EMERGENCY RESPONSE RESOURCES

Guidance for Supervisors at Disaster Rescue Sites

The Challenge

Disaster sites pose a multitude of health and safety concerns. The hazards and exposures are a function of the unstable nature of the site, the potential of hazardous substances being present and the type of work being performed. An accurate assessment of all hazards may not be possible because they may not be immediately obvious or identifiable. Rescue personnel may be selecting protective measures based on limited information. In addition to the hazards of direct exposure, workers are also subject to dangers posed by the unstable physical environment, the stress of working in protective clothing, and the emotional trauma of the situation.

Essential Elements of a Work Plan

• Develop and periodically re-examine and update work plan as new information about site conditions is obtained.
• Review available information, including:
  • Any previous Site records
  • Waste inventory
  • Initial qualitative sampling and monitoring
  • Site photos
• Develop work objectives.
• Determine methods for accomplishing the objectives: e.g., inventory, search and rescue, recovery, disposal, record keeping.
• Determine personnel requirements.
• Determine the need for additional personnel.
• Determine equipment requirements.
• Determine appropriate work-rest cycles as the event devolves from rescue to remediation work phases

Site Safety Checklist

• Assign key personnel and alternates responsible for site safety.
• Describe risks associated with each operation conducted.
• Confirm that personnel are adequately trained to perform jobs.
• Assign key person to handle volunteers.
• Describe the protective clothing and equipment to be worn by personnel during site operations.
• Describe site-specific medical surveillance requirements.
• Describe needed air monitoring, personnel monitoring, and environmental sampling.
• Describe actions to be taken to mitigate existing hazards (e.g., containment) to make work environment less hazardous.
• Define site control measures (e.g., secure the area) and include a site map.
• Establish decontamination procedures for personnel and equipment.
• Establish site access and exit control requirements.
• Establish site food, water, shelter, and sanitation requirements.
• Establish site electrical safety requirements.
• Perform Exit Interviews/Surveys regarding adverse health outcomes and exposures during the response.
• Identify those responders who should receive medical referral and possible enrollment into a long term medical surveillance program, based on concerning exposures, or signs/symptoms of physical or emotional ill health.

Field Team Leader Checklist

Select a Field team leader who will:

• Insure volunteer information is obtained: name, address, phone, and social security number of workers for follow-up.
• Enforce site control.
• Oversee in the on-site rapid training of volunteers on safety, Personal Protective Equipment (PPE), hazards, emergency procedures.
• Enforce the buddy system.
• Notify site safety officer or supervisor of unsafe conditions.

Potential Hazards and General Recommendations

Hazard 1: Massive piles of construction and other types of debris, unstable work surfaces

Risks: Traumatic injuries, including serious fall injuries, from slips trips and falls or collapsing materials.

General Recommendations:

• Ensure that surfaces are stable as possible.
• Use alternative methods, such as bucket trucks, to access work surfaces that are unstable.
• Ensure scaffolding is erected on a stable surface; anchor scaffolding to a structure capable of withstanding the lateral forces generated.
• Ensure that workers have a full array of PPE, including safety shoes with slip resistant soles, cut-resistant gloves, eye protection, and hard hats.
• Ensure that workers use fall protection equipment with lifelines tied off to suitable anchorage points, including bucket trucks, whenever possible.

Hazard 2: Excessive Noise

Risks: Communication and temporary hearing loss.

General Recommendations:

• Use hearing protection devices whenever noisy equipment (e.g., saws, earth-moving equipment, Hurst tools) is used. This will prevent temporary hearing loss that can interfere when listening for cries, moans, and other sounds from victims buried in the rubble.

Hazard 3: Breathing Dust containing asbestos (from pulverized insulation and fireproofing materials) and silica (from pulverized concrete), which are toxic

Risks:

• Short term: irritation of eye, nose, throat, and lung.
• Long term: Chronic effects may depend on the extent and the duration of exposure.

General Recommendations:

• Workers should be protected from breathing dust.
• Respiratory protection: An N-95 or greater respiratory protection is acceptable for most activities, including silica and portland cement dust.
• If there is reason to believe there is an asbestos exposure, at not more than 10 times the safe level, use a half mask elastomeric respirator with N,R, or P-100 series filters.
• If airborne contaminants are causing eye irritation, full face respirators with P-100 OV/AG combination cartridges should be used.
• Respirators must fit properly to protect workers.
• Surgical masks should not be used because they do not provide adequate protection.
• Dust concentrations in the air must be appropriately monitored.
• If dust concentrations are elevated, limit entry to only person with adequate respiratory protection.
• If symptoms of chest pain or chest tightness are present, or if shortness of breath, or rapid breathing persists following a rest break, then medical attention should be sought.
• Respiratory equipment maintenance program should be maintained for the proper cleaning, repair, and storage of reusable respirators.
• Workers should be aware of the risks of "take-home-toxic contaminants" and supervised to ensure end of shift safety compliance.

