Worker Safety in Evacuations

1. Worker Safety in Evacuations OSHA Training Institute – Region IX University of California, San Diego (UCSD) - Extension OSHA Training Institute

2. 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 OSHA Training Institute

3. 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 OSHA Training Institute

4. 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 OSHA Training Institute

5. 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 OSHA Training Institute

6. 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 OSHA Training Institute

7. 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 OSHA Training Institute

8. Secondary Exposure Risks • Technological risk events secondary to a natural disaster are not uncommon. • Examples: Train derailments, refinery damage, major chemical spills all resulting in need to evacuate areas proximal to risk. Photo-credit-FEMA Guam - Burning fuel storage tanks following a typhoon OSHA Training Institute

9. 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 OSHA Training Institute

10. Physical Hazards Potential in Evacuations • Prolonged events can include: • Allergic response from the disturbed environment with increased dust, pollens and other environmental exposures • Exposure to hazardous plants and animals OSHA Training Institute

11. 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 evacuations continue OSHA Training Institute

12. 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 OSHA Training Institute

13. 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

14. 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 equipment, first aid supplies, toiletries, and unanticipated needs Workers find a place to rest OSHA Training Institute

15. 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 OSHA Training Institute

16. Workers’ Stress Signs • Fatigue • Loss of sleep • Gastrointestinal complaints • Difficulty with focus • Reduced performance • Apathy & reduced vigilance OSHA Training Institute

17. 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

18. 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

19. 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

20. 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 OSHA Training Institute

21. 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

22. 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

23. 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

24. Anticipating Road Hazards • Water damage, standing water, skid potentials • Downed power lines and surges OSHA Training Institute

25. Post-Storm Hazards OSHA Training Institute

26. 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

27. 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

28. Serious Injury in Debris Field Electrocution OSHA Training Institute

29. 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

30. Visible Clothing • Light colored clothing or reflective vest or reflective tape applied to clothing sufficient to visualize in subdued lighting FEMA OSHA Training Institute

31. Safety and Clothing • Appropriate clothing to environment, long sleeves and pants to protect skin • Wind resistant clothing and/or rain gear OSHA Training Institute

32. 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

33. 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

34. 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

35. 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

36. 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

37. Patient and Supply Movement • Downed power lines • Limited communications • Limited resources Officer transporting patients from earthquake area with no access by ambulance OSHA Training Institute

38. 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

39. 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

40. 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

41. 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

42. 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

43. 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

44. 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

45. Problems Atypical event and and stressful work situations Potential for insomnia, anxiety, stress Logistical needs Solutions Professional mental health assistance Critical incident stress management Chaplain services Safe sleeping and rest locations. Toilet facilities. Morale boost with showers, laundry access and hot meals Prolonged Evacuations and Care of the Worker OSHA Training Institute

46. 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

47. 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

48. 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

49. 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