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An emergency medical technician (EMT), also known as an ambulance technician, is a health professional that provides emergency medical services.EMTs are most commonly found working in ambulances. In English-speaking countries, paramedics are a separate profession that has additional educational requirements, qualifications, and scope of practice.EMTs are often employed by private ambulance services, municipal EMS agencies, government, and fire departments. Some EMTs are paid employees, while others (particularly those in rural areas) are volunteers.EMTs provide medical care under a set of protocols, which are typically written by a physician.EMTs are exposed to a variety of hazards such as lifting patients and equipment, treating those with infectious disease, handling hazardous substances, and transportation via ground or air vehicles. Employers can prevent occupational illness or injury by providing safe patient handling equipment, implementing a training program to educate EMTs on job hazards, and supplying PPE such as respirators, gloves, and isolation gowns when dealing with biological hazards.Infectious disease has become a major concern, in light of the COVID-19 pandemic. In response, the U.S. Centers for Disease Control and Prevention and other agencies and organizations have issued guidance regarding workplace hazard controls for COVID-19. Some specific recommendations include modified call queries, symptom screening, universal PPE use, hand hygiene, physical distancing, and stringent disinfection protocols.Research on ambulance ventilation systems found that aerosols often recirculate throughout the compartment, creating a health hazard for EMTs when transporting sick patients capable of airborne transmission.Entry-level EMS healthcare professional, with 120 hours of classroom training followed by 40 hours clinical placement.A state-level exam needs to be completed before you are invited to register as an EMT.EMT's are trained in basic life support, anatomy/physiology, pathophysiology, pharmacology, ECG monitoring, advanced airway management (supraglottic airways), spinal immobilization and the administration of medication typically oral, intramuscular, inhaled, nebulised or sublingual.In the United States, EMTs are certified according to their level of training. Individual states set their own standards of certification (or licensure, in some cases) and all EMT training must meet the minimum requirements as set by the National Highway Traffic Safety Administration's (NHTSA) standards for curriculum.The National Registry of Emergency Medical Technicians (NREMT) is a private organization that offers certification exams based on NHTSA education guidelines and has been around since the 1970s.Currently, NREMT exams are used by 46 states as the sole basis for certification at one or more EMT certification levels.A NREMT exam consists of skills and patient assessments as well as a written portion.On June 12, 2019, the NREMT changed the rules regarding age limits for EMTs, AEMTs, and Paramedics. There is no longer an age limit for registered personnel. However, applicants must successfully complete a state-approved EMT course that meets or exceeds the NREMT Standards within the past 2 years of applying. Those applying for the NREMT Certification must also complete a state-approved EMT psychomotor exam. It is possible for the candidate to be refused access to a state-approved course due to their age within the state.LevelsNHTSA recognizes four levels of Emergency Medical Technician:EMR (Emergency Medical Responder)EMT (Emergency Medical Technician)AEMT (Advanced Emergency Medical Technician)ParamedicSome states also recognize the Advanced Practice Paramedic or Critical Care Paramedic level as a state-specific licensure above that of the Paramedic. These Critical Care Paramedics generally perform high acuity transports that require skills outside the scope of a standard paramedic (such as mechanical ventilation and management of cardiac assist devices).In addition, EMTs can seek out specialty certifications such as Wilderness EMT, Wilderness Paramedic, Tactical EMT, and Flight Paramedic.In 2009, the NREMT posted information about a transition to a new system of levels for emergency care providers developed by NHTSA with the National EMS Scope of Practice project.By 2014, these "new" levels will replace the fragmented system found around the United States. The new classification will include Emergency Medical Responder (replacing first responder), Emergency Medical Technician (replacing EMT-Basic), Advanced Emergency Medical Technician (replacing EMT-Intermediate/85), and Paramedic (replacing EMT-Intermediate/99 and EMT-Paramedic). Education requirements in transitioning to the new levels are substantially similar.The procedures and skills allowed at this level include bleeding control, management of burns, splinting of suspected fractures and spinal injuries, childbirth, cardiopulmonary resuscitation, semi-automatic defibrillation, oral suctioning, insertion of oropharyngeal and nasopharyngeal airways, pulse oximetry, blood glucose monitoring, auscultation of lung sounds, and administration of a limited set of medications (including oxygen, epinephrine, dextrose, nalaxone, albuterol, ipratropium bromide, glucagon, nitroglycerin, nitrous oxide, and acetylsalicylic acid). Some areas may add to the scope of practice, including intravenous access, insertion of supraglottic airway devices and CPAP. Training requirements and treatment protocols vary from area to area.An ambulance with only EMTs is considered a Basic Life Support (BLS) unit, an ambulance utilizing AEMTs is dubbed an Intermediate Life Support (ILS), or limited Advanced Life Support (LALS) unit, and an ambulance with Paramedics is dubbed an Advanced Life Support (ALS) unit. Many states allow ambulance crews to contain a mix of crews levels (e.g. an EMT and a Paramedic or an AEMT and a Paramedic) to staff ambulances and operate at the level of the highest trained provider. There is nothing stopping supplemental crew members to be of a certain certification, though (e.g. if an ALS ambulance is required to have two Paramedics, then it is acceptable to have two Paramedics and an EMT). An emergency vehicle with only EMRs or a combination of both EMRs and EMTs is still dubbed a Basic Life Support (BLS) unit. An EMR must usually be overseen by an EMT-level provider or higher to work on a transporting ambulance.Education and trainingEMT training programs for certification vary greatly from course to course, provided that each course at