sog_selectusescba_19990800

8/14/2019 SOG_SelectUseSCBA_19990800

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MOORHEAD FIRE RESCUE DEPARTMENT

STANDARD PROCEDWRES

GOVERNING SELECTION AND USE OF

SELF CONTAINED BREATHING APPARATUS

Revised

August 1999


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W

INDEX

Page

A Program Administrator 1

B Procedure for Selection of Respirator 1

C Medical Evaluation of Employees 1

D Fit Testing Procedure 1

E Procedures and Schedules for Cleaning Storing InspectingRepairing Discarding and Otherwise Maintaining Resprators 5

F Procedures to Ensure Adequate Air Quality Quantity and Flow ofBreathing Air for Amosphere uppyng espirators 5

G Training of Employees in the Respiratory Hazards Donning andDoffing Limtation of Use and Maintenance 5

H Procedures for Regularly Evaluating Effectiveness of the Program 6

1 Record Keeping of Medical Evaluations and Fit Testing 7

J Appendix 1 8Appendix 2 13Appendix 3 14Appendix 4 15

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A PROGRAM ADMINISTRATOR is Fire Chief Marty Soeth

B PROCEDURE FOR SELECTION OF RESPIRATORMSA Model MMR brand SCBA self contained breathing apparatus hasbeen selected on the basis of reliability and service ability to deal withhazards inherent to fire fighting

Confined space MSA Premaire System with escape cylinder inline airsystem has been selected for use in confined space rescue responses

C MEDICAL EVALUATION OF EMPLOYEESThe Moorhead Fire Rescue has selected Dr Wolff of Dakota Clinic asPLHCP for administering the medical evaluations All medicalevaluations will be performed to comply with OSHA 1910 34

The evaluation consists of aquestionnaire enclosed

inAppendix 1pulmonary function test hearing test blood pressure chest x ay

blood test EKG and general physical exam performed by Dr Wolff

Any positive response from the questionnaire Dr Wolff will addressduring the physical exam and recommend further test at no expensesto the employee

When evaluations are complete the PLHCP will inform the employeethat they can use an SCBA or they need further testing If the employeepasses the medical evaluation the PLHCP will inform the employer thatthe employee can use an SCBA in writing The written recommendationshall include limtation of use follow up medical evaluations and astatement that the PLHCP has provided the employee with a copy of thePLHCP written recommendation

D FIT TESTING PROCEDi IPP

Any employee of the Moorhead Fire and Rescue shall be fit tested byDakota Clinic Occupational Health Before using the SCBA this testingshall be done annually Dakota Clinic will perform fit testing using the

quantitativefit test

QNFTIf the fit factor is

equalor

greaterthan

500the employee has passed with the respirator Various sizes of facepieces shall be available during the test so the employee will get thebest fit

Quantitative fit testing of MSA MMR s hall be accomplished bymodifying the facepiece to allow sampling inside the facepiece in thebreathing zone of the user

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Operating Guidelines

1 The test subject shall be allowed to pick the most comfortable respirator froma selection of respirators of various sizes and models

2 Prior to the selection process the test subject shall be shown how to puton a respirator how it should be positioned on the face how to set straptension and how to determne a comfortable fit A mrror shall beavailable to assist the subject in evaluating the fit and positioning therespirator This instruction may not constitute the subject sormaltraining on respirator use because it is only a review

3 The test subject shall be informed that he he s being asked to select therespirator which provides the most comfortable fit Each respiratorrepresents a different size and shape and if fitted and used properly willprovide adequate protection

4 The test subject shall be instructed to hold each chosen facepiece up to the faceand elimnate those which obviously do not give a comfortable fit

5 The mor e comfortable facepieces are noted the most comfortable mask isdonned and worn at least five mnutes to assess comfort Assistance in

assessing comfort can be given by discussing the points in item six 6 elowIf the test subject is not famliar with using a particular respirator the testsubject shall be directed to don the mask several times and to adjust the strapseach time to become adept at setting proper tension on the straps

