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OSHA Proposes Consolidated Standard to Better Protect Emergency Responders

Firefighters spray water during a disaster-response training exercise conducted by National Guard units working with federal, state and local emergency management agencies and first responders. Photo credit: Amy Lovgren

The proposed Emergency Response standard would replace the existing Fire Brigades standard and include a broad range of hazards encountered by emergency responders.

The U.S. Occupational Safety and Health Administration (OSHA) is proposing to issue a new safety and health standard, titled Emergency Response, to replace the existing Fire Brigades Standard. The new standard would address a broader scope of emergency responders and would include programmatic elements to protect emergency responders from a variety of occupational hazards.

Elements of emergency responder (firefighters, emergency medical service providers, and technical search and rescuers) health and safety are currently regulated by OSHA primarily under a patchwork of hazard-specific standards, and by state regulations in states with OSHA-approved State plan programs. In addition, while OSHA standards do not apply to volunteers, some volunteers are covered in states with OSHA-approved State plan programs.

The full document is extensive and is available at the Federal Register. Below we present highlighted information from OSHA’s proposed standard.


Responders Face Hazards in Emergency Situations, Training and Routine Tasks

Workers performing emergency response activities can be assigned to a wide variety of tasks, including firefighting, medical assistance, and search and rescue. The hazards associated with emergency response activities are not limited to emergency situations; OSHA has also identified safety and health risks present during training exercises and other routine tasks.

OSHA estimates that approximately 1,054,611 individuals are exposed on an annual basis in the United States to the workplace hazards associated with these emergency response activities. While some individuals are employed full-time as emergency response workers, a substantial number of personnel are categorized as volunteers. OSHA estimates that, of the 1,054,611 emergency responders anticipated to fall within the scope of the proposed rule, 331,472 will be self-identified as volunteers.

Patchwork of Standards

All of the OSHA standards referred to above were promulgated decades ago, and none was designed as a comprehensive emergency response standard. Consequently, they do not address the full range of hazards currently facing emergency responders, nor do they reflect major changes in performance specifications for protective clothing and equipment or major improvements in safety and health practices that have already been accepted by the emergency response community and incorporated into industry consensus standards.

Furthermore, the OSHA standards do not currently align with the Department of Homeland Security’s National Incident Management System (NIMS), which guides all levels of government, nongovernmental organizations, and the private sector to work together to prevent, protect against, mitigate, respond to, and recover from emergency incidents.

The proposed rule updates by replacing the existing Fire Brigades standard and would expand the scope of OSHA’s standard to include a broad range of hazards emergency responders encounter during emergency response activities and would bring the standard in line with the Federal Emergency Management Agency’s (FEMA) National Response Framework and modernize the standard to align with the current industry consensus standards issued by the National Fire Protection Association (NFPA) on the safe conduct of emergency response activities.

Organizations that provide emergency services vary significantly in size and the type of services they provide. They are often not well suited for “one-size-fits-all” prescriptive standards. Accordingly, the proposed rule is a “performance-based” standard, which provides flexibility for affected employers to establish the specific criteria that best suits their organization. The proposed rule focuses on the achievement of desired results—improving emergency responder health and safety and reducing injuries and fatalities—while providing flexibility as to the precise methods used to achieve those results. The performance-based nature of the proposed rule is particularly beneficial to small and volunteer organizations with limited resources.

Lessons From the 2013 West Texas Chemical Plant Disaster

On April 17, 2013, while engaged in fire suppression activities at a fertilizer plant in West, Texas, ten firefighters died after approximately 40 to 60 tons of ammonium nitrate unexpectedly detonated. Five civilians, two of whom were providing support for firefighting activities, were also killed, and five firefighters were injured. Victims of the blast included both volunteer and career firefighters, ranging in age from 26 to 52 years, each with 1 to 31 years of firefighting experience.

