DOJ Instruction 1600.00.01 (Attachment 2).pdf

U.S. Department of Justice 1600.00.01

DOJ Instruction

SAFETY STATION PROGRAM GUIDE

PURPOSE:

SCOPE:

ORIGINATOR:

CATEGORY:

AUTHORITY:

Establishes the Department of Justice (DOJ or Department) process and procedures for safety station programs in federal facilities.

All DOJ components

Justice Management Division, Facilities and Administrative Services Staff

(I) Administrative, (II) Facilities

5 U.S.C. § 7901 40 U.S.C. § 301 and 121(c) 42 U.S.C. § 238p and § 300u-3 29 C.F.R. § 1960.1 and 1910.151 41 C.F.R. § 102-71.20 and 102-74.230 to 102-74.260 GSA Bulletin FMR C-2024-01 DOJ Policy Memorandum #2024-03

CANCELLATION: None

DISTRIBUTION: Electronically distributed to those referenced in the “SCOPE” section and posted on the DOJ directives electronic repository (SharePoint) at https://doj365.sharepoint.us/sites/jmd-dm/dm/SitePages/Home.aspx

APPROVED BY: Scott Snell Director, Facilities, and Administration Staff https://doj365.sharepoint.us/sites/jmd-dm/dm/SitePages/Home.aspx https://102-71.20 https://1600.00.01

Action Authorized by Date Summary

Initial Document Scott Snell Establishes the Department’s process and procedures for safety station programs in federal facilities.

ACTION LOG

Issuing Component must review its DOJ directives, at a minimum, every 5 years and make revisions as necessary. The action log records dates of approval, recertification, and cancellation, as well as major and minor revisions to this directive and provides a brief summary of all revisions. In the event this directive is cancelled, superseded, or supersedes another directive, that will also be noted in the action log.

TABLE OF CONTENTS

ACTION LOG

TABLE OF CONTENTS

I. Safety Station Program Overview

A. Components of a Safety Station II. Program Management

A. Roles and Responsibilities B. Maintenance C. Training D. Acquisition E. Records Management

III. Safety Station Design A. Safety Station Equipment and Supplies B. Safety Station Placement C. Safety Station Protocols

IV. Waste Management A. Disposal and Replacement

V. Legal

DEFINITIONS

Term Definition

Automated External Defibrillator (AED)

A machine that can detect an abnormal cardiac rhythm and delivers treatment with a shock to eliminate the abnormal rhythm. This allows the heart to resume a normal rhythm.

Cardiopulmonary Resuscitation (CPR)

An emergency lifesaving procedure performed when the heart stops beating. It consists of providing compressions and giving breaths.

Immediate CPR can double or even triple the chances of survival after cardiac arrest.

Component An office, board, division, or bureau of the Department of Justice listed at 28 C.F.R. § 0.1, or any other entity included in the official Department of Justice organizational chart, including the Office of the Inspector General.

Defibrillation The use of an electric current to help the heart return to a normal rhythm.

Hemorrhage The medical term for bleeding. It most often refers to excessive bleeding.

Intranasal Occurring within or administered through the nose.

Law Enforcement Component

The Federal Bureau of Investigation; the Bureau of Prisons;, the Bureau of Alcohol, Tobacco, Firearms and Explosives; the Drug Enforcement Administration; and the United States Marshals Service.

Naloxone A life-saving medication that can reverse an overdose from opioids, including heroin, fentanyl, and prescription opioid medication, when given in time. There are two forms of naloxone that anyone can use without medical training or authorization: prefilled nasal spray and injectable.

Opioid A class of drugs used to reduce pain. They include synthetic opioids, such as fentanyl; pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine; and the illegal drug heroin.

Opioid Use Disorder Previously known as opioid abuse or opioid dependence, Opioid Use Disorder is a problematic pattern of opioid use leading to clinically significant impairment or distress.

Personal Protective Equipment (PPE)

Equipment that is worn to minimize exposure to hazards that cause serious workplace injuries and illnesses.

Term Definition

Public Facing Facility

A component location where the primary mission is to service and interact with the public conducting personal business (e.g., Immigration Courts, United States Trustees Offices, United States Attorneys’ Offices).

Risk Assessment A process used to identify potential hazards and evaluating any associated risks within a workplace, then implementing reasonable control measures to remove or reduce the hazards.

