Infection Control and Medical Response Safety Program

This program is the written, auditable system that keeps members from catching what their patients have, from being stuck, splashed or infected on a medical call, from being hurt lifting and moving people, and from carrying any of it back to the station or home. When it is working, every member who touches a patient has gloves on first and the right eye, face and respiratory protection for the task; every member who may do airway work has a current fit test for an N95; every member is offered the immunizations the standard lists and the department knows who is immune to hepatitis B; every needle in every kit is a safety-engineered device and no one recaps; every exposure to blood or body fluid is washed, reported within the hour, and followed up by a designated officer who knows the clocks for prophylaxis; every piece of equipment and every apparatus that touched a patient is cleaned with the right product for the right time before the next call; and every exposure, lift injury, near miss and outbreak lesson is reviewed and fed back to the people who do the work. The program is owned by a line officer through the Medical First Response Program Improvement Team, with a clinician adviser, verified by the health and safety officer, and consulted on by the JOHSC.

This module answers Program Profile Worksheet Part B (“Does the department provide medical first response, and at what level?”) and Part C module 8 (01 Program Profile Worksheet). It is Required for any department that provides medical first response, and Conditional for every other department, because fire crews treat injured members of the public, injured members and injured contractors at every kind of incident whether or not they are a designated medical agency. A Conditional department adopts elements 5.1 to 5.8, 5.11 and 5.13 at minimum (program, routine practices, PPE, sharps, exposure response, immunization, cleaning, patient handling) and switches off the medical first response governance element 5.12. The level of medical response (first aid only; medical first responder; emergency medical responder or higher) sets the PPE matrix rows and the training in section 6; record the level in the Profile Worksheet.

Terms used in this note, consistent with 06 Glossary and Acronyms.

• Aerosol-generating procedure. A patient-care task that produces fine airborne droplets, such as bag-valve-mask ventilation, suction, cardiopulmonary resuscitation or nebulized medication (Public Health Agency of Canada, 2017).
• Additional precautions. Controls applied on top of routine practices for a patient’s known or suspected mode of transmission: contact, droplet or airborne (Public Health Agency of Canada, 2017).
• Designated infection control officer. The person appointed in writing to run the infection control program and manage exposure follow-up; the health and safety officer may hold the role (NFPA 1550, 2024, s. 4.13).
• Exposure. A percutaneous injury, or contact of blood or a body fluid with a mucous membrane or non-intact skin, or unprotected contact with a patient under airborne or droplet precautions (NFPA 1580, 2025).
• Immune status. The documented result of immunization or post-series antibody testing, recorded as immune, non-responder, pending or declined (Public Health Agency of Canada, 2024).
• Medical first response. Pre-hospital patient care delivered by the fire department under an agreement with the provincial or territorial emergency health services provider, within a defined clinical scope.
• Point-of-care risk assessment. The three-question check a member makes before every patient contact: what am I about to do, what does the patient have, where am I (Public Health Agency of Canada, 2017).
• Post-exposure prophylaxis. Medication or immune globulin given after an exposure to prevent infection, such as antiretroviral drugs for HIV or hepatitis B immune globulin (Public Health Agency of Canada, 2024).
• Routine practices. The infection prevention measures used with every patient, every time: hand hygiene, point-of-care risk assessment, gloves and barrier protection as the task requires, respiratory etiquette, safe sharps handling and cleaning (Public Health Agency of Canada, 2017).
• Safety-engineered device. A needle or lancet with a built-in feature that shields or retracts the sharp after use (CSA Z316.6-20).
• Source patient. The person whose blood or body fluid a member was exposed to; testing of the source is by consent through the receiving facility unless a statute provides otherwise (J25 Infection Control and Medical First Response).

A note on standard numbers. NFPA 1581 (infection control) was consolidated into NFPA 1580 (2025) together with the medical, fitness and rehabilitation standards (NFPA 1580, 2025). NFPA 1585 (2025) covers exposure and contamination control for fireground contaminants and expressly excludes infectious disease (NFPA 1585, 2025); it is not the standard for this program. Full citations are in 02 Standards and Law Master Map.

