Tag: safety

COVID-19 fatalities among EMS clinicians

From EMS1
by
By Brian J. Maguire, Dr.PH, MSA, EMT-P
Barbara J. O’Neill, PhD, RN
Scot Phelps, JD, MPH, Paramedic
Paul M. Maniscalco, PhD(c), MPA, MS, EMT/P, LP
Daniel R. Gerard, MS, RN, NRP
Kathleen A. Handal, MD

The devastating effects of the COVID-19 pandemic resonate around the world. Escalating infection and death rates are reported daily. While emergency medical services clinicians have been operating at the far forward front lines of the COVID-19 pandemic from the start, their infections, lost work time, long-term clinical manifestations and deaths have not been adequately reported or recorded [1]. In this article, we examine currently available EMS COVID-19 mortality data in order to describe the extent of EMS losses and to compare the risks for EMS clinicians to the risks for other related professions.

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COVID-19 Contact Tracing Card Template

The American Ambulance Association recommends that you begin closely tracking all visitors to your facilities in order to facilitate COVID-19 contact tracing in the future, if needed. In addition to a sign-in log, you may wish to present all visitors with a business card listing contact information for your infection control officer. These cards make it easy for visitors to get in touch if they develop symptoms soon after entering your building. Moore EMS Consulting kindly developed these templates for your use:

 

US DOL Issues Guidance Impacting EMS Offices

U.S. Department of Labor Issues OSHA Guidance As Non-Essential Businesses Reopen and Employees Return to Work

WASHINGTON, DC—The U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) has issued guidance  to assist employers reopening non-essential businesses and their employees returning to work during the evolving coronavirus pandemic.

The guidance supplements the U.S. Department of Labor and U.S. Department of Health and Human Services’ previously developed  Guidance on Preparing Workplaces for COVID-19 and the White House’s  Guidelines for Opening Up America Again. The guidelines provide general principles for updating restrictions originally put in place to slow the spread of the coronavirus. During each phase of the reopening process, employers should continue to focus on strategies for basic hygiene, social distancing, identification and isolation of sick employees, workplace controls and flexibilities, and employee training.

Non-essential businesses should reopen as state and local governments lift stay-at-home or shelter-in-place orders and follow public health recommendations from the Centers for Disease Control and Prevention and other federal requirements or guidelines. Employers should continue to consider ways to use workplace flexibilities, such as remote work and alternative business operations, to provide goods and services to customers.

OSHA recommends that employers continually monitor federal, state, and local government guidelines for updated information about ongoing community transmission and mitigation measures, as well as for evolving guidance on disinfection and other best practices for worker protection.

Visit OSHA’s  coronavirus webpage  frequently for updates. For further information about the coronavirus, please visit the  Centers for Disease Control and Prevention.

Under the Occupational Safety and Health Act of 1970, employers are responsible for providing safe and healthful workplaces for their employees. OSHA’s role is to help ensure these conditions for America’s working men and women by setting and enforcing standards, and providing training, education and assistance. For more information, visit  www.osha.gov.

The mission of the Department of Labor is to foster, promote and develop the welfare of the wage earners, job seekers and retirees of the United States; improve working conditions; advance opportunities for profitable employment; and assure work-related benefits and rights.

OSHA | Revised Enforcement Guidance for COVID-19

OSHA Issues Revised Enforcement Guidance for Recording Cases of Coronavirus Disease 2019 (COVID-19)

This week, OSHA published revised guidance for employers on when they need to record the illness, of an employee who has contracted the Coronavirus, as a work-related illness for the purposes of OSHA’s work illness and injury recordkeeping requirements. Under OSHA’s recordkeeping requirements, COVID-19 is a recordable illness if:

  1. The case is a confirmed case of COVID-19, as defined by the Centers for Disease Control and Prevention (CDC);
  2.  The case is work-related as defined by 29 CFR § 1904.5; and
  3.  The case involves one or more of the general recording criteria set forth in 29 CFR § 1904.7.

