01.13.24, Rev. 0, Page 2 of 17
/ Volume 1Environmental, Health, and Safety Standards
Emergency Response Team Medical Evaluation / 01.13.24
Revision 0
March 2003
Page 1 of 17
1. PURPOSE
To define fitness for duty and medical surveillance requirements for personnel who respond to actual or potential AirProducts and Chemicals, Inc. chemical releases, fire situations or medical emergencies. These requirements do not replace procedures in place for other processes that have medical surveillance programs.
2. SCOPE
The medical surveillance program must be instituted for Hazardous Materials (HazMat) Technicians, Hazardous Materials (HazMat) Specialists, Fire Brigade Members, Emergency Medical Service (EMS) personnel, Confined Space Rescue personnel and Hazardous Materials and Waste Operations and Emergency Response (HAZWOPER) Level employees who are required to respond to chemical releases, fire situations or medical emergencies. Vehicle recovery team members and Emergency Coordinator/Administrators do not require any medical evaluation.
3. SUMMARY
Each member of an emergency response team must receive the specified baseline medical evaluation prior to initial assignment as an emergency responder. (4.1.1)
Each member of an emergency team must have the specified medical evaluation at intervals not to exceed every 24 months. (4.1.1)
Medical evaluations must include a medical and a work history with emphasis related to the handling of hazardous material. (4.2.1)
Medical evaluations must include assessment of the ability to wear any required personal protective equipment (PPE). (4.2.21)
Medical evaluations and procedures must be performed by a licensed physician, or by a medical practitioner who is or under the supervision of a licensed physician, who has knowledgeable in occupational medicine. (4.3.1)
The employee must provide the medical practitioner with all forms necessary to complete the evaluation (4.4)
The Physician's/Medical Practitioner's Written Opinion (Form 5585) is kept in the employee file at the facility. This form is the medical practitioner’s statement that the employee is cleared to be a member of an emergency response team. No medical records are kept in the employee file. (4.5)
Medical records must be retained for 40 years from the end of employment. (4.7.2)
4. ROLES AND RESPONSIBILITIES
It is the responsibility of the site manager or team leader to ensure that all medical evaluations are performed in a timely manner and to track which employees have been determined to be fit for emergency response duties.
It is the responsibility of the site manager to select the medical practitioner, with assistance from the Corporate Medical DepartmentGlobal Health and Wellness if needed.
It is the responsibility of the emergency response team member to report any injuries or illnesses related to hazardous exposures, e.g., above permissible exposure limits without personal protective equipment (PPE), to the site manager or team leader so that a medical evaluation can be provided.
It is the responsibility of the site manager to provide this standard practice and forms to the employee to take to the medical practitioner.
In the United States, the medical practitioner must return the evaluation information to the Corporate Medical DepartmentGlobal Health and Wellness, or where applicable, to the onsite Air Products’ medical department.
In non-United States locations, it is the site manager's responsibility to ensure that the medical records are maintained at the offsite medical facility or as required by local regulation. Only the Physician's/Medical Practitioner's Written Opinion (form 5585) is stored in the employee's files. Therefore, mMedical information including diagnosis, symptoms, treatment and examination results is not kept in the employee file.
4.1 Frequency of Medical Evaluations
4.1.1 Initial and Periodic Medical Evaluations
A baseline medical evaluation is required prior to assignment of an employee becoming an emergency response team member.
If the employee has had an Air Products preplacement evaluation meeting all the requirements of an emergency response medical evaluation within 24 months of assignment to an emergency responders team, the preplacement evaluation may be used as a baseline clearance evaluation at the discretion of the country supervisory occupational medical practitioner (outside the U.S.) or the Corporate Medical DepartmentGlobal Health and Wellness.
After the baseline evaluation, the employee must undergo a periodic medical evaluation at intervals not to exceed every 24 months.
At termination of employment or resignation from an emergency response team.
When the company is notified by the employee that he has developed signs or symptoms indicating possible overexposure to hazardous substances or health hazards.
When the employee has been injured during an emergency response.
If the employee has a significant change in health status, e.g., heart attack or newly diagnosed diabetes.
When the employee has been over exposed to hazardous substances (at concentrations above the permissible exposure limits or the published exposure levels) during an emergency incident without the necessary PPE being used, or with the PPE used ineffectively.
At more frequent intervals if the medical practitioner determines that an increased frequency of evaluations is necessary for medical reasons.
