OSHA Long Term Care Worker Protection Program

 Define key terms in Subpart E & L.

 Identify the key elements of the regulations.
 Discuss the implications of these regulations for
long term care settings.
 1.45 million fires 2008; 1,348,500 in 2009.
 Over 3300 civilian deaths; 16,705 injuries.
 Decline in both in 2009.
 15.4 Billion in property loss.
 34% of these fires were in structures.

• NFPA, Fire Loss in the United States, 2008; revised September 2009.
• NFPA, Fire Loss in the United States, 2009
 Exit Routes, Emergency Action Plans, and Fire
Prevention Plans

 1910.33 – 1910.39
 1910.35: An employer who demonstrates compliance
with the exit route provisions of NFPA 101-2000, the
Life Safety Code, will be deemed to be in compliance
with the corresponding requirements in 29 CFR 1910.34,
1910.36, and 1910.37.
 For automatic sprinkler systems, may follow NFPA and
National Board of Fire Underwriters standard in place
at the time of installation.

 A resource for many organizations.

 Triangle Fire March 19, 1911 – New York City.

 Killed 146 workers, many jumped from upper

floors.

 The deadliest accidental industrial building fire in

the nation’s history.

 December 14, 2010: Fire in a garment factory

near Dhaka, the capital of Bangladesh – 30 died,
100 injured.
 Exit Route: a continuous and unobstructed path
of exit travel from any point within a workplace to a
place of safety.
 Exit access: that part of an exit route that leads to
an exit (a corridor that leads to a stairway(Exit).
 Exit: that part of an exit route that provides a
protected way of travel to the exit discharge.
 Exit Discharge: the part of the exit route that
leads directly outside or to a street, walkway,
refuge area, or open area with access to the
outside.
 Exit routes must be permanent.
 An exit must be separated by fire resistant
materials.
 Openings into an exit must be limited.
 The number of exit routes must be adequate.
 Exit discharge must lead directly outside.
 Exit doors must be unlocked from the inside.
 A side-hinged exit door must be used.
 Exit route: ceiling at least 7’6” high, 28” wide.
 The danger to employees and patients must be
minimized.
 Must be free and unobstructed.
 Safeguards (sprinklers, alarms, exit lighting) must
be in working order at all times.
 Lighting and marking of exits must be clearly
visible.
 Signs must say EXIT, at least 6” high, by ¾”.
 (b)(1) At least two exit routes must be available in a
workplace to permit prompt evacuation during an
emergency:
 The exit routes must be located as far away as practical
from each other so that if one exit route is blocked by
fire or smoke, employees can evacuate using the
second exit route.
 Procedures for:
* reporting a fire
* emergency evacuations
* employees who remain to operate
critical plant operations before they evacuate
* accounting for all employees and
patients after evacuation
 (b) An emergency action plan EAP

must be in writing, kept in the

workplace, and available to
employees for review.
 However, an employer with 10 or
fewer employees may
communicate the plan orally to
employees.
 Emergency care procedures.
 Alarm system for employees.
 Employer must designate and train employees to
assist in a safe and orderly evacuation of other
employees.
 Review the action plan with employees when they
start their job, when their responsibilities in the
plan change, or when the plan changes.
 An employer must designate and train employees
to assist in a safe and orderly evacuation of other
employees.

EAP
 RACE

 R: Rescue
 A: Alarm
 C: Contain/confine
 E: Extinguish or evacuate
 Plans should address emergencies that the
organization can reasonably expect in the
workplace:
* Fire
* Toxic chemical release
* Hurricanes
* Tornadoes
* Floods
* ?others
 A fire prevention plan must include:
◦ list of all major fire hazards,
◦ proper handling and storage procedures for hazardous
materials,
◦ potential ignition sources and their control, and
◦ the type of fire protection equipment necessary to control
each major hazard.
  Procedures to control accumulations of flammable
and combustible waste materials

