Pre-Entry Medical Surveillance

[Robert Burke]

What do hazmat teams think about pre-entry medical surveillance at hazmat scenes and can they be theoretically eliminated? Is anyone aware of regulations or mandates that say we have to do these exams?

[ADSN/WFLD]

Look in 29 CFR 1910.120 If its law its in there somewhere.

Our Division Haz Mat team takes vitals prior to entering a suit, But i'm not sure if it's law or just our rule.

[Neen5029]

We also require medical monitoring pror to suiting... Depending on the type of incident, we also have SOP's that require either BLS or ALS standby. If we're doing a level A incident, we have at least 1 if not 2 medics on scene just in case anything goes wrong. In addition on most incidents, we have a rehab unit from one of the local ambulance companies respond to provide everything from plain rehab to BLS support if it's needed...

Hope that helps

Stay Safe

~~ Neen

[Petie]

There is nothing in Hazwoper (1910.120q) that says pre-entry medical exams have to be conducted. All it says is that advanced medical personnel have to stand by with transportation capability. Also, NFPA 471 and 472 do not have as recommendations anything that says pre-entry medicals should be conducted. While many people feel these exams are prudent many also feel that they are redundant and unneccessary in light of annual physical exams.

[hazmatemt]

Hi,
I'm on an industral hazmat team, and we currently do pre-entry checks. Having said that, we are looking into doing quartely checks instead. I think that it is hard to get a good base line on anyone who is getting ready to go swimming in chemicals. It's been a long time since we have had a person with lower vitals pre-entry than in rehab.
Also, I belive that our state requires at least BLS on scene prior to any entry, but I will have to check on that to be sure.
Hope this helps. Take care.

[HILLBILLY70]

I tried to reply to you, but I started a new thread by accident, so go there and see.

[phxfyr]

Pre- and post-entry medical surveillance is an essential component of firefighter/hazmat technician health and welfare. Although not specifically required under 1910.120, having a baseline set of vital signs is important in order to recognize the possible s/s of exposure, contamination, or plain old heat-related illness. In my opinion, pre-entry exams should remaina standard operating proceedure for all hazmat response organizations.

My department uses a H.M.R.T. - Entry Team Checklist. This includeds time, BP, pulse, Resp, and skin condition. The entry time is inducated as well as exit time, immediate vitals after exit and 5 minutes after exit. This form is kept in the incident file.

What has changed is the requirement to have a BP below 150/90 and pulse of not more than 120 prior to entry. A few firefighters may have vitals above this level due to then anticipation of making a hazardous level-A entry. The measurement now is the firefighters physical health and mental state (excitement). Paramedics and officers make the final subjective opinion on who is fit for entry based upon their experience and expertise.

I assert that pre-entry medical surveillance should remain a part of your organizations SOP's. It insures firefighter safety and health. What better reason to do it than that?

[Petie]

Good point Phoenix! But now comes the time critical event of a terrorist attack possibly using nerve agents. With several victims being observed doing the "funky chicken" are you going to go through your methodical pre-entry checks before you suit up in Level A to get in there and maybe save their lives. This is not meant to be inflammatory just a hypothetical situation that needs to be tought out or discussed before hand.
As a note, several departments have opted for other medical methods such as;
FDNY does medical checks of personnel in the morning each day for people who may have to suit up.
Fairfax Co FD does something called "fast tracking" when quick entries are required such as for a victim rescue or a terrorism event.
Last question and comment!
Doesn't an aggressive medical monitoring program help assure our personnel are medically fit for service? Finally, is there a more physically/medically demanding environment than working hard in turnout gear and scba at a structure fire? Do we stop to take vitals before we save the taxpayers in the structure on fire? Just some food for thought! What do you think?

[Tcashel]

There is nothing specific in any of the rules under 1910.120, 472, 473 or other regulations on Haz. Mat. Response about pre-entry physicals.

Therir use is strictly local jurisdiction. While may say they don't do pre-entry during fires and rightfully so due to the time factor (emergecny conditions) Entry by HM members into a site using PPE wil have an effect on the inidivdual. Heat stress is the number 1 issue any time and ever time you wear PPE. Heat stresss is the number 1 mode of injury to HM Team members. Pre-entry data will and does play an integral role in monitoring personnel during incidents and minimizing effects after the incident. Guidelines have been established by OSHA under 1910.120 for on site medical monitoring and rehab of personnel.

Monitoring of personnel BP, Weigh, Core temp, are essential to dermine their fitness to continue to work or even make an entry. While fitness for duty standards are long time in coming ino the fire service, they are coming. Haz. Mat. Work especially due to the nature of the work and degree of unknown or readily unknowns present.

In 1993-94 I developed a Pre/Post entry guideline for HM work. It does work. Thew bottom line it crew safety issue. Protect your people.

[phxfyr]

Petie:

You pose some interesting questions. When do we risk our members for saving lives? Should we forego the administrative elements in order to save time? How much time does it take to get a baseline set of vitals?

Rather than spend time in "what ifs" I thought I'd just reply with a reminder of my department's Risk Assessment Plan (your's is probably very similar):

1. We will begin our response on the assumption that we can protect lives and property.
2. We will risk our lives a lot, if necessary, to protect savable lives.
3. We will risk our lives a little, and in a calculated manner, to protect savable property.
4. We will not risk our lives at all to protect lives or property that are already lost.

Understanding this, I would measure what we have on scene, the possibility of patient survival, and the potential exposure risk to our members against this Risk Assessment tool. It is up to each incident commander, company officer, and hazardous materials technician to decide where we will operate in this framework.

Barring rescue concerns, I believe that the pre- and post-incident medical screening is an essential part of firefighter (and hazmat technician) safety and wellfare. It should not be skipped to save time on the typical incident.

[kbevan]

Be sure to familiarize yourself well with OSHA 1910.120 and EPA regulation on medical surveillance of hazmat and specifically entry team personnel (remember if OSHA does not cover you EPA does). There is specific information on this and should be reviewed and interpreted by qualified personnel within your department or government legal department.

This is one area you do not want to take forum advise from.

Always read QUIPS (Quick Interpretive Points) they are succinct excerpts from letters and memos, containing a single point of OSHA compliance or enforcement information. These always help with the final rule.

Good Luck.