Accidents happen in the workplace. They happen despite exacting precautions. That’s reality.
The federal Occupational Safety and Health Administration (OSHA) expects businesses to strive for safety, even as they plan for mishaps. If a workplace accident occurs, OSHA wants assurances that employees can assist their stricken co-workers.
Rapid response to an incident that injures an employee (e.g., workplace accident) or threatens an employee (e.g., sudden illness, poisoning) constitutes first aid. The concept of first aid is not new, and most of us learned the basic check list in primary school, Scouting or youth groups. The basics still apply.
First aid aims to stabilize someone whose health is suddenly jeopardized. It is not a substitute for medical attention. The goal of first aid is to forestall further deterioration and to avoid making things worse. First aid serves as a stopgap measure until medical care is available.
OSHA offers a comprehensive Web site on medical and first aid. (www.osha.gov/SLTC/medicalfirstaid/index.html) The site includes links to a definition of first aid, OSHA standards that mandate first aid, a guide to develop and maintain a first-aid program, and sources of information about rendering first aid.
The inclusion of ‘medical’ with first aid points to the diversity of today’s workplace. Women of child-bearing age work alongside men and women age 50 and beyond, and so on. No single type of emergency can be anticipated. In fact, the greatest risk to employees is not always from equipment. Using a risk assessment tool, or having a risk assessment performed by a consultant helps businesses identify areas of risk in the workplace.
Whether it is an employee’s medical condition or an injury that affects the worker on the job, co-workers must be ready to respond. Medical conditions encompass stroke, allergic reactions (anaphylaxis), pregnancy complications, and the like. Injuries result from accidents at the job site that may involve machinery, chemicals or simply tripping and falling. First aid training and refresher training ensure that employees can react to the widest range of events.
Best Practices Guide: Fundamentals of a Workplace First-Aid Program (OSHA 3317-05N, 2006) showcases good results in first aid training. Available on the OSHA Web site at www.osha.gov/Publications/OSHA3317first-aid.pdf, the guide emphasizes comprehensive involvement (management and employees), analysis of risk (what’s most likely to happen), prevention (safety) and training (in safety and response to incidents).
The best practices guide also points to help with structuring and teaching first aid, especially from the American Association of Occupational Health Nursing (www.aaohn.org), the American Safety and Health Institute (www.ashinstitute.org) and the National Safety Council (www.nsc.org). Another great source of information is the American National Standards Institute (ANSI), which works to achieve consensus practices in industry and improve the global competitiveness of the U.S.; some ANSI material (www.ansi.org) is available at no charge.
A facility-tailored safety and first aid program gets the fine points across. For instance, protective eyewear or other personal protective equipment (PPE), such as a full face guard for welding, should be worn only when required. If worn when not actually needed, PPE may impede range of motion or vision, doing more harm than good.
Further, an in-house safety program impresses on employees the value of quick, calm thinking in an emergency. Employees know how to respond, and they have the essential supplies for first aid. In every circumstance, one employee will call for help while others attend to the injured.
OSHA expectations for employers regarding first aid depend in part on access to emergency medical service (EMS). The more distant that EMS is, the more requirements fall on the employer. Even so, as with many OSHA statements, interpretation is wide-ranging, but it is best to err on the stringent side.
First aid is the initial response to a medical need, not a substitute for medical attention. Medical attention should be sought as soon as possible, from emergency medical technicians (911 responders) or by transporting the ill or injured individual to a hospital emergency department or urgent-care facility.
Eye injuries are prevalent around work sites with machinery. The National Institute for Occupational Safety and Health (NIOSH) at the Centers for Disease Control and Prevention (CDC) reports there are on average 2,000 eye injuries per day in the workplace. Moreover, eye puncture is a leading cause of blindness.
If dust, metal fragments, wood shavings, or other materials are airborne, or if corrosive materials are used at the work site, employees should wear PPE. Should an eye injury still occur, OSHA expects a company to be ready.