R = responsible, A = accountable (one per row), C = consulted, I = informed. Generic roles are defined in 01 Roles and Responsibilities; team roles in 06 Program Improvement Teams.

Each element states the requirement, the minimum method, the evidence or record, and the stage.

Requirement. The department must have this program in writing, approved by the fire chief, consulted on with the JOHSC, reviewed within 12 months and at least every three years after that, and must appoint in writing a designated infection control officer with the authority to direct post-exposure follow-up, remove contaminated equipment from service, order cleaning, and recommend PPE escalation during an outbreak (NFPA 1580, 2025). A 24/7 exposure reporting line must be published in every station and on every apparatus. (S1)

Minimum method. Adopt this note; complete the placeholders; file the JOHSC consultation record; appoint the officer by memo with a named alternate; post the reporting number on the exposure kit on every apparatus and on the station notice board; list the program in the document register (05 Document Control and Records).

Evidence. Signed program; appointment memo; posted reporting number; JOHSC minutes.

Requirement. A written assessment must list every task with a risk of exposure to blood, body fluids, respiratory pathogens, skin infestations or contaminated sharps, rate the route and likelihood, and set the controls and PPE for each (NFPA 1580, 2025). It must be reviewed annually, after any exposure event, and whenever public health declares a respiratory outbreak. (S1)

Minimum method. Complete toolkit T5 (PPE matrix by task) from the seed rows; add tasks the department performs that are not listed; review at the team’s annual appraisal and after each exposure.

Evidence. Completed T5 with review dates.

Requirement. Members must treat every patient’s blood and body fluids as infectious (routine practices): hand hygiene before and after every patient contact and after glove removal; gloves for any contact with blood, body fluids, mucous membranes, non-intact skin or contaminated surfaces; a point-of-care risk assessment before every contact that asks what the task is, what the patient’s presentation is, and what the environment is; respiratory etiquette and a surgical mask on any patient with cough or fever who can tolerate it (Public Health Agency of Canada, 2017). Additional precautions apply by presentation: contact (gown and gloves for draining wounds, vomiting, diarrhoea, known resistant organisms, scabies or bed bugs), droplet (eye and face protection within two metres of a coughing patient), airborne (fit-tested N95 or better for suspected tuberculosis, measles, varicella, and for any aerosol-generating procedure) (Public Health Agency of Canada, 2017). (S1)

Minimum method. The point-of-care risk assessment is three questions on the SWP card: What am I about to do? What does the patient have? Where am I? Alcohol-based hand rub on every apparatus and in every kit; handwashing within the hour at the station. SWP - Infection Control and Post-Exposure carries the steps.

Evidence. Hand rub in kit checks; SWP sign-off; observation at drills.

Requirement. The PPE matrix (toolkit T5) sets the minimum for each task. The fixed rules: gloves before any patient contact, always; eye protection (sealed goggles or face shield) for any airway work and any task with splash risk; a fluid-resistant gown or coveralls for gross contamination; a fit-tested N95 filtering facepiece or an elastomeric half-mask with P100 filters for suspected respiratory infection, for aerosol-generating procedures (bag-valve-mask ventilation, suction, cardiopulmonary resuscitation, nebulized medication) and during a declared respiratory outbreak (Public Health Agency of Canada, 2017; NFPA 1580, 2025); a surgical mask on the patient when tolerated; structural firefighting gloves are not patient-care gloves. Every member who may do airway work must hold a current fit test for the N95 model the department stocks (CSA Z94.4-18, cl. 9), under the Respiratory Protection Program and SWP - Respirator Fit Testing, recorded on Form - Fit Test Record. PPE stocks must be checked for expiry and rotated. (S1)

Minimum method. Stock each apparatus and kit to toolkit T6; fit test every medical responder annually against the stocked N95 model, and whenever the model changes; keep a clean-shaven rule for N95 wearers consistent with the respiratory program (CSA Z94.4-18, cl. 9.2.2); teach donning and doffing order (gloves last on, first off; hand hygiene between steps) at recruit and annually.