4.2 Content of Medical Evaluations
Medical evaluations must include a medical and work history with special emphasis on:
1) conditions related to the handling of hazardous materials,
2) fitness for duty, including the ability to wear required PPE, tolerate temperature extremes and perform the physical work required
4.2.1 Medical and Work History
The employee must complete the Periodic Medical Health History – form 4093 (Attachment 5) and the Health History Questionnaire for Respirator Users and Emergency Responders – form 4086 (Attachment 6).
The employee or facility manager must complete the top section of the Physician’s/Medical Practitioner’s Written Opinion - form 5585 (Attachment 3) and the top section of the Emergency Responder Medical Evaluation Record -form 5584-1 (Attachment 4) prior to the medical evaluation.
The employee must discuss with the medical practitioner any concerns of inability to perform emergency response duties.
4.2.2 Fitness for Duty
An evaluation of fitness for duty must be included in the medical evaluation. Fitness for dutyThe evaluation must includes clinical judgment regarding the employee’s the ability to don and wear PPE, including a respirator, and to work under conditions, e.g., temperature extremes and physical demands that may be expected during an emergency response.
The medical practitioner must perform the medical evaluation as specified by the Medical Evaluation Content requirements (Attachment 2) of this standard.
The medical practitioner must complete the forms specified by this standard:
Physician's/Medical Practitioner's Written Opinion - form 5585 (Attachment 3)
Emergency Responder Medical Evaluation Record - form 5584-1 (Attachment 4)
The medical practitioner and the employee must discuss and document any concerns related to:
Periodic Medical Health History - form 4093 (Attachment 5)
Health History Questionnaire for Respirator Users and Emergency Responders - form 4086 (Attachment 6)
Worst Case Scenario - only required for HazMat Technicians and HazMat Specialists (Attachment 7)
The Eemployee must self-report or the supervisor must express concerns of any inability to perform emergency response duties.
4.2.3 Information Provided to the Employee
The medical practitioner will discuss the results and findings of all parts of the evaluation with the employee.
4.3 Evaluation by a Medical Practitioner and Costs of the Evaluation
4.3.1 Medical Practitioner Qualifications
All medical evaluations and procedures must be performed by a licensed physician, or under the supervision of a licensed physician knowledgeable in occupational medicine. Medical practitioners who may perform the evaluations include Nurse Practitioners, Physician Assistants, or those properly licensed to do so as outlined in the EH&S Compliance Specification; Qualifications of Occupational Health Professional Retained by AirProducts and Chemicals, Inc. (2.EHS.02.13.09.WW)
In the United States, the Corporate Medical Global Health and Wellness Director is considered the supervisory licensed medical practitioner. In non-United States locations, a regional supervisory licensed occupational medical practitioner will be identified by Air Products.
The medical practitioner will determine the employee's medical clearance status, subject to review and final approval by the Corporate Medical Global Health and Wellness Director or Air Products supervisory licensed occupational medical practitioner.
4.3.2 Cost and Accessibility of Medical Evaluations
The medical evaluation must be provided to the employee without cost or loss of pay during the normal workday. The Air Products’ facility where the employee works is responsible for the cost of the medical evaluation.
4.4 Information Supplied to the Medical Practitioner
The medical practitioner must be provided with:
Letter to the Medical Practitioner (Attachment 1),
a copy of this standard and all related forms (Attachments 2, 3, 4, 5, 6, 7)
a description of the employee's duties including physical requirements and potential for hazardous exposures
a description of any personal protective equipment used or to be used
in the United States, a copy of OSHA Regulations Standard - 29 CFR 1910.120 Hazardous Waste Operations and Emergency Response
The medical practitioner must perform the medical evaluation as specified by this standard. (Attachment 2) Contact the Corporate Medical Department if assistance is needed.
The site manager or employee must complete the appropriate section of the Physician's/Medical Practitioner's Written Opinion (form 5585) and Emergency Responder Medical Evaluation Record (form 5584-1) prior to the medical evaluation. (Attachments 3 and 4)
4.5 Physician's/Medical Practitioner's Written Opinion
4.5.1 Contents of the Physician's/Medical Practitioner's Written Opinion (Fform 5585)
This form contains the following information:
The medical practitioner’s opinion as to whether the employee has any medical conditions that would place the employee at increased risk of an adverse health outcome from performing an emergency response or from wearing PPE.