least meets local and national requirements. In the United States, EMRs receive at least 40–80 hours of classroom training and EMTs receive at least 120–300 hours of classroom training. AEMTs generally have 200–500 hours of classroom training, and Paramedics are trained for 1,500–2,500 hours or more.In addition to each level's didactic education, clinical rotations are typically also be required. Similar in a sense to medical school clinical rotations, EMT students are required to spend a required amount of time in an ambulance and on a variety of hospital services (e.g. obstetrics, emergency medicine, surgery, intensive care unit, psychiatry) in order to complete a course and become eligible for the certification and licensure exams.The number of clinical hours for both time in an ambulance and time in the hospital vary depending on local requirements, the level the student is obtaining, and the amount of time it takes the student to show competency.In addition, a minimum of continuing education (CE) hours is required to maintain certification. For example, to maintain NREMT certification, EMTs must obtain at least 48 hours of additional education and either complete a 24-hour refresher course or complete an additional 24 hours of CEs that would cover, on an hour by hour basis, the same topics as the refresher course would.Recertification for other levels follows a similar pattern.EMT training programs vary greatly in calendar length (number of days or months). For example, fast track programs are available for EMTs that are completed in two weeks by holding class for 8 to 12 hours a day for at least two weeks. Other training programs are months long, or up to 2 years for Paramedics in an associate degree program. EMT training programs take place at numerous locations, such as universities, community colleges, technical schools, hospitals or EMS academies. Every state in the United States has an EMS lead agency or state office of emergency medical services that regulates and accredits EMT training programs. Most of these offices have web sites to provide information to the public and individuals who are interested in becoming an EMT.Medical directionIn the United States, an EMT's actions in the field are governed by state regulations, local regulations, and by the policies of their EMS organization. The development of these policies are guided by a physician medical director, often with the advice of a medical advisory committee.In California, for example, each county's Local Emergency Medical Service Agency (LEMSA) issues a list of standard operating procedures or protocols, under the supervision of the California Emergency Medical Services Authority. These procedures often vary from county to county based on local needs, levels of training and clinical experiences.New York State has similar procedures, whereas a regional medical-advisory council ("REMAC") determines protocols for one or more counties in a geographical section of the state.Treatments and procedures administered by Paramedics fall under one of two categories, off-line medical orders (standing orders) or on-line medical orders. On-line medical orders refers to procedures that must be explicitly approved by a base hospital physician or registered nurse through voice communication (generally by phone or radio) and are generally rare or high risk procedures (e.g. vasopressor initiation).In addition, when multiple levels can perform the same procedure (e.g. AEMT-Critical Care and Paramedics in New York), a procedure can be both an on-line and a standing order depending on the level of the provider.Since no set of protocols can cover every patient situation, many systems work with protocols as guidelines and not "cook book" treatment plans.Finally, systems also have policies in place to handle medical direction when communication failures happen or in disaster situations.The NHTSA curriculum is the foundation Standard of Care for EMS providers in the US.EmploymentEMTs and Paramedics are employed in varied settings, mainly the prehospital environment such as in EMS, fire, and police agencies. They can also be found in positions ranging from hospital and health care settings, industrial and entertainment positions.The prehospital environment is loosely divided into non-emergency (e.g. patient transport) and emergency (9-1-1 calls) services, but many ambulance services and EMS agencies operate both non-emergency and emergency care.In many places across the United States, it is not uncommon for the primary employer of EMRs, EMTs, and Paramedics to be the fire department, with the fire department providing the primary emergency medical system response including "first responder" fire apparatus, as well as ambulances.In many other locations, emergency medical services are provided by a separate, or “third-party”, municipal government emergency agency (e.g. Boston EMS, Austin-Travis County EMS).In still other locations, emergency medical services are provided by volunteer agencies. College and university campuses may provide emergency medical responses on their own campus using students.In some states of the US, many EMS agencies are run by Independent Non-Profit Volunteer First Aid Squads that are their own corporations set up as separate entities from fire departments. In this environment, volunteers are hired to fill certain blocks of time to cover emergency calls. These volunteers have the same state certification as their paid counterparts.NURSEThe authority for the practice of nursing is based upon a social contract that delineates professional rights and responsibilities as well as mechanisms for public accountability. In almost all countries, nursing practice is defined and governed by law, and entrance to the profession is regulated at the national or state level.The aim of the nursing community worldwide is for its professionals to ensure quality care for all, while maintaining their credentials, code of ethics, standards, and competencies, and continuing their education.There are a number of educational paths to becoming a professional nurse, which vary greatly worldwide; all involve extensive study of nursing theory and practice as well as training in clinical skills.Nurses care for individuals of all ages and cultural backgrounds who are healthy and ill in a holistic manner based on the individual's physical, emotional, psychological, intellectual, social, and spiritual needs. The profession combines physical science, social science, nursing theory, and technology in caring for those individuals.To work in the nursing profession, all nurses hold one or more credentials