Evidence. Fit test register; kit checks; training records.

Requirement. Only safety-engineered needles and lancets may be stocked (CSA Z316.6-20). Members must never recap a needle. A sharps container meeting the Canadian standard (CSA Z316.6-20) must be in every medical kit and secured on every apparatus, used at the point of care, and replaced when three-quarters full. Members must assume sharps are present in any home, vehicle, encampment or clothing they search, and must not reach where they cannot see. (S1)

Minimum method. Specify safety devices in the medical supply standard through the Equipment Standards team; check containers on the weekly kit check (toolkit T6); teach “look, then touch” for patient searches; keep tongs or a sharps pick-up tool on each apparatus for needles found at scenes; dispose of full containers through the biomedical waste contractor or the receiving hospital by agreement.

Evidence. Supply standard; kit check sheets; disposal records.

Requirement. An exposure is any percutaneous injury (needle-stick, cut with a contaminated object, bite that breaks skin), any contact of blood or body fluid with a mucous membrane (eyes, nose, mouth) or non-intact skin, and any unprotected exposure to a patient with a suspected airborne or droplet infection (NFPA 1580, 2025). The member must give first aid at once (wash skin with soap and water; flush eyes, nose or mouth with water or saline for several minutes; do not squeeze or scrub a wound), tell the officer, and report to the designated officer within one hour. The designated officer must open Form - Body Fluid Exposure Report and Post-Exposure Checklist, direct the member to the post-exposure clinic or emergency department, request source patient testing through the receiving hospital or the EHS provider, and track the clocks: HIV post-exposure prophylaxis is most effective when started within two hours and is not generally started after 72 hours; hepatitis B immune globulin for a non-immune member is given within seven days with vaccine (Public Health Agency of Canada, 2024, hepatitis B chapter); hepatitis C has no prophylaxis and needs baseline and follow-up testing; tuberculosis contact follow-up runs through public health. Follow-up serology is commonly at six weeks, three months and six months. The department never receives the member’s diagnostic results, only confirmation that follow-up is in place. (S1)

Minimum method. Toolkit T2 and T3 (report fields and the officer’s checklist); exposure kit on every apparatus with the form, the clinic address, the reporting number and eye-wash saline; agreement with the receiving hospitals on source testing requests; the workers’ compensation report filed within the applicable deadline (J08 Incident Reporting and Investigation; SWP - Exposure Reporting, Form - Exposure Report for the general exposure record); learning triage under Incident Investigation and Learning Program.

Evidence. Completed forms with the clock times; clinic confirmation; compensation report date; annual exposure review at the JOHSC.

Requirement. The department must offer, at its cost and on duty time, the immunizations the Canadian Immunization Guide lists for first responders: hepatitis B series with post-series antibody testing one to six months after the last dose, annual influenza (National Advisory Committee on Immunization, 2025), tetanus-diphtheria-pertussis with adult boosters, measles-mumps-rubella and varicella where not immune (Public Health Agency of Canada, 2024, Part 3 and hepatitis B chapter), and COVID-19 per current national guidance. Tuberculosis screening is done on hire and after exposure (NFPA 1580, 2025). A member may decline in writing; the declination is kept with the immunity record and the member may change their mind at any time. The department must know which members are immune to hepatitis B, because that fact changes the post-exposure decision (Public Health Agency of Canada, 2024, hepatitis B chapter). (S1)

Minimum method. Toolkit T7 record fields, kept by the designated officer or the occupational health provider; a candidate medical under Medical, Fitness and Wellness Program captures immunity status at hire; an annual campaign for influenza and COVID-19 at stations and volunteer halls; the immunity list reconciled annually.

Evidence. Immunity register (status only, with the custodian holding the clinical record); declination forms; campaign records.

