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Home My WebLink About2018-574-E Emergency Svc - South orange Rescue Squad operational agreement DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Operational Agreement for South Orange Rescue Squad This Operational Agreement assigns authority for South Orange Rescue Squad (SORS) to operate point-to-point, EMT-Basic level patient care and transportation services within the corporate limits of Orange County. South Orange Rescue Squad shall: 1) Demonstrate to the Orange County Department of Emergency Services-EMS Division, hereinafter referred to as "OCES", and the Orange County Risk Manager's Office that all required insurance coverage as it pertains to worker's compensation,liability, and property damage coverage is in place and continuously valid by providing a certificate of insurance to the Orange County Director of Emergency Services or his/her designee. Required insurance must be maintained at all times. SORS shall notify the Orange County Director of Emergency Services or his/her designee, of any change in the status of required insurance coverage,including policy changes,within three (3) business days of said change. 2) Be credentialed in accordance with 10A NCAC 13P-Office of Emergency Medical Services Regulations, Section.207-Ground Ambulance:Vehicle and Equipment Requirements. 3) Function in accordance with the Orange County EMS System Plan. 4) Provide to the Orange County Director of Emergency Services, or his/her designee, written notice of denial, suspension or revocation of and/or restrictions to any licenses, permits, and/or credentials pertaining to 10A NCAC 13P-Office of Emergency Medical Services Regulations within three (3) business days of receiving notice of same. 5) Respond to requests for information pertaining to investigations within three (3) business days. 6) SORS agrees to staff a SORS owned ambulance with system released EMT seven nights per week. Any changes to the operations of this unit from either OCES or SORS shall be discussed and agreed upon by both parties. 7) SORS agrees to assist OCEMS by responding with ambulances and personnel, when so requested by OCEMS, to emergency calls, disasters, Multiple Casualty Incidents (MCls) and/or in case of system overload. a. When responding to any call for service or incident in a BLS capacity, SORS agrees that upon evaluation of the patient(s) by their personnel, if it is determined that ALS or emergency care and transport is in the best interest of the patient(s), immediate contact with Orange County Communications will be established via radio to coordinate the appropriate response of OCEMS resources. If at any time SORS Providers are uncertain about the need for ALS care and transportation, personnel shall immediately establish communications via radio with the on-duty OCEMS Supervisor for direction. b. SORS must respond in a timely manner to all requests for service within Orange County, and maintain sufficient resources including personnel and apparatus within Page 1 of 4 Version: September 2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County to ensure a timely response. 8) SORS is responsible for updating personnel rosters, vehicle information and provider information in the North Carolina Office of EMS Continuum System. a. New personnel shall be added in Continuum prior to working their first shift and separated members shall be removed from Continuum within seven (7) days of official separation. b. SORS will advise OCES simultaneously with all updates to Continuum for changes affecting SORS's EMS division. This will allow OCES to update the electronic patient care reporting (ePCR) system to ensure that SORS members completing patient care reports are added to the OCES Continuum roster to avoid data errors in State reporting. c. New SORS members shall not participate in PCR documentation until they have been added to the OCES CIS roster and the ePCR system. d. After timely and proper notification of separated members by SORS to OCES,SORS is free from further obligation to ensure that separated members have been removed from the ePCR system. 9) SORS must maintain Continuing Education reports for all personnel and make records electronically available within seven (7) business days to OCES upon request. 10)SORS agrees to comply with the current Agency Credentialing Guidelines for EMT providers, or as may be amended from time to time, by the EMS Medical Director. (See Attachment A, Orange County Credentialing Guidelines for EMT Providers) a. EMS Continuing Education training towards NC OEMS recertification. i. SORS will provide a continuing education plan that details the method by which providers will maintain their certification and how SORS will ensure training needs are met.The plan will include the following 1. Documentation of educational hours and objectives for credentialing cycle 2. Documentation of skills procedures 3. Additional documentation of how to alter the plan when critical issues are identified in the Peer Review process. 4. Implementation of new procedures/equipment. ii. Providers may maintain credentials by attending a refresher course for their level within their credentialing period or may attend monthly training to meet the required topics. 1. Annual training for Blood Borne Pathogens and HIPPA training is to be included annually in the training plan. 2. CPR must be recertified every two years for all EMS Providers. iii. All credentialed providers are required to attend continuing education and receive a pre-set number of hours per year in specified areas of education to be defined in the Orange County EMS System Plan. Page 2 of 4 Version: September 2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD iv. SORS will maintain all rosters for continuing education. All training records are required to be maintained for each provider for a period of at least 6 years v. Continuing education offered by SORS must be overseen by an EMS Level I instructor. vi. SORS must designate a training officer and provide the OCES training officer the individual's name and preferred contact information as well as their credentials / qualifications to ensure the State's continuing education requirements are met. vii. In order for SORS to conduct in-house continuing education instruction in compliance with Orange County Educational Institution, Training Officers must possess a Level I EMS Instructor credential from State OEMS. 11)SORS will designate a representative whose attendance at the statutorily required Peer Review Committee meetings will adhere to the Peer Review Committee System Plan Policy as described in 10A NCAC 13P.0408 (10). 12)In the provision of patient care and transport services, SORS Providers shall adhere to the Orange County Emergency Medical Services Practice Protocols. 13)SORS and OCES agree to a minimum of no less than an annual meeting to review and update this agreement and procedures. Additional group meetings may be requested by any party if needs arise. 14)SORS agrees there shall be a minimum of ninety (90) days written notice prior to the termination of this agreement by the Private Franchise Provider. 15)SORS will provide all equipment and medical supplies necessary to outfit their ambulances initially. OCES agrees that SORS maintains the ability to restock from OCES supplies as needed after the completion of patient care. 16)OCES will provide SORS with fuel cards to allow SORS to fuel their emergency response vehicles for the purposes of assisting OCES with response. 17)SORS agrees to follow the Orange County Mass Gathering Plan in the planning of mass gathering special events and to notify OCES of any and all SORS special event coverage seven (7) days prior to the event. (See Attachment B, Orange County Mass Gathering Plan) In the event that the Mass Gathering plan requires advanced life support coverage, SORS will make the ALS request no less than fourteen (14) days prior to the event. OCES will invoice the event planner separately from SORS. OCES agrees to provide SORS with no less than fourteen (14) days written advance notice for requests for coverage for OCES-coordinated special events. 18)Data collection hardware shall be purchased by SORS that allows SORS to utilize the data resources as prescribed and provided by the County for the acquisition, transmission and reporting of patient care reports and other EMS data associated with BLS Transport and Page 3 of 4 Version: September 2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD EMT Non-Transport. 19)SORS agrees to utilize and comply with the Orange County Infection Control Plan. (See Attachment C, Orange County Infection Control Plan) The infection control officer for Orange County is Chris Pope who can be reached at 919-886-7673. 20)During the course of daily operations, OCES supervisors will communicate directly with the SORS supervisor on call and vice versa via phone at 919-967-1515 ext. 88. Authorized Signatures: FOR SOUTH ORANGE RESCUE SQUAD DocuSigned by: :Fmk U K 5fipc, 9/18/2018 Fred Stipe, Chairman Date FOR ORANGE COUNTY EMERGENCY SERVICES DocuSigned by: �lI�A1l. yffiit,S 9/18/2018 Dinah Jeffries, Emergency Services Director Date Page 4 of 4 Version: September 2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Attachment A Orange County Emergency Services Agency Credentialing Guidelines Introduction Orange County Emergency Services is committed to excellent and timely patient care for our citizens and to partnering with organizations with a similar commitment. Thus, OCES is interested in providing structure, assistance, and guidelines for Orange County Agencies interested in advancing their EMS service levels. This document provides such guidance and structure. OCES personnel are prepared to provide assistance and mentoring to move the process of advancing EMS service to the fullest extent desired by local agencies. Orange County Emergency Services Agency Credentialing Process Every Orange County Agency providing EMS services in Orange County must maintain a credentialing level of Medical Responder as a base certification level. All Agencies who wish to increase their EMS service level must follow the established guidelines below. It would be helpful for Agencies wishing to move to advanced levels of service to have an initial conversation with both the Orange County Operations Manager and the Training Coordinator prior to initiating the process to ensure full understanding of the requirements. Credentialing Requirements The credentialing process requires the submission of the following documents (detailed below): 1. Initial Application (Attachment 1) 2. Agency CONTINUUM Roster Attestation 3. Agency Service Description 4. Agency Service Provision Attestation 5. Agency Training Coordinator Designation 6. Agency Provider Initial Credentialing Process 7. Agency Continuing Education Plan 8. Agency Documentation Process/Policy Rev. 8/8/2018 - 1 - DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD 9. Agency Quality Assurance Plan 10.Agency Equipment Attestation 11.Agency Infection Control Plan/Policy 12.Agency Medical Treatment Agreement Required Document Description 1. Agency CONTINUUM Roster Attestation: Completed Attestation (Attachment 2) that the Agency is maintaining an active and up to date roster in the North Carolina Office of EMS Credentialing Information System. a. CONTINUUM - "Credentialing Information System" is a database of all credentialed providers in the North Carolina EMS system. It is a mechanism for agencies to verify an individual's credential and date of expiration. b. All EMS Response Agencies in Orange County are currently listed in the CONTINUUM. c. As a credentialed provider joins or leaves an Agency, Agencies will update their CONTINUUM roster. d. The North Carolina Office of EMS will update provider's credentials as they change including expiration dates. The EMS system administrator, training Coordinator, and Agency representative receive notification of all expired credentials automatically through the CONTINUUM system. e. Providers receive email notification at thirty days prior to expiration and new credentials are mailed through CONTINUUM to the provider's listed address; therefore it is critical that providers ensure their contact information is current in CONTINUUM. 2. Agency Service Description: Orange County Emergency Services requires a full description of the type and level of EMS service to be provided by the applying Agency, including the location(s) from which it is intended to operate. a. Agencies should define the type and level of service to be provided (e.g. Emergency Medical Technician, Advanced EMT, Paramedic). b. Agencies applying for Advanced EMT or Paramedic Level upgrade to service must obtain Provider License with the North Carolina State Office of EMS as defined in 10A NCAC 13P .0204. Applications to State OEMS must occur at least 30 days prior to projected implementation date. c. Agencies should provide their defined service area and any mutual aid areas for EMS response. d. Agencies should describe the vehicles routinely used for responding to medical calls with the vehicle's staging location. (i.e. If an Agency utilizes a Vt Responder Vehicle for all calls.) Rev. 8/8/2018 - 2 - DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD 3. Agency Service Provision Attestation (Attachment 3): Attestation to the ability to provide at least one certified person at the established level of service on each first due apparatus. A description of the Agency's capability to provide twenty-four hour coverage, seven days per week for the requested level of service in the first due area covered by the Agency. a. For example, if an Agency were going to initiate an Advanced EMT service, a description of how the Agency's Advanced EMT's would be staffed to ensure the first-out unit for medical calls is available 24/7. b. This only applies to the Agency's first due unit. If the first unit is dedicated and a second unit for the same service area is dispatched to a second call, the second unit would not be required to have an A-EMT on the apparatus. 4. Agency Training Coordinator Designation: a. Each Agency must designate a training Coordinator. b. This form (Attachment 4) will include the individual's name and preferred contact information as well as their credentials / qualifications to ensure the State's continuing education requirements are met. c. This individual will be the "go to" person if the State or County request access to provider's continuing education records for auditing purpose. d. The agency training Coordinator should work closely with the OCEMS training Coordinator for mentorship and assistance with training. e. Agencies have the option of naming a backup individual who will serve in the instance that the primary training Coordinator is unable to provide the service. f. In order for agencies to conduct in-house continuing education instruction in compliance with Orange County Educational Institution, Training Coordinators must possess a Level I EMS Instructor credential from State OEMS. 5. Agency Provider Initial Credentialing Process: Agency's Plan for initial credentialing a. Agency selecting EMT upgrade will: i. Ensure all Agency EMT's pass EMT protocol and medication testing. ii. Ensure that providers document all Phase I core competency requirements as described in attachment 5. iii. Ensure completed initial Orange County Emergency Services Credentialing TSOP at EMT level. iv. Ensure completed documentation of process and submission the OCES Training Coordinator for evaluation and Orange County credentialing. b. Agency selecting Advanced EMT upgrade will: i. Ensure that providers meet all Phase II core competency requirements as described in attachment 5.Ensure that all Agency Rev. 8/8/2018 - 3 - DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD AEMT's pass OCES Advanced EMT Protocol and medication testing. ii. Ensure completed initial Orange County Emergency Services Credentialing Technical Scope of Practice Examination (TSOP) at Advanced EMT level. iii. Pass oral board examination with Orange County Emergency Services Medical Direction and Training staff.** c. Agency selecting Paramedic upgrade will: i. Ensure that providers meet all Phase III core competency requirements as described in attachment 5. Ensure that all Agency Paramedics pass Paramedic Protocol and medication testing. ii. Ensure completed initial Orange County Emergency Services Credentialing TSOP at Paramedic level iii. Pass oral board examination with Orange County Emergency Services Medical Direction and Training staff. ** *Field precepting may be concurrent with initial certification course. However, documentation must be retained and all field precepting must occur in Orange County **All Precepting evaluation paperwork must be completed and submitted to the OCES Training Coordinator prior to scheduling board examinations. 6. Agency Continuing Education Plan: Agency's continuing education and skill maintenance plan a. This plan should detail the method by which Agency providers will maintain their certification and how the Agency will ensure training needs are met. i. Documentation of educational hours and objectives for credentialing cycle ii. Documentation of skills procedures iii. Additional documentation of how to alter the plan when critical issues identified in the Peer Review process arise or implementation of new procedures/equipment. b. Providers may maintain credentials by attending a refresher course for their level within their credentialing period or may attend monthly training to meet the required topics. Rev. 8/8/2018 - 4 - DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD i. Annual training for Blood Borne Pathogens and HIPPA training is to be included annually in the training plan. ii. CPR must be recertified every two years for all EMS Providers. iii. Advanced EMT: all EMT requirements plus ITLS or PHTLS every four years. iv. Paramedic: all EMT and A-EMT requirements plus ACLS every two years, PALS or PEPP every two years. c. All credentialed providers are required to attend continuing education and receive a pre-set number of hours per year in specified areas of education to be defined in the Orange County EMS System Plan. (See attached refresher guidelines from NCOEMS) d. ALS Providers will be expected to adhere to OCEMS training standards. The OCEMS Training Coordinator will assist Agencies as much as possible. e. ALS providers are required to obtain an additional 24 hours over their four year recertification period. f. All training records are required to be maintained for each provider for a period of at least 6 years (even if the provider leaves the Agency). 7. Agency Documentation Process/Policy: Provide a written plan of the Agency's patient care documentation capability, retention of patient care documentation policy, and transfer of information process. a. All patient contact by Agency personnel should be documented thoroughly including findings, initial assessment, secondary assessment, all care provided by the Agency prior to EMS arrival. b. Orange County EMS protocol requires the "C.H.A.R.T." method of narrative documentation. c. Included in this plan is the Agency's method of retaining the records in accordance with HIPPA regulations. d. Include how "Pre-EMS" arrival information will be shared with Emergency Medical Services ambulance crew and the hospital receiving facility. 8. Agency Equipment Attestation: Attestation that the Agency has the appropriate equipment to operate at the requested level of service (See attached "Minimum Required Equipment List", Attachment 6 ) a. Pursuant to proposed North Carolina EMS Rule, Agencies seeking AEMT and/or Paramedic level credentialing shall apply to the OEMS for an EMS Non-transporting Vehicle Permit prior to placing the vehicle in service. b. EMS Nontransporting Vehicle Permits shall not be transferred. c. The EMS Nontransporting Vehicle Permit shall be posted as designated by the OEMS inspector. d. Vehicles that are not owned or leased by the EMS Provider are ineligible for permitting. e. The Orange County System Medical Director may choose to require systems to carry equipment and medication beyond the minimum State Rev. 8/8/2018 - 5 - DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD OEMS requirement. Attachment 7 meets the minimum State and County requirements of equipment to be carried by an Agency's service based on the selected credential level. f. Agencies may choose to carry more than what is on the list, as long as the equipment, medication, or supply is approved by the System medical director in advance and is only utilized by appropriately credentialed providers. g. Agencies will determine the amount of equipment necessary to carry in inventory to ensure availability. h. Orange County will continue to restock equipment on scene as they are utilized; however Orange County is not responsible for initial stocking, unintentional opening, or expired stock. (with the exception of glucometer supplies) i. Agencies must provide a copy of their operational procedures for the management of equipment, supplies and medications. Medications must be stored in "Climate Controlled" Areas. j. Written plans for inventorying supplies should be provided. k. A daily vehicle equipment inventory sheet should be provided. 9. Agency Quality Assurance Plan: QA Designation and responsibilities. a. All Agencies will be required to conduct QA activity. b. The QA designee will ensure the providers are following the protocols adequately and not performing above their scope of practice. c. The QA designee is responsible for auditing skills procedures for competency for all practicing providers in the Agency. d. The QA designee will be required to attend Orange County EMS Peer Review sessions and will be responsible for collaborating on required Peer Review audits with the Orange County EMS QA Coordinator. Agency QA representatives should be able to offer insight and offer suggestions to protocols, procedures, etc. e. Agencies may designate the training Coordinator to maintain QA responsibilities or may select an independent QA Coordinator. 10.Agency Infection Control Plan/Policy: Provide a copy of the Agency's Infection Control Policy (a written infectious Disease Control Policy includes written procedures which are approved by the EMS System Medical Director addressing the cleansing and disinfecting of vehicles and equipment used to treat patients) or attestation of the agency's commitment to follow OCEMS System Infection Control Policy. a. The Agency may write their own plan or provide copies of existing plans to Orange County. b. The Agency may adopt and implement Orange County Emergency Services Infection Control Policy. Rev. 8/8/2018 - 6 - DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD 11.Agency Medical Treatment Agreement: (Attachment 7) Orange County EMS Treatment Protocols must be followed by all providers functioning within this county. All providers function at the discretion and permission of the Orange County Emergency Services Medical Director and under his/her supervision. a. The Orange County Emergency Services Medical Director participates actively in training. b. The Medical Director has final authority on provider practice privileges. c. The Medical Directory also has the right and responsibility to suspend any provider he/she deems unfit or unqualified to perform to set standards. d. The Medical Director or Designee will be present at oral boards to determine provider's capability to practice independently. e. Agencies must agree to adhere to the Orange County EMS System Plan medical disciplinary procedure (Attachment 8) Application Completion and Submission Completed Applications should be submitted directly to the Orange County Emergency Services EMS Operations Manager. The Operations Manager will be available by phone or email to discuss submitted applications. Individual Site Visits will be scheduled upon application acceptance. Rev. 8/8/2018 - 7 - DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD ORANGE COUNTY EMERGENCY SERVICES If sz APPLICATION FOR Fire Department Level EMS Credentialing E -'-- Please Mark Category: Level of Agency Credentialing ❑ EMT ❑ EMT Intermediate ❑ Paramedic Department Name: Primary Department Address: (If different) Physical Address City/State/Zip: Telephone number at local base of operations: Name of Primary Contact Person Telephone number for Primary Contact Person: Required Application Attachments 1. Completed attestation that department is maintaining active and up to date roster in the State Office of EMS, Credentialing information system. 2. A full description of the type and level of service to be provided including the location of the place or places from which it is intended to operate. 3. Department attests to the ability to provide at least one certified person on each first due apparatus. A description of the applicant's capability to provide twenty-four hour coverage, seven days per week for the request level of service in the first due area covered by the department. 4. Attestation that the department has the appropriate equipment to operate at the requested level of service (see attached equipment lists) 5. A copy of the applicant's written operational protocols for the management of equipment, supplies, and medications 6. Attach the department's continuing education plan (including skill maintenance plan) 7. Attach the Training Officer designation form. 8. Provide a written explanation of the department's patient care documentation capability, retention of patient care documentation policy, and transfer of information process. 9. Provide a copy of the Department's Infection Control Policy (a written Infectious Disease Control Policy as defined in Rule .0102(33) of this Subchapter and written procedures which are approved by the EMS System medical director that address the cleansing and disinfecting of vehicles and equipment that are used to treat or transport patients) or completed attestation that the department will follow the Orange County EMS System Infection control policy. DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD I attest that the information provided is accurate and I have the authority to submit this application. Authorizing Signature: Date: FOR OCES USE ONLY Reviewed by: Date Filed: Approved by Orange County EMS Medical Director: DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Attestation of Credentialing Information System Compliance Department attests that our Agency is maintaining an active and up to date roster in the North Carolina Office of EMS Credentialing Information System. Department Chief: (Signature) (Date) (Printed Name) FOR OCES USE ONLY Received by: Date: Approved by Orange County EMS Training Officer: Date: DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD (Attachment 3) Agency Service Provision Attestation Department attests that our Agency will provide at least one (certification level) on each first due apparatus to ensure consistent service is available to all areas covered by our Agency. I. Please attach a description of your Department's capability to provide twenty-four hour coverage, seven days per week at the requested EMS service level. ll. Agency Approval Department Chief: (Signature) (Date) (Printed Name) FOR OCES USE ONLY Received by: Date: Approved by Orange County EMS Training Officer: Date: DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD (Attachment 2) DESIGNATION OF TRAINING OFFICER Agency Credentialing Guidelines require that the Agency indicate their designation of the EMS Training Officer. Agency Name: Date: The individual(s) who will provide EMS Training Officer services under the Agency Credentialing Guidelines shall be as follows: I. Agency EMS Training Officer: Contact Information Preferred Method of Contact: IL Back-Up Training Officer: (Optional) Contact Information Preferred Method of Contact: III. If applicable,please attach EMS Level I Instructor Certificate and any other Instructor certificates IV. Agency Approval Department Chief: (Signature) (Date) (Printed Name) FOR OCES USE ONLY Received by: Date: DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD (Attachment 2) Approved by Orange County EMS Training Officer: Date: DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD 1. Phase 1 Training - (EMT) a. Field precepting with an assigned Field Preceptor and/or Field Training Officer. i. Primary focus is to demonstrate that the candidate is able to operate in the field in all settings, and is able to medically manage a basic level call appropriately with confidence and requiring no intervention from the field preceptor. ii. The field preceptor will check off the candidate's skills and knowledge. iii. Components on the task check off booklet and document the candidate's ability to demonstrate the Core Competency Criteria. Once all components have been signed off, and the daily precepting forms reflect that candidate has demonstrated all competencies the field preceptor will complete and sign a Phase 1 Release Form. iv. Once a Phase One Release Form is completed and signed by all required parties (Field Training Officer, Supervisor, Candidate), a candidate will then be required to attend Simulation Lab #1 (Phase 1 concentrates on EMT-B level complexity and treatment modalities) that includes an EMT-B protocol test, patient care simulation, and oral board examination. (A simulation case sample is posted later in this manual.) v. For EMTs only, successful completion of Phase One field precepting and successfully passing the Simulation Lab#1, oral board, and the protocol test officially allows an EMT-B to eligible for release to independent practice. The Training Officer's signature will signify verification of all required training has been accomplished. DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD 1. Phase 2—(AEMT/Intermediate& Paramedic) a. While not required for all components Orange County will accommodate up to 32 shifts with a Paramedic Field Preceptor outside of initial certification requirements to accomplish these goals. i. The candidate demonstrates competency to care for patients in the field in all settings and is able to medically manage advanced level (AEMT/Intermediate) calls appropriately with confidence requiring no intervention from the field preceptor. ii. The field preceptor will check off the attendant skills and knowledge. iii. Components on the task check off booklet and document the candidate's ability to demonstrate the Core Competency Criteria. Once all components have been signed off, and the daily precepting forms reflect that candidate has demonstrated all competencies the field preceptor will complete and sign a Phase 2 Release Form. iv. Once a Phase 2 Release Form is completed and signed by all required parties, a candidate will then be required to attend Simulation Lab #2. The candidate will also complete a AEMT/Intermediate protocol test, EKG rhythm test, and Pharmacology test. b. In the case where the candidate fails the Medication Test the candidate will be given a two week remediation period and then allowed to retest. c. In the case where the candidate fails the field precepting or the Simulation Lab#2, the candidate will be allotted 1 full remediation period that adheres to the same criteria as the original precepting period (32 shifts). d. For those departments that AEMT/Intermediate is the highest level of certification the completion of field precepting and the simulation Lab testing will allow the candidate to sit for Oral boards with members of Medical Direction and Training staff. **It is the discretion of the Medical Direction Staff to be considered for reentry back into the precepting process.** DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD 1. Phase 3 — (Paramedic Only) a. While not required for all components Orange County will accommodate up to 48 shifts with a Paramedic Field Preceptor outside of initial certification requirements to accomplish these goals. i. The candidate demonstrates competency to care for patients in the field in all settings and is able to medically manage advanced level (Paramedic) calls appropriately with confidence requiring no intervention from the field preceptor. ii. The field preceptor will check off the attendant skills and knowledge. iii. Components on the task check off booklet and document the candidate's ability to demonstrate the Core Competency Criteria. Once all components have been signed off, and the daily precepting forms reflect that candidate has demonstrated all competencies the field preceptor will complete and sign a Phase 3 Release Form. iv. Once a Phase 3 Release Form is completed and signed by all required parties, the candidate will then be required to attend Simulation Lab #3 (the phase 3 lab concentrates on Paramedic level complexity and treatment modalities.)The candidate will also complete a Paramedic level protocol test, 12 Lead test, and Pharmacology test. b. With successful completion of Phase 3 field precepting, Simulation Lab #3, and an audit of precepting documentation with appropriate signatures the candidate will then sit for Oral Medical Board. The Medical Board shall consist of a minimum of four personnel with one representative from the Medical Director's office, OCES EMS Training, the OCES EMS operations manager, and First Responder Department Training Officer. c. Successful completion of Medical Board officially concludes Phase 3.The Paramedic will be released from the precepting phase and will be eligible for release to independent practice. Released Paramedics enter a Quality Assurance phase for no less than six months. i. In the case where the candidate fails the field precepting, or Simulation Lab#3, testing, the candidate will be allotted 1 full remediation period (48 shifts) which adhere to the same criteria as the original precepting period. In the case where the candidate fails the Medical Board only the Medical Board will decide via consensus the appropriate remediation period/criteria. ii. If the candidate fails either the field precepting, or the Simulation Lab#3, or required testing the Second time, the candidate is denied the ability to obtain Paramedic credentials in Orange County. **It is the discretion of the Medical Direction Staff to be considered for reentry back into the precepting process.** DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Core Competency Requirements To establish continuity in evaluation of the preceptee the following represents a set of guidelines that outline the core competency that a preceptee should possess. These core competency points should be reflected in the daily evaluation forms. Patient Care: Assesses and applies appropriate care in emergency situations • Assess need for more personnel and /or equipment • Assess chief complaint/problem accurately • Assess need for immediate vs. transport interventions • Uses history and exam findings to accurately diagnose the patient • Assess own need for more information regarding a patient problem/ medical procedure • Demonstrate adequate knowledge of anatomy, physiology, and pathophysiology • Use appropriate terminology, symbols, and abbreviations in oral and written reports • Demonstrate appropriate knowledge of pharmacology • Demonstrate ability to determine which protocol(s) are appropriate for a given patient • Demonstrate knowledge of treatment protocols and procedures Call Management: Plan patient care/scene actions appropriately • Plan a systematic approach to patient care using assessment information • Adhere to appropriate scene times • Demonstrate reasonable and safe priorities of care/action • Obtain appropriate treatment orders which are appropriate for the patient's problem(s) when not specified by standing protocols • Demonstrate ability to adapt to a dynamic working environment Communication: Show ability to effectively communicate with coworkers, patient, and family • Demonstrate ability to effectively transmit and receive information via appropriate communications mediums (i.e. Radio, cell phone, Life pak modem, etc.) • Interact courteously with crew, first responders, patients,families, dispatch, others • Give organized, clear, and accurate reports to hospital via radio and/or phone • Give organized, clear, and accurate report to receiving personnel • Share plan of care/action with crew members and other responders • Display professional behavior at all times on duty Equipment&Supplies: Demonstrate appropriate use and care of equipment • Show working knowledge of equipment for field use • Participate in care and maintenance of equipment • Properly documents all required information and reports problems to supervisor in a timely fashion 101 -' a e DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Scene Safety: Monitors and looks out for the safety of scene • Ensures scene safety at all times for self • Ensures scene safety for other crew members • Ensures scene safety for patient • Effectively communicates will all parties (PD, FD, ect.) • Identifies needs and implements solutions without prompting to ensure scene safety. Skills/Procedures: Demonstrate adequate level of skill(s) performance • Shows proper uses of all equipment • Selects proper procedures for appropriate patients • Performs interventions without remedial assistance from Preceptors Team Integration/Team work: • Effectively uses a team based approach to patient care • Provides feedback to other team members for better communication • Makes suggestions to superiors about solutions to problems • Communicates with other team members without prompting • Accepts feedback from other team members and applies in a constructive manner • Actively participates in activities to build team dynamic • Participates in daily activities and chores without prompting Documentation: Maintain appropriate records • PCR contains an accurate summary of patient assessment and treatment • PCR contains all other pertinent information and signatures • PCR utilizes good spelling, grammar, and appropriate medical abbreviations • PCR is filed in acceptable time frame Personal Evaluation: Ability to evaluate his/ her own performance • Identify areas in which skill improvement is needed • Identify areas in which knowledge deficits are apparent • Identify strengths in terms of skills and knowledge • Accept criticism or suggestions • Use suggestions or criticisms to improve one's self. Navigation: Appropriately locate and navigate to destinations • Locating and navigating to destinations using maps when appropriate • Identifying major and secondary landmarks for key locations • Correctly identifies address and other call locations without prompting • Correctly uses lights and sirens according to call codes and local laws 11 � :Page DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD ORANGE COUNTY EMERGENCY SERVICES Precepting Shift Performance Record TRAINEE: PRECEPTOR: DATE: STATION# Instructions :Section 1 The trainee should complete the section below listing each patient care skill performed for each call. The preceptor should rate each skill performed and discuss the evaluation with the trainee. ALS assistance skills can be rated by the medic on the call. Ratings: 1 2 3 1=Needs Remediation 2=Needs Improvement 3=Demonstrates Proficiency CFS# CHIEF COMPLAINT: SKILLS RATING Expectations: Preceptee Comments: Preceptor Comments: CFS# CHIEF COMPLAINT: SKILLS RATING Expectations: Preceptee Comments: Preceptor Comments: DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD CFS# CHIEF COMPLAINT: SKILLS RATING Expectations: Preceptee Comments: Preceptor Comments: CFS# CHIEF COMPLAINT: SKILLS RATING Expectations: Preceptee Comments: Preceptor Comments: CFS# CHIEF COMPLAINT: SKILLS RATING Expectations: Preceptee Comments: Preceptor Comments: DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD ORANGE COUNTY EMERGENCY SERVICES End of Shift Performance Record Preceptee Name: Preceptor Name: Instructions:Section 2 At the conclusion of each shift preceptors should evaluate the trainee's performance for the day and develop a plan for the future. **Preceptors should document rating in a fashion that can reflect the true fashion of how well a preceptee progresses. Ratings: 1 2 3 4 5 6 7 8 9 10 N/A 1=Needs remediation:Competency not demonstrated to the point of didactical remediation is necessary. 3=Needs improvement:Very basic components are demonstrated but needs improvement. 5=Demonstrates basic profiency but may periodically require prompting. 7= Demonstrates profenicy and meets all current standards. 10=Superior performance Overall Assessment of Evaluation Factors EVALUATION FACTOR RATING EVALUATION FACTOR RATING Patient Care: BLS Communications Patient Care:ALS Documentation: Duty Preparedness Equipment and Supplies Scene Safety Interpersonal/Teamwork Vehicle Operations Call Management Navigation Teamwork Comments Overall Performance: Indicate how the trainee performed overall on all evaluation factors during this shift. Development Plan: Identify specific competencies which need to be improved or learned andspecific actions to achieve this. Preceptor Signature: Date: I have read and understand this evaluation.Trainee Signature: Date: DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Orange County Preceptee Task Book Name: Phase 1 Skill/Task Date Trained Preceptee FTO Initials 02 Tank maintenance: a. Portable b. Main Oxygen Cylinder c. Locate Spare Tanks Portable Suction Unit a.Turning on the device b. Locations of different suction catheters c. Proper use of suction unit d. Charging the Suction Unit Thomas Pack a. Location of equipment/supplies Yellow Medication Bag a. Locate medications b. Locate and assemble bristojets c. Know brand and generic name for all medications Decontamination a. location of equipment b. Infection Control Procedure Pediatric Bag a. Location of equipment/supplies Mass Casualty Triage a. START Triage b.JumpSTART Triage c. Smart Triage Pack Miscellaneous a. Mass Casualty Plan b. Infection Control Plan c. CERT Program d. Injury Prevention Programs e. Falls Prevention Campaign f. Continuing Education Special Events a. High School Football b. Public School Athletic Field Access c. UNC Special Events d. UNC Athletics Locations (See List) e. Franklin St. Celebrations f. Orange Co. Speedway Operations DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Documentation a. Documentation Completion/Submission b. Signature Collection c. CHARTE Method d. Refusals/Referral e. Discontinuation of Resuscitation e. Zoll ePCR Procedures f. QA/QI process g. Dispositions BIAD: King Airways a. Equipment location b. Indications c. Contraindications d. Procedure Airway Suctioning Basic a. Equipment location b. Indications c. Procedure Adult and Pediatric Assessment a. Adult Procedure b. Pediatric Procedure Cardiac Monitor a.Turning on the monitor b. Recording a strip c. Changing the battery d. Changing EKG paper e. Apply limb leads f.Apply 12\lead g. Apply Defib/Pacer pads h. Apply Pulse Oximeter i.Transmitting data\Computer and j. Storing Cables k. CO2, CO, Met HgB Child Birth a. Location of OB kit b. Procedure Pain Assessment and Documentation a. Procedure b.0\10 Scale c.Wong\Baker faces scale Spinal Immobilization a. Location of equipment b. Indications c. Procedure: Long Board KED Pediatric Immobilizer DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Splinting a. Location of equipment b. Indications c. Procedure d. Padded Board e. Hare traction f. Sling and Swathe g. Miscellaneous: Pillow, Blanket, Ladder Venous Access: IV Line Assembly a. Location of equipment b. Procedure Wound Care a. Location of equipment b. Hemorrhage control procedure Defibrillation Automated a. Indications b. Contraindications c. Procedure Orthostatic Blood Pressure Measurement a. Indication b. Contraindication c. Procedure Verification of all Phase 1 Skills/Tasks completed with proficiency: Preceptee (sign) (date) FTO/Preceptor Supervisor (1520) / DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD PHASE 2 Skills/Tasks Skill/Task Date Trained Preceptee Initials FTO Initials Airway Nebulizer Inhalation Therapy a. Equipment location b. Indications c. Assemble Device d. T-tube adapter/inline neb set up e. Procedure Airway Suctioning Advanced a. Equipment location b. Indications c. Procedure Capnography (ETCO2) a. Indications b. Procedures Restraints a. Indications b. Procedure Stroke Scale: LAPSS Documentation a. Indications b. Procedure c. Appropriate scene time d. Early ED Notifications e. Stroke Centers/Triage Destination Plan Venous Access External Jugular a. Indications b. Contraindications c. Procedure Venous Access Extremity a. Indications b. Procedure Triage Destination Plans and Procedures a. Trauma b. Pediatric c. Burns d. STEMI e. Stroke Centers f. Alert Procedures (ICC Express, Bat Phone, RACE Hotline,Trauma Notification) DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD CPAP a. Location of equipment b. Indications c. Contraindications d. Assembling the device e. Procedure Injections a. Location of equipment b. SQ and IM procedure Intranasal Medication Administration a. Location of equipment b. Indication c. Contraindications d. Procedure Nasogastric Tube Insertion a. Indications b. Contraindications c. Procedure Medications (indication, dose, route, and contraindications) a. Acetaminophen b. Adenosine c. Afrin (Oxymetazoline) d. Albuterol e. Amiodarone f. Ammonia capsules g. Aspirin h. Atropine i. Diazepam j. Diphenhydramine k. Calcium Chloride I. Dextrose 5%Water m. Dextrose 10%Solution n. Diltiazem o. Dopamine p. Epinephrine 1:1,000 q. Epinephrine 1:10,000 r. Glucagon s. Haloperidol t. Lidocaine u. Magnesium Sulfate v. Midazolam w. Methyl prednisolone x. Morphine y. Naloxone z. Nitroglycerine Aa . Normal Saline Bb. Ondansetron Cc. Sodium Bicarbonate DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Verification of all Phase 2 Skills/Tasks and Medications completed with proficiency: Preceptee (sign) _� / (date) FTO/Preceptor Supervisor (1520) _� / DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD PHASE 3 Skills/Tasks Orange County Preceptee Task Book Name Skill/Task Date Trained Preceptee Initials FTO Initials Airway Surgical Cricoth rotom a. Equipment location b. Indications c. Contraindications d. Procedure Induced Hypothermia a. Equipment location b. Indications c. Contraindications d. Procedure Cardioversion a. Indications b. Contraindications c. Procedure Chest Decompression: a. Location of equipment b. Indications c. Procedure Intravenous Drip Administration a. EPI drips b. Dopamine drips c.Amiodarone drips Venous Catheters Accessing Existing a. Indications b. Procedure c. Specialty Equipment Defibrillation Manual a. Indications b. Contraindications c. Procedure External Cardiac Pacing a. Indications b. Contraindications c. Procedure Verification of all Phase 3 Skills/Tasks completed with proficiency: Preceptee (sign) (date) FTO/Preceptor Supervisor (1520) _/ / DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Recommendation for Release Phase The trainee Recommendation for Release should be completed with Precepting Shift Performance Records. If the trainee is recommended for release, complete Part 1. If the preceptor recommends that the trainee continues precepting, complete Part 2. Areas of competency that have been addressed and are critical to the success of employment of Orange County Emergency Services: • Patient Care • Communications • Documentation • Navigation • Call Management • Team Integration • Scene Safety • Vehicle Operations • Interpersonal/Team work • Skills/Procedures • Professionalism Trainee Recommended for Release: YES or NO Part 1: The trainee has completed all requirements to be released and has passed the written map and knowledge test. The trainee has demonstrated capability in all competency areas as indicated on the attached Periodic Progress Report. Trainee Signature: Preceptor Signature: Date: Date: Training Officer: Supervisor Signature: Date: Date: Medical Director: Date: For Training Officer use #of Shifts Drug Test Medical Boards Protocol Test #of Skills Check off Precepting Sheets 12 Lead test Patients SOG Test Sim-Lab Map Test 29 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Part 2: The trainee is recommended for extended field shifts due to the following factor(s): Inability to consistently perform patient care skills Inability to demonstrate capability in all competency areas Inability to demonstrate adequate communication skills Inability to independently complete adequate PCRs Inability to demonstrate assertiveness/proactive behavior Inadequate number of patient contacts Inadequate coverage of competencies during precepting shifts Other Areas needing further development and plans for improvement are indicated on the attached Period Progress Report. Number of additional shifts recommended: Preceptor Signature: Trainee Signature: Date: Date: 1525 Signature: Supervisor Signature: Date: Date: Training Officer: Medical Director: Date: Date: For Training Officer use #of Shifts Drug Test Medical Boards Protocol Test #of Skills Check off Precepting Sheets 12 Lead test Patients SOG Test Sim-Lab Map Test 30 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD • ' ' Phase 1: Oral Board Examination P. Guidance for Candidates and Preceptors One of the key steps in demonstrating competency and readiness to function as a provider(EMT-B or Paramedic)with Orange County Emergency Medical Services is passing the Phase 1 Oral Board Examination. Each provider is expected to sit for the examination and must be able to demonstrate competency to all members of the examining board in order to pass the examination. The examiners will consist of at least one physician representative from The Office of the Medical Director plus additional providers within the OCEMS system.The examination usually lasts 15 to 30 minutes, however it may run longer. The oral board is broad in scope and focuses on multiple content areas. It is firmly expected that each Phase 1 candidate be well prepared in advance having mastered all EMT-B level protocols and procedures prior to taking the Phase 1 oral board examination. Candidates must prove satisfactory knowledge of medical practices within the OCEMS system to all members of the examining board in order to pass. The oral board's content is generally case based with an emphasis on protocol knowledge, medication knowledge, scene management, resource utilization, and operational competency. For example, the questions below are similar to those questions used in prior oral board examinations: "A 65 years old male develops sudden shortness of breath during a walk. What are some of the possible causes of his shortness of breath (i.e. differential diagnosis)?" "You and your partner respond to a park in Chapel Hill.The scene is safe. You find a 23 year old male who is unconscious, but breathing. His respiratory rate is 6 and his radial pulse is weak at about 120 beats per minute. What step do you want to perform next?" "How to you perform a 12-lead EKG? How is it transmitted on the LifePak 12?" (Please note this is not asking for EKG interpretation.This is asking how to perform an EKG and then transmit it to the receiving hospital.) "When can an EMT-B administer oral glucose?" "What is the procedure for conducting a prehospital stroke screen?" "What hospitals in our service area are trauma centers?" The Phase 1 Oral Board Examination is designed to be a challenging exam that will only be passed if the candidate can demonstrate mastery of the OCEMS protocols, procedures, and policies. Please direct questions about preparation for the oral examination to the Training Officer. Sincerely, Jane Brice, MD Mark Quale, MD Ryan Grebe, EMT-P Medical Director Assistant Medical Director Training Officer 34 a e DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services 17 i2 Sample Oral Board Examination 14,115 Cato, NN� Basic Medic (Candidate) Passed: YesNo Date: / / Thought Process: (Organized/Disorganized, Deductive Reasoning) Scene Management: Resources Management, Scene Times) Protocol Knowledge: ROW Medication Knowledge: Technical Skills Knowledge: 35 age DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Confidence/Appearance: Comments: Evaluator Signatures: Name: ame: Position: sition: Signature: gnature: Name: ame: Position: Position: Signature: Signature: Name: Name: Position: Position: Signature: Signature: 36 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD SIMULATION CASE SAMPLE Candidate: ' Date of Eval: PHASE 1 SIMULATION LAB EXAMINATION CARDIACARREST Examination Goals 1. Perform all critical actions competently to pass(denoted by"C*") and 2. Obtain a minimum 70%or higher individual point score to pass Summary:Sick call(nausea),afebrile,normotensive and non-orthostatic,while being transported develops chest pain, 12-lead shows MI,cardiac arrest(fib),defibrillation, ROSC with GCS 15.Continue to transport without complications or further incidents. Scene: Summer—Dry—Night(20:00 hours) Single story residence—easy access to patient—no trip hazards—scene is clean and safe Dispatch Information: 26-A-06,Sick Person (nausea). Patient is a 63 year old male,conscious and breathing,complaining of nausea.The wife has called 911 stating that she feels something is wrong with her husband. Present on scene/General Impression: Husband and Wife couple—no family—no other persons—no animals Patient location:Patient reclining in chair recliner in the living room and has his hands over his upper abdomen. AVPU-Patient is ALERT and oriented to person,place,time,and event Skin pale,cool,and clammy.Approximate weight: 220 Ibs-No apparent distress Patient Complaint: Patient complains of slight nausea with one episode of vomiting. 1 SAMPLE History Obtained S: Nausea,clam my A: Na Known Drug Allergies M:Simvastatin,Omeprazole, Nitroglycerin tabs P: Hyperlipidemia,cholecystectomy, heart problem Familial history: Brother died from a heart attack at age 62.Father died from a heart attack at the age of 60. L: 3-day-old Chicken Casserole approx.30 minutes prior to calling 911 E: The patient had just finished eating a 3-day old chicken casserole when he began to feel "slightly nauseated". Patient wentto the bathroom and vomited once.The patient apologizes to EMS for being called to his house and states that he "feels fine".The wife of the patient looks at you and states, "I know my husband and something is just not right.He never gets sick.Maybe it was the casserole.Please help him." 1 OPQRST History Obtained O: 19:30—sudden onset—no signs or symptoms prior to acute onset P: Patient was sitting and resting at onset of nausea. Nothing makes it better. Q:Patient has a sense of being full,even after vomiting once. R:Gastric/Epigastric region,nausea S: Patient is not experiencing any pain or pressure T: Onset of nausea is 19:30. EMS dispatched at 20:00. 