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OSHA Training Institute 1
OSHA Regulations & Legal Issues for Evacuation of Health Care Facilities
OSHA Training Institute – Region IXUniversity of California, San Diego (UCSD) - Extension
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Objectives
To describe the current Occupational Safety and Health Administration (OSHA) regulations regarding evacuation as they pertain to healthcare facilities.
To describe other regulatory and legal issues associated with evacuation.
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OHSA
“OSHA's mission is to assure the safety and health of America's workers by setting and enforcing standards; providing training, outreach, and education; establishing partnerships; and encouraging continual improvement in workplace safety and health.“
OSHA Website 2007
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OSHA 29 CFR 1910
General Industry Requirements for Emergency Response and Preparedness Includes general requirements for exit routesMedical & First AidAlarmsEmergency Action Plans (EAP)
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Requirements for Exit Routes
Permanent; free from obstructions Number of exits based on number
of employees, occupants Size, arrangement,
marking/signage, lighting specifications
Must lead to an outside area “with enough space for all participants”
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General Requirements (cont)
Medical services & first aid
Fire extinguishers Employee alarm
systems“distinctive and
perceivable…for emergency action or safe evacuation”
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OSHA 29-CFR 1910e: Emergency Action Plans
EAPs should:Address potential expected
emergencies Evacuation and Shelter-in-Place
Give detailed procedures for employees
For operations, rescue and medical duties, Chain of Command, evacuation procedures
Provide maps with evacuation routes Color coding
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1910e During an Evacuation Employees must know:
Type of evacuationTheir role in evacuation ‘Safe Areas’ in Plan
Fire Walls, Open SpacesTraining
Evacuation Wardens scheduled during working hours (1:20)
Practice evacuation routes
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OSHA: Evacuation Plans and Procedures eTools
www.osha.gov/SLTC/etools/evacuation Develop & Implement an EAP Evacuation Plans & Procedures Employee Responsibilities Shelter-in-Place Fire Extinguishers:
Fight or Flee Reporting Emergencies
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OSHA: Evacuation Planning Matrix
Worksite Risk Assessment List (DHS)HazMatProvision of essential servicesHigh pedestrian traffic volumeLimited means of egressHigh profile sitePart of transport system
www.llr.state.sc.us.workplace/Full%20Report.pdf
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OSHA: Evacuation Planning Matrix
Developed in response to terrorist attacks Help assess risk of being a target Risk based on:
Workplace VulnerabilitiesRecognized ThreatAnticipated Consequences
Specifics for your EAPSafety & Security considerations
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OSHA: Emergency Preparedness Guidelines for Floods Types: Dam/levee failure, flash, coastal, river Public Warnings: Flood “Watch”, “Warning”—
activate plan Workers at Risk: Utility, Law, Fire, EMS, other
outside workers Specific Hazards: Electrical, carbon monoxide,
musculoskeletal hazards, thermal stresses, hypothermia, HazMat, fire, drowning, exhaustion, dehydration, biohazards, falls from height, falling objects, MVAs, burns, structural instability and collapse…
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OSHA: Emergency Preparedness Guidelines (cont)
Earthquakes Hurricanes: Winds, tidal surges, flash floods Tornadoes: Travel quickly, unpredictable Others: Heat or Cold Stress; Secondary
Explosives, Toxic Chemicals
www.osha.gov.SLTC/emergencypreparedness/guides
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Other Regulations
FEMA NIMS PETS Act OES NIOSH The Joint Commission (formerly JCAHO) DHHS
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Legal Authorities
Stafford Act- FEMA/DHS is authorized to coordinate Fed agencies, after a POTUS Declaration of a major disaster or emergency
HHS has lead for health and medical services, can activate USPHS CC or NDMS, and maintains the Strategic National Stockpile.
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NIMS
Nationwide, standardized approach to incident management and response
Developed by Homeland Security at the request of the President – Homeland Security Presidential Directive—5.
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NIMS Requirement
Requires that federal departments and agencies adopt and use NIMS to support state, local, tribal entities.
Stipulates that federal departments and agencies require state and local entities to adopt the NIMS as a condition for federal preparedness assistance.
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NIMS Directive for States, Local Agencies and Tribes
State/local/tribes should:Complete NIMS Awareness Course – IS 700Formally adopt NIMS principles and policiesEstablish a NIMS compliance baselineDevelop a timeframe and strategy for full
NIMS implementation Institutionalize use of the Incident Command
System
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NIMS Requirements for StatesStates are required to: Incorporate NIMS into existing training
programs and exercisesEnsure that federal preparedness funding
supports state, local, and tribal NIMS implementation
Incorporate NIMS into Emergency Operations Plans
Promote intrastate mutual aid agreementsCoordinate and provide NIMS technical
assistance to local entities
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NIMS and Evacuations
NIMS does not outline specific steps or requirements for evacuations.