A subsequent investigation into the incident performed by the National Institute for Occupational Safety and Health (NIOSH) revealed numerous contributing factors in the incidents that led to the fatalities, including limited responder knowledge and recognition of the hazards created by ammonium nitrate, inadequate pre-incident emergency response planning for the fertilizer plant, and the fact that response personnel performed fire suppression activities from a location that was within the blast radius of the explosion (NIOSH 2014, Document ID 0331).

As part of its investigation report, NIOSH made several recommendations for how fire departments could prevent fatalities and injuries, including the development of a written risk management plan, the conducting of pre-incident planning inspections for the buildings located within a fire department’s jurisdiction, the development and implementation of a written incident management system for all emergency incident operations, the mandated use of turnout clothing and other personal protective equipment (PPE) that has been determined to be appropriate for each task, and a minimum standard of training for every firefighter.

Annual Number of Deaths

Review of the overall rate of reported workplace-related deaths for emergency response personnel contained within these reports revealed substantial variation among reporting agencies.

OSHA concluded that a conservative estimate of workplace deaths for emergency response personnel falling within the scope of the proposed rule would include those firefighter deaths reported by NFPA (an average of 72.4 deaths annually, including career and volunteer firefighters), combined with Bureau of Labor Statistics (BLS) information on the number of non-firefighter emergency responder deaths (an average of 11.3 deaths, annually), which produces an estimate of 83.7 emergency responder deaths annually, on average.

USFA reports 105.2 deaths (1990-2012 excluding 2001); FEMA 102 in 2020 includes 36 COVID-19 related deaths); NFPA 72.4 deaths from 2007-2021 which excludes COVID-19 deaths; NIOSH 99.3 from 2007-2021; NWCG 17 (wildlandfire deaths only); OSHA OIS 18.2 excluding COVID-19 related); and BLS reports 11.3 from 2007-2021 for non-firefighter personnel, excluding COVID-19 related deaths.

OSHA believes that the fatalities present in the OSHA OIS dataset are likely a significant underestimation of the fatalities occurring annually within the emergency response community. This is likely because the OIS database contains information about fatality investigations performed by OSHA field investigators, but does not contain information about deaths not reported to OSHA, which includes many volunteer firefighter deaths.

The total number of fatalities may also be underestimated as there is no blanket mandatory reporting requirement for emergency responder deaths. This is also likely due in part to varying methodology among reporting organizations for categorizing a heart attack as work-related.

NFPA reports are limited to deaths occurring among firefighters. The OIS dataset includes deaths of all emergency response personnel determined to fall within the scope of the proposed rule, including other, non-firefighter individuals. Additionally, the NFPA dataset contains little to no information regarding identified workplace hazards associated with the reported deaths, while the OIS dataset includes summary information for contributory hazards, as identified by the standards cited by the OSHA investigator and the information contained in each accident’s summary abstract. For these reasons, while OSHA determined that the overall number of firefighter deaths annually is more accurately reflected by the NFPA annual summary reports, OSHA determined that the descriptive information available in the OIS dataset regarding task at time of death, cause of death, and workplace hazards identified by the OSHA inspector while investigating an individual’s death is a representative sample of the characteristics of emergency response fatalities across the larger dataset.

A review of the available literature identifying common causes of death for emergency responders supports OSHA’s analysis of the fatalities available in the OIS dataset. From this review, OSHA determined that some of the most common safety and health hazards encountered by emergency responders include vehicle collisions; falls from heights to lower levels due to structural or building collapses; being struck by, caught in between, or crushed by vehicles; falling objects or debris; burns; and entrapments.

Among these 273 fatalities, hazards identified by OSHA investigators as present on-site at the time of death included hazards involving the incorrect use of PPE and other equipment, inadequate vehicle preparedness and operation, lack of effective implementation of standard operating procedures in various emergency scenarios, failure to adhere to practices for Immediately Dangerous to Life and Health (IDLH) situations, failure to meet medical evaluation requirements, failure to meet minimum training requirements, lack of or ineffective implementation of an Emergency Response Plan (ERP), and the lack of an effective Risk Management Plan (RMP).