depending on their scope of practice and education. In the United States, a Licensed Practical Nurse (LPN) works independently or with a Registered Nurse (RN). The most significant difference between an LPN and RN is found in the requirements for entry to practice, which determines entitlement for their scope of practice. RNs provide scientific, psychological, and technological knowledge in the care of patients and families in many health care settings. RNs may earn additional credentials or degrees.In the United States, multiple educational paths will qualify a candidate to sit for the licensure examination as an RN. The Associate Degree in Nursing (ADN) is awarded to the nurse who has completed a two-year undergraduate academic degree awarded by community colleges, junior colleges, technical colleges, and bachelor's degree-granting colleges and universities upon completion of a course of study usually lasting two years. It is also referred to as Associate in Nursing (AN), Associate of Applied Science in Nursing (AAS), or Associate of Science in Nursing (ASN).The Bachelor of Science in Nursing (BSN) is awarded to the nurse who has earned an American four-year academic degree in the science and principles of nursing, granted by a tertiary education university or similarly accredited school. After completing either the LPN or either RN education programs in the United States, graduates are eligible to sit for a licensing examination to become a nurse, the passing of which is required for the nursing license. The National Licensure Examination (NCLEX) test is a standardized exam (including multiple choice, select all that apply, fill in the blank and "hot spot" questions) that nurses take to become licensed. It costs two-hundred dollars to take the NCLEX. It examines a nurses ability to properly care for a client. Study books and practice tests are available for purchase.Some nurses follow the traditional role of working in a hospital setting. Other options include: pediatrics, neonatal, maternity, OBGYN, geriatrics, ambulatory, and nurse anesthetists and informatics (eHealth). There are many other options nurses can explore depending on the type of degree and education acquired. RNs may also pursue different roles as advanced practice nurses.Nurses are not doctors' assistants. This is possible in certain situations, but nurses more often are independently caring for their patients or assisting other nurses.RNs treat patients, record their medical history, provide emotional support, and provide follow-up care. Nurses also help doctors perform diagnostic tests. Nurses are almost always working on their own or with other nurses. Nurses will assist doctors in the emergency room or in trauma care when help is needed.Medication management and administration are part of most hospital nursing roles, however, prescribing authority varies between jurisdictions. In many areas, registered nurses administer and manage medications prescribed by a professional with full prescribing authority such as a nurse practitioner or physician. As nurses are responsible for evaluating patients throughout their care - including before and after medication administration - adjustments to medications are often made through a collaborative effort between the prescriber and the nurse. Regardless of the prescriber, nurses are legally responsible for the drugs they administer. There may be legal implications when there is an error in a prescription, and the nurse could be expected to have noted and reported the error. In the United States, nurses have the right to refuse any medication administration that they deem to be potentially harmful to the patient.Nursing is the most diverse of all health care professions. Nurses practice in a wide range of settings but generally nursing is divided depending on the needs of the person being nursed.The major populations are:communities/publicfamily/individual across the lifespanadult-gerontologypediatricsneonatalwomen's health/gender-relatedmental healthinformatics (eHealth)acute care hospitalsambulatory settings (physician offices, urgent care settings, camps, etc)school/college infirmariesThere are also specialist areas such as cardiac nursing, orthopedic nursing, palliative care, perioperative nursing, obstetrical nursing, oncology nursing, nursing informatics, telenursing, radiology, and emergency nursing.Nurses practice in a wide range of settings, including hospitals, private homes, schools, and pharmaceutical companies. Nurses work in occupational health settings (also called industrial health settings), free-standing clinics and physician offices, nurse-led clinics, long-term care facilities and camps. They also work on cruise ships and in military service. Nurses act as advisers and consultants to the health care and insurance industries. Many nurses also work in the health advocacy and patient advocacy fields at companies such as Health Advocate, Inc. helping in a variety of clinical and administrative issues.Some are attorneys and others work with attorneys as legal nurse consultants, reviewing patient records to assure that adequate care was provided and testifying in court. Nurses can work on a temporary basis, which involves doing shifts without a contract in a variety of settings, sometimes known as per diem nursing, agency nursing or travel nursing. Nurses work as researchers in laboratories, universities, and research institutions. Nurses have also been delving into the world of informatics, acting as consultants to the creation of computerized charting programs and other software. Nurse authors publish articles and books to provide essential reference materials.The fast-paced and unpredictable nature of health care places nurses at risk for injuries and illnesses, including high occupational stress. Nursing is a particularly stressful profession, and nurses consistently identify stress as a major work-related concern and have among the highest levels of occupational stress when compared to other professions. This stress is caused by the environment, psychosocial stressors, and the demands of nursing, including new technology that must be mastered, the emotional labor involved in nursing, physical labor, shift work, and high workload. This stress puts nurses at risk for short-term and long-term health problems, including sleep disorders, depression, mortality, psychiatric disorders, stress-related illnesses, and illness in general. Nurses are at risk of developing compassion fatigue and moral distress, which can worsen mental health. They also have very high rates of occupational burnout (40%) and emotional exhaustion (43.2%). Burnout and exhaustion increase the risk for illness, medical error, and suboptimal care provision.Nurses are also at risk for violence and abuse in the workplace.Violence is typically perpetrated by non-staff (e.g. patients or family), whereas abuse is typically perpetrated by other hospital personnel. Of American nurses, 57% reported in 2011 that they had been threatened at work; 17% were physically assaulted.In the US, scope of practice is determined by the state or territory in which a nurse is licensed. Each state has its own laws, rules, and regulations governing nursing care. Usually the making of such rules and regulations is delegated to a state board of nursing, which performs day-to-day administration of these rules, licenses for nurses and nursing assistants, and makes decisions on nursing issues. In some states, the terms "nurse" or "nursing" may only be used in conjunction with the practice of a registered nurse (RN) or licensed practical or vocational nurse (LPN/LVN).In the hospital setting, registered nurses often delegate tasks to LPNs and unlicensed assistive personnel.RNs are not limited to employment as bedside nurses. They are employed by physicians, attorneys, insurance companies, governmental agencies, community/public health agencies, private industry, school districts, ambulatory surgery centers, among others. Some registered nurses are independent consultants who work for themselves, while others work for large manufacturers or chemical companies. Research nurses conduct or assist in the conduct of research or evaluation (outcome and process) in many areas such as biology, psychology, human development, and health care systems.Many employers offer flexible work schedules, child care, educational benefits, and bonuses. About 21 percent of registered nurses are union members or covered by union contract.Nursing is the nation's largest health care profession. In 2017, there were more than 4,015,250 registered nurses and 922,196 licensed practical nurses nationwide.Of all licensed RNs, 2.6 million or 84.8% are employed in nursing. Nurses comprise the largest single component of hospital staff, are the primary providers of hospital patient care, and deliver most of the nation's long-term care. The primary pathway to professional nursing, as compared to technical-level practice, is the four-year Bachelor of Science in Nursing (BSN) degree. Registered nurses are prepared either through a BSN program; a three-year associate degree in nursing; or a three-year hospital training program, receiving a hospital diploma. All take the same state licensing exam. (The number of diploma programs has declined steadily—to less than 10 percent of all basic RN education programs—as nursing education has shifted from hospital-operated instruction into the college and university system.)Educational and licensure requirementsDiploma in NursingThe oldest method of nursing education is the hospital-based diploma program, which lasts approximately three years. Students take between 30 and 60 credit hours in anatomy, physiology, microbiology, nutrition, chemistry, and other subjects at a college or university, then move on to intensive nursing classes. Until 1996, most RNs in the US were initially educated in nursing by diploma programs.[62]According to the Health Services Resources Administration's 2000 Survey of Nurses only six percent of nurses who graduated from nursing programs in the United States received their education at a Diploma School of Nursing.Associate Degree in NursingThe most common initial nursing education is a two-year Associate Degree in Nursing (Associate of Applied Science in Nursing, Associate of Science in Nursing, Associate Degree in Nursing), a two-year college degree referred to as an ADN. Some four-year colleges and universities also offer the ADN. Associate degree nursing programs have prerequisite and corequisite courses (which may include English, Math and Human Anatomy and Physiology) and ultimately stretch out the degree-acquiring process to about three years or greater.Bachelor of Science in NursingThe third method is to obtain a Bachelor of Science in Nursing (BSN), a four-year degree that also prepares nurses for graduate-level education. For the first two years in a BSN program, students usually obtain general education requirements and spend the remaining time in nursing courses. In some new programs the first two years can be substituted for an active LPN license along with the required general studies. Advocates for the ADN and diploma programs state that such programs have an on the job training approach to educating students, while the BSN is an academic degree that emphasizes research and nursing theory. Some states require a specific amount of clinical experience that is the same for both BSN and ADN students. A BSN degree qualifies its holder for administrative, research, consulting and teaching positions that would not usually be available to those with an ADN, but is not necessary for most patient care functions. Nursing schools may be accredited by either the Accreditation Commission for Education in Nursing (ACEN) or the Commission on Collegiate Nursing Education (CCNE).Graduate educationAdvanced education in nursing is done at the master's and doctoral levels. It prepares the graduate for specialization as an advanced practice registered nurse (APRN) or for advanced roles in leadership, management, or education. The clinical nurse leader (CNL) is an advanced generalist who focuses on the improvement of quality and safety outcomes for patients or patient populations from an administrative and staff management focus. Doctoral programs in nursing prepare the student for work in nursing education, health care administration, clinical research, public policy, or advanced clinical practice. Most programs confer the PhD in nursing or Doctor of Nursing Practice (DNP).Advanced practice registered nurse (APRN)Areas of advanced nursing practice include that of a nurse practitioner (NP), a certified nurse midwife (CNM), a certified registered nurse anesthetist (CRNA), or a clinical nurse specialist (CNS). Nurse practitioners and CNSs work assessing, diagnosing and treating patients in fields as diverse as family practice, women's health care, emergency nursing, acute/critical care, psychiatry, geriatrics, or pediatrics, additionally, a CNS usually works for a facility to improve patient care, do research, or as a staff educator.Licensure examinationCompletion of any one of these three educational routes allows a graduate nurse to take the NCLEX-RN, the test for licensure as a registered nurse, and