A student of mine called me the other day and complained that his employer refused to give him a TB test on the grounds that it was not necessary. He came to me because he knows that I am an angry, squatty little man who will get to the bottom of this. He further told me that his employer had not been able to find anything in the Kentucky or OSHA regulations that requires TB skin tests for EMS personnel. He asked me to find the evidence, and send him the links so that he could set his employer straight. So I went to this thing called “Google” and this is what I found:
OSHA has a website with another search page. Which soon led me to this handy dandy page on everything tuberculosis. Man, there sure is a lot of stuff there. So much so, that it might be overwhelming to someone slow. So I thought I would break it down in little bitty chunks, and find the original documents that started it all:
OSHA regulation 1910:1030 spells out the standards for bloodborne pathogens. Oddly enough, there is no mention of tuberculosis on this page. However, this page does talk in general about the respiratory protection of employees who come into contact with disease and harmful substances. OSHA obviously thinks TB is harmful because on this page they state that “TB is now the second most common cause of death from infectious disease in the world after human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS).” So it would seem that employers would have to do something about this.
Despite this, people still had questions. So many people had questions in fact that OSHA answered these questions in one of their famous opinion memos back in 1997. This memo states that employers should follow the methodology outlined in a CDC document entitled “Guideline for Preventing the Transmission of Mycobacterium Tuberculosis in Health-Care Facilities, 1994.” So I did a search on Google again to find this document. What I found was a CDC report from 2005 that revisited that original document and made a few recommendations. A PDF of that report can be found here. It is pretty dry reading, so I will spare you. On page 3 you will find this quote: “Recommendations for annual respirator training, initial respirator fit testing, and periodic respirator fit testing have been added.” Alright, so this gets you to annual testing for most people, but does this apply to EMS? On that same page it lists health care workers that may be at risk and specifically mentions EMS: “Nontraditional facility-based settings include emergency medical service (EMS)”. Also on the same page, it lists all the occupations that will be affected and EMS is listed again: “Patient transport staff, including EMS”.
So there you go. Just a few degrees of separation form the original 1910:1030 document, but still easy to find with about 10 minutes worth of detective work. To put a little icing on the cake, Kentucky is one of the states that has an OSHA approved state plan to deal with such things. Kentucky has put annual testing into law specifically for EMS employers. 202 KAR 7:501 clearly states that all providers shall provide “annual tuberculin skin testing or other method of evaluation.” When you put it all together, this is what you get:
1. All new employees must be fit tested, and skin tested.
2. All employees must be provided with protective equipment (N95 Respirators) that complies with the fit testing above.
3. All employees are to be fit tested and skin tested every 12 months after that.
4. If a skin test ever turns up positive, the employer must provide a chest X-ray every 12 months.
6. These records are to be kept for 30 years…no kidding.
7. OSHA can fine a service between $7,000 to $70,000 for EACH INFRACTION of this regulation. Go back in the filing cabinet to count the screw ups and this adds up.
8. No one has disputed this in about 15 years, and I have never worked for an employer that did not comply with it.
Watch your back people. There is no such thing as a free lunch and your government does not love you. Hold your employers accountable and stay safe.
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