The medical practitioner’s recommended work restrictions.
A statement that the employee has been informed by the medical practitioner of the results of the medical evaluation and any medical conditions that may require further evaluation or treatment.
The site manager must furnish a copy of this form to the employee if so requested.
The Physician's/Medical Practitioner’s Written Opinion must not reveal specific findings or diagnoses unrelated to occupational exposures.
4.6 Tasks Requiring Respirators
Persons should not be assigned to tasks requiring respirators, including air supplied respirators, unless it has been determined that they are physically able to perform the work and use the equipment. All sites must comply with the global EH&S standard Respiratory Protection - 01.13.10.
4.7 Record Keeping
4.7.1 Record Filing Process
Within the United States, the site manager is responsible for assuring that all medical records are directed from the medical practitioner to the Corporate Medical Department Global Health and Wellness, or where applicable, to the onsite Air Products medical department. In non-United States locations, it is the site manager's responsibility to ensure that medical records are maintained with the medical practitioner or according to global EH&S standard Management of Medical Records – 2.EHS.02.10.01.WW.
The facility retaining medical records of the medical evaluations will, when requested, and with employee written permission, provide the medical practitioner with information from previous medical evaluations of the employee. In addition, the medical practitioner is responsible for furnishing the Corporate Medical Department Global Health and Wellness with the evaluation results and a copy of the Physician's/Medical Practitioner's Written Opinion.
4.7.2 Required Duration of Record Retainment
The Corporate Medical DepartmentGlobal Health and Wellness, the onsite Air Products medical department, or in non-U.S. locations, the supervisory licensed medical practitioner, is responsible for maintaining an accurate record of all emergency responders' medical clearance evaluations for 40 years from the end of employment.
4.7.3 Information Required for Records
The record requirements will include at least the following information:
The name and social security number or other identifier, where applicable.
Medical practitioner’s written opinions, recommended work restrictions and results of evaluations and tests.
Any employee medical complaints related to exposure to hazardous substances.
A copy of the job/exposure information provided by Air Products to the medical practitioner.
4.8 Attached Forms
Attachment 1 - Letter to the Medical Practitioner
Attachment 2 - Medical Evaluation Content
requirements
Attachment 3 - Physician's/Medical Practitioner's Written Opinion (Form 5585)
NOTE: The site manager/employee completes the first section BEFORE medical evaluation.
Attachment 4 - Emergency Responder Medical Evaluation Record (Form 5584-1)
Attachment 5 - Periodic Medical Health History (Form 4093)
Attachment 6 - Health History Questionnaire for Respirator Users and Emergency Responders (Form 4086)
Attachment 7 - Worst Case Scenario (Only required for HazmMat Technicians and HazMat Specialists)
NOTE: These forms are for the employee/medical practitioner to reference and complete.
Current forms can be accessed through the Air Products’ Corporate Medical Global Health and Wellness website.
5. RELATED DOCUMENTS
OSHA 1910.120 Hazardous waste operations and emergency response (HAZWOPER)
NFPA Responders to Hazardous Materials Incidents
01.08.06 Emergency Response Team Training and Certification Requirements
01.08.16 Emergency Response Program
01.13.10 Respiratory Protection
2.EHS.02.10.01.WW Management of Medical Records
2.EHS.02.13.09.WW EH&S Compliance Specification; Qualifications of Occupational Health Professional
Retained by AirProducts and Chemicals, Inc
6. DEFINITIONS
First Responders Awareness Level are individuals who in the course of their normal duties may be the first on the scene of an emergency involving hazardous materials.
First Responders Awareness Level are expected to recognize the presence of hazardous materials or conditions, protect themselves from the hazardous materials, call for trained personnel, and secure the scene, i.e., keep non-emergency response trained individuals away, etc.
Emergency Medical Service (EMS) are personnel who respond to medical incidents, may be required to wear medical PPE to protect themselves from body fluids. They will not be required to wear additional PPE or go into contaminated atmospheres.
First Responders (HAZWOPER) Operations Level are individuals who initially respond to conditions or releases or potential releases of hazardous materials for the purpose of protecting nearby persons, the environment, or property from the effects of the release. They must be trained to respond in a defensive fashion to control the release from a safe distance, keep it from spreading, and prevent exposures. They are only required to wear minimal PPE, very rarely up through Level B and work in non-exposed areas.