Ambulance Division
Ontario Emergency Medical Services
October 5, 2010
Ontario Emergency Medical Services guidance notes are intended
to assist Emergency Medical Services (EMS) employers, supervisors, workers and
joint health and safety committees by explaining the minimum requirements of the
Occupational Health and Safety Act and its regulations and promoting “accepted
practices” in EMS to protect the health and safety of EMS personnel.
Application of EMS Guidance Notes
Purpose
Guidance notes are intended to assist Emergency Medical Services
(EMS) employers, supervisors, workers and joint health and safety committees by
explaining the minimum requirements of the Occupational Health and Safety Act
and its regulations and promoting “accepted practices” in EMS to protect the
health and safety of EMS personnel. The guidance notes are intended to assist
the workplace in ensuring a healthy and safe workplace. Reference should always
be made directly to the Act and regulations to determine the legal rights and
duties of the workplace parties. It is the responsibility of all workplace
parties to ensure compliance with the Act and the regulations.
Guidance notes are developed by the EMS (Section 21) Advisory
Sub-Committee and distributed by the Ministry of Labour on behalf of the
Committee and made available on the Association of Municipal Emergency Medical
Services of Ontario (AMEMSO) and the Public Services Health & Safety Association
(formerly: Municipal Health and Safety Association) websites. The Committee is
made up of members from AMEMSO, the Canadian Auto Workers (CAW), the Canadian
Union of Public Employees (CUPE), the Ontario Public Service Employees Union
(OPSEU), and the Service Employees International Union (SEIU).
Enforcement
Ministry of Labour inspectors may refer to these guidance notes
and additional information such as alerts, standards, guidelines, etc. when they
carry out their enforcement duties under the Occupational Health and Safety Act
and its regulations. However, inspectors are not bound by the guidance notes.
They may be considered, as one source of information, in determining if every
precaution reasonable in the circumstances is being taken by employers as
required under section 25(2)(h) of the Act to protect the health and safety of
EMS personnel.
Note: It is recommended that EMS incorporate the principles set
out in guidance notes into standard operating procedures/guidelines and/or
workplace health and safety policies and programs where appropriate.
Additional Information
Guidance notes may be accompanied by, or make reference to,
additional material to give more detailed assistance to the workplace parties
for the development of workplace health and safety programs. This may include
best practices and standards set by other organizations such as the Canadian
Standards Association, or the Ministry of Health and Long Term Care (e.g.
Ontario Public Health Standards), etc.
Download Application of EMS Guidance Notes
EMS Vehicle Occupant Safety
Collisions and / or unanticipated movement involving EMS
vehicles are a major cause of injury and death amongst EMS workers. It is well
established that the use of safety belts is the single most effective means of
reducing injuries and fatalities in motor vehicle incidents.
All EMS workers and passengers are required to use seat belts at
all times when a vehicle is in motion in accordance with the provisions of the
Highway Traffic Act (HTA) unless they are exempted by section 5 of Regulation
613 (Seat Belt Assemblies) which states: “an ambulance attendant or any other
person transported in the patient’s compartment of an ambulance as defined in
section 61 of the Act is exempt from subsection 106 (3) of the Act where
attendance to a patient makes it impracticable to wear a seat belt assembly”.
During activities such as emergent care (i.e. CPR, artificial
ventilation, medication administration, or reassessment of unstable patients)
workers may be required to leave their seated and belted position during the
transport of these patients. Studies have demonstrated that if involved in a
crash, the occupants in the patient compartment are at a substantially greater
risk for injury or fatality, than those restrained in the front seats. If
attendance to a patient makes it impracticable for a worker to wear a seat belt,
the amount of time a worker is unrestrained is to be minimized. For example
where possible an EMS worker should provide optimal patient care prior to
departure. Where the section 5 exemption does not apply all EMS personnel and
passengers in the patient compartment are required to wear seat belts while the
vehicle is in motion.
It is equally important that all items in the cab and patient
compartment be secured at all times while the vehicle is in motion. Any items
that are not properly secured become projectiles in the event of a collision and
can cause serious injury to occupants of the vehicle. Paraphernalia such as,
oxygen tanks, defibrillators, zip packs, medical response bags and personal
belongings transported in the vehicle must be secured or stored in compartments.
