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					             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
                           OSHA Training Institute                   8
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
                     OSHA Training Institute   10
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
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.
                     OSHA Training Institute   13
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
                        OSHA Training Institute                     14
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


                 OSHA Training Institute    17
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
                      OSHA Training Institute       18
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

          OSHA Training Institute                19
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
                       OSHA Training Institute   21
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
                      OSHA Training Institute         22
Anticipating Road Hazards
   Expect change in
    roadways
   Destroyed or
    missing signage
   Damaged lighting
    and traffic signals
   Soft road
    shoulders
    and missing or
    damaged
    guardrails
                          OSHA Training Institute   23
Anticipating Road Hazards
   Water damage, standing water, skid
    potentials
   Downed power lines and surges




                     OSHA Training Institute   24
Post-Storm Hazards




           OSHA Training Institute   25
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
.

                  OSHA Training Institute    26
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

                      OSHA Training Institute   27
Serious Injury in Debris Field
Electrocution




             OSHA Training Institute   28
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
                      OSHA Training Institute   29
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



             OSHA Training Institute                   31
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

                      OSHA Training Institute   32
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
                       OSHA Training Institute         33
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
                       OSHA Training Institute   34
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.
             OSHA Training Institute                      35
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
            OSHA Training Institute              36
Patient and Supply Movement
                              Downed power lines
                              Limited communications
                              Limited resources




Officer transporting
patients from earthquake
area with no access by
ambulance                                               37
                      OSHA Training Institute
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

                   OSHA Training Institute    38
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
                       OSHA Training Institute   39
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
                       OSHA Training Institute      40
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
                      OSHA Training Institute   41
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
                       OSHA Training Institute             42
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


                     OSHA Training Institute   43
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!
                      OSHA Training Institute       44
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
                   OSHA Training Institute                   45
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


                   OSHA Training Institute       46
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



                         OSHA Training Institute               47
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
                 OSHA Training Institute   48
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
                       OSHA Training Institute       49

				
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