Nonfatal Injury Estimates

OSHA reviewed the available literature to examine the extent and nature of workplace injuries occurring among emergency response personnel. From this review, OSHA determined that, overall, emergency responders are at higher risk of injury than the general population. Workplace hazards identified in the literature as leading to injury among emergency response personnel include exposure to toxic chemicals, falls, environmental hypoxia, exposure to excessive noise, over-exertion due to lifting heavy objects, wearing heavy protective equipment, repetitive motion, and other similar activities.

Estimations of the increased risk as compared to all private industries varied by the type of emergency service provided, ranging from 1.7 times for private ambulance service workers to 4 times for EMS responders. For the purposes of this analysis, OSHA focused on lost-time injuries; expected lost-time injuries for the hazards identified above include fractures, sprains, internal bodily trauma, dislocations, chemical burns, and chemical pneumonia.

OSHA determined that the most common cause of injury among emergency medical services providers was overexertion or strain. Multiple studies identified overexertion or strain as the leading causes of injury, with reported proportions of injury ranging from 23% to 60% and body motion injuries (e.g., lifting, carrying, or transferring a patient and/or equipment) commonly serving as the leading event.

In addition to reviewing the available literature, OSHA conducted an analysis of the injury statistics available from the BLS for the EMT and Paramedic categories of emergency response professions, from the years 2007 through 2020. In total, 107,720 non-fatal incidents requiring days away from work were reported, an average of 7,694 injuries annually. In addition to the common sources of injury as identified by the literature review, the BLS injury statistics revealed further causes of frequent injury among emergency response professionals:

The total number of non-fatal injuries to EMTs and Paramedics in the United States reported from 2007-2020 included: 260 fire and explosion injuries; 7,010 exposures to harmful substances or the environment; and 57,790 injuries due to overexertion and bodily reaction.

To determine the number of injuries occurring annually among firefighters, OSHA reviewed the annual NFPA injury summary reports from 2007 to 2020 (Docket Nos. 0362–0376). These reports show that, on average, 67,964 injuries occurred among firefighters annually, with an average of 14,172 of those classified as a lost time injury, 21% of total injuries.

Exposures

Emergency responders are exposed to a variety of health hazards in the workplace. OSHA focused its literature review on three areas: combustion products, other contaminants and substances, and infectious diseases.

The combustion products review covers substances released during fires. The other contaminants and substances review examines specific situations where emergency responders were exposed to harmful chemicals (e.g., vinyl chloride, phosphine, opioids) while responding to emergency situations in the field or when participating in training exercises that involved simulated smoke. It also includes studies that assessed contaminants inside firehouses and substances off-gassing from emergency response gear. The infectious diseases review summarizes research on a variety of diseases, including hepatitis B, Clostridiodes difficile, Methicillin-resistant Staphylococcus aureus (MRSA), and COVID–19.

Many of the studies identified under these three topics focused solely on examining the likelihood or the extent of exposures among emergency responder populations. In some cases, the studies also provided information about the health effects observed among exposed groups.

Combustion Products

Combustion products, many of which are considered respiratory hazards, are released when materials burn. The combustion product studies identified during OSHA’s literature review addressed firefighters, including both structural and wildland firefighters. Firefighters may be exposed to a wide variety of combustion products, even when wearing protective gear, and exposures can occur during a broad range of activities. Emergency responders can be exposed to combustion products during live training exercises as well as when responding to actual events; while performing exterior operations and during interior fire attack operations; during the early phase of operations as they delay donning self-contained breathing apparatus to conserve vital air supply, through leaks while wearing respiratory protection, or during post-fire clean-up activities. Emergency responders can also be exposed to combustion products through off-gassing from contaminated protective clothing and equipment or while cleaning such items after fire operations.

The literature provides evidence of firefighters being exposed to a variety of different combustion products, including carbon monoxide, particulate matter, dioxins, radionuclides, and a variety of volatile organic compounds (VOCs) and semi-volatile organic compounds (SVOCs), including polycyclic aromatic hydrocarbons (PAHs).

