OSHA Inspection: LIFE SUPPORT AMBULANCE, INC.

Issued

Jul 11, 1996

Abate by

Aug 13, 1996

Penalty

Initial $6,300 · Current $3,150 Reduced

General-duty citation text

Section 5(a)(1) of the Occupational Safety and Health Act of 1970:  The
employer did not
furnish employmnent and a place of employment which were free from
recognized hazards that
were causing or likely to cause death or serious physical harm to
employees in that: employees
(EMT's, Paramedics, Nurses, and Paratransit Drivers) transporting
patients, clients from long
term care facilities for the elderly, and responding to medical
emergencies were exposed to the
hazard of being infected with tuberculosis (TB) through exposure to
exhaled air of individuals
with suspected or confirmed pulmonary TB in that:
(a) Most employees were not offered a two-step baseline PPD tuberculin
skin test, or were not
offered the test at the appropriate frequency (a formal PPD tuberculin
skin testing program for
all employees was not initiated until 02/96). Observed 03/05/96.
(b) Management of cases involving incidences of employee exposures to
patients/clients with
suspected TB were not followed up to completion (i.e. a second PPD skin
test
12 weeks after
the exposure incident) as evidenced by the following cases:
1. An EMT, on or about 04/95, reported as being exposed to an active TB
patient while
in the course of transporting the patient. The employee received a PPD
tuberculin skin
test a month later, which was determined to be negative, but did not
receive the second
skin test until 02/96; 7 months late.  Observed 05/02/96.
2. An EMT, on or about 02/95, reported as being exposed to an active TB
patient while
transporting the patient by ambulance.  The employee received a PPD
tuberculin skin test
approximately two weeks later which was determined to be positive, but did
not receive
the second PPD tuberculin skin test which was due on or about 06/95, and
terminated
employment on 10/95. Observed 05/02/96.
3. An EMT (partner to EMT in no.2 above), on or about 02/95, reported as
being
exposed to an active TB patient while transporting the patient by
ambulance.  The
employee received a PPD tuberculin skin test approximately two weeks later
which was
determined to be negative, but did not receive the second PPB tuberculin
skin test which
was due on or about 06/95; and as of 04/27/96 has not received it, thus
making it at least
10 months overdue.  Observed 05/02/96.
(c) Many employees did not receive formal TB training and education, or
received untimely
training (35 employees as described in citation no. 2, items 3a and 3b).
Observed 01/24/96.
ABATEMENT NOTE:  Feasible and useful abatement methods for reducing this
hazard, as
recommended by the CDC, include, but are not limited to:
1. Protocol for early identification of individuals with active
tuberculosis.
2. Medical surveillance (at no cost to the employee) including
pre-placement
evaluation,administration and enterpretation of PPD tuberculin skin tests,
and periodic
evaluations shall be offered to employees as follows: an initial baseline
screening at the time ofemployment, annual PPD tuberculin skin testing,
and tuberculin PPD skin testing every 6
months for employees with exposure to individuals with known or suspect
TB.
3. Evaluation and management of workers with a positive skin test, or with
skin test conversion
on repeat testing, and who are exhibiting symptoms of TB, including work
restrictions for
infectious employees.
4. Initial and annual employee training and information to ensure employee
knowledge of such
issues as the hazards of TB transmissions, its signs and symptoms, medical
surveillance and
therapy, and site specific protocols, including the purpose and proper use
of controls to prevent
exposure.
5. Establish a respiratory protection program as outlined in 29 CFR
1910.134(b). Consult CDC
and NIOSH guidelines which specify performance criteria for respirators,
which include
fittesting
criteria.

Issued

Jul 11, 1996

Abate by

Jul 16, 1996

Penalty

Initial $1,350 · Current $675 Reduced

Issued

Jul 11, 1996

Abate by

Aug 13, 1996

Penalty

Initial $1,800 · Current $900 Reduced

Issued

Jul 11, 1996

Abate by

Jul 16, 1996

Issued

Jul 11, 1996

Abate by

Jul 16, 1996

Issued

Jul 11, 1996

Abate by

Aug 13, 1996

Penalty

Initial $2,250 · Current $1,125 Reduced

Issued

Jul 11, 1996

Abate by

Aug 13, 1996

Issued

Jul 11, 1996

Abate by

Aug 13, 1996

Penalty

Initial $2,250 · Current $1,125 Reduced

Issued

Jul 11, 1996

Abate by

Jul 16, 1996

Issued

Jul 11, 1996

Abate by

Aug 13, 1996

Penalty

Initial $1,800 · Current $900 Reduced

Issued

Jul 11, 1996

Abate by

Aug 13, 1996

Issued

Jul 11, 1996

Abate by

Aug 13, 1996

Penalty

Initial $63,000 · Current $24,750 Reduced

Issued

Jul 11, 1996

Abate by

Aug 13, 1996

Issued

Jul 11, 1996

Abate by

Aug 13, 1996

Issued

Jul 11, 1996

Abate by

Aug 13, 1996

Penalty

Initial $49,500 · Current $31,500 Reduced

Issued

Jul 11, 1996

Abate by

Aug 13, 1996

Issued

Jul 11, 1996

Abate by

Aug 13, 1996

Penalty

Initial $5,000 · Current $2,500 Reduced

Issued

Jul 11, 1996

Abate by

Aug 11, 1996

Issued

Jul 11, 1996

Abate by

Jul 16, 1996

Issued

Jul 11, 1996

Abate by

Jul 16, 1996