The cause of a community-wide hazardous material emergency may range from an industrial accident or unplanned release to a criminal or terrorist attack. Prior community planning for the response to emergencies involving hazardous substances is critical. No one is immune to the effects of contamination: Everyone at an industrial operation; The community emergency response elements; The by-passing general public; and The healthcare workers dealing with emergencies all may be exposed to chemical, biological, physical or radioactive hazards. Hospitals providing emergency response services must be prepared to carry out their community response missions without jeopardizing the safety and health of patients and their own workers. While medical EMS doctrine is to decontaminate at the scene of the incident, of special concern are the situations where contaminated patients arrive at the hospital for triage or definitive treatment following a major incident.
In many localities, hospitals have not been firmly integrated into the community disaster response system and may not be prepared to safely treat multiple casualties resulting from an incident involving hazardous substances. Without effective prior planning to integrate the hospital into emergency response plans, the effectiveness of the hospital's support to the community is at risk. As well, an increased awareness of the need to protect health care workers and understanding the principal considerations in emergency response planning will help reduce the risk of health care worker exposure to hazardous substances.
At the federal level, FEMA, OSHA and EPA have guidelines and regulations that have been developed with the aim to help protect the public and workers during hazardous material emergency operations. For example: EPA has established Title III of the Superfund Amendments and Reauthorization Act of 1986 (SARA) which requires each state to establish a State Emergency Response Commission (SERC) that designates and coordinates the activities of Local Emergency Planning Committees (LEPC). The LEPCs must develop a community emergency response plan (contingency plan) that contains emergency response methods and procedures to be followed by facility owners, police, hospitals, local emergency responders, and emergency medical personnel. The Environmental Protection Agency (EPA) generates these requirements and ensures that states implement emergency response planning programs. FEMA has published an Emergency Management Guide for Business and Industry, which integrates SERC and LEPC structure into an emergency preparedness and response methodology for private industry and provides a step-by-step approach to community emergency planning, response and recovery.
In planning for emergencies, LEPCs must designate a local hospital that has agreed to accept and treat victims of emergency incidents. The designated local hospital, which should have a representative participate in the LEPC or SERC, becomes part of the community emergency response organization. SARA also directed the Occupational Safety and Health Administration (OSHA) to establish a comprehensive rule to protect employee health and safety during hazardous waste operations, including emergency responses to the release of hazardous substances. Accordingly, OSHA published the Hazardous Waste Operations and Emergency Response (HAZWOPER) Standard, Title 29, Code of Federal Regulations (CFR) 1910.120, which became effective in 1990.
