Health care workers are at risk from exposure to hazardous materials when treating contaminated patients. The Occupational Safety and Health Act (OSHA) has recognized this fact and places the responsibility for ensuring a safe work environment upon the employer. This responsibility requires protection for workers, even in cases of emergencies, caused by the release (intentional or accidental) of hazardous materials.

OSHA considers hospital health care workers, who receive and treat patients contaminated by hazardous substances, to be "First Receivers." First receivers are a subset of "First Responders" and as such require "First Responder" training which will allow them to perform their duties safely.



"First Receiver"
Initial training (8 hrs.) &
Annual refresher

All employees with designated roles in the Hospital Decontamination Zone. This group includes, but is not limited to:
1. Decontamination staff, including decontamination victim inspectors; clinicians who will triage and/or stabilize victims prior to decontamination.
2. Security staff [e.g., crowd control and controlling access to the emergency department (ED)]; setup crew; and patient tracking clerks.

OSHA, 2003,
1992c, 1999


"First Receiver"
Initial training (8 hrs.) &
Annual refresher

1. Security personnel, setup crew, and patient tracking clerks assigned only to patient receiving areas proximate to the Decontamination Zone, where they might encounter, but are not expected to have contact with, contaminated victims, their belongings, equipment, or waste.
2. ED clinicians, clerks, triage staff, and other employees associated with emergency departments, who might encounter self-referred contaminated victims (and their belongings, equipment, or waste) without receiving prior notification that such victims have been contaminated.
OSHA, 1991a, 1991b


Expedient Orientation
* Nature of the hazard
* Expected duties.
* Appropriate use of PPE.
* Other appropriate safety and health precautions (e.g., decontamination procedures).

Other employees whose role in the Hospital Decontamination Zone was not previously anticipated (i.e., who are called in incidentally).

For example, a medical specialist or trade person, such as an electrician.

OSHA, 1997


Hazard Communication Standard: sufficient education to understand hazards and implement protective measures

Other personnel in the Hospital Post-Decontamination Zone who reasonably would not be expected to encounter or come in contact with unannounced contaminated victims, their belongings, equipment, or waste.
For example, other ED staff, such as housekeepers.
29 CFR 1910.1200(h)
Following a mass contamination event, whether biological, chemical or radioactive, large numbers of wounded and/or contaminated victims will eventually enter the medical system. They will need:
As many as 80% of the victims may bypass the normal emergency medical service system (EMS) and self-present directly to the local Emergency Room. The challenge for your hospital will be to serve these victims without contaminating the facility. Contamination of the hospital or the staff could require closure of the facility, eliminating a local source of treatment.

To assist hospitals to provide a safe environment for workers and patients, OSHA has published "Best Practices for Hospital Based First Receivers Of Victims from Mass Casualty Incidents Involving the Release of Hazardous Substances".

If OSHA's site is not up and running, you can access this publication here! (takes about 10 seconds to show up)

For the rest of us who will not receive "First Receiver" training, but who may be victims of weapons of mass destruction, the following sections will give some idea of the Decontamination Process.

Definition: Decontamination involves the reduction of infectious or hazardous agents to an acceptable level.
Three methods of decontamination include:

Effective decontamination, rapidly and safely reduces harm, while containing and controlling the hazardous agent in order to prevent secondary exposures.

What Contaminated Victims Should Expect At A Decontamination Site

  • Enter a Decontamination area, usually not the ER entrance
  • Expect all personnel in Personal Protective Equipment (PPE) with Respiratory devices
  • Patient ID banded
  • Triage personnel will separate those that can "Self Decontaminate"
    • Young children stay with parents or guardians
    • Probably separate victims by gender
  • Directed to area for disrobing
    • all clothes and personal effects bagged, tagged and secured
    • up to 90% of contamination may be removed with clothing
  • Directed to shower area; may be secured area with fire engines spraying water or may be shower stalls, etc.
    • may include monitoring personnel to ensure adequate decontamination
    • shower for a minimum of 1 minute or as directed up to 15 minutes
    • tepid water if possible to improve compliance
    • start at head, work to toes
    • use high surfactant soap if available, plain water on irritated skin
    • modesty covering if possible
    • warm air or other drying mechanism to avoid hypothermia
    • scrubs or gowns to replace clothing
  • Directed to Post-Decontamination treatment area


  • Enter a Decontamination area, not ER entrance
  • Expect all personnel in Personal Protective Equipment (PPE) with Respiratory devices
  • Patient ID banded
  • Transfer on gurney, backboard etc.
  • Triage personnel will manage Airway, Breathing and Circulation
  • All clothes and personal effects bagged, tagged and collected
  • Transfer to shower area
  • All skin surfaces washed 1-15 minutes by personnel
  • Use high surfactant soap if possible
  • Water temp 100? to avoid hypothermia
  • Skin dried & covered
  • Retriage, if needed
  • Transfer to Post-Decontamination treatment area

The Federal Bureau of Investigation has released information indicating that hospitals and large shopping venues have been included in terrorist training schemes. This information adds more urgency to the need for all employees to be familiar with their facility's Emergency Management Plan. Your ability to anticipate and respond promptly can save lives in any emergency.