Best Practices for Protecting EMS Responders during Treatment and Transport of Victims of Hazardous Substance Releases OSHA 3370-11 2009 Occupational Safety and Health Act of 1970 “To assure safe and healthful working conditions for working men and women; by authorizing enforcement of the standards developed under the Act; by assisting and encouraging the States in their efforts to assure safe and healthful working conditions; by providing for research, information, education, and training in the field of occupational safety and health.” This publication provides a general overview of a particular standards-related topic. This publication does not alter or determine compliance responsibilities which are set forth in OSHA standards, and the Occupational Safety and Health Act. Moreover, because interpretations and enforcement policy may change over time, for additional guidance on OSHA compliance requirements, the reader should consult current administrative interpretations and decisions by the Occupational Safety and Health Review Commission and the courts. Material contained in this publication is in the public domain and may be reproduced, fully or partially, without permission. Source credit is requested but not required. This information will be made available to sensory impaired individuals upon request. Voice phone: (202) 693-1999; teletypewriter (TTY) number: 1-877- 889-5627. Best Practices for Protecting EMS Responders during Treatment and Transport of Victims of Hazardous Substance Releases Occupational Safety and Health Administration U.S. Department of Labor OSHA 3370-11 2009 Cover photo courtesy of Dr. John Hick This document is not a standard or regulation, and it creates no new legal obligations. It contains recommendations as well as descriptions of mandatory safety and health standards. The recom- mendations are advisory in nature, informational in content, and are intended to assist employers in providing a safe and healthful workplace. The Occupational Safety and Health Act requires that employers to comply with safety and health standards promulgated by OSHA or by a state with an OSHA-approved state plan. In addition, the Act’s General Duty Clause, Section 5(a)(1), requires employers to provide their employees with a workplace free from recognized hazards likely to cause death or serious physical harm. Employers may be cited for violating mandatory safety and health standards or other OSH Act requirements, including the General Duty Clause. Acknowledgements Numerous individuals, agencies and organizations The following agencies and organizations reviewed assisted in the development of this publication. and provided comments: OSHA wishes to express its deepest appreciation to the following for their significant contributions to this Emergency Nurses Association guide. EnMagine, Inc. Hennepin County Medical Center, American Ambulance Association Department of Emergency Medicine American Medical Response National Association of EMS Educators Agency for Toxic Substances and Disease Registry, National Association of EMS Physicians Emergency Response National Association of State EMS Officials Boston Emergency Medical Services National Institute for Occupational Safety and Department of Homeland Security, Health, Emergency Preparedness and Federal Emergency Management Agency, Response Coordination Office National Emergency Training Center New Jersey Department of Health and Senior Emergency Nurses Association Services, Division of Epidemiology EnMagine, Inc. Environmental and Occupational Health Hennepin County Medical Center, New York City Fire Department, Dept of Emergency Medicine Office of Medical Affairs Elsevier Public Safety, National Institutes of Health/National Institute Journal of Emergency Medical Services of Environmental Health Sciences, National Association of EMS Educators Worker Education Training Branch National Association of EMS Physicians North Shore – LIJ Health System, National Institute for Occupational Safety and Center for Emergency Medical Services Health Objective Safety, LLC New York City Fire Department U.S. Agency for Toxic Substances and Disease North Shore – LIJ Health System, Registry, Emergency Response Center for Emergency Medical Services, U.S. Department of Homeland Security, Special Operations Division Federal Emergency Management Agency Objective Safety, LLC U.S. Department of Health and Human Services U.S. Department of Health and Human Services U.S. Department of Transportation U.S. Department of Transportation U.S. Environmental Protection Agency 2 Occupational Safety and Health Administration Contents Acronyms 6 EMS Responder Roles that Require No HAZWOPER Training 24 Executive Summary 7 Skilled Support Personnel 24 Introduction 9 Relevance of Other HAZWOPER