is accepted by every state as an adequate indicator of minimum competency for a new graduate. However, controversy exists over the appropriate entry-level preparation of RNs. Some professional organizations believe the BSN should be the sole method of RN preparation and ADN graduates should be licensed as "technical nurses" to work under the supervision of BSN graduates. Others feel the on-the-job experiences of diploma and ADN graduates makes up for any deficiency in theoretical preparation.RNs are the largest group of health care workers in the United States, with about 2.7 million employed in 2011.It has been reported that the number of new graduates and foreign-trained nurses is insufficient to meet the demand for registered nurses; this is often referred to as the nursing shortage and is expected to increase for the foreseeable future. There are data to support the idea that the nursing shortage is a voluntary shortage.In other words, nurses are leaving nursing of their own volition. In 2006 it was estimated that approximately 1.8 million nurses chose not to work as a nurse. The Bureau of Labor Statistics (BLS) reported that 296,900 healthcare jobs were created in 2011. RNs make up the majority of the healthcare workforce, therefore these positions will be filled primarily by nurses. The BLS also states that by 2020, there will be 1.2 million nursing job openings due to an increase in the workforce, and replacements.With health care knowledge growing steadily, nurses can stay ahead of the curve through continuing education. Continuing education classes and programs enable nurses to provide the best possible care to patients, advance nursing careers, and keep up with the Board of Nursing requirements. The American Nurses Association and the American Nursing Credentialing Center are devoted to ensuring nurses have access to quality continuing education offerings. Continuing education classes are calibrated to provide enhanced learning for all levels of nurses. Many States also regulate Continuing Nursing Education. Nursing licensing boards requiring Continuing Nursing Education (CNE) as a condition for licensure, either initial or renewal, accept courses provided by organizations that are accredited by other state licensing boards, by the American Nursing Credentialing Center (ANCC), or by organizations that have been designated as an approver of continuing nursing education by ANCC.There are some exceptions to this rule including the state of California, Florida, and Kentucky. National Healthcare Institute has created a list to assist nurses in determining their CNE credit hours requirements. While this list is not all-inclusive, it offers details on how to contact nursing licensing boards directly.Board certificationProfessional nursing organizations, through their certification boards, have voluntary certification exams to demonstrate clinical competency in their particular specialty. Completion of the prerequisite work experience allows an RN to register for an examination, and passage gives an RN permission to use a professional designation after their name. For example, the passage of the American Association of Critical-care Nurses specialty exam allows a nurse to use the initials 'CCRN' after his or her name. Other organizations and societies have similar procedures.The American Nurses Credentialing Center, the credentialing arm of the American Nurses Association, is the largest nursing credentialing organization and administers more than 30 specialty examinations.

Emergency Response PlanThe actions taken in the initial minutes of an emergency are critical. A prompt warning to employees to evacuate, shelter or lockdown can save lives. A call for help to public emergency services that provides full and accurate information will help the dispatcher send the right responders and equipment. An employee trained to administer first aid or perform CPR can be lifesaving. Action by employees with knowledge of building and process systems can help control a leak and minimize damage to the facility and the environment.The first step when developing an emergency response plan is to conduct a risk assessment to identify potential emergency scenarios. An understanding of what can happen will enable you to determine resource requirements and to develop plans and procedures to prepare your business. The emergency plan should be consistent with your performance objectives.At the very least, every facility should develop and implement an emergency plan for protecting employees, visitors, contractors and anyone else in the facility. This part of the emergency plan is called “protective actions for life safety” and includes building evacuation (“fire drills”), sheltering from severe weather such as tornadoes, “shelter-in-place” from an exterior airborne hazard such as a chemical release and lockdown. Lockdown is protective action when faced with an act of violence.When an emergency occurs, the first priority is always life safety. The second priority is the stabilization of the incident. There are many actions that can be taken to stabilize an incident and minimize potential damage. First aid and CPR by trained employees can save lives. Use of fire extinguishers by trained employees can extinguish a small fire. Containment of a small chemical spill and supervision of building utilities and systems can minimize damage to a building and help prevent environmental damage.Some severe weather events can be forecast hours before they arrive, providing valuable time to protect a facility. A plan should be established and resources should be on hand, or quickly, available to prepare a facility. The plan should also include a process for damage assessment, salvage, protection of undamaged property and cleanup following an incident. These actions to minimize further damage and business disruption are examples of property conservation.Guidance for the development of an emergency response plan can be found in this step.Protective Actions for Life SafetyWhen there is a hazard within a building such as a fire or chemical spill, occupants within the building should be evacuated or relocated to safety. Other incidents such as a bomb threat or receipt of a suspicious package may also require evacuation. If a tornado warning is broadcast, everyone should be moved to the strongest part of the building and away from exterior glass. If a transportation accident on a nearby highway results in the release of a chemical cloud, the fire department may warn to “shelter-in-place.” To protect employees from an act of violence, “lockdown” should be broadcast and everyone