• What should be monitored, what are the biomarkers, and how often should monitoring occur?

• What precautions should be taken to eliminate risks and adverse effects? If the risks cannot be eliminated, how can their effects be reduced?

• What are the appropriate communication strategies and messages?

The last question is very important because public health officials need to reassure the public. False reassurance would serve no purpose and could impede the recovery process, cautioned Stephens.

According to Howard Frumkin of the National Center for Environmental Health and the Agency for Toxic Substances and Disease Registry (NCEH/ ATSDR), the Department of Health and Human Services, the Department of Homeland Security including the Federal Emergency Management Administration, and the Department of Defense are the first agencies to respond to disasters requiring federal support. The state and local agencies also have important responsibilities that sometimes, but not always, overlap with federal agency responsibilities and can lead to a very complex set of challenges. The central challenges were communication among the agencies and responding to environmental health issues.

A wide range of environmental health issues surfaced in the aftermath of the hurricane, and even though public health concerns are important to all in government, they are not the only concern, noted Frumkin. NCEH/ATSDR had to confront a number of crosscutting social and organizational challenges in trying to address health, safety, and environmental problems following Hurricanes Katrina and Rita. In the lifesaving phase of the response, some immediate decisions had to be made to identify and address life-threatening environmental hazards. Medium-term decisions included controlling hazards so that people could reenter the city. Finally, long-term questions include ensuring environmental health in reconstruction.

Workers are the common denominator in all disasters, whether natural disasters, accidents, or terrorist events. They are the first responders who have to go to the scene to perform rescue and recovery operations, said Max Kiefer of the National Institute of Occupational Safety and Health (NIOSH). During the aftermath of Hurricane Katrina, providing occupational safety and health services