Worker Safety
in Evacuations
OSHA Training Institute – Region IX
University of California, San Diego (UCSD) - Extension
OSHA Training Institute 1
Objectives
Understand the alternative environments
in which employees may need to work to
accomplish evacuations
Identifying risk reduction opportunities for
rescuers in evacuations
Cite practical solutions to reduce work risk
in evacuations
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Occupational Risk
Occupational risk is part of every
evacuation procedure
Worker safety may be overlooked in the
effort to prepare for and respond to victim
needs
Serious injury to a worker during an
evacuation procedure can devastate co-
workers’ ability to function
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Safety First
Employees faced with evacuating others
are themselves victims of the event
Unsafe actions will jeopardize both the
workers and the individuals being
evacuated
Environmental factors will greatly affect
the safety and the procedures impacting
evacuations
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Risk for Workers in Evacuations
Evacuations occur in environments that
are damaged or threatened
There is likely to be increased risk directly
related to the environment especially when
evacuations occur after the event
Pre-event evacuations may have less
environmental risk but can be equally
exhausting, physically and emotionally
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Evacuations Outside the Facility
Many facilities have plans for vertical and
lateral evacuations; fewer have designated
sites and plans for relocation
Evacuations that include field response
have additional potential for hazardous
exposures and require alert, careful
planning and operations
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Environmental Hazards and
Potential Exposure
Risks: chemical spills or flammables, asbestos,
disturbed building components, electrical
hazards and sewage in evacuations, sunburn,
wind or cold exposure
Disturbed environments with potential for
increased insects, wild animals, and lost
domestic animals
Household animals may approach humans but
may be stressed, reactive or aggressive
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Secondary Exposure Risks
Technological risk
events secondary to
a natural disaster are
not uncommon.
Examples: Train
derailments, refinery
damage, major
chemical spills all
Photo-credit-FEMA resulting in need to
evacuate areas
Guam - Burning fuel storage proximal to risk.
tanks following a typhoon
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Physical Hazards Potential in
Evacuations
The physical environment
may be grossly altered and
usual lighting marginal or
non existent. Increased risk
for:
Slips and falls
Puncture wounds from nails
and debris
Eye and inhalational injuries
from dust, wind, smoke, and
debris
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Physical Hazards
Potential in Evacuations
Prolonged events can
include:
Allergicresponse from the
disturbed environment with
increased dust, pollens
and other environmental
exposures
Exposure to hazardous
plants and animals
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Evacuating Victims and Pets
Victims will come to
facilities with pets
Evacuation may need
to include pets and
service animals
Stray or lost animals
may become a risk as
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evacuations continue
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Stresses Faced by Workers in
Evacuations
Lack of preparedness
Living situation altered
Psychological / emotional toll
Medical needs for victims and possibly the
workers
Safety and crisis management needs
Concerns about family and home safety
Stress on workers family and friends
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Safety and Prolonged Hours
Potential for long shifts
Minimal or inadequate breaks
Change in shift adjustment. Day to night
rotation is preferable
Physician describes
destruction and damage to
the ED during a typhoon
and attempts to evacuate
patients and staff.