should hide or barricade themselves from the perpetrator.Protective actions for life safety include:EvacuationShelteringShelter-In-PlaceLockdownYour emergency plan should include these protective actions. If you are a tenant in multi-tenanted building, coordinate planning with the building manager.EvacuationPrompt evacuation of employees requires a warning system that can be heard throughout the building. Test your fire alarm system to determine if it can be heard by all employees. If there is no fire alarm system, use a public address system, air horns or other means to warn everyone to evacuate. Sound the evacuation signal during planned drills so employees are familiar with the sound.Make sure that there are sufficient exits available at all times.Check to see that there are at least two exits from hazardous areas on every floor of every building. Building or fire codes may require more exits for larger buildings.Walk around the building and verify that exits are marked with exit signs and there is sufficient lighting so people can safely travel to an exit. If you find anything that blocks an exit, have it removed.Enter every stairwell, walk down the stairs, and open the exit door to the outside. Continue walking until you reach a safe place away from the building. Consider using this safe area as an assembly area for evacuees.Appoint an evacuation team leader and assign employees to direct evacuation of the building. Assign at least one person to each floor to act as a “floor warden” to direct employees to the nearest safe exit. Assign a backup in case the floor warden is not available or if the size of the floor is very large. Ask employees if they would need any special assistance evacuating or moving to shelter. Assign a “buddy” or aide to assist persons with disabilities during an emergency. Contact the fire department to develop a plan to evacuate persons with disabilities.Have a list of employees and maintain a visitor log at the front desk, reception area or main office area. Assign someone to take the lists to the assembly area when the building is evacuated. Use the lists to account for everyone and inform the fire department whether everyone has been accounted for. When employees are evacuated from a building, OSHA regulations require an accounting to ensure that everyone has gotten out safely. A fire, chemical spill or other hazard may block an exit, so make sure the evacuation team can direct employees to an alternate safe exit.ShelteringIf a tornado warning is broadcast, a distinct warning signal should be sounded and everyone should move to shelter in the strongest part of the building. Shelters may include basements or interior rooms with reinforced masonry construction. Evaluate potential shelters and conduct a drill to see whether shelter space can hold all employees. Since there may be little time to shelter when a tornado is approaching, early warning is important. If there is a severe thunderstorm, monitor news sources in case a tornado warning is broadcast. Consider purchasing an Emergency Alert System radio - available at many electronic stores. Tune in to weather warnings broadcast by local radio and television stations. Subscribe to free text and email warnings, which are available from multiple news and weather resources on the Internet.Shelter-In-PlaceA tanker truck crashes on a nearby highway releasing a chemical cloud. A large column of black smoke billows into the air from a fire in a nearby manufacturing plant. If, as part of this event, an explosion, or act of terrorism has occurred, public emergency officials may order people in the vicinity to “shelter-in-place.” You should develop a shelter-in-place plan. The plan should include a means to warn everyone to move away from windows and move to the core of the building. Warn anyone working outside to enter the building immediately. Move everyone to the second and higher floors in a multistory building. Avoid occupying the basement. Close exterior doors and windows and shut down the building’s air handling system. Have everyone remain sheltered until public officials broadcast that it is safe to evacuate the building.LockdownAn act of violence in the workplace could occur without warning. If loud “pops” are heard and gunfire is suspected, every employee should know to hide and remain silent. They should seek refuge in a room, close and lock the door, and barricade the door if it can be done quickly. They should be trained to hide under a desk, in the corner of a room and away from the door or windows. Multiple people should be trained to broadcast a lockdown warning from a safe location.Resources for Protective Actions for Life SafetyIn addition to the following resources available on the Internet, seek guidance from your local fire department, police department, and emergency management agency.Exit Routes and Emergency Planning – U.S. Occupational Safety & Health Administration (OSHA) 29 CFR 1910 Subpart ENFPA 101: Life Safety Code® – National Fire Protection AssociationEmployee Alarm Systems – OSHA 29 CFR 1910.165Evacuation Planning Matrix – OSHAEvacuation Plans and Procedures eTool - OSHADesign Guidance for Shelters and Safe Rooms ­– Federal Emergency Management Agency (FEMA 453)Incident StabilizationStabilizing an emergency may involve many different actions including: firefighting, administering medical treatment, rescue, containing a spill of hazardous chemicals or handling a threat or act of violence. When you dial 9-1-1 you expect professionals to respond to your facility. Depending upon the response time and capabilities of public emergency services and the hazards and resources within your facility, you may choose to do more to prepare for these incidents. Regulations may require you to take action before emergency services arrive.If you choose to do nothing more than call for help and evacuate, you should still prepare an emergency plan that includes prompt notification of emergency services, protective actions for life safety and accounting of all employees.Developing the Emergency PlanDeveloping an emergency plan begins with an understanding of what can happen. Review your risk assessment. Consider the performance objectives that you established for your program and decide how much you want to invest in planning beyond what is required by regulations.Assess what resources are available for incident stabilization. Consider internal resources and external resources including public emergency services and contractors. Public emergency services include fire departments that may also provide rescue, hazardous materials and emergency medical services. If