Given the rate of infection and the ease with which the virus is transmitted, employers have found it particularly challenging to determine if an employee, who is diagnosed with COVID-19, contracted the virus at work. In making that determination, employers must make a “reasonable determination” of work-relatedness. In this guidance, OSHA outlines the criteria that Compliance Safety and Health Officers (CSHOs) will utilize to evaluate if the employer met the “reasonable determination”, as required by the Regulations. Those criteria include:

  1. The reasonableness of the employer’s investigation into work-relatedness
  2. The evidence available to the employer at the time of the work-relatedness determination
  3. The evidence that the illness was contracted at work

The guidance highlights that employers can make limited inquires to employees about their exposure provided they respect the employee’s privacy and keep the medical inquiries limited to the COVID-19 transmission factors. Additionally, the guidance provides some examples of the types of evidence an employer may consider in making a work-relatedness determination. These include if the employee has come in contact or worked in close proximity with an individual who has a confirmed diagnosis of COVID-19 or employees who have frequent contact with the public. However, employers can also consider if an employee has or had close contact outside of work with a family member or close friend who has a confirmed cased. In that instance, it may suggest that the illness is not work-related.

After conducting a reasonable investigation about work-relatedness, if the employer cannot make the determination that the employee’s illness is work-related, then they are not required to record the illness under OSHA’s recordkeeping requirements.

If you require assistance with this guidance or any other human resources or compliance matters, be sure to contact the AAA for assistance.

CDC: PPE Guidance and Burn Rate Calculator

U.S. Centers for Disease Control |  April 7, 2020

U.S. Strategies to Optimize the Supply of PPE and Equipment

Personal protective equipment (PPE) is used every day by healthcare personnel (HCP) to protect themselves, patients, and others when providing care. PPE helps protect HCP from potentially infectious patients and materials, toxic medications, and other potentially dangerous substances used in healthcare delivery.

PPE shortages are currently posing a tremendous challenge to the US healthcare system because of the COVID-19 pandemic. Healthcare facilities are having difficulty accessing the needed PPE and are having to identify alternative ways to provide patient care.

CDC’s optimization strategies for PPE offer options for use when PPE supplies are stressed, running low, or absent. Contingency strategies can help stretch PPE supplies when shortages are anticipated, for example, if facilities have sufficient supplies now but are likely to run out soon. Crisis strategies can be considered during severe PPE shortages and should be used with the contingency options to help stretch available supplies for the most critical needs. As PPE availability returns to normal, healthcare facilities should promptly resume standard practices.

PPE Burn Rate Calculator

The Personal Protective Equipment (PPE) Burn Rate Calculator is a spreadsheet-based model that will help healthcare facilities plan and optimize the use of PPE for response to coronavirus disease 2019 (COVID-19). Non-healthcare facilities such as correctional facilities may also find this tool useful.

To use the calculator, enter the number of full boxes of each type of PPE in stock (gowns, gloves, surgical masks, respirators, and face shields, for example) and the total number of patients at your facility. The tool will calculate the average consumption rate, also referred to as a “burn rate,” for each type of PPE entered in the spreadsheet. This information can then be used to estimate how long the remaining supply of PPE will last, based on the average consumption rate. Using the calculator can help facilities make order projections for future needs.

 

 

DOL: Guidance for Respiratory Protection During N95 Shortage

U.S. Department of Labor  |  April 3, 2020

U.S. Department of Labor Issues Guidance for Respiratory Protection During N95 Shortage Due to COVID-19 Pandemic

WASHINGTON, DC – The U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) has issued interim enforcement guidance to help combat supply shortages of disposable N95 filtering face piece respirators (N95 FFRs). The action marks the department’s latest step to ensure the availability of respirators and follows President Donald J. Trump’s Memorandum on Making General Use Respirators Available.

Due to the impact on workplace conditions caused by limited supplies of N95 FFRs, employers should reassess their engineering controls, work practices and administrative controls to identify any changes they can make to decrease the need for N95 respirators.

If respiratory protection must be used, employers may consider use of alternative classes of respirators that provide equal or greater protection compared to an N95 FFR, such as National Institute for Occupational Safety and Health (NIOSH)-approved, non-disposable, elastomeric respirators or powered, air-purifying respirators. 

When these alternatives are not available, or where their use creates additional safety or health hazards, employers may consider the extended use or reuse of N95 FFRs, or use of N95 FFRs that were approved but have since passed the manufacturer’s recommended shelf life, under specified conditions.

This interim guidance will take effect immediately and remain in effect until further notice. This guidance is intended to be time-limited to the current public health crisis. Visit OSHA’s Coronavirus webpage regularly for updates.

For further information about COVID-19, please visit the U.S. Department of Health and Human Services’ Centers for Disease Control and Prevention.

Under the Occupational Safety and Health Act of 1970, employers are responsible for providing safe and healthful workplaces for their employees. OSHA’s role is to help ensure these conditions for America’s working men and women by setting and enforcing standards, and providing training, education and assistance. For more information, visit www.osha.gov.