6 Assessment of comfort shall include reviewing the following points with thetest subject and allowing the test subject adequate time to determne thecomfort of the respirator

a osition of the mask on the nose

b oom or eye protection

c oom o talk

d osition of mask on face and cheeks

7 The following criteria shall be used to help determne the adequacy of therespirator fit

a hin properly placed

b dequate strap tension not overly tightened2


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c it across nose bridge

d espirator of proper size to span distance from nose to chin

e tendency of respirator to slip

f s bservation in mrror to evaluate fit and respirator position

8 The test subject shall conduct the negative and positive pressure fit checksusing procedures in Appendix 2 or those recommended by the respiratormanufacturer Before conducting the negative or positive pressure fit checksthe subject shall be told to seat the mask on the face by moving the head fromsde t de nd up and down slowly while taking in a few slow deep breathsAnother facepiece shall be selected and retested if the test subject fails the fitcheck tests

9 The test shall not be conducted if there is any hair growth between the skin andthe facepiece sealing surface such as stubble beard growth beard or sideburnswhich cross the respirator sealing surface Any type of apparel which interfereswith a satisfactory fit shall be altered or removed

10 If a test subject exhibits difficulty in breathing during the tests she or he shallbe referred to a physician to determne whether the test subject can wear arespirator while performing her or his duties

11 If the employee finds the fit of the facepiece unacceptable the test subject shall

be given the opportunity to select a different facepiece and to be retested

12 Exercise regimen Prior to the commencement of the fit test the test subjectshall be given a description of the fit test and the test subject sesponsibilitiesduring the test procedure The description of the process shall include adescription of the test exercises that the subject will be performing Therespirator to be tested shall be worn for at least five 5 nutes before the startof the fit test

13 Test Exercises The test subject shall perform exercises in the test

environmentwhile

wearing any applicable safety equipmentthat

maybe worn

during actual respirator use which could interfere with fit in the mannerdescribed below

a Normal breathing In a normal standing position without talking thesubject shall breathe normally

b Deep breathing In a normal standing position the subject shallbreathe slowly and deeply taking caution so as to not hyperventilate

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c urning head side to side Standing in place the subject shall slowlyturn hs er head from side to side between the extreme positions oneach side The head shall be held at each extreme momentarily so thesubject can inhale at each side

d Moving head up and down Standing in place the subject shall slowlymove hs er head up and down The subject shall be instructed to inhalein the up position i hen looking toward the ceiling

e Talking The subject shall talk out loud slowly and loud enough so asto be heard clearly by the test conductor The subject can read from aprepared text such as the Rainbow Passage count backward from 100or recite a memorized poem or song

Rainbow Passage

When the sunlight strikes raindrops in the air they ac like a prism and

form a rainbow The rainbow is a division of white light into manybeautiful colors These take the shape of a long round arch with its pathhigh above and its two ends apparently beyond the horizon There isaccording to legend a boiling pot of gold at one end People look but noone ever finds it When a man looks for something beyond reach hisfriends say he is looking for the pot of gold at the end of the rainbow

f rimace The test subject shall grimace by smiling or frowning

g Bending ov er The test subject shall bend at the waist as if he hewere to

touchhs

er toes Jogging in place shall be substituted for thisexercise in those test environments such as shroud type QNFT unitswhich prohibit bending at the waist

h Normal breathing Same as exercise a

Each test exercise shall be performed for one mnute except for the grimace exercisewhich shall be performed for 15 seconds

The test subject shall be questioned by the test conductor regarding the comfort of therespirator upon completion of the protocol If it has become uncomfortable anothermodel of respirator shall be tried

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E PROCEDURES AND SCHEDULES FOR CLEANING STORING INSPECTINGREPAIRING DISCARDING AND OTHERWISE MAINTAINING RESPIRATORS

Each individual breathing apparatus SCBA shall be checked each weekon Monday morning The inspection shall include full air bottle lowpressure alarm sounds at not less than 420 PSI hose connections aretight and straps are in good condition Inspection

findingsshall be noted

on an inspection sheet provided for each unit and initialed by the personinspection Form is found in Appendix 3

