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Following the World Trade Center (WTC) attack, the Congress appropriated more than $8 billion to the Department of Homeland Security's (DHS) Federal Emergency Management Agency for response and recovery activities. The Department of Health and Human Services (HHS) received some of this funding to establish health screening and monitoring programs for responders to the disaster and later received additional appropriations to fund treatment. In total, about $369.2 million has been appropriated or awarded for the WTC health programs. GAO previously reported on problems that these programs have had in ensuring the availability of services for all responders. GAO was asked to examine lessons from the WTC health programs that could guide future programs. GAO examined (1) lessons from the programs' experience and (2) HHS actions or plans that incorporate the lessons. GAO interviewed WTC health program officials and other experts and reviewed DHS and HHS documents.

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Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Health and Human Services To ensure that effective programs are developed to deal with the health effects that responders may experience in the event of a future disaster, Secretary of HHS should develop a department-level responder screening and monitoring plan that defines the roles and responsibilities of HHS components and incorporates the five lessons identified from the experience of the WTC health programs. Specifically, this plan should facilitate the registration of all responders and ensure that screening and monitoring services are designed to foster epidemiologic research; provide timely mental health screening and monitoring that is integrated with physical health screening and monitoring; include a treatment referral process; and make comparable services available to all responders, regardless of their employer or geographic location.
Closed - Not Implemented
On April 3, 2014, officials in the Department of Health and Human Services' (HHS) Centers for Disease Control and Prevention (CDC) provided an update from its National Institute of Occupational Safety and Health (NIOSH). NIOSH, which administered the health programs for World Trade Center (WTC) responders, reported that the National Response Team published two guidance documents that incorporate the lessons learned from the WTC health programs such as registration of all responders and screening and monitoring health to foster epidemiologic research. These documents were titled Emergency Responder Health Monitoring and Surveillance (ERHMS): National Response Team Technical Assistance Document and ERHMS: Guide for Key Decision Makers. These documents provide guidance and tools to any response organization and are not specific to HHS or any of its components. The guidance documents do not include a plan for how HHS as a whole or each of its components intends to implement the guidance during the next major disaster.

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