Cans of paint left open,

not stored or disposed
of upon completion of
work
 Need to assure that an adequate number of employees
are available at all times during working hours to act as
“evacuation wardens” so that employees can be swiftly
moved from the danger location to safe areas.
 They must know the correct place to direct employees,
trained in workplace layout and alternative escape
routes, aware of handicapped employees who may need
extra assistance, check all rooms and enclosed spaces
for employees, an account for or verify that all
employees are in the safe areas.
 This subpart contains requirements for:
◦ Fire brigades
◦ All portable and fixed fire suppression equipment
◦ Fire detection systems
◦ Fire or employee alarm systems
1. Oxygen source

2. Fuel source

3. Ignition mechanism
 "Class A fire" - involves ordinary combustible materials
such as paper, wood, cloth, and some rubber and plastic
materials.
 "Class B fire" - involves flammable or combustible
liquids, flammable gases, greases and similar materials,
and some rubber and plastic materials.
 "Class C fire" – involves energized electrical equipment
where safety to the employee requires the use of
electrically nonconductive extinguishing media.
 “Class D fire” – fire involving combustible metals such
as magnesium, titanium, zirconium, sodium, lithium, and
potassium.
 Noted in CAMH (Jan 2009) LS.O2.01.35
 Kitchen grease and oil fires.
 Significant risk area.
 Avoid splashing.

Never pick up a burning pan of grease!

 (a)Scope:
◦ The placement

◦ Use

◦ Maintenance

◦ Testing of portable fire extinguishers provided for the use

of employees

◦ Training and education

 Employee Education
* General principles of fire extinguisher use
* Upon employment, if role or
equipment changes, and annually

 Inspection, maintenance and testing

* Portable extinguishers: inspected every 30 days
* Annual maintenance
 Always know where they are located.

 To use one:
* P: Pull the pin
* A: Aim low
*S: Squeeze the lever
*S: Sweep the fire
 If required:
 The employer shall provide portable fire extinguishers
and shall mount, locate and identify them so that they
are readily accessible to employees without subjecting
the employees to possible injury.

Any problem here?

 Visually inspected annually and tagged with date
of the inspection.
Important!
Dates must be
recorded, and all
extinguishers tagged.
* Are selected and distributed based on the
classes of anticipated workplace fires and on
the size and degree of hazards affecting their
use.
 Travel distance to extinguisher: 75 ft

 For Class K (grease fire areas): 30 ft

 Fires in healthcare settings are never good.

 Devastating results.

 Need to protect patients and employees from the

serious hazard of a fire.

 Use of the “defend-in-place” concept from NFPA

101- Life Code.
 Building construction
 Sprinkler system
 Detection and alarm systems
 Horizontal movement to safety
 Compartmentation
 Staff training

 Key: Provide occupants with enough protection to

enable them to survive a fire while remaining in
the building.
 What we have learned…..

 What we can do…..

 April 13th, 1918: Norman, OK, State Hospital – 38
 May 15th, 1929: Cleveland Clinic – 125
 April 5th, 1949: St. Anthony’s Hospital, Illinois – 74
 July 14th, 1960: Guatemala City, Mental Hospital - 235
 December 8, 1961: Hartford Hospital, CT - 15
 May 20th, 1980: Kingston, Jamaica, Residential Care
Facility – 157
 Feb 26, 2003: Hartford, CT, Nursing Home – 16
 January 31, 2009: Northwest Russia,
Nursing home – 23
 Kitchen fires

 Electrical fires

 Waste material fires

 Fires due to smoking

 Talking with patients and families/visitors about fire
hazards related to smoking.
 Assessing smoking behaviors.
 Help all staff to be alert to any obstruction to fire
exits/fire routes.
 Know where the fire extinguishers are located.

 Recognizing every fire drill as a learning/teaching

opportunity.
 What can happen with simple appliances?

 How can we prevent this?

 Recognize the importance of employee education.
 Special focus on use of appliances/equipment and
smoking.
 Reminders.
 Debriefing after drills/events.
 Keys to success:
* a clear plan.
* employee education and practice.
* awareness of fire exits and use/location of fire
extinguishers.
* awareness/abatement of potential fire hazards.

Think Safety, Not Just Compliance!