Implementing a Implementing a Respiratory Protection Program: Respiratory Protection Program:

A Guide for EMS and Other A Guide for EMS and Other Health Care ProvidersHealth Care Providers

VT Department of HealthVT Department of HealthEmergency Medical Services OfficeEmergency Medical Services Office

June 2009June 2009

IntroductionIntroduction

Before an employer can expect its Before an employer can expect its employees to use respiratory protection, employees to use respiratory protection, OSHA requires several stepsOSHA requires several steps

The VT Dept of Health does not enforce The VT Dept of Health does not enforce OSHA rules, but is providing materials to OSHA rules, but is providing materials to assist agencies in protecting their assist agencies in protecting their personnelpersonnel

IntroductionIntroduction

The Vermont Dept of Health (VDH) is The Vermont Dept of Health (VDH) is providing this document for agency providing this document for agency officials (director, chief, training officer, officials (director, chief, training officer, infection control officer, etc.) to inform infection control officer, etc.) to inform them of what OSHA requires when an them of what OSHA requires when an agency implements respiratory protection agency implements respiratory protection for its employeesfor its employeesA separate package includes materials for A separate package includes materials for training employeestraining employees

IntroductionIntroduction

The model respiratory protection program The model respiratory protection program (RPP) from VDH should be suitable for an (RPP) from VDH should be suitable for an agency using disposable N95 respiratorsagency using disposable N95 respirators

If an agency wishes to use respirators that If an agency wishes to use respirators that are not disposable or are beyond N95, the are not disposable or are beyond N95, the agency must create its agency must create its ownown RPP in RPP in accordance with OSHA’s requirements accordance with OSHA’s requirements

IntroductionIntroduction

THE VDH MODEL RESPIRATORY THE VDH MODEL RESPIRATORY PROTECTION PROGRAM IS PROTECTION PROGRAM IS

INTENDED ONLY FOR AGENCIES INTENDED ONLY FOR AGENCIES USING USING DISPOSABLE N95DISPOSABLE N95

RESPIRATORSRESPIRATORS

Respiratory Protection ProgramRespiratory Protection Program

Respiratory Protection Program

Medical Evaluation

Training

Fit Testing

Storage, Maintenance, Evaluation, Annual retraining and fit testing,

Triennial medical evaluation

These are the steps for an agency to implement respiratory protection

Respiratory Protection ProgramRespiratory Protection Program

Download the model respiratory protection Download the model respiratory protection program (RPP) from VT EMS program (RPP) from VT EMS (www.vermontems.org)(www.vermontems.org)Read the documentRead the documentInsert the name of your agency in the Insert the name of your agency in the appropriate blanksappropriate blanksFill in the other blanks Fill in the other blanks Modify your agency’s procedures to agree Modify your agency’s procedures to agree with the planwith the plan

Medical EvaluationMedical Evaluation

Determine which physician or licensed Determine which physician or licensed health care professional (PLHCP) will health care professional (PLHCP) will evaluate and screen your employeesevaluate and screen your employees– May be RN, PA, MD, DOMay be RN, PA, MD, DO– May not be EMT, paramedic, chiropractor, May not be EMT, paramedic, chiropractor,

acupuncturist, naturopathacupuncturist, naturopath– There is to be no cost to the employeeThere is to be no cost to the employee– If the PLHCP asks you how to screen people, If the PLHCP asks you how to screen people,

you should probably look for another PLHCPyou should probably look for another PLHCP

Medical EvaluationMedical Evaluation

Provide the PLHCP with a copy of: Provide the PLHCP with a copy of: – OSHA’s respiratory protection standard OSHA’s respiratory protection standard

[1910.134 (e)][1910.134 (e)]– Your agency’s respiratory protection programYour agency’s respiratory protection program

Distribute medical questionnaire to Distribute medical questionnaire to employees and allow them to complete it employees and allow them to complete it at workat work

Medical EvaluationMedical Evaluation

DO NOT collect the forms -- they have DO NOT collect the forms -- they have confidential informationconfidential information

You must provide a means of getting the You must provide a means of getting the forms to the PLHCP at no charge to the forms to the PLHCP at no charge to the employee, e.g., envelope with postageemployee, e.g., envelope with postage

