Worker Health and Safety
Content
Worker Health and Safety
1. OUTCOME
No further harm to any first responder due to preventable exposure to secondary explosions, chemical release,
contagious disease, or stress after the initial event
2. CAPABILITY DESCRIPTION
The capability to protect the health of on-scene first responders and hospital personnel through:
• Effective decontamination
• Infection control
• Adequate work schedule relief
• Psychological support
• Appropriate self-protection
3. ESF/ANNEX: ESF#8 Public Health and Medical Services
4. CAPABILITY MEASURES
Yes/No
Worker operating guidelines and standards are in place that incorporate health and safety
concerns
Number
Of trained and equipped personnel to perform worker decontamination
Number
Of personnel trained to provide psychological support to workers during and following a
mass casualty event
5. CAPABILITY ELEMENTS
5.1 Personnel
Health and safety officers
Mental health personnel
Decontamination personnel
5.2 Planning
Worker safety plans
First responder prophylaxis plans (including family members)
5.3 Equipment
Interoperable communications equipment
First responder pharmaceutical stockpile
Personal protective equipment (PPE)
5.4 Training
Medical training for safe handling of contaminated patients
Training in use of PPE
HAZMAT training
Training in mental health services related to mass casualties
5.5 Exercises, evaluations, and corrective actions
Exercises incorporate worker safety plans
System for incorporating lessons learned into plans and procedures
6. PERFORMANCE METRICS
Yes/No
Workers successfully protected
Number
Of personnel exposed to hazard
Number
Of persons adequately decontaminated
Number
Of first responder households that received prophylaxis
Number
Of emergency workers who developed mental health symptoms
Number
Of first responders served by support services
7. CRITICAL TASKS
IPR 8.8
Provide for Worker Health and Safety
IM 8.2
Develop public health and recovery worker management guidelines
8. LINKED CAPABILITIES
Environmental Protection and Vector Control (ESF#8)
Isolation and Quarantine (ESF#8)
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Mass Care (ESF#6)
Mass Prophylaxis and Vaccination (ESF#8)
Medical Logistics and Distribution (ESF#8)
On-site Incident Management (ESF#5)
Pre-Hospital Triage and Treatment (ESF#8)
9. REFERENCES
1. Homeland Security Presidential Directive/HSPD-8, “National Preparedness”. December 2003.
http://www.whitehouse.gov/news/releases/2003/12/20031217-6.html
2. National Response Plan (NRP), Draft. Department of Homeland Security. November 2004.
3. National Incident Management System (NIMS). Department of Homeland Security. March 2004.
http://www.dhs.gov/interweb/assetlibrary/NIMS-90-web.pdf
4. Crisis Counseling and Assistance Training Program. Substance Abuse and Mental Health Services Administration
(SAMHSA), National Mental Health Information Center. 2004.
http://www.mentalhealth.samhsa.gov/cmhs/EmergencyServices/progguide.asp
5. Emergency Response Training Necessary for Hospital Physicians/Nurses That May Treat Contaminated Patients.
OSHA standard interpretation. March 1999.
http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=INTERPRETATIONS&p_id=22710
6. Emergency Response Training Requirements for Hospital Staff. Occupational Safety and Health Administration
(OSHA) standard interpretation. April 1997.
http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=INTERPRETATIONS&p_id=22393
7. Hazardous Waste Operations and Emergency Response, 29 CFR 1910.120. Occupational Safety and Health
Administration (OSHA). November 2002.
http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9765
8. Medical Personnel Exposed to Patients Contaminated with Hazardous Waste. Occupational Safety and Health
Administration (OSHA) standard interpretation. March 1992.
http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=INTERPRETATIONS&p_id=20609
9. Training Requirements for Hospital Personnel Involved in an Emergency Response of a Hazardous Substance.
Occupational Safety and Health Administration (OSHA) standard interpretation. October 1992.
http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_id=20911&p_table=INTERPRETATIONS
10. SCENARIO CONDITIONS
The primary factors affecting this capability are:
• The nature of the incident,
• The number of first responders and hospital personnel involved (which is related in part to the number of victims)
• The time period of the initial response
Applicable in all chemical, biological, and nuclear/radiological attack scenarios and natural disasters.
In all of the chemical scenarios, protection of first responders includes appropriate Personal Protective Equipment (PPE),
and adequate decontamination of victims as well as equipment and procedures to protect workers without PPE. For
example, mustard involves lingering exposure effects. The time period of greatest risk in most of the chemical attacks is
short (hours), with the exception of mustard, which may pose a risk to those without PPE over a longer period of time. The
greater the sense of demand for services, the greater may be the stress. For most of the chemical scenarios, an
appropriate ratio of responder to victim will mitigate this. However, in the larger scenarios such as Chlorine or mustard
where there are over 70,000 immediate casualties, psychological stress is likely in many first responders.
