060421
Brewster/EasCare Ambulance Service
Respiratory Protection Program
I. OBJECTIVE
The Brewster/EasCare Respiratory Protection Program is designed to protect employees by establishing accepted practices for respirator use, providing guidelines for training and respirator selection, and explaining proper storage, use and care of respirators. This program also serves to help the employer and its employees comply with Occupational Safety and Health Administration (OSHA) respiratory protection requirements as found in 29 CFR 1910.134.
II. ASSIGNMENT OF RESPONSIBILITY
A. Employer
Brewster/EasCare Ambulance Service is responsible for providing respirators to employees when they are necessary for health protection. Brewster/EasCare will provide respirators that are applicable and suitable for the intended purpose at no charge to affected employees. Any expense associated with training and respiratory protection equipment will be borne by the company.
B. Program Administrator
The Chief Clinical Officer will serve as the Respiratory Protection Program Administrator. The Program Administrator, in close coordination with the Director of Purchasing, is responsible for administering the respiratory protection program. Duties of the program administrator include:
1. Identifying work areas, process or tasks that require workers to wear respirators.
2. Evaluating hazards.
3. Selecting respiratory protection options.
4. Monitoring respirator use to ensure that respirators are used in accordance with their specifications.
5. Ensuring proper storage and maintenance of respiratory protection equipment.
6. Evaluating the program.
7. Updating written program, as needed.
C. Training and Fit-Testing
The Director of Training and Education is responsible for ensuring new employees requiring respirators are properly trained and fit-tested, and for the ongoing training and testing of incumbent employees as required. Duties of the Director of Education include:
1. Arranging for and/or conducting training
2. Conducting qualitative fit testing
3. Maintaining records required by the program
D. Supervisors
Supervisors are responsible for ensuring that the respiratory protection program is implemented in their particular areas. In addition to being knowledgeable about the program requirements for their own protection, supervisors must also ensure that the program is understood and followed by the employees under their charge. Duties of the supervisor include:
1. Ensuring the availability of appropriate respirators and accessories.
2. Being aware of tasks requiring the use of respiratory protection.
3. Enforcing the proper use of respiratory protection when necessary.
4. Ensuring that respirators are properly cleaned, maintained, and stored according to this program.
5. Continually monitoring work areas and operations to identify potential respiratory hazards.
6. Coordinating with the Program Administrator on how to address respiratory hazards or other concerns regarding this program.
E. Employees
Each employee is responsible for wearing his or her respirator when and where required and in the manner in which they are trained. Employees must also:
1. Care for and maintain their respirators as instructed, guard them against damage, and store them in a clean, sanitary location.
2. Inform their supervisor if their respirator no longer fits well, and request a new one that fits properly.
3. Inform their supervisor or the Program Administrator of any respiratory hazards that they feel are not adequately addressed in the workplace and of any other concerns that they have regarding this program.
4. Use the respiratory protection in accordance with the manufacturer’s instructions and the training received.
III. APPLICABILITY and TRAINING PORTABILITY
This program applies to all employees who are required to wear respirators during normal work operations, as well as during some non-routine operations.
Brewster/EasCare Ambulance Service recognizes that many of our employees work for Fire Services or other departments with similar Respiratory Protection Programs and training requirements. Through “training portability”, Brewster/EasCare Ambulance Service is permitted to accept basic respirator training that an employee has received from an outside party within the last 12 months.
The performance nature of the standard allows employers to forego retraining employees who have been previously trained by another employer as long as they can demonstrate the knowledge and skills needed to use the respirator correctly.
In addition, any employee who voluntarily wears a half mask air purifying respirator (APR) when one is not required is subject to the medical evaluation, cleaning, maintenance, and storage elements of this program, and will be provided with necessary training. Employees who voluntarily wear filtering face pieces (dust masks) are not subject to the medical evaluation, cleaning, storage, and maintenance provisions of this program.
IV. PROGRAM
A. Hazard Assessment and Respirator Selection
The Program Administrator, in close coordination with the Director of Purchasing, will select respirators to be used on site, based on availability and the hazards to which workers are potentially exposed and in accordance with the OSHA Respiratory Protection Standard. The Program Administrator will conduct a hazard evaluation for each operation, process, or work area to determine which tasks may expose staff to airborne infectious agents or other airborne hazards.
