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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