Training Levels to EMS Responders 25 Scope and Objectives 9 Purpose 11 Conclusions Regarding EMSTraining 25 Organization of this Guide 11 Personal Protective Equipment 26 Determinants of Training and PPE: Using OSHA’s Rationale for Hazard Personnel Roles, Hazard Assessments Assessment and PPE Selection 26 and Emergency Response Plans 12 PPE Selection Based on Reasonably EMS Responder’s Role in the Community 12 Anticipated Worst-Case Scenarios 26 Defining the EMS Responder Role in Community Response: Factors to Required Written Documentation for Evaluate, Contacts, Information Sources Respirator and PPE Selection Processes 27 and Special Considerations 12 Assessing the Need for Respiratory Protection 27 The Value of Open Dialogue 14 Respiratory Protection Required for EMS The EMS Hazard Assessment 14 Responders 27 Requirement and Purpose 14 Types of Respiratory Protection Available 27 Sources of Hazard Assessment Information National Institute for Occupational Safety in the Community 15 and Health (NIOSH) Approval and Chemical, Biological, Radiological, Nuclear (CBRN) Include EMS Responder Health and Safety Certifications 28 Experience in Hazard Assessments 16 Respiratory Protection for an Identified or Incorporating EMS Responder Preparation Characterized Hazard 28 into an Effective Emergency Response Plan 16 Other Requirements Related to Respiratory Training 18 Protection 28 Background 18 Gloves, Boots and Garments 28 Summary of Existing Training Guidelines Gloves and Boots 28 for EMS Responders 18 Protective Garments 29 Applicability of HAZWOPER Training to EMS Responders 18 Modifying PPE Selections Based on Available Information 30 EMS Responder Roles Requiring Proper Size and Fit of PPE 31 HAZWOPERTraining 20 Considerations for Effectively Using, First Responder Awareness Level Training 20 Maintaining and Storing PPE 31 Training Duration,Topics and Competencies 20 Conclusions Regarding Personal Protective Annual Refresher Training 21 Equipment 31 First Responder Operations Level Training 21 Summary of OSHA’s Recommendations Training Duration 21 for Training and PPE 32 Option to Demonstrate Competence 22 Topics for Training or Demonstration Best Practices for Pre-Transport Patient of Competency 22 Decontamination 35 Annual Refresher Training 22 Removing Contaminated Clothing and Associated Training 22 Personal Effects 35 Associated Training – PPE 23 Associated Training – Respiratory Protection 23 Cleansing with Soap and Water 35 Sources of Training and Curricula 23 Assistance for Non-Ambulatory and Ambulatory Patients 36 OSHABESTPRACTICESFORPROTECTINGEMSRESPONDERS 3 Decontamination in Low Water Situations 37 Appendix J Vehicle and Equipment Decontamination 38 Summary of Respirator Types and Selection Information 71 Discovering that a Patient in the Ambulance Summary of Respirator Types and is Contaminated 38 Characteristics 71 Detection Equipment 39 Advantages and Disadvantages of Various Types of Respiratory Protection 72 Detection Instruments 39 Advantages and Disadvantages of Various Ionizing Radiation Meters 39 Respirator Facepiece Styles 73 Chemical and Biological Agent Detection OSHA Assigned Protection Factors for Equipment 40 Respiratory Protective Devices 74 Methamphetamine Detection Equipment 42 Respirators for IDLH Atmospheres 75 Conclusion 44 Respirators for Atmospheres that are Not IDLH 75 Appendix A Glossary 45 Appendix K Thermal Stress: Working in Appendix B Hot or Cold Environments 76 References 48 Heat Stress and Strain 76 Appendix C Cold Stress and Hypothermia 76 Additional Sources of Information 54 Appendix L Appendix D Decontamination Foam and Examples of Mutual Aid Agreements Barrier Cream 77 and Templates 55 Appendix M Appendix E Examples of PPE Donning Using Hazardous Substances Emergency and Doffing Sequences 78 Events Surveillance System (HSEES) Information in Community Hazard Appendix N Evaluations – A Review 56 General Description and Discussion of the Levels of Protection and Protective Evaluation of Data from the Early 1990s 57 Gear 79 Rural/agricultural area compared to all other non-rural areas 58 Appendix O Appendix F Occupational Health Hazard Experience of EMS Responders 83 Special Considerations for Responses Involving Methamphetamine Laboratories 59 Background/Overview 83 Review of the Literature on Risks to Appendix G EMS Responders 83 Clandestine Drug Labs – First Responder Awareness Card 64 Experience of EMS Responders Exposed to Hazardous Substances 83 Appendix H EMTs at the Tokyo Subway Sarin Training Curricula Options 66 Gas Attacks 83 Training Curricula for EMS Responders 66 Hazardous Substances Emergency Tips for Successful EMS Responder Events Surveillance (HSEES) Data HAZWOPER Training Programs 68 for EMS Responders 84 Other Reports of EMS Responder Injury Appendix