37 I > a ; e DocuSign Envelope ID:79C5D167-66CA-4E59-B4AC-AA38CC1 B20BD SIMULATION CASE SAMPLE ' Candidate: Date of Eval: PHASE 1 SIMULATION LAB EXAMINATION CARDIACARREST Examination Findings: C* Obtain Full Set of Vital Signs Correctly BP: 110/70 in sitting position. P: 100-strong-regular RR:15 Temp:98.0 oral 02:—99%On Room Air Glucose: 110(Glucose measurement not required) 1 Perform physical exam(to include cardiac,resp,and GI at minimum) Respiratory: Lung sounds clear in all fields with equal chest rise and fall. Cardiovascular: No chest pain or pressure.Regular pulse. Lead II unremarkable. Gastrointestinal:Soft,tender to palpation epigastric region only,no distention,no discoloration.Vomiting x1 without blood. Normal RM and Urine Musculoskeletal: No tenderness, No pain.No signs of trauma Neurological:Alert.No motor or sensory deficits noted.LA Stroke Scale=Neg Integumentary: No signs of trauma.Skin is pale,cool,and clammy to touch. Orthostatics: BP: 105/68 in standing position. P: 104—strong—regular RR: 15 02:—99%On Room Air ---Patient placed in unit and en route to UNC-- Patient suddenly develops chest pain while en route to hospital. Pain is substernal,squeezing 10/10, radiating to the left chest/shoulder/arm Repeat Vitals: BP: 100/60 P: 115—weak-regular RR: 20 02:—99% 1 Follows CHEST PAIN Protocol: Patient interventions: 1 Oxygen C* 12-Lead Performed Correctly(***Acute MI Suspected***) _/C* Aspirin given 1 Nitroglycerin SL given 1 Demonstrates how to transmit 12-lead See Page 3 38 Page DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Candidate: Date of Eval: ---VFIB ARREST--- Patient states"I don't feel so good. I feel dizzy." The patient proceeds into V-Fib Arrest with agonal respirations. _/1 Follows CARDIAC ARREST Protocol(including CPR/defibrillation): Patient interventions: C*Automated Defibrillation Procedure(CPR as required,place pads,turn on monitor,utilize AED mode appropriately) ---Patient ROSC post defibrillation and is ALERT with a GCS of 15--- 1 Reassess patient vital signs/exam BP: 100/60 P:70-weak-regular RR: 15 02:94% Respiratory: Lung sounds clear in all fields with equal chest rise and fall. Cardiovascular:Chest Pain,Pulse regular Gastrointestinal:Soft,tender to palpation epigastric/gastric region only,no distention,no discoloration. Musculoskeletal: Mild discomfort to chest secondary to defibrillation Neurological:Alert.No motor or sensory deficits noted.LA Stroke Scale=Neg Integumentary: No signs of trauma.Skin is pale,cool,and clammy to touch J 1 Call in appropriate report to receiving hospital a Score Summary Critical Actions Completed: of 4 Individual Points Total: _of 10 Final outcome (pass/fail): Examiner Signature: 39 Page DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD IS W 12-Lead 2 HR 65 bpm`' ` ACI1TE M I SX11TED 1 49124 Mar 12 94:45:31 'Abnormal ECG Boni'i rm ed** 18: PR 9.868s WS 9.80 'UmletermireQ rhythm Indmd: 4T/OTc 8.W.455s ISTeletiati or.mi der inferolateraI ige 48 i Sex- P-QRS-T fees i 720 98c injury or acute infarct if JV2 f ' 41.8 .65-1598t NTWset � _ �= 1371-13416G5LRMM7JIP1?M78 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD (Attachment 6) Attestation of EMS Equipment and Supplies Management Department attests that our Agency has the appropriate EMS equipment, supplies and pharmaceuticals to operate at the level of service a. Please attach a copy of your operational procedures for the management of equipment, supplies and medications. b. Please attach written plans for the inventorying of supplies. c. Please provide a copy of the daily EMS vehicle equipment inventory sheet should be provided. Department Chief: (Signature) (Date) (Printed Name) FOR OCES USE ONLY Received by: Date: Approved by Orange County EMS Training Officer: Date: DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Attachment 7 Minimum Equipment to be Carried by Non-Transport Emergency Medical Provider Vehicles. (All items pertain to the level of certification the provider is intending to function as.) The Following Will be Required on all BLS Vehicles: • Appropriate Restraints o Crew o Non-patient passengers • Warning devices (lights and sirens) • Two-way radio mounted in front of vehicle • 02 cylinder with regulator • Suction apparatus • BVMs o Adult with mask o Child with masks ■ Child ■ Infant ■ Neonatal • AED with adult and pediatric pads • Sphygmomanometers o Adult o Large Adult o Pediatric • Stethoscope • Tourniquet (Hemorrhage Control) • Blind Insertion Airway Devices with syringes (BIADS) • Medications at discretion of department with the Medical Directors approval and proof of proper knowledge by providers: o Acetaminophen o Albuterol o Ibuprofen o Benadryl PO o Oxymetazoline (Nasal Spray) o Nerve Agent Kit o Nebulizer o Aspirin o Epinephrine Auto Injector (Adult and Ped) o Nitroglycerin o Naloxone Rev. 11/21/2013 - 1 - DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Attachment 7 • Nasal Mucosal Administration Device • Cervical Immobilization Collars (S, M, L, Pediatric) • Upper and Lower Extremity Immobilization Devices • Oropharyngeal Airways (3 adult & 3 Pediatric sizes) • Nasopharyngeal Airways (3 adult & 3 Pediatric Sizes) • Nasal Cannula Adult & PED • Non-rebreather with tubing (Adult and Pediatric) • Suction Catheters o One between 6 & 10 F. o One between 12 & 16 F. • Rigid Pharyngeal Suction Device • Wide Bore Suction Tubing • Thermometer (with Low Temp. capability) • Glucometer • Pulse Oximeter (adult and pediatric sizes) • Gloves (Latex Free) • Gloves (Non-sterile) • Mounted Fire Extinguisher • Flashlight with extra batteries • Infectious Control Kit (Mask, Gowns, Jumpsuits, eye protection,& shoe covers) • Disposable Biohazard Trash Bags • N-95 or HEPA masks • Disinfectant hand wash • Disinfectant for cleaning equipment • Sharps containers (2 sources) • Emesis Collection Device • Thermal Blanket (or other heat conserving device) • Sterile OB Kit (scissors, bulb suction, cord clamps) • Bulb syringe (Separate from OB Kit) • Length/weight-based pediatric tape • Dressing, bandages, roll gauze • Triangular Bandages (2) • Occlusive Dressing • Adhesive Tape • Heavy Duty Scissors • Alcohol Wipes • Lubricating Jelly • Triage system • Sterile Irrigation Solution • Burn Sheet Rev. 11/21/2013 - 2 - DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Attachment 7 • Cold Packs • Medications and fluid kept in climate controlled environment • Provider name displayed on each side • Reflective tape on all sides • Equipment secured in compartment • Copy of Protocols • Exterior Cleanliness • Interior Cleanliness In Addition to The Above, The Following Will be Required on all EMT-Intermediate Vehicles: • ET Blades (3 adults & 3 Pediatric sizes) • ET handles with extra batteries & Bulbs • ET Tubes (3 adult & 3 pediatric sizes) • ET Stylettes (adult and pediatric) • ET Tube Holder • McGill Forceps (adult & pediatric sizes) • IV Administration Sets Micro and Macro • IV Catheters in at least 4 sizes • Needles of various sizes, one must be at least 1.5 in. for IM injections • Syringes (In at least 3 sizes) • IV arm board • Color Metric/Waveform/Numeric End Tidal CO2 Detector • Medications at discretion of department, approval of Medical Director and proof of proper knowledge by providers, in addition to those in EMT-Basic List: o Crystalloid Solution o Diphenhydramine o Epinephrine 1:1000, 1:10,000, & 1:100,000 o Glucagon o Glucose solution o Ketorolac o Vasopressin* o Nitroglycerin Paste o D1o% • Meconium Aspirator Adaptor In Addition to all of The Above, The Following Will be Required on all EMT-Parmedic Vehicles: Rev. 11/21/2013 - 3 - DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Attachment 7 • Monitor/Defibrillator with Electrodes & 2 sizes of Pads/Paddles with 12-Lead Capabilities • Waveform Capnography • Pacemaker (external) • Intraosseous Needles (Adult and Pediatric Sizes) • Advanced airway kit for Cricothyrodomy • Chest Decompression equipment (3" 14 ga angiocath) • Medications at discretion of department, approval of Medical Director and proof of proper knowledge by providers, in addition to those in EMT-Basic and EMT-Intermediate List: o Adenosine o Antiarrhythmic o Antiemetic o Atropine o Calcium Chloride/Gluconate o Beta Blocker o Narcotic Analgesic o Sodium Bicarbonate o Steroid Preparation o Versed o Ativan* o Haloperidol o Morphine o Fentanyl* o Dopamine o Diltiazem o Magnesium Sulfate o Amiodarone o Lidocaine o Vecuronium o Ondasteron o Sodium Bicarbonate o Diazepam o Pralidoxime North Carolina OEMS recognizes the above equipment as the MINIMUM required equipment for the respective provider level, it does not negate the responsibility of the providing service to maintain a minimum level of equipment sufficient to function per the protocols of the provider level responding to a call. * Items are alternatively approved medications in the event there is a shortage, these may be substituted for continuation of care. Rev. 11/21/2013 - 4 - DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD (Attachment 8) Agency Medical Treatment Attestation Department understands that Orange County EMS Treatment Protocols must be followed by all providers functioning within the County. We understand that all EMS providers function at the discretion and permission of the Orange County Emergency Services Medical Director and under his/her supervision. a. The Medical Director has final authority on provider practice privileges. b. The Medical Directory also has the right and responsibility to suspend any provider he/she deems unfit or unqualified to perform to set standards. c. The Medical Director or Designee will be present at oral boards to determine provider's capability to practice independently. Department Chief: (Signature) (Date) (Printed Name) FOR OCES USE ONLY Received by: Date: Approved by Orange County EMS Training Officer: Date: DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD r Orange County Emergency Services 510 Meadowlands Drive Hillsborough,NC 27278 -- 919.245.6100 Policy 21: Peer Review Committee Objective: • To clearly state and define the purpose, function, and structure of the Peer Review Committee. Definition: • The Peer Review Committee is a panel composed of EMS program representatives to be responsible for analyzing patient care data and outcome measures to evaluate the ongoing quality of patient care, system performance, and medical direction within the OCES System. Meeting Schedule: • The OCEMS Peer Review Committee meets quarterly, at UNC Hospitals, in the months of March, June, September, and December, on the second Thursday of the month at 9:00 AM. Function of Committee: • The OCEMS Peer Review Committee is tasked with quality assurance oversight functions. The committee collects, analyzes, and evaluates data from all aspects of the OCES System, including the Emergency Communications Center, the EMS Transportation Division, the various First Responder Programs including law enforcement, and the UNC Hospitals Emergency Department, and makes system recommendations designed to improve patient outcomes, continuing education programs, and the quality of the system. • The committee is also charged with reviewing and supporting the practice standards established by the Director and Medical Director, and with providing suggestions to medical staff for areas of focus in programmatic, educational, and operational aspects of the EMS System A Prepared, Coordinated, and Integrated Emergency Services System Twitter Cct,'�ocneemergeney DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Guarantee of Due Process: • Each individual that temporarily or permanently has their practice privileges suspended will be given due process as required by G.S. 10A NCAC 13P.0408 (7)• • The Peer Review Committee has delegated the responsibility for review of situations involving medical discipline to the Medical Review Panel. (See Medical Disciplinary Procedure) Minutes: • The secretary of the Peer Review Committee maintains minutes for the Peer Review meetings and publishes minutes for all participants. • Minutes are reviewed and approved at each meeting. • Minutes will remain on file throughout the duration of the OCES System Approval Duration. Committee Structure Membership: • The membership of the OCEMS Peer Review Committee will consist of representatives from at least the following categories or agencies: o OCES System Medical Director (Core) o OCES Director (Core) o OCES Training Coordinator (Core) o OCES System Assistant Medical Director o OCES System Administrator (Core) o OCES EMS Quality Assurance Coordinator (Core) o OCES Communications Quality Assurance Coordinator (Core) o OCES System Training Coordinator (Core) o South Orange Rescue Squad Representative o JAS Representative o North State Representative o Carolina Air Care Representative o Municipal Fire Representative o Volunteer Fire Representative o Law Enforcement Representative o UNC Hospitals EMS Nurse Liaison o UNC Hospitals ED Nurse Manager o NCOEMS Official. o UNC Trauma Coordinator o UNC STEMI/Chest Pain Coordinator o UNC Comprehensive Stroke Coordinator - 2 - DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Officers: • The OCES System Medical Director will serve as the chairperson of the Peer Review Committee. • Two OCES System Assistant Medical Directors will serve as the vice chairs. • The OCES Quality Assurance Coordinator will serve as the Peer Review Secretary. The secretary will be responsible for sending notification of meetings, will keep and distribute minutes, and shall maintain an attendance roster. Appointment of Members: • At the December meeting, the chairperson will ask the general membership for recommendations for additional or replacement members. • The appointment of members to the Peer Review Committee will be by the EMS Core Committee, defined above. • The EMS Core Committee will either appoint the person(s) recommended by the Peer Review Committee, or report back to the Peer Review Committee with the reason that the recommended individual is not appointed. Terms of Membership: • The term for general membership is for two years, at which time the EMS Core Committee may re-appoint the member or seek recommendation from the Peer Review Committee for other members. Meeting Attendance and Quorum for Business: • Peer Review Committee Members are encouraged to attend all meetings. • Members who are absent from two consecutive meetings will be sent a letter by the Peer Review Committee Secretary reminding them of the importance of the Peer Review Function. • Members who are absent from four consecutive meetings will be suspended from the Committee pending review by the EMS Core Committee. • A quorum of the members for meeting purposes is at least five members present. Confidential Documents and Records: • In the course of its business, the Peer Review Committee will review both the medical records of identifiable patients and the personnel records of identifiable EMS or Hospital personnel. • All these documents and records are confidential and not to be circulated or released outside of committee meetings. • Other materials submitted for the review of the Peer Review Committee which do not clearly identify either patients or personnel may become public record as noted by G.S. 143-518. - 3 - DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Responsibility • The Peer Review Committee Chair is responsible for enforcing the confidentiality of the records reviewed during Peer Review meetings. Penalty for Release: • The inappropriate release of confidential records by a member of the Peer Review Committee will result in their immediate suspension from the Peer Review Committee pending a review of the situation by the EMS Core Committee. - 4 - DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Orange County EMS System Peer Review Committee Organization Name Title Role UNC Joseph Grover, MD OCES System Medical Director (Core) Chair UNC Irfan Husain, MD OCES Assistant Medical Director Vice- Chair UNC Glen Burket, MD OCES Assistant Medical Director Vice-Chair UNC Diana Miller, MD OCES Assistant Medical Director OCES Thomas R. Griggs, MD OCES Assistant Medical Director OCES Dinah Jeffries OCES Director OCES Kim Woodward, EMT P OCES System Administrator (Core) OCES Kyle Ronn, EMT P OCES Quality Assurance Coordinator Secretary OCES Laura Piche, EMD OCES Communications Quality Assurance (Core) OCES Chris Pope, EMT-P OCES System Deputy EMS Operations Manager (Core) OCES James Gusler, EMT -P Training Coordinator (Core) SORS Spencer Lindgren, EMT-P South Orange Rescue Squad (Core) SORS Matthew Mauzy, EMT South Orange Rescue Squad Representative First Choice Mark Varsano First Choice Representative North State Brian Pearce North State Representative CAC Jennifer Haynes, MSN, MHA, Carolina Air Care Representative RN, CMTE, CPEN Chapel Hill Fire Jacob Sinkiewicz, EMT Municipal Fire Representative Department Chief's Council Philip Nasseri, EMT Volunteer Fire Representative UNC Gary Barker, RN UNC Hospitals EMS Nurse Liaison UNC Jeff Phillips , RN ED Nurse Manager NCOEMS Doug Calhoun State Office of EMS Representative Police Chris Atack Field Operations Commander Department UNC Trauma Tricia B. Harrison. RN, BSN Trauma Coordinator UNC STEMI Katy Strauss, BSN, RN, STEMI/Chest Pain Coordinator PCCN, UNC Nicole Burnett BSN, RN, Comprehensive CNRN, SCRN, CCRN-K Comprehensive Stroke Coordinator Stroke - 5 - DocusiLin Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD NCCEP Standards NCCEP Standards for EMS Performance Improvement Performance Standards 2009 0 North Carolina College of Emergency Physicians ■■■■■ Cn MEN 0 Standards for the Selection and Performance of ■■■■■ loll m ©1919®© ■■■■■ EMS I • • • 0 m V North Carolina EMS Performance Improvement Guidelines 0 0 The purpose of this guideline is to provide direction to EMS Agencies with respect to patient care based quality management and performance improvement. Each of these topics address either an EMS Service Delivery, Personnel Performance, or Patient Care issue which is either important to quality or has been identified as a high risk or high liability area for Emergency Medical Services. D m Please refer to the North Carolina College of Emergency Physicians Standards for Medical Oversight and Data Collection Frequently W Asked Questions (FAQs) for information on how each EMS System's Peer Review Committee must address this document. D The items listed in this guideline are of more value when trended (monthly or quarterly as noted) and then divided up among the yearly peer review CO meetings for review and discussion. How frequently each item is presented and discussed within the Peer Review Committee should be determined by the EMS Systems call volume and resources. Every item in this guideline is designed to be reviewed and discussed at a minimum of once each year with the exception of the 6 EMS Toolkits which are designed to be reviewed and discussed twice per year. W 0 Topics are grouped into the following areas: Service Delivery: Resources and Equipment Service Delivery: Time Parameters Service Delivery: Complaints and Investigations Personnel Performance �k Patient Care: Treatment Patient Care: High Risk Patients Patient Care: High Risk Events Performance Standards (Page 1 of 11) 2009 0 • • . - • - • • - ' o NONE " Cn Standards for the Selection and Performance of 1Vj m EE • • • y , CD PFr 0 m ' • Record • • Data SelectionTopic Mandatory of Events Definition Loop Closure 10 - •uency Source 0 Reviewed Service Delivery: Resources and Equipment 1. Vehicle Failures All On Duty Monthly Yes 100% Number of Vehicle EMS Implement or evaluate Occurrences Failures while in Service Agency Vehicle Maintenance Plan D i, m 01 2. Vehicle Crashes All On Duty Monthly Yes 100% Vehicle Crashes while in EMS Evaluate and Discuss 1P Occurrences Service Agency Crash etiology from D vehicle, personnel, patient, and any other perspectives. co 3. Patient Care All On Duty Monthly Optional 100% Number and type of EMS Evaluate and establish W Equipment Occurrences required EMS equipment Agency method to assure all W missing from daily EMS and CIS equipment is present on 0 Agency and State Inspectio all active EMS units. Regulatory Inspections n Report 4. Patient Care Device All On Duty Monthly Yes 100% Number and type of EMS Establish or monitor plan Failures Occurrences patient care or medical Agency to assure all active EMS while in use device failures while in units have properly use. working equipment. 5. First Responder On All 911 Monthly Yes 100% %of events FR on EMS Establish target and work Scene % events with Scene where they were Agency for 95% compliance FR Dispatch dispatched and PreMIS Report Service Delivery: Time Parameters 6. Dispatch Center 911 Events Monthly Yes 100% of 911 Call time until EMS PreMIS Establish target and work Time Emergent Notification Time Report for 95% Compliance Dispatches 7. Turn-out(Wheels- 911 Events Monthly Yes 100% of EMS Notification until PreMIS Establish target and work Rolling Time) Emergent EMS En Route Time Report for 95% Compliance Dispatches Performance Standards (Page 2 of 11) 11 • Carolinallorth • - • - of • - 0 ■■■■■ ■■■ . Standards . Performance EM ■■■■■ ©oo®© M ■■■■■ EMS - - . - . . - - 0 mill _0 Percentage of D, o TopicD- . . . Closure Selection Frequency Source Reviewed Cn 8. Response Time to All Events Monthly Yes 100% of EMS En Route Time PreMIS Establish target and work Scene Dispatches by until Arrival at Scene Report for 95% Compliance W group: or Patient Location Emergent 911, Non-Emergent M 911, Non- 1P W Scheduled D Medical D Transports, and W 00 SUP Transports N O 9. Response Time to 911 Events Monthly Optional 100% of EMS Arrival EMS PreMIS Establish target and work o Patient Emergent Arrival On Scene until Report for 95% Compliance Dispatches Arrival at Patient Time 10.Scene Time All Events Monthly Yes 100% of EMS Arrival on Scene PreMIS Establish target and work Dispatches by until Depart Scene Report for 95% Compliance group: Time Emergent 911, Non-Emergent 911, Non- Scheduled Medical Transports, and SUP Transports 11.Transport Time All Events Monthly Yes 100% of Depart Scene until PreMIS Establish target and work Dispatches by Arrive at Destination Report for 95% Compliance group: Time Emergent 911, Non-Emergent 911, Non- Scheduled Medical Transports, and SUP Transports � � • 0 North Carolina College of Emergency Physicians 0 ■■■■■ Cn MEN 0 Standards for the Selection and Performance of In ■■■■■ 1►Il ■■■■■ EMS • • • 0 Percentage of m Record • • Data SelectionF_ Topic Mandatory Events Definition Loop Closure - •uency Sourceco Reviewed cn 12.Back in Service All Events Monthly Yes 100% of Arrive at Destination PreMIS Establish target and work P Time Dispatches by until Back in Service Report for 95% Compliance group: Time Emergent 911, D Non-Emergent M 911, Non- 1P W Scheduled D Medical Transports, and W SCTP00 Transports N O 13.Dispatch Center 911 and Monthly Yes 100% Documented Delays PreMIS Identify and address o Delays SCTP from PCR Report noted trends Events 14.Response Time 911 and Monthly Yes 100% Documented Delays PreMIS Identify and address Delays SCTP from PCR Report noted trends Events 15.Scene Time Delays 911 and Monthly Yes 100% Documented Delays PreMIS Identify and address SCTP from PCR Report noted trends Events 16.Transport Time 911 and Monthly Yes 100% Documented Delays PreMIS Identify and address Delays SCTP from PCR Report noted trends Events 17.Turn-Around Time All Events Monthly Yes 100% Documented Delays PreMIS Identify and address Delays from PCR Report noted trends 18.Frequency of ED All Events Monthly Optional 100% Not a current PreMIS EMS Identify and address Off-Load Delays Data Element. Must be Agency noted trends documented locally. 0 ■■■■■ North Carolina College of Emergency Physicians 0 ■■■ • • for • and Performance of n NONE EMS 10101911 NEON • • • 0 Percentageof m Record • • Data SelectionTopic Mandatory Events Definition Loop Closure .-4 •uency Sourcen Reviewed 19.First Responder 911 Events Monthly Yes 100% of All 90% Fractile Time of EMS Establish a target and Response Time Events with FR Response Time Agency work for 95% compliance W First Responder (Dispatch until Arrival Data or Response on Scene)for all PreMIS D emergent events Report M where FR was W dispatched. y Service Delivery: Complaints and Investigations CO 20.Internal Service All Monthly Yes 100% Formal written or verbal EMS Evaluate merit and address Delivery, Personnel, Complaints complaints as defined Agency or Patient Care by EMS Agency W Complaints 0 21.External Service All Monthly Yes 100% Formal written or verbal EMS Evaluate merit and address Delivery, Personnel, Complaints complaints as defined Agency or Patient Care by EMS Agency Complaints Personnel Performance 22.General PCR All Events Monthly Yes 10% Manual Data Quality Score and EMS Set target and work for Documentation Review by % Complete by Agency 90% compliance Supervisor Supervisor Manual and and 100% Review PreMIS Review using Report Data Quality Score 23.Protocol All Events Monthly Yes 100% %of PCRs with PreMIS Set target and work for Documentation Documentation of the Report 100% compliance Protocol Used 24.Vital Sign All Events Monthly Yes 100% %of PCRs with the PreMIS Set target and work for Documentation documentation of a Report 100% compliance minimum of one Systolic BP, Diastolic BP, Pulse, Respiratory Rate, Pain Score (if appropriate), and GCS (if injury). Performance Standards (Page 5 of 11) � � • 0 c North Carolina College of Emergency Physicians vn Standards for the Selection and Performance of 9 PerformanceEMS Improvement m 0 Percentage m Record • • DataTopic Mandatory of Events Definition Loop Closure .-4 Selection - •uency Sourceco Reviewed 25.Skills Performed All Events Monthly Yes 100% Number of Skills PreMIS Identify individuals without performed by each Report skill within a 6 month professional interval and address through training/education D m 26.Skill Proficiency All Events Monthly Yes 100% Success Rate using PreMIS Use PreMIS report to W PreMIS Personnel Report identify and address y Performance Report for individuals in need of skill 9 each EMS professional training CO 0 27.Protocol All 911 and Monthly Yes 100% 100% Review by EMS Set Target and work for q Compliance SCTP Supervisor and available Agency, 95% compliance. o Events PreMIS and EMS Toolkit PreMIS, Investigate deviations o Reports identifying any and associated with a care deviation (missing or Toolkit issue additional treatment) by Reports the Primary Caregiver 28.Patient Contact All Events Monthly Yes 100% Number of PCR's where PreMIS Identify individuals without Numbers (Crew) EMS personnel are Report EMS patient contact within listed as any crew a 6 month interval and member address through training/education 29.Patient Contact All Events Monthly Yes 100% Number of PCR's where PreMIS Identify individuals not Numbers (10 EMS personnel are Report functioning as primary Caregiver) listed as the Primary patient caregivers within a Caregiver 6 month interval and address through training/education 30.PCR's Completed All Events Monthly Yes 100% Number of PCR's PreMIS Monitor to assure all staff entered by each EMS Report on roster are involved in professional patient care documentation and maintain skills 31.Education/CME All Quarterly Yes 100% CME hours and EMS Identify and address any Personnel licensure status Agency individual not current or on and CIS track to maintain credential Re orts 0 North Carolina College of Emergency Physicians MMMM • • • • • Performance• • n■■■ ■■■■ 10101911 MEMO EMS • • • 0 Percentage Record • • p SelectionTopic Mandatory of Events Definition Loop Closure - • Source V Reviewed (O� 32.EMD Individual All 911 Monthly Yes, if EMD 100% of All 911 Call time until EMS Establish target and work o Dispatch Times Events Used Dispatches Dispatch of EMS Unit for Agency for 95% compliance M4 grouped by each EMD professional Emergent and y Non-Emergent m 01 1P 33.EMD Protocol All 911 Monthly Yes, if EMD Based on Call EMD Compliance per EMS Establish target and work co Compliance Events Used Volume using EMD Vendor Quality Agency for 95% compliance cDi Priority Management Dispatch Recommendation co Review Guideline W N O W 34.Controlled All Events Monthly Yes 100% %of narcotic uses with EMS 100% of narcotic uses 0 Substance Counts with sign-out and counts Agency should be accounted for or Narcotic Use appropriate deviation logged Patient Care: Treatment 35.No Protocol All 911 and Monthly Yes 100% PCR's where no PreMIS Set target and work for Documented SCTP protocol (or only Report 95%compliance for Events Universal Patient Care protocol documentation Protocol) is listed 36.No Patient Category All Events Monthly Yes 100% PCR's with no (E09_11) PreMIS Set target and work for Documented Chief Complaint Report 95% compliance for Anatomic Location, documentation of these (E09_12) Chief required data elements. Complaint Organ System, (09_13) Primary Symptom, and (E09_15) Provider's Primary Impression Documented 37.Medication All Events Monthly Yes 100% Medication PreMIS Discuss and address if Complications Complications Report preventable care issue. Documented in PCR 38.Skill Complications All Events Monthly Yes 100% Procedure PreMIS Discuss and address if Complications Report preventable care issue. Documented in PCR Performance Standards (Page 7 of 11) *=EEEE3* 0 North Carolina College of Emergency Physicians ■■■■■ Cn MEN 0 Standards for the Selection and Performance of ■■■■■ EMS 1►Il 0�0®g MEMO■■ • • • 0 m Percentage Reco Trending Data SelectionTopic Mandatory of Events Definition Loop Closure - •uency SourceC� Reviewed 39.System Triage and All 911 Quarterly Yes 100% Triage and Destination PreMIS Discuss findings and Destination Plan Events based on EMS System Reports adjust plan as needed. Compliance Plans for Pediatric, and Work with your RAC. D STEMI, Stroke and EMS m Trauma Toolkits Cn W 40.Pain Control All Events Monthly Optional 100% Pain recorded as VS and PreMIS Set Target and work for addressed with pain Report 90% compliance medication if pain score co is greater than 6 on a scale of 10 N O Patient Care: High Risk Patients 41.Frequent Flyers All 911 Quarterly Optional 100% Patients accessing EMS PreMIS Discuss appropriateness of Events >4 times per month? Report EMS use from a patient care perspective. If inappropriate identify plan to address 42.Repeat patients All 911 Monthly Yes 100% Patients with repeat PreMIS Evaluate patient care event within 48 hours Events EMS use in any 48 hour Report and discuss any EMS care time period related issue that may have contributed. Develop and implement plan to address any identified issues. ° North Carolina College of Emergency Physicians ■■■■■ MEN 0 Standards for the Selection and Performance of ■■■■■ IN®®®© D MENEM EMS Performance Improvement PercentageN Record • • Data p SelectionTopic Mandatory of Events Definition Loop Closure - •uency Sourcecfl Reviewed n Cn 43.Deaths All Events Monthly Yes 100% All Deaths will under EMS Discussion and address EMS Care Agency identified issues and o PreMIS D Reports m 44.Restraint Use All Events Monthly Yes 100% All Restraint use EMS Review and Discussion of D Agency appropriateness and care and associated with procedure v PreMIS and event. Address any 00 Reports identified issues or trends. N O W 45.Refusals All Events Monthly Yes 100% review All PCRs with patient EMS Discussion and address ° by Supervisor contact but non- Agency identified issues or trends with concerns transport and referred to PreMIS Committee Report 46.Cancel by FR All Events Monthly Yes 100% All Dispatches cancelled EMS Discussion and address by a First Responder Agency identified issues or trends with NO EMS Arrival On and Scene PreMIS Report 47.Obstetrical All Events Monthly Yes 100% All Deliveries PreMIS Discussion and address Deliveries documented in PCR Report identified issues or trends 48.Assisted Ventilation All Events Monthly Yes 100% All BVM and Invasive PreMIS Review and Discussion of or Invasive Airway Airways documented in Report appropriateness and care Use PCR and Airway and associated with procedure Evaluation Form Airway and event. Address any Form identified issues or trends. 49.Drug Assisted All Events Monthly Yes 100% Documented in PCR and PreMIS Review and Discussion of Intubation Airway Evaluation Form Report appropriateness and care and associated with RSI event. Airway Address any identified Form issues or trends. 0 North Carolina College of Emergency Physicians 0 ■■■ ■■■ ■ Standards for . . Performance of Ell1 ■■■■■ 01919®© M EMS Performance Improvement CD MENEM Percentagem PicRecord • • Data SelectionMandatory of Events Definition Loop Closure - •uency Sourceco Reviewed Cn 50.Chest All Events Monthly Yes 100% Documented in PCR PreMIS Review and Discussion of Decompression Report appropriateness and care W associated with procedure and event. Address any D identified issues or M trends. W A D 51.Card ioversion All Events Monthly Yes 100% Documented in PCR PreMIS Review and Discussion of D Report appropriateness and care W 00 associated with procedure and event. Address any identified issues or o trends. 07 0 52.Toolkit Results All 911 Twice each Yes 100% using all Patient Care Evaluation EMS Review, Discuss, Identify, Events year 6 EMS using: Toolkit and implement 1 based on Toolkits -System Response Time Reports intervention per Toolkit EMS Toolkit -Trauma Care use (2 interventions per Topics -Cardiac Arrest Care year) -STEMI Care -Stroke Care -Pediatric Care Performance Standards (Page 10 0 MENEM • . • foNorth r College of Emergency• • • -Physicians Cn ■■■ ■ of ■■■■■ INININ®© ■■■■■ EMS • . ' • • ' ' m 0 Percentage m —'Moll_-Topic Mandatory of Events Definition Loop Closure .