Worker Safety in Evacuations

OSHA Training Institute 1

Worker Safety in Evacuations

OSHA Training Institute – Region IXUniversity of California, San Diego (UCSD) - Extension


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


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


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


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


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


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


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


Physical Hazards Potential in Evacuations The physical environment

may be grossly altered and usual lighting marginal or non existent. Increased risk for:Slips and fallsPuncture wounds from nails

and debrisEye and inhalational injuries

from dust, wind, smoke, and debris


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


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 continueQuickTime™ and a

TIFF (Uncompressed) decompressorare needed to see this picture.


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


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.


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


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


Workers’ Stress Signs

Fatigue Loss of sleep Gastrointestinal

complaints Difficulty with focus Reduced performance Apathy & reduced

vigilance


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


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


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


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, pensPhone numbers (supervisor, facilities, security,

field office, numbers of other evacuation team members)

Money – small bills and change


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


Anticipate Communication Loss

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

Damaged Communication Towers from High Winds


Anticipating Road Hazards

Expect change in roadways

Destroyed or missing signage

Damaged lighting and traffic signals

Soft road shoulders and missing or damaged guardrails


Anticipating Road Hazards Water damage, standing water, skid

potentials Downed power lines and surges


Post-Storm Hazards


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

.


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


Serious Injury in Debris Field Electrocution


Personal Protective Equipment in Field Evacuations Water resistant

Boots (steel toeand shank)

Hard hat Goggles/safety

glasses with side shields

Dust mask Hearing protection (ear plugs or muffs) Leather gloves and water resistant gloves


Visible Clothing

Light colored clothing or reflective vest or reflective tape applied to clothing sufficient to visualize in subdued lighting

FEMA


Safety and Clothing

Appropriate clothing to environment, long sleeves and pants to protect skin

Wind resistant clothing and/or rain gear


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


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


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


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.


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


Patient and Supply Movement

Downed power lines Limited communications Limited resources

Officer transporting patients from earthquake area with no access by ambulance


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


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


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


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


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


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


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 onesOn 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!


Prolonged Evacuations and Care of the WorkerProblems 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


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


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


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


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

Worker Safety in Evacuations

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