Every day across the nation, emergencies occur that threaten our lives, well-being, property, peace, and security. Every day, we rely upon our local police officers, firefighters, emergency medical technicians, public health professionals, and others to arrive quickly and do what needs to be done to restore the safety, the security, the peace, and the routine to our lives. These emergency responders are trained to handle such emergencies that occur day by day in our cities, towns, villages, and countrysides. On rare occasions, emergencies occur that are so large in scale and so severe that local responders may not have the resources-people, equipment, expertise, funds-to effectively and safely respond. Even in such cases, local responders do not hesitate to do what they have been trained to do-go to the site prepared to save lives, protect property, and remove the threat. When a disaster, whether natural or manmade, overwhelms the resources and capabilities of local organizations, responders come in from other cities, counties, and states-jurisdictions near and far-as well as from federal agencies, to assist those with local responsibility. Skilled support workers are engaged for specialized activities, such as removing debris and restoring utilities and transportation. Neighbors and other volunteers may travel to the disaster site to try to do their part. Other concerned individuals and organizations send food, supplies, and equipment. Journalists press in to the closest possible vantage points to get the pictures and stories. Public officials arrive to examine the damage and consult with the responders. One characteristic of these large, rare, dynamic events is the rapidly evolving complexity that faces individuals trying to effectively manage all of the organizations and people, operations and tasks, equipment and supplies, communications, and the safety and health of all involved. Another characteristic is that all disasters present risks to emergency response workers-risks that may be familiar or unfamiliar, and that may vary widely depending on the nature of the event or the phase of the response. This report addresses the protection of emergency responders against injury, illness, and death on just such rare occasions, when emergencies become disasters. It builds on a broad base of National Institute for Occupational Safety and Health programs and RAND Corporation research on protecting emergency responders. This report focuses on preparedness (especially planning and training) and management as means of controlling and reducing the hazards emergency responders face. It provides a set of recommendations on how disaster site safety and health management might be improved. Much of the information contained herein is based upon the firsthand experience and suggestions of emergency responders who were there at the World Trade Center and at the Pentagon on and after September 11, as well as those who responded to the Northridge earthquake (in California) and Hurricane Andrew (in Florida). This report builds on systems and practices currently in use and was developed primarily for use by local emergency responders, those individuals and organizations who have been tasked with disaster site safety and health responsibilities. Additionally, the report should prove useful to legislators and other federal, state, county, and municipal officials; trade union officials; industry executives; safety and health professionals; and researchers who are engaged in and committed to efforts to make our nation more secure, to respond effectively and safely to disaster, and to protect a critically important resource-the community of emergency responders.