OSHA Regulations & Legal Issues for Evacuation of Health Care Facilities

1. OSHA Regulations & Legal Issues for Evacuation of Health Care Facilities OSHA Training Institute – Region IX University of California, San Diego (UCSD) - Extension OSHA Training Institute

2. 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. OSHA Training Institute

3. 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 OSHA Training Institute

4. OSHA 29 CFR 1910 • General Industry Requirements for Emergency Response and Preparedness • Includes general requirements for exit routes • Medical & First Aid • Alarms • Emergency Action Plans (EAP) OSHA Training Institute

5. 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” OSHA Training Institute

6. General Requirements (cont) • Medical services & first aid • Fire extinguishers • Employee alarm systems • “distinctive and perceivable…for emergency action or safe evacuation” OSHA Training Institute

7. 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 OSHA Training Institute

8. 1910e During an Evacuation • Employees must know: • Type of evacuation • Their role in evacuation • ‘Safe Areas’ in Plan • Fire Walls, Open Spaces • Training • Evacuation Wardens scheduled during working hours (1:20) • Practice evacuation routes OSHA Training Institute

9. 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 OSHA Training Institute

10. OSHA: Evacuation Planning Matrix • Worksite Risk Assessment List (DHS) • HazMat • Provision of essential services • High pedestrian traffic volume • Limited means of egress • High profile site • Part of transport system • www.llr.state.sc.us.workplace/Full%20Report.pdf OSHA Training Institute

11. OSHA: Evacuation Planning Matrix • Developed in response to terrorist attacks • Help assess risk of being a target • Risk based on: • Workplace Vulnerabilities • Recognized Threat • Anticipated Consequences • Specifics for your EAP • Safety & Security considerations OSHA Training Institute

12. 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… OSHA: Emergency Preparedness Guidelines for Floods OSHA Training Institute

13. 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 OSHA: Emergency Preparedness Guidelines (cont) OSHA Training Institute

14. Other Regulations • FEMA • NIMS • PETS Act • OES • NIOSH • The Joint Commission (formerly JCAHO) • DHHS OSHA Training Institute

15. 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. OSHA Training Institute

16. NIMS • Nationwide, standardized approach to incident management and response • Developed by Homeland Security at the request of the President – Homeland Security Presidential Directive—5. OSHA Training Institute

17. 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. OSHA Training Institute

18. NIMS Directive for States, Local Agencies and Tribes State/local/tribes should: • Complete NIMS Awareness Course – IS 700 • Formally adopt NIMS principles and policies • Establish a NIMS compliance baseline • Develop a timeframe and strategy for full NIMS implementation • Institutionalize use of the Incident Command System OSHA Training Institute

19. NIMS Requirements for States States are required to: • Incorporate NIMS into existing training programs and exercises • Ensure that federal preparedness funding supports state, local, and tribal NIMS implementation • Incorporate NIMS into Emergency Operations Plans • Promote intrastate mutual aid agreements • Coordinate and provide NIMS technical assistance to local entities OSHA Training Institute

20. 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. OSHA Training Institute

21. 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. OSHA Training Institute

22. 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 them • 61 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 OSHA Training Institute

23. 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 OSHA Training Institute

24. Office of Emergency Services (OES) • Emergency Services Act • State 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 OSHA Training Institute

25. National Institute of Occupational Safety and Health (NIOSH) • Emergency Management Guide for Business & Industry • Alarm Systems • Hurricane Response OSHA Training Institute

26. The Joint Commission (formerly JCAHO) • EAP • Assignment of staff • Evacuation procedures • Patient transfers • Communications • Utilities—Sentinel Event alert • Drill requirements OSHA Training Institute

27. 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 OSHA Training Institute

28. Good Samaritan Laws, Etc. • Good Samaritan Laws in all states • The US Volunteer Protection Actof 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 OSHA Training Institute

29. 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. OSHA Training Institute

30. 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. OSHA Training Institute

31. Legal Issues • Certain states can require staff designated as “Emergency Service Personnel” to stay at work during an general evacuation order • Employer must provide adequate emergency shelter • Legal cases from Katrina • Neglect • Euthanasia OSHA Training Institute

32. 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” OSHA Training Institute

33. Summary • Need to have specific procedures for evacuation for your facility • Emergency Action Plan • Need to include provisions for pets • Laws providing for immunity when responding in a disaster situation • Can vary by State OSHA Training Institute

34. 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 OSHA Training Institute

35. 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 OSHA Training Institute

36. 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 OSHA Training Institute