All SCBA s emoved from an apparatus and worn by a member of theMoorhead Fire and Rescue shall not be returned to the apparatus untilsaid unit shall have been inspected for the following and noted on theinspection form Appendix 3 he inspection shall include full air bottlelow pressure alarm tight hose connections and straps are in goodcondition

Any units found to have any problems upon inspection shall be removedfrom service and immediately tagged and placed in the SCBA filling areaand notify the SCBA technician

Each member of the Moorhead Fire and Rescue Department are issuedtheir own SCBA facepiece and have been instructed in the propercleaning and testing of the facepiece It is their responsibility to maintaintheir facepiece In the event the individual

sacepiece is inoperable it

will be turned into a SCBA Technician for repair or replacement

F PROCEDURES TO ENSURE ADEQUATE AIR QUALITY QUANTITY AND FLOWOF BREATHING AIR FOR ATMOSPHERE UPPLYNG ESPIRATORS

Breathing air supplied by our compressor will be tested byT nv ronment a Inc Austin Texas at least twice a year

The only time Moorhead Fire and Rescue use atmosphere suppliedrespirators is in hazardous materials decontamnation line At that timeair monitors are used to make sure atmosphere supplied respiratorsare safe

G TRAINING OF EMPLOYEES IN THE RESPIRATORY HAZARDS DONNING ANDDOFFING LIMITATION OF USE AND MAINTENANCE

The Moorhead Fire and Rescue Director of Training will conducttraining sessions for recruits and all personnel in proper donningdoffing limitations and maintenance of the SCBA This training willinclude proficiency testing and class room Records for individualtraining shall be maintained by the training division

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When fire is beyond the incipient stage fire that cannot be controlledby portable fire extinguishers or small hose streams without the needof protective clothing or SCBA it is considered to be an IDLHatmosphere requiring SCBA and two in wo out

The Moorhead Fire Rescue Department will use the two in wo out rulein all IDLH atmospheres in structure fires

a wo Firefighters must enter the burning building and remain in visualor voice contact with each other at all times

b wo Firefighters must be on standby and be in communication if twoFirefighters are engaged in interior structural fire fighting in a burningbuilding

c xemption If life is in jeopardy Firefighters have the discretion toperform the rescue and two in wo out rule is waived until rescueoperations have been accomplished

d The standard allows one of the standby Firefighters to have otherduties such as Incident Commander or Safety Officer

e ne of the outside Firefighters must actively monitor the status of theinside Firefighter and may not be assigned additional duties

f n an emergency where outside Firefighters need to evacuate a

building three long blasts of an air horn will be sounded

g The Incident Commander has the responsibility and flexibility todetermne when mor e than two outside Firefighters are necessary giventhe circumstances of the fire

H PROCEDURES FOR REGULARLY EVALUATING EFFECTIVENESS OF THEPROGRAM

Staff Officers shall monitor and evaluate the SCBA program for

effectiveness and complianceduring training

and actual firegroundsituations Officer shall also be researching state of the art developments

and technological changes that can or should be included in the program

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I RECORD KEEPING OF MEDICAL EVALUATIONS AND FIT TESTING

All medical and fit testing records shall be maintained by Dakota ClinicEnvironment Health A copy of the medical respirator evaluation formand quantitative respirator fit test results will be sent to the ProgramAdmnistrator of Moorhead Fire and Rescue by Dakota ClinicOccupational Health

Fit testing records shall comprise of the following Name of employeetested quantitative test make model and size of respirator date of testand fit factor strip chart recording Records shall be maintained untilnext fit testing is admnistered Written materials shall be made availableto the affected employee upon request Appendix 4

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APPENDIX 1OSHA RESPIRATOR MEDICAL EVALUATION

QUESTIONNAIRE

To the employer Answers to questions in Section 1 and to question 9 in Section 2 ofPart A do not require a medical examnation

To the employee

Can you read circle one Yes No

Your employer must allow you to an swer this questionnaire during normal workinghours or at a time and place that is convenient to you To maintain your confidentiality youremployer or supervisor must not look at or review your ans wer s and your employer must tellyou how to deliver or send this questionnaire to the health care professional who will reviewit