Requirement. After every patient contact, members must clean and disinfect the equipment used (monitor, bag-valve-mask, suction, stair chair, cot or carry device, stethoscope, pulse oximeter, radios and the apparatus surfaces touched) with a disinfectant that carries a Health Canada Drug Identification Number, applied for the labelled contact time, before the equipment returns to service (NFPA 1580, 2025). Single-use items are discarded. Contaminated uniforms are bagged at the scene, laundered at the station in the designated machine, and never taken home. Each station must have a decontamination area with a sink and a laundry separate from the kitchen, dormitory and living areas (NFPA 1580, 2025), consistent with Facilities and Station Safety Program and Decontamination and Contamination Control Program. Biomedical waste (sharps, blood-soaked materials) goes in labelled containers to a licensed contractor or receiving hospital by agreement; it never goes in station garbage. (S1)

Minimum method. Toolkit T4 disinfection log per apparatus; the product list with contact times posted in the decon area; a weekly check of disinfectant stock and expiry; the WHMIS data sheet for each product on file; apparatus cab and patient compartment surfaces wiped after each patient contact and deep cleaned weekly.

Evidence. Disinfection logs; product list; station inspection findings.

Requirement. The department must have a written respiratory outbreak protocol that can be activated on notice from public health, with: triggers and the person who activates it; PPE escalation (N95 for all patient contacts; eye protection at all times; gowns per presentation) (Public Health Agency of Canada, 2017); screening questions relayed by dispatch to crews; crew cohorting and reduced station crossover; station visitor and public access limits; increased cleaning frequency; a PPE reserve sufficient for 90 days at outbreak consumption rates; a vaccination campaign plan; a sick-leave rule that keeps symptomatic members home without penalty; return-to-work criteria agreed with the occupational health provider; and a plan for the volunteer stations, where members come from the community every day. (S1 written; S2 exercised)

Minimum method. Toolkit T8 readiness checklist reviewed annually before respiratory season; reserve stock counted quarterly; one tabletop exercise a year; after any activation, a Tier 2 Post-Incident Analysis.

Evidence. Protocol; reserve count; exercise record; activation review.

Requirement. Where the department carries naloxone, members must be trained to the applicable medical first response protocol for opioid poisoning (J25 Infection Control and Medical First Response), and naloxone must be checked and in date on every kit check (Health Canada, 2016). Scene safety on an overdose call combines three things: the violence controls (a patient who wakes after naloxone may be agitated, frightened or aggressive: stand back, speak calmly, keep the exit clear, and stage for police where the scene is unsafe, under SWP - Violent Scene Staging); routine practices (gloves; an N95 and eye protection only where visible powder may become airborne, such as a drug-preparation surface being disturbed); and accurate risk information: the evidence is that dermal contact with fentanyl and its analogues carries very low risk of poisoning, that brief incidental contact does not cause overdose, and that members who feel unwell at an overdose scene are far more likely to be experiencing anxiety or exertion than opioid toxicity (American College of Medical Toxicology, 2017)DOI. The program does not repeat “touch overdose” stories, because fear-driven responses delay patient care and feed stigma. Members who believe they have been exposed report it as an exposure (5.6) and are assessed. Clandestine laboratory and encampment awareness, and the chemical hazards of drug production, belong to Hazardous Materials, CBRN and Energy Hazards Program. (S1)

Minimum method. Naloxone in the kit standard; protocol training with the medical first response certification; an annual scene-safety refresher using a learning-team session with crews who run these calls; the exposure form used for any reported contact.

Evidence. Kit checks; training records; exposure reports.

Requirement. Lifting and moving patients is a leading source of musculoskeletal injury on medical calls. The department must assess the lifting tasks members do, provide lifting aids (stair chair, scoop stretcher, slide sheets, soft stretchers, and where the department transports or regularly assists transport, a powered cot and lift), set a two-person minimum for any patient lift and a call for additional resources for bariatric patients and stairs, and train members in body mechanics and the use of each aid. The assessment and the controls are managed under an ergonomics process consistent with CSA Z1004:24. (S1 for the two-person rule and aids; S2 for the Z1004 process)

Minimum method. Toolkit T5 lifting rows; a bariatric response plan with the EHS provider; lift injuries investigated as injuries with a learning-team session; equipment on the Equipment Standards list.