-4 Record • • Data Selection - • • m Reviewed 53.GCS < 9 All Events Monthly Yes 100% Documented in PCR PreMIS Review and Discussion of Report care associated with W event. Address any identified issues or D trends. m 01 1P co 54.Abnormal Vital All Events Monthly Yes 100% Abnormal Vital Signs in PreMIS Discussion and address y Signs Age > 12 years as Report identified issues or trends defined by: CO -Systolic BP < 90 -Systolic BP > 200 -Heart Rate < 40 0 -Heart Rate > 130 0 -Respiratory Rate < 8 -Respiratory Rate >28 (Pediatric VS evaluated through the Pediatric Toolkit) Patient Care: High Risk Events 55.Physician on Scene All 911 Monthly Yes 100% EMS Events with a non- EMS Discussion and address Events EMS Physician on Scene Agency identified issues 56.Multi-Patient Event All Events Monthly Yes 100% EMS Events PreMIS Discussion and address Documented as multi- Report identified issues patient 57.Mass Gatherings All Events Monthly Yes 100% Mass Gatherings within EMS Discussion and address the EMS System Agency identified issues post event. Adjust plan 58.Police Custody All Events Monthly Yes 100% EMS Events with patient EMS Discussion and address under police custody Agency identified issues 59.Tactical EMS All Events Monthly Yes 100% EMS Tactical Activations EMS Discussion and address with Patient Contact Agency identified issues 60.Wilderness EMS All Events Monthly Yes 100% Wilderness EMS Rescue EMS Discussion and address Rescue Patient Contacts A enc identified issues Performance Standards (Page 11 of 11) 2009 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Attachment B Ott, C°„n Orange County Emergency Services v a System Plan -i°r , arnst a - 7M7 A S S Guide to an Effective Emergency Response to Planned or Impromptu Mass Gathering G Incidents A T H E September, 2018 R I N G Prepared By: +WC6tk.D P Kim Woodward Operations Manager, L Emergency Medical A Services Branch N Revised September,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services System Plan �`>r%t . e°oo n °r'17 �xr°"'°A Mass Gathering Plan Objective: • To provide guidance to Orange County emergency response agencies to establish minimum medical services so that inter-agency planning and response to a mass gathering incident is managed effectively. Introduction: • To establish the capabilities to respond effectively to a planned or impromptu mass gathering incident, this plan defines the responsibilities of both the event planners and Orange County Emergency Services (OCES) personnel. • A mass gathering incident is defined as any incident involving the expected or actual presence of people in a venue or area for a specific purpose or time that by the nature of the gathering poses a threat to the health, safety, and welfare of the community or participants. • Mass gatherings include planned events like street fairs and festivals, sporting and entertainment events, and political rallies, and impromptu events, such as post-sporting-event street celebrations. • The North Carolina Fire Code requires that appropriate plans be developed for the safety and medical care of persons at mass gathering incidents. • This plan defines the responsibilities of the OCES system in providing the safety and medical care for people at mass gatherings. Revised September, 2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services System Plan �`>r%t . e°oo n °r'17 �xr°"'°A Mass Gathering Plan Responsibilities: • Event Planner(s): o The Event Planner(s) will be responsible for notifying OCES of planned mass gathering events. o For private events, the event planner is responsible for notifying OCES. o For public events, the law enforcement authority having jurisdiction should coordinate with OCES to provide the requisite medical coverage. o Notification of OCES must occur no later than 60 days prior to the scheduled event. o The event planner(s) are responsible for the following: ■ Involving OCES, Fire, and Law Enforcement in early planning efforts. ■ Providing ground plans, building plans, or site plans to response agencies. ■ Providing accurate estimates of the possible attendance at the gathering and all activities expected. ■ Clearly identifying any special hazards that may be present at the gathering such as pyrotechnics, mechanical / vehicle competitions, etc. ■ Maintaining a copy of the approved medical plan that shall be retained by the event planner and OCES. • Emergency Services Staff: o OCES personnel will provide medical coverage for mass gathering incidents. o Based on the anticipated attendance and special hazards, OCES staff will develop an incident-specific operation plan with clear definitions of appropriate dedicated event-specific response, triage, treatment, and transport capabilities. o Participate in the Incident Action Plan (IAP) planning process. (See Appendix) o Submit a medical plan (ICS 206) that has been crafted in collaboration with OCES and approved by both the OCES Operations Manager and the OCES Medical Director. Revised September, 2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services System Plan �`>r%t . e°oo n °r'17 �xr°"'°A Mass Gathering Plan Emergency Services Staff (Continued): o Based on the size of the event, the following tasks may be assigned to separate individuals, separate teams, or grouped and assigned to a single individual: ■ Event Medical Operations - This function oversees all aspects of the medical operation at the event. • Event Triage. o This function directs and conducts medical assessment of casualties in a designated treatment area or while roving through the mass gathering area. o If the triage function is conducted while moving around the venue, then transport of the injured to a central treatment area is also a component part of this responsibility. • Event Treatment. o This function directs the treatment of sick and injured people in the mass gathering area. • Event Transportation Officer. o This function directs the transport of severely injured or ill persons to facilities for further treatment. o This function may also involve liaison with the normal OCES operations through the OCES Operations Manager. • Event Logistics Officer. o This function provides for the necessary support of OCES personnel providing coverage at the event. • Other anticipated Functions. o Based on the type and venue of the event, there may be a need to include specialty teams, such as haz-mat, decontamination, wilderness medicine, or amateur radio groups in the OCES event plan. • Communications Plan • Ingress/Egress Plan Revised September, 2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services System Plan �`>r%t . e°oo n °r'17 �xr°"'°A Mass Gathering Plan Responsibilities (Continued): • Interface with Routine OCES Operation o Depending on the size of the mass gathering, some of the medical functions may be provided by on-duty EMS resources (hospital transport, for example). o If dedicated units are used to provide medical support at the mass gathering, those units are unavailable for other tasks unless released by IC/Med Ops. o Units may only be diverted from a mass gathering assignment by the on-duty EMS Supervisor, the OCES Operations Manager, or the OCES Director. The Plan: • Mass gathering or special event medical plans shall include, but are not limited to the following considerations: o Event description, including event name and expected attendance o Participant safety o Non-participant (Spectator, Bystander) safety • Direct communications, using wireless means when possible, shall be included in medical plans as follows: o Between venue staff and/or security personnel, event coordinator, and medical personnel o Between medical personnel located at a first aid station and mobile teams and/or satellite stations o Between medical personnel and Emergency Communications Department o Between medical personnel and ambulances o Between medical staff and receiving hospitals • If the mass gathering is a protest registered with the Police Department, organizers are encouraged to provide CPR and 911 access by gathering personnel. • Medical resources will be employed for the mass gathering or special event based on the following template: Revised September, 2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services System Plan �`>r%t . e°oo n °r'17 �xr°"'°A Mass Gathering Plan Event Type Crowd Size CPR & 1StAid 1StAid 1StAid BLS or Mobile (anticipated) 911 Station Station w/ Station ALS Teams Access@ w/ Paramedic w/ Ambulance EMT Physician Concert/ Music < 2,500 X X Festival 2500-15,500 X X BLS* 15,500- X X ALS (X)# X 80,000 >80,000 X X ALS (X)# X Athletic/Sporting < 2,500 X X Event" 2500-15,500 X X BLS X 15,500- X X ALS (X)# X 80,000 >80,000 X X ALS (X)# X Parade"/ Block < 2,500 party/Street fair/ X Outside Venue 2500-15,500 X X * BLS* X 15,500- X X ALS (X)# X 80,000 >80,000 X X ALS (X)# X Conference or < 2,500 X Convention 2500-15,500 X X * BLS* 15,500- X X ALS (X)# X 80,000 >80,000 X X ALS (X)# X X =REQUIRED * = RECOMMENDED #=MULTIPLE UNITS MAY BE REQUIRED depending on history and size of event. A reasonable planning guide is 1 unit per 10,000 participants or spectators. A=If a parade or sporting event takes place over 1 mile or more, more than 1 first aid station is recommended @=AED access recommended Revised September, 2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services System Plan 1n aO °A Mass Gathering Plan Definitions / Background: • CPR & 911 Access: o Event staff and/or safety personnel have the capability to notify 911 of any medical emergency and to provide CPR/AED access (within 5 minutes, 90% of occurrences). • Medical Aid Station with EMT: o A fixed or mobile facility with the ability to provide first aid level care staffed by at least one Emergency Medical Technician or higher skill level personnel. o First Aid level care is defined as treatment of minor medical conditions and injuries by care providers that have received training in First Aid. ■ Examples of First Aid are: • Cleaning • Bandaging simple wounds such as scrapes and shallow cuts • Providing cold packs for musculoskeletal strains and bruises • Giving drinking water and providing a place to rest for mildly dehydrated patients ■ Examples of a First Aid Station are: • Tent • Clinic • Ambulance or vehicle of some type ■ First Aid stations must have 911 Communications capability. o EMTs must be fully credentialed with an Orange County franchised ambulance provider agency. o First Aid Stations must notify the Orange County 911 Center once their operations begin and again when they are concluded. • Medical Aid Station with Paramedic: o A similar facility to the one listed above, but staffed by at least one Paramedic. ■ Paramedics must be fully credentialed with an Orange County franchised ambulance provider agency. o The First Aid Station must notify the Orange County 911 Center once their operations begin and again when they conclude. Revised September, 2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services System Plan �`>r%t . e°oo n °r'17 �xr°"'°A Mass Gathering Plan Definitions / Background (Continued): • Medical Aid Station with Physician: o A similar facility to the one listed above, but staffed by at least one Physician holding a current North Carolina license. ■ It is preferred that the physician be experienced in emergency medical care and triage of seriously ill or injured patients to higher levels of care. • Examples would be physicians with Emergency Medicine, Family Practice, Sports Medicine, Internal Medicine, or Trauma Care Specialization. • BLS (Basic Life Support) or ALS (Advanced Life Support) Ambulance: o An ambulance staffed by 2 EMTs (BLS) or at least one Paramedic and one EMT (ALS). o ALS units may be used to substitute for BLS units. o At least one unit must remain on-site at all times. o In cases where a patient is in extremis, the unit may transport if the ETA to the closest receiving hospital is less than the ETA of responding ALS personnel. o BLS units may substitute for a fixed First Aid Station with an EMT. • Mobile Teams: o Mobile teams consist of two or more personnel, one of whom must be an EMT or higher-level provider, with treatment supplies necessary for the provider's skill level, and communications capability with at least the Medical Aid Station. o Mobile teams will be classified as either ■ BLS Mobile Team • Includes at least one EMT. ■ ALS Mobile Team • Includes at least one Paramedic. Revised September, 2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services System Plan 1n aO °A Mass Gathering Plan Procedure: • Event medical plans shall be submitted to Orange County Emergency Services no later than 60 days prior to the proposed event. • The Orange County Emergency Services Operation Officer and the Orange County Emergency Services Medical Director shall review the medical plan within 15 days and respond to both the event sponsor and the permitting agency as follows: o Recommended without modification o Recommended, contingent upon acceptance of modifications o Not recommended • Those plans not recommended shall be returned and will include an explanation of the decision. • The applicant may appeal the decision by resubmitting the plan to the Orange County Emergency Services Director and requesting review of the decision within 5 working days. • The point of contact for questions regarding this policy is the Orange County Emergency Services Operations Manager. Revised September, 2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services System Plan n �xr° Mass Gathering Plan Appendix Revised September, 2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services System Plan 1n aO °A Mass Gathering Plan Incident Action Plan ( IAP) Documentation Revised September, 2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services System Plan �`>r%t . e°oo n °r'17 �xr°"'°A Mass Gathering Plan MEDICAL PLAN 1, INCIDENT NAME 2. DATE 8. TIME 4. OPERATIONAL PERIOD PREPARED PREPARED 5. INCIDENT MEDICAL AID STATIONS PARAMEDICS MEDICAL AID STATIONS LOCATION YES NO 6. TRANSPORTATION A. AMBULANCE SERVICES PARAMEDICS NAME ADDRESS PHONE YES NO B. INCIDENT AMBULANCES PARAMEDICS NAME LOCATION YES NO 7. HOSPITALS TRAVELTIME HELIPAD BURN CENTER NAME ADDRESS AIR I GRND PHONE YES NO YES NO 8. MEDICAL EMERGENCY PROCEDURES IC$206 5-94 1 9. PREPARED BY(MEDICAL UNIT LEADER) 10. REVIEWED BY(SAFETY OFFICER) Revised September, 2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services System Plan �`>r%t . e°oo n li �z �} °''f7 �xr°"'°A Mass Gathering Plan I. BRANCH z. DIVISIONIGROUP ASSIGNMENT LIST ICS 204 (5-94) 3. INCIDENT NAME 4. OPERATIONAL PERIOD DATE TIME S.OPERATIONS PERSONNEL OPERATIONS CHIEF DIVISIONIGROUP SUPERVISOR BRANCH DIRECTOR AIR TACTICAL SUPERVISOR 6.RESOURCES ASSIGNED THIS PERIOD NUMBER TRANS. DROP OFF PICK UP RESOURCE DESIGNATOR LEADER PERSONS NEEDED PTJTIME PT.InME 7, CONTROL ASSIGNMENT(S) 8. SPECIAL INSTRUCTIONSISAFETY MESSAGE 9. DIVISIOWGROUP COMMUNICATION SUMMARY FUNCTION FREQ. SYSTEM CHAN. FUNCTION FREQ. SYSTEM CHAN, LOCAL LOCAL COMMAND SUPPORT REPEAT REPEAT DIVIGROUP GROUND TO AIR TACTICAL PREPARED BY(RESOURCE UNIT LEADER) APPROVED BY(PLANNING SECTION CHIEF) DATE TIME Revised September, 2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Attachment C 0t11nag . °r�a Orange County Emergency Services ' Exposure Control Policy Date of Preparation: May, 1992 Dates of Update: March, 1995 May, 1998 March, 2001 June, 2002 February, 2010 February, 2013 July 31, 2018 Annual Review Dates Reviewed By February 15, 2013 Crystal Gualdoni, James Lunsford, Erin Ray July 31, 2018 Kim Woodward, EMS Operations Manager Department Director: Dinah Jeffries Infection Control officer: Chris Pope Revised February, 2018 919-245-6100 (office) 919-732-5063(24-hour) 919-732-8130(fax) PO Box 8181, Hillsborough,North Carolina 27278 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services Exposure Control Policy ` °° Ir �acn� Index Index Policy Statement Definitions Exposure Control Plan Roles and Responsibilities Standard Operating Procedures: EC 1 : Health Maintenance EC 2: Exposure Control Training EC 3: Workplace Environment EC 4: Personal Protective Equipment EC 5: Scene Operations EC 6: Post Response EC 7: Post Exposure Protocols EC 8: Compliance / Quality Monitoring EC 9: Annual Review Exposure Control Plan EC 10: Engineered Sharps and Needle-less Systems EC 11 : Hepatitis B Vaccine and Post Exposure Evaluation Appendices: Appendix 1 : Approved Disinfectants Appendix 2: Laundry Procedure Appendix 3: Report of Occupational Exposure Appendix 4: Respirator Use Evaluation Form Appendix 5: Treatment Declination Appendix 6: Hepatitis B Vaccination Declination Appendix 7: 29 CFR 1910.1030 Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services Exposure Control Program Policy Statement Goal: • Orange County Emergency Services is committed to providing a safe and healthy work environment for our entire staff. In pursuit of this endeavor, the following policies and procedures have been adopted. Objective: • To provide a comprehensive exposure control program that maximizes protection against communicable diseases for all personnel, and for the public, which they serve. • To provide emergency medical services to the public without regard to known or suspected communicable infection in any patient. • To regard all patient contacts as potentially infectious. Responders will observe universal precautions at all times. • To provide all personnel with the training, immunizations and personal protective equipment (PPE) necessary for protection from communicable diseases. • To recognize the need for responder work restrictions based on infection control concerns. • To prohibit discrimination against personnel for health reasons including infection and/or seroconversion with HIV, HBV or HCV. • To regard all medical information as strictly confidential. No personal health information will be released without the signed written consent of the personnel involved. Scope: • This policy applies to all personnel, career and volunteer that provide emergency medical services within Orange County. • This department recognizes that communicable disease exposure is an occupational health hazard. Communicable disease transmission is possible during any aspect of emergency response, including workplace operations. The health and welfare of each personnel is a joint concern of the personnel and of management. While each person is ultimately responsible for their own health, the department recognizes a responsibility to provide as safe of a workplace as possible. The goal of this program is to provide all personnel with the best available protection from identified occupationally acquirable communicable disease. Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services ' Exposure Control Programx ` 17 32 ° n�G �r gat Definitions Objective: • To identify a standard definition of personnel, equipment, statements and procedures. Definitions: • AIRBORNE PATHOGENS: pathogenic microorganisms or compounds which may be carried in the air and which when inhaled into the lungs may cause disease in humans. • BLOOD: human blood, human blood components, and products made from human blood. • BLOODBORNE PATHOGENS: pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV) and human immunodeficiency virus (HIV). • BODY SUBSTANCE ISOLATION: procedures used to protect emergency workers from ALL blood, blood products and body fluids. • CONTAMINATED: the presence or the reasonably anticipated presence of blood or other potentially infectious materials on an item or surface. • CONTAMINATED LAUNDRY: laundry, which has been soiled with blood or other potentially infectious materials or may contain sharps. • CONTAMINATED SHARPS: any contaminated object that can penetrate the skin including, but not limited to, needles, scalpels, broken glass, broken capillary tubes, and exposed ends of dental wires. • DECONTAMINATION: the use of physical or chemical means to remove, inactivate, or destroy bloodborne pathogens on a surface or item to the point where they are no longer capable of transmitting infectious particles and the surface or item is rendered safe for handling, use, or disposal. • ENGINEERING CONTROLS: controls (e.g., sharps disposal containers, self- sheathing needles) that isolate or remove the bloodborne pathogens hazard from the workplace. • EXPOSURE INCIDENT: a specific eye, mouth, or other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee's duties. • HBV: Hepatitis B virus. • HCV: Hepatitis C virus. • HIV: Human immunodeficiency virus. • HEPA MASK: a high efficiency particulate air respirator as defined by NIOSH, which is used as PPE to provide respiratory protection from airborne pathogens. • OCCUPATIONAL EXPOSURE: a reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee's duties. Revised February,2013 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Definitions (Continued): • OTHER POTENTIALLY INFECTIOUS MATERIALS (OPIM): 1) The following human body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, and all body fluids in situations contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids; 2) Any unfixed tissue or organ (other than intact skin) from a human (living or dead); and 3) HIV-containing cell or tissue cultures, organ cultures, and HIB- or HBV- containing culture medium or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV. Also includes the following if there is visible blood: feces, nasal secretions, sputum, sweat, tears, urine, vomitus and saliva (other than dental procedures). • PARENTERAL: piercing mucous membranes or the skin barrier through such events as needlesticks, human bites, cuts, and abrasions. • PERSONAL PROTECTIVE EQUIPMENT (PPE): specialized clothing or equipment worn by an employee for protection against a hazard. General work clothes (e.g., uniforms, pants, shirts, or blouses) not intended to function as protection against a hazard is not considered to be personal protective equipment. • REGULATED WASTE: liquid or semi-liquid blood or other potentially infectious materials; contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed; items that are caked with dried blood or other potentially infectious materials and are capable of releasing these materials during handling; contaminated sharps; and pathological and microbiological wastes containing blood or other potentially infectious materials. • SHARPS: items that may puncture the skin (e.g. needles, broken glass). • SOURCE INDIVIDUAL: any individual, living or dead, whose blood or other potentially infectious materials may be a source of occupational exposure to the employee. Examples include, but are not limited to, hospital and clinic patients, clients in institutions for the developmentally disabled, trauma victims, clients of drug and alcohol treatment facilities, residents of hospices and nursing homes, human remains, an individuals who donate or sell blood or blood components. • STERILIZE: the use of a physical or chemical procedure to destroy all microbial life including highly resistant bacterial endospores. • SUPERVISOR: an employee who oversees the work of another employee (e.g. EMS Lieutenant). The responsibilities of the Supervisor are listed in the "Responsibilities" section of this plan. • TUBERCULOSIS (TB): an infectious airborne pathogen. • UNIVERSAL PRECAUTIONS: an approach to infection control. According to the concept of universal precautions, all human blood and blood components including serum; other body fluids such as semen, vaginal secretions, cerebrospinal, synovial, pleural, peritoneal, pericardial, and amniotic fluids are treated as if they are infectious for HIV, HBV, and other bloodborne pathogens. • WORK PRACTICE CONTROLS: controls that reduce the likelihood of exposure by altering the manner in which a task is performed (e.g. prohibiting recapping of needles by a two-handed technique). Revised February,2013 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services f. Exposure Control Program Exposure Control Plan Objective: • To identify those tasks and corresponding job classifications for which it can be reasonably anticipated that an exposure to blood, body fluids or other potentially infectious materials (OPIM) may occur; To minimize or eliminate the occupational exposure to blood or OPIM and to comply with the OSHA BBP Standard, 29 CFR 1910.1030 and the Needlestick Safety and Prevention Act (Pub. L. 106-430). Exposure Determination: • All aspects of emergency medical care to medical and or trauma patients are reasonably anticipated to involve exposure to blood, body fluids or other potentially infectious materials. • The following job classifications are reasonably anticipated to involve exposure to blood, body fluids, or other potentially infectious substances in the performance of their duties relating to emergency medical services: o Firefighter o First Responder o EMS Field Supervisor o Emergency Medical Technician o Paramedic o Rescue Team Member o Fire Marshal / Assistant Fire Marshal o Medical Director and Staff o Telecommunicators o Emergency Services Director / Deputy Director o Training Coordinator Implementation: • The Exposure Control Program is applicable to all personnel, career and volunteer that provide emergency medical services through Orange County agencies. This policy was effective immediately on its implementation in 1992. The plan will be reviewed annually and updates / revisions will be made as needed. Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Implementation (Continued): • The Exposure Control Program consists of specific program components that are identified as follows: o Exposure Control Policy Statement o Exposure Control Plan o Exposure Control Roles and Responsibilities o Standard Operating Procedures: ■ EC 1 : Health Maintenance ■ EC 2: Exposure Control Training ■ EC 3: Station/Work Area Environment ■ EC 4: Personal Protective Equipment ■ EC 5: Scene Operations ■ EC 6: Post-Response ■ EC 7: Post-Exposure Protocols ■ EC 8: Compliance and Quality Monitoring ■ EC 9: Annual Review of Exposure Plan ■ EC 10: Engineered Sharps / Needle less System ■ EC 11 : Hepatitis B Vaccine / Post Exposure Evaluation o Appendix: ■ 1 : Definitions ■ 2: Approved disinfectants ■ 3: Laundry Procedure ■ 4: Report of Occupational Exposure ■ 5: Respirator Use Form ■ 6: Treatment Declination Form ■ 7: Hepatitis B Vaccine Declination Form ■ 8: OSHA 29 CFR 1910.1030 Evaluation of Exposure Incidents: • The procedure for the evaluation / investigation of circumstances surrounding incidents of potential exposure to blood, body fluids, or other potentially infectious materials is detailed in SOP EC 7: Post Exposure Protocols. This SOP also identifies medical follow-up, documentation, recordkeeping and confidentiality requirements. Compliance Methods: • Universal precautions will be observed at this facility in order to prevent contact with blood or other potentially infectious materials. All blood or other potentially infectious material will be considered infectious regardless of the perceived status of the source individual. • Engineering and work practice controls will be utilized to eliminate or minimize exposure to employees at this facility. Engineering controls are the primary means of eliminating or minimizing employee exposure and include the use of safer medical devices, such as needle-less devices, shielded needle devices, and plastic capillary tubes. Medical devices with engineered sharps injury protections and needle-less systems constitute an effective engineering control and must be used where feasible. Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Compliance Methods (Continued): • Where occupational exposure remains after institution of these controls, personal protective equipment shall also be utilized. These controls will be examined and maintained on a regular schedule. Appendix (B) includes the schedule for reviewing the effectiveness of the control for this department/establishment. • Hand washing facilities shall be made available to the employees who incur exposure to blood or other potentially infectious materials. These facilities are to be readily accessible after incurring exposure. If there is a case where a hand washing facility is not accessible, an antiseptic cleanser in conjunction with clean cloth/paper towels or antiseptic towelettes is to be provided. If this alternative is used, then the employee is to wash their hands with soap and running water as soon as possible after the occupational exposure. The location(s) of the nearest hand washing facility should be readily available to employees that are using the alternative method. • Supervisors shall ensure that after the removal of personal protective gloves, employees shall wash hands and any other potentially contaminated skin area immediately or as soon as feasible with soap and water. • Supervisors shall ensure that if employees incur exposure to their skin or mucous membranes then those areas shall be washed or flushed with water as soon as feasible following contact. Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services Exposure Control Plan ` 17 32 Roles and Responsibilities Department Director: • The tasks of managing the department Occupational Health and Safety and Exposure Control Programs are delegated to appropriate staff as noted below. The ultimate responsibility for the health and welfare of all personnel remains that of the Department Director. Designated Exposure Control Officer: • The Exposure Control Officer is the Staff Officer in Life Safety Management for Orange County Emergency Services. The designated officer shall: o Develop a schedule and method of implementation for the various requirements of the OSHA BBP Standard. o Identify training needs for all OCES related personnel regarding OSHA standards for bloodborne pathogens and PPE. o Evaluate possible personnel exposures to communicable diseases and coordinate communications between the Department Director, the Medical Director, area hospitals, UNC Hospital Occupational Health Services, Local and State Health Departments. o Collect quality assurance data on the Exposure Control Program. o Notify the EMS Operations Manager and Medical Director if quality assurance data indicate a safety hazard requiring immediate attention. o Conduct spot inspections of on-scene and workplace operations to assure compliance with department Exposure Control policy. o Coordinate the immunization program and maintain immunization records. o Maintain a confidential database of exposure incidents and follow-up treatment visits, in conjunction with the UNC Hospital Occupational Health Services. o Provide technical expertise in the revision of the Exposure Control Plan. o Keep abreast of new developments in the field of Exposure Control and make appropriate recommendations to the EMS Director and revisions to the Exposure Control Plan as needed. o Enforce compliance of the Exposure Control Plan, polices and procedures. o Develop and deliver a comprehensive exposure control educational program, which complies with OSHA Regulation 29 CFR Part 1910.1030. o Not allow new personnel to assume emergency response duties until initial medical evaluation, immunizations, and Exposure Control training has been completed. Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Department Managers and Supervisors: • Managers and Supervisors will: o Support and enforce compliance with the Exposure Control Program. o Correct any unsafe acts, and refer personnel for remedial exposure control training if required. o Assure safe operating practices on-scene and in the workplace. o Refer for medical evaluation any personnel possibly unfit for work for Exposure Control or other reasons. o Conduct formal workplace tours and document the results monthly. Personnel: • All personnel will: o Assume responsibility for their health and safety. o Always utilize appropriate personal protective equipment as the situation and current protocol dictates. o Assure personal compliance with Exposure Control Program SOPs. o Immediately report any incident of suspected occupational exposure to communicable diseases to their supervisor and to the Exposure Control Officer. o Immediately Report any diagnosis of communicable disease to the Department's Exposure Control Officer. Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services ` Exposure Control Program x Standard Operating Procedures EC 1 : Health Maintenance: • No new personnel will be assigned to emergency response duties until an entrance physical assessment has been performed and has been certified as fit for duty. • The Exposure Control Officer may initiate work restrictions for reasons of Exposure Control. These may be temporary or permanent. For example, personnel with extensive dermatitis or open skin lesions on exposed areas may be restricted from providing patient care or handling and / or decontamination of patient care equipment. • All personnel will be offered a TB Skin Test, immunization against hepatitis B, and will be required to show proof of immunization against influenza, measles, mumps, rubella, poliomyelitis (polio), tetanus, and diphtheria. The risks and benefits of hepatitis B immunization will be explained to all personnel and informed consent obtained prior to immunization. • Personnel who refuse immunization will be counseled on the occupational risks of communicable disease, and required to sign a refusal of immunization form. Personnel who initially refuse immunization may later receive immunization upon request. • All personnel will be offered initial and yearly screening for tuberculosis exposure. • All personnel will receive annual health evaluations. • Any personnel returning to work following injury, illness or communicable disease, (occupational or not) will be released by the Exposure Control Officer prior to resuming emergency response duties. • All personnel will receive an exit health evaluation upon being reassigned to non- response duties or upon termination of employment of the department. • The Department Exposure Control Officer will maintain records in accordance with OSHA CFR 29, Part 1910.1030. Personnel participation in the Exposure Control Program will be documented, including: o Name and SSN of personnel. o Immunization records. o Annual medical evaluation records as needed. o Infection control / exposure control plan training participation. o PPE training and fitting. o Incidents of potential exposure to communicable diseases and incident investigation results. o Post-exposure medical evaluation, treatment, and follow-up. • Exposure Control records will become a part of the personnel's personal health file and will be maintained for duration of employment plus thirty (30) years. Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD EC 1 : Health Maintenance (Continued): • Medical records are strictly confidential. Medical records will be maintained by the department, and will not be kept in the personnel records. Medical records will not be released without the signed written consent of the personnel. There will be no exceptions to this policy for Department Administration, Government Administrators, insurance companies or any other persons. • Records of participation in personnel assistance programs or critical incident stress debriefing are considered medical records and kept as strictly confidential. • Personnel may examine their own medical records, and may obtain one copy for personal use. Abstracts of medical records without personal identifiers may be made for quality assurance, compliance monitoring, or program evaluation purposes, so long as the identity of individual personnel cannot be determined from the abstract. • Communications between medical and personnel sections will focus on fitness to work or restrictions, and not on diagnoses. Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services "• ' Exposure Control Program ' Standard Operating Procedures EC 2: Exposure Control Training: • All personnel providing emergency services will be required to complete: o Initial Exposure Control training at the time of assignment to tasks where occupational exposure may occur. Personnel shall not be assigned to such tasks until they have received such training. o Refresher and updated exposure control training at least annually thereafter. • All Exposure Control training materials will be appropriate in content and vocabulary to the educational level, literacy, and language of personnel being trained. • Training will be in compliance with OSHA Regulation 29 CFR Part 1910.1030 and shall include: o An accessible copy of 29 CFR Part 1910.1030 and an explanation of its contents. o A general explanation of the epidemiology and symptoms of bloodborne / airborne diseases. o An explanation of the modes of transmission of bloodborne / airborne pathogens. o An explanation of the department exposure control plan including the location of an accessible copy for personnel to examine at any time. o An explanation of the appropriate methods for recognizing tasks and other activities that may involve exposure to blood and other potentially infectious materials. o Information on the types, proper uses, location, removal, handling, decontamination and disposal of personal protective equipment. o An explanation of the basis for selection of personal protective equipment. o Information on the hepatitis B vaccination program provided to all personnel at no cost, including information regarding its efficacy, safety, and benefits. o Information on the appropriate actions to take and persons to contact in an emergency involving blood or other potentially infectious materials. o An explanation of the procedure to follow if an exposure incident occurs, including the method of reporting the incident, exposure determination, and the medical follow-up that will be made available o Information on the post-exposure evaluation and follow-up that the department is required to provide following an exposure incident. o An explanation of the signs, labels and / or color-coding required for biohazard materials including the proper storage and disposal of materials. o Opportunity for interactive questions and answers. Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD EC 2: Exposure Control Training (Continued): • Exposure Control trainers shall be knowledgeable in all of the program elements listed above, particularly as they relate to emergency services provided by this department. • Written records of all training sessions will be maintained for three years after the date on which the training occurs. Training records will include: o The dates of the training sessions. o The contents or a summary of the training sessions. o The names and qualifications of persons conducting the training. o The names and job titles of all persons attending the training sessions. Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services77 f ' Exposure Control Policy Standard Operating Procedures EC 3: Workplace Environment: • STORAGE, DECONTAMINATION, AND DISPOSAL AREAS: o All workplaces will designate separate areas for: • Equipment decontamination and disinfection. • Storage of clean patient care equipment and infection control personal protective equipment. • Storage of bio-hazardous waste. • Under no circumstances will kitchen, bathrooms, or living areas be used for decontamination or storage of patient care equipment or infectious waste. • Decontamination areas will be marked with biohazard signs and will be equipped with: o A sink, constructed of nonporous materials, equipped with a single hot / cold faucet and connected to a sanitary sewer system. o Proper lighting and adequate ventilation. o Adequate counter areas constructed of nonporous materials. o Adequate rack space to allow air-drying of equipment. o Appropriate containers for disposal of biohazard waste. o Facilities for the safe storage, use, and disposal of cleansing and disinfecting solutions. o Appropriate PPE for the use of disinfecting solutions. o Material safety data sheets (MSDS) for cleansing and disinfecting solutions. All personnel using these solutions will be familiar with the MSDS and will use the recommended PPE. o Instructions for routine cleaning and decontamination of patient care equipment and clothing. Infectious waste storage areas will be marked with biohazard signs. • Contaminated sharps will be stored in closed, puncture resistant containers (sharps boxes) with appropriate Biohazard markings and color-coding. • Contaminated materials will be stored in leak proof bags with appropriate biohazard markings and color-coding. o If outside contamination of a disposal bag is a possibility, a second bag with identical markings will be placed over the first. o Reusable bins and containers used to store biohazard waste will be inspected, cleaned, and disinfected weekly, and immediately if outside contamination is present. • All disposal of biohazard waste will be in accordance with UNC Hospitals regulations. Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD EC 3: Workplace Environment (Continued): • LAUNDRY AREA: o Personnel will have access to a clean laundry area with washer, dryer, and wash sink. o All contaminated work uniforms will be washed in-station before being taken home. Under no circumstances will personnel, due to the possibility of family contamination, wash contaminated work clothes at home by infectious or chemical agents. o All personnel will maintain extra clean work uniforms in the station, so that potentially contaminated uniforms can be exchanged and washed upon return to the station. o All linen used for patient transport is considered contaminated. Linen will be exchanged by the medical facility receiving the patient, if possible. If not, the linen will be secured in a linen bag in the ambulance or at the station. Contaminated linen will not be washed in station laundry facilities. Contaminated linen will be transported to UNC hospital for decontamination. Appropriate PPE for handling of potentially contaminated linen will consist of a minimum of disposable gloves. • KITCHEN AREA: o Kitchens will be equipped with double sinks constructed of nonporous materials. o Food preparation areas, counter tops, and cutting boards will be constructed of nonporous materials. o Under no circumstances will any kitchen facility be used for the purpose of cleaning, sterilizing, disinfecting, storing, or disposal of any infectious material or waste. o Food will be properly prepared and cooked. Hands will be washed before and after preparing food. Food will be returned to the refrigerator before leaving the station if a meal is interrupted by a call. Consumption of food or drink will not be allowed in the patient care areas of ambulances. • BATHROOM AREAS: o Bathrooms will have push-to-open doors without handles. o Disposable hand-drying materials will be used. Cloth towels will not be used. o Personnel will have access to shower facilities for use in the event of blood or OPIM soak through the person's uniform and grossly contaminate the skin. Soiled towels will be placed with other used linen in contaminated linen containers for transport to UNC Hospital. • SLEEPING AREAS: o Suitable sleeping quarters will be furnished for on-duty personnel to accommodate downtime while on duty. o Adequate ventilation will be provided and HVAC system will be maintained and in a safe working condition. Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services "* Exposure Control Policy F 17 32 Standard Operating Procedures EC 4: Personal Protective Equipment: • PPE PROVISION: o Supervisors are responsible for ensuring that required PPE is available in all ambulances as well as the stations. o All PPE used will be provided without cost to the employee. o PPE will be chosen based on the anticipated exposure to blood or other potentially infectious materials (OPIM). o The PPE will be considered appropriate if it does not permit blood or OPIM to pass through or reach the employees' clothing, skin, eyes, mouth or other mucous membranes under normal conditions of use and for the duration of time that the PPE will be used. • PPE USE: o Supervisors shall ensure and enforce employee use of appropriate PPE. • PPE ACCESSIBILITY: o Supervisors shall ensure that appropriate PPE in the appropriate sizes is readily accessible at the work site or is issued without cost to employees. Hypoallergenic gloves, glove liners, powderless gloves, or other similar alternatives shall be readily accessible to those employees who are allergic to the gloves normally provided. • PPE CLEANING, LAUNDERING and DISPOSAL: o All personal protective equipment will be cleaned, laundered, or disposed of by the employer at no cost to the employees. The employer makes all repairs and replacements with no cost to employees. o All garments that are penetrated by blood shall be removed immediately or as soon as feasible. All PPE will be removed prior to leaving the work area. o When PPE is removed, it shall be placed in an appropriately designated area or container for storage, washing, decontamination, or disposal. Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD EC 4: Personal Protective Equipment (Continued): • GLOVES: o Gloves shall be worn where it is reasonably anticipated that employees will have hand contact with blood, other potentially infectious materials, non-intact skin, and mucous membranes; when performing vascular access procedures and when handling or touching contaminated items or surfaces. o Disposable gloves used at this facility are not to be washed or decontaminated for re-use and are to be replaced as soon as practical when they become contaminated or as soon as feasible if they are torn, punctured, or when their ability to function as a barrier is compromised. o Where possible, gloves should be changed between patients in multiple casualty situations. o Heavy-duty utility gloves will be used for the handling, cleaning, decontamination, or disinfection of potentially contaminated patient care equipment. • EYE and FACE PROTECTION: o Masks in combination with eye protection devices, such as goggles or glasses with solid side shield, or chin length face shields, are required to be worn whenever splashes, spray, splatter, or droplets of blood or other potentially infectious materials may be generated and eye, nose, or mouth contamination can reasonably be anticipated. • ADDITIONAL PPE PROTECTION: o Fluid-resistant gowns and coveralls are designed to protect clothing from splashes. Turnout gear also protects clothing from splashes and is preferable in fire, rescue, or vehicle extrication activities. Gowns may interfere with, or present a hazard to the personnel in these circumstances. The decision to use barrier protection to protect clothing and the type of barrier protection to be used will depend on the type call (See SOP EC 5). o Under certain circumstances, head covers and/or shoe covers will be required to protect these areas from potential contamination. Structural firefighting gear (impervious boots, helmets) also may be used for barrier protection. o In general, personnel should select PPE appropriate to the potential spill, splash, or exposure to body fluids. No standard operating procedure or PPE ensemble can cover all situations. Common sense must be used. When in doubt, select maximal rather than minimal PPE. Guidelines for use of PPE on scene are found in SOP EC 5. Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services Exposure Control Policy Standard Operating Procedures EC 5: Scene Operations: • The blood, body fluids, and tissues of all patients are considered potentially infectious and Universal Precautions / Body Substance Isolation procedures will be used for all patient contact. Recommended PPE (minimum required) for use while performing specific tasks includes: All Patient Contact Requires Gloves! Task Gown or Mask and Coveralls eye protection Bleeding control, spurting blood Yes Yes Bleeding control, minimal bleeding No No Childbirth Yes Yes IV insertion No No ET Tube placement No Yes Suctioning, splashing likely No Yes Suctioning, splashing unlikely No No Medication administration No No Other tasks require personnel to utilize PPE based on the risk of exposure to potentially infectious materials. • Personnel are encouraged to use maximal rather than minimal PPE for each situation. • While complete control of the emergency scene is not possible, scene operations as much as possible will attempt to limit splashing, spraying, or aerosolization of body fluids. • The minimum number of personnel required to complete the task safely will be used for all on-scene operations. Personnel not immediately needed, will remain a safe distance from operations so that possible communicable disease exposure for extra personnel is reduced. • Hand washing is the most important Exposure Control procedure. • Members will wash hands: o After removing PPE. o After each patient contact. o After handling potentially infectious materials. o After cleaning or decontaminating equipment. o After using the bathroom. o Before eating. o Before and after handling or preparing food. Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD EC 5: Scene Operations (Continued): • Hand washing with soap and water will be performed for ten to fifteen seconds. If soap and water is not available at the scene, a waterless hand wash will be used, provided that a soap and water wash is performed immediately upon return to the station of arrival at the hospital. • Eating, drinking, smoking, handling contact lenses, or applying cosmetics or lip balm is prohibited at the scene of operations or in the potentially contaminated area of the emergency vehicle. • Heads will be protected with covers as specified in this policy and additionally hair lengths longer than the collar will be secured so that it does not come in contact with patients or equipment. • Used needles and other sharps shall be disposed of by the technician performing the procedure in approved sharps containers. Sharps will not be handled by any other person for any reason. • Needles will not be recapped, resheathed, bent, broken, or separated from disposable syringes. The most common occupational blood exposure occurs when needles are recapped. • Used sharps will not be temporarily laid down or stuck in any seat, bench or elsewhere for any reason. • All instruments used for starting IVs, drawing blood, injecting medication and all other skills that require penetration of the skin of patients will be properly disposed of at the completion of the procedure. The container used to hold or store blood or body fluids will be the responsibility of the technician performing the procedure. • Sharps containers will be easily accessible. • Lost sharps will be reported in writing to the Supervisor immediately and a search of the unit and scene will be conducted to find the item. When found document location and dispose of properly. • Disposable resuscitation equipment will be used whenever possible. For CPR, the order of preference is: o Disposable bag-valve mask. o Reusable bag-valve mask. o Disposable pocket mask with one-way valve. • Patients with suspected airborne communicable diseases will be transported wearing a facemask whenever possible. Ambulance windows will be open and ventilation systems turned on whenever possible. • Fluid spills and broken containers will be cleaned up immediately. Fluid spills will be adsorbed using bandaging material and broken containers will be cleaned up using mechanical means, such as a brush and dustpan, tongs, or forceps. • At conclusion of on-scene operations, all potentially contaminated patient care equipment will be removed for appropriate disposal or decontamination and reuse. This includes, but is not limited to sharps, dressing materials, etc. Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services Exposure Control Policy Standard Operating Procedures EC 6: Post Response: • HOUSEKEEPING: o All vehicles, equipment, environmental and working surfaces (fixed and non-fixed) will be cleaned as soon as possible at the conclusion of each call. This will include but not be limited to, wiping down the floor, walls, stretcher, and squad bench with an approved disinfectant. (See definitions.) o All contaminated work surfaces will be decontaminated after completion of procedures and immediately, or as soon as feasible after any spill of blood or other potentially infectious materials, as well as at the end of the work shift if the surface may have become contaminated since the last cleaning. o All bins, pails, and similar receptacles shall be inspected and decontaminated on a regular scheduled basis. o Any broken glassware that may be contaminated will not be picked up directly with the hands. Dustpans and hand-brooms or forceps are to be used. o Contaminated equipment will be stored only in the decontamination area. Cleaning and decontamination will be performed immediately. o Disposable equipment (such as endotracheal tubes, suction catheters, suction tubing, plastic oral airways, respiratory supplies, linen soiled with blood, vomitus, blood/soiled bandages, etc.) and other biohazard waste generated during on-scene operations will be handled as infectious waste. Sharps containers, when 3/4 full, will be closed and disposed of in accordance with the UNC Hospitals policy. o Gloves will be worn for all contact with contaminated equipment or materials. Other PPE will be used depending on splash or spill potential. Heavy-duty utility gloves will be used for cleaning, disinfection, or decontamination procedures. o Blood and body fluid spills will receive priority cleaning: • Heavy-duty rubber, utility (nondisposable), or doubled disposable (if clean up is done at the hospital) gloves will be worn when cleaning blood and body fluid spills. • Wipe up all blood and body fluids using a clean towel or absorbent material. Dispose of these towels as infectious waste. Reusable towels are to be bagged with linen. Disposable materials will be treated as infectious waste. • Saturate the contaminated area with approved cleaning solution. Soak up this solution with towels or other absorbent material and dispose of as infectious waste. Reusable towels will be treated as infectious waste. Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD EC 6: Post Response (Continued): HOUSEKEEPING o Eating, drinking, smoking, handling contact lenses, or applying cosmetics or lip balm is prohibited during cleaning or decontamination procedures. o Disinfection will be performed with a department-approved disinfectant. All disinfectants will be tuberculocidal and EPA approved and registered. o Any damaged equipment will be cleaned and disinfected before being sent out for repair. o The manufacturer's guidelines will be used for the cleaning and decontamination of all equipment. Unless otherwise specified: • Stretcher linen must be changed after each use and exchanged as per SOP EC 3. The stretcher parts and mattress will be cleaned and disinfected with an approved disinfectant. • Portable suction equipment, laryngoscope blades, and bag-valve- masks will be soaked for thirty minutes in approved disinfectant, thoroughly rinsed with clean water, and air-dried after use. Fixed suction bags will be properly disposed of and the contained cleaned with an approved disinfectant. Remember, suction is an aerosol; meaning particles of the contained material may be released into the air. • Durable equipment (backboards, splints, cervical collars, MAST, etc.) will be washed with hot soapy water, rinsed with clean water, and disinfected with an approved disinfectant. Equipment will be allowed to air dry. • Delicate equipment (radios, cardiac monitors, stethoscopes, BP cuffs, etc.) will be wiped clean of any debris using hot soapy water (if available), wiped with clean water (if available), and then wiped with disinfectant. If water is not available, wipe with disinfectant. Equipment will be allowed to air dry. • Work surfaces will be decontaminated with an appropriate disinfectant after completion of procedures, and after spillage or contamination with blood or potentially infectious materials. Seats on response vehicles contaminated with body fluids from soiled PPE also will be disinfected upon return to station. • Contaminated turnout coats / bunker pants will be cleaned according to manufacturer's recommendations found on attached labels. Normally, this will consist of a wash with hot soapy water followed by a rinse with clean water. Turnout gear will be air-dried. Chlorine bleach may impair the fire-retardant properties of structural firefighting gear and will not be used. • Contaminated boots will be brush-scrubbed with a hot solution of soapy water, rinsed with clean water, and allowed to air dry. • Contaminated uniforms will be removed and exchanged for clean clothes. The personnel will shower if body fluids were in contact with skin under work clothes. • Contaminated work clothes will be laundered at the station using hot water. Under no circumstances will any personnel launder contaminated work clothes or PPE at home. Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD • Infectious wastes generated during cleaning and decontamination operations will be properly bagged and placed in the biohazard disposal area. EC 6: Post Response (Continued): • REGULATED WASTE DISPOSAL: o A list of disposable sharps containers and other regulated waste containers used by OCES is included in the Appendix. o Disposable Sharps: • Contaminated sharps shall be discarded immediately, or as soon as feasible in containers that are closable, puncture resistant, leak proof on sides and bottom, and labeled or color-coded. • During use, containers for contaminated sharps shall be easily accessible to personnel and located as close as feasible to the immediate area where sharps are used or can be reasonably anticipated to be found. • The containers shall be maintained upright throughout use and replaced routinely and not be allowed to overfill. • When moving containers of contaminated sharps from the area of use, the containers shall be closed immediately prior to removal or replacement to prevent spillage or protrusion of contents during handling, storage, transport, or shipping. • The container shall be placed in a secondary container if leakage of the primary container is possible. The second container shall be closable, constructed to contain all contents and prevent leakage during handling, storage, transport or shipping. The second container shall be labeled or color-coded to identify its contents. • Reusable containers shall not be opened, emptied, or cleaned manually or in any other manner which would expose employees to the risk of percutaneous injury o Other Regulated Waste: • Other regulated waste shall be placed in containers, which are closable, constructed to contain all contents, and prevent leakage of fluids during handling, storage, transportation, or shipping. • The waste must be labeled or color-coded and closed prior to removal to prevent spillage or protrusion of contents during handling, storage, transport, or shipping. • Disposal of all regulated waste shall be in accordance with applicable United States, state, and local regulations. • LAUNDRY PROCEDURES: o Laundry contaminated with blood or other potentially infectious materials will be handled as little as possible. Such laundry will be placed in appropriately marked (biohazard labeled, or color-coded red) bags at the location where it was used. Such laundry will not be sorted or rinsed in the area of use. o Whenever Body Substance Isolation or Universal Precautions are used in the handling of all soiled laundry (i.e. all laundry is assumed to be contaminated), no labeling or color-coding is necessary as long as all Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD employees recognize the hazards associated with the handling of this material. EC 6: Post Response (Continued): LAUNDRY PROCEDURES o The appendix identifies where laundry at this facility will be cleaned and the procedures to follow. o Whenever contaminated laundry is shipped off-site to a second facility, which does not utilize Universal Precautions in the handling of all laundry, contaminated laundry must be placed in bags or containers, which are labeled or color-coded. One possible solution would be to include a requirement in the laundry facility contract requiring the laundry to utilize the equivalent of Universal Precautions. o See Appendix 9: Laundry Procedures for further information Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services f Exposure Control Policy ` Standard Operating Procedures EC 7: Post Exposure Protocols: • Any personnel exposed to potentially infectious material will immediately wash the exposed area with soap and water or saline eyewash (if the eyes are involved) and contact the supervisor. • Any personnel having an occupational communicable disease exposure will immediately report the exposure to his or her supervisor. Needlestick injuries (whether used or not) will be reported to the supervisors and Exposure Control officers immediately. After proper notification to supervisors, call the Needlestick Hotline @ 966-4480 and answer all appropriate questions. • The personnel will fill out an exposure report form immediately following exposures: o Needlestick injury o Break in skin caused by a potentially contaminated object o Splash of blood or other potentially infectious material onto eyes, mucous membranes, or non-intact skin. o Other exposure that the personnel may feel is significant. • The report will include details as requested on the form. • The supervisor will review the exposure report and forward it to the Exposure Control Officer. • If volunteer fire personnel are involved, they should complete the same paperwork as EMS personnel, as well as any internal paperwork required. Copies of this documentation should be forwarded to the on-duty EMS supervisor immediately and Exposure Control Officer within 12 hours. Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD � >�g` Orange County Emergency Services Exposure Control Policy ` ` Standard Operating Procedures EC 8: Compliance and Quality Monitoring / Program Evaluation: • Compliance and Quality Monitoring: o All personnel are responsible for following standard operating procedures while performing job duties. Spot scene monitoring will be conducted. Supervisors will also conduct, at a minimum, formal workplace tours and document the results monthly to assure safe work practices such as: o Hand washing provisions and technique; o Disposal of contaminated needles and other sharps; o Availability and use of PPE; o Housekeeping, including cleaning, handling of contaminated laundry, decontamination, and labeling and disposing of regulated waste. o Inspection of personnel and equipment (including vehicles). • Formal monitoring will be done monthly and no later than the 5t" day of the following month. A Bloodborne/Airborne Pathogens Surveillance and Monitoring Manual will be maintained that will contain: o The monthly Bloodborne/Airborne Pathogens Monitoring Form o Recommendations for corrective actions; o Documentation of personnel counseling, retraining, or education; and o A record of monitoring personnel's work practices and personnel disciplinary actions related to personal compliance on the Bloodborne/Airborne Pathogens Monitoring Log. • Monitoring and its documentation on the Monitoring Log will include all personnel and procedures observed. Personnel whose practices are satisfactory will be noted for positive feedback and incorporation with personal job performance evaluations. When monitoring reveals a personnel's noncompliance with standard operating procedures, the need for procedural revision or update, or modification to the work environment or equipment, it will be documented on the Monitoring Log. Recommendations for corrective action, such as personnel discipline, retraining, etc. or purchasing new equipment, will be recorded. The expected outcome of the recommendation and its date of completion will be noted. • Corrective action that involves personnel work practice improvement(s) and any observed work practice improvement will be documented within two weeks. Continued personnel noncompliance will be documented in permanent personnel records and disciplinary action instituted according to personnel policies. • The Exposure Control Officer and the EMS Operations Manager will review each Bloodborne/Airborne Pathogens Surveillance Monitoring Manual quarterly. Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services0 t Exposure Control Policy Standard Operating Procedures EC 9: Annual Review Exposure Control Plan: • An annual review and update will be conducted to reflect changes in technology that eliminate or reduce exposure to bloodborne pathogens. Medical devices with engineered sharps injury protections and needle-less systems constitute an effective engineering control and will be considered during our review. These devices will be used where feasible to ensure employee safety. Refer to Appendix (E). • This review will: o Take into account innovations in medical procedure and technological developments that reduce the risk of exposure (e.g., newly available medical devices designed to reduce needlesticks); and o Document consideration and use of appropriate, commercially available, and effective safer devices (e.g., describe the devices identified as candidates for use, the method(s) used to evaluate those devices, and justification for the eventual selection). • Since no one medical device is considered appropriate or effective for all circumstances, we will select devices that, based on reasonable judgment: o Will not jeopardize client or employee safety or be medically inadvisable; o Will make an exposure incident less likely to occur OSHA States: (During your annual review of devices, you must inquire about new or prospective safer options and document this fact in your written Exposure Control Plan. This would include, but would not be limited to, newly available medical devices designed to reduce the risk of percutaneous exposure to bloodborne pathogens. Consideration and implementation of safer medical devices could be documented in the Exposure Control Plan by describing the safer devices identified as candidates for adoption; the method or methods used to evaluate devices and the results of evaluations; and justification for selection decisions. This information must be updated at least annually. The revised Exposure Control Plan requirements make clear that employers must implement the safer medical devices that are appropriate, commercially available, and effective. No one medical device is appropriate in all circumstances of use. For purposes of this standard, an "appropriate"safer medical device includes only devices whose use, based on reasonable judgment in individual cases, will not jeopardize patient or employee safety or be medically contraindicated. Although new devices are being continually introduced, OSHA recognizes that a safer device may not be available for every situation. If a safer device is not available in the marketplace, the employer is not required to develop any such device. Furthermore, the revised requirements are limited to the safer medical devices that are considered to be Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD "effective." EC 9: Annual Review Exposure Control Plan (Continued): For purposes of this standard, an "effective"safer medical device is a device that, based on reasonable judgment, will make an exposure incident involving a contaminated sharp less likely to occur in the application in which it is used. If no engineering control is available, work practice controls shall be used and, if occupational exposure still remains, personal protective equipment must also be used.) • Employee Input: o Input will be solicited from non-managerial employees responsible for direct patient care regarding the identification, evaluation, and selection of effective engineering controls, including safer medical devices. o The employees providing input will represent the range of exposure situations encountered in the workplace, such as those in the health department, substance abuse, or EMS, along with others involved in direct care of patients. (OSHA will check for compliance with this provision during inspections by questioning a representative number of employees to determine if and how their input was requested. No specific procedures for obtaining employee input are prescribed. This provides the employer with flexibility to solicit employee input in any manner appropriate to the circumstances of the workplace. A dental office employing two hygienists, for example, may choose to conduct periodic conversations to discuss identification, evaluation, and selection of controls. A large hospital, on the other hand, would likely find that an effective process for soliciting employee input requires the implementation of more formal procedures. The solicitation of input required by the standard requires employers to take reasonable steps to obtain employee input in the identification, evaluation, and selection of controls. Methods for soliciting employee input may include involvement in informal problem-solving groups;participation in safety audits, worksite inspections, or exposure incident investigations;participation in analysis of exposure incident data or in job or process hazard analysis;participation in the evaluation of devices through pilot testing.) • Documentation of Employee Input: o Employers are required to document, in the Exposure Control Plan, how they received input from employees. This obligation will be met by: ■ Listing the employees involved and describing the process by which input was requested; or ■ Presenting other documentation, including references to the minutes of meetings, copies of documents used to request employee participation, or records of responses received from employees. (Small medical offices may want to seek input from all employees when making their decisions. Larger facilities are not required to request input from all exposed employees; however, the employees selected should represent the range of exposure situations Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD encountered in the workplace (e.g., pediatrics, emergency department, etc.). The solicitation of employees who have been involved in the input and evaluation process must be documented in the Exposure Control Plan.) Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services ' Exposure Control Policy 17 32 Standard Operating Procedures EC 10: Engineered Sharps & Needle-less Systems: • Sharps with Engineered Sharps Injury Protections: o Non-needle sharps or needle devices containing built-in safety features that are used for collecting fluids or administering medications or other fluids, or other procedures involving the risk of sharps injury will be used where feasible. During our annual review, these devices will be discussed, reviewed as to their effectiveness with our procedures, and used where feasible. This covers a broad array of devices, including: ■ Syringes with a sliding sheath that shields the attached needle after use; ■ Needles that retract into a syringe after use; ■ Shielded or retracting catheters ■ Intravenous medication (IV) delivery systems that use a catheter port with a needle housed in a protective covering. (Safety equipment must be available at all times. If for some reason an engineering control is not available due to supply shortages, back orders, shipping delays, etc.), this must be documented in your Exposure Control Plan. You would then be responsible to implement the chosen control(s) as soon as it becomes available and adjust your exposure control plan to illustrate such. In the meantime, work practice controls must be used and, if occupational exposure still remains, personal protective equipment must also be used.) • Needleless Systems o Needleless Systems is defined as devices, which provide an alternative to needles for various procedures to reduce the risk of injury involving contaminated sharps. During our annual review, these devices will be discussed, reviewed as to their effectiveness with our procedures, and used where feasible. Types of needle-less systems include: ■ IV medication systems which administer medication or fluids through a catheter port using non-needle connections; and ■ Jet injection systems, which deliver liquid medication beneath the skin or through a muscle. (A key element in choosing a safer medical device, other than its appropriateness to the procedure and effectiveness, is its availability on the market. If there is no safer option for a particular medical device used where there is exposure to blood or OPIM, you are not required to use something other than the device that is normally used. ) Revised February, 2013 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD EC 10: Engineered Sharps & Needle-less Systems (Continued): • Needles o Contaminated needles and other contaminated sharps will not be bent, recapped, removed, sheared, or purposely broken. An exception to this is allowed if the procedure would require that the contaminated needle be recapped or removed and no alternative is feasible and the action is required by the medical procedure. If such action is required, then the recapping or removal of the needle must be done by the use of a mechanical device or a one-handed technique. Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services Exposure Control Policy °°` ` EM Standard Operating Procedures EC 11 : Hepatitis B Vaccine and Post-Exposure Evaluation and Follow Up: • General: o Orange County Emergency Services will make available the Hepatitis B vaccine and vaccination series to all employees who have occupational exposure, and post exposure follow-up to employees who have had an exposure incident. o Orange County Emergency Services will ensure that all medical evaluations and procedures, including the Hepatitis B vaccine and vaccination series and post exposure follow-up (including prophylaxis), are: ■ Made available at no cost to employee; ■ Made available to the employee at a reasonable time and place; ■ Performed by or under the supervision of a licensed physician or by or under the supervision of another licensed healthcare professional; and ■ Provided according to the recommendations of the U.S. Public Health Service. o An accredited laboratory at no cost to the employee shall conduct all laboratory tests. • Hepatitis B Vaccination: o The Infection Control Officer is in charge of the Hepatitis B vaccination program. Vaccinations will be administered by the County Health Department or other identified facility. o Hepatitis B vaccination will be made available after the employee has received the training in occupational exposure (see information and training) and within 10 working days of initial assignment to all employees who have occupational exposure unless the employee has previously received the complete Hepatitis B vaccination series, antibody testing has revealed that the employee is immune, or the vaccine is contraindicated for medical reasons. o Participation in a pre-screening program is not a prerequisite for receiving Hepatitis B vaccination. o If the employee initially declines Hepatitis B vaccination but at a later date, while still covered under the standard, decides to accept the vaccination, the vaccination shall then be made available. o Each employee who declines the Hepatitis B vaccination offered shall sign a waiver indicating his or her refusal. Appendix (C) includes the OSHA declination statement to be used for this purpose. o If a routine booster dose of Hepatitis B vaccine is recommended by the U.S. Public Health Service at a future date, such booster doses shall be made available by Orange County Emergency Services at no cost the employee. Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD EC 11 : Hepatitis B Vaccine and Post-Exposure Evaluation and Follow Up (Continued): • Post-Exposure Evaluation and Follow-Up: o All exposure incidents shall be reported, investigated, and documented. When the employee incurs an exposure incident, it shall be reported to the Infection Control Officer for investigation. o Following a report of an exposure incident, the exposed employee shall immediately receive a confidential medical evaluation and follow-up, including at least the following elements: ■ Documentation of the route of exposure, and the circumstances under which the exposure incident occurred; ■ Identification and documentation of the source individual, unless it can be established that identification is infeasible or prohibited by state of local law. ■ The source individual's blood shall be tested as soon as feasible and after consent is obtained in order to determine HBV and HIV infectivity. If consent is not obtained, the Infection Control Officer shall establish that legally required consent cannot be obtained. When law does not require the source individual's consent, the source individual's blood, if available, shall be tested and the results documented. ■ When the source individual is already known to be infected with HBV or HIV, testing for the source individual's known HBV or HIV status need not be repeated. ■ Results of the source individual's testing shall be made available to the exposed employee, and the employee shall be informed of applicable laws and regulations concerning disclosure of the identity and infectious status of the source individual. ■ Collection and testing of blood for HBV and HIV serological status will comply with the following: • The exposed employee's blood shall be collected as soon as feasible and tested after consent is obtained; • The employee will be offered the option of having their blood collected for testing of the employee's HIV/HBV serological status. The blood sample will be preserved for up to 90 days to allow the employee to decide if the blood should be tested for HIV serological status. ■ Each employee who incurs an exposure incident will be offered post-exposure evaluation and follow-up in accordance with the OSHA standard. All post exposure follow-up will be performed by the County/Entity Health Department or other identified healthcare provider. Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD EC 11 : Hepatitis B Vaccine and Post-Exposure Evaluation and Follow Up (Continued): • Information Provided To The Healthcare Professional: o The County/Entity Bloodborne Pathogens Coordinator shall ensure that the healthcare professional responsible for the employee's Hepatitis B vaccination is provided with the following: ■ A copy of the OSHA Bloodborne Pathogens Standard, 29 CFR 1910.1030; (While the standard outlines the confidentiality requirements of the healthcare professional, the County/Entity Bloodborne Pathogens Coordinator is to remind the healthcare professional of these requirements) ■ A written description of the exposed employee's duties as they relate to the exposure incident; ■ Written documentation of the route of exposure and circumstances under which exposure occurred; ■ Results of the source individual's blood testing, if available; and ■ All medical records relevant to the appropriate treatment of the employee including vaccination status. • Healthcare Professional's Written Opinion: o The County/Entity Bloodborne Pathogens Coordinator shall obtain and provide the employee with a copy of the evaluating healthcare professional's written opinion within 15 days of the completion of the evaluation. o The healthcare professional's written opinion for HBV vaccination shall be limited to whether HBV vaccination is indicated for an employee, and if the employee has received such vaccination. o The healthcare professional's written opinion for post exposure follow-up shall be limited to the following information: ■ A statement that the employee has been informed of the results of the evaluation; and ■ A statement that the employee has been told about any medical conditions resulting from exposure to blood or other potentially infectious materials which require further evaluation or treatment. NOTE: All other findings or diagnosis shall remain confidential and shall not be included in the written report. Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services Exposure Control Policy APPENDICES Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services System Plan APPENDIX 1 Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services W Exposure Control Policy ` ` 17 32 Approved Disinfectants Department Recommendations: • Quat Plus TB and SANI-CLOTH Plus will be used to disinfect surfaces, clean blood spills, and for disinfection of medical equipment such as laryngoscope blades or portable suction equipment. Equipment will be soaked for 30 minutes, rinsed, and allowed to air dry. • Spray bottles containing Quat Plus TB and containers of SANI-CLOTH Plus will be kept on each unit (EMS and Fire) for use away from the stations. • The manufacturers recommended guidelines will be used for mixing, storing and usage. • The appropriate MSDS will be on hand for all personnel. Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services System Plan �x APPENDIX 2 Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services K.. ' Exposure Control Policy Laundry Procedure Department Policy: • Laundry contaminated with blood or OPIM shall be handled as little as possible. • Personnel should remove clothing as soon as possible after contamination occurs. For this reason, all personnel are required to bring a second uniform to work. • Contaminated clothing should be placed into a labeled, leak-proof container for transport to the unit's primary station. A biohazard bag is preferred for this activity. • All contaminated laundry can be washed at either EMS station 1 or 2. Under no circumstance should contaminated clothing be taken to a private residence and washed. • Contaminated clothing and bunker gear may be washed at the individual fire departments, per individual protocol. Care should be taken to follow all manufacturers recommendations regarding decontaminating bunker gear. Certain common cleaning chemicals may degrade bunker gear and not damage other clothing. • Personnel shall utilize appropriate PPE and remove the contaminated clothing from the container. Gross contaminates shall be removed and placed in a biohazard container along with the transport container used. • Care shall be given in assessing the type of clothing fabric and recommended washing procedures. Do Not wash any type of fabric against the manufacturers' recommendation / cleaning guidelines. • The contaminated clothing shall be placed in the washing machine with care given so as not to contaminate the outside of the washing machine. • Personnel should remove any contaminated PPE and dispose of in a biohazard container. • Personnel should add the appropriate type and amount of laundry detergent to the wash based on the manufacturer's directions. Care shall be taken to avoid contact with the contaminated clothing at this time. Non-chlorine bleach may also be added if desired. • Personnel should close and start the washing machine as per manufacturer's instructions for the load size and amount of clothing. The heavy soil setting is preferred with a warm water wash and cold rinse. • Once the wash cycle is complete, the clothing can be removed and placed in a dryer and dried according to the type of fabric and size of load. • If the exterior of the washing machine was contaminated, it should be decontaminated using standard decontamination procedures during the wash cycle so as not to re-contaminate the clothing on removal. Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services . 17 32 System Plan �rlr fat°� APPENDIX 3 Revised February, 2013 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services Exposure Control Policy Report of Occupational Exposure Employee Name Division / Department Job Title Supervisor Date of Exposure Time of Exposure am / pm Type of Exposure: Needlestick Splash Other (explain) Type of Fluid Amount of Fluid Severity (depth of injury) Part of Body Exposed Location of Exposure (address of incident) Please describe how/why the exposure occurred. Include job duties being performed at time of exposure, extent and duration of exposure: Personal Protective Equipment Used: Gloves Face Mask Face / Eye Shield Goggles Gown Other (explain) Date and Time Reported to Supervisor / / am / pm Time Needle Stick Hotline Called am / pm Date and Time Reported to EC Officer / / am / pm Preliminary Instructions to the Employee Date Employee Seen at UNC By Report Received By EC Officer Revised July,2018 1 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Signed Revised July,2018 2 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services 7 32 System Plan ` ` �rlr fat°� APPENDIX 4 Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD >�g` Orange County Emergency Services Exposure Control Policy ` ` Respirator Use Form Date: Name: Affiliation: Birthdate: Social Security#: Address: City: State: Zip: A Questionnaire similar to the one below will be completed online through El Assessor Health. This Questionnaire is confidential and an important component of our assessment for your potential respirator use. The only information received will be whether or not you are able to be fit tested. DO YOU HAVE OR HAVE YOU HAD THE FOLLOWING IN THE PAST TWO (2) YEARS? 1. Uncontrolled high blood pressure? YES NO 2. Respiratory Condition or disease? YES NO Chest pain or tightness Severe shortness of breath or a chronic cough Asthma or wheezing 3. Allergies that would interfere with you wearing a respirator? YES NO 4. Fainting spells, dizziness, or seizures? YES NO 5. Anxiety attack due to being in enclosed places? YES NO 6. Heart condition (heart attack, heart failure) YES NO 7. Severe medical condition/medications that may interfere YES NO with mask/respirator wearing? If yes, please explain: 8. Do you smoke more than 4 cigarettes per day? YES NO If yes, how many per day? How long have you smoked? THE ABOVE NAMED PERSON IS APPROVED TO WEAR THE HEPA/ N95 RESPIRATOR. Fit Tester Signature Fit Tester Name Date Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD If person named above is not able to wear the HEPA/ N95 respirator, he/she will be referred to a physician for further evaluation. Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services Ir �acn� Fit Test Report Date: Name: Affiliation: Birthdate: Social Security #: Address: City: State: Zip: Respirator Size: Manufacturer: NIOSH Approval #: Model: Fit Testing: ❑ Quantitative ❑ Saccharin Solution Qualitative Fit: ❑ Pass ❑ Fail Comments: Employee Acknowledgement of Test Results: Employee Signature: Date: Test Conducted By: Date: Revised July, 2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services Medical Screening Pre / Post Fit Testing Date: Name: Affiliation: Birthdate: Social Security #: Pre-Fit Test Evaluation: Evaluator: Blood Pressure: Respirations: Pulse: Pulse Oximitry: Post-Fit Test Evaluation: Evaluator: Blood Pressure: Respirations: Pulse: Pulse Oximitry: Revised July, 2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services ' System Plan APPENDIX 5 Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services Exposure Control Policy ` ` Treatment Declination Form I understand that due to my occupational exposure to blood or other potentially infectious materials I may be at risk of acquiring hepatitis B virus (HBV) infection, hepatitis C virus (HCV) infection or any other bloodborne disease. I have been given the opportunity to be evaluated and treated as necessary, at no charge to my self. However, I decline such treatment at this time. I understand that by declining this treatment, I could be at risk of acquiring any known bloodborne disease or any potential complication from this injury / exposure. By signing below I release Orange County Emergency Services and its personnel from any responsibility whatsoever, should I contract any disease, infection or disability from this injury/ exposure. Signature Date Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services ' System Plan ` 17 32 APPENDIX 6 Revised July,2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD �t'"g` ' car/ � Orange County Emergency Services ' x +tt Hepatitis B Vaccination Declination ,o ; I understand that due to my occupational exposure to blood or other potentially infectious materials that I may be at risk of acquiring hepatitis B virus (HBV) infection. I have been given the opportunity to be vaccinated with hepatitis B vaccine, at no charge to myself. However, I decline hepatitis B vaccination at this time. I understand that by declining this vaccine, I continue to be at risk of acquiring hepatitis B, a serious disease. If in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with hepatitis B vaccine, I can receive the vaccination series. Print Name Date Signature Date Name of Witness Date Signature of Witness Date Revised July, 2018 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1 B20BD Orange County Emergency Services Infection Control Plan 17 32 APPENDIX 7 Revised July,2018 411THFNTIC.ATFI3 / �.l D...Sign Envelope ID:79C5D167-136CA-4E59-134AC-AA38CC1 B20BD GPDX Occupational Safety and Health Admin., Labor §1910.1030 APPENDIX B TO §1910.1029—INDUSTRIAL HY- 10. Weigh the Teflon cup and the weight GIENE AND MEDICAL SURVEILLANCE GUIDE- gain is due to the benzene soluble residue in LINES half the Sample. I.INDUSTRIAL HYGIENE GUIDELINES H.MEDICAL SURVEILLANCE GUIDELINES A. Sampling (Benzene-Soluble Fraction A. General. The minimum requirements for Total Particulate Matter). the medical examination for coke oven Samples collected should be full shift (at workers are given in paragraph (j) of the least 7-hour) samples. Sampling should be standard. The initial examination is to be done using a personal sampling pump with provided to all coke oven workers who work pulsation damper at a flow rate of 2 liters at least 30 days in the regulated area. The per minute. Samples should be collected on examination includes a 14"x 17'posterior-an- 0.8 micrometer pore size silver membrane fil- terior chest x-ray reading, pulmonary func- ters (37 mm diameter) preceded by Gelman tion tests(FVC and FEV 1.0),weight, urinal- glass fiber type A-E filters encased in three- ysis, skin examination, and a urinary piece plastic(polystyrene)field monitor cas- cytologic examination. These tests are need- settes. The cassette face cap should be on ed to serve as the baseline for comparing the and the plug removed. The rotameter should employee's future test results. Periodic be checked every hour to ensure that proper exams include all the elements of the initial flow rates are maintained. exam, except that the urine cytologic test is A minimum of three full-shift samples to be performed only on those employees should be collected for each job classifica- who are 45 years or older or who have worked tion on each battery, at least one from each for 5 or more years in the regulated area; shift. If disparate results are obtained for periodic exams,with the exception of x-rays, particular job classification, sampling are to be performed semiannually for this should be repeated. It is advisable to sample group instead of annually; for this group, x- each shift on more than one day to account rays will continue to be given at least annu- for environmental variables(wind,precipita- ally. The examination contents are min- tion, etc.) which may affect sampling. Dif- imum requirements; additional tests such as ferences in exposures among different work lateral and oblique x-rays or additional pul- shifts may indicate a need to improve work monary function tests may be performed if practices on a particular shift. Sampling re- deemed necessary. sults from different shifts for each job classi- B.Pulmonary function tests. fication should not be averaged. Multiple Pulmonary function tests should be per- samples from same shift on each battery formed in a manner which minimizes subject may be used to calculate an average expo- and operator bias. There has been shown to sure for a particular job classification. be learning effects with regard to the results B.Analysis. obtained from certain tests,such as FEV 1.0. 1. All extraction glassware is cleaned with Best results can be obtained by multiple dichromic acid cleaning solution,rinsed with trials for each subject. The best of three tap water, then dionized water, acetone, and trials or the average of the last three of five allowed to dry completely. The glassware is trials may be used in obtaining reliable re- rinsed with nanograde benzene before use. sults. The type of equipment used(manufac- The Teflon cups are cleaned with benzene turer, model, etc.) should be recorded with then with acetone. the results as reliability and accuracy varies 2. Pre-weigh the 2 ml Teflon cups to one and such information may be important in hundredth of a milligram (0.01 mg) on an the evaluation of test results. Care should be autobalance AD 2 Tare weight of the cups is exercised to obtain the best possible testing about 50 mg. equipment. 3. Place the silver membrane filter and [39 FR 23502, June 27, 1974, 41 FR 46784, Oct. glass fiber filter into a 15 ml test tube. 22, 1976, as amended at 42 FR 3304, Jan. 18, 4. Extract with 5 ml of benzene for five 1977; 45 FR 35283, May 23, 1980; 50 FR 37353, minutes in an ultrasonic cleaner. 37354, Sept. 13, 1985; 54 FR 24334, June 7, 1989; 5.Filter the extract in 15 ml medium glass 61 FR 5508, Feb. 13, 1996; 63 FR 1290, Jan. 8, fritted funnels. 1998; 63 FR 33468, June 18, 1998; 70 FR 1142, 6. Rinse test tube and filters with two 1.5 Jan,5, 2005;71 FR 16672, 16673,Apr. 3,2006; 71 ml aliquots of benzene and filter through the FR 50189, Aug. 24, 2006; 73 FR 75585, Dec. 12, fritted glass funnel. 20081 7. Collect the extract and two rinses in a 10 ml Kontes graduated evaporative concen- §1910.1030 Bloodborne pathogens. trator. 8.Evaporate down to 1 ml while rinsing the (a)Scope and Application. This Section sides with benzene. applies to all occupational exposure to 9. Pipet 0.5 ml into the Teflon cup and blood or other potentially infectious evaporate to dryness in a vacuum oven at 40 materials as defined by paragraph (b) °C for 3 hours. of this section. 265 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD §1910.1030 29 CFR Ch. XVII (7-1-10 Edition) (b) Definitions. For purposes of this with blood or other potentially infec- section, the following shall apply: tious materials that results from the Assistant Secretary means the Assist- performance of an employee's duties. ant Secretary of Labor for Occupa- Handwashing Facilities means a facil- tional Safety and Health, or designated ity providing an adequate supply of representative. running potable water, soap and single Blood means human blood, human use towels or hot air drying machines. blood components, and products made Licensed Healthcare Professional is a from human blood. person whose legally permitted scope Bloodborne Pathogens means patho- of practice allows him or her to inde- genic microorganisms that are present pendently perform the activities re- in human blood and can cause disease quired by paragraph (f) Hepatitis B in humans. These pathogens include, Vaccination and Post-exposure Evalua- but are not limited to, hepatitis B tion and Follow-up. virus (HBV) and human immuno- HBV means hepatitis B virus. deficiency virus(HIV). HIV means human immunodeficiency Clinical Laboratory means a work- virus. place where diagnostic or other screen- Needleless systems means a device that ing procedures are performed on blood does not use needles for: or other potentially infectious mate- rials. (1) The collection of bodily fluids or Contaminated means the presence or Withdrawal of body fluids after initial venous or arterial access is established; the reasonably anticipated presence of blood or other potentially infectious (2) The administration of medication or fluids; or materials on an item or surface. Contaminated Laundry means laundry (3)Any other procedure involving the which has been soiled with blood or potential for occupational exposure to other potentially infectious materials bloodborne pathogens due to or may contain sharps. percutaneous injuries from contami- Contaminated Sharps means any con- nated sharps. taminated object that can penetrate Occupational Exposure means reason- the skin including, but not limited to, ably anticipated skin, eye, mucous needles, scalpels, broken glass, broken membrane, or parenteral contact with capillary tubes, and exposed ends of blood or other potentially infectious dental wires. materials that may result from the Decontamination means the use of performance of an employee's duties. physical or chemical means to remove, Other Potentially Infectious Materials inactivate, or destroy bloodborne means pathogens on a surface or item to the (1) The following human body fluids: point where they are no longer capable semen, vaginal secretions, cerebro- of transmitting infectious particles and spinal fluid, synovial fluid, pleural the surface or item is rendered safe for fluid, pericardial fluid, peritoneal fluid, handling, use, or disposal. amniotic fluid, saliva in dental proce- Director means the Director of the dures, any body fluid that is visibly National Institute for Occupational contaminated with blood, and all body Safety and Health, U.S. Department of fluids in situations where it is difficult Health and Human Services, or des- or impossible to differentiate between ignated representative. body fluids; Engineering controls means controls (2)Any unfixed tissue or organ (other (e.g., sharps disposal containers, self- than intact skin) from a human (living sheathing needles, safer medical de- or dead); and vices, such as sharps with engineered (3) HIV-containing cell or tissue cul- sharps injury protections and tures, organ cultures, and HIV- or needleless systems) that isolate or re- HBV-containing culture medium or move the bloodborne pathogens hazard other solutions; and blood, organs, or from the workplace. other tissues from experimental ani- Exposure Incident means a specific mals infected with HIV or HBV. eye, mouth, other mucous membrane, Parenteral means piercing mucous non-intact skin, or parenteral contact membranes or the skin barrier through 266 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Occupational Safety and Health Admin., Labor §1910.1030 such events as needlesticks, human microbial life including highly resist- bites, cuts, and abrasions. ant bacterial endospores. Personal Protective Equipment is spe- Universal Precautions is an approach cialized clothing or equipment worn by to infection control. According to the an employee for protection against a concept of Universal Precautions, all hazard. General work clothes (e.g., uni- human blood and certain human body forms, pants, shirts or blouses) not in- fluids are treated as if known to be in- tended to function as protection fectious for HIV, HBV, and other against a hazard are not considered to bloodborne pathogens. be personal protective equipment. Work Practice Controls means controls Production Facility means a facility that reduce the likelihood of exposure engaged in industrial-scale, large-vol- by altering the manner in which a task ume or high concentration production is performed (e.g., prohibiting recap- of HIV or HBV. ping of needles by a two-handed tech- Regulated Waste means liquid or nique). semi-liquid blood or other potentially (c)Exposure control—(1) Exposure Con- infectious materials; contaminated trol Plan. (i) Each employer having an items that would release blood or other employee(s) with occupational expo- potentially infectious materials in a sure as defined by paragraph (b) of this liquid or semi-liquid state if com- section shall establish a written Expo- pressed; items that are caked with sure Control Plan designed to elimi- dried blood or other potentially infec- nate or minimize employee exposure. tious materials and are capable of re- (ii) The Exposure Control Plan shall leasing these materials during han- contain at least the following ele- dling; contaminated sharps; and patho- ments: logical and microbiological wastes con- (A) The exposure determination re- taining blood or other potentially in- quired by paragraph(c)(2), fectious materials. (B) The schedule and method of im- plementation for paragraphs (d) Meth- ods of Compliance, (e) HIV and HBV tory producing or using research-lab- Research Laboratories and Production oratory-scale amounts of HIV or HBV. Facilities, (f) Hepatitis B Vaccination Research laboratories may produce and Post-Exposure Evaluation and Fol- high concentrations of HIV or HBV but low-up, (g) Communication of Hazards not in the volume found in production to Employees, and (h) Recordkeeping, facilities. of this standard, and Sharps with engineered sharps injury (C) The procedure for the evaluation protections means a nonneedle sharp or of circumstances surrounding exposure a needle device used for withdrawing incidents as required by paragraph body fluids, accessing a vein or artery, (f)(3)(i) of this standard. or administering medications or other (iii) Each employer shall ensure that fluids, with a built-in safety feature or a copy of the Exposure Control Plan is mechanism that effectively reduces the accessible to employees in accordance risk of an exposure incident. with 29 CFR 1910.20(e). Source Individual means any indi- (iv) The Exposure Control Plan shall vidual, living or dead, whose blood or be reviewed and updated at least annu- other potentially infectious materials ally and whenever necessary to reflect may be a source of occupational expo- new or modified tasks and procedures sure to the employee. Examples in- which affect occupational exposure and clude, but are not limited to, hospital to reflect new or revised employee po- and clinic patients; clients in institu- sitions with occupational exposure. tions for the developmentally disabled; The review and update of such plans trauma victims; clients of drug and al- shall also: cohol treatment facilities; residents of (A) Reflect changes in technology hospices and nursing homes; human re- that eliminate or reduce exposure to mains; and individuals who donate or bloodborne pathogens; and sell blood or blood components. (B) Document annually consideration Sterilize means the use of a physical and implementation of appropriate or chemical procedure to destroy all commercially available and effective 267 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD §1910.1030 29 CFR Ch. XVII (7-1-10 Edition) safer medical devices designed to elimi- (ii) Engineering controls shall be ex- nate or minimize occupational expo- amined and maintained or replaced on sure. a regular schedule to ensure their ef- (v) An employer, who is required to fectiveness. establish an Exposure Control Plan (iii) Employers shall provide shall solicit input from non-managerial handwashing facilities which are read- employees responsible for direct pa- ily accessible to employees. tient care who are potentially exposed (iv) When provision of handwashing to injuries from contaminated sharps facilities is not feasible, the employer in the identification, evaluation, and shall provide either an appropriate an- selection of effective engineering and tiseptic hand cleanser in conjunction work practice controls and shall docu- with clean cloth/paper towels or anti- ment the solicitation in the Exposure septic towelettes. When antiseptic Control Plan. hand cleansers or towelettes are used, (vi) The Exposure Control Plan shall hands shall be washed with soap and be made available to the Assistant Sec- running water as soon as feasible. retary and the Director upon request (v) Employers shall ensure that em- for examination and copying. ployees wash their hands immediately (2) Exposure determination. (i) Each or as soon as feasible after removal of employer who has an employee(s) with gloves or other personal protective occupational exposure as defined by equipment. paragraph (b) of this section shall pre- (vi) Employers shall ensure that em- pare an exposure determination. This ployees wash hands and any other skin exposure determination shall contain with soap and water, or flush mucous the following: membranes with water immediately or (A) A list of all job classifications in as soon as feasible following contact of which all employees in those job classi- such body areas with blood other po- fications have occupational exposure; tentially infectious materialiss. (vi ) Contaminated needles and other (B) A list of job classifications in contaminated sharps shall not be bent, which some employees have occupa- recapped, or removed except as noted tional exposure, and in paragraphs (d)(2)(vii)(A) and (C) A list of all tasks and procedures (d)(2)(vii)(B) below. Shearing or break- or groups of closely related task and ing of contaminated needles is prohib- procedures in which occupational expo- ited. sure occurs and that are performed by (A) Contaminated needles and other employees in job classifications listed contaminated sharps shall not be bent, in accordance with the provisions of recapped or removed unless the em- paragraph(c)(2)(i)(B) of this standard. ployer can demonstrate that no alter- (ii) This exposure determination native is feasible or that such action is shall be made without regard to the required by a specific medical or dental use of personal protective equipment. procedure. (d) Methods of compliance—(1) General. (B) Such bending, recapping or needle Universal precautions shall be observed removal must be accomplished through to prevent contact with blood or other the use of a mechanical device or a potentially infectious materials. Under one-handed technique. circumstances in which differentiation (viii) Immediately or as soon as pos- between body fluid types is difficult or sible after use, contaminated reusable impossible, all body fluids shall be con- sharps shall be placed in appropriate sidered potentially infectious mate- containers until properly reprocessed. rials. These containers shall be: (2) Engineering and work practice con- (A)Puncture resistant; trols. (i) Engineering and work practice (B) Labeled or color-coded in accord- controls shall be used to eliminate or ance with this standard; minimize employee exposure. Where (C) Leakproof on the sides and bot- occupational exposure remains after tom; and institution of these controls, personal (D) In accordance with the require- protective equipment shall also be ments set forth in paragraph used. (d)(4)(ii)(E)for reusable sharps. 268 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Occupational Safety and Health Admin., Labor §1910.1030 (ix) Eating, drinking, smoking, ap- and shall be decontaminated as nec- plying cosmetics or lip balm, and han- essary, unless the employer can dem- dling contact lenses are prohibited in onstrate that decontamination of such work areas where there is a reasonable equipment or portions of such equip- likelihood of occupational exposure. ment is not feasible. (x) Food and drink shall not be kept (A) A readily observable label in ac- in refrigerators, freezers, shelves, cabi- cordance with paragraph (g)(1)(i)(H) nets or on countertops or benchtops shall be attached to the equipment where blood or other potentially infec- stating which portions remain con- tious materials are present. taminated. (xi) All procedures involving blood or (B) The employer shall ensure that other potentially infectious materials this information is conveyed to all af- shall be performed in such a manner as fected employees, the servicing rep- to minimize splashing, spraying, spat- resentative, and/or the manufacturer, tering, and generation of droplets of as appropriate, prior to handling, serv- these substances. icing, or shipping so that appropriate (xii) Mouth pipetting/suctioning of precautions will be taken. blood or other potentially infectious (3) Personal protective equipment—(i) materials is prohibited. Provision. When there is occupational (xiii) Specimens of blood or other po- exposure, the employer shall provide, tentially infectious materials shall be at no cost to the employee, appropriate placed in a container which prevents personal protective equipment such as, leakage during collection, handling, but not limited to, gloves, gowns, lab- processing, storage, transport, or ship- oratory coats, face shields or masks ping. and eye protection, and mouthpieces, (A) The container for storage, trans- resuscitation bags, pocket masks, or port, or shipping shall be labeled or other ventilation devices. Personal color-coded according to paragraph protective equipment will be consid- (g)(1)(i) and closed prior to being ered "appropriate" only if it does not stored, transported, or shipped. When a permit blood or other potentially infec- facility utilizes Universal Precautions tious materials to pass through to or in the handling of all specimens, the reach the employee's work clothes, labeling/color-coding of specimens is street clothes, undergarments, skin, not necessary provided containers are eyes, mouth, or other mucous mem- recognizable as containing specimens. branes under normal conditions of use This exemption only applies while such and for the duration of time which the specimens/containers remain within protective equipment will be used. the facility. Labeling or color-coding (ii) Use. The employer shall ensure in accordance with paragraph (g)(1)(i) that the employee uses appropriate is required when such specimens/con- personal protective equipment unless tainers leave the facility. the employer shows that the employee (B) If outside contamination of the temporarily and briefly declined to use primary container occurs, the primary personal protective equipment when, container shall be placed within a sec- under rare and extraordinary cir- ond container which prevents leakage cumstances, it was the employee's pro- during handling, processing, storage, fessional judgment that in the specific transport, or shipping and is labeled or instance its use would have prevented color-coded according to the require- the delivery of health care or public ments of this standard. safety services or would have posed an (C) If the specimen could puncture increased hazard to the safety of the the primary container, the primary worker or co-worker. When the em- container shall be placed within a sec- ployee makes this judgement, the cir- ondary container which is puncture-re- cumstances shall be investigated and sistant in addition to the above charac- documented in order to determine teristics. whether changes can be instituted to (xiv) Equipment which may become prevent such occurences in the future. contaminated with blood or other po- (iii) Accessibility. The employer shall tentially infectious materials shall be ensure that appropriate personal pro- examined prior to servicing or shipping tective equipment in the appropriate 269 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD §1910.1030 29 CFR Ch. XVII (7-1-10 Edition) sizes is readily accessible at the work- (D) If an employer in a volunteer site or is issued to employees. blood donation center judges that rou- Hypoallergenic gloves, glove liners, tine gloving for all phlebotomies is not powderless gloves, or other similar al- necessary then the employer shall: ternatives shall be readily accessible to (1) Periodically reevaluate this pol- those employees who are allergic to the icy; gloves normally provided. (2) Make gloves available to all em- (iv) Cleaning, Laundering, and Dis- ployees who wish to use them for phle- posal. The employer shall clean, laun- botomy; der, and dispose of personal protective (3) Not discourage the use of gloves equipment required by paragraphs (d) for phlebotomy; and and (e) of this standard, at no cost to (4) Require that gloves be used for the employee. phlebotomy in the following cir- (v) Repair and Replacement. The em- cumstances: ployer shall repair or replace personal (i) When the employee has cuts, protective equipment as needed to scratches, or other breaks in his or her maintain its effectiveness, at no cost skin; to the employee. (ii) When the employee judges that (vi) If a garment(s) is penetrated by hand contamination with blood may blood or other potentially infectious occur, for example, when performing materials, the garment(s) shall be re- phlebotomy on an uncooperative moved immediately or as soon as fea- source individual;and sible. (iii) When the employee is receiving (vii) All personal protective equip- training in phlebotomy. ment shall be removed prior to leaving (x) Masks, Eye Protection, and Face the work area. Shields. Masks in combination with eye (viii)When personal protective equip- protection devices, such as goggles or ment is removed it shall be placed in glasses with solid side shields, or chin- an appropriately designated area or length face shields, shall be worn when- container for storage, washing, decon- ever splashes, spray, spatter, or drop- tamination or disposal. lets of blood or other potentially infec- (ix)Gloves. Gloves shall be worn when tious materials may be generated and it can be reasonably anticipated that eye, nose, or mouth contamination can the employee may have hand contact be reasonably anticipated. with blood, other potentially infectious (xi) Gowns, Aprons, and Other Protec- materials, mucous membranes, and tive Body Clothing. Appropriate protec- non-intact skin; when performing vas- tive clothing such as, but not limited cular access procedures except as speci- to, gowns, aprons, lab coats, clinic fied in paragraph (d)(3)(ix)(D); and jackets, or similar outer garments when handling or touching contami- shall be worn in occupational exposure nated items or surfaces. situations. The type and characteris- (A) Disposable (single use) gloves tics will depend upon the task and de- such as surgical or examination gloves, gree of exposure anticipated. shall be replaced as soon as practical (xii) Surgical caps or hoods and/or when contaminated or as soon as fea- shoe covers or boots shall be worn in sible if they are torn, punctured, or instances when gross contamination when their ability to function as a bar- can reasonably be anticipated (e.g., au- rier is compromised. topsies, orthopaedic surgery). (B) Disposable (single use) gloves (4)Housekeeping—(i) General. Employ- shall not be washed or decontaminated ers shall ensure that the worksite is for re-use. maintained in a clean and sanitary (C) Utility gloves may be decontami- condition. The employer shall deter- nated for re-use if the integrity of the mine and implement an appropriate glove is not compromised. However, written schedule for cleaning and they must be discarded if they are method of decontamination based upon cracked, peeling, torn, punctured, or the location within the facility, type of exhibit other signs of deterioration or surface to be cleaned, type of soil when their ability to function as a bar- present, and tasks or procedures being rier is compromised. performed in the area. 270 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Occupational Safety and Health Admin., Labor §1910.1030 (ii) All equipment and environmental (2) During use, containers for con- and working surfaces shall be cleaned taminated sharps shall be: and decontaminated after contact with (i) Easily accessible to personnel and blood or other potentially infectious located as close as is feasible to the im- materials. mediate area where sharps are used or (A)Contaminated work surfaces shall can be reasonably anticipated to be be decontaminated with an appropriate found(e.g., laundries); disinfectant after completion of proce- (ii) Maintained upright throughout dures; immediately or as soon as fea- use; and sible when surfaces are overtly con- (iii) Replaced routinely and not be al- taminated or after any spill of blood or lowed to overfill. other potentially infectious materials; (3) When moving containers of con- and at the end of the work shift if the taminated sharps from the area of use, surface may have become contami- the containers shall be: nated since the last cleaning. (i) Closed immediately prior to re- (B) Protective coverings, such as moval or replacement to prevent spill- plastic wrap, aluminum foil, or imper- age or protrusion of contents during viously-backed absorbent paper used to handling, storage, transport, or ship- cover equipment and environmental ping; surfaces, shall be removed and replaced as soon as feasible when they become (ii) Placed a secondary container if leak overtly contaminated or at the end of age it possible. The second con- tainer shall be: the workshift if they may have become (A)Closable; contaminated during the shift. (B) Constructed to contain all con- (C) All bins, pails, cans, and similar tents and prevent leakage during han- receptacles intended for reuse which dling, storage, transport, or shipping; have a reasonable likelihood for be- and coming contaminated with blood or other potentially infectious materials ( Labeled ) color-coded according p to p shall be inspected and decontaminated paragraph(gont)of this standard. c on a regularly scheduled basis and (4) Reusable containers shall not be cleaned and decontaminated imme- opened, emptied, or cleaned manually diately or as soon as feasible upon visi- or in any other manner which would ble contamination. expose employees to the risk of (D) Broken glassware which may be percutaneous injury. contaminated shall not be picked up (B) Other Regulated Waste Contain- directly with the hands. It shall be ment—(1) Regulated waste shall be cleaned up using mechanical means, placed in