OSHA Requirements for First Receivers

ACMP Meeting Las Vegas
OSHA Requirements for First Receivers
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Dean W. Broga, PhD, Medical Physicist
Director of Environmental Health & Safety
VCU/VCU Medical Center Radiation Safety Officer

You and the The Dirty Bomb (RDD)
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Radiation Accidents - Goiania, Brazil
� Three doctors had owned the private Cancer Clinic
simply abandoned the facilities in 1985 leaving the
radiotherapy machine and the building to deteriorate
without windows or doors.
� In September of 1987, scavengers dismantle a metal
canister from a radiotherapy machine at an abandoned
Cancer Clinic.
� Five days later a junkyard worker pried open the lead
canister to reveal a pretty blue, glowing dust:
radioactive cesium-137. Both children and adults
rubbed the "luminous blue powder" on their bodies.
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Radiation Accidents - Goiania, Brazil
� A 6 year old who "rubbed the powder on her body so that she
glowed and sparkled" later ate a sandwich tainted with cesium
powder from her hands; she reportedly received five to six times
the lethal dose [of radiation] for adults.
� The cesium was later parceled out to friends and family, spreading
the contamination from the junkyard to homes around the city,
although mainly contained within a localized area.
� The radioactive substance continued to contaminate the population
for a week before an individual who went to a public clinic was
correctly diagnosed with radiation illness and the authorities
alerted.
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Radiation Accidents - Goiania, Brazil
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1,375 Ci 137 Cs
Fourteen patients developed some degree of marrow
failure, eight developed the clinical signs and symptoms
of acute radiation syndrome (ARS), and four eventually
died of ARS complications.

Contamination Survey
� About 112,000 people (10 % of the total population)
were monitored at the Olympic Stadium using survey
meters
� 250 people were identified as contaminated
� 50 contaminated people were isolated in a camping area
inside the Olympic Stadium for more detailed screening
� 20 people were hospitalized or transferred to special
housing with medical and nursing assistance
� 8 patients transferred to the Navy Hospital in Rio de
Janeiro
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How did we get here?
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SARA Title III Program
Superfund Amendments and Reauthorization Act of 1986
� Planning at State Level
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Virginia Emergency Response Council,
VERC(created in 1987)
� Local emergency planning committees
� The LEPCs must develop a community emergency
response plan (contingency plan) that contains
emergency response methods and procedures to
be followed by facility owners, police, hospitals,
local emergency responders, and emergency
medical personnel.
� Companies must develop Emergency Release
Contingency Plan.

SARA Title III to HAZWOPER
� SARA Title III also directed the Occupational Safety and Health
Administration (OSHA) to establish a comprehensive rule to
protect employee health and safety during hazardous waste
operations, including emergency responses to the release of
hazardous substances.
� Accordingly, OSHA published the Hazardous Waste Operations
and Emergency Response (HAZWOPER) Standard, Title 29,
which became effective in 1990
� President Bush on December 17, 2003 , directive, emergency
management, public health, clinical care, public works, and
other skilled support personnel that provide immediate support
services during prevention, response, and recovery operations
are now defined as First Responders
� July, 2004, OSHA Best Practices for Hospital-based First
Receivers
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HAZWOPER – Medical Personnel
� Medical personnel who are expected to decontaminate victims
or handle victims before they are thoroughly decontaminated
will be provide First Responder Operations Level training
� Operations level training, enables employees to respond
initially to a hazardous substance release and to take
defensive action to protect people, property, and the
environment with emphasis on the use of PPE and
decontamination procedures.
� First responders at the operational level shall have received at
least eight hours of training or have had sufficient experience
to objectively demonstrate competency in the following areas
in addition to those listed for the awareness level and the
employer shall so certify.
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Just in Time Training
� Briefing for Skilled Support Personnel Whose
Participation Was Not Previously Anticipated
� While a “just in time” briefing during the response is
the only required training for these personnel, time and
resource limitations inherent in a crisis likely will
diminish the effectiveness of such training. Thus,
hospitals should diligently consider the broad range of
skills/capabilities that may be required within the
Decontamination Zone during a mass casualty event
and attempt to identify, and train, all persons who may
be called to work in the Decontamination Zone prior to
a mass casualty event.
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Training First Responder Operations Level
� Knowledge of the basic hazard and risk assessment
techniques.
� Know how to select and use proper personal protective
equipment provided to the first responder operational level.
� An understanding of basic hazardous materials terms.
� Know how to perform basic control, containment and/or
confinement operations within the capabilities of the
resources and personal protective equipment available with
their unit.
� Know how to implement basic decontamination procedures.
� An understanding of the relevant standard operating
procedures and termination procedures.
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ODLS Course Content
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� Introduction/Course Content
� Chemical Emergencies
• Biological Emergencies
• Nuclear/Radiological Emergencies
• Selecting PPE
• Donning/Doffing PPE
• General Decontamination Procedures
• HEICS HazMat Decon Team
• Course Summary