Hazard 4: Heat Stress from wearing encapsulating/insulating bunker gear or doing heavy work in a hot, humid climate

Risks: Significant fluid loss that frequently progresses to clinical dehydration, raised core body temperature, impaired judgment, disorientation, fatigue, and heat stroke.

General Recommendations:

• Adjust work schedules, rotate personnel, add additional personnel to work teams.
• Replenish fluids (1 cup water/sports drink every 20 minutes) and food (small frequent carbohydrate meals).
• Monitor heart rate. If over 180 beats per minute minus age for more than a few minutes, stop work and rest immediately.
• Provide frequent medical evaluation for symptoms and signs of heat stress, such as altered vital signs, confusion, profuse sweating, excessive fatigue.
• Provide shelter in shaded areas and the ability to unbutton and remove bunker gear.
• Make available a cooling station which contains water misting capability, fans, and ice packs.

Hazard 5: Confined Spaces (limited openings for entry and exit, unfavorable natural ventilation)

Risks: Low oxygen, toxic air contaminants, explosions, entrapment, death by strangulation, constriction, or crushing.

General Recommendations:

• Purge, flush, or ventilate the space.
• Monitor the space for hazardous conditions.
• Lock out/tag out procedures for power equipment in or around the space.
• Use appropriate PPE--such as a self-contained breathing apparatus (SCBA).
• Light the area as much as possible.
• Establish barriers to external traffic such as vehicles, pedestrians, or other hazards.
• Use ladders or similar equipment for safe entry and exit in the space.
• Use good communications equipment and alarm systems.
• Have rescue equipment nearby.

Specific Recommendations: Confined Space Attendant

• Provide at least 1 person (attendant) outside the confined space to be in communication with entrant for the duration of the operation.
• Maintain an accurate count of individuals entering the space.
• Evacuate the space if any hazards that could danger the entrants is detected.
• Monitor the behavior of entrants for any effects that suggest they should be evacuated.
• Perform no other duties that may interfere with their primary responsibilities.

Specific Recommendations: Confined Space Entrant

• Use a chest or full body harness with retrieval line attached at the center of entrant's back with the other end of line attached to mechanical device designed for immediate rescue.
• Notify attendant if they experience any warning signs or symptoms of exposure or detect a dangerous condition
• .
• Exit the permit space when instructed by the attendant or if warning signs indicate an evacuation.

Hazard 6: Potential Chemical Exposures from Fire Scene
Exposure to the following chemicals must be anticipated:

• Metals (dust and fume)
• Hydrogen cyanide
• Inorganic acids (particularly sulfuric acid)
• Aldehydes (including formaldehyde)
• PAHs (polycyclic aromatic hydrocarbons)
  • Benzo(a)anthracene
  • Benzo(b)fluoranthene
  • Benzo(a)pyrene
• VOCs (volatile organic chemicals)
• Aliphatic hydrocarbons
• Acetone
• Acetic acid
• Ethyl acetate
• Isopropanol
• Styrene
• Benzene
• Touene
• Xylene
• Furfural
• Phenol
• Napthalene
• PCBs (polychlorinated biphenyls) may be present in older buildings with electrical equipment manufactured prior to 1977

Risks: Eye, nose, throat, upper respiratory tract, and skin irritation; flu like symptoms; central nervous system depression, fatigue, loss of coordination, memory difficulties, sleeplessness, mental confusion. Chronic effects depend on the extent and the duration of exposure.

General Recommendations:

• Fire Fighting: Use self Contained Breathing Apparatus (SCBA) with full face piece in pressure demand or other positive pressure mode.
• Entry into unknown concentration: Use SCBA gear.
• Rescue operations with fumes present: Use gas mask with front mounted organic vapor canister (OVC) or any chemical cartridge respirator with an organic vapor cartridge.
• Dusty environments: Use combination HEPA/OVC.

Warning! A surgical or a dust mask will not protect you from chemical vapors.

Hazard 7: Traumatic Incident Stress: Information For Emergency Response Workers

Hazard 8: Electrical, overhead power lines, downed electrical wires, cables

Risk: Electrocution

General Recommendations:

• Use appropriately grounded low-voltage equipment.

Hazard 9: Carbon Monoxide Risk from gasoline- or propane-powered generators or heavy machinery

Risk: Headache, dizziness, drowsiness, or nausea; progressing to vomiting, loss of consciousness, and collapse, coma or death under prolonged or high exposures.

General Recommendations:

• Locate temporary generators downwind and away from sheltering sites and mass gathering locations.
• Use CO warning sensors when using or working around combustion sources.
• Shut off engine immediately if symptoms of exposure appear.

Warning! Do not use gasoline generators or portable fuel driven tools in confined spaces or poorly ventilated areas.

Warning! Do not work in areas near exhaust (CO poisoning occurs even outdoors if engines generate high concentrations of CO and worker is in the area of the exhaust gases). With symptoms of exposure, shut off the engine.

