OSHA Regulations & Legal Issues for Evacuation of Health Care Facilities

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

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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
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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)

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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

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General Requirements (cont)

• Medical services first aid
• Fire extinguishers
• Employee alarm systems
• distinctive and perceivablefor emergency action
  or safe evacuation

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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

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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 (120)
• Practice evacuation routes

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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

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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/Full20Report.pdf

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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

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OSHA Emergency Preparedness Guidelines for Floods

• Types Dam/levee failure, flash, coastal, river
• Public Warnings Flood Watch,
  Warningactivate 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

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OSHA Emergency Preparedness Guidelines (cont)

• 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

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Other Regulations

• FEMA
• NIMS
• PETS Act
• OES
• NIOSH
• The Joint Commission (formerly JCAHO)
• DHHS

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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.

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NIMS

• Nationwide, standardized approach to incident
  management and response
• Developed by Homeland Security at the request of
  the President Homeland Security Presidential
  Directive5.

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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.

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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

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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

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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.

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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.
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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

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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

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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

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National Institute of Occupational Safety and
Health (NIOSH)

• Emergency Management Guide for Business
  Industry
• Alarm Systems
• Hurricane Response

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The Joint Commission (formerly JCAHO)

• EAP
• Assignment of staff
• Evacuation procedures
• Patient transfers
• Communications
• UtilitiesSentinel Event alert
• Drill requirements

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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

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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

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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.

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ESAR-VHP System Aims

• Readily available verifiable information about
  the volunteers 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.

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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

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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 law94 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

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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

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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

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References

• Pesik N, Keim ME, Iserson KV. Terrorism and the
  Ethics of Emergency Medical Care. Annals of
  Emergency Medicine. 2001. 37642646.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/ev
  ac.html

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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/emergencypreparedn
  ess/guides/index.html