Understanding Bloodborne Pathogens and Trauma Scenes..

An insurance claim involving bloodborne pathogens is normally the result of some sort of trauma event. The trauma can range from a car accident, a cut or puncture wound, to the loss of life from a stabbing or shooting. However, they all have one thing in common - they involve body fluids being released from a person or persons that require careful management and cleanup. We are choosing our words carefully because this is a delicate subject. It is not our intention to scare the reader. The information presented here is what coroners, detectives and specialty cleanup people refer to as trauma scene management.

The World Health Organization and the Centers for Disease Control and Prevention state that all human blood and body fluids should be treated as infectious (pathogenic), and universal precautions must be administered when coming in contact with them. Federal OSHA regulations mandate worker protection when coming in contact with blood. The federal information about bloodborne pathogens is found in 29-CFR 1910.1030.

While the OSHA regulations for the Bloodborne Pathogens Standard were initially conceived for medical management practices, the standard reaches beyond the medical community. It mandates protection of all workers who have an anticipated exposure risk to bloodborne pathogens. This includes workers involved with commercial, hotel, and hospital laundries; ambulance; police; funeral; lifeguards; schools; and public use facilities. What we forget are carpet and upholstery cleaners, auto restorers, and janitorial workers who are asked to cleanup blood spills and stains on a surprisingly frequent basis. They are also mandated to comply with federal and state regulations.

Now that it is established that human blood is to be treated as infectious, insurers and adjusters who are involved with the management and cleanup of a trauma scene must provide appropriate care in managing and abating potentially infectious situations. In an insurance claim, the adjuster may be required to assign specialty contractors who are trained in bloodborne pathogens and trauma scene management. They are hired to remove the pathogens and sanitize the environment as part of their job.

Finding a qualified contractor to manage trauma scenes "professionally" is not as easy as one would think. Hiring Joe Contractor, who has "Blood-R-Us Cleanup" on the side of his truck, should not be your first choice. Most often, the contractor who is qualified does not advertise on his trucks.

In my 15 years of teaching bloodborne pathogen standards and trauma scene management practices, over 90 percent of the contractors have advised me, "The risk of a health exposure to our workers is too great, along with complying with state and local health and safety regulations. Insurance adjusters do not understand or respect the level of worker protection required, and the risk of exposure, and they are not willing to pay the increased labor rates for what OSHA and worker's comp carriers consider to be high hazard work. For these reasons, I no longer want to be in this business. It's not because we don't do a good job or our services are not needed. It's just not worth it." 

The Trauma Scene
The emotional impact of a trauma scene can be devastating. The scenes of a struggle for a life lost, or the remains of a person who has taken his or her own life can leave an unforgettable image. The trauma scene worker must be psychologically balanced. This is not an easy profession in which to train personnel. On more than one occasion, workers have left the job due to "emotional stress." It is not unusual for trauma scene workers to experience long-term emotional problems, or "Critical Incident Stress Syndrome," that require medical leave from their employment and psychological counseling.

Trauma scene management companies are 24-hour emergency responders, faced with car accident cleanups, shootings, drug houses, stabbings, multiple homicides, and clean up after long-term death scenes, where the person or persons were not found for a period of days. The malodor permeates clothing, even with protective garments on. They must also deal with distraught families, friends, and neighbors, who provide additional emotional stress on the workers. 

A state licensed medical specialist who consults with me on large trauma scene cleanup jobs recently remarked, "Contractors who clean up blood and brains for a living are themselves crazy, since it is only a matter of time before they too, become statistics because of their increased exposure to infection and illness every time they go out to one of these disasters."

No matter how carefully you manage a trauma scene, simply providing proper training and equipment is not enough because hidden risks are there and, eventually, employees will be compromised. Hazardous activities include pulling up carpet and padding where tack strips contaminated with blood cause tears and puncture wounds through safety gloves; removing carpet or upholstery with drug needles hidden within the carpet fibers and upholstery foam; cleaning up glass from broken windows contaminated with blood; or removing blood-soaked upholstery from cars and trucks, where sharp metal parts and glass can cause puncture wounds. 