Hazard 10: Eye Injuries from dust, flying debris, blood

Risk: Blood borne pathogen infection, eye injury.

General Recommendations: Protective Eyewear:

• Use goggles or face shield and mask for those handling human remains, recovering deceased. Make sure to cover the nose and mouth to protect the skin of the face and the mucous membranes.
• Use safety glasses with side shields as a minimum by all workers. An eye wear retainer strap is suggested.
• Consider safety goggles for protection from fine dust particles, or for use over regular prescription eye glasses.
• Any worker using a welding torch for cutting needs special eye wear for protection from welding light, which can cause severe burns to the eyes and surrounding tissue.
• Only use protective eyewear that has an ANSI Z87 mark on the lenses or frames.

Hazard 11: Flying debris; particles; handling a variety of sharp, jagged materials

Risk: Traumatic injuries, ranging from minor injuries requiring first-aid to serious, even disabling or fatal traumatic injury.

General Recommendations:

• Use safety glasses with side shields as a minimum. An eye wear retainer strap is suggested.
• Consider safety goggles for protection from fine dust particles, or for use over regular prescription eyeglasses.
• Any worker using a welding torch for cutting needs special eye wear for protection from welding light, which can cause severe burns to the eyes and surrounding tissue.
• Only use protective eyewear that has an ANSI Z87 mark on the lenses or frames.
• Educate workers regarding safe work procedures before beginning work.
• Provide workers with a full array of personal protective equipment, including hard hats, safety shoes, eye glasses, and work gloves.
• Ensure that workers do not walk under or through areas where cranes and other heavy equipment are being uses to lift objects.

Hazard 12: Work with numerous types of heavy equipment, including cranes, bucket trucks, skid-steer loaders, etc.

Risks: Traumatic injury, including serious and fatal injuries, due to failure or improper use of equipment, or workers being struck by moving equipment.

General Recommendations:

• Train workers to operate equipment correctly and safely.
• Ensure operators are aware of the activities around them to protect workers on foot from being struck by moving equipment.
• Ensure operators do not exceed the load capacity of cranes and other lifting equipment.
• Ensure that workers do not walk under or through areas where cranes and other heavy equipment are being used to lift objects.
• Ensure that workers do not climb onto or ride loads being lifted or moved.
• Ensure operators do not exceed site speed limits and obey traffic lane safety when travel on and exiting the site.

Hazard 13: Rescuing Victims, Recovering Deceased, Handling Human Remains, Contact with surfaces contaminated with blood and body fluids

Risk: Blood, bloody fluids, body fluids, and tissues are potential sources of blood-borne infections from pathogens including Hepatitis B, Hepatitis C, and HIV.

Route of exposure: Through the skin via a cut or puncture wound; through mucous membranes (eye, nose, mouth); through non-intact skin (dermatitis/rashes, injuries, abrasions).

General Recommendations:

• Standard precautions: Universal precautions should be strictly observed regardless of time since death. Workers who will have direct contact with the victims, bodies, or surfaces contaminated with blood or body fluids should use universal precautions including:
  • Use heavy-duty work gloves (such as leather) to protect against injury from sharp objects.
  • Use appropriate barrier protection when handling potentially infectious materials. These barriers include latex gloves (preferably powder-free latex gloves with reduced latex protein content) and nitrile gloves. These gloves can be worn under the heavy-duty gloves. Workers should be aware that individuals can develop allergic reactions to latex gloves which can result in respiratory problems (asthma), hives, and skin rashes. Those with known latex allergies should use nitrile gloves.
  • Use eye protection (goggles or face shield) and mask covering the nose and mouth to protect the skin of the face and the mucous membranes.
  • Use protective clothing to protect exposed skin surfaces.
  • Immediately after removing gloves or other protective equipment, wash hands with soap and water.
• Specific Recommendations: If an injury or an exposure to blood, body fluids, or tissue were to occur, the following should be carried out:
  • Report injuries or blood/body fluid exposures to the appropriate supervisor immediately.
  • File an occupational exposure report.
  • Wash wounds and skin sites that have been in contact with blood or body fluids with soap and water; mucous membranes should be flushed with water; eyes should be rinsed with an irrigant marketed for that purpose or with clean water.
  • The application of caustic agents (e.g., bleach) or the injection of antiseptics or disinfectants into the wound is not recommended.
  • The worker should be seen by a health care professional as soon as possible for evaluation and counseling.
  • The health care professional should follow guidelines as listed in the following reference: Centers for Disease Control and Prevention. Updated US Public health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis. MMWR 2001;50(No. RR-11). In addition, the University of California, Los Angeles and CDC have developed an interactive web site to help guide clinicians in making decisions about post-exposure care.
  • Clinicians also are encouraged to consult experts via the free 24/7 National Clinicians' Needlestick Hotline for advice about assessing and managing treatment of exposures to blood and other body fluids at 888-488-4911 (toll free) or 415-469-4417 (back-up).