The mission of the Department of Labor is to foster, promote and develop the welfare of the wage earners, job seekers and retirees of the United States; improve working conditions; advance opportunities for profitable employment; and assure work-related benefits and rights.

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Media Contacts:

Emily Weeks, 202-693-4676, weeks.emily.c@dol.gov

Release Number:  20-572-NAT

NIEHS Worker Training Program COVID-19 Resources

The National Institute of Environmental Health Sciences (NIEHS) Worker Training Program (WTP) has been tracking information about the coronavirus disease 2019 (COVID-19) as it pertains to protecting workers involved in emergency response and cleanup activities performed in the United States. This page contains health and safety resources for workers who may be at risk of exposure to COVID-19.

Training Resources

The National Clearinghouse creates training tools to aid in the development of awareness-level courses or other awareness-level materials. These tools provide health and safety guidance to workers who work in industries with the potential for exposure to COVID-19.

WTP Resources

COVID-19 is a new disease and we are still learning much about it, including how it spreads. This Training Tool will be updated with new information as the situation evolves.

WTP Awardee Resources

WTP Technical Workshops

Federal Links and Documents

Centers for Disease Control and Prevention (CDC)

CDC National Institute for Occupational Safety and Health (NIOSH)

Federal Aviation Administration (FAA)

National Institutes of Health (NIH)

NIH National Institute for Allergy and Infectious Disease (NIAID)

NIH National Library of Medicine (NLM)

Occupational Safety and Health Administration (OSHA)

U.S. Department of Labor

U.S. Environmental Protection Agency (EPA)

State/Local Links and Documents

Please refer to your local and state Department of Health for additional state-specific guidance on COVID-19.

Other Links and Documents

CDC Interim Infection Control Guidance for COVID-19

On March 10, the CDC issued the following changes to its interim guidance pm COVID-19.

  • Updated PPE recommendations for the care of patients with known or suspected COVID-19:
    • Based on local and regional situational analysis of PPE supplies, facemasks are an acceptable alternative when the supply chain of respirators cannot meet the demand.  During this time, available respirators should be prioritized for procedures that are likely to generate respiratory aerosols, which would pose the highest exposure risk to HCP.
      • Facemasks protect the wearer from splashes and sprays.
      • Respirators, which filter inspired air, offer respiratory protection.
    • When the supply chain is restored, facilities with a respiratory protection program should return to use of respirators for patients with known or suspected COVID-19. Facilities that do not currently have a respiratory protection program, but care for patients infected with pathogens for which a respirator is recommended, should implement a respiratory protection program.
    • Eye protection, gown, and gloves continue to be recommended.
      • If there are shortages of gowns, they should be prioritized for aerosol-generating procedures, care activities where splashes and sprays are anticipated, and high-contact patient care activities that provide opportunities for transfer of pathogens to the hands and clothing of HCP.
  • Included are considerations for designating entire units within the facility, with dedicated HCP, to care for known or suspected COVID-19 patients and options for extended use of respirators, facemasks, and eye protection on such units.  Updated recommendations regarding need for an airborne infection isolation room (AIIR).
    • Patients with known or suspected COVID-19 should be cared for in a single-person room with the door closed. Airborne Infection Isolation Rooms (AIIRs) (See definition of AIIR in appendix) should be reserved for patients undergoing aerosol-generating procedures (See Aerosol-Generating Procedures Section)
  • Updated information in the background is based on currently available information about COVID-19 and the current situation in the United States, which includes reports of cases of community transmission, infections identified in healthcare personnel (HCP), and shortages of facemasks, N95 filtering facepiece respirators (FFRs) (commonly known as N95 respirators), and gowns.
    • Increased emphasis on early identification and implementation of source control (i.e., putting a face mask on patients presenting with symptoms of respiratory infection).

Read the full interim guidance►

OSHA Injury Tracking Update

Earlier this week the AAA reminded its members of their obligation to post their 2018 injury data represented on the OSHA Form 300A in all work sites from February 1st through April 30th.  In addition, all EMS employers are required to report all injury data on the OSHA Injury Tracking Application (ITA).  Historically, all EMS employers were to electronically report the data represented on Form 300A.  However, larger employers (250 or more) also had to electronically submit the injury specific information from the Form 300 and Form 301 to the ITA.  OSHA announced yesterday that employers that larger employers will no longer be required to submit the information from Forms 300 and 301.  Citing privacy concerns, OSHA announced that employers of all sizes will only be required to submit the workplace injury summary information from Form 300A.