not provided by your local fire department, these services may be provided by another department, agency or even a private contractor. Reach out to local law enforcement to coordinate planning for security related threats.Document available resources. Determine whether external resources have the information they would need to handle an emergency. If not, determine what information is required and be sure to document that information in your plan.Prepare emergency procedures for foreseeable hazards and threats. Review the list of hazards presented at the bottom of the page. Develop hazard and threat specific procedures using guidance from the resource links at the bottom of this page.Warning, Notifications, and CommunicationsPlans should define the most appropriate protective action for each hazard to ensure the safety of employees and others within the building. Determine how you will warn building occupants to take protective action. Develop protocols and procedures to alert first responders including public emergency services, trained employees and management. Identify how you will communicate with management and employees during and following an emergency.Roles and Responsibilities for Building Owners and Facility ManagersAssign personnel the responsibility of controlling access to the emergency scene and for keeping people away from unsafe areas. Others should be familiar with the locations and functions of controls for building utility, life safety and protection systems. These systems include ventilation, electrical, water and sanitary systems; emergency power supplies; detection, alarm, communication and warning systems; fire suppression systems; pollution control and containment systems; and security and surveillance systems. Personnel should be assigned to operate or supervise these systems as directed by public emergency services if they are on-site.Site and Facility Plans and InformationPublic emergency services have limited knowledge about your facility and its hazards. Therefore, it is important to document information about your facility. That information is vital to ensure emergency responders can safely stabilize an incident that may occur. Documentation of building systems may also prove valuable when a utility system fails—such as when a water pipe breaks and no one knows how to shut off the water.Compile a site-plan and plans for each floor of each building. Plans should show the layout of access roads, parking areas, buildings on the property, building entrances, the locations of emergency equipment and the locations of controls for building utility and protection systems. Instructions for operating all systems and equipment should be accessible to emergency responders.Provide a copy of the plan to the public emergency services that would respond to your facility and others with responsibility for building management and security. Store the plan with other emergency planning information such as chemical Material Safety Data Sheets (MSDS), which are required by Hazard Communication or “right to know” regulations.Training and ExercisesTrain personnel so they are familiar with detection, alarm, communications, warning and protection systems. Review plans with staff to ensure they are familiar with their role and can carry out assigned responsibilities. Conduct evacuation, sheltering, sheltering-in-place and lockdown drills so employees will recognize the sound used to warn them and they will know what to do. Facilitate exercises to practice the plan, familiarize personnel with the plan and identify any gaps or deficiencies in the plan.10 Steps for Developing the Emergency Response PlanReview performance objectives for the program.Review hazard or threat scenarios identified during the risk assessment.Assess the availability and capabilities of resources for incident stabilization including people, systems and equipment available within your business and from external sources.Talk with public emergency services (e.g., fire, police and emergency medical services) to determine their response time to your facility, knowledge of your facility and its hazards and their capabilities to stabilize an emergency at your facility.Determine if there are any regulations pertaining to emergency planning at your facility; address applicable regulations in the plan.Develop protective actions for life safety (evacuation, shelter, shelter-in-place, lockdown).Develop hazard and threat-specific emergency procedures using the Emergency Response Plan Template for Businesses.Coordinate emergency planning with public emergency services to stabilize incidents involving the hazards at your facility.Train personnel so they can fulfill their roles and responsibilities.Facilitate exercises to practice your plan.Links to Emergency Planning InformationPre-Incident Planning (Site and Building Information for First Responders)Fire Service Features of Buildings and Fire Protection Systems - U.S. Occupational Safety & Health Administration (OSHA) Publication 3256-07NStandard on Pre-Incident Planning - National Fire Protection Association (NFPA) 1620Protective Actions for Life SafetyEvacuation Planning Matrix – OSHAEvacuation Plans and Procedures eTool - OSHADesign Guidance for Shelters and Safe RoomsMedicalCPR and ECC Guidelines - American Heart AssociationAutomated External Defibrillators (AEDs) – OSHABloodborne pathogens – OSHA 29 CFR 1910.1030Model Plans and Programs for the OSHA Bloodborne Pathogens and Hazard Communications Standards – OSHA Publication 3186FirefightingFire Protection – OSHA 29 CFR 1910 Subpart LFire Brigades - OSHA 29 CFR 1910.156Standard on Industrial Fire Brigades - NFPA 600Hazardous materialsHazardous Materials Emergency Planning Guide (NRT-1) - U.S. National Response TeamNatural hazardsNatural Disasters and Weather Emergencies - U.S. Environmental Protection AgencyNational Hurricane Center, Publications, Tropical Cyclone Advisory Mailing Lists, Hurricane Preparedness, The Saffir-Simpson Hurricane Wind Scale (Experimental) - National Weather Service (NWS)Thunderstorms, Tornadoes, Lightning, Nature's Most Violent Storms: A Preparedness Guide, Including Tornado Safety Information for Schools - NOAA, National Weather ServiceTornado Protection: Selecting Refuge Area in Buildings - FEMA 431RescuePermit-Required Confined Spaces - OSHA 29 CFR 1910.146Standard for Rescue Technician Professional Qualifications - NFPA 1006Standard on Operations and Training for Technical Search and Rescue Incidents - NFPA 1670Workplace ViolenceActive Shooter: How to Respond -U.S. Department of Homeland Security (DHS)Dealing with Workplace Violence: A Guide