OSHA by yaofenji


									             Worker Safety
             in Evacuations

OSHA Training Institute – Region IX
University of California, San Diego (UCSD) - Extension

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 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
 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
 Environmental factors will greatly affect
  the safety and the procedures impacting
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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
   The physical environment
    may be grossly altered and
    usual lighting marginal or
    non existent. Increased risk
     Slips and falls
     Puncture wounds      from nails
      and debris
     Eye and inhalational injuries
      from dust, wind, smoke, and
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Physical Hazards
Potential in Evacuations
   Prolonged events can
     Allergicresponse from the
      disturbed environment with
      increased dust, pollens
      and other environmental
     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
               QuickTime™ and a
      TIFF (Uncompressed) decompre ssor
         are neede d to see this picture.

                                                              evacuations continue

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Stresses Faced by Workers in
 Lack of preparedness
 Living situation altered
 Psychological / emotional toll
 Medical needs for victims and possibly the
 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
                                             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
   Difficulty with focus
   Reduced performance
   Apathy & reduced

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Work Cycle in Prolonged
 Schedule rotations - Days to evening to
 Quiet, unobserved space for rest away
  from victims’ view
 Meals, companionship, separate respite
  areas for responders

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   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
                           Buddies provide
                            emotional support
                            and look out for each

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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
   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
   Destroyed or
    missing signage
   Damaged lighting
    and traffic signals
   Soft road
    and missing or
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Anticipating Road Hazards
   Water damage, standing water, skid
   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
 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
   GPS may be helpful

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Serious Injury in Debris Field

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Personal Protective Equipment in
Field Evacuations
   Water resistant
    Boots (steel toe
    and shank)
   Hard hat
   Goggles/safety
    glasses with side
   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


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Safety and Clothing
                              Appropriate clothing
                               to environment,
                               long sleeves and
                               pants to protect skin
                              Wind resistant
                               clothing and/or rain

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Additional Equipment & Safety
   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
   Most hospital
    evacuations are done by
    staff who did not have
    physical assessment for
    prolonged and heavy
    lifting yet may do so in an
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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
                       Physician at earthquake site and
                       evacuating victims from remote
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Fuel Resupply in Evacuations
                            Fuel sources may be
                            Plan for alternative
                            A Memorandum of
                             Agreement (MOA) for
                             pre-arranged access to
                             city, county or depot
                             fuel resources can be
                             activated in an
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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
 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
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Body Fluid Exposures
   Personal Protective Equipment (PPE) should
    be available and transported with patients in
   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
   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
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Post-exposure Prophylaxis
 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

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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
     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
  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
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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

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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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   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.
   Berggren, Ruth. Perspective Unexpected
    Necessities -- Inside Charity Hospital. N Engl J
    Med 2005 353: 1550-1553
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