Evidence. Lifting aids on apparatus; training records; injury trend reviewed quarterly.

Requirement. Where the department provides medical first response, it must do so under a written agreement with the provincial or territorial emergency health services provider that sets the clinical scope, the protocols, medical oversight by {{Medical Director}}, certification and recertification, quality review of patient care records, equipment and medication standards, and incident reporting (J25 Infection Control and Medical First Response). The department must handle oxygen cylinders as compressed gas (secured, valves protected, no oil, stored away from heat) (MLITSD, n.d., GN 1-9), check automated external defibrillators and oxygen daily, and keep patient care records confidential under Policy - Records, Privacy and Health Information. Calls involving children, deaths, violence or multiple casualties are flagged for the check-in and support path in Psychological Health and Safety and Peer Support Program. (S1 where medical first response is provided)

Minimum method. Agreement on file; certification tracked by the training division; daily apparatus check includes AED and oxygen; quality review results summarized to the team quarterly without member names.

Evidence. Agreement; certification register; apparatus checks; quality review summaries.

Requirement. Medical calls carry the department’s highest violence exposure. Members must stage for calls flagged as violent or unknown-safety until police declare the scene secure, must keep an exit and crew integrity, and must disengage and withdraw when a patient or bystander becomes a threat. The controls, the training and the reporting are in Workplace Violence and Harassment Program and SWP - Violent Scene Staging; this program adds the clinical piece: a patient in crisis, in withdrawal, hypoglycemic, post-ictal or post-naloxone can be aggressive without intent, and de-escalation is patient care. (S1)

Minimum method. The violence SWP on every apparatus; the de-escalation module in medical first response training; every assault or threat reported through the violence program and counted here as a medical-call indicator.

Evidence. Reports; training records.

Requirement. The department must keep: the risk assessment; PPE matrix; fit test records; immunity register and declinations; exposure reports and the officer’s checklists; disinfection logs; kit checks; training and certification records; outbreak protocol and exercise records; quality review summaries (NFPA 1580, 2025). Exposure records must be kept for the length of service plus 30 years, the benchmark of the United States occupational exposure records rule (OSHA, n.d.-a, 29 C.F.R. § 1910.1020), unless your jurisdiction sets a longer period (J09 Records Retention), because an infectious disease claim may surface decades later. Immunity and exposure records are health information: held by the designated officer or the occupational health provider, separate from personnel files, access limited to the officer, the provider and the member. (S1)

Evidence. Records in {{Records system}} with the retention schedule in 05 Document Control and Records.

Requirement. The Medical First Response team reviews the indicators quarterly and the whole program annually with the appraisal, including every exposure of the year (de-identified), every lift injury, every outbreak activation and every violence event on a medical call, and presents the review to the JOHSC. (S2)

Evidence. Quarterly updates; annual appraisal; JOHSC minutes.

Infection control is the program members most often quietly adapt. Gloves go on late because the patient is already bleeding; the mask stays in the pocket because the call sounded routine; a needle gets recapped because there was no container within reach; a uniform goes home because the station washer was full. Every one of those is a signal about the conditions, not the member (Hollnagel, 2014). This section is how the program listens to them.

(a) Work-as-done. Before the team writes or changes any step in this program, it runs a learning-team session with members who run medical calls at career and volunteer stations (Conklin, 2012): how PPE actually gets on in the first minute of a cardiac arrest; what happens to a sharps container in a cramped bathroom; who really cleans the monitor at 03:00 and where; how a volunteer gets to the post-exposure clinic 60 kilometres away on a Sunday; what members believe happens when they report a needle-stick. The procedure and the kit layout are designed from that description. The PPE matrix rows that members cannot follow in real conditions are redesigned, not re-issued with a memo.

