June 7, 1991

Ms. Dalena Berrett
Loss Control Coordinator
HCA Parthenon Insurance Company
One Park Plaza, Post Office Box 550
Nashville, Tennessee 37202-0550

Dear Ms. Berrett:

This is in response to your inquiry of February 21 concerning the Occupational Safety and Health Administration's (OSHA) Hazardous Waste Operations and Emergency Response final rule (29 CFR 1910.120). Please accept my apology for the delay in this reply.

Your specific question relates to the responsibilities for hospitals to comply with the Hazardous Waste Operations Emergency Response (HAZWOPER) standard (1910.120) "taking into consideration the types of chemicals found in the hospitals and the use of the fire department for emergency response." Hospitals are not specifically exempted from coverage under 1910.120.

After considerable review OSHA interprets the scope of 1910.120 to cover hospitals in at least three scenarios; 1) when hospitals have an internal release of a hazardous substance which requires an emergency response, 2) when hospitals respond as an integral unit of a community-wide emergency response to a release of hazardous substance and, 3) if a hospital is a RCRA permitted Treatment, Storage and Disposal Facility.

The first scenario, albeit rare, includes the accidental release of hazardous substance within a hospital, that requires an emergency response. Incidental releases that can be safely handled by the workers who spilled the substance are not considered emergency responses and therefore are not covered under 1910.120. However, other training requirements, such as those found in the Hazard Communication Standard (1910.1200) would apply.

Spills or releases inside a hospital that require emergency response are covered in paragraph (q) of 1910.120. There are several different levels of training required for emergency responders. The level of training required is a function of the responsibilities the individual will assume during an emergency response.

It is pertinent to note that the definition of "hazardous substance" used in the standard was corrected on April 13, 1990 to include;

"(B) any biological agent and other disease causing agent which after release into the environment and upon, exposure, ingestion, inhalation, or assimilation into any person, either directly from the environment or indirectly by ingestion through food chains, will or maybe anticipated to cause death, disease, behavioral abnormalities, cancer, genetic mutation, physiological malfunctions (including malfunctions in reproduction) or physical deformations in such persons or their offsprings."

Therefore hospitals must include medical wastes in their effort to comply with paragraph (q) of HAZWOPER.

Your letter mentions the use of the fire department in the event of an emergency. The employer may enlist outside assistance in the event of an emergency. However, the assistance of outside emergency responders should be coordinated in the emergency response plan prior to an emergency response incident. There are other requirements of the plan such as designating personnel roles, the "senior official" and lines of authority. The emergency response plan may include evacuation procedures for employees and patients and may be a part of the hospital's internal disaster plan.

The second scenario covers hospitals in their role as a part of a community wide emergency response to the release of a hazardous substance. Under the Superfund Amendments and Reauthorization Act of 1986, Title III, communities must prepare an emergency response action plan. It is mandated by the statute that the local hospital participate in the planning process.

If the community emergency response plan identifies a hospital as having decontamination facilities in the event of an emergency, designated hospital personnel must have emergency responder training as outlined in 1910.120 paragraph (q). The level of training required for a particular individual depends on the role he or she will be expected to play in the event of an emergency response. However, the designated hospital employee who will set up and operate the decontamination facility must have at least first responder operations level training.

Although, hospitals that may be involved in emergency response are required to designate emergency responders and train them accordingly, other hospital personnel that may have to enter the decontamination area may not have to be trained as emergency responders. There is an exception to paragraph (q) training requirements for "skilled support personnel." These employees are not required to have had emergency responder training, however, they must be given an initial briefing at the time of the incident, including instruction in the wearing of appropriate personal protective equipment, what chemical hazards are involved and what duties are to be performed. This category might include emergency room personnel as well as doctors and technicians.

Hospitals that employ emergency medical service personnel (i.e. ambulance personnel) may be required by paragraph (q) to train these personnel depending on the role they will be expected to play in the event of a hazardous substance release incident.

The third scenario involves hospitals that are RCRA permitted Treatment, Storage and Disposal Facilities (TSDF) for hazardous waste. If a hospital has a RCRA permitted facility, the employees working at that facility (the TSD facility, not the entire hospital) must be trained in accord with 1910.120 paragraph (p).

As you may be aware, the state of Tennessee administers its own occupational safety and health program under the provision of the Occupational Safety and Health Act of 1970. If you wish to contact them the address and phone number are: Tennessee Department of Labor, 501 Union Building, Suite A - 2nd floor, Nashville, Tennessee, 37219, (615)-741-2582.

To further assist you with the training requirements under this standard, I have enclosed a copy of the following OSHA article, "Hazardous Waste Operations and Emergency Response: A Closeup Look at Training".

I hope this information is helpful. If you have any further questions please contact MaryAnn Garrahan at (202) 523-8036.

Sincerely,



Patricia K. Clark, Director
Directorate of Compliance Programs

Enclosure



February 21, 1991

Mary Anne Garrahan
Industrial Hygienist
OSHA OFFICE OF COMPLIANCE
DEPARTMENT OF LABOR
200 Constitutional Northwest Avenue
OSHA N 3469
Washington, DC 20210

Dear Mary Anne:

As I discussed with you on the telephone recently, I would like to request a written interpretation from OSHA regarding the responsibility for hospitals to comply with the HAZWOPER (1910.120) standard. Taking into consideration the types of chemicals found in the hospitals and the use of the fire department for emergency response, are the educational requirements mandated for hospital personnel?

Your attention and response is greatly appreciated. The Risk Management Department functions as a resource for over 100 hospitals. Please consider as soon as possible.

Sincerely,



Dalena Berrett
Loss Control Coordinator