Implementing a Respiratory Protection Program: A Guide for EMS and Other Health Care Providers

1. Implementing a Respiratory Protection Program: A Guide for EMS and Other Health Care Providers VT Department of Health Emergency Medical Services Office June 2009

2. Introduction • Before an employer can expect its employees to use respiratory protection, OSHA requires several steps • The VT Dept of Health does not enforce OSHA rules, but is providing materials to assist agencies in protecting their personnel

3. Introduction • The Vermont Dept of Health (VDH) is providing this document for agency officials (director, chief, training officer, infection control officer, etc.) to inform them of what OSHA requires when an agency implements respiratory protection for its employees • A separate package includes materials for training employees

4. Introduction • The model respiratory protection program (RPP) from VDH should be suitable for an agency using disposable N95 respirators • If an agency wishes to use respirators that are not disposable or are beyond N95, the agency must create its own RPP in accordance with OSHA’s requirements

5. Introduction THE VDH MODEL RESPIRATORY PROTECTION PROGRAM IS INTENDED ONLY FOR AGENCIES USING DISPOSABLE N95 RESPIRATORS

6. Respiratory Protection Program Respiratory Protection Program These are the steps for an agency to implement respiratory protection Medical Evaluation Training Fit Testing Storage, Maintenance, Evaluation, Annual retraining and fit testing, Triennial medical evaluation

7. Respiratory Protection Program • Download the model respiratory protection program (RPP) from VT EMS (www.vermontems.org) • Read the document • Insert the name of your agency in the appropriate blanks • Fill in the other blanks • Modify your agency’s procedures to agree with the plan

8. Medical Evaluation • Determine which physician or licensed health care professional (PLHCP) will evaluate and screen your employees • May be RN, PA, MD, DO • May not be EMT, paramedic, chiropractor, acupuncturist, naturopath • There is to be no cost to the employee • If the PLHCP asks you how to screen people, you should probably look for another PLHCP

9. Medical Evaluation • Provide the PLHCP with a copy of: • OSHA’s respiratory protection standard [1910.134 (e)] • Your agency’s respiratory protection program • Distribute medical questionnaire to employees and allow them to complete it at work

10. Medical Evaluation • DO NOT collect the forms -- they have confidential information • You must provide a means of getting the forms to the PLHCP at no charge to the employee, e.g., envelope with postage • Give the PLHCP copies of the form “Documentation of Medical Evaluation for Disposable N95 Respirator Use”

11. Medical Evaluation • The PLHCP evaluates the employee’s responses on the questionnaire and if necessary examines the employee • The PLHCP completes the “Documentation of Medical Evaluation for Disposable N95 Respirator Use” (fit test form) and gives the original to the employee

12. Medical Evaluation • The employee presents the completed fit test form (NOT the medical questionnaire) to the employer BEFORE being fit tested

13. Training • Before an employee can use an N95, the employee must receive training • At the end of training, the employee must demonstrate knowledge of • Why the respirator is necessary • How improper fit or usage may be harmful • The limitations and capabilities of the device • How to use it in emergencies, including when it malfunctions

14. Training • How to inspect and use the respirator • Procedures for maintenance and storage • How to recognize signs and symptoms that may limit or prevent the effective use of the N95 • The general requirements of the OSHA rule

15. Training • Training must be repeated at least annually and when • Changes occur which make the previous training obsolete, e.g., new model of N95 • It becomes apparent an employee does not have the necessary knowledge or skill • Retraining is necessary to ensure safe use

16. Fit Testing • Either qualitative or quantitative fit testing is acceptable • VDH has qualitative fit test kits available for agencies to borrow • VDH will provide with the kit • Small number of N95s • Saccharin or Bitrex®

17. Post-Implementation • Storage and Maintenance • Annual retraining and fit testing • Triennial medical evaluation • Evaluation of program

18. Post-Implementation • Storage and Maintenance • Store N95s in accordance with the manufacturer’s instructions so they will be • Kept dry, clean and in their original shape • Easily available when needed • Disposable N95s do not require repair, but should be inspected periodically

19. Post-Implementation • Annual retraining and fit testing • Every year, review new developments and other changes • Employees must demonstrate they still have knowledge to use N95s safely • Obtain fit test kit from VDH and repeat fit testing of all employees who may need to use N95

20. Post-Implementation • Triennial medical evaluation • Every 3 years, have each employee complete another medical questionnaire and submit it to a PLHCP for review • PLHCP examines any employee the PLHCP feels needs further evaluation • PLHCP completes documentation of medical evaluation

21. Post-Implementation • Evaluation of program • RPP administrator regularly • Evaluates workplace and potential hazards • Consults employees to identify problems

22. Conclusion • A respiratory protection program must be in place before an agency requires employees to use N95 or other respirators • Consult OSHA’s rules on this subject (CFR 1910.134) • Act in the best interest of your patients and employees

23. Conclusion • For more information: • Vermont Dept of Health • Personal protective equipment: 802-951-0058 • EMS: 800-244-0911 in VT and 802-863-7310 • Vermont Occupational Safety and Health • Project WORKSAFE: 888-723-3937 www.labor.vermont.gov/?tabid=74