EMS workers are responsible to ensure the patient(s), stretcher,
and/or incubator/ isolette are secured properly in the EMS vehicle prior to
vehicle movement using the current Ministry of Health and Long Term Care
Emergency Health Services Branch approved standards. Workplace parties are
advised to reference the OHSA sections 25(2)(a) requiring the provision of
information, instruction and supervision to a worker and 25(2)(h) which requires
the employer to take every precaution reasonable in the circumstances for the
protection of a worker.
Download EMS Vehicle Occupant Safety Guidance Notes
Reducing Diesel Exhaust in EMS Stations
Although commercial EMS diesel vehicles currently meet emissions
standards and are legislated to undergo an annual emission testing requirement,
the potential for exposure to diesel fumes may still exist inside EMS stations.
Workers and employers should take the necessary steps to prevent or adequately
control their exposure to diesel emissions in the workplace.
Incomplete combustion by diesel engines produces diesel exhaust
fumes. Breathing in diesel fumes can have adverse health effects on workers.
Exposure to the fumes can cause irritation of the eyes or respiratory tract.
Prolonged exposure to diesel exhaust fumes may lead to respiratory diseases.
Diesel exhaust is a complex mixture of gases and diesel particulate matter (DPM).
Components of the diesel exhaust include:
Air sampling for these chemical components has been found to be
both difficult and expensive. In addition, results of these tests have been
inconsistent due to the varying factors involved (i.e.: engine revolution
levels, engine efficiency etc). Workplaces are advised to seek the assistance of
a qualified industrial hygiene consultant when developing an air quality
program.
In the development of an air quality program and air sampling
with respect to diesel emissions the workplace parties are advised to reference
the Regulation for Industrial Establishments (Reg.851), sections 124, 127, and
128, the Regulation respecting Control of Exposure to Biological or Chemical
Agents (Reg.833) and the OHSA section 25(2)(h).
It is recommended that the installation of direct capture type
exhaust system extractors or automated vehicle exhaust removal/ventilation
systems be installed through renovation or new construction. An engineered
ventilation system should also be considered to limit workers exposure to diesel
exhaust emissions.
In addition exposures to diesel fumes may be reduced through
engineering controls at the source such a diesel exhaust converters or
purifiers. The discharge of air from any exhaust system should be in such a
manner so as to prevent the return of contaminants to the workplace.
The following actions may further assist in decreasing exposure
to diesel exhaust fumes:
Ventilate the garage by opening the doors prior to starting the
engine.
Move vehicles outdoors as soon as possible after start up
period. In the event EMS vehicles are equipped with air brakes, the vehicle
should be moved as soon as low pressure warning devices are deactivated.
-
Isolate adjacent occupied spaces from all emissions by
ensuring that doors are self-closing and have adequate seals.
-
Ensure regular diesel engine tuning/maintenance.
-
Avoid unnecessary idling of vehicles.
-
Selection of fuel with reduced sulfur content if possible.
-
Ensure all patient care equipment, linen, or personal
belongings are enclosed if stored in garage area
-
Ensure annual review of this guidance note by The Health and
Safety Committee and/or worker health and safety representative.
-
A reduction in soot discoloration of stations will be a
visible indication that your controls are reducing exposure to EMS staff.
Download Reducing Diesel Exhaust in EMS Stations Guidance Notes
For additional information on the requirements under the
Occupational Health and Safety Act (OHSA), please contact your local Ministry of
Labour Office, or visit the website at;
http://www.labour.gov.on.ca
These guidance notes are developed for informational purposes
only. Reference should always be made to the OHSA and regulations to ascertain
one’s rights and duties under the law. It is the responsibility of all workplace
parties to ensure compliance with the OHSA and regulations, and to seek
independent legal advice where questions remain.
The Public Services Health & Safety Association (formerly:
Municipal Health and Safety Association) of Ontario may be contacted for
assistance in the development and implementation of an occupational health and
safety policy and program: http://www.mhsao.com |