(b) Capacity and margins. The work goes right most days because crews cue each other (“gloves”), kits are laid out the same way on every apparatus, hand rub is within reach, and members know their patients’ presentations from dispatch (Hollnagel, 2014). That capacity erodes when kits are restocked differently at different stations, when dispatch information does not reach the crew, when the station has no clean place to decontaminate, when PPE sizes do not fit everyone, and when a shift is short so the same two people lift every patient. The program protects the margin through the standard kit layout, dispatch screening, the facility requirement, a full size range in stock, and the two-person lift rule backed by a call for more hands.

(c) Just culture. A member who missed a glove, recapped a needle or took a uniform home has usually done the sensible thing under the conditions (Dekker, 2016). The learning firewall applies: what members say in learning teams, exposure reports and after-action reviews is used to fix conditions and is never the basis for discipline. The exposure report is a medical pathway, not a performance record; a member is never made to explain an exposure in front of the crew. Conduct concerns (deliberate contamination, falsifying an immunization record, refusing a lawful instruction that protects a patient) go to a separate process run by different people under Policy - Internal Responsibility and Accountability.

(d) Psychological safety. A member speaks up by naming it: “I need gloves before we move her.” “Stop, there is a needle on the floor.” “I got splashed; I need to flush.” “I am not comfortable lifting him with two.” The officer’s response is fixed: acknowledge, act (pause, re-glove, call for hands, start first aid), and review later for learning without naming anyone. Leaders show reporting is safe by reporting their own exposures the same way, by thanking the member who stopped a lift, by sharing each quarter what members reported and what changed because of it, and by never asking “why didn’t you have your gloves on” before “are you all right” (Edmondson, 1999)DOI. An exposure reported within the hour is treated as a success of the system, whatever happened before it.

(e) Learning link. A needle-stick, a splash to the eyes, an assault on a medical call, a lift injury with lost time, or an outbreak transmission inside a station is a Tier 2 Post-Incident Analysis; a death or critical injury on a medical call is Tier 3 Independent Learning Review. A near miss (needle found by hand, PPE breach without exposure, a patient who turned aggressive but no one was hurt) is a Tier 1 After-Action Review by the company officer within 72 hours. The AAR questions after a medical call: “What did we have on, and when did it go on?” “What got in the way of doing it the way we planned?” “What surprised us about the patient or the scene?” “What would make the next one safer?” Method: Incident Investigation and Learning Program and, for the full tiers, Manual 02 - The Three Tiers and Event Triage.

• SWP - Infection Control and Post-Exposure

Procedures this program depends on but does not own: SWP - Violent Scene Staging (Workplace Violence and Harassment); SWP - Respirator Fit Testing (Respiratory Protection); SWP - Exposure Reporting and SWP - Post-Call Station Decontamination (Decontamination and Contamination Control).

Loop test. A volunteer member reports on Monday night that she was splashed in the eye during a bag-valve-mask ventilation and the goggles in the kit were scratched so badly she had not put them on. By the end of the call she has flushed her eye, the officer has called the designated officer, and she is on her way to the post-exposure clinic with the form started. By Tuesday the source testing request is in, the compensation report is filed, and the member has heard what happens next. By Friday the scratched goggles are replaced at that station and the designated officer has asked every station to check theirs; the item is in the register with the Equipment Standards team as owner. Within the quarter, the goggle model has been reviewed with the crews who use it, a change notice has gone to every station, the member’s follow-up schedule is on track, and the item is closed with evidence and reported in the quarterly update and to the JOHSC.

Audit category: Checklist - Infection Control and Medical Response. The five questions an auditor asks first:

1. Show me the exposure reporting number on an apparatus, and tell me who answers it at 02:00 on a Sunday.
2. Show me the last three exposure files. Where are the first-aid time, the one-hour report, the clinic contact and the prophylaxis decision?
3. Pick a member who does airway work. Show me their fit test for the N95 in this kit, and their hepatitis B immunity status.
4. Open this kit. Show me a safety-engineered needle, the sharps container level, the goggles, the hand rub and the naloxone date.
5. Show me the disinfection log for this apparatus for the last ten patient contacts, and the product and contact time used.