Site Specific Training
� The employee should be able to demonstrate competence in
wearing the complete PPE ensemble, including respirator,
protective garment, gloves, boots, and other safety equipment
required for the employee’s role, prior to using the protective
equipment in the workplace.
� First receivers who wear respiratory protection shall be deemed
medically qualified to do so. Employees who wear tight-fitting
respirators also must be properly fit tested.
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Completing Your Training
� Site Specific Training
⑉ Location & types of PPE
⑉ Donning/Doffing real-time
⑉ Decon setup and termination
⑉ HEICS
⑉ Medical Evaluation
⑉ Fit Testing
� Employer Certification
⑉ Didactic materials
⑉ Site Specific Training
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How do you validate what they were
trained if you didn’t train them?
HRSA requires validation.

OSHA Requirements for PPE
The facility must have a current
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� Hazard Vulnerability Analysis (HVA) and
� Emergency Management Plan (EMP)

Hazard Vulnerability Analysis
POTENTIAL
IMPACT
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NUCLEAR
WEAPON
IMPROVISED
NUCLEAR
DEVICE
RADIOACTIVE
MATERIAL
PROBABILITY/LIKELIHOOD
BIOLOGICAL
AGENT
CHEMICAL AGENT
OR TOXIC
INDUSTRIAL
CHEMICAL

EVENT
SCORE
PROBABILITY HUMAN
IMPACT
Likelihood this
will occur
0 = N /A
1 = Lo w
2 = M o de rate
3 = High
Possibility of
death or injury
0 = N/A
1 = Lo w
2 = Moderate
3 = High
HAZARDOUS MATERIALS EVENTS
PROPERTY
IMPACT
Physical losses
and damages
0 = N/A
1 = Lo w
2 = M o derate
3 = High
SEVERITY = (MAGNITUDE - MITIGATION)
BUSINESS
IMPACT
Interruption of
services
0 = N /A
1 = Lo w
2 = M o de rate
3 = High
PREPARED-
NESS
Preplanning
0 = N /A
1 = High
2 = M o de rate
3 = Low or none
INTERNAL
RESPONSE
Time,
effectiveness,
resources
0 = N /A
1 = High
2 = M o de rate
3 = Low or none
EXTERNAL
RESPONSE
Community/
Mutual Aid staff
and supplies
0 = N/A
1 = High
2 = M o derate
3 = Low or none
RISK
Relative threat*
0 - 100%
Chemical Exposure,
/Cloud From External
Source (Fwy, Rail,
Plant, etc)
Hazmat Incident
2 3 2 3 3 3 2 59%
Mass Cas ualty (From
historic events at your
MC with >= 5 victims)
Hazmat Incident
1 3 1 3 3 3 1 26%
Small Size (From
historic events at your
MC with < 5 victims)
1 1 1 1 2 3 2 19%
Large Internal Spill
or Release
1 2 2 1 3 3 1 22%
Radiologic
Exposure, External
1 1 1 1 2 2 2 17%
Radiologic
Exposure, Internal
1 0 1 1 2 2 2 15%
Shelter in Place 1 1 2 3 3 3 2 26%
Small-Medium Sized
Internal Spill
2 1 2 2 3 3 1 44%
Terrorism, Biological 1 3 1 3 3 3 1 26%
Terrorism, Blast 1 2 0 3 3 3 2 24%
Terrorism, Chemical 1 3 2 3 3 3 2 30%
Terrorism,
Radiologic
1 1 1 2 3 3 2 22%
AVERAGE 1.17 1.75 1.33 2.17 2.75 2.83 1.67 27%