containers which are: such as a brush and dust pan, tongs, or (i)Closable; forceps. (ii) Constructed to contain all con- (E) Reusable sharps that are con- tents and prevent leakage of fluids dur- taminated with blood or other poten- ing handling, storage, transport or tially infectious materials shall not be shipping; stored or processed in a manner that (iii) Labeled or color-coded in accord- requires employees to reach by hand ance with paragraph (g)(1)(i) this into the containers where these sharps standard; and have been placed. (iv) Closed prior to removal to pre- (iii) Regulated Waste—(A) Contami- vent spillage or protrusion of contents nated Sharps Discarding and Contain- during handling, storage, transport, or ment. (1) Contaminated sharps shall be shipping. discarded immediately or as soon as (2) If outside contamination of the feasible in containers that are: regulated waste container occurs, it (i)Closable; shall be placed in a second container. (ii)Puncture resistant; The second container shall be: (iii) Leakproof on sides and bottom; (i)Closable; and (ii) Constructed to contain all con- (iv) Labeled or color-coded in accord- tents and prevent leakage of fluids dur- ance with paragraph (g)(1)(i) of this ing handling, storage, transport or standard. shipping; 271 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD §1910.1030 29 CFR Ch. XVII (7-1-10 Edition) (iii) Labeled or color-coded in accord- apply to clinical or diagnostic labora- ance with paragraph (g)(1)(i) of this tories engaged solely in the analysis of standard; and blood, tissues, or organs. These re- (iv) Closed prior to removal to pre- quirements apply in addition to the vent spillage or protrusion of contents other requirements of the standard. during handling, storage, transport, or (2) Research laboratories and produc- shipping. tion facilities shall meet the following (C) Disposal of all regulated waste criteria: shall be in accordance with applicable (i) Standard microbiological practices. regulations of the United States, All regulated waste shall either be in- States and Territories, and political cinerated or decontaminated by a subdivisions of States and Territories. method such as autoclaving known to (iv) Laundry. (A) Contaminated laun- effectively destroy bloodborne patho- dry shall be handled as little as pos- gens. sible with a minimum of agitation. (1) Contaminated laundry shall be bagged (ii) Special practices. (A) Laboratory or containerized at the location where doors shall be kept closed when work it was used and shall not be sorted or involving HIV or HBV is in progress. rinsed in the location of use. (B) Contaminated materials that are (2) Contaminated laundry shall be to be decontaminated at a site away placed and transported in bags or con- from the work area shall be placed in a tainers labeled or color-coded in ac- durable, leakproof, labeled or color- cordance with paragraph (g)(1)(i) of coded container that is closed before this standard. When a facility utilizes being removed from the work area. Universal Precautions in the handling (C) Access to the work area shall be of all soiled laundry, alternative label- limited to authorized persons. Written ing or color-coding is sufficient if it policies and procedures shall be estab- permits all employees to recognize the lished whereby only persons who have containers as requiring compliance been advised of the potential bio- with Universal Precautions. hazard, who meet any specific entry re- (3) Whenever contaminated laundry quirements, and who comply with all is wet and presents a reasonable likeli- entry and exit procedures shall be al- hood of soak-through of or leakage lowed to enter the work areas and ani- from the bag or container, the laundry mal rooms. shall be placed and transported in bags (D)When other potentially infectious or containers which prevent soak- materials or infected animals are through and/or leakage of fluids to the exterior. present in the work area or contain- ment module, a hazard warning sign in- (B) The employer shall ensure that corporating the universal biohazard employees who have contact with con- symbol shall be posted on all access taminated laundry wear protective gloves and other appropriate personal doors. The hazard warning sign shall comply with paragraph (g)(1)(ii) of this protective equipment. standard. (C) When a facility ships contami- nated laundry off-site to a second facil- (E) All activities involving other po- ity which does not utilize Universal tentially infectious materials shall be Precautions in the handling of all laun- conducted in biological safety cabinets dry, the facility generating the con- or other physical-containment devices taminated laundry must place such within the containment module. No laundry in bags or containers which work with these other potentially in- are labeled or color-coded in accord- fectious materials shall be conducted ance with paragraph(g)(1)(i). on the open bench. (e) HIV and HBV Research Labora- (F) Laboratory coats, gowns, smocks, tories and Production Facilities. (1) This uniforms, or other appropriate protec- paragraph applies to research labora- tive clothing shall be used in the work tories and production facilities en- area and animal rooms. Protective gaged in the culture, production, con- clothing shall not be worn outside of centration, experimentation, and ma- the work area and shall be decontami- nipulation of HIV and HBV. It does not nated before being laundered. 272 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Occupational Safety and Health Admin., Labor §1910.1030 (G) Special care shall be taken to I, 11, or III) or other appropriate com- avoid skin contact with other poten- binations of personal protection or tially infectious materials. Gloves physical containment devices, such as shall be worn when handling infected special protective clothing, respirators, animals and when making hand con- centrifuge safety cups, sealed cen- tact with other potentially infectious trifuge rotors, and containment caging materials is unavoidable. for animals, shall be used for all activi- (H) Before disposal all waste from ties with other potentially infectious work areas and from animal rooms materials that pose a threat of expo- shall either be incinerated or decon- sure to droplets, splashes, spills, or taminated by a method such as aerosols. autoclaving known to effectively de- (B) Biological safety cabinets shall stroy bloodborne pathogens. be certified when installed, whenever (I) Vacuum lines shall be protected they are moved and at least annually. with liquid disinfectant traps and high- (3) HIV and HBV research labora- efficiency particulate air (HEPA) fil- tories shall meet the following criteria: ters or filters of equivalent or superior (i) Each laboratory shall contain a efficiency and which are checked rou- facility for hand washing and an eye tinely and maintained or replaced as wash facility which is readily available necessary. within the work area. (J) Hypodermic needles and syringes (ii) An autoclave for decontamina- shall be used only for parenteral injec- tion of regulated waste shall be avail- tion and aspiration of fluids from lab- able. oratory animals and diaphragm bot- (4)HIV and HBV production facilities tles. Only needle-locking syringes or shall meet the following criteria: disposable syringe-needle units (i.e., (i) The work areas shall be separated the needle is integral to the syringe) from areas that are open to unre- shall be used for the injection or aspi- stricted traffic flow within the build- ration of other potentially infectious ing. Passage through two sets of doors materials. Extreme caution shall be shall be the basic requirement for used when handling needles and sy- entry into the work area from access ringes. A needle shall not be bent, corridors or other contiguous areas. sheared, replaced in the sheath or Physical separation of the high-con- guard, or removed from the syringe fol- tainment work area from access cor- lowing use. The needle and syringe ridors or other areas or activities may shall be promptly placed in a puncture- also be provided by a double-doored resistant container and autoclaved or clothes-change room (showers may be decontaminated before reuse or dis- included), airlock, or other access fa- posal. cility that requires passing through (K) All spills shall be immediately two sets of doors before entering the contained and cleaned up by appro- work area. priate professional staff or others prop- (ii) The surfaces of doors, walls, erly trained and equipped to work with floors and ceilings in the work area potentially concentrated infectious shall be water resistant so that they materials. can be easily cleaned. Penetrations in (L) A spill or accident that results in these surfaces shall be sealed or capa- an exposure incident shall be imme- ble of being sealed to facilitate decon- diately reported to the laboratory di- tamination. rector or other responsible person. (iii) Each work area shall contain a (M) A biosafety manual shall be pre- sink for washing hands and a readily pared or adopted and periodically re- available eye wash facility. The sink viewed and updated at least annually shall be foot, elbow, or automatically or more often if necessary. Personnel operated and shall be located near the shall be advised of potential hazards, exit door of the work area. shall be required to read instructions (iv) Access doors to the work area or on practices and procedures, and shall containment module shall be self-clos- be required to follow them. ing. (iii) Containment equipment. (A) Cer- (v)An autoclave for decontamination tified biological safety cabinets (Class of regulated waste shall be available 273 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD §1910.1030 29 CFR Ch. XVII (7-1-10 Edition) within or as near as possible to the the employee has previously received work area. the complete hepatitis B vaccination (vi) A ducted exhaust-air ventilation series, antibody testing has revealed system shall be provided. This system that the employee is immune, or the shall create directional airflow that vaccine is contraindicated for medical draws air into the work area through reasons. the entry area. The exhaust air shall (ii)The employer shall not make par- not be recirculated to any other area of ticipation in a prescreening program a the building, shall be discharged to the prerequisite for receiving hepatitis B outside, and shall be dispersed away vaccination. from occupied areas and air intakes. (iii)If the employee initially declines The proper direction of the airflow hepatitis B vaccination but at a later shall be verified (i.e., into the work date while still covered under the area). standard decides to accept the vaccina- (5) Training Requirements. Additional tion, the employer shall make avail- training requirements for employees in able hepatitis B vaccination at that HIV and HBV research laboratories and time. HIV and HBV production facilities are (iv) The employer shall assure that specified in paragraph(g)(2)(ix). employees who decline to accept hepa- (f) Hepatitis B vaccination and post-ex- titis B vaccination offered by the em- posure evaluation and follow-up—(1) ployer sign the statement in appendix General. (i) The employer shall make A. available the hepatitis B vaccine and (v) If a routine booster dose(s) of hep- vaccination series to all employees atitis B vaccine is recommended by the who have occupational exposure, and U.S. Public Health Service at a future post-exposure evaluation and follow-up date, such booster dose(s) shall be to all employees who have had an expo- made available in accordance with sec- sure incident. tion(f)(1)(ii). (ii) The employer shall ensure that (3) Post-exposure Evaluation and Fol- all medical evaluations and procedures low-up. Following a report of an expo- including the hepatitis B vaccine and sure incident, the employer shall make vaccination series and post-exposure immediately available to the exposed evaluation and follow-up, including employee a confidential medical eval- prophylaxis, are: uation and follow-up, including at least (A) Made available at no cost to the the following elements: employee; (i) Documentation of the route(s) of (B) Made available to the employee exposure, and the circumstances under at a reasonable time and place; which the exposure incident occurred; (C) Performed by or under the super- (ii) Identification and documentation vision of a licensed physician or by or of the source individual, unless the em- under the supervision of another li- ployer can establish that identification censed healthcare professional; and is infeasible or prohibited by state or (D) Provided according to rec- local law; ommendations of the U.S. Public (A) The source individual's blood Health Service current at the time shall be tested as soon as feasible and these evaluations and procedures take after consent is obtained in order to de- place, except as specified by this para- termine HBV and HIV infectivity. If graph(f). consent is not obtained, the employer (iii) The employer shall ensure that shall establish that legally required all laboratory tests are conducted by consent cannot be obtained. When the an accredited laboratory at no cost to source individual's consent is not re- the employee. quired by law, the source individual's (2) Hepatitis B Vaccination. (i) Hepa- blood, if available, shall be tested and titis B vaccination shall be made avail- the results documented. able after the employee has received (B) When the source individual is al- the training required in paragraph ready known to be infected with HBV (g)(2)(vii)(I)and within 10 working days or HIV, testing for the source individ- of initial assignment to all employees ual's known HBV or HIV status need who have occupational exposure unless not be repeated. 274 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Occupational Safety and Health Admin., Labor §1910.1030 (C) Results of the source individual's vaccination is indicated for an em- testing shall be made available to the ployee, and if the employee has re- exposed employee, and the employee ceived such vaccination. shall be informed of applicable laws (ii) The healthcare professional's and regulations concerning disclosure written opinion for post-exposure eval- of the identity and infectious status of uation and follow-up shall be limited to the source individual. the following information: (iii) Collection and testing of blood (A) That the employee has been in- for HBV and HIV serological status; formed of the results of the evaluation; (A) The exposed employee's blood and shall be collected as soon as feasible (B) That the employee has been told and tested after consent is obtained. about any medical conditions resulting (B) If the employee consents to base- from exposure to blood or other poten- line blood collection, but does not give tially infectious materials which re- consent at that time for HIV serologic quire further evaluation or treatment. testing, the sample shall be preserved (iii) All other findings or diagnoses for at least 90 days. If, within 90 days of shall remain confidential and shall not the exposure incident, the employee be included in the written report. elects to have the baseline sample test- (6) Medical recordkeeping. Medical ed, such testing shall be done as soon records required by this standard shall as feasible. be maintained in accordance with para- (iv) Post-exposure prophylaxis, when graph(h)(1) of this section. medically indicated, as recommended (g) Communication of hazards to em- by the U.S. Public Health Service; ployees—(1) Labels and signs—(i) Labels. (v) Counseling; and (A) Warning labels shall be affixed to (vi)Evaluation of reported illnesses. containers of regulated waste, refrig- (4) Information Provided to the erators and freezers containing blood Healthcare Professional. (i) The em- or other potentially infectious mate- ployer shall ensure that the healthcare rial; and other containers used to professional responsible for the em- store, transport or ship blood or other ployee's Hepatitis B vaccination is pro- potentially infectious materials, ex- vided a copy of this regulation. cept as provided in paragraph (ii) The employer shall ensure that (9)(1)(i)(E), (F)and(G). the healthcare professional evaluating (B) Labels required by this section an employee after an exposure incident shall include the following legend: is provided the following information: (A)A copy of this regulation; (B) A description of the exposed em- ployee's duties as they relate to the ex- posure incident; (C) Documentation of the route(s) of 1Z 04 exposure and circumstances under which exposure occurred; �4c, V (D) Results of the source individual's blood testing, if available; and (E) All medical records relevant to the appropriate treatment of the em- ployee including vaccination status which are the employer's responsibility BIOHAZARD to maintain. (5) Healthcare Professional's Written (C) These labels shall be fluorescent Opinion. The employer shall obtain and orange or orange-red or predominantly provide the employee with a copy of so, with lettering and symbols in a con- the evaluating healthcare profes- trasting color. sional's written opinion within 15 days (D) Labels shall be affixed as close as of the completion of the evaluation. feasible to the container by string, (i)The healthcare professional's writ- wire, adhesive, or other method that ten opinion for Hepatitis B vaccination prevents their loss or unintentional re- shall be limited to whether Hepatitis B moval. 275 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD §1910.1030 29 CFR Ch. XVII (7-1-10 Edition) (E) Red bags or red containers may (A) At the time of initial assignment be substituted for labels. to tasks where occupational exposure (F) Containers of blood, blood compo- may take place; nents, or blood products that are la- (B)At least annually thereafter. beled as to their contents and have (iii) [Reserved] been released for transfusion or other (iv) Annual training for all employ- clinical use are exempted from the la- ees shall be provided within one year of beling requirements of paragraph(g). their previous training. (G) Individual containers of blood or (v) Employers shall provide addi- other potentially infectious materials tional training when changes such as that are placed in a labeled container modification of tasks or procedures or during storage, transport, shipment or institution of new tasks or procedures disposal are exempted from the label- affect the employee's occupational ex- ing requirement. posure. The additional training may be (H) Labels required for contaminated limited to addressing the new expo- equipment shall be in accordance with sures created. this paragraph and shall also state (vi) Material appropriate in content which portions of the equipment re- and vocabulary to educational level, main contaminated. literacy, and language of employees (I) Regulated waste that has been de- shall be used. contaminated need not be labeled or (vii) The training program shall con- color-coded. tain at a minimum the following ele- (ii)Signs. (A)The employer shall post ments: signs at the entrance to work areas (A) An accessible copy of the regu- specified in paragraph (e), HIV and latory text of this standard and an ex- HBV Research Laboratory and Produc- planation of its contents; tion Facilities, which shall bear the (B) A general explanation of the epi- following legend: demiology and symptoms of bloodborne diseases; (C) An explanation of the modes of transmission of bloodborne pathogens; (D) An explanation of the employer's exposure control plan and the means by which the employee can obtain a copy of the written plan; (E)An explanation of the appropriate methods for recognizing tasks and other activities that may involve expo- BIOHAZARD sure to blood and other potentially in- fectious materials; (Name of the Infectious Agent) (F) An explanation of the use and (Special requirements for entering the area) limitations of methods that will pre- (Name, telephone number of the laboratory vent or reduce exposure including ap- director or other responsible person.) propriate engineering controls, work (B) These signs shall be fluorescent practices, and personal protective orange-red or predominantly so, with equipment; lettering and symbols in a contrasting (G) Information on the types, proper color. use, location, removal, handling, de- (2) Information and Training. (i) The contamination and disposal of personal employer shall train each employee protective equipment; with occupational exposure in accord- (H) An explanation of the basis for ance with the requirements of this sec- selection of personal protective equip- tion. Such training must be provided at ment; no cost to the employee and during (I) Information on the hepatitis B working hours. The employer shall in- vaccine, including information on its stitute a training program and ensure efficacy, safety, method of administra- employee participation in the program. tion, the benefits of being vaccinated, (ii) Training shall be provided as fol- and that the vaccine and vaccination lows: will be offered free of charge; 276 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD Occupational Safety and Health Admin., Labor §1910.1030 (J) Information on the appropriate (h) Recordkeeping—(1) Medical actions to take and persons to contact Records. (i) The employer shall estab- in an emergency involving blood or lish and maintain an accurate record other potentially infectious materials; for each employee with occupational (K) An explanation of the procedure exposure, in accordance with 29 CFR to follow if an exposure incident oc- 1910.1020. curs, including the method of reporting (ii)This record shall include: the incident and the medical follow-up (A) The name and social security that will be made available; number of the employee; (L) Information on the post-exposure (B) A copy of the employee's hepa- evaluation and follow-up that the em- titis B vaccination status including the ployer is required to provide for the dates of all the hepatitis B vaccina- employee following an exposure inci- tions and any medical records relative dent; to the employee's ability to receive (M) An explanation of the signs and vaccination as required by paragraph labels and/or color coding required by (f)(2); paragraph(g)(1); and (C) A copy of all results of examina- (N) An opportunity for interactive tions, medical testing, and follow-up questions and answers with the person procedures as required by paragraph conducting the training session. (f)(3); (viii) The person conducting the (D) The employer's copy of the training shall be knowledgeable in the healthcare professional's written opin- subject matter covered by the elements ion as required by paragraph (f)(5); and contained in the training program as it (E) A copy of the information pro- relates to the workplace that the train- vided to the healthcare professional as ing will address. required by paragraphs (f)(4)(ii)(B)(C) (ix) Additional Initial Training for and(D). Employees in HIV and HBV Labora- (iii) Confidentiality. The employer tories and Production Facilities. Em- shall ensure that employee medical ployeesin HIV or HBV research labora- records required by paragraph (h)(1) tories and HIV or HBV production fa- are: cilities shall receive the following ini- (A)Kept confidential; and tial training in addition to the above (B) Not disclosed or reported without training requirements. the employee's express written consent (A) The employer shall assure that to any person within or outside the employees demonstrate proficiency in workplace except as required by this standard microbiological practices and section or as may be required by law. techniques and in the practices and op- (iv) The employer shall maintain the erations specific to the facility before records required by paragraph(h)for at being allowed to work with HIV or least the duration of employment plus HBV. 30 years in accordance with 29 CFR (B) The employer shall assure that 1910.1020. employees have prior experience in the (2) Training Records. (i) Training handling of human pathogens or tissue records shall include the following in- cultures before working with HIV or formation: HBV. (A) The dates of the training ses- (C) The employer shall provide a sions; training program to employees who (B)The contents or a summary of the have no prior experience in handling training sessions; human pathogens. Initial work activi- (C) The names and qualifications of ties shall not include the handling of persons conducting the training; and infectious agents. A progression of (D) The names and job titles of all work activities shall be assigned as persons attending the training ses- techniques are learned and proficiency sions. is developed. The employer shall assure (ii) Training records shall be main- that employees participate in work ac- tained for 3 years from the date on tivities involving infectious agents which the training occurred. only after proficiency has been dem- (3)Availability. (i) The employer shall onstrated. ensure that all records required to be 277 DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD §1910.1043 29 CFR Ch. XVII (7-1-10 Edition) maintained by this section shall be employee. The sharps injury log shall made available upon request to the As- contain, at a minimum: sistant Secretary and the Director for (A) The type and brand of device in- examination and copying. volved in the incident, (ii) Employee training records re- (B) The department or work area quired by this paragraph shall be pro- where the exposure incident occurred, vided upon request for examination and and copying to employees, to employee rep- (C) An explanation of how the inci- resentatives, to the Director, and to dent occurred. the Assistant Secretary. (ii) The requirement to establish and (iii) Employee medical records re- maintain a sharps injury log shall quired by this paragraph shall be pro- apply to any employer who is required vided upon request for examination and to maintain a log of occupational inju- copying to the subject employee, to ries and illnesses under 29 CFR 1904. anyone having written consent of the (iii) The sharps injury log shall be subject employee, to the Director, and maintained for the period required by to the Assistant Secretary in accord- 29 CFR 1904.6. ante with 29 CFR 1910.1020. (4) Transfer of Records. (i) The em- APPENDIX A TO SECTION 1910.1030—HEPATITIS ployer shall comply with the require- B VACCINE DECLINATION(MANDATORY) ments involving transfer of records set I understand that due to my occupational forth in 29 CFR 1910.1020(h). exposure to blood or other potentially infec- tious materials I may be at risk of acquiring hepatitis B virus (HBV) infection. I have ness and there is no successor employer been given the opportunity to be vaccinated to receive and retain the records for with hepatitis B vaccine,at no charge to my- the prescribed period, the employer self. However, I decline hepatitis B vaccina- shall notify the Director, at least three tion at this time. I understand that by de- months prior to their disposal and clining this vaccine, I continue to be at risk transmit them to the Director, if re- of acquiring hepatitis B, a serious disease. If quired by the Director to do so, within in the future I continue to have occupational that three month period. exposure to blood or other potentially infec- tious materials and I want to be vaccinated (i) Dates—(1) Effective Date. The with hepatitis B vaccine, I can receive the standard shall become effective on vaccination series at no charge to me. March 6, 1992. (2) The Exposure Control Plan re- F 12 7, A Dec. 6, 2; 5 F amended at 57 FR 12717, Apr. 13, 1992; 57 FR 29206, July 1, quired by paragraph (c) Of this Section 1992;61 FR 5508,Feb.13,1996;66 FR 5325,Jan. shall be completed on or before May 5, 18, 2001; 71 FR 16672, 16673, Apr. 3, 2006; 73 FR 1992. 75586,Dec.12,20081 (3) Paragraph (g)(2) Information and Training and (h) Recordkeeping shall §1910.1043 Cotton dust. take effect on or before June 4, 1992. (a) Scope and application. (1) This sec- (4) Paragraphs (d)(2) Engineering and tion, in its entirety, applies to the con- Work Practice Controls, (d)(3) Personal trol of employee exposure to cotton Protective Equipment, (d)(4) House- dust in all workplaces where employees keeping, (e) HIV and HBV Research engage in yarn manufacturing, engage Laboratories and Production Facili- in slashing and weaving operations, or ties, (f) Hepatitis B Vaccination and work in waste houses for textile oper- Post-Exposure Evaluation and Follow- ations. up, and (g) (1) Labels and Signs, shall (2) This section does not apply to the take effect July 6, 1992. handling or processing of woven or (5) Sharps injury log. (i) The employer knitted materials; to maritime oper- shall establish and maintain a sharps ations covered by 29 CFR Parts 1915 injury log for the recording of and 1918; to harvesting or ginning of percutaneous injuries from contami- cotton; or to the construction industry. nated sharps. The information in the (3) Only paragraphs (h) Medical sur- sharps injury log shall be recorded and veillance, (k)(2) through (4) Record- maintained in such manner as to pro- keeping—Medical Records, and Appen- tect the confidentiality of the injured dices B, C and D of this section apply 278