An accredited or accrediting department maps the audit findings to the criteria this program answers: infection prevention procedures with an improvement process and exposure records (CPSE, 2019, criteria 11A.4, 11A.10), medical evaluations (CPSE, 2019, criterion CC 11B.1), and for medical first response the protocols, medical control, patient care record, privacy program, quality improvement and annual appraisal (CPSE, 2019, criteria CC 5F.2, CC 5F.4, CC 5F.5, CC 5F.6, 5F.7, CC 5F.9). The annual program appraisal in 06 Program Improvement Teams section 10 is the evidence for the appraisal criterion.

Fire service infection exposures follow a short list of patterns recorded in exposure guidance and investigation reports (MLITSD, n.d., GN 4-14 and GN 2-7). Needle-sticks come from recapping, from searching pockets and bedding by feel, and from sharps left in kits with no container within reach. Splash exposures to the eyes come from airway work done without goggles because the call was “just a lift assist”. Respiratory infections pass between members in dormitories, kitchens and apparatus cabs, and from patients during bag-valve-mask ventilation and compressions without an N95 (Public Health Agency of Canada, 2017); the pandemic years showed how fast a station can lose a shift. Hepatitis B titres lapse unnoticed, so a member who thought they were protected turns out not to be at the moment it matters (Public Health Agency of Canada, 2024). Exposures reported late miss the window for HIV prophylaxis. Contaminated equipment returns to service because no one owned the cleaning step at the end of a long night. Uniforms get laundered at home. Overdose scenes produce assaults after naloxone and, separately, anxious responders who believe a myth about touching powder (American College of Medical Toxicology, 2017)DOI. Scabies, bed bugs and skin infections move from patients to apparatus to stations. Lifting and moving patients is a leading source of responder injury on medical calls.

This program answers each with a specific control: safety devices and point-of-use containers; “look, then touch”; the goggles rule for all airway work; fit-tested N95 for aerosol-generating procedures and the outbreak protocol with cohorting; the immunity register with titres; the one-hour report and a designated officer who knows the clocks; the disinfection log owned by the crew before the apparatus is back in service; the no-home-laundering rule and a station laundry; evidence-based opioid scene safety and the violence staging link; contact precautions for infestations; and the two-person lift rule with aids.

Stage 1 (Foundation) minimum. This program adopted and signed; designated infection control officer appointed with a 24/7 number posted; risk assessment T5 completed; gloves, goggles, gowns, N95 and hand rub in every kit; every airway-capable member fit tested; safety-engineered needles only and a sharps container in every kit; the exposure kit and form on every apparatus; hepatitis B immunity documented for every member and the rest of the schedule offered; agreement with the receiving hospitals or EHS provider on source testing; disinfectant with a DIN and the contact time posted; disinfection log running; no-home-laundering rule in force with a station washer; two-person lift rule and a stair chair on every first-due apparatus; the outbreak protocol written; the SWP in force; exposures in the register.

Cost (people). Designated officer about half a day a week in a department of 300 to 500 members, scaling with medical call volume, plus call-outs for exposures (two to four hours each); fit testing shared with the respiratory program; a nurse or the occupational health provider for one immunization clinic per station per year; instructor time for the annual refresher (one hour per member); member time for the refresher and the fit test.

Cost (money, order of magnitude; confirm locally). Immunizations where not publicly funded (hepatitis B series and titres are the main line); N95 stock and the 90-day reserve; goggles in a model that fits over eyewear; safety-engineered device premium on the medical supply contract; sharps containers and biomedical waste collection; DIN disinfectant and wipes; a station washer and dryer for any station without one; stair chairs and slide sheets for apparatus without them; a powered cot where the department transports. The reserve stock and the washers are usually the real Stage 1 cost; put them on the team’s five-year budget worksheet (06 Program Improvement Teams section 11).