An N-95 filtering facepiece respirator (FFR) is designed to reduce a worker’s exposure to airborne contaminants. A proper seal between the user’s face and the respirator forces the inhaled air though the respirator’s filter material and not through gaps between the face and respirator. This removes particles from the air that are breathed though it. An N-95 is a particulate respirator. These respirators filter out at least 95% of very small (0.3 microns) particles. N-95 FFR are capable of filtering out all types of particles, including bacteria and viruses. EMS personnel who may come into close contact with a patient suspected of having a communicable disease should utilize a fit-tested N-95 respirator. N-95 respirators or respirators that offer an equivalent or higher level of protection shall be used by clinical personnel (EMTs, Paramedics) instead of a facemask when performing or present for an aerosol generating procedure in accordance with CDC or OEMS guidance.
An N-95 Respirator will be used by Fleet Maintenance personnel when exposed to particles such as those from grinding, sanding, welding, and whenever ventilation controls and work practices are not adequate to reduce exposures for particulates or chemicals. Properly trained personnel will utilize a double bib Tyvek hood breathing air blower respirator system when operating in the paint booth.
B. Updating the Hazard Assessment
The Program Administrator must revise and update the hazard assessment as needed. If an employee feels that respiratory protection is needed during a particular activity, he/she is to contact his/her supervisor or the Program Administrator. The Program Administrator will evaluate the potential hazard, and arrange for outside assistance as necessary. The Program Administrator will then communicate the results of that assessment to the employees. If it is determined that respiratory protection is necessary, all other elements of the respiratory protection program will be in effect for those tasks, and the respiratory program will be updated accordingly.
C. Training
The Director of Training and Education will arrange for training to respirator users and their supervisors on the contents of the Brewster/EasCare Ambulance Service Respiratory Protection Program and their responsibilities under it, and on the OSHA Respiratory Protection Standard. All affected employees and their supervisors will be trained prior to using a respirator in the workplace.
The training course will cover the following topics:
1. The Brewster/EasCare Ambulance Service Respiratory Protection Program;
2. the OSHA Respiratory Protection Standard (29 CFR 1910.134);
3. respiratory hazards encountered at the Company and their health affects;
4. proper selection and use of respirators;
5. limitations of respirators;
6. respirator donning and user seal (fit) checks;
7. fit testing;
8. maintenance and storage; and
9. medical signs and symptoms limiting the effective use of respirators.
Employees will be retrained at least annually. Respirator training will be documented by the Director of Training and Education or designee. The documentation will include the type, model, and size of respirator for which each employee has been trained and fit tested.
D. NIOSH Certification
All respirators must be certified by the National Institute for Occupational Safety and Health (NIOSH) and shall be used in accordance with the terms of that certification. Also, when applicable, all filters, cartridges, and canisters must be labeled with the appropriate NIOSH approval label. The label must not be removed or defaced while the respirator is in use.
E. Voluntary Respirator Use
The Program Administrator may authorize voluntary use of respiratory protective equipment as requested by other workers on a case-by-case basis, depending on specific workplace conditions and the results of medical evaluations.
The Program Administrator will provide all employees who voluntarily choose to wear the above respirators with a copy of Appendix D of the OSHA Respiratory Protection Standard. (Appendix D details the requirements for voluntary use of respirators by employees.) Employees must comply with the procedures for Medical Evaluation, Respirator Use, Cleaning, Maintenance and Storage portions of this program.
F. Medical Evaluation
Employees who are either required to wear respirators, or who choose to wear a respirator voluntarily, must pass a medical exam provided by a Physician or other Licensed Health Care Professional (PLHCP) before being permitted to wear a respirator on the job. Employees are not permitted to wear respirators until a physician has determined that they are medically able to do so. Any employee refusing the medical evaluation will not be allowed to work in an area requiring respirator use.
Medical evaluation procedures are as follows:
1. The medical evaluation will be conducted during new employee orientation using the questionnaire provided in Appendix C of the OSHA Respiratory Protection Standard.
2. The Chief Medical Officer (CMO) or other licensed health care professional will review the questionnaire and follow-up with the employee as necessary to determine if the employee can wear a respirator safely. If so, the CMO or licensed health care professional will provide a written recommendation to the employer clearing the employee for respirator use.