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Worker Support in Prolonged
Evacuations Management must
provide care for the
worker during the
duration of the
evacuation
Safe place for rest
Potable water
Re-supply of food,
water, evacuation
Workers find a place to rest equipment, first aid
supplies, toiletries, and
unanticipated needs
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Risk in Austere Environments
Contaminated food
and water are not
unlikely results in
natural disasters
Immediate planning is
required to anticipate
the need for fresh
supplies to maintain
workers and victims in
evacuation situations
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Workers’ Stress Signs
Fatigue
Loss of sleep
Gastrointestinal
complaints
Difficulty with focus
Reduced performance
Apathy & reduced
vigilance
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Work Cycle in Prolonged
Evacuations
Schedule rotations - Days to evening to
nights
Quiet, unobserved space for rest away
from victims’ view
Meals, companionship, separate respite
areas for responders
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Solutions
Training in Safety Awareness
Drills with real people, not just on paper
Review of safety points at the time of evacuation
Assignment of a Safety Officer
Frequent briefings and information for staff
Sign in and sign out procedure
Proper gear available for distribution
Ability to be self sustaining in situations
Regular accountability for staff
Follow-up up plan following demobilization
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Teamwork and Buddy Systems
Use of a buddy
system to account for
all the team members
on a regular basis for
on-and off-duty
periods
Buddies provide
emotional support
and look out for each
other
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Communication Tools and other
Essentials in Evacuations
Staff sent to accompany patients to another site
should be provided with essentials:
Communication devices (radio, cell phones,
back up batteries and recharging devices)
Papers, pens
Phone numbers (supervisor, facilities,
security, field office, numbers of other
evacuation team members)
Money – small bills and change
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Know the Region
Number and location for local
medical support and emergency
system
Maps
Security locations
Highway patrol contact
Major infrastructure status in area
such as open airports, hospitals,
arenas, etc
Difficult evacuations may require
escort or convoy
Know evacuation routes
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Anticipate Communication Loss
Damaged Communication
Towers from High Winds
Overloaded circuits
Interrupted service
Provide evacuating workers with a plan in case
they are not able to use communication tools
Evacuating teams should report back
observations, road conditions, isolated persons
or animals needing assistance
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Anticipating Road Hazards
Expect change in
roadways
Destroyed or
missing signage
Damaged lighting
and traffic signals
Soft road
shoulders
and missing or
damaged
guardrails
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Anticipating Road Hazards
Water damage, standing water, skid
potentials
Downed power lines and surges
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Post-Storm Hazards
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Driving Safety
Drive defensively
Use headlights full time
Anticipate fatigue in other drivers and
yourself
Be prepared for unfamiliar roadways,
detours, damaged roads and the potential
for unfamiliar road rules across state lines
.
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Convoys Responding to
Hurricane Evacuations
Evacuations often
require additional
vehicles. Familiarize
the worker with the
vehicle they may
drive during an
evacuation
GPS may be helpful
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Serious Injury in Debris Field
Electrocution
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Personal Protective Equipment in
Field Evacuations
Water resistant
Boots (steel toe
and shank)
Hard hat
Goggles/safety
glasses with side
shields
Dust mask
Hearing protection (ear plugs or muffs)
Leather gloves and water resistant gloves
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Visible Clothing
Light colored clothing
or reflective vest or
reflective tape applied
to clothing sufficient
to visualize in
subdued lighting
FEMA
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Safety and Clothing
Appropriate clothing
to environment,
long sleeves and
pants to protect skin
Wind resistant
clothing and/or rain
gear
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Additional Equipment & Safety
Items
Flashlights or headlamps
Sunscreen & lip balm
Antibacterial wipes and alcohol hand gel
Adequate food and water
Personal medications
Over the counter medications (such as
ibuprofen, aspirin, antacids, etc)
Personal first aid supply
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Victim Interactions
Rescuers may need to work with victims who
are anxious, confused, hostile
Assess the situations
Speak quietly, calmly and maintain safe
distance between yourself and an openly
hostile situation.
You are there to help evacuate, but injury to
yourself will only delay or or increase the risk
to others
Seek assistance if needed
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Movement and Transportation
Workers using litters or
hand carries in
evacuation may not have
proper training nor
experience
Most hospital
evacuations are done by
staff who did not have
physical assessment for
prolonged and heavy
lifting yet may do so in an
evacuation
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Smaller Facilities and Clinic
Surge of Victims
Victims may go to
clinics for help and
require evacuation
Long periods of time
may occur before road
conditions are managed
and evacuation must be
attempted in unusual
circumstances
Physician at earthquake site and
evacuating victims from remote
clinics.
