How Small Practices Can Train Staff on OSHA Emergency Plans (29 CFR § 1910.38(e))

Small healthcare practices face unique challenges in meeting OSHA’s requirements for emergency action planning. Under 29 CFR § 1910.38(e), employers must ensure that staff are trained to carry out their roles during emergencies such as fires, chemical exposures, or workplace violence incidents. For clinics with fewer than 30 employees, proper training is not only a regulatory requirement but a critical safeguard against patient harm and costly citations. This article provides a structured approach for understanding the regulation, designing compliant training programs, and embedding emergency preparedness into daily operations.

Emergencies in healthcare settings can escalate rapidly, endangering patients, staff, and property. OSHA requires every employer to maintain an Emergency Action Plan (EAP) under 29 CFR § 1910.38, and subsection (e) mandates that staff be trained to implement that plan. For small practices with limited resources, this obligation can seem daunting. However, with clear procedures, documented training, and low-cost resources, compliance is achievable. This guide explains the rule, identifies compliance steps, highlights common pitfalls, and provides strategies tailored for small healthcare organizations.

Understanding Staff Training on OSHA Emergency Plans Under 29 CFR § 1910.38(e)

Section 1910.38(e) requires employers to:

• Designate and train employees to assist in safe and orderly evacuation of other employees.

• Review the EAP with each employee when the plan is developed, when the employee’s responsibilities change, and when the plan itself changes.

For small practices, this means ensuring all staff, administrators, nurses, medical assistants, and even part-time personnel, are trained on evacuation routes, alarm systems, reporting procedures, and patient safety protocols. Without this knowledge, both compliance failures and safety hazards increase significantly. Understanding these requirements is essential to reduce liability, ensure continuity of care, and avoid OSHA penalties that can reach thousands of dollars.

While OSHA enforces workplace safety standards, the Office for Civil Rights (OCR) under HHS may also become involved when patient care is compromised due to emergency mismanagement. Audit or investigation triggers often include:

• Complaints filed by staff or patients about unsafe evacuation procedures.

• Self-reports following an incident where patients were endangered.

• Random compliance reviews after broader OSHA inspections.

In these cases, OCR may evaluate whether failures in emergency planning indirectly compromised patient rights under HIPAA’s Security Rule or continuity of care standards. Small practices should recognize the overlapping oversight between OSHA and OCR and ensure that their emergency plan training protects both staff and patients.

To comply with 29 CFR § 1910.38(e), small practices should implement the following steps:

1. Develop or Update the Emergency Action Plan (EAP).
   Ensure the plan includes evacuation procedures, reporting methods, critical operations protocols, and post-incident communication.

2. Identify Key Staff Roles.
   Assign responsibilities such as fire wardens, patient transport coordinators, or alarm responders.

3. Conduct Initial Training.
   Review the EAP with all employees when it is first created or updated. Provide hands-on instruction for high-risk areas like sterilization rooms or labs.

4. Schedule Regular Drills.
   Conduct at least one annual drill, documenting participation and outcomes. For higher-risk facilities, semiannual drills may be appropriate.

5. Document All Training.
   Maintain sign-in sheets, training agendas, and post-drill evaluations in compliance binders. Documentation is critical during audits.

6. Provide Refresher Training.
   Offer reviews whenever the plan changes, or staff responsibilities shift. Annual refreshers keep compliance current.

7. Use Free or Low-Cost Resources.
   Leverage OSHA fact sheets, FEMA guides, and HHS preparedness tools to support training without adding costs.

Case Study

A small outpatient clinic with 15 employees experienced a fire in its break room after faulty wiring ignited near an overloaded electrical outlet. The fire triggered alarms, but because the clinic had never conducted evacuation drills, staff were unprepared to respond effectively. Some employees froze, unsure of which exits to use, while others attempted to lead patients out through hallways that quickly filled with smoke. The confusion was particularly dangerous for two patients in wheelchairs, whose evacuation was delayed because no staff member had been assigned responsibility for assisting individuals with mobility limitations. While everyone eventually exited safely, the incident created chaos, fear, and unnecessary risk for vulnerable patients.