Safety Station Program

Program that encompasses the procurement and installation of safety station components (Automated External Defibrillator, opioid reversal agent, and hemorrhagic control), the protocols and procedures of their use, and training of employees.

Sudden Cardiac Arrest

The sudden loss of all heart activity due to an irregular heart rhythm.

This abnormal rhythm causes the heart to quiver so that it can no longer pump blood to the brain, lungs, and other organs. Within seconds, the person becomes unresponsive and is not breathing or is only gasping. Death occurs within minutes if the victim does not receive immediate lifesaving treatment.

Ventricular Fibrillation

A condition in which there is uncoordinated contraction of the heart muscle. This is when the heart's lower chambers suddenly start beating chaotically and do not pump blood.

ACRONYMS

Acronym Meaning

ADA Americans with Disability Act

AED Automated External Defibrillator

CAT Combat Application Tourniquet

CDC Centers for Disease Control and Prevention

CPR Cardiopulmonary Resuscitation

CoTCCC Committee on Tactical Combat Casualty Care

DEA Drug Enforcement Administration

Acronym Meaning

DOJ Department of Justice

EMS Emergency Medical Services

EPA Environmental Protection Agency

FDA Food and Drug Administration

GSA General Services Administration

HHS Department of Health and Human Services

LE Law Enforcement

PPE Personal Protective Equipment

SCA Sudden Cardiac Arrest

STB Stop the Bleed

VA Department of Veteran Affairs

I. Safety Station Program Overview

The Department of Justice (DOJ) is committed to providing a safe and healthy work environment. In pursuit of this goal, law enforcement (LE) components and components located in public facing federal facilities are required to establish safety station programs. All other components must conduct a risk assessment to determine whether their facilities require implementation of a safety station program.

The safety station program is based on guidance in the General Services Administration (GSA) and Department of Health and Human Services (HHS) jointly issued Bulletin, FMR C–2024–01, Safety Station Program Guidelines in Federal Facilities (Dec. 21, 2023). A safety station incorporates three modular bystander-empowered components: automated external defibrillator (AED), opioid reversal agents (such as naloxone), and/or hemorrhagic control (such as Stop the Bleed® kits).

All components implementing safety station programs must develop written policies or procedures that meet or exceed the requirements in this Instruction.

Additionally, safety station programs must include training in first aid and cardiopulmonary resuscitation (CPR)/AED, opioid reversal agents, and hemorrhagic control as described in section II.C.

A. Components of a Safety Station

1. Automated External Defibrillator

Each safety station program must include an AED that is accessible to employees and supporting equipment (such as unexpired defibrillation pads). The AED should be inspected regularly by assigned employees or contractors as required by section

II.B.

2. Opioid Reversal Agent

Naloxone is an approved medication by the Food and Drug Administration (FDA) to rapidly reverse opioid overdose. In March 2023, the FDA approved naloxone nasal spray as the first over the counter opioid reversal agent. All safety stations programs must include naloxone or another within expiry date FDA-approved opioid reversal nasal spray product.

3. Hemorrhagic Control

The Stop the Bleed® (STB) program is a good resource for components in developing the hemorrhagic control components of their safety station. It expands bleeding control principles by informing, educating, and empowering the public to serve as immediate responders. Providing bystanders with the tools and information on the simple steps they can take in an emergency to stop life threatening bleeding can save lives. All safety stations programs must include STB kits or other hemorrhagic control kits.

II. Program Management

Components with safety station programs must have written standard operating procedures that are specific to their worksites.

A. Roles and Responsibilities

1. Heads of Components

Heads of Components or their designees are responsible for the implementation and oversight of their components’ safety station programs.

2. Medical Director

A medical director may be designated to review, approve, and oversee component medical treatment protocols, training recommendations, quality control measures, and/or post-incident reviews. This may include consideration of additional state and local rules, regulations, and protocols. Medical oversight can be provided either by a facility’s own physician, through existing federal resources, or by a contracting physician, in accordance with applicable federal laws. A medical director can provide expertise related to the use of safety station components.

B. Maintenance

Routine checks of equipment contents and integrity should be included in the safety station program protocols. The program should be evaluated periodically and assessed for new risks. Plan for maintaining equipment and restocking expended supplies, expired supplies (including replacement of expired opioid reversal agents), other consumable first aid supplies, personal protective equipment (PPE), and malfunctioned accessories.

