When, how, where do you do baseline monitoring

Here is the question at hand. When, how often do you do your baseline monitoring and where do you document this information if you are not doing it immediately prior to entry?

We are discussing this issue at work right now, because reaility is when you need to suit up, that is not the right time to take all your vitals. They are going to be high even before you go in.

At our work we all carry badges at work for access into our buildings. The responders all carry a second badge with printed information on it. One of our thoughts is to have printed on the back of that card, a series of numbers. If you knew what you were looking for, you would understand that it was your pulse, B/P and weight.

One of the main concerns by people is whether or not this would be construed as a HIPPA violation.

In some of my classes, I remember some folks talking about how they took vitals once a month, or every six months or some were every day. We discussed what OSHA meant by 'prior to entry' and my classes agreed that you could take your vitals way prior to entry and still meet OSHA requirements.

Thanks!
Anthony

Bump! Anyone wanna share how they do it in their department?

Thanks!
Anthony

You would be hard pressed to find any requirement in 1910.120q (Hazwoper) that says pre-entry medical exams have to be conducted. In fact, all it says is that ALS medical personnel have to stand by with transportation capabilities. Even NFPA 471 & 472 do not have suggestions as to When, where and how often baseline surveys should be performed. While many people feel these surveys are important, many also feel that they are unnecessary paperwork in the hazmat cog of documentation. Especially in light of the required annual physical exams for hazmat team members.

Even with that said, I would suggest that on-scene pre-entry medical surveys be a Standard Operating Procedure for all hazmat teams. Having a baseline set of vital signs prior to entry is important in order to recognize the possible health issues, signs & symptoms of exposure, contamination issues, or heat-related illness. Pre-entry Medical baselines only take 5 minutes. Yes some people may feel a little anxiety just before being zipped up in a level “A” suit, but that has to be factored in when establishing on scene baselines. Some HM teams do a baseline every morning when reporting for work.

We use a "Medical Survey Checklist" prior to entry. It list individual team member's baseline vitals; B/P, pulse, resp. temp, and if time permitting a baseline heart rhythm to establish trending. This Medical Survey Checklist stays with the HM Medical Group Officer until such time the team member exit the hot zone. Then vitals are taken again immediately after decon and then again 5-15 minutes after that. If the team member has to be transported to the hospital, the medical survey goes with him or her and is used to assist with their emergency treatment. Once the incident is over, the form is place in the employee's file along with a copy of the incident report for the rest of the employee's career and eight years beyond that.

As for the HIPPA concern our Fire dept. has strict privacy policies that limit access to medical information and personnel file sharing.

Firefighter/HM Tech. safety and health are paramount at all Hazmat incidents. With the increased rate of heart attacks and associated heart related deaths in our profession, it only makes sense to perform on scene pre-entry medical baselines. Why take a chance?

I hope this helps, Stay safe

Capt

I am not advocating to NOT take baselines. Completely the opposite as I want them done more than they are now.

The team here is completely voluntary. We all work for one private company to make the almighty dollar; and some of our bosses allow us a "limited" amount of time to respond to event here on site. So, what we are trying to do is shorten some of our on scene times.

I know OSHA/NFPA require that we take a baseline--it does not say anywhere in the regs when that baseline has to be taken. A couple of us are trying to write a policy so that baseines are taken, recorded and available when needed.

We are looking at taking them every month and attaching these 'labels' to our work badges. If you don't have a current 'label', you are not eligible to suit up/or we take the baseline then. The biggest concern people had was regarding HIPPA and would not be a violation. I don't think it would as this information is needed to perform the job. In addition, we have strict policies in place that don't allow you to share this information with others.

Thanks for the info!

Anthony

Sounds like you need a card like I get at my local oil change shop. When I first pulled my car in to the shop, a guy came out and collected all my pertinent info; name, address, make, model, year, type of oil ect. He put this info into the computer and then took a plastic card with a magnectic strip on the back and swiped through a card reader/writer machine. The card then had all that info emmebed onto that magnectic strip.

I'm sure you could utilize the same principal with a little investment into a laptop, software and a card reader/writer.

Then all you have to do is show up, swipe your card through the supervisor's laptop and go to work.

You keep the card with all the info with you and no one else can read it if you lose it or leave it laying around. As far as HIPPA is concern, if you don't want someone seeing your baseline information, then don't show up to work.

I think you may onto a good idea here. Keep us posted on your outcome. Hell who knows you may even market it, charge an arm and a leg for it and get rich! HA HA!

Be Safe!

John

John

I like the idea of a magnetic card!! ... I need to seriously look into that.

Any ideas of where to start ... I have a meeting on Monday and must make the proposal then.

Thanks!
Anthony

Anthony,


As a member of a regional hazmat team in Tallahassee, FL. All team members get their baseline vitals done at the beginning of the shift. Then when we are called out on a call prior to going in on a recon just after arrival we all get them taken again to make sure we are still within our limits. We have limits set for blood pressure, heart rate, temp, etc. and being a paramedic on the team we are required by our department to do 12-lead EKG on team members with they are above the limits.



Jody

On our team we just to a complete vital check before you enter the suit... however some talk has been to have them checked once a week. These include BP, Pulse, Respirations, and if time permits an EKG. Also as part of the State/Federal requirement all Hazmat Techs need to complete their yearly physical, and what a physical it is.

The argument that medical monitoring just prior to suit entry is unneeded is an extremely dangerous one. While vital signs may be slightly elevated just prior to an entry we really are not using this monitoring to establish a baseline. Typically baseline vitals are established at the time of physicals and or weekly / monthly v/s monitoring. The real purpose of the pre-entry monitoring is to evaluate the entrant to make sure they are in condition to make entry. That is, while their baseline v/s may normally be very good, today they have a virus their body is fighting and their current b/p is 180/100. I would seriously look at this person and their ability to make a safe entry.

Chris DePaola, CHMM

I would be glad to share forms for vitals/medicals. As a side note if some one goes DOWN down-range, you have their baseline vitals. NFPA 471 states vitals are at least one hour before entry. Prior to 1910.120 the 4 agency book referenced vitals for heat stress monitoring while in suits.....