Following an investigation, OSHA cited the clinic under 29 CFR 1910.38(e), which requires employers to provide training so employees understand the roles and responsibilities outlined in an Emergency Action Plan (EAP). Because there were no records of drills or training, OSHA issued fines totaling $9,200. The incident also caused reputational harm, as patients who witnessed the disorder expressed concern about the clinic’s ability to handle emergencies, leaving negative feedback online and discouraging new visits. Staff morale also declined, with employees admitting they felt unsafe and unsupported in crisis situations.

In contrast, another clinic of similar size had established a proactive emergency preparedness program. Leadership scheduled quarterly evacuation drills, rotating scenarios to prepare for fires, gas leaks, and power outages. Roles were clearly assigned: specific staff members were trained to guide patients, assist those with disabilities, and secure critical medical equipment when time allowed. After each drill, supervisors documented attendance and provided feedback to improve performance. Evacuation maps were posted throughout the building, and staff received refresher training during regular safety meetings.

When OSHA conducted a surprise inspection, the clinic immediately produced detailed documentation of its emergency drills and training program. Inspectors confirmed compliance with 29 CFR 1910.38(e), and no citations were issued. More importantly, staff reported confidence in their ability to manage emergencies, and patients felt reassured knowing the facility prioritized safety.

This comparison illustrates how neglecting simple preparedness measures can result in costly fines, reputational damage, and safety risks, while consistent training and documentation protect both people and practices from harm.

Common Pitfalls to Avoid Under 29 CFR § 1910.38(e)

• Failure to Conduct Drills. Skipping regular drills leaves staff unprepared and violates the training mandate.

• Poor Documentation. Without attendance logs or training records, compliance cannot be demonstrated.

• Role Confusion. Not assigning clear responsibilities can result in chaos during emergencies.

• Ignoring Part-Time Staff. All employees, regardless of hours worked, must be trained.

• One-Time Training Only. Compliance requires ongoing reviews whenever the plan or staff changes.

Avoiding these pitfalls ensures both regulatory compliance and patient safety.

• Integrate Patient Care Scenarios. Include wheelchair evacuations, oxygen-dependent patients, and language barrier considerations.

• Leverage Technology. Use digital training modules or compliance apps to track participation.

• Empower Staff Leadership. Assign team leads for evacuation who receive advanced training.

• Encourage Feedback. After drills, collect staff input to improve the EAP.

• Collaborate with Local Fire Departments. Invite local emergency responders to observe or participate in drills.

These practices strengthen compliance and build confidence among staff.

To embed OSHA emergency preparedness into daily operations, small practices should:

• Conduct short monthly safety reminders.

• Add emergency procedures to onboarding checklists.

• Involve leadership in drills to set the tone for compliance.

• Recognize staff participation in training as part of performance evaluations.

When emergency readiness becomes part of the workplace culture, compliance shifts from a one-time activity to an ongoing commitment.

Compliance with OSHA’s 29 CFR § 1910.38(e) is more than a regulatory requirement, it is a lifesaving measure that ensures staff and patients can act decisively in emergencies. Small practices must create written EAPs, train all employees, conduct and document drills, and regularly review procedures.

Advisers

Small practices can benefit from affordable compliance software and free resources that streamline training and documentation. Tools such as the OSHA Emergency Action Plan eTool, FEMA’s preparedness templates, and the HHS Assistant Secretary for Preparedness and Response (ASPR) resources provide cost-effective support. Centralized compliance software can help practices maintain training logs, generate audit-ready reports, and receive alerts when retraining is due.

To safeguard your practice, adopt a compliance management system. These tools consolidate regulatory obligations, provide ongoing risk monitoring, and ensure you’re always prepared for audits while demonstrating your proactive approach to compliance.

• 29 CFR 1910.38, Emergency Action Plans (OSHA)

• OSHA Emergency Action Plan eTool

• FEMA Emergency Management Guide for Business & Industry

• HHS ASPR, Healthcare Emergency Preparedness Information

• HHS Office for Civil Rights (OCR) Compliance Resources