March 31, 1992

Mr. Randy Ross
Marian Health Center
801 Fifth Street
Sioux City, Iowa 51101

Dear Mr. Ross:

This is in response to your inquiry of January 30, concerning the Occupational Safety and Health Administration's (OSHA) Hazardous Waste Operations and Emergency Response final rule (29 CFR 1910.120).

The state of Iowa operates under an OSHA-approved state plan, which covers all occupational safety and health concerns for Iowa. As a state with an approved plan, Iowa must provide employee protection that is "at least as effective" as Federal OSHA's and may be more stringent. For any particular requirements applying in the States, you may contact Iowa's office at the following address:

         Allen J. Meier, Commissioner
         Iowa Division of Labor Services
         1000 E. Grand Avenue
         Des Moines, Iowa 50319
         Telephone:  (515)281-3447

During your telephone conversation you explained that your hospital is not part of a community emergency response plan although hospital personnel may be asked to go to hazardous waste sites, and the hospital will often receive accident victims from local sites. You reviewed OSHA's letter to Dalena Berrett with Ms. Prueitt and decided that the following two points were relevant to your situation.

First, hospital employees who are involved in an emergency on a hazardous waste site or are part of an emergency response to a release of hazardous substance may be considered skilled support personnel in accordance with subparagraph (q)(4). Skilled support personnel, as stated in the Berrett letter:

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 [such as decontamination procedures].

The second relevant point in the Berrett letter explains that responders may be trained to the appropriate emergency response level in subparagraph (q)(6):

If a community 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.

After reviewing your situation, and similar accounts, the Federal OSHA office amends the Dalena Berrett letter to read:

... the designated hospital employee who will operate the decontamination facility must have at least first responder operations level training. Individuals who will develop the decontamination procedures and select personal protective equipment for workers who will help decontaminate, must receive additional training in decontamination.

Hospitals that provide decontamination services in order to attend to medical problems are in a unique situation. They do not need training in control, containment, or confinement operations required for the HAZMAT team, although they are part of an emergency response. HAZWOPER requires that "training shall be based on the duties and function to be performed by each responder of an emergency response organization." The hospitals that will receive contaminated accident victims must stress decontamination and personal protective equipment in their training for the designated personnel who will be expected to set up decontamination. This may mean developing an in-house training course for hospital personnel who will receive and decontaminate hazardous waste site accident victims or providing additional training in decontamination after sending personnel to a standard "first responder operations level" course.

An individual from the hazardous waste site trained in accordance with paragraph (e) may also develop the decontamination procedures and select personal protective equipment for hospital personnel who will help decontaminate.

Employees trained to the first responder operations level are required only to "know how to implement basic decontamination procedures"; they are not required to be trained to select specialized chemical personal protective equipment and set up decontamination operations. It may be preferable to decontaminate patients completely before they leave the hazardous waste site or at least to have qualified personnel from the hazardous waste site set up and oversee the decontamination. However, hospital personnel who are trained to the first responder operations level, with additional training in decontamination, may also set up and supervise the decontamination.

Emergencies often require immediate medical attention. Hospital personnel need to be trained to reduce the possibility of health hazards' spreading to the ambulance and emergency room. From this perspective, and when medically appropriate, decontamination should occur at the hazardous waste site, not the hospital.

HAZWOPER requires that decontamination procedures at hazardous waste sites comply with the following two provisions, among others, in paragraph (k):

(k)(2)(iii): All employees leaving a contaminated area shall be

appropriately decontaminated; all contaminated clothing and equipment leaving a contaminated area shall be appropriately disposed of or decontaminated.

(k)(2)(iv): Decontamination procedures shall be monitored by the

site safety and health supervisor to determine their effectiveness. When such procedures are found to be ineffective, appropriate steps shall be taken to correct any deficiencies.

It is obvious that hazardous waste sites do need the use of your hospital and accident victims may arrive, independent of your ambulance service, in various stages of decontamination. HAZWOPER requires hazardous waste sites to address emergency medical treatment and first aid procedures in their emergency response plan. This means not only identifying the hospitals that will receive their employees but also ensuring that the hospitals have appropriate equipment and trained personnel to decontaminate. The sites that send you accident victims apparently have not developed their emergency response plan sufficiently.

If you feel that any of the hazardous waste sites have not adequately planned for medical emergencies on their site, you should contact the employers and bring it to their attention. You may also make a referral to the state or regional OSHA office for enforcement action.

We hope this information is helpful. If you have any further questions please feel free to contact us at (202) 523-8036.

Sincerely,



Dorothy L. Strunk
Acting Assistant Secretary