Part A Section 1 Mandatory The following information must be provided by everyemployee who has been selected to use any type of respirator please print

1 Todays ate2 Your name

3 Your age to nearest year4 Sex circle one Me ema e

5 Your height ft in

6 Your weight Ibs

7 Your job title

8 A phone number where you can be reached by the health care professional whoreviews this questionnaire include the Area Code

9 The best time to phone you at this number

10 Has your employer told you how to conac the health care professional who willreview this questionnaire circle one Yes No

11 Check the type of respirator you will use you can check mor e than one category

a N R or P disposable respirator fi lte ask non artridge type onlyb Other type for example half or ful acepiece type power edar urifyingsupplieda se ontaned breathing apparatus

12 Have you worn a respirator circle one Yes No

If yes what types

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Part A Section 2 Mandatory Questions 1 through 9 below must be answered by every

employee who has been selected to use any type of respirator please circle yes or no

1 Do you currently smoke tobacco or have you smoked tobacco in the last month Yes No

2 Have you ever had any of the following conditionsa Seizures fits Yes No

b Diabetes sugar disease Yes Noc Allergic reactions that interfere with your breathing Yes No

d Claustrophobia fear of cosedin aces Yes No

e Trouble smelling odors Yes No

3 Have you ever had any of the following pulmonary or lung problemsa Asbestosis Yes No

b Asthma Yes No

c Chronic bronchitis Yes No

d Emphysema Yes No

e Pneumonia Yes No

f Tuberculosis Yes No

g Silicosis Yes No

h Pneumothorax collapsed lung Yes No1 Lung cancer Yes No

j Broken ribs Yes No

k Any chest injuries or surgeries Yes No

1 Any other lung problemthat

youveeen told about Yes No

4 Do you currently have any of the following symptoms of pulmonary or lung illness

a Shortness of breath Yes No

b Shortness of breath when walking fast on level ground or walking up a slight hill or incline

Yes No

c Shortness of breath when walking with other people at an ordinary pace on level groundYes No

d Have to stop for breath when walking at your own pace on level ground Yes No

e Shortness of breath when washing or dressing yourself Yes No

f Shortness of breath that interferes with your job Yes No

g Coughing that produces phlegm thick sputum Yes No

h Coughing that wakes you early in the morning Yes No

1 Coughing that occur s mostly when you are lying down Yes No

j 03ughing up blood in the last month Yes No

k Wheezing Yes No1 Wheezing that interferes with your job Yes No

m Chest pains when you breathe deeply Yes No

n Any other symptoms that you think may be related to lung problems Yes No

5 Have you ever had any of the following cardiovascular or heart problemsa Heart attack Yes No

b Stroke Yes No

c Angina Yes Nod Heart failure Yes No

e Swelling in your legs or feet not caused by walking Yes No

f Heart arrhythmia heart beating irregularly Yes No

g High blood pressure Yes No

h Any other heart problems that youve een told about Yes No

6 Have you ever had any of the following cardiovascular or heart symptomsa Frequent pain or tightness in your chest Yes No

b Pain or tightness in your chest during physical activity Yes No

c Pain or tightness in your chest that interferes with your job Yes No

d In the past two years have you noticed your heart skipping or missing a beat YesNo

e Heartburn or indigestion that is not related to eating Yes No

f Any other symptoms that you think may be related to heart or circulation problems YesNo

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7 Do you currently take medications for any of the following problemsa Breathing or lung problems Yes No

b Heart trouble Yes No

c Blood pressure Yes No

d Seizures fits Yes No

8 If youve sed a respirator have you ever had any of the following problems If youve ever

used respirator check the following space and go to question 9a Eye irritation Yes Nob Skin allergies or rashes Yes No

c Anxiety Yes Nod General weakness or fatigue Yes Noe Any other problem that interferes with your use of a respirator Yes No

9 Would you like to talk to the health care professional who will review this questionnaire about

your ans wer s to this questionnaire Yes No

Questions 10 to 15 below must be answered by every employee who has been selected to

use either a fu acepiece respirator or a sef ontaned breathing apparatus SCBA For employees

who have been selected to use other types of respirators answering these questions is voluntary