Multiple studies found that firefighters are exposed to VOCs, especially PAH compounds, through the dermal and inhalation routes; the studies conducted personal air sampling on the exterior of firefighter gear and compared urinary metabolites from before and after firefighter trainings. For firefighters wearing self-contained breathing apparatus (SCBA), the dermal route appears to be the main route of exposure. Firefighter PAH levels were correlated with estimated exposures (based on combustion products identified in environmental samples), length of exposure, and number of fire suppressions.

Many of the articles identified in the combustion product literature review focused on wildland firefighters, who have much longer fire suppression shifts (8 to 13 hours) compared to structural firefighters (typically 30 minutes) and are more likely to be exposed to combustion products through inhalation since they often wear no respiratory protection or sometimes only a bandana or an N95 respirator rather than an SCBA. Prescribed burns were found to produce higher exposures of particulate matter and carbon monoxide than wildfires. Time spent on the fireline increased carbon monoxide exposure, and VOC levels were highest for Type 1 crews, which typically have the most experienced firefighters performing the most complex tasks.

OSHA has preliminarily determined that emergency responders, specifically both structural and wildland firefighters performing firefighting activities, are exposed to combustion products. These combustion products contain components that are known to cause cardiovascular and pulmonary illness and to be carcinogenic to humans. OSHA therefore preliminarily finds justification to promulgate a standard which requires protective equipment and practices to limit exposure to combustion products. In addition, since exposure cannot be completely eliminated due to the nature of firefighting activities, OSHA has preliminarily determined that medical surveillance is necessary for these responders to detect and respond to health conditions as soon as possible in order to mitigate the long-term health impact of such exposures on emergency responders.

Other Contaminants and Substances: Hazmat, Chemical Release Events

In addition to the combustion products reviewed, emergency responders may be exposed to varied, unpredictable, and often unknown contaminants and substances while performing their duties. Overall, OSHA’s literature review found evidence of adverse health effects among emergency responders who encountered contaminants and other potentially harmful substances on the job, with the most injuries seen among firefighters. As an example of the sources of these contaminants, in 2022 the U.S. Department of Transportation’s Pipeline and Hazardous Materials Safety Administration recorded 23,178 highway incidents involving hazardous materials (hazmat) and 355 railway spill hazmat incidents. Additionally, the U.S. Chemical Safety Board reported 102 reportable chemical release events in 2022. Studies also show that emergency responders can be exposed to hazardous substances through equipment contamination and inside their workplaces even when they are not responding to emergencies.

Studies show that emergency responders are exposed to a variety of chemicals in the field, including vinyl chloride, phosphine, ammonia, and hydrochloric acid. Examples of emergency response activities that can involve such exposures include attending to drug overdose victims, putting out a fire at a chemical manufacturing facility, working with chainsaws that released carbon monoxide and generate wood dust, and participating in training that exposed them to a variety of chemicals and potential irritants in simulated smoke such as mineral oil, diethylene glycol, aldehydes, PAHs, VOCs, and carbonaceous particles. The literature review also captured studies that examined diesel exhaust particulate matter and PAH concentrations inside firehouses, as well as contaminants associated with firefighting gear, including residual combustion products that adhere to the gear, and substances used to make the gear, such as organophosphorus flame retardants, per-and polyfluoroalkyl substances (PFAS) chemicals, and plasticizers.

Respiratory effects (e.g., cough, asthma-like symptoms) were the most frequently reported symptoms among the emergency responders who were assessed. One study examined 566 acute chemical exposures among 1,460 emergency responders and found that respiratory system problems were the most common adverse health effect, constituting 56.3 percent of all adverse effects. Other adverse health effects included trauma (11.3 percent), eye irritation (10.5 percent), headache (9.9 percent), and dizziness/other non-head-related central nervous system symptoms (9.9 percent). The chemicals most likely to cause adverse health effects were respiratory irritants, including ammonia (12.4 percent); unspecified, illegal methamphetamine-related chemicals (7.4 percent); carbon monoxide (6.2 percent); propane (6.0 percent); and hydrochloric acid (4.8 percent).