In the blister agent scenario, there are 70,000 exposed individuals. In the toxic industrial chemicals scenario, there are
1,000 injuries There would also be large fires and an (unspecified) number of secondary devices. In the nerve agent
scenario, there would be 350 injured people. In the chlorine tank scenario, there would be 100,000 people injured
sufficiently to require hospitalization.
In the explosive scenario, the primary risk is from secondary attacks, or injury from debris. The extraction of victims from
collapsed buildings may extend more than a few days, and first responders must be protected from excessive fatigue.
There are 450 injured people. There may be toxic smoke resulting from fires and explosions.
In the biological scenarios, workers must be protected from contagious diseases and receive prophylaxis if required.
PPE is required for responders in the anthrax and plague scenarios. There is also the need to consider personal (i.e.
family) concerns responders may have in this scenario. In the anthrax scenario, where there are 328,000 exposed
individuals workers must be protected from re-aerosolized spores in the dispersal area, or from spores transmitted out of
that area on clothing or vehicles. Because first responders also include clinical staff, support epidemiological workers, and
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transport, there will be many workers over a large region to protect. In the pandemic influenza scenario, tens of thousands
of health care workers will require vaccination as it becomes available, as well as protection from droplets. The length of
the outbreak and the large numbers of sick people (42.2 million outpatient visits and 733,800 hospitalizations with an
attack rate of 15%) will likely lead to stress and fatigue in the medical community. In the plague scenario where there are
7,348 sick individuals, exposed health care providers will require prophylaxis.
In the natural disaster scenarios, the primary issues will be the significant amount of recovery work that will go on for
many days and weeks. In the earthquake scenario, there are 20,000 missing people trapped in collapsed structures. In the
hurricane scenario, there are hundreds of thousand of gallons of extremely hazardous substances spilled into floodwaters.
These environmental hazards pose a significant risk to responders.
In the nuclear scenario, the damage caused by the explosion will provide immense challenges to protection of workers in
the debris, and contaminated areas. Recovery efforts will go on for a long period of time. The scale of destruction (total
damage within radius of 0.5 to 1.0 miles from blast site) and the large numbers of casualties (over 100,000) will likely lead
to severe stress and fatigue.
In the radiological scenario, there is a large area of contamination (over 36 city blocks at each of three sites) and
responders would have to remove victims from damaged or collapsed buildings.
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1. OUTCOME
No further harm to any first responder due to preventable exposure to secondary explosions, chemical release,
contagious disease, or stress after the initial event
2. CAPABILITY DESCRIPTION
The capability to protect the health of on-scene first responders and hospital personnel through:
• Effective decontamination
• Infection control
• Adequate work schedule relief
• Psychological support
• Appropriate self-protection
3. ESF/ANNEX: ESF#8 Public Health and Medical Services
4. CAPABILITY MEASURES
Yes/No
Worker operating guidelines and standards are in place that incorporate health and safety
concerns
Number
Of trained and equipped personnel to perform worker decontamination
Number
Of personnel trained to provide psychological support to workers during and following a
mass casualty event
5. CAPABILITY ELEMENTS
5.1 Personnel
Health and safety officers
Mental health personnel
Decontamination personnel
5.2 Planning
Worker safety plans
First responder prophylaxis plans (including family members)
5.3 Equipment
Interoperable communications equipment
First responder pharmaceutical stockpile
Personal protective equipment (PPE)
5.4 Training
Medical training for safe handling of contaminated patients
Training in use of PPE
HAZMAT training
Training in mental health services related to mass casualties
5.5 Exercises, evaluations, and corrective actions
Exercises incorporate worker safety plans
System for incorporating lessons learned into plans and procedures
6. PERFORMANCE METRICS
Yes/No
Workers successfully protected
Number
Of personnel exposed to hazard
Number
Of persons adequately decontaminated
Number
Of first responder households that received prophylaxis
Number
Of emergency workers who developed mental health symptoms
Number
Of first responders served by support services
7. CRITICAL TASKS
IPR 8.8
Provide for Worker Health and Safety
IM 8.2
Develop public health and recovery worker management guidelines
8. LINKED CAPABILITIES
Environmental Protection and Vector Control (ESF#8)
Isolation and Quarantine (ESF#8)
Worker Health and Safety
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Mass Care (ESF#6)
Mass Prophylaxis and Vaccination (ESF#8)
Medical Logistics and Distribution (ESF#8)
On-site Incident Management (ESF#5)
Pre-Hospital Triage and Treatment (ESF#8)
9. REFERENCES
1. Homeland Security Presidential Directive/HSPD-8, “National Preparedness”. December 2003.
http://www.whitehouse.gov/news/releases/2003/12/20031217-6.html
2. National Response Plan (NRP), Draft. Department of Homeland Security. November 2004.
3. National Incident Management System (NIMS). Department of Homeland Security. March 2004.
http://www.dhs.gov/interweb/assetlibrary/NIMS-90-web.pdf
4. Crisis Counseling and Assistance Training Program. Substance Abuse and Mental Health Services Administration
(SAMHSA), National Mental Health Information Center. 2004.
