December 02, 2002

Captain Kevin J. Hayden
Acting Commanding Officer
State of New Jersey
Emergency Management Section
Department of Law and Public Safety
PO Box 7068
West Trenton, NJ 08628-0068

Dear Captain Hayden:

Thank you for your May 7 letter to Occupational Safety and Health Administration's (OSHA's) Directorate of Technical Services. Your letter was forwarded to the Directorate of Enforcement Programs to answer your emergency response related questions. This letter constitutes OSHA's interpretation only of the requirements discussed and may not apply to any question not delineated within your original correspondence.

You had questions concerning training and personal protective equipment (PPE) requirements under the Hazardous Waste Operations and Emergency Response (HAZWOPER) standard for hospital employees who may have to decontaminate patients exposed to biological, chemical, or nuclear agents resulting from a weapon of mass destruction incident. You state that in such an incident, many ambulatory victims/patients would be self-referrals to hospitals, while decontamination and treatment of highly contaminated, non-ambulatory victims/patients would begin at the scene of the incident. Your questions and our responses are listed below.

Question 1: Since decontamination will occur in an open-air environment outside the hospital's emergency department, could Level C respiratory protection be used instead of Level B as described in the HAZWOPER standard?

Response: OSHA does not require hospital staff members who decontaminate patients to wear Level B respiratory protection (positive pressure, full-facepiece self-contained breathing apparatus (SCBA), or positive pressure supplied air respirator with escape SCBA). The requirement to wear positive pressure self-contained breathing apparatus in 29 CFR 1910.120(q)(3)(iv) applies to employees under an Incident Command System who are engaged in emergency response with the intent of handling or controlling the release. These employees respond to areas proximate to the point of release where exposure to inhalation hazards is anticipated.

In contrast, hospital staff members who decontaminate a patient at the hospital are removed from the site of the emergency and the point of release. Normally, these personnel do not need to be trained or equipped for the same level of control, containment, or confinement operations as required for the hazardous materials (HAZMAT) team. Potential exposures to hospital staff usually result from proximity to, or contact with a patient whose skin and/or clothing may be contaminated. The hospital staff's personal protective equipment must be sufficient for the type and exposure levels an employee can reasonably anticipate from such incidents. Anticipated exposures are likely to include airborne or absorption hazards from a patient whose skin or clothing has come in contact with hazardous liquids or has been contaminated with hazardous particles.

Emergency response planning therefore, includes selection of PPE based on worst-case employee exposure scenarios. PPE selection should be based on the hospital's role in community emergency response evaluation.

Question 2: Since a majority of the victims/patients will be self-referrals and will be going to the hospital "on their own," how badly contaminated are they? If they can travel to the hospital wearing no respiratory protection, would not a hospital employee wearing Level C respiratory protection be better protected than the victims/patients?

Response: Depending on the contaminant present and the type of Level C respiratory protection provided (full-face or half-mask, air purifying respirators), a hospital employee wearing an air purifying respirator (APR) may be adequately protected. APRs are appropriate when the types of airborne substances are known and the worse case exposure estimates have been calculated for such events. For example, when preparing for an industrial chemical emergency response where an MSDS for a particular chemical substance is available, a hospital can select APRs to protect employees from being over exposed when decontaminating patients at the hospital. However, this may not be the case for a response to unknown biological, chemical, or nuclear agents resulting from a weapon of mass destruction incident.

There is no clear answer to how contaminated a victim may be if he/she is a self-referral, and OSHA certainly cannot predict the levels or severity of these types of exposures. Some types of nuclear/chemical contaminants can kill quickly. Also, biological agent contamination may not be recognized when a victim arrives at a hospital because of the delay between the incident and the onset of symptoms. As a result, we are obviously unable to provide an absolute response to this concern.

Question 3: Should all the competencies listed for First Responder Operations Level training be met for hospital employees or could the minimum 8-hour course concentrate on personal protective equipment and contamination? For example, must a hospital employee know basic hazard and risk assessment techniques including placard recognition?