OSHA has preliminarily determined that in the course of their duties, firefighters, emergency medical service providers and technical rescuers are exposed to hazardous substances in the workplace. OSHA therefore preliminarily finds justification to promulgate a standard which requires protective equipment and practices to limit exposure to hazardous substances. In addition, since exposure cannot be completely eliminated due to the nature of emergency response activities, OSHA has preliminarily determined that medical surveillance is also necessary for these responders to detect and respond to health conditions as soon as possible in order to mitigate long-term health impacts.

Infectious Diseases

When responding to community needs, emergency responders come in direct contact with people who have infectious diseases. OSHA’s literature review identified multiple infectious diseases that firefighters, technical rescue responders, and emergency medical service providers are exposed to, including hepatitis B, Clostridiodes difficile, Methicillin-resistant Staphylococcus aureus (MRSA), and COVID–19.

Generally, bloodborne diseases (e.g., hepatitis B, hepatitis C, and human immunodeficiency virus) pose low risk to emergency responders, whereas infectious diseases spread through airborne pathways (e.g., meningococcal meningitis, severe acute respiratory syndrome (SARS), influenza, and tuberculosis) and direct contact transmission (e.g., MRSA) pose higher risk. However, EMS providers’ exposure to infectious diseases declined between 1993 and 2011 and remains generally low except during pandemics.

MRSA and Staphylococcus aureus prevalence was generally high among emergency responders. EMTs and paramedics have a significantly higher nasal colonization rate of MRSA compared to the general population (4.5% vs. 0.084%). One study found that found that paramedics had the highest rate of Staphylococcus aureus nasal colonization (57.7%), but the lowest rate of MRSA compared to other health care professionals ( i.e., nurses, clerical workers, and physicians). The authors suggested that the lower relative rate of MRSA may be due to paramedics spending more time in the field compared to other health care professionals. However, two studies examining the contamination of environmental surfaces that emergency responders contact found MRSA in fire stations and Clostridiodes difficile on EMS monitoring equipment.

COVID-19

COVID–19 can serve as a proxy for both epidemic and pandemic exposures for emergency responders. Inconsistent results were found for COVID–19 prevalence among emergency responders. Two studies that examined seroprevalence rates found that first responders had a higher risk of contracting COVID–19 than other health care professionals. In contrast, other studies found that the prevalence of COVID–19 was not elevated in first responders compared to the general public or to other medical professionals. Some of these studies suggested that increased PPE usage and the strict infection control measures that emergency responders instituted during the COVID–19 pandemic helped prevent elevated rates among this population. Additionally, two studies showed that vaccination may mitigate occupational risks. Other variables also affected first responders’ occupational risk of contracting COVID–19 or developing severe COVID–19. Two studies cited both found that community levels of COVID–19 correlated with seroprevalence rates of SARS-CoV–2 in first responders. Moreover, emergency responders who resided in more socially vulnerable response areas (gauged using the CDC’s Social Vulnerability Index) were found to have increased exposure to COVID–19. Additionally, increased levels of wildfire smoke inhalation may increase occupational risk for developing severe COVID–19 among wildland firefighters.

OSHA has preliminarily determined that emergency responders are exposed to infectious diseases in the course of their work. Exposures occur due to contact with victims of emergencies (e.g., traumatic injuries) and the treatment and transport of emergency medical patients suffering from either traumatic injuries or illness (e.g., viral meningitis). Infectious agents can contaminate emergency response vehicles and response equipment; protective clothing and equipment; or station uniforms and be brought back to communal quarters such as a fire stations or wildfire basecamps. OSHA therefore preliminarily finds justification to promulgate a standard which requires protective equipment and practices to address exposures to infectious disease.

National Consensus Standards

In development of the proposed rule, OSHA extensively examined numerous relevant consensus standards. Many of the provisions in the proposed rule are based on or consistent with provisions in these standards. Many of the provisions in the proposed rule are based on or consistent with provisions in these standards. Additionally, OSHA is proposing to incorporate by reference (IBR) several consensus standards including:

NFPA 1006, Standard for Technical Rescue Personnel Professional Qualifications

This standard contains the minimum job performance requirements including the requisite knowledge and skills to perform technical rescue operations for twenty different rescue scenarios for fire service and other emergency responders who perform these operations.