10 Have you ever lost vision in either eye temporarily or permanently Yes No

11 Do you currently have any of the following vision problemsa Wear contact lenses Yes No

b Wear glasses Yes No

c Color blind Yes No

d Any other eye or vision problem Yes No

12 Have you ever had an injury to your ears including a broken ear drum YesNo

13 Do you currently have any of the following hearing problemsa Difficulty hearing Yes No

b Wear a hearing aid Yes No

c Any other hearing or ear problem Yes No

14 Have you ever had a back injury Yes No

15 Do you currently have any of the following musculoskeletal problemsa Weakness in

yf

yourarm hands

legsor feet Yes No

b Back pain Yes No

c Difficulty fully moving your arm and legs Yes No

d Pain or stiffness when you lean forward or backward at the wast YesNo

e Difficulty moving your head up or down Yes No

f Difficulty fully moving your head side to side Yes No

g Difficulty bending at your knees Yes No

h Difficulty squatting to the ground Yes No

L Cimbing a flight of stairs or a ladder carrying more than 25 Ibs Yes No

j Any other muscle or skeletal problem that interferes with using a respirator YesNo

Part B Any of the following questions and other questions not listed may be addedto the

questionnaire at the discretion of the health care professional who will reviewthe questionnaire

1 In your present job are you working at high altitudes over 5 00 feet or in a place thathas

lower than normal amounts of oxygen Yes No

If yes do you have feelings of dizziness shortness of breath pounding in yourchest or

other symptoms when youre orking under these conditions Yes No

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2 At work or at home have you ever been exposed to hazardous solvents hazardous airbornechemcals e ases fumes or dust or have you come into skin conac with hazardouschemcals Yes No

If yes name the chemcals if you know them

3 Have you ever worked with any of the materials or under any of the conditions listed below

a Asbestos Yes No

b Silica e n sandblasting Yes Noc Tungst en obat e rinding or welding this material Yes Nod Beryllium Yes Noe Alumnum Yes No

f Coal for example mning Yes No

g Iron Yes No

h Tin Yes No

i Dusty environments Yes No

j Any other hazardous exposures Yes No

If yes describe these exposures

4 List any second jobs or side businesses you have

5 List your previous occupations

6 List your current and previous hobbies

7 Have you been in the military services Yes NoIf yes wer e you exposed to biological or chemcal agents either in trainingor combat Yes No

8 Haveyou

ever worked on a HAZMAT team Yes No

9 Other than medications for breathing and lung problems heart trouble blood pressure andseizures mentioned earlier in this questionnaire are you taking any other medications for anyreaso n including ov houn e edications Yes No

If yes name the medications if you know them

10 Wll you be using any of the following items with your respirators

HEPA Filters Yes No

b Canisters for example gas masks Yes Noc Cartridges Yes No

11 How often are you expected to use the respirators

ircle yes or no or all ans wer s

that apply to youa Escape only no rescue Yes No

b Emergency rescue only Yes No

c Less than 5 hours per week Yes No

d Less than 2 hours per day Yes Noe 2 to 4 hours per day Yes No

f Over 4 hours per day Yes No

12 During the period you are using the respirators

s your work eff ort

a Light less than 200 kcal per hour Yes No

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If yes how long does this period last during the average shft hs mns

Examples of a light work effort are sitting while writing typing drafting or performing lightassembly work or standing while operating a drill press 0 bs or controlling machines

b Moderate 200 to 350 kcal per hour Yes No

If yes how long does this period last during the average shft hs mns

Examples of moderate work effort are sitting while nailing or filing driving a truck or bus inurban traffic standing while drilling nailing performing assembly work or transferring a moderateload about 35 lbs at trunk level walking on a level surface about 2 mph or down a 5egreegrade about 3 mph or pushing a wheelbarrow with a heavy load about 100 lbs on a levelsurface

c Heavy above 350 kcal per hour Yes No

If yes how long does this period last during the average shift hrs mns

Examples of heavy work are lifting a heavy load about 50 lbs from the floor to your waistor

shoulder workingon a

loading dock shoveling standing while bricklaying or chipping castingswalking up an 8 egree grade about 2 mph climbing stairs with a heavy load about 50 Ibs