OSHA Reminder 2019

OSHA Injury Posting & Reporting of 2018 Injury Data

It is important that employers remember that they must post a copy of their OSHA Form 300A which is a summary of workplace injuries starting February 1, 2018 through April 30, 2018.  The OSHA Form 300A is a summary of all job-related injuries and illnesses that occurred in an employer’s workplace during 2018.  If a company recorded no injuries or illnesses in 2018, the employer must enter “zero” on the total line. The form must be signed and certified by a company executive. The OSHA Form 300A Injury Summary must be displayed in a common area where notices to employees are usually posted.  In addition to posting these reports in the workplace, covered employers should be electronically submitting their 2018 workplace injury data to OSHA via the Injury Tracking Application (ITA).  If members need assistance with the workplace posting or electronic injury reporting submission, contact the AAA.

2019 OSHA Penalty Adjustment

Also, a reminder to employers who are subject to OSHA or to those who operate in a state with an OSHA approved state level plan, the penalty amounts for OSHA violations are increasing effective the publication of the new rates in the Federal Register.  In accordance with the Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015, the Department of Labor is required to adjust penalties for inflation each year. New penalties for willful and repeat violations are $132,598 per violation; serious, other-than-serious, and posting requirements are $13,260 per violation; and failure to correct violations is $13,260 for each day the condition continues.  The new penalty details can be found in the OSHA Enforcement Section of their website.

OSHA Injury Reporting

Last year we notified AAA members that they must begin electronically reporting their workplace injury data to OSHA starting December 1, 2017 for 2016. This is just a reminder to all employers can begin electronically reporting their 2017 workplace injury data through the OSHA Injury Tracking Application (ITA). 2017 Injury Data must be submitted to OSHA no later than July 1, 2018. For employers in states that are covered by OSHA approved state level work injury regulations, OSHA has announced on April 30, 2018 that employers in states that have not completed the adoption of a state rule must also report their 2017 injury data through the OSHA ITA. If any member has not set up their account with OSHA on the ITA, we strongly suggest that you do so immediately. The AAA can assist members who need assistance ensuring they are compliant with this reporting requirement.

OSHA Updates & Reminders 2018

It is important that employers remember that they must post a copy of their OSHA Form 300A which is a summary of workplace injuries starting February 1, 2018 through April 30, 2018.  The OSHA Form 300A is a summary of all job-related injuries and illnesses that occurred in an employer’s workplace during 2017.  If a company recorded no injuries or illnesses in 2018, the employer must enter “zero” on the total line. The form must be signed and certified by a company executive. The OSHA Form 300A Injury Summary must be displayed in a common area where notices to employees are usually posted.  In addition to posting these reports in the workplace, covered employers will have to electronically report their injury data on the Injury Tracking Application (ITA) by July 1, 2018.

Also, a reminder to employers who are subject to OSHA or to those who operate in a state with an OSHA approved state level plan, the penalty amounts for OSHA violations are increasing effective January 2, 2018.  In accordance with the Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015, the Department of Labor is required to adjust penalties for inflation each year. New penalties for willful and repeat violations are $129,336 per violation; serious, other-than-serious, and posting requirements are $12,934 per violation; and failure to correct violations is $12,934 for each day the condition continues.  The new penalty details can be found in the OSHA Enforcement Section of their website.

 

OSHA: Transportation-Related Incidents Top Workplace Fatality List

Yesterday, OSHA issued a statement regarding fatal occupational injuries in 2016. Transportation-related incidents were the most frequent cause of workplace fatality in the United States last year. While the biggest part of our services is providing highest-quality medical care to people in need, the safe transportation of patients and crews plays a significant role. As an industry, we should do everything we can to ensure that every provider goes home at the end of their shift.

EMS.gov Ambulance Crash Data

NHTSA’s Office of EMS has partnered with a number of organizations, Federal agencies and U.S. Department of Transportation offices to develop resources that help EMS agencies understand ambulance crashes, transport patients safely, report ambulance and equipment defects and build or buy safer ambulances.

Download the ambulance crash infographic►
Visit the site today►

OSHA to Launch Electronic Injury Reporting on August 1, 2017

A few weeks ago, we alerted AAA members that the Occupational Safety and Health Administration (OSHA) had announced that it would further delay the deadline for employers to electronically file injury data.  The new rules, which require electronic injury data reporting were originally to take effect on July 1, 2017.  These rules were delayed until this December 1, 2017.  It was believed the requirements, an Obama administration initiative, might never see the light of day under the new administration.  However, OSHA announced Friday that all employers (ambulance providers) who employ twenty or more employees will be able to begin submitting electronic report injury data starting August 1, 2017.