3. After an employee has received clearance to wear his or her respirator, additional medical evaluations (either by the employee’s personal physician, or a Company-designated physician/licensed health care professional for determining fitness for duty) will be provided under the following circumstances:
a. The employee reports signs and/or symptoms related to their ability to use the respirator, such as shortness of breath, dizziness, chest pains or wheezing.
b. The evaluating Physician/Licensed Health Care provider or supervisor informs the Program Administrator that the employee needs to be reevaluated.
c. Information found during the implementation of this program, including observations made during the fit testing and program evaluation, indicates a need for reevaluation.
d. A change occurs in workplace conditions that may result in an increased physiological burden on the employee.
All examinations and questionnaires are to remain confidential between the employee and the physician. The employer will only retain the physician’s written recommendations regarding each employee’s ability to wear a respirator.
G. Fit Testing
Employees who are required to wear tight fitting air purifying respirators will be fit tested:
1. Prior to being allowed to wear any respirator with a tight-fitting face piece;
2. Annually; or
3. When there are changes in the employee’s physical condition that could affect respiratory fit (e.g., obvious change in body weight, facial scarring, etc.).
Employees will be fit tested with the make, model, and size of respirator that they will actually wear. The Director of Training and Education will oversee fit tests in accordance with the OSHA Respiratory Protection Standard. N-95 respirators will be fit tested with a qualitative fit test protocol using an aerosol solution or either saccharin or Bitrex®. Other tight fitting face pieces will be fitted with one of the protocols outlined in Appendix A of 1910.134.
H. General Respirator Use Procedures
1. Employees will use their respirators under conditions specified in this program, and in accordance with the training they receive on the use of each particular model. In addition, the respirator shall not be used in a manner for which it is not certified by NIOSH or by its manufacturer.
2. Employees are not permitted to wear tight-fitting respirators if they have any condition, such as facial scars, facial hair, or missing dentures, which would prevent a proper seal. When using a respirator, employees are not permitted to wear jewelry or other items that may interfere with the seal between the face and the face piece.
I. Change Schedules
When applicable, respirator cartridges shall be replaced as determined by the Program Administrator, supervisor(s), and manufacturers’ recommendations.
J. Cleaning
N-95 Respirators will be disposed of after use if worn in the presence of an individual who has a disease that could be transmitted person to person via an airborne route of exposure, or in accordance with current CDC guidance.
Non-disposable respirators (such as PAPRs) are to be regularly cleaned and disinfected. Respirators issued for the exclusive use of an individual employee shall be cleaned as often as necessary.
The following procedure is to be used when cleaning and disinfecting reusable respirators:
1. Disassemble respirator, removing any filters, canisters, or cartridges.
2. Wash the face piece and all associated parts (except cartridges and elastic headbands) in an approved cleaner-disinfectant solution in warm water (about 120 degrees Fahrenheit). Do not use organic solvents. Use a hand brush to remove dirt.
3. Rinse completely in clean, warm water.
4. Disinfect all facial contact areas by spraying the respirator with an approved disinfectant.
5. Air dry in a clean area.
6. Reassemble the respirator and replace any defective parts. Insert new filters or cartridges and make sure the seal is tight.
7. Place respirator in a clean, dry plastic bag or other airtight container.
The Director of Purchasing will ensure an adequate supply of appropriate cleaning and disinfection materials at the workplace. If supplies are low, employees should use the established process to request resupply.
K. Maintenance
Respirators are to be properly maintained at all times in order to ensure that they function properly and protect employees adequately. Maintenance involves a thorough visual inspection for cleanliness and defects. Worn or deteriorated parts will be replaced prior to use. No components will be replaced or repairs made beyond those recommended by the manufacturer. All respirators shall be inspected routinely before and after each use.
L. Storage
After inspection, cleaning, and necessary repairs, respirators shall be stored appropriately to protect against dust, sunlight, heat, extreme cold, excessive moisture, or damaging chemicals.
M. Respirator Malfunctions and Defects
Respirators that are defective or have defective parts shall be taken out of service immediately.
N. Program Evaluation
The Program Administrator will conduct periodic evaluations of the workplace to ensure that the provisions of this program are being implemented. The evaluations will include regular consultations with employees who use respirators and their supervisors, site inspections, and a review of records.
O. Documentation and Recordkeeping
1. A copy of the OSHA Respiratory Protection Standard shall be kept in the Program Administrator’s office and made available to all employees who wish to review it.
2. Copies of training and fit test records shall be maintained by the Director of Training and Education. These records will be updated as new employees are trained, as existing employees receive refresher training, and as new fit tests are conducted
3. The Director of Human Resources shall maintain copies of the physician’s written recommendation regarding each employee’s ability to wear a respirator.