1. AED

An AED maintenance schedule is necessary to keep the device and its accessories properly functioning. Maintenance requirements vary among AED models.

Manufacturer recommendations should be followed.

2. Opioid Reversal Agent

An intranasal opioid reversal agent should be kept in the box or storage container until ready for use. It should be protected from light and stored at room temperature (59 – 77 °F or 15 - 25° C). The expiration date should be noted, and replacement should be made when it has expired.

3. Hemorrhagic Control

The shelf life of most supplies and equipment in the kits is undated. However, hemostatic dressings have shelf lives that require tracking for expiration date and replacement. Kits should be checked on a regular basis to monitor for unrecognized use, tampering, and degradation due to environmental exposure.

C. Training

Training in first aid/cardiopulmonary resuscitation (CPR)/AED, use of opioid reversal agents, and hemorrhagic control must be included as part of a component’s safety station program. The greater the number of well-trained lay responders and rescuers that are available, the more effective a safety station program will be.

In facilities where there are enough personnel to permit in-house training programs, a routine training schedule should be established. An additional benefit of in-house training is that training in groups that correspond closely with work groups tends to build a better sense of team and responsibility than would individual, separate training.

Training should not be a one-time event. Formal training should be conducted at least every two years, or as recommended by the nationally recognized training organization (e.g., American Red Cross, American Heart Association) used by the DOJ component for the component’s training program. Also, mock drills and refresher sessions are important to maintain knowledge and skills. Mock drills are recommended on an annual basis, and they should be reviewed by the program’s medical director.

DOJ components should identify first responders or existing emergency response resources, such as building security. All training should also include a section that describes and explains the facility-specific program. It is important that all employees are educated regarding the existence and activation of the safety station program.

1. AED

Training employees increases the potential to reduce response times and increase the probability of survival and full recovery. Nationally recognized training organizations, such as the American Heart Association and American Red Cross, provide comprehensive AED and CPR training with certifications every 2 years.

The training teaches the latest life-saving techniques in emergency situations, including:

a. Ability to recognize a cardiac event and administer CPR chest compression and artificial ventilation.

b. Knowledge of administering an electric shock to the heart using AED equipment.

2. Opioid Reversal Agent

Training employees to know the signs of an opioid overdose and how to use an opioid reversal agent alleviates concerns that employees may have in administering an opioid reversal agent on an individual. The training should enable employees to:

a. Recognize the signs and symptoms of an opioid overdose.

b. The appropriate care to provide based on the person's breathing and level of responsiveness.

c. How to give naloxone using several different products to reverse the effects of an opioid overdose.

3. Hemorrhagic Control

Training should include knowledge on how to use the items in the hemorrhagic/bleeding control kit. The STB course trains on three quick techniques to help save a life before someone bleeds out, including:

a. How to use your hands to apply pressure to a wound.

b. How to pack a wound to control bleeding.

c. How to correctly apply a tourniquet.

D. Acquisition

The costs and expenses to establish and operate the safety station program are the responsibility of the DOJ component and each component must coordinate with its authorized acquisition professional (contracting officer or equivalent) when purchasing the supplies and equipment.

1. Federal Acquisition Vehicles

There are several federal acquisition vehicles that may be used in the establishment or maintenance of a safety station, such as:

a. GSA Global Supply Ordering Site – offers AED and STB kits and contains a search functionality to find a specific product for a safety station.

b. GSA Advantage – offers AED and STB kits and contains a search functionality to find a specific product for a safety station.

c. GSA Federal Supply Schedule – offers STB kits.

d. U.S. Department of Veterans Affairs (VA) Federal Supply Schedule – find contracts for items for a safety station.

e. VA Contract Catalog – find contracts for items for a safety station.

f. Defense Logistics Agency Medical Electronic Catalog – an e-commerce acquisition program that offers 1.1 million medical items from 215 vendors across the United States.

g. HHS Medical Supply Fulfillment and Support – offers opioid reversal agents.

2. Environmental Preferable Purchasing

The Environmental Protection Agency (EPA) Recommendations of Specifications, Standards, and Ecolabels for Federal Purchasing helps federal purchasers identify and purchase environmentally preferable products and services. It is recommended, where applicable and feasible, to procure healthcare products and services per EPA’s guidance to minimize the safety station program’s environmental footprint at a federal facility.