OSHA announced Friday that it will be launching the new electronic Injury Tracking Application (ITA) on August 1, 2017.  The new rules are an effort to “nudge” employers to improve safety in the workplace by publishing employee injury data, as reported by employers.  Electronic data reporting would give job candidates and employees the ability to compare potential employers and their safety records.  Currently, most employers are required to record injuries that occur in the workplace, but this data is not easily available to candidates or OSHA itself.  It is anticipated that employers can expect greater investigative and enforcement actions after electronic injury reporting begins.

Under the Old & New Rules

Every year, ambulance services with 10 or more employees are required to record all workplace injuries that involve medical treatment beyond first aid, days away from work, restricted/transfer of duties, or loss of consciousness.  There are certain injuries that must be reported immediately to OSHA if they occur, workplace fatalities, hospitalization, loss of an eye, or an amputation.  The injury logs must be compiled and kept for five years.  Each year, employers are required to post a summary (Form 300A) of all workplace injuries in the workplace for from February 1 through April 30.

Currently, OSHA does not collect workplace injury information except through complaints from employees, onsite inspections, mandated reports of specific serious injuries, or through data collection from limited “high hazard” industries.  This new rule, will require that injury data reports be reported electronically to OSHA.  Many ambulance services already report this information electronically to the Bureau of Labor Statistics (BLS), who collects data on behalf of the Department of Labor but the employer specific information is not released publicly.  Under these new rules, employer injury data will be published.

Who Do These Rules Effect?

The electronic reporting requirements are based on the size of employer.  For the purposes of determining employer size, employers must count each individual employed at any time during the calendar year as one employee.  This includes full-time, part-time, seasonal, and temporary workers.  All employers with 250 or more employees in industries covered by the recordkeeping regulation must electronically submit to OSHA injury and illness information from OSHA Forms 300, 300A, and 301.  Employers with 20-249 employees must electronically submit information from OSHA Form 300A only.

Phase In

The new rules are being phased in by employer size.  In 2017, all employers, with 20 or more employees must report the information from OSHA Form 300A, which is the summary of all injury data by December 1, 2017.  By July 1, 2018, employers with 250 or more employees, will report all injury data from Forms 300, 300A, and 301 and employers with 20-249 employees will only report the data from the Form 300A.  Starting in 2019, all covered employers will have to report their 2018 injury information electronically by March, 2019.  Thereafter, all employers will report injury data electronically by March of each year.

Data Submission

The electronic data submission process involves four steps:

  1. Creating an establishment (employer account);
  2. Adding 300A summary data;
  3. Submitting data to OSHA; and
  4. Reviewing the confirmation email.

The secure website offers three options for data submission. One option will enable users to manually enter data into a web form. Another option will give users the ability to upload a CSV file to process single or multiple establishments at the same time. A third option will allow users of automated recordkeeping systems to transmit data electronically via an application programming interface (API).

OSHA states that the creation of the account in the electronic Injury Tracking Application (ITA) will only take employers about ten minutes.  After creating an account, OSHA predicts that it will take employers about ten minutes to report the data on Form 300A.  For large employers reporting also required to submit Form 300 and 301 information, OSHA is predicting it will take about 10 minutes per incident.

For those who are already reporting injury information to the Bureau of Labor Statistics (BLS) electronically, you will be required to report the information to OSHA also.  OSHA states that it is working on eliminating the duplicate reporting requirements but that until they do, employers will have to input data to both agencies.

Conclusion

The new Injury Tracking Application (ITA) does not launch until August 1, 2017. Employers will have until December 1, 2017 to submit their first set of injury data from 2016.  If AAA members are uncertain if they are tracking and reporting injury data appropriately or believe that they need assistance with this new requirement, be sure to contact the AAA for assistance.  Members should look to the Daily Digest or the AAA website for further announcements regarding this or any employment regulatory change that will impact our members.

10 Safety Topics that Will Move EMS Forward in 2016

What are your ambulance services’s safety priorities for 2016? AAA member The Center for Patient Safety has just released 10 Safety Topics that Will Move EMS Forward in 2016, a free download covering:

  • Airway Management
  • Behavior Health Encounters
  • Crashes: Ambulance and Helicopter
  • Device Failures
  • Medication Errors
  • Mobile Integrated Healthcare
  • Pediatric Patients
  • Safety Culture
  • Second Victim Intervention
  • Transition of Care

Get your copy today to learn how to ensure safety for your employees and patients.

Download Now