Guide Occupational Strain and Efficacy in Human Service Workers: When the Rescuer Becomes the Victim

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Learn more Check out. Abstract Objective: To identify key workplace demands and resources for nurses working in very remote Australia and measure levels of occupational stress in this population. Setting: Health centres in very remote Australia.

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Occupational Strain and Efficacy in Human Service Workers

Old Password. New Password. Password Changed Successfully Your password has been changed. Returning user. Request Username Can't sign in? Forgot your username? Enter your email address below and we will send you your username. Hospitals should consider offering a basic level of training for other employees in the ED, such as housekeeping staff. This group could include those personnel who do not have a role in the decontamination process, reasonably would not be expected to encounter self-referred contaminated patients, and reasonably would not be expected to come in contact with contaminated victims, their belongings, equipment, or waste.

OSHA's Hazard Communication Standard offers a useful model for appropriate training, which could include general information on the hospital's emergency procedures and plans for mass casualty incidents involving contaminated victims, steps the employees can take to protect themselves usually by leaving the area , and the measures the hospital has implemented to protect employees in the ED. While not required under the OSH Act, such training could help to ensure that all staff in the ED understand what precautions and actions would and would not be expected of them if an incident occurred.

Table 4 summarizes OSHA's current guidance on training first receivers for mass casualty emergencies. References to related OSHA interpretation letters are included. Employees are categorized according to zone namely, Hospital Decontamination Zone and Post-decontamination Zone ; whether they have designated roles in the zone; and the likelihood of contact with contaminated victims, their belongings, equipment, or waste. Hospitals should note that the training levels presented are minimum training levels and can be increased or augmented, as appropriate, to better protect employees, other patients, and the facility in general.

All employees with designated roles in the Hospital Decontamination Zone O This group includes, but is not limited to:. Briefing at the time of the incident Q , R.

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Other employees whose role in the Hospital Decontamination Zone was not previously anticipated i. Training similar to that outlined in the Hazard Communication Standard S. Other personnel in the Hospital Post-decontamination Zone who reasonably would not be expected to encounter or come in contact with unannounced contaminated victims, their belongings, equipment, or waste. The following appendices provide references and examples, which might be useful to hospitals developing or upgrading emergency management plans EMPs.

This Appendix supplements the Best Practices from OSHA by providing useful background information on how various aspects of a hospital's preparation, response, and recovery impact employee protection during hazardous substance emergencies. Look in Appendix A for:. The following discussion provides examples of ways hospitals have attempted to enhance employee protection as part of general preparedness for mass casualty emergencies involving contaminated victims. However, statements in this appendix cannot create nor diminish obligations under the occupational safety and health OSH Act.

In making preparations, hospitals must consider key assumptions regarding communication, resources, and victims. When developing plans, hospitals should anticipate:. Administrators making preparations for mass casualty incidents should note that hospitals are part of the community's critical infrastructure and continuity of operations must be maintained.

The hospital emergency management plan EMP outlines how the facility will respond to an emergency. The plan should address the hazards the hospital will encounter, identify the hospital's role in the response, and serve as a road map for incident preparation, response, and recovery.

No organization can prepare fully for every conceivable emergency. To use resources effectively, a hospital requires information that will help emergency planners make informed decisions about the type, probability, severity, and impact of specific hazards to which the hospital might be subject. A hazard vulnerability analysis HVA assists a hospital in organizing this information, which is used to customize the hazard assessment for personal protective equipment PPE selection a critical aspect of the EMP.

The HVA and resulting preparations are only as specific to the individual hospital as the information on which preparation decisions are based. Important modifying factors include the hospital's role in the community, how up-to-date the hospital EMP is, and formal planning agreements between the hospital and other organizations that have roles in emergency response activities. With knowledge of these details, hospitals can customize EMPs and effectively tailor preparedness including employee protection to address the circumstances relevant to that hospital.

As noted previously, an HVA helps hospitals organize information and guide decision making. A thorough HVA can serve as the basis for informed decisions regarding the training and equipment employees will require to protect themselves under foreseeable emergency scenarios. The hospitals interviewed use variations of a few publicly available HVA formats.


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See Appendix F for examples of two formats additional examples are available from other sources. The tool is often slightly modified by the individual hospital to include additional information that the hospital finds helpful for making decisions or communicating with management. A popular HVA, an electronic spreadsheet, prompts the user to enter a numerical rating e.

JCAHO offers a matrix of threats that hospitals might consider. The user generates or the spreadsheet calculates a hazard vulnerability score based on the inputs. The inputs may be weighted to reflect the importance of certain information to the final score.

Hospitals use both the final score and the individual numerical rating inputs to identify and rank priority areas that should receive administrative attention or resources. Other hospitals use a tabular format HVA and more descriptive text input to guide the user through the analysis. The tables can provide more information, but are also more cumbersome for evaluating a large selection of threats.

Because these formats are more likely to have been developed in-house, they tend to be more diverse. None of the HVA formats have been validated to determine whether the inputs and final assessment accurately reflect hazard vulnerability. Nevertheless, an informal qualitative review conducted by the developer of one HVA spreadsheet tool suggested that independent users, when operating in similar hospital and community environments, do generally arrive at similar conclusions regarding vulnerability and priorities for improvement Saruwatari, By collaborating with Local Emergency Planning Committees LEPCs , hospitals can keep current with information on changes in threats in their localities.

As an example, Hospital D had rated "preparation for chlorine-related emergencies" as a top priority. When the local potable water facility changed processes, the threat of a large-scale chlorine emergency was eliminated from the community. Upon revising the HVA, Hospital D was able to redirect resources to address the next most urgent threat without waiting until the next annual review cycle. Characteristics of the community e.

This information should be considered in the HVA. These factors range from the number and condition of victims that the hospital might reasonably anticipate, to the rate at which hazard information could become available during an emergency. The community in which a hospital is located and the hospital's role in that community impact emergency preparations on several levels.

Hospital D's emergency manager suggested that the real objective of emergency planning is "community preparedness, and a hospital's preparedness represents only one component. Fully coordinated planning helps hospitals identify their roles in their communities. Roles vary considerably with individual circumstances, but ultimately have a strong impact on the conditions and hazards for which a hospital must plan employee protection.

Examples of roles some hospitals fill or expect to fill in their communities include:. The hospitals interviewed for this project also note that, in addition to a better coordinated community emergency response plan, they receive additional financial, informational, and business benefits from active participation in community-focused emergency preparedness and planning. The following list indicates benefits that hospitals can derive from an active role in community emergency preparedness:.

Additionally, during the periodic EMP evaluation, hospitals should review the regulations to ensure the plan continues to be compliant. Well-coordinated EMPs ensure that hospitals are aware of the capabilities of first responders and other hospitals, as well as what the local professional and response community expects from them. The following example demonstrates the value of coordinated EMPs.