E. Records Management

All safety station program records should be maintained by the DOJ component.

a. Training Records https://www.gsaglobalsupply.gsa.gov/ https://www.gsaadvantage.gov/ https://www.gsa.gov/buy-through-us/purchasing-programs/gsa-multiple-award-schedule https://www.va.gov/opal/nac/fss/schedules.asp https://www.vendorportal.ecms.va.gov/nac/ https://www.medical.dla.mil/Portal/ECAT/EquipmentECAT.aspx https://www.hhs.gov/about/agencies/asa/psc/supply-chain-management/medical-supply-fulfillment-support/index.html https://www.epa.gov/greenerproducts/recommendations-specifications-standards-and-ecolabels-federal-purchasing https://www.epa.gov/greenerproducts/recommendations-specifications-standards-and-ecolabels-federal-purchasing

All training certifications should be maintained. DOJ components should maintain an active list of current certified/trained employees.

b. Maintenance Records

All maintenance and checks of safety station equipment should be maintained.

c. Incident Records

An incident form or report should be used by the DOJ component to document incidents when the safety station is deployed. Additional notifications may be needed, to include the following:

a. All work-related injuries and/or illnesses should be documented on the OSHA Form 301- Injury and Illness Incident Report via ECOMP at www.ecomp.dol.gov.

b. Your building’s security organization may also need to be notified of a medical emergency.

III. Safety Station Design

DOJ components should assess their facilities to determine the best design for their safety station program.

A. Safety Station Equipment and Supplies

1. PPE

The following PPE should be stored with other safety station supplies for responder safety: disposable nitrile gloves, CPR rescue mask, face shield or bag valve mask, and safety glasses.

2. AED

Select FDA-approved AEDs and AED accessories, which can be checked at the following links: FDA-approved AEDs and FDA-approved AED accessories.

Each AED device typically includes a battery and two sets of electrode pads.

Additional supplies may include an alarmed AED wall cabinet, AED carrying case, AED wall sign, AED check tags, and a rescue ready kit (which includes CPR mask, scissors, razor, and nitrile gloves).

3. Opioid Reversal Agent http://www.ecomp.dol.gov/ https://www.fda.gov/medical-devices/cardiovascular-devices/automated-external-defibrillators-aeds#approved https://www.fda.gov/medical-devices/cardiovascular-devices/automated-external-defibrillators-aeds#accessories

It is recommended to have at least two doses of an intranasal opioid reversal agent per safety station. The size, layout, and accessibility of the workplace may require placement of doses in multiple locations. Consider the time needed to replace supplies when determining the number of doses to stock. Some workplaces may choose to stock more than two doses per safety station depending on risk assessment.

4. Hemorrhagic Control

Hemorrhagic or bleeding control kits have standardized supplies. Each kit will typically contain a tourniquet, an instructional booklet or pamphlet, assorted dressings, some form of hemostatic gauze or agent, a chest seal, trauma shears, an emergency survival blanket, and a miniature permanent marker.

a. Wound Management Supplies

Bleeding control gauze dressings should include hemostatic dressings, and/or compression-type pressure dressings. Dressings can be placed over the wound while providing manual pressure or packed directly into bleeding wounds. Hemostatic dressings contain compounds that promote the clotting of blood and facilitate timely control of bleeding. Compression-type pressure dressings may also be included as additional treatments to allow for pressure to be maintained.

b. Chest Seal

A Chest Seal is used for the treatment of penetrating injuries to the chest.

c. Tourniquet

Effective tourniquets are commercially manufactured, and they should be aligned with the Committee on Tactical Combat Casualty Care (CoTCCC) Recommended Devices & Adjuncts, such as the Combat Application Tourniquet (CAT).

d. Support Equipment

This typically includes disposable nitrile gloves, instructions for lay people, trauma shears, an emergency blanket, and a permanent marker.

B. Safety Station Location

Not all components of the safety station (AED, opioid reversal agent, and hemorrhagic control) need to be co-located. Law enforcement components may consider mobile safety station components depending on their mission needs.

For stationary safety stations, components should consider the following elements to determine the appropriate number and location of safety stations:

1. Multi-Tenant Facilities

Components in multi-tenant facilities with non-DOJ tenants may install safety stations in their own spaces. They should coordinate with the building management, the primary tenant, or other facility officials when establishing their safety station program. If building alterations are necessary to accommodate the placement of safety stations in facilities under the jurisdiction, custody, or control of GSA, GSA should be notified. If a facility already has a component of a safety station, that may satisfy the requirement for that safety station component in that facility. For example, if a facility already has an AED, then the safety station program need only ensure that an opioid reversal agent and hemorrhagic control be accessible at that location.