However using NIMS will support a more cohesive response among agencies and will support assistance in preparedness for evacuations as well as any other disaster experience.
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Pet Evacuations PETS Act of 2006 as an
Amendment to the Stafford Act
Grants FEMA authority to provide assistance for individuals with pets and service animals, and the animals themselves, following a major disaster.
Helicopter transport of victims and pets with a DMAT disaster responder.
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Community Opinion and Evacuation Consequences Post Hurricane Katrina: 49 percent of all adults say they would
refuse to evacuate ahead of a disaster if they could not take their pets with them61 percent of pet owners “would be likely
to refuse an order to evacuate”24 percent of non-pet owners would refuse
to leave.Report from the nationwide Zogby
Interactive Poll 3,185 adults polled September 13 to 15, 2005
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Pet Transportation Standards Act (“PETS”) Requires local and state emergency
preparedness authorities include plans for pets and service animals in disaster plans to qualify for FEMA grants
Authorizes federal funds to help create pet-friendly emergency shelter facilities
Grants FEMA authority to assist states and local communities in
developing disaster plans to accommodate people with pets and service animals
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Office of Emergency Services (OES)
Emergency Services ActState responsibility for disaster mitigation Mutual aid from outside state/area
Declaration of local emergency provides additional immunity from liability for the public entity and its employees
CA Gov Code 8657: extends ESA immunities to disaster service workers
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National Institute of Occupational Safety and Health (NIOSH)
Emergency Management Guide for Business & Industry
Alarm Systems Hurricane Response
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The Joint Commission (formerly JCAHO) EAP Assignment of staff Evacuation procedures Patient transfers Communications Utilities—Sentinel Event alert Drill requirements
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Dept of Health and Human Services
Emergency Medical Treatment and Active Labor Act (EMTALA)
Health Insurance Portability and Accountability Act (HIPAA)
Secretary of DHHS permitted to temporarily waive these requirements for healthcare providers in an emergency area
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Good Samaritan Laws, Etc.
Good Samaritan Laws in all states The US Volunteer Protection Act
of 1997 (42 U.S.C. 14501 - 14505) CA Gov Code 8657 Immunity to healthcare providers responding
during an emergency Some states place higher burden on plaintiffs for
cases regarding provision of care during an emergency
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ESAR-VHP
Emergency System for Advance Registration of Volunteer Health Professionals
Public Law: the Public Health Security and Bioterrorism Preparedness and Response Act of 2002
Each State and Territory to establish a standardized, volunteer registration system.
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ESAR-VHP: System Aims Readily available & verifiable information
about the volunteer’s identity, licensing, credentialing, accreditation, and privileging in hospitals/ medical facilities.
State ability to quickly identify & better utilize health professional volunteers in emergencies & disasters.
Sharing of these pre-registered & credentialed health care professionals across State lines & even nationally.
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Legal Issues
Certain states can require staff designated as “Emergency Service Personnel” to stay at work during an general evacuation orderEmployer must provide adequate emergency
shelter Legal cases from Katrina
Neglect Euthanasia
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Legal Issues
NYTimes.com By Jane Gross August 18, 2006 [DHHS] Report Calls for Tighter Rules in Nursing
Home Evacuations
“…all emergency plans [met] the requirements of federal and state law…94% of nursing homes have [these]…”
“But it found that the plans had rampant deficiencies especially in ensuring the safe and comfortable evacuation of residents with complex needs”
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Summary
Need to have specific procedures for evacuation for your facilityEmergency Action Plan
Need to include provisions for pets Laws providing for immunity when
responding in a disaster situationCan vary by State
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References
California Office of Emergency Services. Legal Guidelines for Flood Evacuation. 1997.
Davis & Davis, PC. The Legal Angle Electronic Newsletter: Hospital staffing during a hurricane evacuation. Spring 2006.
FEMA. National Incident Management System. SEMS Advisory Committee Meeting, Mather, CA March 24, 2005. Slide Set
Zogby International. Americans: make disaster plans for pets,too! Interactive polls ZOGBY International New York. October 14, 2005
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References
Pesik N, Keim ME, Iserson KV. Terrorism and the Ethics of Emergency Medical Care. Annals of Emergency Medicine. 2001. 37:642–646.Davis & Davis, PC.
US Dept of Labor: OSHA. General industry (29 CFR 1910) requirements for emergency response and preparedness. www.osha.gov
US Dept of Labor: OSHA. Evacuation Plans and Procedures. www.osha.gov/SLTC/etools/evacuation/evac.html
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References US Dept of Labor: OSHA. Evacuation planning
matrix. “Matrix to provide employers withplanning considerations and on-line resources that may help employers reduce their vulnerability to a terrorist act or the impact of a terrorist release.” www.osha.gov/dep/evacmatrix/index.html
US Dept of Labor: OSHA. Emergency Preparedness and response: Safety and Health Guides.http://www.osha.gov/SLTC/emergencypreparedness/guides/index.html
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