The Air That You Breathe

     Just as I leaned in close to better hear my soft-spoken patient's answer to my question, he coughed, forcefully. A mist of sputum launched from his mouth and coated the side of my face and neck. His complaint was sudden onset of fever, weakness, chills, congestion and productive cough. Whatever he had, I could now feel it, smell it or taste it.

     Personal safety is always the EMS provider's first priority. This article reviews the Occupational Safety and Health Administration (OSHA) standard for respiratory protection. It also explores occupational exposure to tuberculosis.

     When respirators are provided by an EMS employer to protect the health of an employee, the employer must comply with the provisions of the OSHA Respiratory Protection Standard. According to standard 1910.134, "Respirators shall be provided by the employer when such equipment is necessary to protect the health of the employee. The employer shall be responsible for the establishment and maintenance of a respiratory protection program."

     Additionally, employees must have access to a local respiratory protection program administrator to answer questions about respiratory protection, perform medical evaluations and administer respirator fit tests. For questions about any of the content in this article or your organization's respiratory protection plan, contact your respiratory protection program administrator or designee.

WHY A RESPIRATORY PROTECTION PROGRAM?
      The purpose of a respiratory protection program is to minimize the risk to EMS providers from respiratory hazards, such as tuberculosis, during the performance of their regular job duties. The standard outlines these elements for a respiratory protection program:

• Respirator selection;
• Medical evaluation;
• Fit testing;
• Respirator use, maintenance, storage, care and disposal;
• Breathing air quality and use;
• Respiratory hazards training;
• Program evaluation.

     The standard requires employers to develop and implement written respiratory protection programs with required worksite-specific procedures and elements for required respirator use. Programs must be administered by trained administrators. The standard requires the employer provide effective training to employees who are required to use respirators. Employees who complete the training must demonstrate knowledge of respirator need and how improper fit, usage and maintenance can compromise its protective effect; its capabilities and limitations; use in emergency situations; respirator inspection; maintenance and storage; and recognition of medical signs and symptoms that may make the respirator ineffective.

     Training, respirators and medical evaluations must be provided to employees during work hours at no cost. Training is provided at the time of job assignment—before the employee has to wear a respirator in the workplace and at least annually thereafter, or when tasks are added or modified. Retraining is required annually and when:

• Changes in the workplace or the type of respirator render previous training obsolete;
• Inadequacies in the employee's knowledge or use of the respirator indicate that the employee has not retained the training;
• Any other situation arises in which retraining appears necessary to ensure safe respirator use.

     The standard requires employers to ensure that the written respiratory protection program is properly implemented, and to consult employees to ensure they are using the respirators properly. Factors to be assessed include:

• Respirator fit, including employee ability to use a respirator without interfering with effective work performance;
• Appropriate respirator selection for the hazards to which the employee is exposed;
• Proper respirator use under the workplace conditions the employee encounters;
• Proper respirator maintenance.