Response: HAZWOPER is a performance-based regulation allowing employers flexibility in meeting the requirements of the regulation, although the level and type of training is to be based on worst-case scenarios. Generally, all the competencies listed in 29 CFR 1910.120(q)(6)(ii) should be met for hospital employees trained to the First Responder Operations Level designated to decontaminate victims. The competencies may be tailored to fit the tasks the employees are expected to perform.

For instance, placard recognition is not required as a basic hazard and risk assessment technique. The ability to identify placards is important for a HAZMAT team, but not for hospital personnel designated to perform decontamination. Employees who will decontaminate patients must be trained to identify when a hazardous substance is present. They should also receive training on identifying potential contaminants so that the correct decontamination methods are used, selecting proper PPE, controlling the spread of further contamination, and properly handling decontamination chemicals. Employees need to know their capabilities and limitations so they can determine when their training and equipment is not adequate to handle a situation.

Question 4: Are all hospitals nationwide preparing to equip and train their employees in the donning of Level B respiratory protection? It is our understanding that there are hospitals in other states that equip their employees with only Level C respiratory protection.

Response: We are unaware of what types of preparation hospitals are taking for emergency responses to such incidents. As previously stated, depending on the expected response by a hospital, Level C personal protective equipment may be appropriate.

Question 5: Does Level B respiratory protection exclude the supplied air hood?

Response: The personal protective equipment protection levels described in Appendix B of 29 CFR 1910.120 are guidelines that an employer may use to begin the selection of appropriate PPE. PPE must be selected which will protect employees from the specific hazards that they are likely to encounter during their work. If a hood type respirator offers sufficient protection for the task or potential emergency, then such a protective measure is acceptable.

Under 1910 Subpart I, the employer must perform a hazard assessment to select appropriate personal protective equipment for the hazards that are present, or likely to be present, including foreseeable emergencies. The hazard assessment must be in the form of a written certification as described in 29 CFR 1910.132(d)(2). In addition, the employer must include procedures for selecting respirators in the written respiratory protection program as described in 29 CFR 1910.134(c). Hospital employees who are trained to the HAZWOPER First Responder Operations Level must be trained to know how to properly select and use the proper PPE that is provided to them.

Please be aware that our reply addresses Federal OSHA standards and applies to employers under Federal OSHA's jurisdiction. Federal OSHA has no jurisdiction over state and local government employees, such as the public employees of a state-owned hospital. The OSHAct does, however, encourage States to assume responsibility for their own occupational safety and health programs under plans approved by the U.S. Department of Labor. Such plans must extend coverage to State and local government employees. Twenty-three (23) States operate programs that cover both private and public sector employees. Three (3) States, including New Jersey, operate programs that are limited in scope to state and local government employees. (In New Jersey, Federal OSHA continues to cover private sector safety and health issues.) The New Jersey Department of Labor, Office of Public Employees Safety and Health (PEOSH) is the State plan agency. It covers hospital and emergency services personnel employed by State and local governments, and adopts and enforces its own occupational safety and health standards, which for the most part are identical to Federal OSHA's standards. For additional information about the requirements of the New Jersey Public Employee Only State Plan and its standards, you may contact the New Jersey Department of Labor directly at the following address:

Leonard Katz, Assistant Commissioner
New Jersey Department of Labor
P.O. Box 054
Trenton, New Jersey 08625-0054

Telephone: (609) 292-2313

Thank you for your interest in occupational safety and health. We hope you find this information helpful. OSHA requirements are set by statute, standards, and regulations. Our interpretation letters explain these requirements and how they apply to particular circumstances, but they cannot create additional employer obligations. This letter constitutes OSHA's interpretation of the requirements discussed. Note that our enforcement guidance may be affected by changes to OSHA rules. Also, from time to time we update our guidance in response to new information.

To keep apprised of such developments, you can consult OSHA's website at http://www.osha.gov. If you have any further questions, please feel free to contact the Office of Health Enforcement at (202) 693-2190.

Sincerely,



Richard E. Fairfax, Director
Directorate of Enforcement Programs

cc: Leonard Katz, Assistant Commissioner, New Jersey Department of Labor
Patricia Clark, Regional Administrator - II