13 Wll you be wearing protective clothing and o quipment other than the respirator whenyou e sing your respirator Yes No f yes describe this protective clothing and oequipment

14 Wll you be working under hot conditions temperatures exceeding 77 deg F Yes No15 Wll you be working under humd conditions Yes No16 Describe the work youll e doing while you e sing your respirator

s17 Describe any special or hazardous conditions you might encounter when you e sing your

respirator

sor example confined spaces l i fe hreatening gases

18 Provide the following information if you know it for each toxic substances that youll e

exposed to when youre sing your respirators

Name of the first toxic substance

Estimated maximum exposure level per shift

Duration of exposure per shft

Name of second toxic substance

Estimated maximum exposure level per shift

Duration of exposure per shift

Name of the third toxic substance

Estimated maximum exposure level per shiftDuration of exposure per shft

The name of any other toxic substances that youll e exposed to while using yourrespirator

1910 34

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APPENDIX 2

The individual who uses a t igh itting espirator is to perform a user seal check to ensur ethat an adequate seal is achieved each time the respirator is put on Either the positive andnegative pressure checks listed in this appendix or the respirator manufacturer

secommended user seal check method shall be used User seal checks are not substitutes

for qualitative or quantitative fit tests

1 Facepiece Positive and o Negative Pressure Checks

A Positive pressure check Close off the exhalation valve and exhale gently into thefacepiece The face fit is considered satisfactory if a slight positive pressure can bebuilt up inside the faceplece without any evidence of outward leakage of air at theseal For most respirators this method of leak testing requires the wea rer to firstremove the exhalation valve cover before closing off the exhalation valve and thencarefully replacing it after the test

B Negative pressure check Close off the inlet opening of the canister or cartridges

ycovering with the palm of the hand s r by replacing the filter sea snhale gently sothat the faceplece collapses slightly and hold the breath for ten seconds The designof the inlet

openingof some

cartridgescannot be

effectivelycovered with the

palmof

the hand The test can be performed by covering the inlet opening of the cartridgewith a thin latex or nitrite glove If the facepiece remains in its slightly collapsedcondition and no inward leakage of air is detected the tightness of the respirator isconsidered satisfactory

1910 34

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APPENDIX 3

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APPENDIX 4

DAKOTA CLINICManaging Your Healthcare Today Tomorrow

Medical Classification for Respirator Use

APPLICANT NAME

SOCIAL SECURITY

JOB TITLE

EMPLOYER

This evaluation recommendation is my medical opinion

RECOMMENDED

NOT RECOMMENDED

ADDITIONAL INFORMATION NEEDED

OTHER PHYSICIAN COMMENTS

HE EVALUATION AND RECOMMENDATIONS HAVE BEEN REVIEWED WTH THEAPPLICANT

igned Applicant Date

Physician NameClinic 3 T I olffAddress Dakota ClinicCity State cc Naiional Health Center

1401 1 th Ave EastWe s t Fargo ID

igned Physician Date

efer to standard CFR 1910 34

15

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APPENDIX 4FIT TESTER 3000 QUANTITATIVE RESPIRATOR FT TEST RESULTSSUBJECT IDENTIFICATION

Subjects IDS

OperatorTEST DATE

TEST PARAMETERSModeled Work Rat e

Mask TypeCartridge TypeChallenge PressureModeled Breathing Rat eTest Subject Gender

Step Type Description Leak Rate Duration FF1 Test Face Forward2 Exer Bend a Wst3 Exer Head Side to Sde4 Test Face Forward5 Exer

R onnng6 Test Face Forward7 Exer R onnng8 Test Face Forward

Average o LeakEquivalent Ft Factor

1

Pass Minimum FFNOTES

SIGNATURES

Oper at or Subect

Dr T L WolffDakota Clinic

O ccupationalHeafth Center1401 13th Ave East

West Fargo NIA 5807

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sog_selectusescba_19990800

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