for Agency Planners - United States Office of Personnel ManagementWorkplace Violence—Issues in Response - Federal Bureau of InvestigationTerrorism, Bomb Threats, and Suspicious PackagesEnsuring Building Security – DHSSafe Rooms and Shelters - Protecting People Against Terrorist Attacks - FEMA 453Guidance for Protecting Building Environments from Airborne Chemical, Biological, or Radiological Attacks - National Institute for Occupational Safety and Health, Publication No. 2002-139, 2002Hazards to Consider When Developing the Emergency PlanNatural hazardsGeological hazardsEarthquakeTsunamiVolcanoLandslide, mudslide, subsidenceMeteorological HazardsFlood, flash flood, tidal surgeWater control structure/dam/levee failureDroughtSnow, ice, hail, sleet, arctic freezeWindstorm, tropical cyclone, hurricane, tornado, dust stormExtreme temperatures (heat, cold)Lightning strikes (wildland fire following)Biological hazardsFoodborne illnessesPandemic/Infectious/communicable disease (Avian flu, H1N1, etc.)Human-caused eventsAccidentalHazardous material spill or releaseNuclear power plant incident (if located in proximity to a nuclear power plant)Explosion/FireTransportation accidentBuilding/structure collapseEntrapment and or rescue (machinery, confined space, high angle, water)Transportation Incidents (motor vehicle, railroad, watercraft, aircraft, pipeline)IntentionalRobberyLost person, child abduction, kidnap, extortion, hostage incident, workplace violenceDemonstrations, civil disturbanceBomb threat, suspicious packageTerrorismTechnology caused eventsUtility interruption or failure (telecommunications, electrical power, water, gas, steam, HVAC, pollution control system, sewerage system, other critical infrastructure)Cyber security (data corruption/theft, loss of electronic data interchange or ecommerce, loss of domain name server, spyware/malware, vulnerability exploitation/botnets/hacking, denial of service)Property ConservationTaking action before a forecast event, such as a severe storm, can prevent damage. Prompt damage assessment and cleanup activities following the storm can minimize further damage and business disruption. These actions are considered “property conservation”—an important part of the emergency response plan. Much of the following guidance is directed to building owners and facility managers. However, tenants should also develop a plan in coordination with building owners and managers as well as public authorities.Preparing a Facility for a Forecast EventBody copy: Actions to prepare a facility for a forecast event depend upon the potential impacts from the hazards associated with the event. Conduct a risk assessment to identify severe weather hazards including winter storms, arctic freeze, tropical storm, hurricane, flooding, storm surge, severe thunderstorm, tornado and high winds. Also consider non-traditional hazards, such as a planned event involving a large crowd.Property conservation actions should focus on protection of the building and valuable machinery, equipment and materials inside. Potential damage may be prevented or mitigated by inspecting the following building features, systems and equipment:Windows and doorsRoof flashing, covering and drainageExterior signsMechanical equipment, antennas and satellite dishes on rooftopsOutside storage, tanks and equipmentAir intakesHigh value machinerySensitive electronic equipment including information technology and process controllersThe review of building components may also identify opportunities for longer-term mitigation strategies.Property conservation activities for specific forecast events include the following:Winter storm - Keep building entrances and emergency exits clear; ensure there is adequate fuel for heating and emergency power supplies; monitor building heat, doors and windows to prevent localized freezing; monitor snow loading and clear roof drains.Tropical storms and hurricanes - Stockpile and pre-cut plywood to board up windows and doors (or install hurricane shutters); ensure there is sufficient labor, tools and fasteners available; inspect roof coverings and flashing; clear roof and storm drains; check sump and portable pumps; backup electronic data and vital records off-site; relocate valuable inventory to a protected location away from the path of the storm.Flooding - Identify the potential for flooding and plan to relocate goods, materials and equipment to a higher floor or higher ground. Clear storm drains and check sump and portable pumps. Raise stock and machinery off the floor. Prepare a plan to use sandbags to prevent water entry from doors and secure floor drains.Salvage and Actions to Prevent Further Damage Following an IncidentSeparating undamaged goods from water-soaked goods is an example of salvage. Covering holes in a roof or cleaning up water and ventilating a building are also part of property conservation. The property conservation plan should identify the resources needed to salvage undamaged good and materials; make temporary repairs to a building; clean up water, smoke and humidity; and prepare critical equipment for restart.Resources for property conservation include the following:water vacuums and tools to remove waterfans to remove smoke and humiditytarpaulins or plywood to cover damaged roofs or broken windowsplastic sheeting to cover sensitive equipmentCompile an inventory of available equipment, tools and supplies and include it with the emergency response plan. Identify precautions for equipment exposed to water or high humidity and procedures for restarting machinery and equipment.Identify contractors that may be called to assist with clean up and property conservation efforts. Keep in mind that competition for contractors, labor, materials and supplies prior to a forecast storm or following a regional disaster may be intense. Plan ahead and secure contractors and other resources in advance.Resources for Property ConservationProtect Your Property from High Winds - Federal Emergency Management AgencyNatural Disasters - U.S. Environmental Protection AgencyEmergency Drying Procedures for Water Damaged Collections - Library of CongressLast Updated: 09/11/2020Disasters and EmergenciesMake a PlanGet InvolvedReady BusinessBusinessLeaders in Business Community ResilienceProgram AdministrationPlanningImplementationEmergency Response PlanResource ManagementCrisis Communications PlanBusiness Continuity PlanBusiness Continuity Planning SuiteIT Disaster Recovery PlanEmployee Assistance & SupportIncident ManagementTrainingTesting & ExercisesTestingExercisesProgram ImprovementProgram ReviewsCorrective ActionBusiness TestimonialsReady Kids