HEICS
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Logistic
Chief
Public
Information
Officer
Safety & Security
Officer
Planning
Chief
Hospital
Incident
Commander
Finance
Chief
Liaison
Officer
Operations
Chief

Decon Team Structure
Decon Group
Leader
Directs ops
Assigns teams
Supports
resources
Keeps OSC
Informed.
Ensures
recovery.
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Decon Safety
Officer
Monitors
decon
ops & haz
conditions.
Evals
potential haz.
Has authority
to stop
ops.
Decon Triage
Leader
Triages &
segregates
pts for decon.
Provides airway
management.
Decon Rad
/Chem Monitor
Decon Access
Leader
Directs decon.
Ensures
containment.
Monitors decon
resources.
Decon
Wash/Rinser
Decon Site
Leader
Est.
decon
site. Oversees
decon team
& med eval,
and site
decon.
Decon
Dryer/Dresser
Decon Entry
Leader
Controls
access.
Initial triage.
Est. safe
refuge.
Directs gross
decon.
Decon
Stripper/Bagger

Decontamination Plan
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Scale of Events
� 5 - 50 - 500 - 5,000 Victims
� Liability varies with numbers
� Capabilities varies with numbers
� Risk varies with number
� Increase numbers stress personnel and resources
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PPE for Healthcare Workers
� Chemical resistant suit -
APF 20
� Gloves
• inner - Nitrile
• outer – Butyl
� Boots - rubber
� PAPR - APF 1000
� All seams taped
(APF) assigned protection factor
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Level C

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Radiation/HazMat Level 1 Response
DTL
DAL
DSL
Police/Security

Deployment - Decon Tent
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Shower Heads
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Decon Tent Layout
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Decon Deluge Shower
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Decon Deluge Shower
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Decon Deluge Shower
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Decon Deluge Shower
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Patient Decon Procedure
� Patients will:
• quickly rinse themselves from head to
toe with water from hand-held sprayer,
garden hose, or shower head
• wash body in a systematic fashion using
body bath, shampoo, and nail brush
found in kit
• clean open wounds, if applicable
• wash body from head to toe
continued on next page
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Patient Decon Procedure
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continued from previous page
• wash for:
• 5 minutes when agent is non-persistent
• 8 minutes when agent is persistent or
unknown
• if necessary, use topical eye anesthetic for
effective eye irrigation
� Discourage patients from rubbing too vigorously
when washing

Patient Decon Procedure
� Observe each patient to ensure they wash their entire
body, paying special attention to the axilla, creases,
folds and hair, as well as under ID bracelet
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• offer help as necessary
� Once washing is complete, patients will:
• thoroughly rinse themselves again for 1 minute
• obtain their respective post-decon kit

Patient Decon Procedure
� To begin rinse/wash/rinse procedure for non-ambulatory
patients, place patient on backboard, EMS stretcher on a
saw-horse-type device or mechanical feeder.
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Decon Deployment Issues
� Expected patient load
• ambulatory
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• non-ambulatory
� Patient through-put limitations
• Maximum capacity of decon corridor(s)
• expected decon time per patient
• 7-10 min
• Establish the hourly limit
� Establishment of Safe Refuge Area(s)

Pre-Decon Kit
pre-decon kit contains:
− white modesty
garment
− personal effects bag
− all weather pen
− nail brush
− shampoo and body
bath
− contaminated clothing
bag
− snap-on ID bracelet
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Decon Support Issues
� Based on expected patient load and through-put:
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• staff rotation needs (15-20 min)
• additional decon supplies
• holding areas for decontaminated green patients
• decon and reuse of critical materials
− PAPR
− batteries
− boots

Money Talks – Nobody Walks
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HRSA Funding - Virginia
Year State Region
VCU
Medical Center
FY02 $3,078,980 $381,627 $95,339
FY03 $11,762,695 $1,947,792 $275,210
FY04 $12,090,053 $1,927,470 $216,878
FY05 $11,701,905 $1,879,139 $208,938
Total $38,633,633 $6,136,028 $796,365
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You will most likely be involved.
� You need didactic training
� You need site specific training
� You need to know how to Don and Doff
� You need to know how to use a PAPR
� You need to work with you hospital Emergency
Planning Committee to ensure they understand the
limitation of what your facility can do with the
instruments, personnel and materials they have.
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