http://www.mentalhealth.samhsa.gov/cmhs/EmergencyServices/progguide.asp
5. Emergency Response Training Necessary for Hospital Physicians/Nurses That May Treat Contaminated Patients.
OSHA standard interpretation. March 1999.
http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=INTERPRETATIONS&p_id=22710
6. Emergency Response Training Requirements for Hospital Staff. Occupational Safety and Health Administration
(OSHA) standard interpretation. April 1997.
http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=INTERPRETATIONS&p_id=22393
7. Hazardous Waste Operations and Emergency Response, 29 CFR 1910.120. Occupational Safety and Health
Administration (OSHA). November 2002.
http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9765
8. Medical Personnel Exposed to Patients Contaminated with Hazardous Waste. Occupational Safety and Health
Administration (OSHA) standard interpretation. March 1992.
http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=INTERPRETATIONS&p_id=20609
9. Training Requirements for Hospital Personnel Involved in an Emergency Response of a Hazardous Substance.
Occupational Safety and Health Administration (OSHA) standard interpretation. October 1992.
http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_id=20911&p_table=INTERPRETATIONS
10. SCENARIO CONDITIONS
The primary factors affecting this capability are:
• The nature of the incident,
• The number of first responders and hospital personnel involved (which is related in part to the number of victims)
• The time period of the initial response
Applicable in all chemical, biological, and nuclear/radiological attack scenarios and natural disasters.
In all of the chemical scenarios, protection of first responders includes appropriate Personal Protective Equipment (PPE),
and adequate decontamination of victims as well as equipment and procedures to protect workers without PPE. For
example, mustard involves lingering exposure effects. The time period of greatest risk in most of the chemical attacks is
short (hours), with the exception of mustard, which may pose a risk to those without PPE over a longer period of time. The
greater the sense of demand for services, the greater may be the stress. For most of the chemical scenarios, an
appropriate ratio of responder to victim will mitigate this. However, in the larger scenarios such as Chlorine or mustard
where there are over 70,000 immediate casualties, psychological stress is likely in many first responders.
In the blister agent scenario, there are 70,000 exposed individuals. In the toxic industrial chemicals scenario, there are
1,000 injuries There would also be large fires and an (unspecified) number of secondary devices. In the nerve agent
scenario, there would be 350 injured people. In the chlorine tank scenario, there would be 100,000 people injured
sufficiently to require hospitalization.
In the explosive scenario, the primary risk is from secondary attacks, or injury from debris. The extraction of victims from
collapsed buildings may extend more than a few days, and first responders must be protected from excessive fatigue.
There are 450 injured people. There may be toxic smoke resulting from fires and explosions.
In the biological scenarios, workers must be protected from contagious diseases and receive prophylaxis if required.
PPE is required for responders in the anthrax and plague scenarios. There is also the need to consider personal (i.e.
family) concerns responders may have in this scenario. In the anthrax scenario, where there are 328,000 exposed
individuals workers must be protected from re-aerosolized spores in the dispersal area, or from spores transmitted out of
that area on clothing or vehicles. Because first responders also include clinical staff, support epidemiological workers, and
Worker Health and Safety
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transport, there will be many workers over a large region to protect. In the pandemic influenza scenario, tens of thousands
of health care workers will require vaccination as it becomes available, as well as protection from droplets. The length of
the outbreak and the large numbers of sick people (42.2 million outpatient visits and 733,800 hospitalizations with an
attack rate of 15%) will likely lead to stress and fatigue in the medical community. In the plague scenario where there are
7,348 sick individuals, exposed health care providers will require prophylaxis.
In the natural disaster scenarios, the primary issues will be the significant amount of recovery work that will go on for
many days and weeks. In the earthquake scenario, there are 20,000 missing people trapped in collapsed structures. In the
hurricane scenario, there are hundreds of thousand of gallons of extremely hazardous substances spilled into floodwaters.
These environmental hazards pose a significant risk to responders.
In the nuclear scenario, the damage caused by the explosion will provide immense challenges to protection of workers in
the debris, and contaminated areas. Recovery efforts will go on for a long period of time. The scale of destruction (total
damage within radius of 0.5 to 1.0 miles from blast site) and the large numbers of casualties (over 100,000) will likely lead
to severe stress and fatigue.
In the radiological scenario, there is a large area of contamination (over 36 city blocks at each of three sites) and
responders would have to remove victims from damaged or collapsed buildings.
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