Give the PLHCP copies of the form Give the PLHCP copies of the form ““Documentation of Medical Evaluation Documentation of Medical Evaluation for Disposable N95 Respirator Usefor Disposable N95 Respirator Use””

Medical EvaluationMedical Evaluation

The PLHCP evaluates the employee’s The PLHCP evaluates the employee’s responses on the questionnaire and if responses on the questionnaire and if necessary examines the employeenecessary examines the employee

The PLHCP completes the The PLHCP completes the ““Documentation of Medical Evaluation Documentation of Medical Evaluation for Disposable N95 Respirator Usefor Disposable N95 Respirator Use” (fit ” (fit test form) and gives the original to the test form) and gives the original to the employeeemployee

Medical EvaluationMedical Evaluation

The employee presents the completed fit The employee presents the completed fit test form (NOT the medical questionnaire) test form (NOT the medical questionnaire) to the employer to the employer BEFOREBEFORE being fit tested being fit tested

TrainingTraining

Before an employee can use an N95, the Before an employee can use an N95, the employee must receive trainingemployee must receive trainingAt the end of training, the employee must At the end of training, the employee must demonstrate knowledge ofdemonstrate knowledge of– Why the respirator is necessaryWhy the respirator is necessary– How improper fit or usage may be harmfulHow improper fit or usage may be harmful– The limitations and capabilities of the deviceThe limitations and capabilities of the device– How to use it in emergencies, including when How to use it in emergencies, including when

it malfunctionsit malfunctions

TrainingTraining

– How to inspect and use the respiratorHow to inspect and use the respirator– Procedures for maintenance and storageProcedures for maintenance and storage– How to recognize signs and symptoms that How to recognize signs and symptoms that

may limit or prevent the effective use of the may limit or prevent the effective use of the N95N95

– The general requirements of the OSHA ruleThe general requirements of the OSHA rule

TrainingTraining

Training must be repeated at least Training must be repeated at least annually and whenannually and when– Changes occur which make the previous Changes occur which make the previous

training obsolete, e.g., new model of N95training obsolete, e.g., new model of N95– It becomes apparent an employee does not It becomes apparent an employee does not

have the necessary knowledge or skillhave the necessary knowledge or skill– Retraining is necessary to ensure safe useRetraining is necessary to ensure safe use

Fit TestingFit Testing

Either qualitative or quantitative fit testing Either qualitative or quantitative fit testing is acceptableis acceptable

VDH has qualitative fit test kits available VDH has qualitative fit test kits available for agencies to borrowfor agencies to borrow

VDH will provide with the kitVDH will provide with the kit– Small number of N95s Small number of N95s – Saccharin or BitrexSaccharin or Bitrex®®

Post-ImplementationPost-Implementation

Storage and Maintenance

Annual retraining and fit testing

Triennial medical evaluation

Evaluation of program

Post-ImplementationPost-Implementation

Storage and Maintenance– Store N95s in accordance with the

manufacturer’s instructions so they will beKept dry, clean and in their original shape

Easily available when needed

– Disposable N95s do not require repair, but should be inspected periodically

Post-ImplementationPost-Implementation

Annual retraining and fit testing– Every year, review new developments and

other changes– Employees must demonstrate they still have

knowledge to use N95s safely– Obtain fit test kit from VDH and repeat fit

testing of all employees who may need to use N95

Post-ImplementationPost-Implementation

Triennial medical evaluation– Every 3 years, have each employee complete

another medical questionnaire and submit it to a PLHCP for review

– PLHCP examines any employee the PLHCP feels needs further evaluation

– PLHCP completes documentation of medical evaluation

Post-ImplementationPost-Implementation

Evaluation of program– RPP administrator regularly

Evaluates workplace and potential hazards

Consults employees to identify problems

ConclusionConclusion

A respiratory protection program must be in place before an agency requires employees to use N95 or other respirators

Consult OSHA’s rules on this subject (CFR 1910.134)

Act in the best interest of your patients and employees

ConclusionConclusion

For more information:– Vermont Dept of Health

Personal protective equipment: 802-951-0058

EMS: 800-244-0911 in VT and 802-863-7310

– Vermont Occupational Safety and HealthProject WORKSAFE: 888-723-3937

www.labor.vermont.gov/?tabid=74www.labor.vermont.gov/?tabid=74