How a company prepares illustrates both the wide latitude that OSHA allows and some of the confusion the latitude produces. For example, if corrosive materials are used, OSHA expects a business to provide a way to flush chemicals from the eye. It does not have to be a commercially available eye-wash station, but it must be located no more than 10 seconds and 100 feet from each employee at risk. The system must be capable of providing a flow of tepid water (around 60 degrees F) at a rate of about 0.4 gallons per minute for 15 minutes. (www.osha.gov/SLTC/eyefaceprotection/hazards_solutions.html).
Assume no injury is too small to require a medical professional’s appraisal. A tiny puncture wound coupled with an out-of-date tetanus immunization could prove fatal. Certain bacteria increasingly show resistance to antibiotics, so having a physician ensure a wound is clean reduces risk of large-scale infection.
First aid benefits the employee first and foremost, but it does more than that. The sooner a physician evaluates an employee injured on a job, the better documentation a company has regarding the seriousness of the incident. If an injured employee later pursues a claim via workers’ compensation, the records will be important.
Most of us can recall first aid basics. Depending on the injury, what should be done first varies. Generally, an injured person should not be moved, but common sense rules. If not moving the person increases risk of more injury – from fire or machinery, for example — moving is a must. A stocked first-aid kit should have a blanket to slide under the person and use as a tote if necessary.
Unless a limb has been severed, the best way to stop bleeding is by putting pressure on the wound. Take a clean cloth and use the palm of the hand to apply pressure. Do not remove the cloth when the bleeding stops. (Tourniquets can cause more damage than they are supposed to prevent; they should only be used in extreme situations.) If possible, elevate the part of the body that is bleeding so it is higher than the heart, which will slow blood flow to the injured area.
Burns caused by a fire should be flushed with clean water, nothing more. If no sterile cloth is available, the best course is to leave the burn open to air. Never try to remove singed clothing from the burn area.
Chemical burns must be treated as directed on the corresponding material safety data sheet (MSDS). The availability of the MSDS is as important as a first-aid giver.
Always keep an injured person warm by covering with a blanket if possible. (Exception: when a person suffers heat exhaustion or heat stroke – signaled by mental confusion, collapse, mottled skin; with prolonged exposure to high temperature, the individual should be cooled by pouring on cool water and fanning.)
The Heimlich maneuver, used to dislodge food or a foreign object that causes a person to choke, has saved many lives. It is critical, however, that employees be trained to identify if a person is choking or suffering from something else. A candidate for a Heimlich maneuver will not be able to cough, speak or breathe.
Cardiopulmonary resuscitation (CPR) can save lives when it is administered to a victim of a sudden cardiac arrest, such as a cardiac infarction (heart attack). But the commitment to CPR training and intervention is best discussed with an insurer risk manager. Today, there is a great deal of concern about mouth-to-mouth resuscitation and the risk of transmitting disease. In short, if an employer mandates that workers provide CPR, the employer could potentially be liable for any adverse outcome, including infection of a co-worker. In certain industries, including logging, OSHA mandates CPR training.
Similarly, adoption of the automated external defibrillator (AED), which is now widely available, conveys some risk to the business owner. If an AED is available but an employee uses it incorrectly because of improper training, the employer could be liable. If an AED is not available, some employees may question why it is not.
First aid kits – commercial or self-assembled – should be easy to access and up-to-date. Many vendors supply first aid kits, and some will check them and restock kits at regular intervals. The American Red Cross offers a check list for a self-assembled, first aid kit at www.redcross.org/services/hss/lifeline/fakit.html.
First aid kids should contain sterile gauze, compresses, bandages, sterile gloves and a blanket. The greater the distance a workplace is from an EMS, the more ancillary first aid supplies should be available, such as antiseptic, cold packs, hand cleaner, batteries and flashlight. Any MSDSs that apply to chemicals used in a workplace should be kept with the first aid kit.
As dreary as it is to assess risk and anticipate worst-case scenarios in order to develop ways to respond to them with first aid, the attention pays dividends. Healthy employees, less lost time from employee absences, and lower premiums for insurance and workers’ compensation are the top three positive returns.
