From the Massachusetts Nurse Newsletter
May/June 2008 Edition
Healthcare workers risk occupational exposures to chemical, biological or radiological materials when hospitals receive contaminated patients during emergency response activities with mass casualties. These hospital employees are called first receivers and generally work at health care facilities remote from the location where the emergency occurred. The health care worker’s exposures to chemical, biological or radiological materials are usually limited to what is transported to the hospital on victims’ skin, hair, clothing or personal belongings.
OSHA considers sound planning to be the first line of defense in all types of emergencies. By tailoring emergency plans to reflect the reasonably predictable “worst-case” scenario under which first receivers might work, the hospital can protect its employees. During mass casualty emergencies, hospitals can anticipate little or no warning before victims begin arriving. In addition, first receivers can anticipate that information regarding the hazardous materials would not be immediately available. Hospitals also may treat a large number of self-referred victims.
The appropriate healthcare employee training and personal protective equipment selection are defined in the OSHA standards. Each healthcare employee’s role and the hazards the employee might encounter determine the level of training that must be provided to any individual first receiver. Personal protective equipment selection must be based on a hazard assessment that carefully considers both the healthcare employee’s role and the hazards the employee might encounter, along with the steps taken to minimize the extent of the employee’s contact with hazardous substances.
Unprotected healthcare workers can be injured by secondary exposure to hazardous substances when they treat contaminated patients. Secondary exposure of healthcare workers is usually limited to a level at which chemical protective clothing (including gloves, boots, and garments with openings taped closed) and powered air purifying respirators (PAPR) will provide adequate protection from a wide range of hazardous substances to which first receivers most likely could be exposed.
The training indicated for first receivers depends on the individuals’ roles and functions and the likelihood that they will encounter contaminated patients. The OSHA Hazardous Waste Operations and Emergency Response (HAZWOPER) standard (29 CFR 1910.120) First Responder Operations Level and First Responder Awareness Level training meet the requirements for first receivers in certain roles and positions. For example, all employees with designated roles in the hospital decontamination zone including decontamination staff, clinicians, and security staff must be trained to the Operations Level including initial training and an annual refresher. For employees whose role in the hospital decontamination zone was not previously anticipated such as those who are called in incidentally (i.e. medical specialist or trade person such as an electrician), a briefing at the time of the incident will be appropriate.
Employees such as security personnel, setup crews and patient tracking clerks who are assigned only to patient receiving areas proximate to the decontamination zone where they might encounter, but are not expected to have contact with contaminated victims or their belongings must be trained to the Awareness Level including initial training and an annual refresher. This group also includes emergency department clinicians, clerks, triage staff, and other employees associated with emergency departments who might encounter selfreferred contaminated victims without receiving prior notification that such victims have been contaminated. In each case, the training must be effective. It must be provided in a manner the employee is capable of understanding.
For more information please visit the OSHA website at www.osha.gov. Specifically, the OSHA publication, OSHA Best Practices for Hospital-Based First Receivers of Victims reviews and expands upon the ideas outlined in this article and is designed to provide hospitals with practical information to assist them in developing and implementing emergency management plans that address the protection of hospitalbased emergency department personnel during the receipt of contaminated victims from mass casualty incidents occurring at locations other than the hospital. Among other topics, it covers victim decontamination, personal protective equipment and employee training, and also includes several informational appendices. Additional information on emergency preparedness can also be found on the OSHA Web site under Safety and Health Topics, Emergency Preparedness and Response.
This article was developed cooperatively through the MNA – OSHA – Mass. Division of Occupational Safety Alliance.
Congress on Nursing Practice seeks additional members
The Congress on Nursing Practice is responsible for identifying issues and practices impacting the nursing community, and it is currently working to develop a mentorship program for members and a position statement specific to the compact legislation filed by the Board of Registration in Nursing. The Congress meets on the fourth Monday of each month, from 5:30–7:30 p.m., at MNA headquarters in Canton. If you are interested in joining the Congress on Nursing Practice, please contact Dorothy McCabe, director of the MNA’s divisions of nursing and health and safety, at 781.830.5714 or via e-mail at firstname.lastname@example.org.