Not all blood related trauma scenes involve infectious disease such as AIDS. Trauma scenes also involve bacterial diseases - hepatitis and other viral infections. OSHA's "Bloodborne Pathogens Rule" requires that occupationally exposed employees be offered shots for hepatitis B infection. When a trauma scene worker suffers scrapes, cuts, or punctures; has skin contact with body fluids; or inhales bacteria or viruses from airborne vapors and mists, reasonable care requires the employer to implement a company medical surveillance and safety program. Medical specialists can provide vaccinations and boosters for some viruses, yet they are not available for all disease-causing agents. Bacterial and viral exposures are usually not detected immediately after a cut or injury. It may be weeks, months or years after an exposure before medical signs and symptoms become apparent. For this reason, trauma scene management companies, like other 24-hour emergency responders, must keep records on all known and potential work-related exposures for up to 30 years after employment ends. 

The Adjuster's Dilemma
In a typical scenario, a building owner phones the claims office. He reports he has been robbed and two of his employees were badly injured. If this is an insured claim, what is the adjuster to do? 

First, the adjuster should recognize that the health department, police, paramedics, and coroner do not clean up blood and body fluids as part of their normal practices, even if it involved a crime. On an insured claim, the adjuster may be required to step in and recommend that a specialty contractor be retained to clean up the mess. The claims office should have a list of local remediation contractors who will certify they have been trained in all aspects of worker safety and bloodborne pathogen management, including complying with 29 CFR 1910.1030, and all state and local requirements. Those firms must also have appropriate liability and medical insurance coverage. In California, trauma scene waste management contractors must register annually with the state department of health. A list of registered practitioners is available through the State of California Department of Health Services. Other state health departments may provide similar information.

Additionally, trauma scene management companies should carry adequate liability insurance and they should have been in business more than a year. 

Standards of Practice
Standard procedures require that blood-soaked carpet, pad, beds, and other items be carefully cut out, bagged, removed, and disposed of properly. In California, as well as in most other states, blood-soaked items are considered medical waste and, as such, should be appropriately contained, removed, and disposed through licensed medical waste transporters. In California, refer to the Trauma Scene Waste Management Act (Senate Bill 1034, Chapter 732, Statutes of 1997).

The general cleanup scenario of a trauma scene requires a methodical approach. A full assessment of the problem and its challenges should be completed to limit risk, injury, and illness to cleanup workers. On completion of the assessment, all hazards and obstacles should be safely removed. If necessary, such as in a shopping mall or office building, appropriate barricades or other constraints should be positioned to secure the trauma scene and keep onlookers and others away from the blood-soaked and splattered areas. The trauma scene contractor should bring into the work area only those materials and equipment that are part of the containment and removal process. They must either be cleaned and disinfected, or disposed of at the end of the job. Other equipment for first aid and eye washing should be staged nearby in a clean and secure area where it can be easily accessed, if required.

Trauma scene management workers should wear personal protective equipment, such as moisture and splash resistant full body suits. Workers must also wear appropriate respirators for eliminating inhalation and splash hazards. Typically, this includes donning surgical-like masks, half-face masks, or full-face respirators with HEPA/organic or particulate filters. Hand and eye protection is essential. 

The assessment may reveal that surfaces only have a light spattering of blood and body fluids. In this case, a careful detergent cleaning, rinsing, and topical disinfectant may be all that is necessary to take care of the problem. For scenes involving a more radical scenario, bullets, blood, body pieces, brain matter, drug residue, and tear gas can be everywhere, dramatically expanding the risk assessment and project management. This often includes bagging, removal, and disposal of drywall, insulation, and other building materials, along with the contaminated contents. 

Managing Costs

The challenge for many adjusters is how to manage and pay for this type of clean up, while justifying the increased costs to their supervisors. How is an adjuster to recognize the scope of the project if the contractor contained and removed all pathogenic waste? Usually they don't. They pay the bill and go on to the next claim, hoping to never have another claim of this type again. However, experienced firms should be ready to describe the scope of work and the basis for their charges.

The need for trauma scene management is growing, and untrained people are increasingly putting themselves and others at risk, oblivious to the hidden hazards. Human blood cleanup is not like a fire or water damage claim, and the risk, liability, and exposure of trauma scenes far exceed the hazards most firms and their employees are willing to accept.