NFPA 1140, Standard for Wildland Fire Protection

This standard contains requirements for wildland fire management as well as the job performance requirements including the requisite knowledge and skills to perform wildland fire positions. Included in the standard are requirements for fighting wildland/urban interface fires.

NFPA 1407, Standard for Training Fire Service Rapid Intervention Crews

This standard contains requirements for training fire service personnel to safely perform rapid intervention operations to rescue firefighters who become lost, injured, trapped, incapacitated, or disoriented at an emergency scene or during training operations.

NFPA 1951, Standard on Protective Ensembles for Technical Rescue Incidents

This standard specifies the minimum design, performance, testing, and certification requirements for utility technical rescue, rescue and recovery technical rescue, and chemical, biological, radiological, and nuclear (CBRN) technical rescue protective ensembles including garments, helmets, gloves, footwear, interface, and eye and face protection.

NFPA 1952, Standard on Surface Water Operations Protective Clothing and Equipment

This standard specifies the minimum design, performance, testing, and certification requirements for protective clothing and equipment items, including full body suits, helmets, gloves, footwear, and personal flotation devices designed to provide limited protection from physical, environmental, thermal, and certain common chemical and biological hazards for emergency services personnel during surface water, swift water, tidal water, surf, and ice operations.

NFPA 1953, Standard on Protective Ensembles for Contaminated Water Diving

This standard specifies the minimum design, performance, testing, and certification requirements for protective clothing and protective equipment used during operations in contaminated water dive operations.

NFPA 1984, Standards on Respirators for Wildland Fire-Fighting Operations and Wildland Urban Interface Operations

This standard specifies the minimum design, performance, testing, and certification requirements for respirators to provide protection from inhalation hazards for personnel conducting wildland firefighting operations for use in non-immediately dangerous to life or health (IDLH) wildland environments during wildland firefighting operations and/or wildland urban interface operations.

NFPA 1990, Standard for Protective Ensembles for Hazardous Materials and CBRN Operations

This standard specifies the minimum design, performance, testing, documentation, and certification requirements for new ensembles and new ensemble elements that are used by emergency responders during hazardous materials emergencies and CBRN (chemical, biological, radiological and nuclear) terrorism incidents.

Submit Feedback on Rule Change

Any stakeholders or the public may submit comments by May 6, 2024 on any aspect of the Proposed Rule. Submit comments and attachments, identified by Docket No. OSHA–2007–0073, electronically at Regulations.gov. All comments, including any personal information you provide, are placed in the public docket without change and may be made available online.


NIOSH Pocket Guide to Chemical Hazards

The NIOSH Pocket Guide to Chemical Hazards (NPG) informs workers, employers, and occupational health professionals about workplace chemicals and their hazards. The NPG gives general industrial hygiene information for hundreds of chemicals/classes. The NPG clearly presents key data for chemicals or substance groupings (such as cyanides, fluorides, manganese compounds) that are found in workplaces. The guide offers key facts, but does not give all relevant data. The NPG helps users recognize and control workplace chemical hazards. NIOSH offers four versions of the NPG: print, online, PDF, and mobile web app. (CDC)

The Chemistry of Fires at the Wildland-Urban Interface

The chemistry and ultimate health impacts of WUI fires are still poorly understood. WUI fires lead to higher human exposures than remote wildland fires because of their proximity to communities. They also have unique chemistry due to the combination of natural and human-made fuels that are burned, which may lead to the formation or release of toxic emissions not found in purely wildland fires. CDC, NIEHS, and NIST asked the National Academies to evaluate chemistry information that would improve the mitigation of acute and long-term health effects of residential burning during wildfires and to recommend chemistry research that could help to inform decision-makers charged with mitigating wildfire impacts on the general public. As a result of the request, the National Academies convened the Committee on the Chemistry of Urban Wildfires, which prepared this report. (National Academies 2022)

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