2. Response Time

Placement of safety station components should enable an optimal response time of three minutes or less. This interval begins from the moment a person is identified as needing emergency care to when the safety station component is deployed and is at the side of the victim. The ability to quickly respond to an event increases the chance of survival for an individual experiencing cardiac arrest, an opioid overdose, or hemorrhagic incident.

3. Visitors

Facilities that host large numbers of visitors are more likely to experience an event. An appraisal of the demographics of visitors should be included in an assessment.

4. Specialty Areas

Facilities where strenuous work is conducted are more likely to experience an event. Additionally, specialty areas within facilities, such as exercise and workout rooms, should be considered to have a higher risk of a cardiac event than areas where there is minimal physical activity. For this reason, additional AEDs can be considered for areas such as a fitness room or larger meeting spaces.

5. Physical Layout of Facility

The response time should be calculated based on how long it will take a lay responder to walk at a rapid pace to reach a victim with the necessary safety station component. Large facilities and buildings with unusual designs, elevators, campuses with separate buildings, and physical impediments may present unique challenges.

6. Americans with Disability Act Accessibility Guidelines

The safety station should satisfy accessibility requirements of the Americans with Disability Act (ADA). For safety equipment with an unobstructed approach, the maximum forward reach to the equipment is 48 inches above the floor. Objects shall not protrude more than 4 inches from the wall into walkways, corridors, passageways, or aisles.

7. Security

Safety stations should be placed in a secure location that prevents or minimizes the potential for tampering, theft, or misuse. Facilities should take steps to ensure the safety station will not be stolen or improperly removed.

C. Safety Station Protocols

Protocols should clearly address procedures for activating local Emergency Medical Services (EMS) and notifying your building’s security organization. DOJ facilities may need to coordinate building access for first responders as they arrive on scene.

1. Protocols should include information on the quantity, brands/models, and location of AEDs within the facility.

2. It is best practice that a security or control center be automatically notified when equipment is removed from the safety station.

IV. Waste Management

Always follow manufacturer instructions for storing and disposing of AEDs, opioid reversal agents, and hemorrhagic control kits. Safety station components should be kept in the box or storage container until ready for use.

A. Disposal and Replacement

1. PPE

Nitrile gloves should be replaced every five years to ensure that they do not tear or break when needed.

2. AED

An AED typically lasts 5 to 15 years on average, based on how it was stored and how well it was maintained. AED and AED accessories should be disposed of or recycled according to federal, state, and local regulations. It is recommended to dispose of all end-of-life AEDs through an accredited electronics recycling facility. AED batteries containing lithium, which, when spent, are classified as universal waste by the EPA. Lithium batteries should be recycled or disposed of properly per EPA recommendations.

3. Opioid Reversal Agent

An opioid reversal agent must be disposed of before the expiration date or after it has been used. The Drug Enforcement Administration (DEA) has authorized permanent collection sites to safely and securely gather and dispose of unused or expired medications. An authorized drug collection site may be located through the following website:

https://apps.deadiversion.usdoj.gov/pubdispsearch/spring/main?execution=e1s1 or by calling the DEA Diversion Control Registration Call Center at 1-800-882- 9593. DEA also hosts National Prescription Take Back events every April and October. More information can be found on the following website:

https://www.dea.gov/takebackday.

4. Hemorrhagic Control

Hemostatic dressings should be replaced when they expire. All other supplies of the hemorrhagic control kits do not expire but should be replaced if they are broken or no longer usable.

V. Legal

A component’s safety station program should be reviewed by legal counsel to ensure that the program follows all applicable federal laws.

https://www.epa.gov/smm-electronics/certified-electronics-recyclers https://www.epa.gov/smm-electronics/certified-electronics-recyclers https://www.epa.gov/recycle/frequent-questions-lithium-ion-batteries https://www.epa.gov/recycle/frequent-questions-lithium-ion-batteries https://apps.deadiversion.usdoj.gov/pubdispsearch/spring/main?execution=e1s1 https://www.dea.gov/takebackday

V. Legal