments
subsections: section_title: Acknowledgments
paragraphs: Revae E. Moran, Assistant Director, and Karen A. Brown, Analyst in  Charge, managed all aspects of the assignment. Amanda M. Mackison,  Claudine L. Pauselli, and Linda W. Stokes made significant contributions  to the report. In addition, James D. Ashley, Lise Levie, Sheila R. McCoy,  Jean L. McSween, David Perkins, and Tovah Rom provided key technical  and legal assistance.
section_title: Related GAO Products
paragraphs: September 11: HHS Has Screened Additional Federal Responders for  World Trade Center Health Effects, but Plans for Awarding Funds for  Treatment Are Incomplete. GAO-06-1092T. Washington, D.C.: September  8, 2006.
Catastrophic Disasters: Enhanced Leadership, Capabilities, and  Accountability Controls Will Improve the Effectiveness of the Nation’s  Preparedness, Response, and Recovery System. GAO-06-618. Washington,  D.C.: September 6, 2006.
Coast Guard: Observations on the Preparation, Response, and Recovery  Missions Related to Hurricane Katrina. GAO-06-903. Washington, D.C.:  July 31, 2006.
Hurricane Katrina: Better Plans and Exercises Needed to Guide the  Military’s Response to Catastrophic Natural Disasters.GAO-06-643.  Washington, D.C.: May 15, 2006.
Hurricane Katrina: Status of the Health Care System in New Orleans  and Difficult Decisions Related to Efforts to Rebuild It Approximately 6  Months After Hurricane Katrina. GAO-06-576R. Washington, D.C.: March  28, 2006.
GAO’s Preliminary Observations Regarding Preparedness and Response  to Hurricane Katrina and Rita. GAO-06-365R. Washington, D.C.:  February 1, 2006.
Hurricanes Katrina and Rita: Provision of Charitable Assistance.  GAO-06-297T. Washington, D.C.: December 13, 2005.
September 11: Monitoring of World Trade Center Health Effects Has  Progressed, but Not for Federal Responders. GAO-05-1020T. Washington,  D.C.: September 10, 2005.