This chapter relies on the following legal requirements, which differ by province and territory. Check your jurisdiction’s section on each topic page before adopting it.

Elements from NFPA 1580 (NFPA 1580, 2025).

Designated infection control officer: {{Infection Control Officer}}. Alternate: {{Role}}. Appointed by memo dated {{Date}}. 24/7 reporting number: {{Phone number}}. Post-exposure clinic: {{Post-Exposure Clinic}}.

The full form is Form - Body Fluid Exposure Report and Post-Exposure Checklist. The member completes, or the officer completes with the member: date and time of exposure; incident number; location type; task being performed; route (percutaneous, mucous membrane, non-intact skin, respiratory); body part; fluid involved (blood, visibly bloody fluid, other, unknown); device involved and whether it was safety-engineered and activated; PPE worn at the time; first aid given and time; time reported to officer; time reported to designated officer; source patient available for testing (yes, no, unknown); witnesses (roles); member’s hepatitis B immunity status if known; member’s signature (role and ID, not name on the copy that goes to the register).

Clocks from the Canadian Immunization Guide hepatitis B chapter (Public Health Agency of Canada, 2024) and the applicable post-exposure protocol (J25 Infection Control and Medical First Response).

One log per apparatus. Post the product list and contact times in the decon area.

Weekly deep clean of the patient compartment and cab: date, by whom, officer initial.

Seed rows follow routine practices and additional precautions (Public Health Agency of Canada, 2017).

Reviewed: {{Date}} by the Medical First Response team with the clinician adviser.

Held by the designated officer or the occupational health provider as health information. Fields: member ID; role; hepatitis B series dates (doses one, two, three) and post-series antibody result date and status (immune, non-responder, pending); tetanus-diphtheria-pertussis date; measles-mumps-rubella status; varicella status; influenza season and date; COVID-19 dates per guidance; tuberculosis screening date and result; declinations (vaccine, date, member signature by ID); next due; custodian holding the clinical record. The department’s own list holds status only.

Before the kit goes back on the apparatus after any call: sharps container present and closed, below three-quarters; no loose sharps in the kit; safety devices only; naloxone present, in date, doses per protocol; gloves and goggles replaced. Initial on the weekly sheet.

Completed by the team lead within 15 days of quarter end; goes to the program manager, the senior leadership team and the JOHSC.

The table in section 11 is the program’s accountability loop. Copy it into the team’s terms of reference (06 Program Improvement Teams section 12) with the department’s titles from the mapping table in 01 Roles and Responsibilities section 6. The defaults in one line each:

• Owner: program manager, Medical First Response team (line district chief).
• Doer: members, company officers, designated infection control officer, station cleaning leads, occupational health provider, training division, medical director.
• Verifier: company officer at each call and weekly; station officer monthly; HSO quarterly sample and every exposure file inside 30 days; JOHSC inspections; internal audit annually; independent review every three years.
• Feedback: quarterly update inside 15 days; reply to the reporter inside five working days; change notices with every change; de-identified exposure summary annually.
• Closure: Corrective Action Register with a priority from P1 to P4 (a P1 the same shift, others inside five working days); escalation by priority as the register’s scale sets; evidence and verifier sign-off to close; monthly to the JOHSC, annually to the fire chief.

Section 14 holds the minimum and the cost note. For budgeting, transfer these lines to the team’s five-year worksheet: immunizations and titres; N95 stock and reserve; goggles; safety-engineered device premium; sharps containers and biomedical waste collection; disinfectant; station washers and dryers; stair chairs, slide sheets, powered cots; fit testing share; designated officer time; refresher instructor time.

Occupational Safety and Health Administration [OSHA]. (n.d.-a). Access to employee exposure and medical records (29 C.F.R. § 1910.1020). U.S. Department of Labor. https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1020

Ontario Ministry of Labour, Immigration, Training and Skills Development [MLITSD]. (n.d.). Firefighter guidance notes (Section 21 Advisory Committee; individual notes revised to 2026). https://www.ontario.ca/document/firefighter-guidance-notes