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Fuel Resupply in Evacuations
Fuel sources may be
limited
Plan for alternative
sources
A Memorandum of
Agreement (MOA) for
pre-arranged access to
city, county or depot
fuel resources can be
activated in an
evacuation
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Patient and Supply Movement
Downed power lines
Limited communications
Limited resources
Officer transporting
patients from earthquake
area with no access by
ambulance 37
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Patient and Supply Movement
Solutions
Hospitals can prepare for anticipated
events by calling 72 hours before event
requesting bulk supply from usual vendors
Alternative routes or methods of delivery
should be preplanned
Facilities may need to shelter in place until
evacuations can be accomplished
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Body Fluid Exposures
Exposure to blood or body
fluid is a potential during
evacuation procedures
Prepare victims for
evacuation by
securing lines, emptying
body fluid bags, securing
dressings, thereby reducing
potential of wound opening
or active bleeding during
movement
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Body Fluid Exposures
Personal Protective Equipment (PPE) should
be available and transported with patients in
evacuations
Products include
Gloves
Face shields or goggles
Masks
Alcohol gel
Wash immediately if exposed or use alcohol
hand gel
Report the exposure without delay
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Exposures in Austere
Circumstances
Know what actions to
take if a staff member
sustains a needlestick
or exposure to blood or
body fluid through an
open wound
Notify supervisors of
any such exposures
Arrange for possible
prophylaxis
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Post-exposure Prophylaxis
(PEP)
Prophylaxis may be difficult to obtain
during crisis periods of evacuations
“Small hospitals and other settings may
not have PEP in stock”
Rapid HIV testing of the source patient
may not be possible or feasible
R. H. Goldschmidt MD, Director of the National
HIV/AIDS Clinicians’ Consultation Center, University
of California at San Francisco
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Decontaminating Environment
If evacuation devices,
vehicles, boots and clothing
are contaminated, clean with
10% bleach and water
solution or other hospital
germicidal listed as
appropriate to kill HIV and
hepatitis
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Communication Overload in
Evacuation Situations
USS Cole: Families saw newscasts well
before Navy could confirm anything
WTC: World saw horrific events over & over
again with inability to confirm safety of loved
ones
On site responders frequently know less of total
picture than those watching the news
In chaotic events “news is conflicting” but “no
news” starts rumor mills that travel fast!
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Prolonged Evacuations and
Care of the Worker
Problems Solutions
Atypical event and Professional mental health
assistance
and stressful work
Critical incident stress
situations management
Potential for Chaplain services
insomnia, anxiety, Safe sleeping and rest
stress locations. Toilet facilities.
Morale boost with showers,
Logistical needs laundry access and hot
meals
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Responder Care
Observation of patterns of change
Dependence on buddy reporting
Requirement that all injuries or illness are
reported early
Avoidance of drugs & alcohol
Challenges of co-existence & personal
restrictions in austere situations
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Psycho-social Impact
Prolonged hours
Fatigue
Loss of focus
Sleep disturbance
Stress
Acceptance of consequences of events that may result
in loss of life, significant injures or mass destruction
Need to understand normal reaction to abnormal
situations
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Conclusion:
What is Important in the Safety for
the Worker in Evacuations?
Training before and during the evacuation
Training that enables the worker to react
correctly, swiftly, and automatically.
Effective use of command and control.
Flexibility and ability to adapt
Attention to the physical and emotional
wellness of the responder
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References
AHC Media LLC. Rapid response lowers HIV
needlestick risk. In Hospital Health Vol. 26, No.1.
Jan. 2007
Hayashi KE, Bailey RE, Moser C, Potter BB.
Attack on the Cole: Medical Lessons Learned.
Naval Institute Proceedings.
http://www.usni.org/Proceedings/Articles02/PRO
Berggren, Ruth. Perspective Unexpected
Necessities -- Inside Charity Hospital. N Engl J
Med 2005 353: 1550-1553
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